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The limit which divides the dangerous from the harmless dose differs with every individual, and also
with various circumstances at the time of infection, but on the whole there appears to be no doubt that
large doses (massive infections) are decidedly more dangerous than small ones. "Very large doses
are deadly and overcome the most resistant, while very small doses are harmless even to the most susceptible."
The importance of these observations in relation to the contagiousness of tuberculosis, especially
the pulmonary form, becomes obvious when we remember that it :s those living in constant and close
proximity to the " open case of pulmonary tuberculosis " who are daily inhaling or ingesting large dosee
of the tacilli and similarly it is the milk from a cow with a tuberculous udder rather than the mixed milk
of a herd which conveys the infection in massive doses to the susceptible child.
This may be stated in another form. If everybody is exposed to the risk of serious infection, and
for the purpose of this argument whether exposed, more or less, matters not at all, it follows that it would
be of little use to attempt the segregation of open cases of tuberculosis or the destruction of cows with
tuberculous udders. Reliance would have to be placed instead on all measures calculated to increase
personal resistance. On the other hand, if the question of the size of the " infecting dose " is a matter of
considerable importance there is much more to be hoped from the segregation of open cases of tuberculosis
and the extermination of tuberculous cows.
Hitherto the principal measures relied upon for fighting the disease are the following :—
(1) The improvement in the social conditions of the people—i.e., housing, occupational
environment, food supphes, etc.
(2) (a) The segregation of advanced cases in institutions.
(b) The Education of patients, as to the nature of the infection and the precautions
to be adopted by them for reducing the risks to others.
(3) The eradication of bovine tuberculosis.
Within recent years the further measures adopted for combating Tuberculosis include the
following:—
(1) Compulsory Notification.
(2) Sanatoria and Hospitals.
(3) Tuberculosis Dispensaries.
(4) Open.Air Schools.
Still more recently it has become increasingly common to speak of " Complete Tuberculosis
Schemes " and although no authori'ative statement has, so far as I am aware, been made in this country
in explanation of exactly what is meant by such a scheme, it may be of interest to the Committee to
refer to the Report of the Special Committee appointed, at the meeting of the League of Red Cross
Societies at Cannes in April, 1919, to draw up a comprehensive scheme for combating tuberculosis
Complete Tuberculosis Scheme suggested at a Meeting of League of Red Cross Societies at. Cannes,
April, 1919,
Recognising the wide prevalence of tuberculosis, its incidence at all ages, and Its great importance
as a cause of excessive mortality, disability and economic loss, we recommend that special attention be
given to the fight against this disease in the plan of an organisation having in view common action on the
part of Red Cross Societies.
(1) We believe that in an organised campaign against tuberculosis the following factors are
fundamental and ind'spensable:
(1) Dispensaries on an adequate scale, furnished with laboratories and appropriate equipment
and affording provision for early diagnosis, including the examination of " contacts " by
expert physicians, and with especially trained visiting nurses, who will carry into the homes of
patients the necessary care, assistance, Instruction and advice, who will especially consider the
needs of children, and who will direct the patient to approplate agencies for this purpose.
(2) Provisi n for the careful, regular inspection of schoolchildren with a view to the early
detection of tuberculosis.
(3) Hospital treatment, on an adequate scale, of acute, advanced and hopeless cases of
tuberculosis, separated from other cases not infected with tuberculosis.
(4) Sanatorium facilities for all suitable cases of tuberculosis.
(5) Continuous popular education regarding tuberculosis, its causes and prevention, by all
suitable means and agencies.
(2) It is evident that tuberculosis is inextricably associated with the general living and working
conditions of the people, and we therefore recommend the encouragement of legitimate efforts directed
towards the improvement of these conditions. We regard as of particular importance in this connection
the care of children and the problems of housing, nutrition and alcoholism.
(3) We recommend the institution of appropriate measures to prevent the transmission of tuber
culosis through infected milk.
(4) We approve the establishment of open.air schools for the accommodation of children already
affected by, or suspected of, tuberculosis, and measures should be taken to protect children against
contagion in the household by placing them with healthy families in the country or in special asylums,
when it is'not practicable to remove the infected patient from his family.
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