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efficient sanitary administration renders it possible to adopt
the consequential measures."
Granted that notification is carried out, this must be
supplemented by other measures if an attempt is to be made on
these lines to extinguish the disease. Disinfection of the
houses and rooms will have to be carried out at frequent
intervals, and instructions will have to be given to the patient
with regard to spitting, or any other practice which has been
supposed by the advocates of the frequency of personal
infection conducive to the spread of the disease. But these
instructions will not be of much avail unless we are in the
position to see that they are carried out, and how this is to be
done without the constant supervision of a sanitary inspector
or some one in authority I fail to see.
With the questions of notification and disinfection is
bound up that of isolation—in the case of phthisis, of course, by
means of sanatoria. Opinions apparently differ as to whether
early or late isolation is the more important. Hillier, in a
paper read before the Medical Officers' Society, in January,
1903, quotes Koch as emphasising the necessity for the provision
of an asylum for the late cases ; while from the point
of view of cure the early ones are more in need of attention.
But here it is difficult to say whether the disease has healed up
for the remainder of the patient's life, or whether the morbid
process has been merely checked and is lying dormant ready
to light up again when it is exposed to unhealthy conditions.
That in the great majority of cases this is what happens I do
not for one moment doubt.
"It is," said Koch, " the victim of consumption, who,
after, say, some months· in a general hospital (finding himself
rather worse than better) goes home to die, who is the most
terrible source of further infection. You speak of education
in the sanatoria, and for the early cases which recover this is
of the utmost practical value, but for the dying man in his
cottage home, how can it serve ? The last three or four weeks
of life are the most deadly in the spread of infection. The
man dies at last, but the education in him dies before him ; his
every cough, sneeze, or effort of speech sends forth a spray
laden with bacilli in virulent form, deadly to the poor wife and
children around him. It is not cruelty to isolate these cases ;
it is the truest and highest kindness. Let their days be made
as pleasant as ingenuity can make them. Let them in some