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penalty for the first offense of 300 ducats, and upon repetition, of banishment for ten years.
"2. 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. Household goods which are not susceptible shall be immediately cleansed and those that are susceptible shall at once be burned or destroyed.
"4.. The authorities themselves shall tear out and replaster the house, alter it from cellar to garret, carry away and burn the doors and wooden windows and put in new
"5. The sick poor shall at once be removed to a hospital.
"6. Newly built houses cannot be inhabited before one year from their completion, and six months after plastering has been finished and repairing has been done.
"7. Superintendents of hospitals must keep in separate 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 discovery of the bacillus tuberculosis and its mode of propagation and transmission would almost seem to justify these harsh regulations. Indeed their enforcement appears to have produced a marked reduction in tuberculous diseases. Dr. Flick, who has made a very thorough study of this question, estimates that in 1782, the mortality from tuberculous diseases in the kingdom of Naples was ten per thousand of population. In 1887 the official statistics for the Italian States formerly comprised under the Neapolitan kingdom showed that the death rate from all forms of tuberculosis was only 2.05 per thousand living people.
The efficient carrying out of restrictive measures against consumption requires intelligent co-operation on the part of the public. Hence the education of the laity upon the infectious nature of tuberculosis and the importance of individual measures of prophylaxis must precede any successful enforcement of legal enactments looking toward the restriction of the disease. There can be no doubt that the public press can give most effective aid in spreading such knowledge. The newspapers are always foremost in the dissemination of useful information. The press is the most powerful auxiliary of the sanitarian. The press makes public opinion. Public opinion makes laws, and until laws have the sanction of public opinion it is futile to look for their successful enforcement.
Popular societies, like the French "Ligue preventive contre la phthisie pulmonaire," and the "Pennsylvania Society for the Prevention of Tuberculosis" are also useful and effective agencies in educating the people upon this subject. The organization of similar societies should be encouraged elsewhere.
Our current knowledge of tuberculosis and its means of prevention was effectively summed up in a report made to the New York City Health Department in the early part of 1889, by Drs. T. M. Prudden, H. M. Biggs and H. P. Loomis, the pathologists of the department, and extensively published. In 1890, the Prussian government issued a set of regulations which admirably cover the whole subject. This action was followed by the kingdom of Wurtemberg in 1892. In the same year the State Board of Health of Michigan issued a pamphlet, giving instructions for the disinfection of sputa, and in 1893, the same Board went a step farther and adopted a resolution requiring consumption of the lungs and other tubercular diseases to be reported among "the diseases dangerous to the public health;" this report to be made by householders and physicians to the local health officer as soon as the disease is recognized. The purpose of such report is to secure to the health officer information of
the location of each case "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 the disease."
The publication of the report of Drs. Prudden, Biggs and Loomis seems to have been the first official notification to the public by any health authority of the infectiousness and preventability of tuberculosis, since the Neapolitan decree before quoted. Within a few months the New York Health Department has taken a more aggressive step, and now requires "all public institutions, such as asylums, homes, dispensaries, etc., to transmit to the Board of Health the names and addresses of all persons suffering from pulmonary tuberculosis within seven days of the time when such persons first come under observation." Physicians are requested to notify the Board of all cases coming under their professional care. Hospital authorities are urged to separate consumptive patients from those sick of other diseases. Special inspectors are appointed to visit the residences of consumptives, deliver printed instructions containing methods of prevention, and practice disinfection when required. One of the municipal hospitals is to be set aside as a "Consumptive Hospital" for the exclusive treatment of this disease, and whenever requested by physicians, the Health Department will undertake the bacteriological examination of the sputum in doubtful cases.
Action in a similar direction was contemplated by the Board of Health of Philadelphia, but objection on the part of some physicians to the compulsory notification of the disease was so strong that it has been for the time abandoned.
Within two months the State Board of Health of Washington has placed consumption among the diseases required to be reported to the Board.
The Board of Health of the City of Baltimore is about issuing a circular to the public giving suggestions in reference to preventive measures against tuberculosis.
The Pan-American Medical Congress, in session in Washington last September, adopted resolutions recommending to the various National governments represented effective measures for the restriction of the disease, and the American Public Health Association, which has been studying the question for the past four years through a special committee, set its stamp of approval upon the work of the committee by the adoption of the following report and recommendations in Chicago last October :
"1. Tuberculosis has been conclusively demonstrated to be contagious, by bacteriological experiments, by clinical observations, and by a study of the history of the disease.
"2. Tuberculosis is a preventable disease. Its preventability follows as a logical sequence upon its contagiousness, but has likewise been demonstrated in practical life.
"3. The contagium of tuberculosis resides entirely and solely in broken down tubercular tissue. A person suffering from tuberculosis, therefore, does not become a source of danger to others until he begins to give off broken down tubercular tissue, either in the form of sputa from the throat or lungs, diarrheal discharges from the bowels, or matter from a tuberculous sore such as lupus, white swelling, cold abscess, scrofula or tubercular inflammation of a joint.
"4. A person suffering from tuberculosis can be made entirely harmless to those about him by thorough sterilization of all broken down tissue immediately upon its being given off. With proper precautions it is therefore possible to live in the closest relation and upon the most intimate terms with consumptives without contracting the disease.
"5. Tuberculosis is not hereditary. A predisposition to the disease can be transmitted from parent to offspring, but this is no more true of tuberculosis than it is of all other contagious diseases.
"6. A predisposition to tuberculosis can be created anew by malnutrition or by anything which depresses the nervous system.
"7. Tuberculosis affects animals as well as man, and is identically the same disease in both. In domestic life human beings and animals mutually infect each other.
"8. The media through which human beings are ordinarily infected by animals are milk and meat.
"9. Houses in which consumptives have lived and in which immediate sterilization of all broken down tissue has not been practiced, are infected houses and are liable to convey the disease to subsequent occupants.
"Io. Spitting upon floors and into handkerchiefs, and permitting the broken down tissue to dry and become pulverized is a prolific cause of spreading tuberculosis.
"II. Temporary occupation of hotel rooms, sleeping car berths and steamer cabins by consumptives in the infectious stage can infect them so as to convey the disease to subsequent occupants, unless proper precautions are taken against contamination of the bedding, furniture and walls with broken down tubercular tissue.
"We recommend the following practical measures for the prevention of the disease:
"1. The notification and registration by health authorities of all cases of tuberculosis which have arrived at the infectious stage.
"2. The thorough disinfection of all houses in which tuberculosis has occurred, aud the recording of such action in an open record.
"3. The establishment of special hospitals for the prevention of tuberculosis.
"4. The organization of societies for the prevention of tuberculosis.
"5. Government inspection of dairies and slaughter houses, and the extermination of tuberculosis among dairy cattle.
"6. Appropriate legislation against spitting into places where the sputum is liable to infect others, and against the