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therefore, to swallow the sputum, on account of the danger of infecting other parts of the body.

Tubercle bacilli are not thrown out in ordinary respiration; that is in ordinary quiet breathing. In coughing or sneezing, however, a certain number that have lodged in the throat and mouth may be thrown out and so a paper napkin should be held before the mouth.

Taking all these precautions a patient may still accidentally contaminate his fingers from touching his lips inadvertently, or otherwise: therefore, it is necessary before eating to wash

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Nickel Plated Pocket Sputum Flask.

his hands and at the same time it is not a bad practice to rinse out the mouth in order to infect as little as possible the food he eats. Linen handkerchiefs are against the rule in some sanatoriums. There is probably nothing in use in civilized communities to-day so dirty and so unesthetic as the linen handkerchief. It is not a pleasant thing to think about or talk about, but to correct filthy habits much must be mentioned. A linen handkerchief is used for expectoration once and turned over and put into the pocket or under the pillow; the second time it is used the previous ex pectoration contaminates the fingers and the clothes. A tuberculous patient who uses linen

Sputum Flask, Designed by the U. S Marine Hospital Service

mug. Put on the bottom of this a little lye, ordinary household lye, and moisten it with water. One-tenth or one-eighth of the cup may be filled with this lye water. This makes a very good receptacle for expectoration, and lye acts as a disinfectant. After being used,

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Constructed of tin, gold bronzed. It consists of two receptacles; the inner one is divided into two compartments, one of which is partly filled with water and or opening the spittoon water from the first compartment fills the other. The expectoration is then made when the water receives and washes it back into the first compartment, which can be easily and thoroughly cleansed.

the mouth is not infrequently missed, and the expectoration is thrown on the floor. Moreover, even when this does not occur, there is always more or less spattering. The spattering may be of the minutest drops, invisible to

is the flat, paper sputum boxes, opening with a flap like an envelope. They can be easily carried in the pocket. They are procurable in many drug stores and are worth about twentyfive cents a dozen. These pocket sputum cups

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cannot grow, and is in fact readily killed in bright sunlight.

Tuberculosis is not the only disease disseminated by spitting. Other contagious diseases, especially colds, owe their prevalence to this filthy habit, for it is a habit with many people. If people must spit they should take care of the expectoration.

In factories where women alone are employed the danger of contagion from tuberculosis is not nearly so great as in the factories where men are employed. The reason is plain. Women consider it beneath them to expectorate. Little girls are taught that spitting is a nasty, filthy habit, and as a bit of decorum they refrain from spitting. Boys are given no such teaching by their elders, and are led to understand by their playmates that. like cigarette smoking, spitting is an assertion of manhood. This is thoroughly exemplified in a story told the other day in one of our daily papers. A little fellow of ten, sitting by his father in a street car, was reading the sign forbidding spitting on the floor; a workman next to him cleared his throat and spat into the slit ordinarily used for the window. The conductor came in and expostulated rather roughly with the man, and assured him that if he spat there again he would have him arrested. The little boy looked up at the sign once more, and turning to his father asked. 'Why, where then will the poor fellow spit?"

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An Attempt to Treat

Consumption by

by Sanatorium Methods In the Homes of the Poor.

By Joseph H. Pratt, M. D., of Boston.

PHYSICIAN TO THE DISPENSARY OF THE MASSACHUSETTS GENERAL HOSPITAL.

A tuberculosis class or home sanatorium, consisting probably of not more than fifty members, will be established in Boston under the auspices of Emmanuel Church. It is important that the number of patients should be limited in order that the careful supervision so necessary for success may be secured.

The object of this plan is to carry out the sanatorium methods in the homes of the patients. Dr. Charles L. Minor, of Asheville,

N. C., has shown that the hygienic regimen may be employed with success outside of a sanatorium if sufficiently detailed instructions are given and strict discipline maintained. His work has been among the well-to-do educated classes. We believe that equally good results can be obtained in the homes of the intelligent poor.

The practical application of this plan has been rendered possible by the support received

from the Rev. Elwood Worcester, rector of Emmanuel Church. In the work of organizing the class I have been greatly aided by Dr. John B. Hawes, 2d, who will be associated with me in the medical work.

It is now known that too great value has been attributed to climate in the treatment of tuberculosis. As has been well said, care without climate is more important than climate without care. It is far better to provide the poor consumptives in this locality with facilities for leading an out-of-door life and with nutritious food at home than to send them away to a more favored climate where, however, healthful surroundings, good food and proper medical attention are beyond their slender means.

Our work will not duplicate that of existing organizations. It is a supplement, not a substitute for the tuberculosis dispensary, and is intended for those who are unable to receive the benefit of treatment in the state sanatorium. The essential features in the sanatorium treatment are:

1. Facilities for living an outdoor life in all kinds of weather.

2. Good food.

3. Careful regulation of the details of the daily life. The necessary supervision will be maintained by (a) Frequent visits of the nurse, and occasional visits of the physician; (b) Weekly meetings in the examing room

of the class; (c) The individual record book in which each patient will enter the essential details of the day, e. g., the number of hours at rest, the amount of exercise, the diet, and, if necessary, the temperature.

It is essential that each patient shall have facilities for living and sleeping out of doors. These may be secured by moving to the upper floor of an apartment or tenement with a flat roof, in order that the patient can live on the roof. The full amount of available sunshine will thus be secured and an atmosphere relatively free from dust. Many of the newer tenement and apartment houses have flat roofs. Some families may prefer moving to the less crowded suburban district, where it will be possible to live on a veranda or in a tent. The patients will be aided in providing themselves with bed-tents, shelters from winds, reclining chairs, and the proper wraps and coverings, in order that the out-of-door life may be comfortable in all sorts of weather. A carpenter will be specially trained to make balconies and tents of the most approved design and these will be furnished at the lowest possible cost.

Instruction in the nature of the disease and the prevention of its spread will be given. Sputum cups and paper handkerchiefs will be supplied. Those in charge of the patient's food will be taught its proper perparation, and in special cases, milk, butter, oil and eggs will be furnished.

Boston's Pioneer Day Sanatorium for Tubercu

lous

Patients.

To the Editor of the Journal of The Outdoor Life:

A few days ago I visited the day camp, or day sanatorium, for tuberculous patients on Parker Hill, Boston, and as it is the pioneer institution of its kind in this country some account of it may be of interest to your readers. Arriving at the sightly but quiet and secluded camp, just beyond the Baptist Hospital and on the highest point of land in Boston, I found Dr. Townsend, the visiting physician, and Miss Robbins, the nurse, busy with their work. The patients, some fifty men and women, nearly all young, are for the most part in the more hopeful stages of tubercu

losis, but for one reason or another they cannot be sent away from their tenement homes. I also found four or five children among the patients, some of these perfectly well, but unable to stay at home alone.

The arrangement of the camp is simple, but adequate for its purpose. Several tents are pitched in an old apple orchard on the top of the hill, 230 feet above the sea. From just outside the camp a beautiful view of Boston, with its harbor and its islands, is to be had, a privilege much enjoyed by many of the patients. The tents referred to are capable of sheltering about fifty people from showers, and also furnish facilities for dining, for exam

ining patients, recording cases, and for other purposes. A well-built camp kitchen, in charge of an active German cook, a good water supply, and all necessary sanitary arrangements I found well located and in perfect order. There is also a small but well used library. The camp furniture is of the simplest sort, consisting of reclining chairs, and a few camp cots for such patients as may be feverish. Many patients spend much time reading, and in playing various games. I noticed, also, many of the women had their sewing with them. The patients come regularly, and are brought up the steep hill to the camp each morning between 8 and 9.30 in a barge which meets them at Roxbury Crossing. Between 5 and 6 they walk slowly down the hill to the electric cars on Huntington avenue, and return to their homes, the exercise of walking down the hill being rather beneficial than otherwise, after resting quietly nearly all day.

A substantial hot dinner is served in the mess tent, about noon, also a lunch on arrival in camp, and again a little before leaving. The eggs, milk, bread, and other articles of diet, some of which I was invited to sample, are of the best. The management proposes soon to give the patients some informal lectures or talks on hygiene, with special reference to the prevention and cure of their disease, emphasizing the importance of fresh air both day time and night time, daily bathing. freedom from dust, the selection of proper food, the avoidance of over-fatigue, the need of securing sufficient sleep, and, lastly, methods of preventing communication of the disease.

It is greatly to be desired that the Associa

tion may receive sufficient additional funds to enable it to provide for certain patients who would benefit immensely if they could also spend their nights in the camp, instead of in their poor, stuffy bedrooms in the city. Such an extension of the work would be a natural development of the idea, and is in many places in successful operation. Some of the patients themselves could be made useful in carrying out this plan, and thus pay for the service rendered them.

The four weeks that the camp has now been occupied shows that a general gain in weight has been made, and all report that they eat and sleep better than before. The project originated in the Boston Association for the Relief and Control of Tuberculosis, of which Dr. Edward O. Otis is president and Mr. A. M. Wilson, secretary.

Berlin and a few other German cities have for several years provided day sanatoriums like the one just described, and though of course inferior to complete sanatoriums, they have, nevertheless, done a great deal of good.

The Association intends, if its funds permit, to continue the experiment until the weather conditions of early winter compel it to break camp.

If this pioneer day sanatorium of America should prove to be the success that we hope and expect, we shall undoubtedly see other American cities repeating the experiment and accomplishing much good in curing and preventing one of our commonest and most insidious diseases.

H. LINCOLN CHASE, M. D. BROOKLINE, MASS.

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