The regular inspection of dairies, the scrutiny of the meat supply, the enforcement of the State regulations regarding workshops and factories where unhealthy occupations are carried on, the destruction of ill-lighted, badly ventilated, and imperfectly sewered tenements, and the erection of healthy houses for the poor and artisan classes have already materially reduced the mortality of this dread disease. A strictly regulated munici pal control of the milk supplied to city residents would go a great way towards stamping out the different forms of tuberculosis.
Therapeutic Measures.—Once the diagnosis of tubercle of the lungs was established in former years the physician approached the problem of treatment with a sense of therapeutic powerlessness. In recent years the fact has been so frequently demonstrated of various forms of localised tuberculosis showing a marked tendency towards spontaneous recovery that the treatment of phthisis in its early stage is now approached in a totally different spirit, with the result that numerous lives are saved which in former years would have been allowed to glide into a fatal ending. Yet it cannot be said that any new drug or new system of treatment is answerable for this improved state of matters if we except vaccine therapy, which is occasionally resorted to. The advance consists mainly in the tardy recognition of the value of MacCormac's method of preventing and treating phthisis by living in the pure open air day and night, together with a better appreciation of the value of sunlight, and a clearer knowledge of dietetics and of the laws of health.
As summed up by Cornet, " the present-day treatment of phthisis is essentially nothing more than a heightened hygiene of the body and mind." No single element in the cure, neither air, nor food, nor hydro therapy, nor medicine, affords any guarantee of success, this result being only obtainable by the satisfaction of all the physiological and hygienic demands of the human organism from the gravest to the least significant.
The condition of a patient detected in the first stage of phthisis should lead to a close scrutiny of his environment, habits, occupations, food, &c.
Clothing.—As a rule the amount of clothing worn by phthisical patients in this country is too abundant; they usually select heavy garments, and wear too many of them owing to the insane craze of the dread of draughts. The result is that even moderate exercise is followed by copious perspira tion which soon saturates the clothing, and after rest the clammy moisture induces a feeling of chilliness which drives them indoors to ill-ventilated and warmed rooms.
Thin woollen garments of open texture should be worn next the skin in summer; these should be replaced in winter by thicker ones of the same material, which should he frequently changed. In severe winters a perforated chamois vest may be worn outside a light merino under-shirt. The absorption of perspiration is thereby provided for, and it is decidedly better to guard against moderate extremes of temperature by suitable overclothing which can be readily put on or off as requirements demand than by heavy layers of under-garments which always keep the body surrounded by a layer of moist atmosphere. There is not the same
difficulty regarding foot-wear; the feet and legs should always be protected by thick-soled boots and woollen stockings in both summer and winter. Whilst outer wraps are essential when reclining in the open air or when driving or motoring, these should always be discarded in walking.
Oral Asepsis.—The condition of the mouth should he looked to, the teeth should be constantly cleansed, and the oral cavity kept in as aseptic a condition as possible. It is very remarkable how often numerous carious teeth are found present, and too often the physician considers it as not worth while to submit a phthisical patient to a radical dental operation, since he is already suffering from what is very likely to prove a fatal disease. In every case in its early stage all suppurating stumps and hollow caverns should be extracted; certainly life may be prolonged by this means in patients who have passed beyond the early stage.
In children the air-way should be explored, and in all suspected cases adenoids and diseased tonsils should be removed.
Breathing Exercises.—In association with the condition of the mouth, throat, and nose there arises a subject which has very rarely received the attention that its importance demands, and it is one which in the opinion of the writer is of really vital moment. In auscultating the chest as part of the routine examination in many diseased conditions the observant physician cannot fail to notice how seldom he meets with an individual who is capable of taking a full and deep inspiration even after allowing for the inhibitory nervousness associated with the unusual sensation of a medical examination. One is sometimes almost driven to the conclusion that such individuals have never in their lives flushed out their air cells properly unless involuntarily during some rare violent mechanical exercise. In many instances, therefore, the very first step to he taken in the thera peutics of an early phthisis is the education of the respiratory muscles, as without such instruction the patient will derive the minimum of benefit from any form of open-air treatment, just as he will experience the maxi mum of danger when living in an atmosphere containing a deficient proportion of oxygen. This important subject should also never be neglected in the preventive treatment of pulmonary tuberculosis; freeing the upper respiratory tract from nasal and pharyngeal obstruction is not sufficient; deep respiratory'exercises should be constantly insisted upon. Singing lessons under a teacher who thoroughly understands the mechan ism of breathing is often of far more vital importance than drugging.