Treatment of Chronic Tuberculosis of the There is no known specific for the disease. Koch's tuberculin is used by the minority of physicians and by them only in selected cases. There are at 'present more than 25 different tuberculins (emulsions and sera) on the market, and almost every discoverer claims his is the only one beneficial. The most that can be said with certainty in regard to the treatment with any of them is that in ex pert hands in small doses they do no harm. In the hands of inexperience their employment is fraught with danger. Whether tuberculin is used or not, the most careful hygienic regime must be instituted. The disease progresses on account of a lack of resistance in the patient; the object, therefore, is to increase the resisting power. This is accomplished by rest, fresh air and good nourishment. If the disease is active, that is associated with fever, rapid pulse or rapid emaciation, or other serious symptoms, rest in bed is necessary. The patient should remain in bed until the temperature is below 99.6, the pulse below 100, serious symptoms in abeyance and gain in weight is evident. An early favorable case usually requires from two to six weeks rest in bed; advanced cases cor respondingly longer. Even when ready to be up all day he should lead a regular life, retiring at a proper hour (before 10 P.M. if an Adult), in order to get sufficient rest. He should have nine hours' sleep, must sleep alone and, when possible, in a room alone. The best situation for the room is on the southwest corner of the house. The windows of the sleeping-room should be kept wide open, no matter what the weather. In summer all the windows in the room, and in winter, when the air diffuses much more readily, one window at least, should be wide open. The idea is to make every inhala tion one of fresh air. During the day the patient must spend as much time as possible out of doors, yet in summer he must not be in the sun. When the weather is cold he should be comfortably wrapped. It is better to multiply the coverings which are readily removed than underclothes. Patients suspecting lung trouble frequently come to the physician wearing a chest protector, two or even three undershirts and other clothes. This is not only unnecessary, but probably harmful. The regulation clothes of the kind most comfortable to the patient meet all requirements. • Diet.— Nourishment is most important. If a patient is run down, and he usually it is absolutely necessary to build him up. This can be accomplished only by a proper amount of food. Some physicians of repute in tuberculosis advise a general mixed diet with the addition of two to four pints of milk daily. Some push the nourishment; others, like Bushnell, insist that it should not be forced. In regard to nutritive value foodstuffs stand in the following order : Milk, eggs, meat, vegetables, cereals. Contrary to popular opinion potatoes never made anyone fat. An ordinary good diet would be: Breakfast, 7:30 A.M., fruit, two boiled eggs, and butter and two glasses of milk; lunch, 9:45 A.m., one glass of milk; dinner, 12:30 P.m., soup, meat (preferably rare roast beef or beefsteak), three kinds of vegetables and a simple dessert, like ice cream or rice pud ding; lunch, 3:30 P.M., one glass of milk; sup per, 6 P.M., meat or eggs, potatoes or other vegetable, bread and butter and two glasses of milk. The diet found most generally suitable to the great majority of patients at the Sana torium for Consumptives at White Haven, Pa., is as follows : Breakfast, 7:30 A.M., one and one-half pints of milk, with two raw eggs (the eggs may be broken up in the milk or taken whole) and fruit; lunch, 10 A.M., one pint of milk and one raw egg; dinner, 12:30 P.M., soup, meat, three or four kinds of vegetables and pudding or ice cream; lunch, 3:30 P.M., one pint of milk and one raw egg; supper, 6 P.M., one and one-half pints of milk, two raw eggs and fruit; lunch, 8 P.M. (just before retiring), one-half to one pint of milk. Alcohol (whisky, brandy, wine, etc.), which was at one time much lauded, especially by the laity, is now avoided by experts.
Climate.— Up to recently considerable de pendence was placed on climate. Patients who could afford it were advised to betake them selves to the Southwest, and not infrequently those who could not afford it were told to Meat their way.) It is still generally believed that a dry climate is more suitable for the cure of the majority of patients; yet no matter what the climate, the patient must carry out the fore going or a similar line of treatment. It is to be remembered that tuberculosis is a disease of all climes and altitudes; that cases develop in Colorado and New Mexico as well as in Can ada, and that cases have been and are being cured in all parts of the world. Some writers, among them many eminent in the specialty of tuberculosis, absolutely deny any influence to climate. This, however, may 'be affirmed with certainty: that if the removal to another cli mate entails, or is likely to entail, the least hard ship or privation, it is better for the patient to remain at home. Moreover, if the patient is
sent away he must be referred to another physician, or to a sanatorium, where he will have a physician's care. To send him away to meet his difficulties and emergencies by him self is an acknowledgment on the part of the physician that he does not know how to treat tuberculosis. Tuberculosis is, at least, as seri ous a disease as typhoid fever and requires analogous attention to detail. To send a tuber culous patient to a farmhouse or hotel in the country away from medical supervision is simi lar to instructing the family of a typhoid patient in the regime to be followed without returning to learn if the directions are carried out properly, or if new complications have taken place. In addition, in the hotel or board ing-house the patient is afraid to follow the regime too strictly, fearing that others will recognize his complaint, and he will be asked to leave. Moreover, to send a patient to a farm house where his disease is known has no fur ther advantage. In this case the people have usually had tuberculous patients previously and have some ideas relative to the disease. These ideas are frequently wrong, yet wishing the patient well, they endeavor to instruct him. Any sick individual is more or less at the mercy of the well people about him; if they insist on certain things he has not the will-power to resist. He is, therefore, being treated by lay people not a physician.
Sanatoriums.— New sanatoriums for the treatment of tuberculosis are springing up al most every month. They are opening their doors as a result of private enterprise or bene faction or of a municipal crusade against the disease. They serve a three-fold purpose: (1) they gather in consumptives from large centres of population, and so prevent them from acting as a focus of contagion; (2) they instruct the patient how to take care of himself so that he is not a menace to others even when he returns home; (3) they demand a discipline which, if followed out, will in a favorable case cure. As a rule patients do better in sanatoriums than at home. There are a number of satisfactory sanatoriums throughout the United States, es pecially in the Northeast and Southwest quadrants.
Prevention in Cases of Chronic Tuber culosis of the Lungs.— The contagion is con tained in the matter given off from a tuber culous sore. Therefore, in a case of tubercu losis of the lungs it is only necessary to destroy the sputum to prevent contagion to others. The patient should expectorate only into receptacles where the sputum can be properly handled with out coming in contact with other things. He should never expectorate into rags or hand kerchiefs, but should limit himself to spit-cup and paper napkins. The spit-cup should be made of paper so that it may be burned, or if of china should contain an antiseptic or ger micide. Ordinary lye will suffice. The cup should be boiled daily. When coughing, the patient should hold a paper napkin before his mouth. There should be no question of any one sleeping with the patient. Children are especially susceptible; hence, when the parents are tuberculous, extra care must be exercised. The sick room should be uncarpeted, have no curtains or hangings and contain only the bed, a table, washstand and the necessary two or three chairs. Window shades are permissible. The room should be as open to the sunlight as possible in order to keep up constant disin fection. The patient, however, should not be in the sun. The eating utensils (knives, forks, spoons, cups, saucers, plates and glasses) should be separate and should be boiled after use. Food of any kind left over should be burned; it must not be given to others, or even to the domestic animals, the cow, dog, pig or cat. The patient's soiled clothes should be handled as little as possible. When a change of clothes, sheets, pillow-cases, wearing apparel takes place, the soiled pieces should be rolled up in a clean sheet and boiled without unrolling. They may then be washed in the usual manner. If the patient is walking about the house, every room that he occupies should be as open as possible. He should not be allowed to make the dining room or the kitchen his living-room. Nobody should leave the patient's room without washing the hands immediately. Children should not be allowed in the sick-room. If the patient dies, the bed and furniture should be taken outside and washed. Bureau drawers should be scrubbed. The mattress should be sent to a steam-cleaning establishment, or at least the stains on it washed with soap and water. Fol lowing this the mattress and furniture should be exposed to the sunlight for at least three or four days. The floor and woodwork of the room should be scrubbed and the room opened as much as possible to the air and sunlight for a week A good working rule for all infectious diseases is that everything which has come in contact with the patient should be burned or boiled; if neither is feasible, it should be thor oughly scrubbed and exposed to the sunlight.