The Prevention of Tuberculosis: 
A CENTURY’S EXPERIENCE IN ITALY UNDER 
THE INFLUENCE OF THE PREVEN- 
TIVE LAWS OF THE KINGDOM 
OF NAPLES, ENACTED 
IN 1782. 
Read at the Meeting of the American Public Health Associa- 
tion, Charleston, S. C,, December 16, 1890. 
LAWRENCE F. FLICK, M.D., of Philadelphia. 
Reprinted from The Sanitarian, for February, 1891. 
NEWYORK. THE PREVENTION OF TUBERCULOSIS: A CEN- 
TURY’S EXPERIENCE IN ITALY UNDER THE 
INFLUENCE OF THE PREVENTIVE LAWS OF 
THE KINGDOM OF NAPLES ENACTED IN 1782. 
READ AT THE MEETING OF THE AMERICAN PUBLIC HEALTH 
ASSOCIATION, CHARLESTON, S. C., DECEMBER i6tH,iB9o. 
Lawrence F. Fuck, M.D., of Philadelphia. 
On July 19th, 1782, the sovereign of the kingdom of Naples 
gave his sanction to a legal enactment for the prevention of 
tuberculosis, which, according to De Renzi, the medical histo- 
rian of Italy, contained the following propositions : 
“ 1. That the physician shall report the consumptive pa- 
tient, when ulceration of the lungs has been established, under 
penalty, for the first offence, of 300 ducats, and upon, repeti- 
tion, of banishment for ten years. 
“ 2. That an inventory shall be made by the authorities of 
the clothing in the patient’s room, to be identified after his 
death, and if any opposition shall be made, the person doing 
so, if he belongs to the lower class, shall have three years in 
the galleys or in prison ; if to the nobility, three years in the 
castle and a penalty of 300 ducats. 
“ 3. That household goods which are not susceptible shall 
be immediately cleansed, and those that are susceptible shall 
at once be burned and destroyed. 
“4. That the authorities themselves shall tear out and re- 
plaster the house, alter it from cellar to garret, carry away and 
burn the doors and wooden windows and put in new ones. 2 
The Prevention of Tuberculosis. 
5. That the sick poor shall at once be removed to a hos- 
pital. 
“6. That newly built houses cannot be inhabited before 
one year from their completion, and six months after plaster- 
ing has been finished and repairing has been done. 
“ 7. That superintendents of hospitals must keep in sepa- 
rate places clothing and bedding for the use of consumptives. 
Other severe penalties are threatened to those who buy or sell 
objects which had been used by consumptives, to servants, 
members of the family, and to any transgressor whomsoever.” 
The kingdom of Naples, as it was then constituted, com- 
prised all of the territory of the present kingdom of Italy, 
which constitutes the provinces of Abrozzo, Campania, Apulia! 
Basilicata and Calabria*—an area of about 11,291 square miles. 
Its population at that time was about 4,500,000,f and the 
population of the same territory at present is about 8,038,1864 
Politically it formed one government with Sicily, and through 
its rulers was closely associated with Spain, continuing so 
until iB6O, when all Italy was united under one government.§ 
The probabilities are, therefore, that the laws for the preven- 
tion of tuberculosis extended to the kingdom of Sicily as well 
as to that of Naples ; and it is not at all unlikely that Spanish 
sentiment and Spanish influence had something to do with 
their enactment. 
How strictly the law was enforced it is now difificult to learn, 
but the probabilities are that it was well received and scrupu- 
lously carried out by the people ; for they were thoroughly 
convinced of the contagiousness of tuberculosis and recognized 
the necessity of some practical measures for its prevention, 
even before the law was enacted. De Renzi says that many 
hardships resulted from its enforcement, because of the inter- 
ference with the renting of property, inasmuch as the people 
would not go into a house which was known to have been in- 
fected. |[ I find no reference anywhere to imposition of penal- 
ties, and I am inclined to believe that the law was more strictly 
* Annales d’Hygiene Publique et de Medicine legale, tome 16, p. 302 
f Supra cito, p. 300. 
X Siatistica dell Cause delle Morte, etc., 1887, p. xii. 
§ Cyclopaedia Americana, vol. xv., pp. 19-21. 
| Storia della Medicina in Italia, Salvatore De Renzi, vol, v., pp. 511—14. The Prevention of Tuberculosis. 
3 
enforced by the demands of the people than by the execution 
of the authorities. Efforts were soon made to have the law 
repealed, but it seems to have been allowed to remain on the 
statute books until the termination of the government, in 
iB6O. The medical profession was at first almost unanimous 
in its adherence to the theory of contagion and in its support 
of the law, but as time rolled on it became nearly as unani- 
mous in its disbelief in contagion, and its opposition to prac- 
tical measures for the prevention of the disease.* The masses, 
however, clung tenaciously,f and to this day cling to the be- 
lief that the disease is contagious, and have never given up 
entirely the preventive practices which they acquired during 
the operation of the law.:j; 
Whether any laws for the prevention of tuberculosis were 
ever enacted in any other part of Italy I have been unable to 
ascertain. About the time that the laws of the kingdom of 
Naples were being enacted quite a spirited controversy was 
carried on between some of the most learned medical men of 
the kingdom of Naples and some of the Solons in medicine 
of the northern part of Italy, in which the latter opposed the 
theory of the contagiousness of tuberculosis and the enactment 
of laws for its prevention, and the former defended them.§ 
But whether any such laws were passed or not, the people of 
the northern part of Italy largely held the same ideas about the 
contagiousness of tuberculosis as their southern neighbors, and 
undoubtedly instituted preventive measures against the dis- 
ease, which they continue to practise to this day. 
The preventive measures inaugurated under the laws of the 
kingdom of Naples were based entirely upon empiricism, and 
for that reason were crude, harsh, and inefficient. It was 
known that tuberculosis was contagious, but it was not known 
wherein lay the medium of contagion. It was believed that 
the breath and the odor given off from the body of the con- 
sumptive were infectious, and that consequently it was not 
only dangerous to be near those affected with the disease, but 
* Storia della Medicina in Italia, Salvatore De Renzi, vol. v., pp. 511—14, 
f Briefe über Italien, 1793> hei Wilhelm Xaverius Jansen, pp. 250—51. 
X Histoire de la Contagion de la Phthisic Pulmonaire, par M. E. Boisseau, 
P- 376. 
§ Stona della Medic., etc., vol. v., pp. 5,11-14. The Prevention of Tuberculosis. 
that anything which had been near them was infectious. The 
fact that the contagion is confined to the sputa and tubercu- 
ar pus was not known, and thus the only real sources of dan- 
ger were in a measure overlooked. With the abstract idea 
that tuberculosis is contagious as the basis, the most heroic 
and sweeping preventive measures were haphazardly con- 
structed, many of which could have but little influence in pre- 
venting the spread of the disease. The burning of the cloth- 
ing and furniture used by a consumptive patient, and the 
cleansing of the house which had been occupied by him from 
cellar to garret after his death, would afford some protection 
against the disease ; but the patient during his lifetime was 
allowed to be a constant source of danger to his relatives, 
friends, and neighbors through the dissemination of sputa and 
tubercular pus. The only real efficacious measure practised 
was isolation. Nevertheless, in spite of the oppressive super- 
fluous practices instigated and fostered by the law, and its 
general defectiveness as a sanitary measure against the disease 
which it was intended to restrict, it contained some merit, and 
to some extent fulfilled the object for which it was enacted. 
Inasmuch, moreover, as the practices which it inaugurated,' 
even though defective, have been pretty well carried out by 
the people for more than a century, and some restrictive in- 
fluence upon a disease must necessarily follow a general pro- 
mulgation of the doctrine of its contagiousness, if it is conta- 
gious, it is but fair to accept the result of the operation of this 
law as a test of the practicability of preventing tuberculosis, 
and as an argument for or against the theory of its contagious- 
ness. A comparison of the prevalence of the disease in 1782 
with its prevalence at the present time will show the practical 
results of the law. 
I have unfortunately not been able to find any mortality 
statistics for Italy as far back as 1782, and it is not probable 
that any are in existence.* A good idea of the amount of 
tuberculosis in the kingdom of Naples and in all Italy can be 
obtained, however, from contemporary writers, native and 
foreign. Michele Sarcone, in recounting the diseases which oc- 
curred in the kingdom of Naples during the autumn of 1764, 
* Briefe über Italien, 1793, bei Wilhelm Xaverius Jansen, pp. 250-51. The Prevention of Tuberculosis. 
5 
ends up by saying : “ Consumptives suffered in the largest 
number, and as for these miserable creatures, they do not 
easily give up. ”* Among the most frequent and fatal diseases 
which occurred that year, he puts down peripneumonia, 
pleurisy, diarrhoea, and rheumatism. From his description it 
looks as though many of these cases were acute malignant 
tuberculosis. The peripneumonias and pleurisies were often 
so much alike that many took them as the same disease.f In 
an autopsy of a soldier who died of peripneumonia, he found 
that “ the lungs were adherent at the back to the pleura with 
such strong adhesions that it was necessary to tear the parts 
to divide them. The right lobe was extremely swollen, hard, 
and covered with a yellow, sticky material ; the inside was 
saturated with black curdled blood ; the bronchial substance 
was choked up with a dense glutinous material, yellow in 
places and ash-gray in others, and by a tenacious bloody scum. 
The left lobe, of a purple color, appeared less swollen than 
the right, and there was in the middle an obscure beginning of 
an abscess. The diarrhoeas he describes as sometimes accom- 
panied by most rapid emaciation, and the rheumatisms by 
ulceration. As being among not the least of the ills to which 
human flesh is heir he speaks of a skin disease, which he claims 
is unjustly called the disease of Naples, and which he says 
ordinarily terminates in fatal 
the terrible disease which visited Naples that year in the form 
of a plague, he tells us that it was always accompanied by 
either a remittent or a continued fever, with a disposition to 
the breaking down of tissue and the formation of pus, and 
often terminated in internal and external abscesses and 
tubercles.§ In those days tuberculosis was not recognized 
unless it took the form of a slow wasting disease. 
. one cannot fail to recognize, however, in Sarcone’s descrip- 
tions tuberculosis of every form—acute miliary tuberculosis of 
the lungs and pleura, tubercular peritonitis, tubercular menin- 
gitis, tubercular arthritis, tubercular adenitis and lupus, all in 
* “ tabidi soffrirono moltissimo edi questi miseri se ne perderono facil- 
mente. Regional de Mali, etc., Michele Sarcone. Part 11., p. 658. 
t Stipra cito, Part 1., pp. 166—67 I pp- 67, 73, 102. 
X Regionata de Mali, etc., Michele Sarcone, Parte Prima, pp. 58, 59. 
§ Supra cito, Parte Seconda, p. 227 et seq. 6 
The Prevention of Tuberculosis. 
the most malignant form. If many of the diseases so ably 
portrayed by Sarcone, and which prevailed in his day to such 
a vast extent, were not tuberculosis, there is certainly no dis- 
ease known to modern pathology with which his descriptions 
so well fit in. His appalling picture of the diseases of Naples 
is well sustained, and the suspicion that many of the acute 
forms were of a tuberculous character is entirely borne out by 
the writings of Dr. Benjamin Pugh, an English physician who 
visited Italy in 1783. Dr. Pugh says : “As this climate had 
been so long celebrated for its mildness, I was surprised at the 
obstinate continuance of the complaints of our own family, 
and likewise at the numbers of diseased and miserable objects 
I met in every part of the city. I resolved to visit the hospi- 
tals, where I beheld misery in the extreme, fevers of every 
class, but scarcely one where the lungs had not been primarily 
concerned ; rheumatisms, dropsies, scrofulas, consumptions, 
ulcers of every kind, and venereal diseases without number. 
. . . To what diseases, then, are the inhabitants of this 
country most subject ? They are troubled with fevers of vari- 
ous kinds, in most or all of which I found the lungs concerned ; 
scrofulas, rheumatisms, ophthalmias, scorbutic putrid gums 
with ulcers and eruptions of various sorts. The most prevail- 
ing distemper seemed to be a marasmus. I frequented their 
hospitals often, and found those to be the chief diseases ; all 
which are familiar to those in the hospitals of Naples and other 
towns near the sea-coast in Italy. But if the inhabitants them- 
selves, whose very looks betray marks of ill health, afforded 
not such numerous proofs of the unwholesomeness of this air, I 
am, alas ! furnished with too many by my unhappy country- 
men who wintered there in 1783. There were 24 families, be- 
sides several single English gentlemen, the whole of which 
amounted to 136 persons ; and I believe very few of those who 
came there on account of the air found expected benefit. I 
can except only two : one an elderly gouty gentleman, the 
other a tender, weakly, low-spirited gentleman, with a slow 
fever at times ; but both had sound lungs. The only con- 
sumptive cases which I saw at Nice were six young gentlemen 
and a lady rather advanced in years, all of whom died in the 
course of the winter. Three of these young men were so ac- 
tive and cheerful at times, even a day before their deaths, that The Prevention of Tuberculosis. 
there was reason to hope for their recovery. Had they stayed 
in England, or some parts of the south of France, I firmly be- 
lieve that four of the six, if not now alive, would at least have 
protracted their days. I attended a great many of the Eng- 
lish, who came to Nice in health, in violent inflammatory fe- 
vers, in all of which the lungs were concerned. ”* Dr. Wilhelm 
Xaverius Jansen, a German physician, wrote from Italy, in 
1793, bearing testimony to the same condition of things. “In 
the hospitals,” he says, “ I still found quite a number of chest 
diseases accompanied by inflammation, seldom, too, as this oc- 
curs with us at this time of year. Yet it is not always real in- 
flammation. Mostly they are of a rheumatic character, and 
common people and soldiers, who expose themselves to wet 
and cold, are more frequently attacked than cleanly people. 
Besides these one finds different kinds of consumption ; and 
these, as it appears, are either transmitted by the parents, or 
are conveyed by infection.” f 
The terrible prevalence of tuberculosis in the kingdom of 
Naples and all Italy, at the time when the Neopolitan laws were 
introduced for its restriction, is born testimony to, in possibly 
even stronger terms, by later writers than by contemporaries. 
De Renzi, the medical historian of Italy, who had access to 
all of the controversial writings of that day, says : “ It has 
been asserted in this connection, and not through the instru- 
mentality of the government, from which I do not take my in- 
formation, that consumption had at that time become almost 
general, and that one could daily see death carry off many cit- 
izens and the destruction of numerous families because of the 
little precaution practised.” J. B. Martinez, a Frenchman, 
wrote from Naples even as late as 1834 : “I am free to say 
that consumption is not less frequent in this city than in Paris 
and London, I will add, moreover, that after having visited 
nearly all the important hospitals of France, Switzerland, Eng- 
land, Scotland, and Italy, I have nowhere seen fatal cases of 
phthisis in such large numbers as at Naples. It is true that 
the contagious nature which the Neapolitans ascribe to this 
unfortunate disease is the cause of always confining to the 
* Observations on the Climate of Naples, Rome, Nice, etc., by Beniamin 
Pugh, M.D., 1784, p. 7. 
f Briefe über Italien, 1793, bei Wilhelm Xaverius Jansen, p. 250-51. 8 
The Prevention of Tuberculosis. 
same room the victims which it strikes down. But it is also 
true that the disease is much more frequent. Besides this ob- 
servation agrees with those of Messrs. Pequin, Terrel, Clarke, 
Renzi, etc., and is the same as that of travellers, strangers to 
the healing art, who have written about Italy.” In order to 
fully appreciate Martinez’s statements as taken in connection 
with the contemporary writers I have quoted, one needs to 
further keep in mind the words of De Renzi, who, when com- 
paring the prevalence of consumption in 1848 with that of 
1782, said : ” Which state of things ought to be a source of 
comfort to us now living, as we find it no longer almost gen- 
eral, although the precautions used are less.”* 
We are so accustomed to form our ideas of the prevalence 
of a disease upon the percentage of deaths to the number of 
living people that it may be well to try to make an estimate 
of the mortality rate from tuberculosis in the kingdom of 
Naples in 1782.f De Renzi tells us, in 1848, that tuberculosis 
was not near so prevalent then as it had been when the Neo- 
politan laws were made, Martinez tells us, in 1834, that con- 
sumption was much more prevalent in Naples than it was in 
Paris or London. The mortality rate from consumption in 
London;}: and Paris§ in 1834 ranged from 4 to 6 per 1000 liv- 
ing people. It is safe to conclude, therefore, that the mortality 
rate from consumption in Naples in 1834 could not well have 
been less than 4 per 1000 living people, and that it probably 
was more than 6 per 1000. And as De Renzi, who is most 
excellent authority, informs us that there had already been a 
great reduction, it will not be overstepping the mark to place 
the mortality rate from tuberculosis for the kingdom of Naples 
and for Italy in 1782 at 10 per 1000 living people. That this 
is, if anything out of the way, an underestimate is not only 
shown by the descriptions of contemporary writers, but by 
some hospital statistics which De Renzi gives for the year 
1828. Out of 5285 admissions to one of the hospitals of the 
* “ La quelcosa"deve riuscir di conforto per i present! che non veggono quasi 
generale, comunque minora sieno le cantele che si usino. ” Storia della Medicina 
in Italia, De Renzi. Tome V., pp. 511-14. 
t Storia della Medicina in Italia, Salvatore De Renzi. Tome V., pp. 511-14. 
% Registrar-General’s Report, vol. i. 
§ Paris, Vaccher sur Mortality en, 1865, p. 176, The Prevention of Tuberculosis. 
9 
city of Naples during the year 1828, 1108 were consumptives ; 
and out of 1366 deaths which occurred in the same institution 
during that year, 699 were due to that disease.* Now, after 
making due allowance for the fact that the consumptive poor 
were being isolated in hospitals at this time, it must not be 
forgotten that these are the deaths and admissions to but a 
single hospital, and that Naples at that time had at least four 
large hospitals. If anything further is needed to complete the 
picture of the appalling prevalence of tuberculosis in Italy in 
1782 it can be found in the reputation which that country bore 
throughout northern Europe at that time. Medical men of 
other countries began to advise their people to remain away 
from those sunny skies which canopied eternal spring, as they 
believed them to overhang a climate specially adapted to the 
production of consumption. Pugh wrote, “ And to some or 
all of these causes do I attribute that unbalmy quality of the 
air of Naples, so peculiarly unfavorable to consumptive lungs. ” 
The danger attendant upon a prolonged visit to Italy and 
the fatality of the Italian climate to persons afflicted with con- 
sumption found forcible expression in the proverb, “ Vedi 
Napoli e poi muori/’f “ See Naples and then die.” 
The mortality from tuberculosis in Italy now as compared with 
then is best shown by the official returns. In 1887 the mortal- 
ity rate from consumption for all Italy was 1.29 per 1000 living 
people, and from tubercular affections, including, with phthisis, 
scrofula, tabes mesenterica, and tubercular meningitis, 1.95 per 
1000. During the same year the mortality from consumption 
and general tuberculosis for the towns and cities of the terri- 
tory which formerly constituted the kingdom of Naples was 
1.16 per 1000 living people ; and for the rest of Italy, for the 
same diseases and for like towns and cities, 2.20 per 10004 
The mortality rate for the city of Naples during the same year 
from consumption and general tuberculosis was 1.92 per 1000. 
* Topografia di Napoli, pp. 131-32. 
t Briefe von Dr. Diruf, Deutsche Klinik, Berlin, vol. xiii., 1861. 
% The compiler of the mortality statistics of Italy tries to explain the discrep- 
ancy in the mortality returns from phthisis between the north and south of Italy 
upon the ground of substitution of nomenclature, as the deaths from bronchitis 
in the south of Italy are more numerous than in the north. This is not satis- 
factory, however, as the excess of deaths from bronchitis in the south over 
those in the north occurs in persons under 10 and over 50 years of age. 10 
The Prevention of Tuberculosis. 
The mortality rate during the same year for other tubercular 
diseases, such as tubercular meningitis, scrofula, tabes mesen- 
terica, and tubercular arthritis was, for the territory which 
forrnejly constituted the kingdom of Naples, .89 per 1000 liv- 
ing people ; and for the rest of Italy .85 per 1000. The mor- 
tality rate from the same diseases for the city of Naples dur- 
ing the same year was 1.26 per 1000.* 
It will thus be seen from the figures given that there has 
been a very large reduction in the mortality from tuberculosis 
in the entire kingdom of Italy, and that the reduction has 
been particularly marked in the territory which formerly con- 
stituted the kingdom of Naples. Italy has at present the 
lowest mortality rate from consumption of any country in 
Europef with possibly the exception of Spain ; and that part 
of it which formerly constituted the kingdom of Naples is, in 
the country districts and small towns, practically free from the 
disease. Forty-five towns in this part of Italy, with an aggre- 
gate population of 742,068, had a mortality rate of .58 per 
1000 from consumption and general tuberculosis during the 
year 1887. Ten selected towns, with an aggregate population 
of 146,924, had a mortality rate of .28 per 1000 from the same 
diseases during the same year. Four selected towns, with an 
a§greSat-e population of 36,460, had a mortality rate of .19 per 
loo°4 rt is fair to suppose that the country districts in this 
part of Italy have a still lower death-rate from these diseases. 
Expressed in figures, the reduction in the mortality from 
tuberculosis in Italy since 1782 ranges from 50 per cent to 
90 per cent. The much greater reduction in that part which 
foimerly constituted the kingdom of Naples is no doubt due 
to the immediate influence of the Neopolitan law. This is all 
the more noteworthy, since at the time that the preventive 
measures were begun, the disease seemed to be more preva- 
lent in Naples than in any other part of the country. To 
fully appreciate the magnitude and to understand the entire 
meaning of this reduction, it must further be borne in mind 
that Italy has again become, and has been for the last thirty 
years, a famous resort for consumptive invalids. That the 
* Statistica delle Cause delle Morti avvenute in tutti i Comuni del Regno 
nell’anno 1887. 
t Supra cito. | Statistica delle Cause delle Morti, etc., 1887. The Prevention of Tuberculosis. 
11 
presence of such visitors contributes to keeping up the disease 
in Italy is evident from the mortality returns of the towns and 
cities frequented by them. Pallanza, for example, had a 
death-rate from consumption and general tuberculosis in 1887 
of 4.21 per 1000 ; Pisa, 3.25 per 1000 ; San Remo, 2.44 per 
1000, and Spezzia, 2.35 per 1000.* 
Now, what is the lesson to be learned from this vast reduc- 
tion in the mortality from tuberculosis in Italy under the in- 
fluence of the Neapolitan law ? In the first place, it is a prac- 
tical demonstration of the preventability of the disease ; and 
secondly, it gives us some idea of what measures will bring 
about such a result. When side by side with the reduction in 
the mortality from tuberculosis in the kingdom of Naples un- 
der the operation of the Neapolitan law is placed the reduc- 
tion which has taken place in England during the last forty 
years from the same disease, as the result of isolation in special 
hospitals, it can certainly no longer be said that the preven- 
tion of this disease is a mere theory. In England there has 
been a reduction of 50 per cent in the mortality from tubercu- 
losis in forty years as the result of isolation of from three per 
cent to 18 per cent of all cases yearly.f In the kingdom of 
Naples the disease has been nearly exterminated in one hun- 
dred years by a system of isolation and disinfection, or, rather, 
destruction of infected objects. Either of these facts, stand- 
ing by themselves, might be looked upon as mere coincidences, 
but taken together they must be accepted as the exponents of 
a fixed law. They show that tuberculosis is not only a pre- 
ventable disease, but that it can be prevented by simple, easy 
methods. Now that we have real scientific knowledge of the 
etiology of tuberculosis and know something of the biology 
of the organism which produces the disease, we can under- 
stand how the empirical practices in Italy and the single pre- 
ventive measure in England can have produced such astonish- 
ing results. We observe the law that no new case of tubercu- 
losis can arise without having an old one to spring from, proven 
by the placing of old cases where they cannot produce new 
ones. 
* Supra cito. 
f Special Hospitals for the Treatment of Tuberculosis. L. F. Flick, Timet 
and Register, March 15, 1890. 12 
The Prevention of Tuberculosis. 
In the light of the history of tuberculosis in Italy and in 
England, is the sanitarian of the day fully cognizant of his 
power over this disease, and fully aroused to his duty in the 
matter of its prevention ? If empirical methods could pro- 
duce such results in Italy, and isolation on a comparatively 
small scale could produce such effects in England, what would 
be the result of well-regulated scientific methods for its pre- 
vention ? It is my firm belief, after careful study of the ques- 
tion, that with our present knowledge of the etiology of the 
disease we have it in our power to completely wipe out the 
disease in a single generation. To do this would, of course, 
require well-organized boards oc health, an enlightened public, 
and the co-operation of the entire medical profession. The 
prevention of disease is always nobler than its cure. Were 
half the energy which is being spent in the almost hopeless 
task of searching for a specific cure for tuberculosis devoted 
to its extermination, its accomplishment would be guaranteed. 
Why is nothing practical being done ? The entire medical 
profession seems to have accepted the theory of the con- 
tagiousness of tuberculosis. Are we afraid to follow this 
theory to where it leads ? If the disease is contagious it can 
be prevented. If it can be prevented, why are there not 
already practical measures in operation for its restriction ? 
With the object lessons of Italy and England before us we 
can no longer remain inactive consistently with our convictions. 
Inasmuch as we now know that the contagion of tubercu- 
losis is confined to the sputa and pus, preventive measures are 
much simplified, as the only necessity is to render those sub- 
stances innocuous. How should this be done ? At the present 
stage of public enlightenment on the subject, the one measure 
which will accomplish the most good with the least friction 
with preconceived ideas is the establishment of special hospitals 
for the treatment of the disease. The voluntary withdrawal 
of patients to such institutions would remove centres of infec- 
tion from the family hearthstone and would spread the doc- 
trine of prevention, as well as practical!y educate the public to 
its methods. I believe, moreover, that the time has come 
when we should go further. Tuberculosis should be placed 
on the list of diseases returnable to the Board of Health, so 
that a record may be kept of the whereabouts of every case, The Prevention of Tuberculosis. 
13 
and of its movements from house to house. From a careful 
topographical study of the disease in the Fifth Ward of the city 
of Philadelphia,* extending over a period of twenty-five years, 
I am convinced that fully one half of the cases of tuberculosis 
among the poor people have their origin directly or indirectly 
in infected houses. A family unsuspectingly moves into a 
house which has just been vacated by a family in which a 
death has occurred from tuberculosis. In the course of time 
the weakest member of this family succumbs to the disease, 
and a new series of victims is started. The public certainly 
owes a duty to the individual in this matter, and that duty 
can only be exercised through the Board of Health. By keep- 
ing track of every case of tuberculosis, by showing the family 
of the unfortunate victim how to protect themselves against 
the disease, and by disinfecting every house which has been 
occupied by a consumptive before a new occupant moves into 
it, our boards of health could make themselves a most potent 
factor in the restriction of this fearful destroyer of human life. 
I am aware that a great cry is being raised in advance against 
any practical preventive measures against this disease upon 
the plea of humanity. Why further burden the life of the 
poor consumptive, they sa}', by removing him from his 
family and friends, and emphasizing his hopeless situation ? 
Sincere as the feelings may be which give rise to this con- 
servative protest, it is evident that they are not inspired by 
a thorough understanding of the subject, such as can only be 
obtained by a bedside study of the question. What can be 
more inhuman than consigning an intelligent human being, 
with a long, tedious, loathsome disease, to the care of those 
whom he loves, when that care implies deprivation and death 
to them, and despair to himself ! The classical symptom of 
consumption is hope and unbounded faith in ultimate recov- 
ery, and oh ! what ingenious cruelty to make the poor victim 
feel that no helping hand is extended him, and that his chances 
for recovery are curtailed by the poverty of those who love 
him ! The preventive measures for the restriction of tubercu- 
losis, as dictated by the science of to-day, are all in direct line 
with humanity, and the strongest arguments which can be ad- 
* Contagiousness of Phthisis. 
of State of Pennsylvania, 1888. 14 
The Prevention of Tuberculosis. 
vanced for their adoption are born of the great command, 
“ Love thy neighbor as thyself.” 
It is certainly humane to give the poor man who falls a vic- 
to this disease a home in a hospital where he can receive 
all the aid of medical science for his recovery, and where he 
can feel that he is neither snatching from his dear ones the 
morsel of bread which is necessary for their sustenance, nor 
infecting them with the same horrible disease from the grasp 
of which he is trying to extricate himself. It is certainly 
humane to extend to the poor protection from a disease 
against which they have neither the knowledge nor means to 
protect themselves. Preventive measures against tuberculosis 
imply nothing more, and I trust this convention will not ad- 
journ without taking some steps looking to concerted effort in 
this direction.