RESTRICTION AND PREVENTION 
or 
CONSUMPTION. 
Sometimes called “Tuberculosis,” “Phthisis,” “Phthisis Pulmonalis.” “Tubercular 
Phthisis,” “Tubercular Consumption,’’ or “Pulmonary Consumption,” 
LEAFLET ISSUED BY THK MICHIGAN STATE BOARD OF HEALTH. 
[175.] Seventh Edition (Ten Thousand), May, 1899,-80,000 Printed. 
Consumption is the most common and fatal disease. In Michigan, 
it causes more deaths than any other disease. According to the Registra- 
tion reports, issued by the Secretary of State (1893, p. 156), the average 
annual number of deaths from consumption in this State for the ten years. 
1884-93, is 2,140, and from other tubercular diseases, 166; but it is believed 
that not more than two-thirds of the deaths are reported, so that the 
number of deaths which actually occur in Michigan from consumption is 
probably over three thousand per year. • A large part of this mortality can 
be and ought to be prevented. 
Consumption is now known to be a communicable disease, in 
which, frequently, the contagium 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 their 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 
animals. Interesting experiments have been made in this connection by 
Dr. George Cornet, of the Berlin Hygienic Institute, with the dust of 
rooms inhabited 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 consumptive 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 the walls was certain to yield infectious cultures, 
but where cloths or spittoons had been used this was not the case. 
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 wralls or contents of rooms, and 
find their way to the lungs of persons. 
Destruction of the sputa.—It is evident that the most certain prevent- 
ive of consumption is to destroy the sputum from the consumptive before 
it lias an opportunity to dry and scatter the seeds. It is for the consump- 
tive’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 ascertain whether they contain the Bacillus tuberculosis. Without wait- 
ing for such examination, in all such cases the sputa should be disinfected. 
How the sputa should be destroyed.--No consumptive should ex- 
pectorate on the floor. Cuspidors, in hotels and other public places and 
in rooms occupied by consumptives, should be partly filled with water. 
* For the convenience of physicians in the diagnosis of tuberculosis arrangement has been made 
with the State Laboratory of Hygiene, at Ann Arbor, Michigan, to make bacteriological examina- 
tion of the sputa in suspected cases, at a small expense to the physician or person. Persons wishing 
such an examination made at the State Laboratory, should correspond with Dr. Vaughan, the Director 
of the Laboratory, before sending the sputa. 2 
RESTRICTION AND PREVENTION OF CONSUMPTION. 
They should be washed twice each day in boiling water, and the contents 
should be disinfected with a solution of bichloride of mercury. The 
cuspidor might well contain constantly a disinfectant, such as a five per 
cent solution of carbolic 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 parafitined-paper envelopes 
or wrappers in which the cloth, as soon as once used, may be put and 
securely enclosed, and, with its envelope, burned on the first opportunity. 
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, as in such cases is required by sec- 
tion one of act 137, laws of 1883, should then be considered, by the health 
officer and local board of health. 
Destruction of the dejecta.—All dejecta of a consumptive person 
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 tubercular disease 
of the bowels, and they may be in the faeces of those who swallow sputa 
containing the bacilli, that is, possibly, of any consumptive. Disinfect each 
discharge from the bowrels 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.* 
Ventilation of buildings.—Through better systems of ventilation, 
much may be done for lessening the number of micro-organisms 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 
downwards, 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. 
Personal precautions.—Those who sweep and dust rooms wffiich con- 
sumptives have occupied might well use respirators. Much may be done 
to lessen the liability to contract consumption by having the sanitary sur- 
roundings as nearly perfect as possible, and by keeping the lungs strong 
and healthy. It is stated that “in no less than sixty per 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. Trudeau’s experiments prove that rabbits inoculated with the Bacillus 
tuberculosis 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. 
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 tempera- 
ture. This makes it important that consumptives, and persons susceptible 
to consumption, 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 
accustomed. 
* “ 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 least 25 per cent of available chlorine. “Use one 
quart of this solution for the disinfection 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.” RESTRICTION ' AND PREVENTION OF CONSUMPTION. 
3 
Disinfection.—The dusting of objects in the room, the cleansing of 
the lioor, 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, or of 
formaldehyde. Curtains, draperies, carpets, clothing, and all movable 
articles should be exposed to sunlight in the open ail*. The un- 
washed clothing of a consumptive should not be mingled with the un- 
washed clothing of another person; care should be taken that the hand- 
kerchiefs be boiled, that other articles liable to harbor the bacillus be dis- 
infected, 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, nor 
in a room which has been occupied by a consumptive, unless the room 
(with all its contents) has been previously thoroughly disinfected, first sub- 
jecting it, for twenty-four hours, to strong fumes of burning sulphur, or 
of formaldehyde, and then it should for several hours be exposed to cur- 
rents of fresh air. But neither of these agents should be relied upon 
exclusively. After fumigation, the walls should be whitewashed, ala- 
bastined, painted, repapered, or rubbed with bread crumbs which should 
then be burned; the woodwork, including the floor, should be painted or 
thoroughly washed; and, if any sputum is deposited thereon, it should be 
washed with a solution of bichloride of mercury, one part to five hundred 
parts of water. 
Rooms subjected to sulphurous fumes or to formaldehyde must be va- 
cated. For a room ten feet square at least three pounds of sulphur should 
be burned, or at least eight fluid ounces of formalin containing 40 per cent 
formaldehyde, should be rapidly distilled into the room; and for larger 
rooms proportionately increased quantities should be used, at the rate 
of at least three pounds of sulphur or at least eight fluid ounces of forma- 
lin per each 1,000 cubic feet of air space. 
Hang up and spread out as much as possible all blankets and other 
articles to be disinfected; turn pockets in clothing inside out, and other- 
wise facilitate the access of the disinfecting fumes to all infected places. 
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 
indicate 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 dis- 
ease, boiling the milk will destroy these germs. These experiments ren- 
der it important that all milk from suspected sources be boiled before 
being used. 
Tuberculous meat.-—The Paris Congress, for the study of tuberculosis 
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 un- 
known source should be thoroughly cooked. 
Collection of information.—Householders and physicians in Michi- 
gan are required by law to report every case of well-developed consump- 
tion of the lungs to the local health officer. Health officers and physicians 
are requested to continue to send to the office of the State Board of 
Health, at Lansing, information concerning cases under their observation 
where consumption appears to have been communicated, directly or indi- 4 
THE RESTRICTION AND PREVENTION OP CONSUMPTION. 
rectly, from one person to another, the relation between the individuals, 
the presence of family predisposition, if any, and other interesting facts 
in connection with such cases. 
[PLATE 650.] 
This diagram is accurately drawn to a scale, and the 
relative importance of Consumption, as a cause of deaths in 
Michigan, is, therefore, correctly shown. It is the disease 
which causes most deaths. All the diseases mentioned on 
this page are believed to be preventable, and to be caused 
by micro-organisms, some of which are wTell known ; those 
which cause consumption are represented in the circular 
space above. 
DEATHS IN MICHIGAN, 10 YEARS, 1884-93. 
Corisumftion, Bacilli, feoTr] 
miliary tubercle. 
.Magnified. 
about looo dlameiers. 
CONSUMPTION. 
PNEUMONIA. 
DIPHTHERIA. 
TYPHOID FEVER. 
SCARLET FEVER. 
WHOOPING-COUGH. 
24008 
11000. 
MEASLES. 
SMALL-POX. 
rm». 
ifl® CONSUMPTION IS A DISEASE DANGEROUS TO TOE PUBLIC HEALTH, 
IT SHOULD BE REPORTED TO THE HEALTH AUTHORITIES. 
SUBSTANCE OF RESOLUTION ADOPTED BY THE MICHIGAN STATE BOARD OF HEALTH. 
[334—9th Ed.] 
Hereafter, consumption shall be included in the official list of “ Diseases 
dangerous to the public health,” referred to in sections 1675 and 1676 Howell’s 
statutes, requiring notice by householders and physicians to the local health 
officer, as soon as such disease is recognized. 
[In this resolution the question of isolation of the patient is not mentioned. Its purpose is to secure 
to the local health authorities and to the State Board of Health, information of the location of each 
ease of this most dangerous disease,—commonly known as “Consumption of the lungs, ” with the 
view of placing in the hands of the patient, reliable information how to avoid reinfecting himself or 
herself, or giving the disease to others, and in the hands of those most endangered, information how 
to avoid contracting this disease. 
HENRY B. BAKER, Secretary.] THE PREVENTION OF CONSUMPTION. 
Instructions to Consumptives and their Friends. 
Consumption is the most destructive disease, the number of persons dying annually 
from this cause in Michigan amounting to about three thousand. 
Consumption is a dangerous communicable disease, the most dangerous one in 
Michigan. One consumptive may spread the disease to very many healthy persons. 
The chief danger exists in the expectoration of the consumptive person, and if this 
expectoration is carefully destroyed before it is dried, little danger need be feared. 
Consumptives should be instructed not to spit upon sidewalks, the floors of rooms, 
public halls, street and railway cars, and other vehicles, nor where fowls or dairy cows 
may take in the sputum, or the dust of it with their food. They should spit into pieces 
of cloth, or receptacles made for the purpose, containing a saturated solution of carbolic 
acid (one part of carbolic acid crystals to about fifteen parts of water). Such pieces of 
cloth should be destroyed by fire, before the sputa become dry, and other receptacles 
should be cleansed with scalding water, their contents having been destroyed or other- 
wise carefully disposed of. Handkerchiefs which may have been used from necessity 
should be boiled half an hour before washing. 
It is best that all persons who have a cough 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 on the first opportunity. 
Remember that sputa must; never be allowed to become dry. 
Office of the Secretary of the State Board of Health, 
Lansing, Michigan, August, 1889.