that are
given in this book show in how many ways these rules of action are now
being universalized. Three or four important steps deserve especial
comment:

1. Compulsory notification of all tuberculous cases.

2. Compulsory removal to hospital of those not able at home to
destroy the bacilli, or compulsory supervision of home care.

3. Examination of all members of a family where one member is
discovered to be tuberculous.

4. Special provision for tuberculous teachers.

5. Protection of children about to enter industry but predisposed
to tuberculosis.

6. Prohibition of dry cleaning of schools, offices, and streets.

7. Tax provision for educational and preventive work.

Compulsory notification was introduced first in New York City by
Hermann M. Biggs, M.D., chief medical officer: 1893, partially
voluntary, partially compulsory; 1897, compulsory for all. Physicians
who now hail Dr. Biggs as a statesman called him persecutor, autocrat,
and violator of personal freedom fifteen years ago. Foreign sanitarians
vied with American colleagues in upbraiding him for his exaggeration of
the transmissibility of consumption and for his injustice to its
victims. As late as 1899 one British expert particularly resented the
rejection of tuberculous immigrants at Ellis Island, and said to me,
"Perhaps if you should open a man's mouth and pour in tubercle bacilli
he might get phthisis, but compulsory notification is preposterous." In
1906 the International Congress on Tuberculosis met in Paris and
congratulated New York upon its leadership in securing at health
headquarters a list of the known disease centers within its borders; in
1906 more than twenty thousand individual cases were reported, ten
thousand of these being reported more than once. To know the nature and
location of twenty thousand germ factories is a long step toward
judging their strength and their probable product. To compulsory
notification in New York City is largely due the educational movements
of the last decade against the white plague, more particularly the
growing ability among physicians to recognize and to treat conditions
predisposing to the disease. As in New York City, the public should
provide free of cost bacteriological analysis of sputum to learn
positively whether tuberculosis is present. Simpler still is the
tuberculin test of the eyes, with which experiments are now being made
on a large scale in New York City, and wh