the purpose of emphasis that a consumptive should never, under any circumstances, spit into a place where he cannot disinfect or destroy his sputa; and that, therefore, he should never spit into the street, into public places, or into cars.

We commend the above tracts to the people of New Hampshire. There is no doubt that if the recommendations contained therein were carefully followed, an almost marvellous result in curtailing this disease would be witnessed in a relatively short time.

At a recent meeting of the New York Medical Association, Dr. Porteus read a paper on the "Prevention of Disease" in which he made some strong points.

People showed greater interest in being cured of disease than in avoiding it. How many of us had ever succeeded in convincing a woman, or a man for that matter, that wearing narrow shoes had anything to do with producing their corns. They might admit the fact in their neighbor's case, but would deny it in their own. People inveighed against dirty water and filthy streets, but at their homes they drank water contaminated with their own excreta, and put up with surroundings which were far from cleanly. It was by persistent and intelligent application and spread of knowledge regarding the causes and the prevention of disease, that most good would be done by the medical profession. The discoveries of Pasteur, Koch, and others, had been of incalculable benefit in the prevention of disease, but the necessity for intelligent application of methods based upon their discoveries was shown by the fact that harm had sometimes resulted from their misapplication. The author impressed the necessity for carrying to a practical conclusion the principles enunciated from our laboratories, whereby we would be enabled, in great degree at least, to stamp out typhoid, diphtheria, cholera, and other infectious or contagious diseases. The question of preventing the spread of tuberculosis received more detailed mention. Dr. Porteus made it a custom to distribute among his clientele a card with the following printed instructions:

To Prevent Consumption.-Remember that it is an infectious disease communicated principally by the matter coughed up and spit out. The patient should spit in a cup or wide-mouthed bottle,

containing a little carbolic acid and water, and frequently washed with hot water. Use carbolic acid and water in commode. Never spit on the street, or floor of house, or cars. Sleep alone, and if possible in an airy and sunny room. Have separate bed and table linen; these should be boiled before washing. Use individual table utensils, washed separately. Wash the mouth twice daily with soda and water. Do not kiss any one.

Those who are well should remember that it is an infectious disease, communicated principally by swallowing the germs, by inhaling them, or having them introduced through a wound. Therefore, do not buy or use food that has been handled by a consumptive. Do not share the food or drink of a consumptive. Do not sleep with a consumptive. Do not put coins or small articles in your mouth that may have been handled by a consumptive. Do not use clothing until it is thoroughly disinfected, if it has been used by a consumptive. Do not kiss any one on the lips if they have a cough. Do not take food without first washing your hands.1

At a recent meeting of the New York state board of health, Dr. Edson said the subject was well summed up as follows:

First-Tuberculosis is a contagious disease, and is distinctly

preventable.

Second-It is acquired by direct transmission of the tubercle bacilli from the sick to the well, usually by means of the dried and pulverized sputum floating as dust in the air.

Third-It can be to a great extent prevented by simple and easily applied measures of cleanliness and disinfection.

I have the honor to offer the following recommendations, based upon the foregoing premises, to the board for its consideration:

First-That circulars be sent throughout the state, setting forth the danger of the disease and the fact that the discharges from the lungs of tuberculous patients are not only dangerous to others, but also to the person afflicted, and also setting forth the danger of expectorating in places where the sputum is liable to be dried and carried by the air in the form of dust.

Cases should be reported to local health officers within seven days

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of the time when the sick person comes under observation. Then the officers should take the necessary action.

Second-After the death of a patient, the room occupied by him should be thoroughly disinfected. The entire premises should be carefully treated.

Third-Suitable receptacles or cuspidors should be provided to receive the sputa. These should be put in all public places, such as railroad cars, factories, stations, etc.

He suggested that a circular embodying the following points should be approved by the state board of health, and distributed among local health officers, physicians, and others vitally interested in the matter:

First-Local health officers will register the name, address, sex, and age of each patient suffering from tuberculosis.

Second-When a notice of the existence of the disease shall be obtained inspectors will visit the premises and family, and leave circulars furnishing the necessary advice for preventing the spread of the disease.

Third-Premises which have been occupied by consumptives, when vacated by their death or removal, must be freed from all such articles as carpets, rugs, bedding, etc. Then these articles must be thoroughly disinfected.

Fourth-The authorities of all public institutions under the jurisdiction of the state board of health, such as hospital, dispensaries, asylums, prisons, homes, &c., shall be required to furnish to the state board of health the name and last address of every consumptive coming under observation within seven days.

It is the earnest wish and hope of the state board of health that an earnest and determined effort be made to restrict the ravages of the most prevalent and formidable disease with which modern civilization has to deal.

Consumption is a disease which can be taken from others. It is not simply caused by colds. It is usually caused by germs which enter the body with the air breathed.

What consumptives cough or spit up contains millions of these germs, any one of which may cause a person to get the disease. The matter dries and floats in the air in the form of dust. Then a well person may receive the disease from one afflicted by consumption.

Healthy persons may live safely with consumptives if the matter mentioned is destroyed. This matter should be placed in cups containing water, then the cups should be carefully emptied and washed twice each day. Consumptives should sleep alone.1

The Philadelphia Pathological Society, composed of many able physicians, has recently taken the following action relative to the infectious nature of tuberculosis:

WHEREAS, In the opinion of the Pathological Society tuberculosis is an infectious disease, and the society recognizes the fact that the most frequent source of infection is the human subject affected with the disease, and that there are many practical obstacles to be overcome before a generally accepted system of preventive measures can be established; therefore, be it

Resolved, That in the opinion of this society the line of action to be followed by the health authorities should be one of education and preparation of the people for future action, and that the first step in this direction should take the form of frequent and well propagated announcements to the effect that the health authorities are prepared to undertake, upon request of the attending physician, with the sanction of the family, the disinfection of premises vacated by tuberculous patients.

The state board of health of Michigan, under date of September 30, 1893, adopted the following resolution :

Resolved, That hereafter, consumption (and other diseases due to the bacillus tuberculosis) 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 of householders and physicians to the local health officer, as soon as such a disease is recognized.

Accompanying the resolution was the following explanation, indicating the object of requiring notification of the disease:

In this resolution the question of isolation of the patient is not mentioned. Its purpose is to secure to the local health authorities

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and to the state board of health information of the location of each case of this most dangerous disease, with the view of placing in the hands of the patient reliable information how to avoid giving the disease to others, and in the hands of those most endangered information how to avoid contracting this disease.