stay in bed today, but here again the physician must be consulted if grave mistakes are to be avoided. From what has been said, it is easy to see that a temperature above the usual morning temperature, although normal, may indicate that the temperature will rise above normal during the day. In this case it is wisest to remain in bed until noon and only then, if the temperature is normal, should the patient get up. This holds true even if the increase of temperature is only from 97.5° to 98.5°.

It may be of interest to patients to know that temperatures ranging from 75.2° to 114.8° have been recorded in patients who have recovered. The temperatures of animals are usually higher than that for man: The horse, 99.5°; the cow, 101.5°; the sheep, 104.5°; the pig, 102°; the dog, 101°; the rabbit, 102.5°; the guinea-pig, 102°; the common fowl, 106.9°; the perch, 52°.

The temperature of the body is kept constant by the circulation of the blood. When the heat of the body rises too high more blood flows to the skin, the sweat glands are stimulated, and the evaporation of the moisture (of the skin) cools. the skin, the blood and hence the body. When the body is exposed to cold and the blood vessels of the skin contract, the blood is driven into the internal parts of the body and the cooling of the body lessened. All of this, as has been stated, is under the control of a part of the brain. Exposure of the skin first to hot and then to cold water causes these little blood vessels of the skin to

dilate and contract, keeping them in "condition," and so aids in preventing chilling when exposed to cold or dampness.

It must be borne clearly in mind that the temperature of patients with pulmonary tuberculosis varies from slight causes. Slight excitement, an interesting story, a game of cards, can all raise the temperature. Some patients have a normal temperature until they come into a warm room when the temperature rises above normal.

Here the explanation lies in the fact that that part of the brain which controls the temperature is hypersensitive and cannot regulate the body temperature as readily as it does in health.

It has been mentioned that cold fresh air stimulates the body of a patient vigorous enough to bear it. All the processes of nutrition are whipped up by such treatment better than by any drug. More carbonic acid gas is given off, more oxygen absorbed, more food required, and all the processes of the body quickened. The old idea that life in a room with a temperature that does not vary two or three degrees a day is good for patients with pulmonary tuberculosis has long since been discarded. The equable temperature of the tropics is also bad for most patients. Today we know that a daily change of at least 20° a day is important for tuberculous patients. Greater changes even are good, and some have attributed the activity of Americans to the sudden climatic changes to which they are subjected.

XIV

ON CONTROLLING A COUGH WITHOUT DRUGS

"Be not discontented, be not disheartened, be not out of hope if often it succeed not."

THE best advice that can be given about a cough is that offered by Punch to those about to marry: "Don't!"

To the average patient who is suffering from pulmonary tuberculosis there are two points which are far above all others in importance. The first is the question of cough and the second is a question of whether or not he has developed a cavity in his lungs. Undoubtedly, to the lay mind, the cough is the main characteristic of pulmonary tuberculosis, and, for this reason, it is undoubtedly true that many patients will take any medicine, patent or otherwise, that is suggested to them by their friends or by advertisements. The object of this chapter is to suggest other means than drugs for the treatment of the cough.

When the vast amount of literature that has been written on coughing is consulted, it is seen that the cause of a cough has been at one time or another attributed to an affection of nearly every part or organ of the body. The act of

coughing is explained by the physiologists to be a preliminary inspiration followed by an expiration which is frequently interrupted, the glottis, or upper part of the windpipe, being partially closed at the time of occurrence of each interruption, so that a series of characteristic sounds is produced. The air is forcibly ejected through the mouth and thus foreign particles, such as mucus in the respiratory passages, may be expelled. Hawking, which is very similar to coughing in its effects, is a voluntary act entirely, while coughing may be voluntary or reflex in origin. In hawking, the glottis is open during the respiratory act and the expiration is continuous. The current of air is forced through the contracted passages between the root of the tongue and the soft palate.

Coughing, in the vast majority of cases, is undoubtedly due to an abnormal condition of the lungs, windpipe or larynx (upper end of the windpipe where the voice is produced). However, it is said that it may indicate irritation in even remote and entirely unassociated partsirritation in the nose, ear, pharynx, stomach, liver, spleen, intestines, etc. Such coughs are called "sympathetic" or "reflex" coughs.

Among the various causes of cough, other than that caused directly by tuberculosis, may be mentioned smoking, chilling of cold sheets at night, exposure to sudden differences of temperature, wind, dust, exertion such as rapid walk

ing, talking, laughing-pleurisy, and many other things. Unquestionably, the first remedy to be tried for a cough should be the open air cure. It is astonishing to observe how quickly many patients lose their cough when they "take the cure" faithfully. In others, however, the cough may be so severe that the mere fact that they lead an open air life may not be sufficient to enable them to control their cough.

At this point it may be well to recall the fact that in some instances the cough is undoubtedly due in part to nervousness and can be largely controlled. An instance of this was observed a year or two ago, when a young girl, leaving home to go to a health resort, suffered severely from a cough which her physician thought was due in part to nervousness. On the trip she had a sudden scare and from that time on the cough disappeared. This cough was undoubtedly due to nervousness. It is for patients of this class that Dr. Dettweiler's advice has most weight. He said coughing was merely scratching the throat and that it was as impolite to scratch the throat as to scratch the back in public.

There are many simple devices which one can follow for controlling the cough. Probably the best of all is rest in a reclining position, or indeed for several days in bed, avoiding talking and especially hearty laughing. Coughing during the day can frequently be controlled by sips of cold water, tablets of Iceland moss, slippery elm, or