A preliminary condition for recovery is the conscientious observation of the following hygienic measures : If the patient lives in a district which is dusty and smoky, he should at once leave it, selecting a place remote from the noise of cities and free from manufacturing plants. Localities situated in the neighbourhood of water and forests, and protected (either by trees or by hills) from penetrating winds, are most suitable. The patient should pass the entire day in the open air, taking frequent short walks in the course of the day, but being careful not to fatigue himself. The season permitting, he should even take his meals in the open air. Dwelling-rooms and bed rooms must be frequently ventilated, and the windows should be kept open even when the patient is in the room, naturally with avoidance of draughts. It is an erroneous belief, which is still too prevalent, that it is injurious tc sleep with the bedroom windows open. The air to be inhaled is contaminated, and insufficiently renewed, even in large bedrooms, if the windows be kept closed.
Continuous outdoor life necessarily requires that particular attention be paid to the dress, in order that colds, and consequent aggravation of the condition, may be avoided. The feet must be kept uniformly warm by good footwear, and the stockings should be changed daily if possible. The underwear should be porous and absorbent ; and the outer garments shotild be more or less heavy according to the weather. See DRESS. Even in summer the patient should take no walk without carrying a cloak or plaid with him, in order that he may prevent a too rapid cooling of the body in case he begins to perspire. Especial precaution is necessary when sitting in the open air. One should not be deceived by the pleasant sensation of coolness which is felt by sitting in a strong draught of air during hot weather, for a too marked cooling of the body is liable to cause increased suffering for the patient.
In order to aid metabolism, and to render the skin more resistant, dry or moist, tepid, cool, or cold rubbings may be recommended, according to the patient's strength. Some conditions of the disease may require moist packs. Only the carefully observing physician will be able to choose correctly in this respect ; and it is the duty of the patient conscientiously to follow the directions as given, even if they entail some inconveniences. It is always imperative to be especially careful with the rubbing down of the patient, as well as with the dry packs, so as to prevent fresh colds, which will aggravate the disease.
The patient's nutrition is of great importance in determining his fate. Hence, every digestive disturbance must be speedily combated. In feeding the patient, the governing principle should be " often, little, and good." One should try to introduce variety in the choice as well as in the preparation of the food ; and, if necessary to stimulate the appetite, spices should be used.
No special diet is necessary so long as the digestion is not disturbed. A plentiful mixed diet is preferable to any form of one-sided nutrition, as the latter is very apt to cause a distaste. Artificial food preparations, as well
as the numerous substitutes for meat, should always be considered merely as makeshifts. The most important foodstuffs are, therefore, meat, milk, eggs, butter, rice, farinaceous foods, fresh or preserved vegetables, and stewed fruits. Milk, as is well known, is the foodstuff which best combines all the nutritious elements needed by man, and which, besides, is most readily borne by the stomach. Since the remotest times milk has played an important part in the dietary of tuberculous patients. It should not, however, be given to the exclusion of other foodstuffs. If its continued use in the pure form causes a distaste, it may be given as butter-milk, kephir, or kumiss, or in soups, coffee, tea, or cocoa. Eggs are also advisable in every form— raw, soft or hard boiled, fried, scrambled, or in omelettes.
As to the use of alcohol, moderate amounts of beer or of good wine may be allowed if the patient is accustomed to them, or when they are known from experience to stimulate the appetite. But, as a rule, it may be said that more harm than good results from the use of alcoholic drinks. The question as to whether a consumptive may smoke depends essentially upon whether or not tobacco-smoke causes him to cough. If it does, the use of tobacco must be given up entirely. But, even if it does not, no more than two mild cigars should ever he smoked in the course of one day ; and these should be smoked in the open air and with several hours' interval. Cigarettes should be regarded as injurious.
The treatment of consumptives in sanatoriums is a subject of vast importance. As a rule, these institutions are better able than are homes and ordinary hospitals to carry out the special requirements with regard to the diet, as well as with reference to the well-regulated employment of the physical remedies here discussed. Unfortunately, the pecuniary condition of a patient is a determining factor in this respect, and often precludes the possibility of considering them. If, however, the necessary funds are at hand, the patient should enter a well-directed sanatorium as early as possible. The sooner this is done, the greater will be the benefit derived therefrom. It is advisable, therefore, that even patients in whom merely a suspicion of pulmonary tuberculosis presents itself, decide upon such a treatment. The closed sanatorium at once withdraws the patient from all the harmful influences of his previous surroundings and mode of living ; his blood circulation, the activity of his heart, his voice, and his organs of respiration obtain a uniform rest. A suitable diet is strictly adhered to ; the amounts of muscular activity and rest are regulated under the supervision of a physician ; and, at the same time, the special arrangements of the institution allow the incessant action of pure, fresh air (mostly outdoors), as well as the application of all kinds of hydrotherapeutic measures. The patient learns how to live hygienically, and to be careful of his sputum ; and, later, provided with the necessary knowledge, he becomes the most ardent advocate of hygiene.