When we consider the numbers of patients suffering from phthisis and of mulch cattle affected with tubercle, it must he conceded. notwith standing the protests of Cornet, that in these latitudes the bacillus is ubiquitous. After all has been said. the most important consideration resolves itself into the question of do.),ixe. Small quantities of bacilli are continually being admitted into the human organism by various channels (mainly, if not exclusively. by the intestinal route). and the natural defensive mechanism of the body is equal to cope with these, but when a large close gains admission the phagocytes are overcome and tuberculosis supervenes. Even when a dose has been admitted which under ordinary healthful conditions is innocuous, this may prove potent should the defensive mechanism he deficient or lowered in some region of the body, as, for example, when bones have been previously injured, or exposed glands like the testicles have been the seat of even slight trauma, or the pleura has been previously affected by a simple inflammatory process.
Hence in the prevention of tuberculosis the overwhelming evidence of the importance of guarding the comparatively unprotected intestinal mucosa should he realised. and should command the attention of the
physician and of every officer of public health. The debatable question of the unity of the human and bovine tubercle bacillus has a red herring across the track. hut in a work dedicated entirely to therapeutics there is no space left for discussion of a purely pathological problem. The reader will find this problem in its hearing upon treatment fully dealt with in the author's Cavendish Lecture (T9ols). already referred to: suffice it to say that the issues at stake afford in either case no justification for relaxing the prophylactic measures already mentioned.
The methods so successful in the treatment of every form of tuber culosis, as open-air and over-feeding. are also powerful prophylactic agents, and it is due to MacCormac to remember that he insisted upon an unlimited supply of pure fresh air day and night. together with the freest amounts of nourishing food. as preventives against pulmonary phthisis, and tuberculosis of bones and of lymphatic glands.
Whilst the treatment, medical and surgical. of the different phases of tuberculosis will be found under the headings of each. there remains for consideration the management of the following: