A PLEA 
FOB THE 
PREVENTION OF TUBERCULOSIS. 
By GEO. M. KOBER, M.D., of Fort Bidwell, Cal. 
[Reprint from Proceedings of Second Annual Sanitary Convention, held under the 
auspices of the California State Board of Health, at San Jos6, April 16, 1894.] 
SACRAMENTO: 
STATE OFFICE, : : : A. J. JOHNSTON, SUPT. STATE PRINTING. 
1894. A PLEA FOR THE PREVENTION 0E TUBERCULOSIS. 
Geo. M. Kober, M.D., of Fort Bidwell, California. 
Consumption stands first upon the list of the principal causes of death; 
it caused 12,059 deaths in every 100,000 from all causes during the cen- 
sus year (Billings1). 
The report of our State Board of Health for the year ending June 30, 
1892, shows that this disease caused 2,304 deaths, or nearly one seventh 
of all the deaths in an estimated population of 1,250,000. 
Statistics of consumption include almost as a rule only those who die 
with lung manifestations, and little is said of the children and others 
who perish from tubercular meningitis, peritonitis, and other tubercular 
affections. 
Tuberculosis not only leads the list of diseases in order of frequency 
and mortality, but the loss entailed by the long duration of the disease, 
and the danger to others from infection, renders the subject of grave 
importance from an economic as well as a medical point of view. 
Whilst it is certainly true that the climate in various sections of this 
State exerts not only antagonistic, but also curative effects in this 
disease, we must remember that we have as yet a very sparsely settled 
State, and that certain regions in Europe, formerly exempt from the 
disease, have now become infected since intercourse with phthisical com- 
munities and subjects has been established. 
We have invited for years the victims of consumption to breathe our 
pure air. In doing so we have exposed others to the ravages of a com- 
municable disease, and it becomes our imperative duty to lessen the 
danger from infection, and failure to employ every known means of pre- 
vention can only be classed as criminal negligence, and I hail, therefore, 
with great satisfaction the resolution which declares “ consumption and 
its allied diseases as dangerous to the public health.” Whilst perhaps 
few medical men will be found to-day who do not believe that the disease 
arises either directly or indirectly from a preceding case, yet if we desire 
to influence legislation in matters of public health, our case should be 
stated on good evidence and in unmistakable terms. 
In view of the importance of the subject, I have collected the follow- 
ing data from reliable sources regarding the contagiousness of consump- 
tion: 
The classical researches of Koch2 have established, beyond a doubt, 
the infectious character of tuberculosis in animals and man, whether 
observed in local tubercular deposits or in acute miliary tuberculosis, 
and that the disease is everywhere caused by a specific microbe, the 
bacillus tuberculosis. 
This bacillus has been found in the system and in all tubercular 
deposits, and under a high power of the microscope may be seen to con- 
sist of small, usually curved rods, which readily undergo spore-forma- 
tion. A pure cultivation of these bacilli, when introduced into the body 
of a healthy animal, produces the disease in question. 4 
The tubercle bacilli have not yet been observed in the soil, water, or 
atmosphere. Cornet,* however, demonstrated their presence in the dust 
and on the walls of rooms inhabited by consumptives, and he, as well 
as Cadeac and Malet,4 successfully inoculated the germs thus found into 
healthy animals. 
Martin, quoted by Dr. Potter (N. Y. Medical Record, February 24, 
1894), in examining the dust of one of the most frequented streets of 
Leipzig, found the tubercle bacillus in about 80 per cent of the specimens. 
The bacilli have also been found in the milk of tuberculous mothers 
and cows, especially when the lacteal glands were the seat of the disease, 
or the system infected with general tuberculosis. This last remark also 
applies to the presence of the bacilli in the flesh of animals used for 
food; they have also been found in the blood, of those affected with acute 
miliary tuberculosis, but only in limited numbers. 
Villemin states that the contagious principle has also been found in 
the feces. 
According to Uffelmann,5 the tubercle bacillus is an obligate parasite 
which does not develop in the ordinary culture media, but is l>est propa- 
gated in blood serum, glycerine agar-agar, at a temperature of 99° to 
100°. If the temperature is below 50° or above 108°, they cease to grow. 
The resistance of this germ to external influences, especially to heat and 
cold, is very great. Sormani6 has show n that it requires from fifteen to 
twenty minutes’ exposure to steam under pressure, or the same length of 
boiling, to destroy the vitality of the spores. This same author has 
demonstrated that completely dried and pulverized sputum retains its 
infectious character for weeks and months; and Pietro7 asserts that 
tubercular matter will retain its virulence ten months after drying. 
Putrefaction, so destructive to many bacterial forms, exerts very little 
influence upon the tubercle bacilli. Sormani and Voelsch* claim that 
the vitality of the spores remained unimpaired for one hundred and 
eighty days in the putrefied sputum of consumptives. DeToma,9 how- 
ever, denies this, and found that putrefaction destroys the virulence of 
the germs after three to nine days. 
Dr. Ducor, at a meeting of the Academy of Medicine in Paris (Progres 
Medical, April, 1893), reported an epidemic of tuberculosis in a family 
which had occupied an apartment tenanted two years before by two 
phthisical patients. He examined pieces of wall paper from the rooms 
and found Koch’s bacillus. Guinea-pigs inoculated with cultures from 
this paper died of tul*erculosis. Cadeac and Bournay, in the Sem. Med., 
June 14, 1893, report experiments upon dogs and pigeons which were 
fed with meat infected with tuberculosis. Examination of their stools 
revealed the presence of the bacilli, which had lost none of their virulence. 
The experiments of Wesener and Falk also indicate that the bacilli 
resist the action of the normal gastric juice. 
The experiments of Koch, Weichselbaum," and others prove that 
artificial tuberculosis can be produced in animals by inhalation of a 
spray containing tul>ercle bacilli, by feeding animals with tul>ereulized 
food, or subjecting them to direct inoculation. Indeed, the chain of evi- 
dence is quite complete that tuberculosis is oaused by the multiplication 
of this specific micro-organism in the tissues of the animal body, and 
by no other means. 
In man the disease is most likely set in action by the bacilli intro- 
duced through the respiratory passages, or the digestive tract, and by 5 
the skin and mucous membranes, especially if there be a solution of con- 
tinuity; but, of course, the most frequent and dangerous mode of con- 
tracting the disease is the inhalation of the bacillus suspended in the 
inspired air. 
The evidence as to the transmissibility of bovine tuberculosis to man 
has been strengthened by Demme12, who reports four cases of intestinal 
tuberculosis in children, infected by the milk of a tuberculous cow, and 
adduces chemical and anatomical proof of his assertion. When we con- 
sider the large mortality of children under five years of age from pri- 
mary tubercular ulceration of the intestines, tubercular peritonitis, and 
tabes mesenterica, and the fact that the food of these children consists 
largely of unboiled milk, we are strongly tempted to believe in the 
transmission of bovine tuberculosis through the milk supply. 
Dr. D. E. Salmon, Chief of the Bureau of Animal Industry, in a paper 
read before the Pan-American Medical Congress, October 12, 1893, stated 
that he had no means of estimating the proportion of cases arising from 
infected food, but declared that tuberculosis is one of the most common 
diseases of milch-cows, and may affect 50, 75, or 100 per cent of the 
animals in large herds; the average proportion of cows affected in this 
country is unknown, but in dairies around our large cities from 3 to 5 
per cent have been affected, when the diagnosis was made by the ordi- 
nary methods of examination. Fortunately, the milk from all tubercu- 
lous cows does not contain the bacilli, but when there are tubercles in 
the udder, the milk contains immense numbers of these germs. The 
tuberculin test is proving of immense value in the diagnosis of bovine 
tuberculosis, and the New York State Board of Health is killing by the 
hundred animals condemned by diagnoses with tuberculin. A gentle- 
man writes to the New York “ Medical Record,” January 6, 1894, that 
his valuable herd of thoroughbred cows was twice examined by competent 
veterinarians, and pronounced healthy; a third examination with the 
aid of tuberculin caused a condemnation of over one half the herd, 
showing that it was impossible for the best veterinarian to discover 
tuberculosis by physical examination, except in extreme cases. New 
York, according to the “ Record,” evidently believes in this kind of 
diagnosis, and will probably have to pay -$500,000 to eradicate bovine 
tuberculosis. 
Rieck (Viertelyahrschrift fur gericht med. und offentl Sanibatswesen, 
1892, No. 4) reports the results of the examinations made at the Leipzig 
abattoir as regards tuberculosis during the years 1888 to 1891, both 
inclusive. During this time 67,077 cattle were slaughtered, of which 
20.4 per cent were found to be tubercular. 
The following illustrations of different modes of infection have been 
reported, viz.: 
Lowenthal12 reports the case of a woman who slept on the right side 
of a tuberculous husband, and contracted a conjunctivitis of the left 
upper eyelid, followed by enlargement and ulceration of the glands in 
the parotid and submaxillary region. Excision of the original deposit 
revealed the presence of tubercle bacilli. 
Cornil and Moore14 have shown that infection may take place through 
the genital mucosa, and an interesting article on chronic tubercular 
endometritis, referring to primary genital tuberculosis and sexual rela- 
tions with tuberculous husbands, will be found in the “New York 
Medical Record,” November 30, 1889. 6 
Lehmann11 reports ten cases in which the virus was transmitted by 
the mouth of a tuberculous Rabbi, who was in the habit of applying 
suction to the wound after circumcision. In these cases at the end of 
the second week ulcerations writh a gray base were noticed at the point of 
infection; four of the children died shortly from tubercular meningitis; 
three others after a more prolonged illness; one died from diphtheria, 
and two recovered. 
Eisenberg18 reports a similar case, in which the sputum of the Rabbi 
was found to contain the bacilli. Tehernig, Pfeiffer, and Duering have 
reported instances of infection through the skin, in one case by means 
of expectorated phthisical blood, which infected a slight hand wound 
of a girl. Landouzy and Martin17 have shown that inoculation of the 
spermatic fluid from tuberculous guinea-pigs produced the disease in one 
third of the animals experimented upon. This would seem to render the 
transmission of the disease through the sperma probable, but Gartner 
(Zeitschrift fiir Hygiene und Infections Krunkheiten, 1893, XIII, 101) 
believes the direct transmission of the disease to come solely from the 
mother, for he found it impossible in his ex|)eriments on mice, canaries, 
and rabbits to obtain infected offspring when the mother was healthy, 
even though the semen of the father was teeming with tul>ercle bacilli. 
Under these circumstances, the disease was frequently transmitted to 
the generative organs of the mother, but never to the foetus resulting 
from the contact. 
Uffelmann believes that the secondary lesions of the alimentary tract 
may be produced by the patient’s swallowing a portion of the expectora- 
tion. The most common source of infection of this tract, by means of 
unboiled milk and insufficiently cooked meat from animals affected with 
tuberculosis, has already been referred to. There is no evidence to show 
that the bacilli are transmitted in vaccination; in fact, Acker failed to 
discover the microbes in question in the lymph visicles of vaccinated 
phthisical subjects. 
There is much reason for believing that the germs of the disease may 
be conveyed in clothing. I remember a well-authenticated instance 
where a perfectly healthy man bought the clothing worn by a consump- 
tive, and contracted the disease within six months, and died from the 
effects two years thereafter. Perlen,1* in his dissertation on pulmonary 
tuberculosis and occupation, tells us that of 4,177 tuberculous patients 
treated in the Munich Poliklinic, 709 were engaged in tailoring, cleans- 
ing, and shoe shops. Whilst these figures are suggestive, it is of course 
impossible to estimate the number of instances in which the disease was 
spread by dried sputum contained in clothing. 
As in other infectious diseases, the question as to whether the germs 
are introduced direct, and in sufficient numbers, is of importance. 
The observations of Humphrey, Pollock, and Leudet, conclusively 
show that in well-ventilated wards of chest and consumption hospitals, 
the disease is not usually found to spread. 
In private practice the results are different in this resj>ect. A French 
committee of investigation presents 213 cases of tuberculosis in which 
the communicability of the disease was clearly established. In 64 of 
these cases the disease was conveyed from husband to wife; in 43 from 
the wife to the husband; in 38 it was transmitted to brothers or sisters; 
in 19 from parents to the children; in 16 to distant relatives; and in 32 
to outsiders. The communicability was most marked among the poorer 7 
classes. Another collective investigation of a German medical society 
revealed the fact that of 938 married persons who died of acquired 
tuberculosis, in 101 instances either the husband or wife also contracted 
the disease. In 8.1 per cent of these cases the husband contracted the 
disease from his wife, and in 13.2 per cent the wife was infected from the 
husband. Other statistics might be adduced in favor of the communi- 
cability of the disease, but Zasetzky’s18 observation is of special interest. 
He reports the case of a tuberculous woman who married between 1872 
and 1883 three husbands, all previously healthy; the first husband died 
in 1879 of tuberculosis, the second in 1881, and the third husband, at 
the time of the report in 1884, was also a victim of the disease, the wife 
having in the meantime died of consumption. 
We can only explain the greater contagiousness in such cases by a 
more intimate contact, the occupation of the same room and bed, com- 
mon use of eating and drinking utensils, and the vitiated air of private 
rooms. It is very possible that the bacilli may acquire more virulent 
infective powers in the foul atmosphere of overcrowded rooms, and, as 
suggested by Dr. Ransome, the sporulation of the bacilli may be assisted 
by contact with the kind of organic matter found in such atmospheres. 
Since Cadeac and Malet4 have proved that the bacilli are not con- 
tained in the breath of tuberculous patients, we must conclude that 
when found in the air of rooms occupied by phthisical patients, they 
originate from the dried sputum and other dejections on floors, walls, 
carpets, bedding, and clothing, which are converted into dust particles, 
and thus gain access into the air and the respiratory tract. The virus 
may also be conveyed to others, by small particles of sputum, in kissing, 
coughing, instrumental manipulations, or adhering to utensils in com- 
mon use. 
From what has been said and written on the subject, it is evident that 
the tubercle bacilli must be widely scattered; the modes of invasion are 
also numerous, and the wonder is that, relatively, only a few of those 
exposed to the virus actually contract the disease. This shows that 
invasion of these microbes is not sufficient to produce the disease, but 
that they must also find a susceptible subject for their proliferation and 
pathogenic effects, and hence 'predisposition in this as in other infectious 
diseases plays an important role. 
Clinical experience indicates that faulty nutrition, bad air, lack of 
sunlight, debility, anaemia, mental anxiety, diabetes, whooping-cough, 
measles, and other diseases favor the development of tuberculosis. 
The observations of Dr. Bowditch, of Boston, and Buchanan, of 
England, positively indicate that damp soils and habitations are pre- 
disposing causes to tuberculosis, and whilst this relation has not been 
satisfactorily explained, still it is possible that the bacilli of tuberculosis 
luxuriate best in such an atmosphere, as damp rooms are much more 
likely to contain an excess of organic matter. Another explanation 
may be found in the well-established fact that a damp air predisposes 
to catarrhal affections, or “colds,” and these in turn may render the 
system more susceptible to the invasion of the tubercle bacilli. We also 
know that a predisposition may be inherited, as evidenced by a delicate 
physique, narrow chest, and general vulnerability of the tissues. 
A vulnerability of the tissues to the disease may also be acquired by 
dust-producing occupations, and here the origin of the dust seems less 
important than the character of the particles which compose it. For 8 
this reason, no doubt, the hard, sharp, and angular particles of iron and 
stone dust are more liable to produce lesions of the respiratory mucosa. 
In no other way can we explain the comparative innocuity of coal dust, 
the particles of which are quite free from sharp points and corners. Dr. 
Ogle has shown in his report—in forty-fifth annual report of the Regis- 
trar-General—that coal miners stand at the head of the list as regards 
freedom from phthisis and other lung diseases in dust-inhaling occupa- 
tions, and that the tin miners of Cornish, who inhale a sharp, angular, 
and most irritant stone dust, furnish the largest number of cases. In 
Switzerland (Lagneau) Medical Record, March 7, 1894, 10 out of 100 
stone-cutters die from phthisis, and in England 340 out of 1,000 deaths 
occurring among these workers were from consumption. We know, of 
course, that occupations involving the inhalation of an unusual amount 
of dust tend to produce diseases of the lungs, not necessarily tubercular, 
but what I wish to emphasize is, that certain dust particles are apt to 
cause lesions of the respiratory mucosa, and hence an increased suscep- 
tibility to the invasion of the tubercle bacilli. 
It is also well known, that indoor, sedentary, and intellectual occupa- 
tions predispose to the development of the disease. Of 1,000 deaths in 
Italy among students and seminarians, 459 died of phthisis. In Eng- 
land, of a like number of deaths in printers, 430 died of phthisis. 
Raseris’ Italian Statistics show that college men and scientists generally 
furnish the greatest number, and sailors and tramps, the least number 
of victims to consumption. This indicates the value of out-door life; 
indeed, statistics conclusively show that it is quite exceptional for this 
disease to be the cause of death of those who live in the open air. In 
Switzerland, of 1,000 deaths occurring in out-door laborers and farmers, 
not more than one or two die from phthisis, and in a similar number of 
deaths in Italy among shepherds and farmers, only 44 to 54 died from 
this disease. Lagneau also tells us that the sanitary statistics from 662 
towns in France show that the more the population is crowded, so 
in proportion are the inhabitants gravely affected with tuberculosis. 
Thanks to the climate of our State, we are permitted to enjoy practically 
an out-door life all the year around, and it is doubtless this, together 
with the fact that in many sections of the State, the average temperature 
is just suited for the performance of the physiological functions with 
the least possible strain upon any particular organ, which determine the 
remedial properties of our air. Such climatic virtues cannot fail to pro- 
mote health and bodily vigor, and, therefore, a natural antagonism to 
disease. 
Does climate afford immunity from tuberculosis? The evidence is not 
sufficient to show that any community in any climate is entirely free 
from pulmonary consumption, but we do know that whilst the mortality 
on the plains and in the valleys of Europe is about 3 per 1,000, and as 
high as 5 to 7 per 1,000 living in cities and towns, the inhabitants of 
certain mountainous districts, even under unfavorable sanitary sur- 
roundings, suffer to a far less extent—the mortality amounting in some 
localities at an elevation of 1,500 feet, to only 0.56 and 0.68 per 1,000. 
Fuchs, quoted by Uffelmann, gives the following elevations as likely 
to afford immunity from consumption: 
In the north temperate zones, at an elevation of 1,300-3,000 feet. 
In the middle temperate zones, at an elevation of 2,000-5,000 feet 
In the tropical zones, at an elevation of 7,000-14,000 feet. 9 
Bell, in speaking of our own country, refers favorably to the eastern 
highlands, the Alleghany region of Georgia, the Carolinas, Tennessee, 
Virginia, West Virginia, Pennsylvania, and the White Mountains, 
especially the pine forest region of the Atlantic States, from Virginia 
southerly, at an altitude of from 500 to 1,500 feet, and also the Pacific 
Coast, as notable regions for the small ratio of deaths from pulmonary 
diseases. In 1886 I called attention to the climate of Northern California 
and the infrequency of pneumonia and phthisis among the inhabitants 
of Modoc County, suggesting, in my concluding observations, that the 
great daily range of temperature, dry atmosphere, and elevation (4,700 
feet), might be fatal to the development of the tubercle bacillus. (See 
Ninth Biennial Report of the State Board of Health, 1886.) 
We have seen that the elevation affording immunity differs greatly in 
different zones; therefore, exemption cannot be attributed to the influ- 
ence of diminished atmospheric pressure alone, although we must admit 
that diminished density of the air induces deeper inspirations, more 
effectual inflation and ventilation of the air vesicles, which naturally 
tend to increase the resistance of the pulmonary tissues to the invasion of 
the germs. It is possible that freedom from organic impurities in the air 
is the most important factor. Pasteur, Tyndall, and others have shown 
that the air of great altitudes is entirely free from organic impurities; 
and Miquel, Frankland, Petri, and others have examined the air for 
bacteria at different altitudes, and found the air at an elevation of 
between 6,000 and 7,000 feet to be quite free from germs. 
Similar investigations have been made of the air of sea coasts and the 
high seas. 
Uffelmann found between fifty to three hundred bacteria in one cubic 
meter of air on the Baltic coast, in the summer of 1887, and Moreau, 
Miquel, and Fisher ascertained that the sea air one hundred and twenty 
miles off the coast is absolutely free from bacteria. These facts throw a 
flood of light on Bowdin’s statistics, which show that whilst the deaths 
from consumption in the English army were 10.7 per 1,000, the mor- 
tality in the navy was only 1.76 in 1,000 men. 
PREVENTION OF TUBERCULOSIS.20 
The facts presented in the foregoing pages justify the conclusion: 
1. That tuberculosis is an infectious disease caused by a microbe, 
transmissible to healthy individuals under certain favorable conditions. 
2. Inherited and acquired predisposition plays an important role in 
the invasion and multiplication of the bacilli. 
3. The germs may enter the system by the respiratory and alimentary 
passages, and by the skin and mucous membranes, if there be an abra- 
sion. 
4. That whilst the bacillus has been transmitted through the milk, 
flesh, and blood of animals and man, the most common and effective 
way of distributing the disease is by the dried and pulverized sputum of 
tuberculous patients. Heller calculates that seven thousand two hun- 
dred million of bacilli may be expectorated in a day by a single patient. 
5. The habitations of consumptives, as well as their personal effects, 
unless immediate disinfection has been practiced, are infected houses 
and objects, and liable to convey the disease to subsequent occupants. The indications for the prevention of this disease are: 
1. Notice by householders and physicians to the health authorities as 
soon as the disease is recognized. 
2. The sputum of consumptives should he received in spitcups con- 
taining a 5-per cent solution of carbolic acid, and the contents rendered 
innocuous by boiling for twenty minutes. The paper and wood boxes 
made for this purpose should be burned. All public and private build- 
ings should be provided with spittoons. Patients wdio continue out of 
doors should use handkerchiefs to receive their expectoration, which, if 
old, should be burned; at all events, linen, bedding, or clothing thus 
soiled should not be allowed to dry, but must t>e thoroughly disinfected, 
boiled, or steamed, and laws should be enacted against spitting into 
places w’here the sputum is liable to infect others. 
3. Disinfection of all houses in which tul>erculosis has occurred should 
l>e made compulsory also the disinfection of hotel rooms, sleeping car 
and steamer berths which have been occupied by consumptives. 
4. All objects which have come in contact with consumptives should 
not be given away, sold, or used by others until disinfected by steam 
under pressure, boiling, fumigation, or a coating with lime or corrosive 
sublimate solution. 
5. Isolation of tuberculous patients is indicated in hospitals, asylums, 
and prisons. In private life the patient ought to occupy a separate 
room and bed, use separate eating and cooking utensils, and neither 
receive nor give kisses, and the family physician should encourage the 
treatment of such cases in special hospitals. 
6. Government inspection of dairies and slaughter-houses, and the 
extermination of bovine tuberculosis are urgently called for. In the 
absence of such laws, and as an additional precaution, cows’ milk should 
be thoroughly boiled and meats well cooked. 
7. A tuberculous mother should not nurse her infant, and great care 
must be taken in the selection of a wet nurse. Marriages with a tul>er- 
culous person should not only be discouraged, but absolutely prohibited 
by law. 
8. Predisposed subjects should take special precautions; this is par- 
ticularly true of those born of tuberculous parents, or l>elonging to con- 
sumptive families; those debilitated by privations or excesses, and those 
suffering or recovering from whooping-cough, measles, smallpox, diabetes, 
and catarrhal affections. Clinical experience teaches that it is quite 
possible to overcome this predisposition by improving the tone and 
general nutrition of the system. Apart from medication, careful and 
methodical gymnastics, attention to the skin, and other hygienic rules 
w ill prove of special value. Let us insist on the purity of the air in our 
houses and towns, and guard against dark, damp, and unsanitary 
habitations. 
9. The establishment of sanitary boarding-schools in salubrious locali- 
ties for children predisposed to tuberculosis, in which special attention 
is paid to their physical culture, appears earnestly called for, and in 
choosing a subsequent vocation for them, it is important to avoid occu- 
pations involving sedentary habits and indoor work, especially in a 
dusty atmosphere. 
10. Last, but not least, the public should be educated that this fatal 
malady is a communicable disease, how it may be acquired and pre- 
vented, and this duty devolves not only upon the medical profession, but 
also upon the press, state, school, and church. Mr. President, and members of the Sanitary Convention, I am well 
aware that much mental distress will be engendered by the enforcement 
of the rules just formulated. But the very fact that 15 per cent of the 
community are victims of this fatal disease, would more than justify 
such enlightened legislation as even the prohibition of marriages with 
a tuberculous person. There is entirely too much sentiment on the sub- 
ject of individual rights. The annals of medicine teach us, that men 
and women afflicted with a communicable disease are dangerous to 
society, and it is the duty of the State to take what precautions it can 
to prevent mischief. 
Legislators have a right to look to our medical societies and health 
departments for intelligent advice on matters affecting public health, 
and if a medical body recommends means for the prevention or spread 
of communicable diseases, they should be accepted in a practical sense 
and embodied in effective laws. 
Whilst a conservative spirit should ever animate our profession, we 
should also possess the courage of our convictions; and yet, there are 
men eminent in our ranks, whilst not hesitating for a moment to .urge 
the most heroic measures for the prevention of cholera, yellow fever, and 
smallpox, absolutely oppose the enforcement of efficient means for pre- 
venting the dissemination of consumption, universally admitted to be 
the most fatal of all communicable diseases. For my own part I fail 
to see the difference upon which such distinctions are based. Whilst 
cholera, yellow fever, and smallpox strike terror into a community, be- 
cause these diseases occur in epidemics and are rapidly fatal, we know 
that consumption demands more victims than all these diseases com- 
bined. 
The question of marriage not only involves the prevention of tubercu- 
losis, but other communicable diseases, and no one knows better than 
the members of the medical profession what an excess of pain and sor- 
row, what an ocean of tears and blood might have been prevented, if 
exemption from communicable diseases in candidates for marriage were 
as mandatory as the question of age and race for the procurement of a 
license. I believe few men and women will be found unwilling to 
undergo an examination by their family physician for the detection of 
infectious diseases, the existence of which not only affects the welfare of 
a husband or wife, but also their offspring and the community at large, 
and all those who are so devoid of a feeling of responsibility as to will- 
ingly and knowingly inflict a fatal malady upon others, certainly deserve 
little consideration at the hands of society. 
I sincerely hope that this convention will take a progressive step in a 
question which has occupied and cannot fail to agitate the minds of 
earnest men and women, and whilst we may meet with opposition, we 
know our cause to be just, and can confidently rely upon the intelligence 
and good intentions of the American people, that the cause of humanity 
will ultimately triumph. 
1 Billings, J. S. Cartwright Lectures, N. Y. Med. Record; December 14, 1889. 
2 Koch, It. Mittheil: aus dem k Gesundsheitsamte, II. 
3 Cornet. Zeitschr. f. Hygiene, V, 191. 
4 Cadeac & Malet. Rev. de Medicine; 1887, No. 7. 
5 Uffelmann, J. Handbuch der Hygiene, p. 580; 1890. 
6Sormani, quoted by Uffelmann. 
7 Pietro, quoted by California Health Board; November, 1889. 
8 Voelsch, in Ziegler’s Beitragen zur pathol. anatomie, II, 2. 12 
9 De Toma. Centralblatt f. d. med. Wissen, 1888. 
10 Falk. Virchow’s archiv, 93. 
11 Weichselbaum. Zeitschr. der Wiener arzte, 1883. 2 Heft. 
11 Demme. Jahresbericht des Jennerschen Kinderspitals. Bern, 1882. 
1S Lowenthal. Impftuberculose der Conjunctiva, 1887. 
u Moore. Pacific Record; November 15, 1888. 
15 Lehmann. Deutsche Med. Wochenschr.; 1886; Nos. 9 and 10. 
16 Eisenberg. Berlin klin Wochenschr.: 1886; No. 35. 
17 Landouzy & Martin, in Verneuil Etudes exper. et cliniques. Paris, 1887. 
18Zasetzky. Wrutsch; 1884. 
19Perlen. Lungenschwindsucht und Leruf. Miinchen, 1887. 
"American Jour, of Med. Sciences; January, 1890; pp. 78-79.