suitably lodged in this way, a diminution of infection, and consequently of the sum total of tuberculosis, could not fail to be the result. Permit me to remind you in this connection of what I said about leprosy. In the combating of that disease also great progress has already been made by lodging only a fair number of the patients in hospitals. The only country that possesses a considerable number of special hospitals for tuberculous patients is England, and there can be no doubt that the diminution of tuberculosis in England, which is much greater than in any other country, is greatly due to this circumstance. I should point to the founding of special hospitals for consumptives and the better utilization of the already existing hospitals for the lodging of consumptives as the most important measure in the combating of tuberculosis, and its execution opens a wide field of activity to the State, to municipalities and to private benevolence. There are many people who possess great wealth, and would willingly give of their superfluity for the benefit of their poor and heavily afflicted fellow creatures, but do not know how to do this in a judicious manner. Here is an opportunity for them to render a real and lasting service by founding consumption hospitals or purchasing the right to have a certain. number of consumptive patients maintained in special wards of other hospitals free of expense.

As, however, unfortunately, the aid of the State, the municipalities and rich benefactors will probably not be forthcoming for a long time yet, we must for the present resort to other measures that may pave the way for the main measure just referred to, and serve as a supplement and temporary substitute for it.

NOTIFICATION.

Among such measures I regard obligatory notification as specially valuable. In the combating of all infectious diseases it has proved indispensable as a means of obtaining certain knowledge as to their state, especially their dissemination, their increase and decrease. In the conflict with tuberculosis also we cannot dispense with obligatory notification; we need it not only to inform ourselves as to the dissemination of this disease, but mainly in order to learn where help and instruction can be given, and especially where the disinfection which is so urgently necessary when consumptives die or change their residences has to be effected. Fortunately it is not at all necessary to notify all cases of tuberculosis, nor even all cases of consumption, but only those which, owing to the domestic conditions, are sources of danger to the people about them. Such

limited notification has already been introduced in various places in Norway, for instance, by a special law; in Saxony by a ministe-. rial decree; in New York and in several American towns, which have followed its example. In New York, where notification was optional at first, and was afterwards made obligatory, it has proved eminently useful. It has thus been proved that the evils which it used to be feared the introduction of notification for tuberculosi would bring about need not occur, and it is devoutly to be wished that the examples I have named may soon excite emulation everywhere.

DISINFECTION.

There is another measure, closely connected with notificationnamely, disinfection, which, as already mentioned, must be effected when consumptives die or change their residence, in order that those who next occupy the infected dwelling may be protected against infection. Moreover, not only the dwellings, but also the infected beds and clothes of patients, ought to be disinfected.

EDUCATION OF THE PUBLIC.

A further measure, already recognized on ail hands as effective, is the instructing of all classes of the people as to the infectiousness of tuberculosis, and the best way of protecting oneself. The fact that tuberculosis has considerably diminished in almost all civilized States of late is attributable solely to the circumstance that knowledge of the contagious character of tuberculosis has been more and more widely disseminated, and that caution in intercourse with consumptives has increased more and more in consequence. If better knowledge of the nature of tuberculosis has alone sufficed to prevent a large number of cases, this must serve us as a significant admonition to make the greatest possible use of this means, and to do more and more to bring it about, that everybody may know the dangers that threaten him in intercourse with consumptives. It is only to be desired that the instructions may be made shorter and more precise than they generally are, and that special emphasis be laid on the avoidance of the worst danger of infection, which is the use of bedrooms and small, ill-ventilated workrooms simultaneously with consumptives. Of course the instructions must include directions as to what consumptives have to do when they cough, and how they are to treat their sputum.

SANATORIA.

Another measure which has come into the foreground of late, and which at this moment plays to a certain extent a paramount

part in all efforts for the combating of tuberculosis, works in quite another direction. I mean the founding of sanatoria for consumptives.

That tuberculosis is curable in its early stages must be regarded as an undisputed fact. The idea of curing as many tuberculous patients as possible in order to reduce the number of those that reach the infectious stage of consumption, and thus to reduce the number of fresh cases, was therefore a very natural one. The only question is whether the number of persons cured in this way will be great enough to exercise an appreciable influence on the retrogression of tuberculosis. I will try to answer this question in the light of the figures at my disposal.

According to the business report of the German Central Committee for the Establishment of Sanatoria for the Cure of Consumptives, about 5,500 beds will be at the disposal of these institutions by the end of 1901, and then, if we assume that the average stay of each patient will be three months, it will be possible to treat at least 20,000 patients every year. From the reports hitherto issued as to the results that have been achieved in the establishments, we learn further that about 20 per cent. of the patients that have tubercle bacilli in their sputum, lose them by the treatment there. This is the only sure test of success, especially as regards prophylaxis. If we make this the basis of our estimates, we find that 4,000 consumptives will leave these establishments annually as cured. But according to the statistics ascertained by the German Imperial Office of Health, there are 226,000 persons in Germany over 15 years of age who are so far gone in consumption that hospital treatment is necessary for them. Compared with this great number of consumptives, the success of the establishments in question seems so small that a material influence on the retrogression of tuberculosis in general is not yet to be expected of them. But pray do not imagine that I wish, by this calculation of mine, to oppose the movement for the establishment of such sanatoria in any way. I only wish to warn against an overestimation of their importance which has recently been observable in various quarters, based apparently on the opinion that the war against tuberculosis can be waged by means of sanatoria alone, and that other measures are of subordinate value. In reality the contrary is the case. What is to be achieved by the general prophylaxis resulting from recognition of the danger of infection and the consequent greater caution. in intercourse with consumptives, is shown by a calculation of Cor net's regarding the decrease of mortality from tuberculosis in

Prussia in the years 1889 to 1897. Before 1899 the average was 31.4 per 10,000, whereas in the period named it sank to 21.8, which means that in that short space of time the number of deaths from tuberculosis was 184,000 less than was to be expected from the average of the preceding years. In New York, under the influence of the general sanitary measures directed in a simply exemplary manner by Biggs, the mortality from tuberculosis has diminished by more than 35 per cent. since 1886; and it must be remembered that both in Prussia and New York the progress indicated by these figures is due to the first beginnings of these measures. Considerably greater success is to be expected of their further development. Biggs hopes to have got so far in five years that in the city of New York alone the annual number of deaths from tuberculosis will be 3,000 less than formerly.

Now, I do indeed believe that it will be possible to render the sanatoria considerably more efficient. If strict care be taken that only patients be admitted for whom the treatment of those establishments is well adapted, and if the duration of the treatment be prolonged, it will certainly be possible to cure 50 per cent., and perhaps still more. But even then, and even if the number of the sanatoria be greatly increased, the total effect will always remain but moderate. The sanatoria will never render the other measures I have mentioned superfluous. If their number become great, however, and if they perform their functions properly, they may materially aid the strictly sanitary measures in the conflict with tuberculosis.

CONCLUSION.

If now, in conclusion, we glance back once more to what has been done hitherto for the combating of tuberculosis, and forward to what has still to be done, we are at liberty to declare with a certain satisfaction that very promising beginnings have already been made. Among these I reckon the consumption hospitals of England, the legal regulations regarding notification in Norway and Saxony, the organization created by Biggs in New York-the study and imitation of which I most urgently recommend to all municipal sanitary authorities-the sanatoria, and the instructior of the people. All that is necessary is to go on developing these beginnings, to test, and if possible to increase their influence on the diminution of tuberculosis, and wherever nothing has yet been done, to follow the examples set elsewhere.

If we allow ourselves to be continually guided in this enterpris

by the spirit of genuine preventive medical science, if we utilize the experience gained in conflict with other pestilences, and aim with clear recognition of the purpose and resolute avoidance of wrong roads, at striking the evil at its root, then the battle against tuberculosis, which has been so energetically begun, cannot fail to have a victorious issue.

MEASURES ADOPTED BY DIFFERENT NATIONS FOR

THE PREVENTION OF CONSUMPTION.

From "The London Times" of July 25th.

At the general meeting, held at St. James' Hall, July 24th, an address was delivered by PROFESSOR BROUARDEL, Dean of the Faculty of Medicine in Paris, on "The Measures Adopted by Different Nations for the Prevention of Consumption." The Right Hon. H. Chaplin, M. P., took the chair. Professor Brouardel read his paper in French.

He said that mortality from tuberculosis varied according to the country. In some cases it was accountable for a sixth, a fifth and sometimes a fourth of the total mortality. Havoc such as this made it compulsory that all nations and governments should strictly inquire into, and adopt, measures to arrest the propagation of a disease which, in these days, was the greatest enemy of the human race. The wonder was that the voice of alarm had been so long in making itself heard, and that for centuries our ancestors had looked impassively on the disasters going on around them. There were several reasons for this apparent indifference. The struggle was considered useless; the disease incurable; it was not known how it spread. Exaggerating the import of some observations, it was agreed that phthisis was hereditary. They were lulled to sleep by this formula, which served as a pillow for idleness and exempted them from investigating the origin of the mischief. Popular observations were looked on as old wives' tales-e. g., Morgagni's, who, in the seventeenth century, stated that in Italy