TUBERCULOSIS. 516 TUBEKCULOSIS. an environment favorable for the attainment of the best possible nutrition, to relieve the cough, sweats, and otlicr wearing symptoms, and to give medicines that tend to check the progress of the disease. Fresh air is an essential consideration, whether treatment is carried on in sanatoria or at home. In general, a dry, germ-free bracing atmosphere, with an equable temperature and plenty of sunlight, where the patient can live practically out of doors, should be selected. There is no advantage in sending inevitably fatal eases away from home. Jloderately advanced cases are as a rule more comfortable in warm climates like that of Florida and .South California. The sleeping room of the consumptive should be well ventilated. Nutrition should be kept up to a high point by a plentiful supply of good, easily digested food, given at frequent intervals and carefully adapted to the patient's digestive pow- ers. Jlilk, eggs, koumiss, or brotlis may be taken between meals, and when the stomach is not equal to solid food, a small amount of wine or whisky may be given at meal time to stimu- hite appetite and digestion. Life should be out of doors, but exercise should stop short of fatigue. The mental condition of the patient is of the utmost imjjortance and cheerful surround- ings and occupation should be chosen where pos- sible. Of the drugs that seem to have a definite cura- tive value, the creosote group, cod-liver oil, and the liypophospliites are most valuable. Creosote, creosote carbonate, guaiacol and guaiacol car- bonate, given in gradually increasing doses, are of use in all stages, but particularly in the active inllannnatory stages. They diminish cough very markedl,y. Iodoform is sometimes given instead of creosote. Cod-liver oil improves the nutrition and is especially useful in what is illy termed the pretubercular stage. It acts better in children than in adults, and better in glandular and bone tuberculosis than in pulmo- nar.v. The emulsified fats or cream are good sub- .stitutes when cod-liver oil cannot be taken. Iron, arsenic, strychnine, and similar tonics are given according to indications. Besides gener.Tl meas- ures, special s,vmptoms have to be watched and treated. Fever is combated by rest, fresh air, and small doses of quinine : severe cough by opiates; night sweats by lielladonna, strychnine, and the mineral acids. Hemorrhage from the lungs calls for complete rest, large doses of opium or morpliine, and suprarenal extract, with iee over the point of bleeding when it can be located. Vomiting, headache, indigestion, diarrha?a, etc., are all present and have to be managed as in other diseases. Attempts to treat the disease locally by means of inhalation of antiseptic vapors, and ozonized air, and later liy the X-ray and concentrated sun- light, have had a very small measure of success. Tuberculosis attacks, primarily or secondarily, the lymph glands, bones, joints, intestines, peri- tonemn, brain, kidneys, bladder, spleen, liver, pleurae, pericardium, heart, generative organs, and skin. Its maiiifestations in these situations are described in the articles on Scrofula; Adenitis; PLErBiST: Pejritoxtttr: Mextxgttis: Bbight's Dise.se; Bl.ddeb; Pericarditis ; etc. P.TI10L0GV ANiJ Bacteriology. Tulierculosis is invariably due to the presence in the bod}- and to the action upon the body tissues of a specific microorganism known as the tubercle bacillus. The tubercle bacillus is a thin bacillus from three to four mieromillimeters long, i.e. about one- lialf the diameter of a red blood cell. It is often slightly curved and there is a marked tendency of the bacilli to liang together, two often lying in the shape of a letter V. The bacillus grows on ordinary culture media at body temperature, but the growth is extremely slow. Tlius, cultures on blood serum or on nutrient agar rarely show any signs of growth earlier than two weeks, wlien thin grayish drv scales begin to appear on the surface of the medium. Cultures grow best in the dark; in fact, the bacillus is killed by exposure for a few liours to the direct rays of the sun. From a pure culture successive cultures may be made in- definitel.v. Such cultures show a gradual loss of virulence, but no changes in growth char- acteristic. Inoculation of susceptible animals, such as the guinea-pig, with these cultures re- produces the disease. See Plate of Disease Ger.is. The bacillus stains with difTiculty with the aniline d,ves, but wlien once stained retains the dye with great tenacit,y. It is upon this staining characteristic that our most important method for mor]ihologically differentiating the tubercle bacillus depends. This consists in staining a sus- pected specimen with a strong solution of a red dye known as fuchsin, to which carbolic acid has been added to increase its penetrating powers. After staining, the specimen is washed in dilute acid, which extracts the stain from all other bac- teria. The tubercle bacilli retain the red stain in spite of the action of the acid and may tlius be differentiated. But three other bacilli re- semble the tubercle bacillus in this staining re- action. They are the bacillus of leprosv, the smegma bacillus, and the so-called 'hay bacillus.' The first and last of these can usually be excluded on the ground of the impossibility of their being present. The smegma bacillus as a rule enters into consideration only in examining urine for the tubercle bacillus. The changes which the tubercle bacillus causes in the body tissues are various. Thus it may stimulate the passage of serum and white blood colls from the blood vessels into the tissues, caus- ing an exudative inflammation; or it may stimu- late the production of new connective tissue, caus- ing what is known as a productive inflammation; or its effects may be more severe and lead to death of tissue or necrotic inflammation. Any one of these effects may be produced separately, or. as is commonly the case, they are combined. The most distinctive feature of the action of the tubercle bacillus in the body is the production of what are known as tubercles or tubercle tissue. This tubercle tissue may occur either as the nodular tubercle or as diftuse tubercle tissue. In either ease, according to Osier. "The 'tubercle' presents in its early formation nothinjr distinct- ive or peculiar either in its components or in their arrangement. Identical structures are pro- duced by other parasites, such as the actionomy- cnsis and the strongvlns in the luncs of 'iheep." In the production of the 'tubercle" the bacilli, ac- cording to the extensive researches of Baum- garten. first cause a proliferation of the connec- tive tissue elements with the production of epi- tbeliod and giant cells. Followinc this is an in- flammatorv reaction with the exudation of serum
