3Rtttjftfetbtcat 2O Urual

APRIL J, 19I31 SPREAD OF TUBERCULOSIS BY DUST. [MEDI''L JOU AT 605 _~~~~~~~~~~~~~~~~~~~~~~~~~~ cubic feet of air space. The bedclothes are changedl every we6k. Examiining the sputum of 24 of tlle patients, Chausse found from i,ooo to I6o,ooo tubercle, bacilli in i liig. of the moist expectoration, tlhe 3rtttJft fetbtcat 2o urual, average beinig 6o,ooo. He kept a cage containing tlhirteen guinea-pigs for five weeks in the m-iddle of one of these wards; not one of the animals contracted tuberculosis, although the cage was close by SATURDAY, APRJLL 3RD, 1915. the bed of a patient who couglhed " enlorm-lously," and brought up a sputum containing I 25,000 tubercle bacilli per milligram. In other experiments Chlauss6' kept cages containing from I4 to I9 guinea-pigs for TIHE SPREAI) OF TUBERCU1OSIS weeks by the side of patients with advanced plhtlhisis BY DUST. in smaller separation wvards with onlv two beds in THE idea that tuberculosis couild be conveyed by the eaclh ward. Here the opportunities for infection inhalation of tuberculous dust -or the pulverized appear to have been greater than they were in sputuin of tuberculous patients must be tlhousands the large wvards. In an experimeint carried out during of the summer, when doors and windows were years old. It was definitely formulated by the freely French opened, i guinea-pig out of Villemin in i868, and was proved 14 contracted tubercu- plhysician beyond losis. A similar experimiient at mid winter, when the thle possibility of doubt by Koch's great series of over doors wei-e kept shut and the windows two hundred inhalation experiments with pure almost entirely closed at niight, resulted in the infection of Io out cultures of the bacillus which he had isolated in the of early eighties. i6 guinea-pigs. Two otlher experiments carried out About five-anid-twenty years ago during the cold weather gave similar results. In Corniet claimed to have proved that it was the dust al1, containing ptulverized tuberculous sputum from the out of 76 guinea-pigs exposed for four or fiv-e weeks inimnediate of plhthisical patients to infection 30 became infketed, and the pathological nieiglhbourlhood that lesions found in them post mortem were always those was the main infecting agent conceried in the spread of an inlhalation tuberculosis. of and years Examiniing eighteen tuberculosis, for the next ten this view specimuens of dust collected in the smaller obtained very general acceptance. But in I 899 wards, Fliigge brought forward argumenits to show that Chauss6 founnd that seven of them (or 38 per cent.) contained virulent tubercle bacilli. But the presence plithisical patients were infectious to others by means of the minute droplets of tuberculous sputum they of the patienlts rendered the sojournl of the allimals in dis- these wards far miiore danigerous to them than did the charge on coughing, ratlher than by the dried sputum in the form of dust tlhev leave them. dust alone. An experiment was conltrived and carried behind Their out for ten weeks, in wlichl the twvo coucghincg, sneezing, and even speaking were alleged to phthisical patients the inhabited one separation ward by day, another by load surrounding air with tuberculous sputum, and night. One cage of I9 (lirectly to endanger all persons wlho came near guinea-pigs kept comipany them witlh the patients day and night for five weeks, durinig the performiance of these acts. Fliigge wrote wlhile another cage i8 of the withi all the autlhority of an containing animals was eminent German bacterio- kept constanitly for ten weeks in the ward left logist; and his tlheory of tuberculous infection by just by the patients. Of the I9 guinea-pigs I5 becamle verspr.itzte Tdipfcheni, or sprayed droplets, is videly believed at the present tuberculous, but of the i8 only 2 were infected. timne. Quite recently, how-. The imnmediate source of to ever, the question has been submitted once more to a danger lies, according Chausse, not in the phthisical patient's coughing so careful experimental re-examination by Chauss6l of much as in his handkerchief. He describes Paris, and, as has so often been the case on experi- previous ments showing that tuberculous sputum dried on a occasions in scientific mlatters, the conclusions of handkerchief preserves some of its virulence an(d thie -French mnan of science flatly contradict those obtained by the Germani. vitality for at least ten davs. The patient's bed- clotlhes and person he believes to be much less Chauss6 brings forward reasons and experimental dangerous sources of infection to to prove that in tuberculosis infection is others, although, as w,.ork exclu- he admits, it wvould be hard to demonstrate this fact sively, or almost exclusively, effected by dry particles. by experiment. He quotes further experiments to Indoors, tubercle bacilli possess sufficient Vitality to show that the dust met with in survive drying; on the other hand, phthisical public places, ancl patients even in so apparentlv infectious a as a third- do not often scatter tuberculous spray, and, when spot class smoking compartment in a French train, only they do, the spray is in the form'i of comparatively rarely in actual practice contains virulent tubercle large drops that fall to the ground close by and bacilli. cannot be inhaled by other persons. He finds that, The general coniclusions to wlhich even when guinea-pigs are made to inlhale the Cliausse comes are of considerable practical importance. The spread air expelled by the phthisical patient in coughing, of tuberculosis must be controlled they- not become by limiting the do infected with tuberculosis. dangers of infection by inhalation to which those taving access to the wards of the H6pital Boucicaut whlo Paris, are brought into contact with phthisical patients itn where Professor Letulle's plhtlhisical indoors are exposed. He discards Fliigge's droplet patients are treated, Cliauss manade numerous experi- hypothesis altogether, zand states that it is only dust -ients to determinie in the first place hlow great the contaminated recently with tubercle baciili that is dangger of living with phtlhisical patients is, and, in seconcd, whlat is the origin of that danger. The dangerous. Until it has clried uLp, tuberculous sputuim t1he is practically harmless because it cannot get into the -hospital is of modern constructioni, well lit, -well air in the form of dust; and after it has been driedl veiitilated ; the tiled floors of the two phthisical and exposed to the light for a few days, the tubercle Iivards, whiclh look attractiye if a little crowded in bacilli it contains lose- their virulence even if a photograph reproduced, are washed down daily. they still survive. He attributes an altogether secondary Each of the 32 patients in eaclh ward has about 1,140 importance to any hereditary tecndency to tuber- I Anntales cle lIuistitut Pasteur, Paris, 1914. xxviii. culosis. TTHE ] 6o6 MEDIC fLBRITTESJOURNAL WORK AS IV iND CURE. [APRIL 3, 19!5 rather wvide generalizations of Drs. Whliite and Fran-z WORK AS MIND CURE. appear to be founded-nor in the cautious conclusions M\H1AT appears to be a lopeful line of 'research, and of the two experitnenters, to show lhow lcng tiem one likely to be followed in time by practical results, newly acquired hiabits and adaptations persist after is outlinecl in Bulletin No. 5 of the Government the cessation of instruction. Even if, however, the Hospital for the Insane at Washington.' In hardly gained adaptations and good habits prove an interesting introcluctory paper Dr. William A. temporary arid entirely- incommen-surate witlh tle Wlhite, the' Medical Superintendent, describes the trouble and expense involved so far as the great origin at his asylumt of the scientific investiga- majority of patients are concerne(d, it cannot be tion of occupation in the treatment of the in- doubted that a clearer insight will be gained into the sane. He became imbued with the belief that much mechanisms and procaesses by wlhicil recovery takes of the deterioration of the inmates of large asylums place in the minority, and the possibility and manner was the re-sult of the environment in whichi thev were of assisting these processes made plainer. Tihere may forced to exist, that is to say, that much of the even be possibilities of adjustment lying fallow in a, deterioration was not an inevitable declension deter- considerable proportion of the permanently invalid mined by internal factors, but was due to th-e patients wvhich will repay a more scientific and discriminating taking their colouring Irom their surroundings--in cultivation than las heretofore been attempted. fact, adjusting themiselves to their environment. The studly of wcrk as a therapeutic agent has been He therefore secured the services of a psychologist carried on at Wasbiingtom. Asylum by griaduiate stu- for tile sole purpose of studying tlle problem of dents of universities under the Scientific Director for hlabit formation. The work done, thoughi confined only tlhree years-a time quite insufflicienit to give to very few patients, wvas extremely suggestive, conclusive results. Nevertheless, Dr. White and his I)r. White says, and very hopeful in its results. colleagues have done well even at -this stage in pub- It was quite remarkable," he tells us, " how patients lisliing a bulletin devoted to this problem, as interest who had been considered absolutely inaccessil)le could in arnd }elpful criticism of a miiovement which be awakened to interest, anid how patients who had seems likely to grow in importance will thuls be been considered almost imipossible to care for because stimulated. of noisy, destructive tendencies, could lhave their discharge of nervous energy drafted into more useful channels." THE DETERMINATION OF SEX.

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