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A scheme of systematic investigation of each case of Phthisis
coming to our knowledge has been carried out, with few
exceptions, after notification, and always after death.* A written
report is made on each rase. 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 condition, overcrowding, cleanliness,
light, dampness and ventilation, the source of 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 and other contaminated food. With these factsclearly
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
° This enquiry is not carried out, nor is disinfection, in any case where the
medical attendant advises us that it should not be done. In this way medical
practice is not interfered with, although, by the notification of the case, more
accurate records of the ravages of the disease are obtained.