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mostly taken at railway stations, there were 7 which shewed the
presence of the bacillus of Tubercle. London cows are regularly
inspected for Tuberculosis by the London County Council and do
not show such a high percentage* It is to be hoped that the
same rigorous inspection may be enforced before long on country
cows, for thus only can the London milk supply be protected.
At present all that can be done is to urge the importance of boiling
all milk for young children, and scrupulous cleanliness in all
milk shops.
Special Inspection after Consumption.—During the year a
scheme of systematic investigation of each case of Phthisis
coming to our knowledge was instituted. This was carried
-out, with few exceptions, after notification, and always after
death. A full written report is made on each case. This comprises
the main facts about the patient's illness, his occupation, his places
of abode during the last 5 years, his family history as regards
Phthisis, the house he lives in as regards its sanitary conditions,
overcrowding, cleanliness, light, dampness, and ventilation, the
source of the milk supply, etc. Apart from the important facts
thus obtained the investigation, if carried out tactfully and wisely,
has undoubtedly a certain educational value to the patient himself.
He learns (a) that the disease is infectious, (b) that it is caused by
a germ present in the expectoration in enormous numbers, (c) that
when the expectoration dries on the pavement or floor the dust
disseminates the germ, (d) that such infective dust may convey the
disease, especially in dark, dirty, overcrowded dwellings, (e) and
that in addition to being carried in dry dust by the air the germ may
also be introduced into the body by milk from a tuberculous cow.
With these facts clearly in his mind the patient is able to see that
it is reasonable that the community should be protected as far as
possible by means of simple precautions, namely, that the consumptive
patient should not spit about on floors or pavements but into
small spittoons or cups containing disinfectant solution, that dry
* The Medical Officer of the London County Council, who has
kindly given me much information on this subject, states that on a recent inspection
of London cows (February, 1901) out of 4,317 six had tuberculosis of the
udder. These figures may be compared with those of Dr. Hope, of Liverpool,
who states that whilst six per cent, of the samples of City milk examined were
tuberculous, 14.7 per cent, of samples of Country milk examined showed the
presence of tubercle.