Prof. Koch's Method to Cure Tuberculosis Popularly Treated Part 2

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 _a.s.sociations_ 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 _inst.i.tutions 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.

All this must still be observed in the future. On the other hand above all the numberless remedies will be dropped that have heretofore been applied as presumably specific remedies for consumption.

Creosote, which was so much praised at its appearance a few years ago and still applied, because of the non-existence of a better remedy, will be dropped into obliteration and with it Guajacol which was just getting to be the "fashion".

All the various inhalation methods that have matured in later years will disappear from the picture plane as far as this has not ever now happened.

The medical remedies, which were given for the torturing cough, for hemorrhage of the lungs, sweats etc., will in most cases be superfluous after this. Hemorrhages will now and then still be experienced as the same may set in unexpectedly.

The diatetic cures with whey, koumiss, grapes etc. will retain their importance and also the bathing resorts will be hunted up by patients as formerly.

The owners also of special inst.i.tutes for curing pulmonary consumption need not despair with the idea that they will not be needed in the future. On the contrary, those needing cure will flock to them in all the greater numbers, as they now know that they certainly will be restored to health within a definitely limited time.

The other forms of Tuberculosis.

Of the other forms of tuberculosis _laryngeal consumption_ is very often combined with pulmonary consumption. It is estimated that this is true of at least one-fourth of all cases of pulmonary consumption.

At first laryngeal consumption can not in any way be distinguished from an ordinary inflammation of the larynx. A certain weakness and sensitiveness of the organs however is suspicious, also great liability to hoa.r.s.eness. On the other hand laryngeal consumption may exist without any sort of ailing to the patient.

These appear later, however, when lung tuberculosis is progressing. The larynx shows more distinct outlines on the lean throat, difficulty in swallowing is experienced, pains radiate toward the ear. Food and drinks come up again after being swallowed.

The painful cough has a hollow, barking, harsh sound, provokes vomiting, and the sputum together with foul breath consists of foamy, slimy, purulent lumps. Breathing gradually becomes more difficult and louder.

As regards the duration of laryngeal consumption it generally runs parallel with pulmonary consumption. If the latter progresses more rapidly so also will the destruction of the larynx by the tubercle-bacilli be a more rapid one and vice versa. In several cases it has been observed that, if pulmonary consumption progressed or remained without any extraordinary symptoms, those with diseased larynx have lived for years, with alternating improvements and diminutions, and also an occasional suspension of all symptoms, till on account of often only a trivial, evil influence a new stimulus is given and the disease found an unexpectedly rapid completion of its course.

Until now only few cases of laryngeal consumption could be looked upon as really cured. Lately it has been tried to accomplish cures especially by the application of caustics. This will not now be necessary. But those afflicted in this way, will henceforth be obliged to try and live in air free from dust, to travel south during the winter and to subject themselves to a general strengthening treatment.

_Tuberculosis_ of the _tongue_ is relatively very scarce. The individual in such a case nearly always shows p.r.o.nounced pulmonary tuberculosis.

Sometimes tuberculosis of the tongue is combined with tuberculous sores on the lips and also on the a.n.u.s.

Tongue tuberculosis forms small ulcers, generally on the rim, very seldomly on the back of the tongue. They always are very small, generally about the size of lentils or peas. They often remain unchanged for months. At times they are very painful, though as a rule the pain is mild. The male s.e.x is attacked by tongue tuberculosis especially frequently.

The treatment before this consisted in cutting out all the diseased parts; now it will be much simpler.

_Nasal tuberculosis_ appears similar to the common stopping up of the nose. But when ulcers are formed, the secretions from the nose take on a purulent somewhat malodorous character. But if the affection is neglected, the secretion becomes b.l.o.o.d.y and of very bad odor.

Until now nasal tuberculosis had been treated by applying caustics to the ulcerated portions.

_Tuberculosis of the intestines_ or _intestinal consumption_ is especially found in _children_. The appearance of the same is already characteristic; the limbs are emaciated and withered; the old-looking wrinkled face shows a harsh contrast with the immoderately expanded body (frog-belly) which is caused by an acc.u.mulation of gases in the limp intestines which are then filled to bursting. Many such children have succ.u.mbed to gradually progressing emaciation and weakness.

Probably it will not be possible to save all children in the future that have been stricken with this disease as many are wanting in sufficient vitality to resist all external influences.

With adults intestinal consumption makes itself known by everlasting diarrhoea, a result of the numerous ulcers in the intestines which have been caused by the tubercle-bacilli.

_Tuberculosis of the brain and of the cerebral membranes_ also attack children especially. Before this no attempts have been made to try whether it is now possible to cure the _tuberculous inflammation of the cerebral membranes_ which has previously been unconditionally fatal. The decision will certainly soon be made.

We will give a fuller description of the symptoms of this disease to thus enable timely summons of medical interference. This disease will be known to many as "acute hydrocephalus."

As a rule children of 2-7 years of age are attacked by this fearful disease. The antecedents are extremely peculiar and manifold. Even two or three weeks before the outbreak of the real sickness, emaciation takes place from which the face is strangely enough entirely exempt, so that children, when dressed show no signs of a change. Attentive mothers and nurses, however, regularly notice the same and especially the appearance of the ribs causes no little anxiety. With this a slight pallor of the face is a.s.sociated and a peculiar l.u.s.tre of the eyes. The children lose their former feeling of gayety and activity. They sleep more than usual, withdraw from their favorite game, they become grumbly and shy toward their surroundings and cry for the slightest reason. It also is very peculiar that they avoid trying their former little tricks, such as climbing up on chairs, opening of door bolts that are almost out of their reach, they even will not try to look through a latticed window and asked to do so, decidedly refuse. Boys, that would not stand anything from their a.s.sociates, that fought and wrestled as long as their strength permitted it, sneak away cowardly and crying from such attacks. Other children again become extraordinarily tender-hearted and affectionate, they hug their parents continually and can hardly console themselves when they leave them.

In the case of older children that have already learnt something, teachers notice unusual inattention and indifference, committing to memory comes harder than usual and what is finally learnt is recited in an awkward and stammering way. The children sleep unusually much and often by day; on the other hand their sleep at night is less sound and is interrupted by horrid dreams, frequent turning over in the bed and frequent clamorous outcries.

The appet.i.te is lessened, and often a craving is noticed for stimulating food of which, however, little is eaten. Thirst is not increased. Urinal secretion is somewhat diminished and the urine is characterized by a brick-colored precipitate. The stool is rather costive, especially with larger children; but diarrhoea may attend this disease. The latter is princ.i.p.ally the case with small children that are in the stage of first teething.

Headache is rarely felt and hardly ever complained of even by larger children; dizziness and unsteady walking is frequently observed. The children quite often complain of stomach-ache, which is very much increased by pressure on the abdomen.

Fever is not generally attendant, but the same may be present.

The symptoms just described, separately or collectively, gradually increase; the children finally take to their bed and now the _real cerebral affection_ developes.

Now the princ.i.p.al symptoms are: vomiting, constipation, slow pulse, irregular abrupt breathing, increased temperature of the skin, contracted abdomen, headache, great excitement alternating with drowsiness, beginning decrease of reason, and deranged ability of moving the limbs.

As regards _vomiting_, this is almost a continuous symptom and generally appears in the earlier stages. But the duration of vomiting is very different. Some children vomit only for one or more days and not all they have eaten, while others vomit continuously from the beginning of the disease till they are relieved by death, and no food can be found that is not thrown up shortly after its being eaten. In this connection it is a peculiar fact that vomiting will not recur if it has once ceased for twenty-four hours.

Very important for the recognition of the disease is the manner of vomiting. For a child suffering from a spoiled stomach will be troubled with nausea, belching, choking and cold sweat long before it is forced to vomit, while children with acute hydrocephalus will throw up without any previous symptoms of that kind, just as though they filled the mouth with water and spit it out again. Vomiting is facilitated when children are raised or placed on their side. It ceases for the time the stomach is empty, but as soon as fluid or even solid food is taken in it will be cast out at once without causing any particular distress or inconvenience to the child. Gall is very rarely mixed with the vomit.

A second and nearly as constant a symptom is _constipation_ from which nearly three-fourths of the diseased children suffer. As a rule cathartics have no effect and are generally thrown out through the mouth. This constipation will not last till the end, for a few pappy stools appear later on whether purgatives are administered or not.

Violent diarrhoea resulting from intestinal tuberculosis may be discontinued at the beginning of acute hydrocephalus. But the later stools will again be thin and of cadaverous odor.

During the latter stages of the disease children will often _fail to pa.s.s urine_ for twenty-four hours, so that the physician is obliged to draw it off with a catheter.

The appet.i.te does not disappear entirely as a rule. There may not be any desire for food, but generally little difficulty is experienced in inducing children to take milk or broth, which is all the more surprising as vomiting regularly follows.

The _fever_ is generally not very intense. The temperature of the head, especially the forehead, is considerably increased in all cases and remains so until death ensues, while the feet have great tendency to getting cold.