From the 1905 edition of the Century Book of Health.

EDITOR’S NOTE: Rather than editing out sections which "easy readers" may not find interesting, the whole text is retained. As you scan the article you will find sections which arouse your social, technical or medical interest. You can scroll down to them.

We all enjoy different aspects of articles and this article has many. An example of this is given in comments the following list of sections in this article. This editor adds comments regarding his personal enjoyment of those sections:

RAVAGES OF CONSUMPTION. — interesting; we’re dying in mass.
WHAT CONSUMPTION IS NOW KNOWN TO BE — advance of science.
HOW CONSUMPTION IS SPREAD — an attack on hygienic practices.
PERSONS MOST LIKELY TO BE ATTACKED — some surprises.
HOW CONSUMPTION MAY BE PREVENTED — wonder if we got rid of it.
HOW CONSUMPTION BEGINS: EARLY SYMPTOMS
EARLY SYMPTOMS
MODERN METHODS OF CURING CONSUMPTION — no medicine available.
DIET — wish I could eat that well.
EXERCISE
HOW TO LIVE OUT OF DOORS — should we all get more fresh air?
SHELTER
CLOTHING
SLEEPING OUT OF DOORS — should we all sleep with fresh air?

* * *

MODERN METHODS OF PREVENTING AND CURING CONSUMPTION.

The message which Robert Koch, a physician in an obscure German village, gave to the world in 1882, is by far the most valuable contribution to the public welfare that has been made in modern times. In this message he announced that:
- consumption is spread like other contagious diseases;
- that this greatest of all scourges can be prevented; and,
- most important of all, that those who are afflicted by this “great white plague” may be cured if they take the necessary precautions in time.

The direct result of Koch’s discoveries is that the work of stamping out this frightful menace to public and personal health and life is placed, not upon the physicians of the country, but upon every individual in the community.

As it is upon the intelligent and united action of every man, woman, and child in this country that the prevention and cure of consumption depend there is no hope that this result can be achieved, even in a slight degree, unless the means and the principles of their application are thoroughly understood.

RAVAGES OF CONSUMPTION.—It is the most widespread of all diseases. Every nation in the world suffers from it. Every year, in the United States, a part of the population equal to the entire population of a city the size of Indianapolis, Kansas City, St. Paul, or Rochester, N. Y., dies from it. That means 160,000 persons a year, or about 438 every day in the year.

Every hour, in this country, eighteen persons die from the effects of a disease which can be prevented. The public is appalled by the death of four or five hundred persons in a burning theater, or on a burning steamer, or in a great earthquake. But every day an equal or greater loss of life occurs, in isolated cases, with an awful train of sorrow and suffering, to say nothing of commercial and economic loss.

‘We have learned to look upon diphtheria, scarlet fever, and cholera as diseases which cause a great many deaths. Yet all of the deaths from cholera, diseases of the bowels, diphtheria, scarlet fever, and measles, combined, do not equal one-half the deaths from consumption.

Generally speaking, one out of every ten inhabitants dies of consumption; in cities, one out of every seven. Out of all of the deaths of persons between the ages of fifteen and twenty-four years, consumption kills one out of four; between twenty-five and thirty-four, one out of three; between thirty-five and forty-four, one out of four. Pneumonia is the only disease that approaches consumption in point of fatality.

WHAT CONSUMPTION IS NOW KNOWN TO BE.—Consumption is a contagious or infectious disease. Koch demonstrated conclusively that it is caused by a microbe which enters the body and multiplies there enormously, even to the extent of 16 million in 24 hours.

This microbe is called the ’Bacillus tuberculosis.’ Bacillus is the Latin word for a little rod or stick; and the creature is so named because that is what it looks like when seen under a very high power microscope, which is the only way it can be seen, and then only when stained red.

In this condition the bacilli most resemble a lot of very small cuttings of fine red silk thread. It takes three thousand of them, end to end, to measure an inch in length, and there may be 200 million of them in a spoonful of milk without one realizing that there is anything but milk in the spoon.

These bacilli were found by Koch in the bodies of every one suffering from consumption; but that fact alone was not sufficient to prove that their presence was the cause of the disease. A few of the bacilli were taken and put into a small glass tube containing a jelly or a bouillon, and the open end of the tube was plugged with absorbent cotton to keep other bacteria out.

The tube was then left undisturbed in a warm place for some time. This is what is called a culture, for the bacilli grow and increase in numbers under these favorable conditions. Some of the matter was then injected into rabbits and guinea pigs.

Guinea pigs are chosen for such experiments because the behavior of the disease germs in their bodies is most like that in the human body.

After a lapse of time, some of the animals were examined and were found to be suffering from consumption. Others were allowed to die from the disease, and, on examination, like conditions were met as are found in human sufferers. Some of this matter was in turn used upon other healthy animals, and the poisonous nature of the bacilli proved beyond a doubt.

The disease is called tuberculosis, for in the progress of it, and after the germs have begun to multiply in the lungs, there are formed a number of tubercles. Tubercles are little tubers, and tubers are such root-like parts of plants as the potato.

The tubercles in the lung are small roundish bodies about one-sixteenth of an inch in diameter. They are formed out of the healthy tissues in which the bacilli lodge and are of a grayish, semitransparent appearance. They first become of a substance like cheese, and this later turns to pus.

Little by little the germs multiply, change the tissues in which they live into tubercles, and break down all of the structure of the organ and scatter their poison through the body. The body tries to throw that poison off by fever, known as hectic fever in this case.

The parts are slowly consumed, and the patient eventually dies of consumption. These tubercles are found in many other parts of the body besides the lungs. There are tubercular joints, hip joint disease, consumption of the bowels, and other parts are similarly affected by the bacillus, and in all of these affections tubercles are formed.

HOW CONSUMPTION IS SPREAD.—The ’Bacillus tuberculosis,’ the cause of all infection, enters the body by several pathways. The most common of these is by the nose, mouth, and throat, in the process of breathing. Some also enter with the food and are taken into the stomach and the digestive organs.

They leave the body of a consumptive person chiefly in the sputum, the matter which is coughed up during the progress of the disease. It has been estimated that a person suffering from consumption discharges into the air in the sputum from 200 million to 23 billion of bacilli every twenty-four hours.

If this sputum with its immense number of bacilli is spit out upon the sidewalk or on car floors, and in similar places, there are several ways in which it may be scattered abroad to become infectious. The sputum may dry and be ground as fine under foot as dust to be whirled by the wind into the air.

It is then one of the solid impurities of the air, and in that form is breathed in by those who come within its range.

Or it may be tramped on by passers-by and attach itself to their shoes, or gathered up by sweeping skirts and be carried into the homes. Here it finds a lodgment and becomes dried upon the carpets. On sweeping the floors it is raised upward in the dust of that process to be breathed in by the occupants of the home.

In such ways it invades the homes of all classes, and bacilli are present in rooms where there has never been a case of the disease and where it is least expected.

That this is no alarming theory or a mere possibility was abundantly proved by Cornet, the Berlin scientist. He scattered a small quantity of sputum on the carpet of a room and allowed it to dry for only two days. He placed about fifty guinea pigs on the floor of the room. Then the carpet was vigorously swept.

The guinea pigs were allowed to breathe the dust in the ordinary way. All but two of them died from consumption thus contracted.

In the overcrowded and ill-ventilated clothing factories and workrooms in large cities there are present many conditions favorable to consumption; and the sputum carelessly discharged upon the floor is dried quickly by the steam heat of the buildings, and bacilli in great numbers are not only breathed in by the workmen but infest the clothing that is being made and which is sold all over the country.

Even in the acts of sneezing and coughing by a consumptive, when no perceptible amount of sputum is discharged, a perfect shower of bacilli is violently forced into the air in the fine particles of sputum which always accompany these acts.

Patients often smother a sneeze or a cough in the bedclothes, and so the bacilli are received into them. The mustache and the beard of a consumptive become perfect hives of infection, especially as so many men allow the beard to grow long, either for comfort or as a protection to the throat in cold weather.

The walls of rooms in which a consumptive has lived and died have been known to retain the bacilli in an active state for over two years after the termination of the case.

These are some of the ways in which bacilli are spread through the air and carried from place to place. No man lives long enough to be able to count, during his entire lifetime, the number of bacilli which a consumptive carelessly and needlessly discharges into the air in a few hours.

These myriads of bacilli are breathed into the air and are taken into the lungs by all who come in their way. Every one breathes them, and they lodge on the teeth, the tonsils, in the throat, and in the lungs of all, healthy and unhealthy alike.

Dr. Cornet examined a very great number of healthy persons who were accustomed to frequent public places, and he found bacilli in the mouths of over 75 per cent of them. They lie there in wait with infinite patience, for upon the healthy, right living man their attacks are useless.

But let him neglect his hygienic mode of life, let him be guilty of continued indiscretions, let him become weakened and enfeebled by disease, hunger, privation, and exposure, then he succumbs. And the patience and relentless attack of the invisible little microbe kill one out of every four persons.

And yet even the healthiest in appearance must not be too sure that they have never been caught by this ever present and watchful enemy.

The post-mortem examinations have shown repeatedly that persons who had never been suspected of having consumption have had an attack, and the scars on the lungs prove that they had vitality enough or adopted right modes of living in time to overcome the attack, in other words, to become cured. These are not isolated cases.

These revelations are of almost daily occurrence, and are the most convincing proof of the curability of the disease. No man can say positively either that he has not had consumption or that he is not now attacked by it. Were this possible, the stamping out of this insidious disease would be only a question of a very few years.

PERSONS MOST LIKELY TO BE ATTACKED.—There is great difference of opinion among scientists regarding the transmission of consumption from parents to children. Medical journals are filled with articles affirming and denying the possibility of the communication of the disease in this way.

But upon one point all are agreed, that there is no doubt that children of consumptive parents, one or both, inherit such a weak constitution and so enfeebled a state of health, that they start life with a marked predisposition to the disease.

These, then, form a large proportion of those who are liable to be attacked by consumption. But that does not by any means imply that they will take it. For facts prove that the very large majority of them do not take it. A statistician of a large insurance company gave facts before the Tuberculosis Congress in England that should set that point at rest forever.

Forty thousand applications for insurance were refused because there was a family history of consumption. These cases were followed up, and it was found that less than nine per cent of that large number took consumption. Less than one out of ten took it. And this is the class which in popular opinion is doomed from birth because it is in the blood.

If those figures prove anything they certainly prove that the inherited predisposition to the disease is no greater a predisposition than are those from other causes. For one out of ten the world over is the average mortality among all classes of people.

Right here let us drive home to the members of that class all the hope that this fact gives them. You are under no ban because your father died of consumption. You are not doomed to the disease. You are not going to die of it unless you are willing to. Your chances of escaping it are as great as anyone’s, if you do your part.

To this class are to be added all those who have inherited a weak state of health and a poor constitution from their ancestors. There is in fact no good reason why the two classes should be separated. The bacilli will find a favorable field for operations in both, in one just as good as the other.

It is impossible to tell anything about a person’s vitality or constitution, or power of withstanding disease, with absolute certainty from his appearance. Every one can cite case after case from his own observation, no matter how limited, of those who were apparently sound, splendid specimens who succumbed quickly to an attack.

They can supplement this with other cases of those who were apparently not at all endowed with powers of resistance who have seemingly more than once come back from the gates of death.

It is a fact that men of flesh and men of muscle have, in the great majority of instances, proved but too easy a prey to the bacillus of consumption, perhaps because too much was expected from their apparent vigor.

Nearly every doctor has at least a mental note of more than one instance where a whole generation of the same family of heavy, powerfully built persons succumbed to this disease, although they gave every promise of escaping all danger from it. The vital resistance to the disease was poor, although the physique appeared excellent.

There are two types of build which are particularly prone to the disease.

- The one is represented by those who have inherited a poor chest development, so poor that the lower portions of the lungs seldom if ever are filled with air. These have a light build, small bones, delicate features, thin skin, and blue veins about the temples.

- The second type is a remarkable contrast to these. It includes those whose bones are large, muscles powerful, of that build known as “lanky.”

In these two types, especially the latter, consumption usually runs a rapid course.

The last class of which we have to speak is the largest of all. It is larger than all others combined. It is those persons who do not live hygienic lives. The indiscretions, the carelessness, the ignorance, and the willfulness of men and women, together with the poverty of the lives of many of them, are the great predisposing causes to the deaths by consumption.

HOW CONSUMPTION MAY BE PREVENTED.—The first step in the prevention of consumption is to destroy the bacillus as soon as it leaves the body of the patient. As it passes off in the sputum, this means that the sputum from one suffering from the disease must be thoroughly and effectively destroyed.

There are several good ways of doing this.

A regular sputum cup may be provided, in which a small quantity of the disinfectant and germicide, the perchioride of mercury, is placed. The perchloride solution is the regular 1 in 1,000 solution made by dissolving one-half an ounce of mercury perchloride (corrosive sublimate), and one ounce of hydrochloric acid in three gallons of water. This kills the germs or bacilli, and the destruction is complete.

If there are facilities for burning the sputum, a paper cup, moist rags, old newspapers made into books, may be used to spit in, but they must be promptly and regularly burned.

This care in the disposal of the sputum must be rigidly performed. There should be absolutely no spitting in public places, on the sidewalks, in cars, on floors anywhere, nor on carpets.

As pointed out before, this is the most prolific means of infection. The bacilli are carried about on clothing, dry up and form dust, which is blown about and inhaled, and escape from infection is impossible.

Not only should spitting in public places by consumptives be stopped, but the practice should be prohibited to every one. If a spitter have not consumption, and no one can be sure that he himself has not, he is only passing along such bacilli as he has inhaled and which have attached themselves to his throat and tonsils.

The enforcement of the ordinance in some cities is not alone on the grounds of cleanliness but to prevent the spread of this disease. If a person must spit, let him be both sanitary and decent about it. Let him spit off the curb into the roadway; that is bad enough, and is also a means of infection, but it is not so bad as the risk of it being carried about on the clothing of passers-by into their homes.

The danger of spitting on carpets as a means of infection has already been demonstrated. It is an easy matter to spit in spittoons which have water in them, to spit into a sewer grating, and generally to use a little precaution in disposing of the dangerous and offensive excreta from the mouth and lungs.

It is not right that this matter should be swallowed, as there is very great possibility of carrying the infection into the stomach and bowels, both of which are extremely subject to tubercular infection.

A consumptive should also never cough or sneeze without covering the mouth and nose with a wet cloth. He should always have at hand for use a supply of such material, which may be burned after use. The acts of coughing and sneezing being both explosive in nature and intended to force matter from the lungs, throat, and nose, violently expel much of this infectious matter into the air.

A consumptive person should never kiss another on the mouth. In spite of the comic paragrapher’s humor on this point of infection, there is positive danger of communicating disease by this means.

He should sleep alone and occupy a separate room.

These points on the disposal of the sputum and other preventive measures have to do principally with the prevention of the spread of the disease to others. It is the dissemination of the bacilli that increases the possibility of infection by those who are disposed to the disease.

A person who is predisposed to consumption should avoid infection as far as possible. He should live outdoors all that he can. Many have changed their occupations to secure the sunlight and fresh air, with most favorable results.

The mortality is greatest among those whose occupations cause the breathing of particles of metal, stone, etc., and among those who are most confined. The glassworkers, stoneworkers, hatters, bookkeepers, cigar-makers, printers, supply a very large proportion of deaths.

Predispositions of all kinds are to be closely watched in the early years of life. If a child display a tendency in family history, build, constitution, or if he has been enfeebled by weakening disease, let him be given all of the outdoor life possible.

Let him drop school for a time. Never mind if he does not keep up with his class; give him a chance to keep up with life. The rivalry of school classes and the fear of not making a school year with his classmates are sometimes very pernicious.

The choice of a profession or of a career in life must be largely influenced by his physique. Dangerous occupations and those which entail confinement are not for children or young men and women with any predisposition to disease.

An outdoor life is not only advisable but imperative in all such cases. Fresh air and sunlight are not only in themselves a means of destroying the bacillus and its poison, but are powerful agents in increasing the vital resistance to the disease.

That is what all of the preventive means should aim at doing. Kill the bacillus, and build up a weakened constitution so as to withstand its attacks. The curative agencies, which will be taken up later for consideration, are to be employed to a degree in the prevention where a possibility of contracting the disease is feared.

HOW CONSUMPTION BEGINS: EARLY SYMPTOMS.—Consumption begins by the admission, under circumstances favorable to its growth, of the bacillus into the lungs through the organs of respiration. What it will do after it gets in depends entirely upon the virulence of the bacillus, the state of health of the person, the condition of the organ or part affected, and the power of resistance of the individual attacked.

If there is no predisposition to the disease; if the person is in good health and is living a careful, hygienic life; if he is not weakened by an enfeebling disease, such as pneumonia, typhoid, measles, whooping cough, etc.; if his health and strength are sufficient to resist the invasion; then the bacillus can do nothing, but is expelled in time by coughing and spitting.

But if any of these conditions are present, in a greater or less degree, then the bacillus begins to act. It first sets up an accumulation of cells in the immediate neighborhood. These cells vary in size and in the nature of their contents. They form a tubercle.

In cases of cure, these tubercles, which contain the bacillus, are walled up by a tissue so that the bacillus cannot get out to attack other tissues, and can work no further harm. This is accomplished by a healing process, and when it occurs a scar is left on the lungs just as a scar always marks the place of a wound. This happens in hundreds of thousands of cases, and usually without the individual knowing that he has had the disease.

This is important to be remembered, for there is no clearer and more convincing proof of the possibility of a cure of consumption than the fact that this cure takes place in so many cases, and often without any direct effort on the part of the individual. Certainly much more success can be hoped for when well directed efforts are made to bring about these very conditions.

But if the disease does not terminate in this way at this stage, the next step is the death of the tissues which have been affected by the bacillus, which passes on to attack other parts in the vicinity, the bacillus meanwhile increasing enormously and rapidly.

If these tubercles are quite small they are called miliary tubercles, as they are said to be about the size of a millet seed; but when a number of these miliary tubercies unite to form one large tubercle, the latter is called a nodule, a word derived from the Latin and which means “a little knot.”

Inflammation sets up in the part affected, and, as is always the case when inflammation occurs, there is a secretion which surrounds the tubercle and confines or limits the operation of the bacillus to that particular area, and so prevents the spread of the disease for a time.

This matter secreted by the inflammation surrounds the tubercle with the bacilli, and, in a very great number of cases, grows into a tough envelope or covering so strong that the bacilli are walled up inside of it, cannot escape, and are either prevented from getting out as stated or are destroyed.

The part of the lung inside of the envelope dies or becomes useless for breathing purposes; the scar is left and the disease is stopped. This, then, is a cure at a later stage of the disease.

If, however, the wall or envelope is absorbed while the bacilli are alive and active, or if it breaks down and allows the bacilli to escape, the attack is at once made upon the lung tissue, and the operations are extended.

Sometimes, a disease like pneumonia, typhoid fever, or influenza works a change in the envelope or covering of these walled up sections of the lungs, and an attack is made by the liberated bacilli upon the neighboring tissues.

This is the condition popularly known as “rapid decline,” which often follows these and other diseases. This stage of the consumption may have existed unsuspected for some time, and it took the other inflammatory disease to break down the sealed up barriers and to give the disease full sway with a speedy termination.

The formation of this envelope or barrier to the further progress of the disease does not always take place. Where there is little or no resistance to the attacks of the bacilli, a general spreading of the poisonous matter takes place through the tissues, and, as there is nothing to impede its advance, the course of the disease is very rapid.

EARLY SYMPTOMS.—In the cure of consumption so much depends upon its speedy detection that it is well to have in mind the early symptoms of the approach of the disease. It is not supposed that these are always within the power of the ordinary person to detect. There must always be the assistance or direction of the physician.

No one is capable of diagnosing his own complaint. Even physicians do not attempt this in their own cases when ill, but every one should know the warnings of the approach of consumption so as to be able to tell when a thorough examination by a skilled physician is needed. The neglect to do this upon reasonable grounds for suspecting the existence of incipient consumption is criminal negligence.

It is a common belief that an attack of consumption is heralded by a cough. This is not true of a very great many cases. Sometimes the first symptom is a rise of temperature in the evening. This rise may be very slight and be preceded by a chilly sensation.

A clinical thermometer will tell whether this rise is real or fancied and the extent of it. The average normal temperature is 98.4°, and the temperature should be taken during the day and at evening for comparison.

In other cases the first symptom is persistent hoarseness. That is when the effects are first shown in the larynx. When this huskiness of voice does not quickly yield to ordinary treatment, an examination for consumption must be made. “Only a slight cold” works a lot of damage at this stage of the disease.

Again, the earliest symptom may be the spitting of blood. This does not always mean consumption, but in the great majority of cases it does. It may mean acute pneumonia or some form of heart trouble, with rupture of the blood vessels, but both of these conditions will soon be determined by examination.

The symptoms of consumption do not develop in the same order or in the same degree in all cases. If they did the task of deciding accurately would be much simplified.

There are two symptoms which come some time or other in all cases. They are fever and loss of weight.

- The fever of consumption does not usually run to very high temperature. It is generally moderate, and runs from 100° to 102° and rarely to 103°. If it runs higher than this it may be caused by some complication such as blood poisoning. It is high in the evening and low in the morning. It is easy to relieve it but only temporarily.

- Loss of weight is caused by loss of appetite, cough, and consequent loss of sleep, and by exhaustion, indigestion, anaemia, and the absorption of poisons generated by the disease.

Sometimes the loss of flesh proceeds at the rate of four or five pounds a week. This is a sign that the disease is making rapid progress. Gain in weight, on the other hand, indicates that the disease is making slow headway, or that its progress has been stopped, and that the healing, walling-up process has begun.

Night sweats, as so many suppose, do not aggravate the disease; but on the contrary, are the natural means of relieving conditions. They are to be regarded as an effort to reduce the effects of the absorption of poison into the system. For it is by the perspiration of night sweat that the poison of the disease is carried off.

The cough is a very generally constant symptom of the disease. It is usually worse at night and in the morning on rising. As it is a remedial means of clearing out the accumulations in the lungs, it is not to be stopped.

At first it is a dry hacking cough, and is not accompanied by much discharge, for the simple reason that the disease has not progressed far enough to form matter in the lungs to be discharged. It is the method by which the lungs are kept clear. Later, when there is much discharge, it is sometimes so severe as to cause loss of sleep, exhaustion, and even vomiting.

When sputum is present it, too, is a symptom, for it is capable of microscopical examination which will disclose the presence of the bacilli.

The Board of Health in the city of New York is equipped to make a free examination of sputum, and give a report on its condition, and the presence or absence of bacilli in it. Still, it must be remembered that the absence of bacilli in sputum is no proof that the disease is not present at that time. Bacilli may be present in the lungs but in the walled-up condition already mentioned.

MODERN METHODS OF CURING CONSUMPTION.—It is well to start with the clearly stated announcement that there is no medicine known which will cure consumption. Those who rest their hopes upon this or that medicine which they have read about, or been told about, are leaning upon the worst sort of a broken reed.

They are not only not going to be cured by any of them, but they are wasting valuable time and are allowing the bacilli to get such a start upon them that they will probably never overtake the disease or head it off. This plain statement is made without reserve.

There are some medicines which will help him in the complications which so often attend this disease. There are some medicines which, in the hands of the proper person, will relieve him of pain and inconvenience. But there are positively no medicines which will cure consumption. Those which will help him will be considered in the proper places as they come up.

The things which do cure consumption, and are curing lots of cases every year the world over, do not come from drug stores or out of bottles. They are abundant, and yet are, in some cases, hard to get.

The first is fresh air—not a little bit of fresh air through a half inch of raised window once in a while, but a regular supply of it got by living out of doors, sleeping out of doors, if possible; at any rate, by being out of doors as much as possible.

Fresh air will not only kill the bacilli but will give the patient a vital power to resist the disease and to seal the germ up in a sac whence it cannot escape and so destroy it. There are places where a consumptive can live out of doors, and there are other places where he cannot. The thing, then, to do is to find out where he can live out of doors and to get there as soon as possible.

The one great thing is to get where it is dry. Humidity is above all things to be avoided, for it is the life of bacilli.

The old much-vaunted efficacy of the sea voyage on a sailing ship is all over and forgotten. There are no more good old sailing vessels, and even if there were, the air at sea is not dry, but damp. There are seasickness, personal discomfort, and being shut up in stuffy places during bad weather. All of which will not do.

In the out-of-door life the temperature makes no difference. Dress accordingly. People get well in the cold, dry air of Canada and the northern states just as well as in Florida and on the Pacific coast.

The old theories of not going out before 9 A. M. or after 4 P. M. are exploded. Not only go out but sleep out if
you can. Of course you can in summer, and, with proper arrangement, you can in winter too. Hundreds are doing it today and are getting well too.

Draughts? They are better forgotten. The fear of them and the precaution to avoid draughts that never existed, or never came near a patient, have killed more consumptives than direct draughts ever did.

If you can, sleep in a tent out in the open where there is plenty of good, fresh air. The tent is sheltered from direct winds; and it is made of thick canvas that the air does not blow through. The air is admitted in ventilators in the sides and passes out of the top. There is no draught.

Night air? That is another bugbear. As Florence Nightingale said, when told that one must not breathe the night air: “Why, doctor, what kind of air must one breathe at night if one cannot breathe night air?"

Where tents are impossible, and they are for 90 per cent of consumptives, a back porch, a sheltered place outside in summer and under an open window in winter, can easily be secured, and they will work wonders. It is not the tent that cures; it is being out in the best air, the purest air than can be procured. It is possible to protect against all sorts of low temperature by having enough bedding.

A consumptive must get the best air all of the time, not part of the time, but all of the time. Good fresh air in the daytime and vitiated bad air of the house at night is not half treatment; for the germs make more headway at night than the patient did in the daytime.

There is no doubt that sanitarium treatment is best for those who can afford it. Because there is discipline there, and things must be done. There is no interference with the arrangements of a home or with the comforts of others. The treatment is continuous and is thorough.

But the patient should not go alone if inclined to worry or to homesickness. That will interfere with his rest of mind, which is absolutely necessary to a cure.

In the ordinary out-of-door life of a patient during the day, it is easy to provide a sheltering wall or shield from the wind. It should be thoroughly exposed to the sun and have the direct rays of the sun shine upon the patient.

Sunlight and fresh air will do more towards effecting a cure, even in a locality that is theoretically bad, than the absence of them in the best climate in the world will do unaided. This is to be borne in mind with relation to those cases where a patient cannot avail himself of good climatic conditions.

Where it is possible to secure altitude in addition to dryness of climate, a height of from 3,000 to 6,000 feet is desirable. This is helpful because the rarity or thinness of the atmosphere at that elevation obliges the patient to breathe with all of the available lung machinery in order to get enough air. That keeps the lungs well exercised and exposed to the action of the air.

But weak heart and high pulse indicate that a high location be not chosen. There are scattered now all over the country numerous good sanitariums which are doing splendid work in curing patients and in stopping the spread of the disease.

Where such results can be shown by the methods herein advocated, cures of 72 per cent in incipient cases and 46 per cent in advanced cases, there is much to be hoped for even in home treatment.

DIET.—The matter of diet is to see that the patient eats plenty of nourishing food. This is not so much a matter of appetite as of seeing that he eats enough. There are at least six meals a day. Not much food is to be taken at a time; but be sure that there is plenty of it.

If the weight of the patient can be kept increasing, that is a sure sign that the ravages of the bacilli are being checked.

Milk, eggs, fat meat, and hard bread are the chief articles of diet. The aim is to have the patient eat six meals a day and to drink three quarts of milk and to eat a dozen raw eggs besides. All of the food is to be well chewed.

Even the milk is to be sipped and moved back and forth in the mouth so that it is practically digested before it is swallowed. In this way it will not curdle nor will it make the patient bilious.

Such are the principles of diet. But a more extended course with greater variety may be given. The patient’s digestion must be moderately good to follow such a diet as is here suggested :—

Before rising he may sip a cupful of hot milk. Sipping is essential to good digestion of milk. Rest for fifteen minutes. Then bathe and dress.

Breakfast: Oatmeal or other nourishing cereal, to be well chewed. A chop or small steak. Dry toast. Tea or coffee if used to it and it does not make him irritable. An orange or other fruit.

Light luncheon between breakfast and midday meal: Cup of broth. Piece of toast. A glass of koumyss. A scraped beef sandwich. Eggs raw or cooked. Sherry or red wine; or a glass of good Scotch or rye whisky if desired.

Midday dinner: Soup, preferably a thin soup. Really fresh fish. Roast or broiled meat. Vegetables: potatoes, string beans, macaroni, spinach, asparagus. Sherry or whisky and water. Cornstarch or rice pudding.

Light luncheon in middle of afternoon: Similar to mid-morning luncheon.

Supper: Arrowroot. Eggs. Stewed oysters and toast.

Evening luncheon before going to bed: Cup of broth. A glass of koumyss. Cup of hot milk. Curds and whey.

This or any diet must be supplemented by all possible aids to digestion, such as pepsin. pancreatin, taka-diastase. The bowels must move regularly.

The size of the meals must be regulated according to the patient’s condition. If he has spent a restless night he has not much nervous energy left. Therefore the meal must be a light one. If it has been restful he can digest a heartier meal. If the tongue is coated or foul, the amount must be lessened. It is upon such matters as these that the physician’s advice must be sought and rigidly followed.

EXERCISE.—If the area involved is small and the general and muscular health of the patient is good, he may take gentle exercise, but under no conditions become fatigued.

If the lung area affected is large or if the patient’s health is below the average, he does not want exercise.

Exercise causes heavy breathing. The lungs of a consumptive are wounded. No one thinks of working a sore hand or foot to make it heal. They let it rest. That is what must be done by the consumptive. He must let his lungs heal.

It is infinitely better for such to sit around in the sunshine and fresh air conserving all of the energy they have and devoting it to the digestion of as much nourishing food as possible. If such feel the need of exercise it is best given in the form of massage.

In cases where the ambition of a patient exceeds his discretion, and he wants to walk miles, and play golf over long links as he used to do, that is where the discipline of a good friend or doctor comes in.

Every time a patient gets tired he undoes all that has been done towards gaining resistance to the ravages of the disease. One indiscretion in that direction puts him back several weeks.

Rest for the body and rest for the mind; freedom from worry and the cares of business, will be absolutely necessary to a cure. Everything should be dropped and the attention concentrated upon the cure.

HOW TO LIVE OUT OF DOORS.—It is presumed that the patient has selected the driest possible climate for outdoor life. To those who can afford to go to a sanitarium, there is little to be said further than to go there is quickly as possible. It is to those who cannot, as well as to those who are curious to know what is the modern practice of curing consumption, that these directions are given.

There is first a tremendous prejudice to be overcome about taking cold. That is the great bugbear in the way of the ready and universal adoption of the methods here advocated. Let it be said as convincingly as possible at the outset that you will not take cold as readily or as frequently if you adopt the outdoor life as you will if you follow the indoor life.

Besides if you have consumption and continue to live indoors, with a little outdoor life in the warm part of the day, you will die.

If you live outdoors summer and winter, night and day, fine weather and bad weather, you will get well. Forget all that you have ever heard about draughts, chills, and night air, and do as thousands are doing while you are reading this, and get well.

You are not to suffer the least discomfort in following the outdoor living. If you do, you are not doing it right. In fact, if you do not feel better out of doors than you do indoors, there is something wrong in the way you are trying to do it.

SHELTER.—You are not to sit out exposed to the wind in winter or to the intense heat of the sun in summer. You are to be made as comfortable as possible. While you are to be out of the wind you are not to be away from the direct influence of the fresh air and of the sun.

The fresh air and the sunshine are what you are outside to get, and if you do not get all that you can, you are only half doing your share.

First of all, get a comfortable chair. Remember that you are going to sit many hours a day in that chair, and it must be as restful and snug as it can be made.

A rolling chair or a wheel chair is very desirable, because it is so easy to move about as the wind changes, or as the sun changes, or when you desire to change the scene. Besides, with such an easy chair to move, you can often wait upon yourself when it is not convenient for others to do so on the moment.

An adjustable reclining chair is very good, as it places one at the comfortable angle and will take a larger and softer cushion. Or a canvas chair, which fits itself so well to the shape of the body, is restful. The cushions of the chair are to be as soft and thick as can be provided; a mattress is often desirable, and can be adapted to a large chair very effectively.

A table or book rest is indispensable for reading and writing; for writing is indulged in even when the thermometer is at or below zero, and when the ink freezes at the point of the fountain pen.

If the house has broad porches or verandas, one can always find a sheltered spot in any weather on the lee of the house. But even there a screen, such as must be provided in the absence of porch room, is convenient.

If this is of glass, so much the better, as it will not cut off the sunshine. This does not mean the complete walling-in by glass, but is only a small shield against the wind. In a shut-in porch, with glass all about, one is little better than when in a room.

If glass is not procurable, any form of shield will answer. It should be easily movable, not too heavy, and yet not light enough to blow down in the wind.

CLOTHING.—Again the rule is: be comfortable. It is not intended in the outdoor cure that the body shall be cold. That is not what cures. Cold air is good not because it is cold but because it is dry. Dry air is just as curative in summer as it is in winter.

Remember that you are living where you can get the freshest of air all of the time. As long as that fresh air gets free and abundant access to your lungs that is all that is needed. Comfortable clothing is easily enough secured in the summer and while it is warm; but the comfort on cold stormy days is a matter of experience.

It is not right to go out for a little while improperly or insufficiently clad, get chilled, and then come in to a warm fire to get warm and then to go out again. That means that you sit beside a warm stove until the pores of the skin open; then when you go out to the cold air again, the pores are suddenly closed, and the result is a chill and a cold.

You are not taking much exercise while you are out, so it is necessary to be well clad. Right here you must be careful to remember that weight of clothing and warmth of clothing are not to be confused.

Do not rely upon heavy underclothing, but upon warm outside wraps. It is from them that the protection will best come. The material of which they are made is of little importance; but it is of the greatest importance that they be warm enough. That is the only test of their fitness.

A loose fitting outer garment is not so warm as a rather tight fitting one. It should fit close at the wrists so as not to allow the cold air to affect that particularly sensitive part of the body. A high collar, or, better still, a cape will be found of great service in keeping the neck warm.

Women will find a small shawl a sufficient covering for the head.

Men should have a cap with flaps to pull down over the ears and a peak to keep the sun from the eyes is desirable.

The hands are best protected by mittens. Gloves separate the fingers and are not nearly so warm. A pair of cotton gloves of large size may be worn under warm woolen mittens. This is found to be a very comfortable arrangement.

The feet should be protected by loose-fitting, comfortable shoes. Two pairs of woolen socks or stockings are warmer than one thick pair.

The very great value of newspapers as a means of keeping out cold and of keeping in the warmth of the body must not be forgotten. These can be placed over the chest, the back, and around the feet, with great advantage.

SLEEPING OUT OF DOORS.—The most satisfactory results are secured from sleeping in a tent. This is pretty generally the methods of the best sanitariums. Perfect shelter and protection against all kinds of weather is secured by its use.

The ventilation is provided by the passage of the used air out at the top. Such a form as that shown in Fig. 51 is a standard. But shape has little to do with it.

A porch may easily be fitted up with protective awnings so as to form an ideal sleeping place, free from exposure to weather and to the curious.

Many houses have upstair porches or balconies, which afford abundant shelter with a little added sense of security.

Where such conveniences cannot be obtained, one must fall back upon indoor sleeping with full ventilation. If there are more than one window in the room, close the door, so as not to affect the rest of the household, and
open all of the windows. The arrangement of the room under such conditions is shown in Fig. 54.

Where there is only one window available, there are several ways of arranging. One is nothing more nor less than putting the head of the bed out of the window. Where shelter against observation is desired, an umbrella may be raised, but awnings or screens will be better.

Care must be taken that not more than one-third of the length of the bed is permitted to project, as there would be danger of the bed tipping if more were used. A weight may be attached to the lower part for additional security.

A convenient sort of platform is arranged outside of the window upon which the mattress is placed. The inner part is built up to the required height so that the bed is on a level with the shelf.

As a last resort, when no other accommodations are at hand, raise the window to the full height and place the bed directly under the window.