CONSUMPTION

phthisis or pulmonary tuberculosis, is a disease of the lungs duc to the attack of the tubercle bacillus discovered by Koch in 1882. The causes which enable the germ to succe fully invade the body are various; an inherited tendency, dusty trades, indoor work, overcrowded dwellings, alcoholic exce , insufficient food, rapid child-bearing and prolonged suckling are the chief causes, and generally two or more of these are at work; thus a dusty trade is generally combined with alcoholism and insufficient food with an over-crowded dwelling. The tendency to consumption is not inherited by all the members of a family nece arily; for instance there was a nurse at the Ser pe Hospital for nearly thirty years, who retired _— and who had lost all the Jyh members of her amily from consumption, though none of them had been om to infection as much as herself. The age most is youth, but all ages are susceptible, indeed many of our aged paupers with chronic coughs have consumption of a slowly progre ive kind. The mode of infection is nearly always by means of infected air or food; it is very rarely by direct transmi ion of the germ from mother to child during erent Consumptives infect the air around them only slightly by talking and coughing, but they infect it seriously if the expectoration is allowed to dry and float in the air as dust, hence spitting in train or tram cars is a public danger. The other chief source of infection is infected milk; cows suffer from tuberculosis of the udder, and their milk then contains the germ; such milk is unfit for human food unle pacong sly boiled. Koch has denied that infection can occur in this way, but the work of subuent observers both in his own country and in ours pt re to his being wares: The mode of onset varies, tho chief forms are:—(1) a cold on the chest which does not get well, (2) a gradual lo of energy with indigestion, anemia and some lo of weight, (3) the sudden expectoration of blood may be the first symptom, and (4) it may follow influenza or pleurisy, measles or whooping-cough. The symptoms are cough, manne nian sweats, and a nocturnal rise of temperature. The illne may last months or many years, and it may end in recovery if taken in time, but more often temporary improvement alternates with relapses over a series of years; the mode of death is usually from exhaustion, or is sudden owing to a fatal hemorrhage from the lungs. The prospect of any depends mainly on early treatment. The freatment should be preventive, and as one-tenth of the total death rate is due to phthisis public money will be well spent on prevention [See Perers}. Those with a aaa pty family history should feed well, take little alcohol, if any, and live much in the open air as well ohoreg in well ventilated bedrooms; their place of residence be such as to give the maximum of out-of-door life and their occupation also selected from the same point of View; it is noteworthy that sailors are prone to phthisis, so that the sea is not recommended as a calling. The treatment of consumption has made a great advance by the introduction of the open-air method combined with rest, abundant fatty food, no alcohol and no drugs. Tho fat, in England, is generally given as milk and butter, foar pints of the former and a quarter of a pound of the latter being SUES NEST S55 [s. 346]