Part 4

With many patients the appetite is undisturbed for a long time, and there are consumptives that will eat a comparatively large dinner during an attack of fever reaching 40° C. Generally the desire to eat disappears during the course of the disease, especially toward the end of the sickness.

The stool may be normal or costive, but is very often diarrhoetic. Twelve or more evacuations may take place during a day; as a rule they are much increased by gasses and are of bad odor. They weaken the patient very much and hasten the end.

One of the most constant attendants during the course of consumption is the Fever. It is rather irregular. In cases of slow process the fever is often very insignificant; often it is only a state of general excitement that takes hold of the patient afternoons, slight dizziness, increased lustre of the eyes, slightly flushed appearance, somewhat increased pulse, which invites to test the temperature of the body by means of a thermometer, which by the way shows it to be about 38° C. With quick consumption the fever is generally high.

Sweat is also a characteristic sign. The exceedingly debilitating effect of night-sweats is well known.

During the course of pulmonary consumption extreme emaciation of the patient is brought about. All tissues are subject to the same, most marked is the disappearance of adipose tissue. This symptom is of the greatest importance as a continued increase in weight means improvement and even cure. Therefore weighing the patient from time to time gives a sure meter for the course of the disease.

The course of pulmonary consumption is very different. With quick consumption the end comes within two or three months. Chronic pulmonary consumption may last for years. With this improvements in the fine season alternate with deterioration in the winter.

Concerning the former treatment of pulmonary consumption, this will also be applied in the future in the same manner as far as preventive means and general hygiene is referred to.

For every one will prefer to remain exempt from consumption although it may now be possible to cure those afflicted. The lately published and popularly treated precautionary measures, especially with reference to the expectoration of consumptives retain their full value.

Henceforth the sputum is also to be thrown in a spittoon which is either entirely empty or on account of easier cleansing has the bottom covered with a thin layer of water. It should not be permitted to fill the spittoons with sand or sawdust as the tubercle bacilli can be easily thrown up with the dust.

In the case of a sudden attack of cough a cloth should be held to the mouth to hinder spreading of the fine spray, the same should also be used for wiping the mouth. However the cloth must soon be dampened and cleaned.

As bits of the sputum easily stick to the beard especially the moustache overhanging the lips, therefore lung consumptives are advised to wear a short or no beard.

Glasses, spoons, etc. used by consumptives must only be used by other persons after a thorough cleaning with hot water.

The lungdiseased person should abstain from all active and passive kissing, in unavoidable cases kissing should be done on the forehead or cheek only, or hold out those parts only to be kissed. In the same way he should avoid to touch objects with his mouth that may possible be put in the mouth by other persons, especially children, for instance toy-trumpets.

In the case of death from pulmonary consumption, the walls of all rooms and apartments used by the deceased should be rubbed down with fresh baked bread, which is a sure method of removing the bacilli. The bread crumbs that may have dropped on the floor may be removed by a thorough scrubbing with soap, brush and lye.

Upholstered furniture, beds, clothes and wash should be cleaned in a disinfecting place.

Do not wait with precautionary measures till some member of the family has been attacked by pulmonary consumption, but make preparation to prevent the infection while everybody is still sound and healthy.

This care ought to begin in a measure with the birth of a child. The same should not be nursed by a mother with diseased lungs nor by a wet-nurse with like affections. Generally wet-nurses are only tested for syphilis; scrofula and tuberculosis receive altogether too little attention.

An important precautionary measure consists in the supervision of the food. The abattoirs and dairies should be placed under the supervision of practical physicians, and the sale of products derived from tuberculous cattle be prohibited. This refers to the milk in the first instance. Tuberculous cows should be excluded from dairy-farms. Raw milk should be avoided as much as possible as boiled milk has the same value.

The meat inspection must be strictly conducted especially with reference to tuberculosis in the case of beef, pork and chickens. Sheep are not subject to tuberculosis.

The associations of children in school and on the play-ground should be watched; do not let them visit in strange families before making thorough investigation as to their sanitary relations.

The health of servant girls should receive greater attention than formerly, as the disease is often carried into the house by them as investigation has proven.

In the schools and kindergartens the teacher ought to insist that children do not spit on the floor or in the handkerchief; in case of necessity he should keep sick children out of school and he should especially follow these precautionary measures as regards his own person.

The cleaning of the floor of a room should always be done in a damp way.

Moving into another house it is advised to rub down the walls with fresh baked bread.

As regards societies, every society and every health resort without exception and if possible every hospital should be obliged to have its own apparatus for disinfection and to make extensive use of it. Smaller societies may unite to procure an apparatus of the kind.

Especial attention should be given to the sprinkling of the streets during the dry season.

The state and the larger congregations should make it a point to maintain institutions for consumptives, beyond the city limits if possible, a healthy location in the country preferred.

Every one individually protects himself best from consumption by a methodic habit of washing with cold water, cold rubbing and baths. River and sea baths are generally of excellent results; short shower baths with cool water lasting 20-40 seconds are to be applied later on; they do not only harden the skin but excite deep inhalations and exhalations and in that way act as gymnastics of the lungs. More direct is the action of muscular exercise, such as gymnastics, riding horseback or bicycle, driving, skating, rowing, etc. The carriage of children must be regulated, the drooping forward of their shoulders must be corrected by strengthening the muscles of the back and shoulders by means of dumbbell and other exercises.