are given as believers in its contagion. This is enough to prove that it is not a doctrine of recent date, and, so far as the belief of the older writers, it seems that it was almost universally in the affirmative.

During the latter part of the eighteenth century in America and the northern part of Europe, Clapp, in the work above referred to, says "that a reaction against this almost universal belief set in;" and for a time the negative of the proposition seemed to have the greater number of supporters. While there was this change of opinion in the localities named, in southern Europe it never changed. During the last twenty years the belief in its contagiousness is again in the ascendency. The number of cases which have been noted which it seems impossible to account for except in admitting the infectious character of the disease is great.

In the Medical Bulletin for August, 1884, in an article by Dr. Webb, page 176, we find the following: "Not only among the members of our profession, but among all classes of people, the belief is prevalent, especially in Italy, Southern France, Spain, Portugal and Mexico. At the Canary Islands they look upon consumptives as little better than lepers, and they are kept in a species of quarantine, being subjected to many vexatious restrictions in regard to their intercourse with the indigenous population. This would serve to show that there must be some well grounded reason for such belief, and it ought not to be regarded as superstition."

From this short resumé of the opinions of the fathers in the profession, the belief seems to have been almost universal to within the last century. In many localities that opinion has never changed, and where it has, the preponderance of it is so great that the pendulum is swinging back to its original position. The difference of opinion as to its contagiousness has arisen from the fact that no attempt was made to demonstrate the cause until within a few years, and now, many who do not accept Koch's bacillus as the cause, do, from accumulated clinical facts, accept its contagiousness as the only way of rationally accounting for what is happening around us. A disease which has slain and is taking as its prey such a vast number year by year, must have some cause-it does not just so happen, or is a mere coincidence. We have no effect without an adequate cause-the day of mere speculation is fast giving way to scientific research. While there are many things in medieine which have as yet been unexplained, thanks to such men as Pasteur, Koch, Beale, and a vast array of patient, persevering inves

tigators, the filmy gauze of speculation is fast disappearing.

In Ziegler's Pathological Anatomy I find the following: that the granulative formations in "their developments usually stop short at the fibroblast stage, and having reached it, (or even before that) the constructive process gives place to retrogressive changes.' Virchow described the formation as granulative growths or granulomata; all these growths have furthermore the clinical character of infectiveness, hence they have been termed infective growths by Klebs and Cohnheim and specific inflammations by Rindfleisch." In the same article he uses the following: "to this group of infective granulomata belong the neoplastic formations found in tuberculosis, syphilis, leprosy, lupus, glanders and actinomycosis. All these affections are due to the invasion of the body by a virus or a poison derived from the outer world or from the body of another individual."

Green, in his pathology, says that "the transmissibility from person to person of syphilis and glanders is well known; experimentally tubercle can be transmitted, and the clinical evidence in favor of the communicability of this disease and leprosy is getting stronger." He thinks that the name adopted by Virchow "is better than any other to express the nature of the lesion-tumor-like bodies, consisting of granulation-tissue, and locally and generally infective.

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The number of cases is great which cannot be traced to hereditary taint, that some other means will have to be adopted to account for them. Dr. Walsh (Aitkin's Practice, vol. 2, page 788), has analysed and recorded the family history of one hundred and two phthisical patients admitted in the Brompton Hospital for Consumption. From these records, it appears that about twentysix per cent of phthisical subjects in a given generation come of a tuberculous parent.' On the other hand, while onefourth of the cases in accordance with Walsh's analysis may be traced to hereditary influence, the majority of the cases are non-hereditary. Dr. J. H. Bennet (Reynolds' System of Medicine, vol. 2nd, page 115) says, "instances are not uncommon in which members of the same family are observed to become affected one after the other with phthisis, on arriving at a certain age. This, however, may depend not so much upon weakness inherited from parents, as it does upon a vicious method of rearing the infants and children of certain families. In the clinical wards of the Royal Infirmary, among the six or eight cases then present, not one could be traced to hereditary

causes. Although, therefore, there can be no doubt that weakness in parents is a cause of weakness in the offspring, we are of opinion it is by no means so general or influential a source of phthisis as is usually supposed." Dr. Webb quotes the following from Sir Wm. Jenner: "That tuberculosis is transmitted from parent to child is one of the established facts in medicine." If such were the case,new born infants ought to show the tubercle. The same author quotes from Gluge, "that there is no born tubercle",and from Guizot, who, "in four hundred post-mortem examinations of the bodies of infants failed to find a single deposit of tubercle." The assertion of Dr. Jenner amounts to little, when compared to the autopsies of Guizot.

Green, Webb and others use the term predisposition to express the condition which must exist, before the exciting cause is productive. Green says that we have no knowledge of what constitutes this predisposition. It may be either acquired or inherited. Dr. Webb, in presenting this view, uses the simile of soil and seed. "The earth could not bring forth fruit without seed; the seed could not germinate and reproduce itself without the soil. The soil in order to be productive should be fertile and the seed should embody within itsef the elements of life. *** The body is the soil for disease producing germs;" and when it is in the condition of fallow ground, we have what a tuberculous parent may transmit to his or her offspring; but the seed is not transmitted in the dormant state, planted in that soil. In the cases where there is no inherited predisposition giving us a fertile soil, what may produce or generate it? According to Bennet, the "vicious rearing of infants and children of certain families," The different occupations, such as working in close rooms with particles of dust filling the air, the particles may be of an irritating character; the want of sun light, bad food, irregular and vicious habits, in fact anything and everything which does not give us healthy growth and repair. Mansfelde, in the Journal of the American Medical Association, March 27, 1886, uses the following language: "The worst of all breeding places for tuberculosis is the crowded workshop, il ventilated and overheated, and in which work is performed which produces dust full of irritating particles. The least offensive is a mountain home in an equable, dry and rather cool climate where you are your own neighbor and the only one." If we have the soil which undoubtedly we have in the predisposition and from the causes which we have enumerated and from many

others, where do we get the seed? In the acquired cases, the seed or germ cannot come from transmission, even if we should admit for the sake of argument that theory in all cases of hereditary predisposition; but will have to be accounted for in some other way.

Dessault believes in the contagiousness of this disease. Dr. Webb says that a statement almost prophetic, occurs in his writings upon tuberculosis, viz, "worms propagate the disease and cause its spread." Dr. Loomis, in his address before the American Medical Association in 1878, as the President of the Section on Practice, declares as follows: "there can be little question that there are certain atmospheric germs which, when drawn into the lungs on inhalation, act in a "chemico local" manner. They act not only upon the surface of the mucous membrane, but originate destructive processes in the lung parenchyma. Even when a phthisical constitutional tendency does not exist in an individ ual, particles of dust mixed with the inhaled air taken into the lungs will excite inflammation, by their continuous mechanical irritation. This inflammation is not limited in its effects to the mucous membrane and its epithelium, but, by penetrating deeper, produces destruction in the lung substance, and this excites processes which end in cicatrization and thickening, or a necrosis and ulceration, and finally develops a condition of phthisis. If this occurs in perfectly healthy individuals, we can readily understand how, under such influences, phthisis will more readily and certainly be developed in one with a constitutional phthisical tendency." Dr. Loomis was not a believer in the germ theory, as in the opening paragraphs of the same address he says; "this theory is a very seductive one, and, although investigations in order to estab lish it have been very extensively made, and the statements of some observers are strongly in its favor, yet facts do not warrant us in accepting it."

Dr. T. F. Rochester as chairman of the same section in 1879 in his address quotes Bancroft as follow: "That tubercular phthisis is communicable by the breath, and by the sputa, and by infection of apartments, and made more so by the insanitation of towns, hotels, and boarding houses caused by aggregation of diseased persons."

Insurance companies pay special attention to consumption. Dr. Webb in his article in the Journal of the American Medical Association, April 18, 1885, says, "that the Mutual Life of New York, not only refuses all risks in which there is a phthisical history, however remote; but will not regard an applica

tion in which there is the least predisposition to the disease. Notwithstanding this unusual amount of vigilance, they declare that consumption has been the cause of more deaths than any other disease, giving a percentage of nearly eighteen per cent of the total mortality. Dr. Holden, of the Mutual Benefit, of Newark, N. J., addressed circulars, in relation to the contagiousness of consumption, to leading physicians all over the United States, and received answers to two hundred and fifty; one hundred and twenty-six in the affirmative, seventy-four negative, fifty-four doubtful. I might go on with this kind of testimony, if time would permit until your patience would be exhausted, and not exhaust the material.

The bacillus tuberculosis of Koch as a cause has occupied the time and attention of investigators all over the civilized world. "Ransom has found the bacillus tuberculosis in the air of a room containing several advanced cases of phthisis." "Dr. R. Charnley Smith found them in a respirator worn by a phthisical patient." "Dr. C. T. Williams found them in fair abundance in the extracting flues of Brompton Hospital." "Dr. Webb found them in the air of places of public resort in Philadelphia. The microscopical examination in Dr. Webb's experiments was made by Drs. Shakespeare and Longstreth."

In the armies of the old world where large bodies of men are congregated, the mortality from phthisis is 30 great that it has become a matter of official investigation. Von Lauer, surgeon general of the Prussian army, has issued a circular to the medical officers, directing them not only "to isolate the phthisical from the nonphthisical,but urges special means to be taken for the disinfection of the sputa in tubercular cases."

The testimony of clinicians and general practitioners from cases which have been published is as strongly in favor of infectiousness of the disease as the above. I will refer to only one of this vast array. Dr. Reich, of Nueberg, a town of 1300 inhabitants, which had two midwives designated by the letters S and R. S was a consumptive, ten of the children she nursed died of tubercular meningitis within fourteen months, she died two months after the tenth babe of phthisis. In not one of the cases was there a hereditary predisposition. It was ascertained that S. was in the habit of sucking mucus from the mouth of infants, and caressing and kissing them. At the same time none of the children nursed by the other midwife were seized with the disease. Dr. Reich, in comparing the mortality from that disease, found that more had died of those which had been under the

care of the nurse S in fourteen months, than had died in the hands of all practitioners and nurses in twenty years.

The number of well authenticated cases, in which husband and wife have contracted the disease the one from the other, is too great to commence to enumerate. Again, the number of friends and relatives who were in robust health without any hereditary predisposition, after watching at the bedside for weeks or months have sickened and died needs do proof. The watching day and night is such a strain, particularly in houses poorly ventilated (and such is the case in the majority of our homes), that the vital forces are lowered, furnishing the fallow ground as a nidus for the disease germ to make its home under conditions favorable to its propagation.

Chronic catarrh, with the thickened mucosa covered with the discharge, which is always to a greater or less extent found, is a favorable nidus for the development of the disease should the specific germ, no matter what you call it, come in contact with it. The changeableness of our climate is such as to favor the development of catarrhal inflammation; vast numbers of the young, middle aged and old have it now, the extremes of life being more susceptible than the mean.

The amount of evidence of the infectiveness of consumption is so great that if there are none attending the schools who have hereditary predispositions to it, school boards ought to be cautious about employing any one as a teacher who was suspected to have this disease for fear of contaminating the well. Add to this that in almost every school room containing fifty or more scholars, one or more are likely to have the hereditary predisposition, and all that it requires is the fire in the shape of the disease germ to fan it into a flame. In addition to this you have the acquired predisposition in the catarrhal forms of disease which are so prevalent in our climate, with other irritant causes, which furnish a soil ready for the reception, development and spread to other organs of the body. If insurance companies find it necessary to use so much caution to protect themselves in a financial way from too great a drain on their treasury; if the effectiveness of the armies of the old world is so interfered with that improved sanitary conditions have to be adopted to protect the well by isolation and disinfection of the sputa, what should be done for the children in our schools? Should it be less than for the soldiers in the army? Every sanitary precaution should be used to protect, to use the language of Bermingham, "instead of this neglect, reason demands the greatest caution and the most excellent supervision."

Neglect of these sanitary precautions may cause distress; yea, even death; then it will be too late to put them into execution for the benefit of those now living.

It is no fancy stretch to say that one teacher within the bounds of this society has taught a school of small children for eight months, and during all that time was throwing off sputa of a tubercular character. Chills and

fever were of frequent occurrence. An assistant had frequently to be employed to take the place of the teacher during the school

term.

The room is heated by the Rutan system, taking the foul air out at the floor. If any

PLEDGES FROM CANDIDates.

The whole story is not yet told. The majority of the same board has reappointed the same teacher to the same position the ensuing year in opposition to the advice of the majority of the physicians of the place. Harsh language will not mend the wrong; a simple recital of the case is, or ought to be, enough to stimulate to study what is or what is not infective, and the duties and responsibilities

of school boards in such matters.

-On the occasion of the 200th anniversary ceremonies at Albany, the proceedings dragged in a manner to interfere with the prompt serving of the dinner proposed by Governor Hill, for the President and Cabinet. The delay made the governor fret.

"Keep cool, Governor," said President Cleveland. "Don't stew and fret over the unavoidable. The delay will only stimulate our appetites."

Ah, therein lies the true secret of the president's success in all that he undertakes. He allows nothing to ruffle or disturb him. "Keep cool; don't stew and fret over the unavoidable," is a magnificent philosophy which, if coupled with energy and brains, will accomplish almost anything. How we doctors need to learn a lesson in this philosophy!

The recent action of the State Board of Health of Missouri, in calling the attention of phsicians and medical societies in this state to the propriety and necessity of requiring all candidates for the office of Prosecuting Attorneyship to give pledges that they will, if elected, actively and impartially enforce the law to regulate the practice of medicine, is wise and timely, as one of the prime objects sought to be accomplished by the Legislature in enacting it was to protect the people, and incidentally the medical profession, against the predatory inroads of ignorant, unscrupu lous or dishonest members of the profession, who were driven out of other states where practice acts are vigorously enforced.

It is the desire and wish of the Board that this law shall be enforced until repealed, but without the general cooperation and support of the members of the profession and medical organizations, but little can be accomplished. The reputable physicians of Missouri, who are law abiding themselves, and who desire the enforcement of salutary laws, should see to it that this state does not become the rendezvous and safe harbor of all the disreputables who are driven from other states because of their ignorance or their criminalities. The action of the last Legislature in withholding funds for the support of the Board, was deemed wise and for the best interest of the public, all things considered at the time, but it is hoped that the members of the General Assembly to be elected this fall will see