RESTRICTION AND PREVENTION 
. . . OF . . . 
CONSUMPTION. 
Sometimes called "Tuberculosis," "Phthisis," "Phthisis Pulmo- 
nalis," "Tubercular Phthisis," "Tubercular Consumption," 
or " Pulmonary Consumption." 
[ISSUED BY THE VIRGINIA STATE BOARD OF HEALTH.] 
1. Consumption is the most common and fatal disease. 
Consumption, in its many forms, is the cause of more deaths than any other 
disease. According to the health reports, it far exceeds any other disease 
in its death-rate, and especially is this true in Virginia. It exceeds by fifty 
per cent, any of the infectious or contagious diseases, such as diphtheria, 
scarlet fever, small-pox, or typhoid fever; hence every precaution should be 
taken for its restriction and prevention. Now, this great mortality should 
be, and can be, prevented. 
2. Consumption is now known to be a communicable dis- 
ease, in which, frequently, the contagion is carried from the dried sputum 
of a consumptive to the lungs of a susceptible person, where it grows and 
multiplies, and thus produces the disease. The germ which causes con- 
sumption is called the bacillus tuberculosis, and it is present, in immense 
numbers, in the sputa of consumptives. These bacilli are from about one 
twenty-thousandth to about one ten-thousandth of an inch in length, and 
their breadth is about one-sixth of theii' length. (From 1.5 to 3.5, by .4 
micro-millimeters.) These bacilli have been thoroughly studied, and by 
inoculations with them the disease has repeatedly been caused in lower ani- 
mals. Interesting experiments have been made in this connection by Dr. 
George Cornet, of the Berlin Hygienic Institute, with the dust of rooms in- 
habited by consumptives. Dust collected from those surfaces not likely to 
be contaminated directly by the spitting or coughing of the patient was 
mixed with sterilized bouillon and injected into the peritoneal cavity of 
guinea pigs. Forty days later the animals were killed, and a careful 
necropsy was made. Twenty-one hospital wards, in which there were con- 
sumptive patients, were examined in this way, and from the dust of fifteen 
of them tuberculosis was set up in the guinea pigs experimented upon. 
Private houses where consumptives lived gave similar results; where 
patients had been in the habit of expectorating on the floor the dust from 2 
the walls was certain to yield infectious cultures, but where cloths or spit- 
toons had been used this was not the case. 
3. The mode of communication of this disease is mainly from 
the dried sputa from consumptives. The germs in the sputa are carried 
into the air by sweepings and deposited upon walls or contents of roo 
and find their way to the lungs of persons. 
4. Destruction of the sputa.-It is evident that the most certain 
preventive of consumption is to destroy the sputum from the consumptive 
before it has an opportunity to dry and scattei- the seeds. It is for the con- 
sumptive's own safety to destroy the sputa, because it reduces to a minimum 
the possibility of re-infection. Any person who has an habitual cough, and 
raises sputa, should have a microscopical examination of the sputa to ascer- 
tain whether they contain the bacillus tuberculosis. Without waiting for 
such examination, in all such cases the sputa should be disinfected. 
5. How the sputa should be destroyed.-No consumptive should 
expectorate on the floor. Cuspidors in hotels and other public places and in 
rooms occupied by consumptives should be partly filled with water. They 
should be washed twice each day in boiling water, and the contents should 
be disinfected with a solution of bi-chloride of mercury7. The cuspidor might 
well contain constantly a disinfectant, such as a five per cent, solution of car- 
bolic acid-one ounce of carbolic acid dissolved in a pint and a half of water. 
The consumptive should carry small pieces of cloth (each just large 
enough to properly receive one sputum) and paraffined paper envelopes or 
wrappers, in which the cloth, as soon as once used, may be put and securely 
enclosed, and, with its envelope, burned at the first opportunity. 
6. Isolation of the patient.-If a consumptive is ignorant, insane or 
wilful, and will not use the proper measures for preventing the spread of 
the disease, the question of isolation should then be considered by the 
health officer and local board of health. 
7. Destruction of the dejecta.-All dejecta of a consumptive per- 
son should be destroyed or disinfected, because it has been shown that the 
bacilli are to be found in the urine of persons having tubercular disease of 
the urinary organs and in the faeces of those having tuberculai' disease of 
the bowels, and they may be in the faeces of those who swallow sputa con- 
taining the bacilli, that is, possibly, of any consumptive. Disinfect each 
discharge from the bowels by thoroughly mixing with it at least one ounce 
of chlorinated lime in powder, or one quart of " Standard Solution No. 1," 
recommended by the American Public Health Association's Committee.* 
* "Standard Solution No. 1" is made by adding to each gallon of soft water four 
ounces of chloride of lime of the best quality, which should contain at 1 >ast twenty- 
five per cent, of available chlorine. " Use one quart of this solution for the disinfec- 
tion of each discharge in cholera, typhoid fever, etc. Mix well and leave in vessel for 
at least one hour before throwing into privy-vault or water-closet " 3 
8. Ventilation of buildings.-Through better systems of ventilation 
much may be done for lessening the number of micro-orgajiisms inhaled 
with the dust of floors, carpets, etc., especially by having the foul-air exits 
at the floor level, so that the general motion of the foul air shall be down- 
wards and not upwards into the nostrils of the inmates of the room. This 
is especially important with reference to all public buildings, as also that 
they shall constantly have a liberal supply of fresh air. 
9. Personal precautions.-Those who sweep and dust rooms which 
consumptives have occupied might well use respirators. Much may be 
done to lessen the liability to contract consumption by having the sanitary 
surroundings as nearly perfect as possible and by keeping the lungs strong 
and healthy. It is stated that " in no less than sixty pei' cent, of all patients 
dying at Bellevue Hospital there were old tubercular changes in the lungs, 
the disease having been recovered from." Similar observations have been 
made at the Philadelphia Hospital and at the Paris morgue. Dr. Tru- 
deau's experiments prove that rabbits inoculated with the bacillus tubercu- 
losis and kept in a cellar-like place on restricted diet died of the disease in 
much greater proportion than did similar animals similarly inoculated but 
kept in the open air with an abundance of food. These facts emphasize the 
importance of pure food, pure air, and healthful exercise. 
10. Exposure to cold should be avoided.-Statistics of sickness 
and of deaths, collated with meteorological statistics, seem to prove that the 
consumptive processes go on most actively after times of low atmospheric 
temperature, and least actively after times of high atmospheric temperature. 
This makes it important that consumptives, and persons susceptible to con- 
sumption, should especially guard against the inhalation of cold air. It 
enforces the importance of having such persons spend the winter and 
spring months in a climate warmer than that to which they have been ac- 
customed. 
11. Disinfection.-The dusting of objects in the room, the cleansing of 
the floor, walls, or ceiling of the living or sleeping room of a person suffer- 
ing from pulmonary consumption should be deferred until after the room 
and contents have been subjected to the fumes of burning sulphur. 
The unwashed clothing of a consumptive should not be mingled with the 
unwashed clothing of another person; care should be taken that the hand- 
kerchiefs be boiled, that other articles liable to harbor the bacillus be disin- 
fected, and that no virus come in contact with a cut or injured hand. 
No one should sleep in the same room with a consumptive patient, or in 
a room which has been occupied by a consumptive, unless the room has 
been previously subjected to the fumes of burning sulphur. A room which 
has been occupied by a consumptive person may well (with all its contents) 
be thoroughly disinfected, first subjecting it, for twenty-four hours, to strong 
fumes of burning sulphur, and then it should for several hours be exposed 4 
to currents of fresh air. After fumigation the walls may be rubbed with 
bread crumbs, which should then be burned. 
12. Rooms to be disinfected by sulphurous fumes must be vacated. 
For a room ten feet square, at least three pounds of sulphur should be used; 
for larger rooms proportionately increased quantities, at the rate of three 
pounds for each one thousand cubic feet of air space. 
Hang up and spread out as fnuch as possible all blankets and other 
articles to be disinfected; turn pockets in clothing inside out, and other- 
wise facilitate the access of the sulphurous fumes to all infected places. 
Close the room tightly, place the sulphui' in iron pots or pans which will 
not leak, supported upon bricks over a sheet of zinc or over water in a tub 
or pan, so that in case melted sulphur should leak out of the pot the floor 
may not be burned; set the sulphur on fire with hot coals or with the aid 
of a spoonful of alchohol lighted by a match; be careful not to breathe the 
fumes of the burning sulphur, and when certain the sulphur is burning well 
leave the room, close the door, and allow the room to be closed for twenty- 
four hours. 
13. Boil milk from suspected sources.-While by far the greater 
number of cases of consumption are caused by the inhalation of the germs 
of the disease from the dried sputa, the disease may be communicated by 
the use of milk from tubercular animals. The bacilli of consumption have 
been found in the milk of cows affected with tuberculosis, even where there 
was no evidence of localized tuberculosis of the udder. Experiments indi- 
cate that, while heating the milk to 167° F. so weakened the virus that six 
rabbits which drank the milk did not show any traces of the disease, boiling 
the milk will destroy these germs. These experiments render it important 
that all milk from suspected sources be boiled before being used. 
14. Tuberculous meat.-The Paris Congress, for the study of tuber- 
culosis in man and in animals, voted almost unanimously that the flesh from 
tubercular animals should be destroyed, even where the disease is only 
localized, if a large part of the organ is affected. Not only should all meat 
from tubercular animals be destroyed, but all meat from an unknown source 
should be thoroughly cooked. 
Collection of information.-Health officers and physicians in Vir- 
ginia are requested to continue to send to the office of the State Board of 
Health, at Richmond, information concerning cases under their observation 
where consumption appears to have been communicated directly or indi- 
rectly from one person to another, the relation between the individuals, the 
presence of family predisposition, if any, and other interesting facts in con- 
nection with such cases. 
WHITTET & SHEPPERSON, Printers, Richmond, Vs. Presented to the 
Statistical Division, Surgeon-General's 
Library, United States Army 
Washington, D. C. 
BY 
The Prudential Insurance Co. of America 
Newark, New Jersey