Never empty upon dust-heaps, into the garden or latrines, where it may become a source of infection to animals as well

as man.

When away from home, he should carry a small spit-cup containing a slip of absorbent cotton or gauze wet with bichloride solution, to be emptied as often as possible.

Warn him, and also his relatives and friends, especially of the danger of spitting into handkerchiefs.

Sometimes, when the patient has reached the latter stage of the disease and is confined to bed, the exertion of moving to spit into cuspidors causes pain or severe attacks of coughing. In such cases I have found it very convenient to keep a pad of toilet paper at hand and allow the patient to spit into pieces of this, dropping them afterwards into the cuspidor containing the bichloride solution.

Legislation cannot accomplish what we wish; the influence or authority of the physician often is of no avail, and we may eventually be obliged to quarantine,-reporting cases of tuberculosis as we do diphtheria.

This would be unnecessary if we could only arouse the general public to a sense of its danger, and have its assistance and influence to aid the physician.

BEST MEANS OF PROTECTING THE HEALTHY OF THE HOUSEHOLD AGAINST PHTHISIS.

BY CARL R. FELD, M. D., OF WATERTOWN.

To the physician who is convinced in his own mind of the various influences causing the spread of tuberculosis, the means of protecting the healthy of a household invaded by that disease will readily suggest themselves.

The following remarks contain nothing new to the profession, my aim being simply to present, of the many methods of protection, those which are known to be the best and most available.

That consumption "runs in families" is a fact well understood by all classes of people; that it "runs in houses" as well, if I may use that expression, that it lurks in the dwellings of the innocent, and stealthily and silently infects their inmates, is a fact known to few outside of our profession. To impress this knowledge upon those whose health may be intrusted to his care, is one of the most serious duties of the physician of to-day.

At a meeting of the Berlin Medical Society about a year ago, Cornet whose researches in the field opened by Koch's discoveries are of the greatest practical value, showed that the bacillus tuberculosis finds only conditions unfavorable for its existence outside of the body, and that, as we prevent the drying of the expectoration and other discharges of tuberculous patients, we may restrict the disease with almost absolute certainty. Of all the factors in the etiology of tuberculosis the bacillus is the one most open to attack. Our first duty, then, is to render the expectoration of consumptives harmless. To accomplish this, consumptives should be made to thoroughly understand that their disease is a menace to those about them, and that they must cooperate with the

physician to protect those nearest and dearest to them. They must be made to know that the necessary measures of protection do not involve ostracism nor isolation, and that if the bacillus be destroyed and the other simple directions of their physician be religiously followed, the most intimate relation can exist between them and the well of the household.

The most important lesson to learn is that they are never to use handkerchiefs for their sputum, nor to spit upon the floor. How important these prophylactic measures are, will be readily understood when we bear in mind that according to the demonstrations of Dr. Nutall, of Johns Hopkins University, the bacilli daily thrown off by one patient may reach the enormous number of 4,000,000,000, and that according to Dr. Prudden, of New York, the average patient throws off between 30,000,000 and 40,000,000 of germs per diem.

Experiments with all the known antiseptics for the rapid destruction of the tubercle bacillus have proved unsatisfactory. The best means of destroying it is heat, hence receptacles of paper, such as are used in hospitals, should be introduced in private practice. These are little inexpensive paper boxes so constructed as to prevent all leakage. daily destroyed with their contents by fire.

They are

Destruction of the bacillus-laden sputa is the first and most important safeguard against the disease, but there are others. which must not be overlooked, and in regard to which we must give special instructions.

Kissing and caressing of a consumptive patient should always be strictly forbidden, as the saliva often contains the bacillus. Well persons should not occupy the same bed with consumptives, nor even the same room, unless they have no other choice.

It is a well-known fact that the disease is most prevalent in dirty, badly ventilated homes. Tuberculosis thrives on soil especially prepared for it. Wherever we are able to improve the habits and habitations of the people, we may feel

confident that our efforts of prevention will be crowned with success. Dr. Arthur Ransome found that "there were few, if any, records of transmission of the disease in well ventilated, clean and well lighted houses or hospitals, even in those for consumption," and that even before we knew anything of the contagium of tuberculosis, its conveyance from person to person was, under such circumstances, a very rare event. Ransome further proved by scientific and very interesting experiments that sunshine and free currents of fresh air rapidly deprived tuberculous matter of its virulence, while in dark places and in the absence of sufficient air, the bacillus remained active for a long time. We should therefore insure these conditions to our patients and their families by insisting upon their using the largest and airiest room of the house as a sick room. This and even other parts of the house much frequented by the patient, should contain no heavy draperies, no carpet, no upholstered furniture. The floor should be painted or covered with oil cloth or linoleum, and the walls as well as floor and woodwork should be in a condition to be frequently washed with hot water and soft soap or whitewashed, and frequent scrubbing of the whole house should be insisted upon. Clothing and other articles used by consumptives should be frequently sterilized by boiling in water for fifteen minutes.

The systems of ventilation in modern houses are insufficient for our purposes of protection, as they do not provide a strong free current of air. In summer and winter doors and windows on opposite sides of the house should be opened at frequent intervals during the day to allow the wind to blow through the apartments. While this is being done the family may retire to another part of the house which may be treated in the same way as soon as the other rooms are again ready for occupancy.

Members of the same family, descendants from the same stock, living together in the same apartments invaded by

tuberculosis, facilitate the transmission of the disease. Here we have the two necessary conditions: germ and hereditary tendency, the attacking poison and the point of least resistance. We must, therefore, direct our attention not only to the outward conditions, but must teach those most endangered how to avoid the disease by fortifying themselves in their own bodies against it. Therefore, it is necessary that we become apostles of proper living. We must teach tuberculous mothers not to nurse their own infants. Milk, one of the most important articles of diet for young and old, should never be consumed raw, but should be well boiled. If raw milk must be used, as for instance, in making butter, it should be taken from many cows, as it is claimed that the bacillus may be rendered innocuous by dilution, and it is reasonable to suppose that only a limited number of the cows supplying the milk are tuberculous.

As children and young adults are most liable to contract the disease, especial attention should be given by the physician to their diet and mode of living. They should have only the most nutritious food, and we must point out what article of diet that comprises; general directions in such matters being of no avail.

The slightest catarrhal troubles should not be overlooked, as they may prepare the soil for the lodgment and growth of the bacillus in persons who possess hereditary tendencies toward the disease.

At all times of the year, children, of course always sufficiently clad, should spend as much time out of doors as possible.

It is a matter of record that the wife more often takes tuberculosis from the husband than the husband from the wife, she being more at home and almost continually exposed to the contaminated air of the dwelling.

In conclusion let me say that only the most explicit directions of the doctor will be carried out by the patient and his