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by the air in the propagation of lung dis- virulence would be obtained which the ease :—Is the breath of persons suffering microscope could never furnish. The from phthisis charged, as assumed by dust, after being intimately mixed with a some, with bacilli ? or is it, as assumed suitable liquid, was injected into the abby others, free from the organism? The domen of the guinea-pig. For every samdrawing of the air through media able to ple of dust, two, three, four, or more aniintercept its floating particles, and the ex mals were employed. In numerous cases amination of the media afterward, might, the infected animal died a day or two at first sight, appear the most simple way after inoculation. Such rapid deaths, of answering this question. But to ex- however, were not due to the tubercle amine a thousand litres of air would re- bacillus, which, as already stated, is exquire a considerable time, and this is only tremely slow of development, but to orone-twelfth of the volume which a man ganisms which set up peritonitis and other breathing quietly expires every day. If fatal disorders. Usually, however, some the air were only sparingly charged with of the group of guinea-pigs escaped this bacilli, the amount necessary for a thor. quick mortality, and, to permit of the deough examination might prove overwhelm- velopment of the bacilli, they were allowed ing. Instead of the air, therefore, Cornet to live on thirty, forty, or fifty days. chose for examination the precipitate from The survivors were then killed and examthe air ; that is to say, the dust of the ined. In some cases the animals were sick-room, which must contain the bacilli found charged with tubercle bacilli, the in greater numbers than the air itself. virulence of the inoculated matter being
He chose for his field of operations seven thus established. In other cases the ordistinct hospitals (Krankenhäusern), three gans of the guinea-pigs were found heallunatic asylums (Irrenanstalten), fifty- thy, thus proving the harmlessness of the three private houses, and various other lo- dust. calities, including private asylums, lecture It inust here be borne in mind that the rooms, surgical wards, public buildings, bacilli mixed with Cornet's dust must have and the open street. The smallness of first floated in the air, and have been dethe bacilli has given currency to erroneous posited by it. Considering the number notions regarding their power of floating of persons who suffer from phthisis, and in the air. The bacilli are not only living the billions of bacilli expectorated by each bodies, but heavy bodies, which sink in of them, it would seem a fair à priori dewater and pus, and much more rapidly in duction that wherever people with their calm air. Cornet gathered his dust from normal proportion of consumptive subplaces inaccessible to the sputum issuing jects aggregate, the tubercle bacillus must directly from the coughing patient. He be present everywhere. Hence the docrubbed it off high-hung pictures, clock- trine of “ubiquity," enunciated and decases, the boards and rails at the back of fended by many writers on this question. the patient's bed, and also off the walls Common observation throws doubt upon behind it. The enormous care necessary the doctrine, while the experiments of in such experiments, and, indeed, in the Cornet are distinctly opposed to it. Testuse of instruments generally, has not yet, ed by the dust deposited on their furniI fear, been universally realized by medi- ture or rubbed from their walls, the wards cal men. With a care worthy of imita- of some hospitals were found entirely free tion, Cornet sterilized the instruments from bacilli, while others were found to with which his dust was collected, and be richly and fatally endowed with the also the vessels in which it was placed. organism. Cornet, it may be remarked,
The cultivation of the tubercle bacilli does not contend that his negative results directly from the dust proved impractica- possess demonstrative force. He is quite ble. Their extraordinary slowness of de- ready to admit that, where he failed to velopment enabled other organisms find them, bacilli may have escaped him, weeds of the pathogenic garden-which But he justly remarks that, until we have were always present, to overpower and discovered a bacterium magnet, capable practically stifle them. Cornet, there- of drawing every bacillus from its hidingfore, resorted to the infection of guinea- place, experiment must remain more or pigs with his dust. If tuberculosis fol- less open to this criticism. Cornet's oblowed from such inoculation, a proof of ject is a practical one. He has to cou.
sider the probability rather than the re which will show whether we are able to mote possibility, of infection. The pos- protect ourselves against tuberculosis, sibility, even in places where no bacilli whether we can impose limits on
the show themselves, may be admitted, while scourge, or whether, with hands tied, we the probability is denied. Such places, have to surrender ourselves to its maligCornet contends, are practically free from nant sway. If the tubercle bacilli are danger.
carried outward by the breath, then nothIn the differences as to iufectiousness ing remains for us but to wait till an inhere pointed out, we have an illustration fected puff of expired air conveys to us of wisely applied knowledge, care, and our doom. A kind of fatalism, somecontrol, as contrasted with negligence, or times dominant in relation to this ques. ignorance, on the part of hospital authori- tion, would thus have its justification. ties. And this may be a fitting place to There is no inhabited place without its refer to a most impressive example of proportion of phthisical subjects, who, if what can be accomplished, by resolute the foregoing supposition were correct, supervision, on the part of hospital doc- would be condemned to infect their neightors and nurses. A glance at the state of bors. Terrible in this case would be the things existing some years ago will enable doom of the sufferer, whom we should be us to realize more fully the ameliorations forced to avoid, as, in earlier ages, the of to-day. I once had occasion to ask plague-stricken were avoided. Terrible, Professor Klebs, of Prague, for his opin- moreover, to the invalid would be the ion of the antiseptic system of surgery. consciousness that with every discharge He replied, “You in England are not in from his lungs he was spreading death a position to appreciate the magnitude of among those around him. "Such a state the advance made by Lister. English of things,” says Cornet, “would soon surgeons were long ago led to recognize loosen the bonds of the family and of sothe connection between mortality and dirt, ciety.' Happily the facts of the case and they spared no pains in rendering are very different from those here set their wards as clean as it was possible to forth. make them. Wards thus purified showed “I would not,” says our author, go a mortality almost as low as other wards into this subject so fully, I would not in which the antiseptic system was em here repeat what is already known, were ployed. The condition of things in our I not convinced that, in regard to this hospitals is totally different ; and it is special point, the most erroneous notions only among us, on the Continent, that the are prevalent, not only among the general vast amelioration introduced by Lister can pub'ic, but even among highly cultivated be properly apprehended." I may say medical men. Misled by such notions, that Lister himself once described hospi- precautions are adopted which are simply tals in his own country which, in regard calculated to defeat the end in view. to uncleanness and consequent mortality, Thus it is that while one physician anxmight have vied with those on the Con- iously guards against the expired breath tinent. Klebs's letter was written many of the phthisical patient, another is careyears ago. Later on the authorities of ful to have his spittoon so covered up
that German hospitals bestirred themselves, no bacilli can escape into the air by evapwith the splendid result disclosed by Cor- oration. Neither of them makes
innet, that institutions which were formerly quiry about the really crucial pointthe chief breeding-grounds of pathogenic whether the patient has deposited all his organisms are now raised to a pitch of sputum in the spittoon, thus avoiding the salubrity surpassing that of the open possibility of the expectorated matter bestreet.
coming dry, and reduced afterward to a Cornet thus grapples with the grave powder capable of being inhaled. question which here occupies us. How, " While a positive phthisiophobia aphe asks, does the tubercle bacillus reach pears to have taken possession of some the lungs, and how is it transported minds, others ignore almost completely thence into the air ? Is it the sputum the possibility of infection. The fact alone that carries the organism, or do the that investigations have been published of bacilli mingle with the breath ? This is late, with the object of discovering tuberthe problem of problems, the answer to cle bacilli in the breath, sufficiently indi
cates that the conclusive researches of health resorts. He regards them as earlier investigators have not received the sources of danger, and he insists on the proper amount of attention.
necessity of disinfecting the rooms and " We must regard it,” says Cornet, effects after the death or removal of tuber
as firmly established that, under no cir- culous patients. He recomiends physicumstance, can the bacteria contained in cians, before sending patients abroad, or a liquid, or strewn upon a wet surface, to health resorts at home, to inform themescape by evaporation or be carried away selves, by strict inquiry, regarding the by currents of air. By an irrefragable precautions taken to avoid infectious disseries of experiments Nägeli has placed eases, tuberculosis among the number. this beyond doubt.”
The attention of those responsible for the The evidence that the sputum is the sanitary arrangements in the health resorts real source of tuberculous infection is of England may be invited to the followconclusive ; and here Cornet carnestly ing observation of Cornet :-“On a promdirects attention to the fact that in the enade, amid a hundred phthisical persons houses of the poor the patient commonly who are careful to expectorate into spitspits upon the floor, where the sputum toons, the visitor is far safer than among dries and is rubbed into infectious dust a hundred men, taken at random, and by the feet of persons passing over it. embracing only the usual proportion of The danger becomes greatest when the phthisical persons who spit upon the dry floor is swept by brush or broom. ground.” There is a still graver danger connected with the habits of well-to-do people who With regard to the permanence of the occupy clean and salubrious houses. This tubercle contagium, the following facts is the common practice of spitting into are illustrative. A woman, who had for pocket-handkerchiefs. Here the sputum two years suffered from a phthisical is soon dried by the warmth of the pock- cough, and who had been in the habit of et, the subsequent use of the handkerchief spitting first upon the ground, and aftercausing it to be rubbed into virulent dust. ward into a glass or a pocket-handker. This constitutes a danger of the highest chief, was visited by Cornet. During her consequence, both to the individual using life-time he proved the dust of her room the handkerchief and to persons in his to be infectious. Six weeks after her immediate neighborhood.
death he again visited the dwelling. RubIt is a primary doctrine with both Koch bing the dust from a square metre of the and Cornet that tuberculosis arises from wall on which he had formerly found bis infection by the tubercle bacillus. Pre- infectious matter, and which had not been disposition, or hereditary tendency, as a cleansed after the woman's death, he incause of phthisis, is rejected by both of oculated with it three of his guinea-pigs. them. Facts, however, are not wanting Examined forty days after the inoculation, which suggest the notion of predisposi- two of the three were found tuberculous. tion. Cornet once attended, in a hotel, Cornet reasons thus :"No doubt the an actress far advanced in phthisis. A dust which had thus proved its virulence guest, taking possession of her room after would have retained it for a longer time. her death, or removal, might undoubtedly Schill and Fischer, indeed, have proved become infected. The antecedents of the that, after six months' preservation, dried room being unknown, the case of such a sputum may retain its virulence. During guest would, in all probability, be referred this period, therefore, the possibility of to predisposition. It might be declared, infection by this dust is obviously open, with perfect sincerity, that for years he When, moreover, the quantity of infechad had no communication with phthisi- tious matter inhaled is very small, a concal persons. There is very little doubt siderable time elapses before the developthat numbers of cases of tuberculosis, ment of the bacilli renders the malady diswhich have been referred to predisposi- tinct. Even if a year should elapse after tion or inheritance, are to be really ac- the death of a phthisical patient before counted for by infection in some such ob- another member of the same household scure way.
shows symptoms of lung disease, we are Cornet draws attention to hotels and not entitled to assume a hereditary tenlodging-houses at, and on the way to, dency without further proof. Aware of
the facts above mentioned, we ought opportunity of infecting each other. The rather to ascribe the disease to infection infection, moreover, occurred among tailby the dwelling, not to mention its pos- ors, who are known to be special sufferers sible derivation from other sources. from phthisis.
On January 14th, 1888, Cornet visited The general belief some time ago, a patient who, for three-quarters of a which, to some extent, may hold its year, had suffered from tuberculosis of ground to the present hour, was that this the lung and larynx. The dust of the wasting malady arose froin some pecuroom occupied by this man was proved to liarity in the individual constitution, incontain virulent infective matter. A dependent of infection from without. brother of the patient who, at the time of Enormous mischief has been done through the examination of the dwelling, was al- exaggerated and incorrect notions regardleged to be in perfect health, exhibited ing the influence of predisposition and inphthisis of the larynx four months after- heritance. Members of the same family ward. “We are, surely,” says Cornet, were observed to fall victims to this “ warranted in ascribing this result, not to scourge, but each was regarded as an inheredity, or any other hypothetical cause, dependent source of the disease, to the exbut to the naked fact that the dust of this clusion of the thought that the one had dwelling contained tubercle bacilli which infected the other. Two or three days were capable of infecting the lungs and ago an old man here at Ilind Head told larynx of a man, as they did the perito- me that he had lost three children in sucneum of a guinea-pig."
cession through phthisis ; and he menOn the 31st December, 1887, Cornet tioned another case where five or six robust visited a man who for two years had suf- brothers had fallen, successively, victims fered from phthisis. He lived in the same to the same disease. “I am sure, room with two brothers who were very the man, with a flash of intelligence across robust, one of whom, however, had be- his usually unintelligent countenance, gun to cough, though without any further must be catching. Cornet describes evidence of serious disorder. The patient some cases which irresistibly suggest famhad been at home for eight days, while ily infection. In 1887 he visited a papreviously he had acted as foreman in a tient, the father of a fainily, who, six tailoring establishment. It was proved, years previously, had lost by consumption to a certainty, that this patient had taken a little girl fourteen years old. A year the place of a colleague who had died from and a half afterward a daughter of the phthisis of the throat, and who had been same man, twenty-one years old, fell a in the habit of expectorating copiously victim to the disease. One or two years upon the floor.
In the work-room, more later a robust son succumbed, while, a over, the present sufferer had occupied a fortnight before Cornet's visit, a child a place next to the man who died. Cornet year and a half old had been carried away. called upon the proprietor of the estab- Without doing violence to the evidence, lishment, who allowed him every oppor
as Cornet remarks, these cases may be tunity of examining the room, in which justly regarded as due to family infection. eight or ten workmen were engaged. For many years the father had suffered With dust rubbed from about two square from a phthisical cough, and directly or metres of the wall, near the spot where indirectly he, in all probability, infected the patient now works, Cornet infected his children. guinea-pigs and produced tuberculosis. In connection with this subject, I may He ridicules the notion of ascribing this be permitted to relate a sad experience of man's malady to any hereditary endow- my own. It is an easy excursion from ment or predisposition, derived, say, from my cottage in the Alps to the remarkable a phthisical mother, which, after sleeping promontory called “The Nessel,” on for twenty years, woke up to action at which stands a cluster of huts, occupied the precise time when he was surrounded by peasants during the summer months. by infective matter. Our author regards On visiting The Nessel three years ago, I this, and other similar cases which he ad. was requested to look into a hut occupied duces, as of special interest. The tuber- by a man suffering from a racking cough, culous virus was here found in rooms con- accompanied by copious expectoration. taining several workmen, who had thus an I did so. It was easy to see that the
poor fellow was the victim of advanced cases, been detected. It behooves those lung disease. In the same hut lived his who have arrived at an opposite result to daughter, who, when I first saw her, pre- repeat their experiments with the most sented the appearance of blooming health scrupulous care, so that no doubt should and vigor. Acquainted as I was with be suffered to rest upon a point of such Koch's discoveries, I remarked to a friend supreme importance. The lungs, air paswho accompanied me, that the girl lived sages, throat, and mouth all present wet in the midst of peril. We had here the surfaces, and it has been proved that even precise conditions notified by Cornet. with sputum rich in bacilli, over which a Spitting on the floor, drying of the spu- current of air of considerable force had tum, and the subsequent treading of the been driven, the air was found perfectly infectious matter into dust. Whenever free from the organism. the hut was swept, this dust mingled freely The immunity as regards infection with the air, and was of course inhaled. which to so great an extent is observed,
I warned the girl against the danger to is ascribed by Cornet in part to the inwhich she was exposed. But it is some. tensely viscous character of the sputum times difficult to make even cultivated when wet. Even after it has been subjectpeople comprehend the magnitude of this ed to a drying process its completo desicdanger, or take the necessary precautions. cation is opposed by its hygroscopic charA year afterward I visited the same hut. acter. Cornet calls other investigators to The father was standing in the midst of bear him witness that the task of reducthe room-a well-built man, nearly six ing well-dried sputum to a fine powder, feet high, and as straight as an arrow. even in a mortar, is by no means an easy He was wheezing heavily, being at inter- one. It is difficult to produce, in this vals bowed down by the violence of his way, a dust fine enough to remain suscough. On a stool in the same room sat pended in the air. It would be an error his daughter, who, a year previously, had to suppose that dry tuberculous phlegm, presented such a picture of Alpine strength when trodden upon in the streets, sends a and beauty. Her appearance shocked cloud of infected dust upward. Its hygrome. The light had gone out of her eyes, scopic qualities in great part prevent this. while the pallor of her face and her pant- When dried sputum is reduced to powder in ing breath showed only too plainly that a humid place, it attracts to itself moisture, she also had been grasped by the destroy- and collects into little balls. The streets
There are thousands at this moment in which phthisical persons expectorate are in England in the position which I then rendered innocuous by rain, or by the artioccupied—standing helpless in the pres- ficial watering common in towns. Cornet cnce of a calamity that might have been regards this watering as an enormous saniavoided. All that could be done was to tary advantage. No doubt when dry eassend the sufferers wine and such little deli- winds prevail for a sufficient time, infect cacies as I could command. Last summer tious dust will iningle with the air. DurI learned that both father and daughter ing easterly winds infectious diseases are were dead, the daughter having been the known to be particularly prevalent. Our first to succumb.
sufferings from influenza during the presIn opposition to those who considerent year have been connected in my mind that they have found bacilli in the breath with the long-continued easterly and of phthisical patients, Cornet adduces a north-easterly winds, which, sweeping number of very definite results. Patients over vast areas of dry land, brought with have been caused to breathe against plates them the contagion that produced the of glass coated with glycerine, which malady. Besides the difficulty encoun. would undoubtedly have held the bacilli tered before the sputum reaches the state fast. Water has been examined, through of very fine powder, other difficulties are which the air expired by phthisical lungs presented by the numberless angles and had been caused to pass.
In this case obstacles of the respiratory tract, and by the bacilli, being moist, would have been the integrity of the ciliary-epithelium, to infallibly intercepted by the water. The the more or less vigorous action of which aqueous vanor exhaled by consumptive is due the fact that amid thousands of oplungs has been carefully condensed by portunities we have only here and there a ice ; but no bacilli has, in any of these case of infection.