ter made from such milk is particularly liable to be infected with tubercle bacilli, for the reason that they stick to the fat globules and when the milk is "separated" by a machine, they are thrown off with the cream from which the butter is made.

For several reasons there is little danger in contracting tuberculosis from infected meat. First of these, is the fact that the muscle, which constitutes the "meat" we eat, is usually not affected by the disease.

Besides this, the meat is usually well cooked and this process destroys any germs that may be present. Then all of the beef that is killed in the large slaughterhouses of the West is inspected and unhealthy and tubercular meat is condemned and destroyed. So you need not be afraid to eat beef.

Now let us return to the consideration of the milk and butter question.

How many cases of tuberculosis are caused by infection. through this agency?

There is no means of determining what the status of this question is with us here in Georgia. It is a question that has not been asked frequently here. We have not taken sufficient interest in the lives and welfare of our little ones, for it affects these chiefly, to investigate this very important matter.

In other words, there are no statistics either for the mortality of children from tuberculosis or the condition. of the sources from which we obtain our milk. We can only consider the data furnished us by more enterprising and careful people elsewhere.

In Germany and England it has been shown that about one-fourth of all cases of tuberculosis are probably due to infection through milk from tuberculous cattle. In some of the Northern States whole herds of dairy cattle have been found to be tuberculous.

With us it is probable that this state of affairs does not exist. Personally, I believe that the cattle of the South are comparatively free from tuberculosis.

But you may be very sure they are not entirely free from it. Even if a small per cent. of the cows that fur

nish our milk-supply are tuberculous I think you will allow that it is high time something should be done to detect their condition and remove this menace to the public health.

You would not drink the milk from a tubercular cow if you knew it.

I am sure that you would feel better if you knew that the cattle of your dairyman were proven free from the disease. Unfortunately a cow may be giving milk loaded with tubercle bacilli and present no symptoms of the disease. It has been repeatedly demonstrated that it is not necessary that the udder of an animal be tuberculous in order that the milk shall contain the organism. Many tubercle bacilli may gain access to the milk when the udder and teats are entirely healthy, though when they become diseased the number of tubercle bacilli in the milk is much greater.

How, then, may we demonstrate whether or not a given animal is producing milk that is contaminated with tubercle bacilli?

Fortunately there is a very sure and easy method.

This is the tuberculin test. It consists in injecting beneath the skins of the animal a solution known as tuberculin, which is derived from the tubercle bacilli grown artificially in the laboratory. When this is done, if the cow is tubercular, there is a characteristic rise of the body temperature within a few hours.

In the absence of this rise of temperature the animal may be declared free from tuberculosis.

This test has been used upon many thousands of cattle and is known to be as reliable as any test can be, quite enough so for all practical purposes.

Remember, that without this test we can only presume that a cow is healthy. The test is entirely free from danger to the cow. The test is simple and reliable. The test is not expensive. These three facts are worth consideration even though we have a very small per cent. of tuberculous cattle among our milk herds. Among the many laws that are needed to insure the public safety, is one requiring that this tuberculin test shall be periodically ap

plied to all cattle from which milk is sold. If the people of Georgia want such a law, they may have it for the asking. "The people make the laws"-sometimes.

So if you care for the health of yourself and your family and if you believe I have stated the plain facts of the case to you, see that you, for one, take some steps in the regulation of your milk-supply. Know that the cows. from which it comes are not tuberculous.

If you are not willing to take my statements, investigate the subject for yourself. You can at least ask your milkman, are your cattle tuberculin tested? Do this first, then see about the enactment of laws by our city councils and by our State Legislature.

Having gone thus far, let us once more take stock. What are the chief points that should be borne in mind? 1. Tuberculosis is an infectious, communicable dis

ease.

2. Tuberculosis is the cause of at least one of every ten deaths.

3. Tuberculosis is transmitted chiefly: (a) through infected sputa; (b) through infected milk.

4. Tuberculosis is a preventable disease. What are we doing to prevent it?

Let me ask again that you ask yourself.

COMMITTEE ON TUBERCULOSIS,
Medical Association of Georgia.

DUTY OF THE TUBERCULAR PATIENT TO THE PUBLIC.

LETTER NO. 4.

In the former letters of this series we have seen that tuberculosis is a disease caused by the tubercle bacillus and that this tubercle bacillus, or germ, is transmitted from one person to another through the sputa or spit that is coughed up from a lung affected with the disease. We found that this germ, like all bacteria, is a plant, just as much a plant as is an oak tree or a potato vine. That being a plant it is alive and grows according to certain laws as do all other plants. That it must have the right kind

of soil the body of some warm-blooded animal-in which to grow, that it must have heat and moisture.

We found also that in common with the seeds of higher plants, as corn and wheat, and in fact like some plants themselves, it can retain its vitality for a long time even when dried, and resume its growth when it is again brought under favorable conditions. We also found that it may be grown outside of the animal body upon certain substances known as "artificial media" and studied in the laboratory.

It will interest you, perhaps, to know that the yeast that is used in making your bread and beer is similar to bacteria, is a kind of germ. And if we go a step higher the molds, though more complex in structure than the bacteria, are in many respects like them. They are only a simple form of plant without the green coloring-matter of the higher forms of plant-life. We saw also that a consumptive in the latter stages of the disease coughed up daily several billions of these little plants called tubercle bacilli, each one of which may produce the disease in some one else provided it gains access to his body and the cells of his body are not able to destroy it. And beside the above is the stern fact that of every ten people of our community one at least will die from infection with these little plants-the tubercle bacilli.

This brings it home to us, to you and me. It seems strange that it should be necessary to say this fact over and yet I know that it is necessary and if I could feel sure that every person in our community who is old enough to think, would pause for a moment and let this fact stare him in the face, I should feel that my object in writing these letters had been attained. But history shows that all great reforms have been brought about gradually.

It would be visionary to even hope that the public will be suddenly impressed with the gravity of the situation in regard to the "Great White Plague."

Granting that the person who has tuberculosis of the lungs is daily coughing up enough germs to infect the whole community, we must allow that he may be a constant and ever-present source of danger to all of us.

And so he undoubtedly does owe something to the general public, to those other persons who are not infected with this death-dealing plant, and to those who will surely become infected if he and others afflicted as he is fail to do their duty to their neighbor.

It is well first to inquire what these duties are.

I should say that the primary one is to be sure that he has tuberculosis. Early diagnosis is of the first importance to the patient and to the public, for without this no one is in a position to either intelligently take care of his sputum or to employ the proper measure for his cure. And, yet, physicians are constantly brought in contact. with people who, strange as it may seem, do not want to know it if they have tuberculosis.

They will say: "Doctor, I am afraid my lungs are weak; but if I have anything the matter, I don't want you to tell me." Or else some well-meaning relative or friend will tell the doctor: "I am sure that it would never do, doctor, to let John know there is anything the matter with his lungs."

"If he has consumption you must not tell him so, because he would give up and die."

Such requests are all too frequent. Surely it needs no argument to prove they are entirely unwise. How is it possible for one with tuberculosis to intelligently co-operate in his treatment, and, more important still, to carry out the necessary precautions in regard to his sputa unless he knows in full his condition and the facts appertaining to it? I have no hesitation in making the assertion that in the light of present knowledge the physician who withholds from his patient the fact that he has pulmonary tuberculosis is negligent of his patient's interest and of his plain duty to the public.

Therefore you who read this, if you have any reason, the slightest to suspect that you have tuberculosis, you are doing yourself and your fellow men a great injustice if you do not at once set about determining whether or not such is the case.

For yourself, you are losing valuable time, for it is the early stages of the disease that are the most hopeful and