When people change their residence, they should always con sider the possibility that the previous tenant may have had tubercu losis, and clean or disinfect accordingly. These precautions are recom mended for summer resorts and watering places. Such objects as retain the dust, e.g., carpets, upholstered furniture, should he exposed to the sun before they are used, or better still, they should be entirely dis pensed with in children's rooms. Frequent sunning and ventilation will help to exterminate any tubercle bacilli that may be present. Creeping children should not be permitted to wander about, but should be confined to a small enclosed part of the room which has been covered with a clean sheet.
From earliest infancy we ought to combat the mischievous habit children have of putting everything into their mouths and of sucking their fingers. Nipples or "pacifiers" are a cause of many diseases, including tuberculosis, as we can readily understand when we see them taken from the dirty floor and put into the child's mouth. Another habit that should not be tolerated is the tasting of the milk by the mother or by the nurse, either by putting the nipple or the spoon into her mouth before giving it to the child.
Children should be kept away from people who cough. They should be taught cleanly habits, such as washing their hands before eating, for the nails are a favorite site for the deposit of dirt and bacteria.
Although human beings are by far the most frequent source of contagion, tuberculosis of cattle must be taken into consideration.
It is a disgrace to be compelled to admit that a large proportion of our milch cows have tuberculosis, and that their products. milk, cream, butter, meat, etc., are not without danger. We should there fore give infants only such milk in the raw state as comes from carefully inspected cows (frequently repeated tuberculin tests). Prophylaxis against tuberculosis without guarding against. the evils of tuberculous cattle is a vain endeavor.
We should also take care that the milk of healthy cattle is not contaminated, an occurrence which is by no means rare. Therefore no one suffering from tuberculosis should be allowed to handle the milk at any stage.
Recently Behring has introduced a vaccine which promises to ac complish the immunization of cattle against tuberculosis. For man, however, no such means has been discovered.
2. Special Prophylaxis for Children Predisposed to T ubereidosis.— Every tuberculous individual who marries and has a family assumes a great responsibility. No person whose tuberculosis is not positively healed should be encouraged to marry. A child born of tuberculous parents, especially if the mother is affected, should be taken away from its parents immediately if we wish to provide for its future wel fare. However, this radical measure will never be complied with unless the mother is in an advanced stage of tuberculosis. The most we can accomplish is to give the mother warning and advice.
How shall we nourish the child? Where the social conditions are good in every particidar, I recommend the employment of a good wet-nurse. However, such instances are the exception and generally the child must be fed with cow's milk. Only when the mother's tuber culosis is incipient can we risk an attempt at maternal nursing.
From the standpoint of the tuberculous mother, it is far more injurious for her to become pregnant again after a short interval than it is for her to nurse.
It is very true that occasionally tubercle bacilli have been found in the milk of tuberculous women. However they are few in num ber and play an unimportant part when compared to the many cases of infection of the child by the tuberculous mother in the crowded quarters of the poor. This is especially true where the mother prepares the infant's milk.
If the tuberculous parent be the father, then the child should surely be nursed by the mother. Theoretically the father should be separated from the child but in practice this is rarely feasible. It is principally among the poor that our good advice is difficult to follow. When the father is in the advanced stages of the disease and thus unable to support the family, the mother is compelled to become the bread-winner. The father in his turn attends to the household and to the children, and becomes a dangerous source of infection.
Children who have been subjected to tuberculosis must be reared with especial care. Every catarrh of the upper respiratory passages must be given particular attention, and infectious diseases such as measles and whooping-cough must be carefully guarded against. Men tal and physical strain should be avoided. Nourishment and physical development are very important. some conditions, climatic measures exert a good prophylactic influence. In the summer such children should be sent to the sea-shore for a period of at least six or eight weeks. Such outing should be repeated and in some cases pro longed for months or even years. Mountain air is likewise beneficial. Tonics are also of value, especially arsenic when prescribed in the form of some natural mineral water. Iron may be used, preference being given to non-alcoholic preparations. At times a "Alastkur" or forced feeding, may be of benefit..
Finally we must repeat that a successful campaign against tuber culosis can be waged only if we prevent infection during childhood. For it is during this period of life in the great majority of cases that the infection takes place, although the disease may not become manifest until later in life.
yet we know of no specific treatment. We hope for the best from Behring's latest investigations, especially his "tulase." Koch's tuberculin has a curative effect in some cases, but it is not widely applicable, and is valueless in generalized tuberculosis. In spite of these therapeutic deficiencies we must not be pessimistic, for tuberculosis is in certain stages a curable disease.