and feasible a room to himself, but separate dishes and silver are not necessary if they are washed carefully and scalded and polished. The room may contain a few pictures and rugs. Washable curtains are permissible. Dry dusting or dry sweeping is inexcusable.

The skin is crowded with tiny bloodvessels in whose walls are still smaller muscles which narrow or dilate the bloodvessels. Through the contact of the blood in these tiny vessels and in lungs with the air the body loses heat. In colder air the skin blanches, in hot air it becomes reddened through the contraction and dilation of these blood vessels. To meet sudden changes of temperature these tiny vessels must be quickly contracted or dilated, or otherwise we become chilled or overheated and catch cold. We must strive to keep the muscles of these blood vessels in good condition to avoid these mishaps. We can best do this by washing with hot water and quickly sponging off with cold. The neck, arms, chest and back should be treated in this way every day, but the room must be at least 60°. Twice every week a hot bath using plenty of soap should be taken, followed by a cold sponge, performed in cold weather while still standing in the hot water. Every patient should begin to sponge himself as soon as possible, but his physician must decide when he should begin.

XXIV

ON THE CARE OF THE MOUTH

"Out of thine own mouth will I judge thee."

THE stomach has been described as the bulwark in the individual's fight against tuberculosis. If this be true, and it is in part at least, should we not look to our first and second lines of defense, the gums and teeth? More than 80 per cent. among civilized races are said to suffer from dental caries (decayed teeth). Sound teeth and a healthy mouth are necessary to maintain health and are of much more importance in tuberculosis patients. Decayed teeth prevent perfect mastication and may lead to aches and abscesses that greatly upset the even tenor of a patient's way.

The mouth harbors constantly germs of many sorts and at times those that produce pus and are capable of producing blood poisoning, as well as the diphtheria germ and the pneumonia germ. These germs are found in greater numbers in patients with uncleanly mouths, proof that cleansing the mouth reduces greatly the number of its germs. It has long been recognized that it is impossible to render the mouth sterile for any period of time, but it is well known that wounds of the mouth heal very quickly, and our

aim should be to keep the number of harmful germs in the mouth so reduced that they can produce no injurious effect. If this be not done decay of the teeth may set in or progress more rapidly, the gum may become affected with Rigg's disease (pyorrhea alveolaris), and at times the germs may gain access through these places of entry to the heart, kidney, or joints and cause serious disease. A tooth with an abscess on its root (an ulcerated tooth) may cause this trouble, and unclean false teeth and plates may also bring about disease.

Again the author has known patients who, suffering for years from diarrhea and other digestive disturbances, were cured by having their mouths put in good condition. Every patient whose mouth and teeth are not in perfect order should have them attended to as soon as his physician thinks it advisable.

Once in order the teeth should be inspected at least every six months by a competent dentist, and the patient should be scrupulous in his care of them. It is said that "a clean tooth never decays" and "a lazy tooth in time becomes a rotten one." From this the importance of suitable food and a proper tooth toilet can readily be seen.

Foods which necessitate considerable chewing are of much benefit to the teeth and should be eaten, as such mastication would in itself help cleanse and so greatly preserve the teeth.

But for most of us this is not or cannot be followed out so completely as to do away with other methods of cleansing. Simple rinsing of the mouth with water is not sufficient and a tooth brush, with bristles, as stiff as the individual can stand, and shaped after the form of the so-called prophylactic brush, should be used at least twice a day (night and morning) and if possible after each meal. The brush should be placed against the teeth and gums, with the bristles resting on the gums, and then turned in a rotatory manner so that the bristles pass lightly over the edges of the gums, enter into the spaces between the teeth, cover the surface of the teeth and so clean parts that the bristles do not reach in the ordinary methods. This procedure must of course be modified to cleanse the inner surface of the teeth. Warm water should then be forced between the teeth and dental floss passed gently between them. The tooth brush should always be dry when put in use and it is often advisable to use several brushes in rotation. They should hang in the sunlight when not in use. The advice given to patients to keep their tooth brushes in a weakly germicidal solution may help to destroy the teeth as well as the germs upon the bristles. Immersion in such a solution may be carried out where three or four brushes are kept in use and dried before using.

The question of a good mouth-wash has long

been discussed and experts have said a good mouth-wash should be non-poisonous, neutral (in reaction), non-corrosive, germicidal, pleasant to taste and smell, and refreshing. Patients, however, should not get the idea that any mouthwash can kill the tubercle germs in the mouth. It has been held and many still hold that an alkaline alcoholic solution is excellent for the mouth and teeth but recent work has cast some doubt upon this. In fact Prof. Gies advocates the use of fruit juices or vinegar diluted with 2 or 3 parts of water (to suit the individual taste), instead of alkaline dentifrices or mouth-washes, and in some patients they may be useful. The problem is still, like many others in medicine, unsettled, and the patient should seek the advice of his dentist or physician for a suitable formula. As a rule the formula prepared by the author and druggists at the Trudeau Sanatorium is good but not suitable for everyone. It follows:

Only a part of this should be made up. For use it should be diluted freely. Too free use of tooth powders should not be made.