To limit the dissemination of pulmonary tuberculosis, special attention must be paid to the sputum. In the first place, all persons affected with cough should be earnestly cautioned against expectorating carelessly on the floor or into a handkerchief. In the house a cuspidor should be used ; outside, a wide-mouthed flask, which may be carried in the pocket, is advisable. No house should be without a cuspidor ; and, better still, every room and every hall should be provided with one. The same holds good for all public buildings, factories, and shops, and also public conveyances. Hygienic spittoons are made of glass, glazed earthenware, or enamelled tin, have wide openings, and should be partly filled with water or with an antiseptic solution. They must be emptied and cleansed with boiling water at least once a day.
The authorities should exercise strict surveillance over dairies and dairy farms, paying particular attention to the sanitary condition of the animals. Cows affected with inflammation of the udders should be segregated, and the milk of such animals should not be drunk. If tuberculosis of the udders be demonstrated, the affected animals should be killed, and the owner indemnified. It may be recalled to mind that Robert Koch, the great German investigator of tuberculosis, upholds the opinion that tuber culosis of man and that of animals are of an entirely different nature. This fundamental question, however, has not been sufficiently elucidated as yet ; and so long as investigators, on the basis of experiments, maintain that there is a relation between the two varieties of tuberculosis, it is advisable to continue the prevailing precautions with regard to the milk of tuberculous cows.
It should be the concern of public authorities to cause thorough disinfections in the dwellings of deceased consumptives ; and inns, lodging-houses, railway cars, ships' cabins, prison-cells, etc., that have been occupied by tuberculous patients, should likewise be thoroughly disinfected.
When tuberculosis has made its appearance, or even if this disease is merely suspected of being present, a physician should be consulted without delay. His directions should be most minutely followed. Even the most insignificant suggestions which he may give with reference to nutrition and dress, to the regulation of work and recreation, to the enjoyment of fresh air and to the hardening of the body, should be carefully heeded.
Although, as yet, no absolutely sure remedy for this disease is known—no remedy which will destroy the tubercle-bacillus in the human body without detriment to the organism—yet that period is long since past when every consumptive is to be regarded as lost. In fact, the picture is quite the opposite ; and the hope is now most emphatically held ont that, taken in time, a great many patients can recover from tuberculosis. Daily experience of physicians at the autopsy-tables teaches that the lungs, even of persons who had lived under unfavourable hygienic and pecuniary conditions, may present changes which must be looked upon as unmistakable signs of their having recovered from pulmonary tuberculosis. Some pathologists of wide experience say that as high as 70 per cent. of people show recovery from some form of tuberculosis. Every experienced physician can point out a number of patients who have had \ vel I -developed tuberculosis, but who, nevertheless, by conscientiously having followed directions, have recovered, or, at least, have improved so much that they are able to attend to their callings for many years, and may live to a ripe old age.
The standpoint of physicians with regard to the treatment of tuberculosis is that the so-called physico-mechanical remedies (water, light, dress, and regulation of diet, work, and recreation) are of primary importance. This is the view held for years. Nevertheless, one cannot dispense with the numerous remedies which, as experience has taught, are capable of exerting a favourable influence upon the distressing symptoms ; and which, by allaying the latter, facilitate the healing of the diseased areas. In addition to these expedients, a number of remedies for tuberculosis are constantly being placed on the market. Some of these are introduced on the basis of serious investigation by scientific experts ; others are marketed by unscrupulous speculators who, for selfish motives, advertise as " specifics for tuberculosis " remedies which may or may not have proved beneficial in a few isolated cases. All these considerations make it appear not only improper, but dangerous for consumptives to employ any remedy on their own responsibility. It cannot be reiterated too often that consumption requires the most careful and constant detailed supervision .by a trained physician. The question of life or death may hang on the slightest thread.