Circular No. 54. 
STATE BOARD OF HEALTH OF MAINE. 
The Prevention of Consumption 
That insidious disease which we call consumption, phthisis, 
or tuberculosis of the lungs, is the most terrible destroyer of 
lives with which civilization has to contend. 
At the present time the fact of the infectiousness of con- 
sumption is firmly established in a scientific way, and enough 
is known of the natural history of the infective agent, the 
bacillus of tuberculosis, and of the ways in which it is com- 
municated to man, to enable us to lay down rules for the 
prevention of the disease with more positiveness than was 
formerly possible. 
The source of infection is two-fold, from one human being 
to another, and from tuberculous animals to man. 
Consumptive human beings, are, however, by far the great- 
est source of infection, but fortunately the ways in which 
the contagion is disseminated are but few, and by intelligent 
care they may be effectually controlled. 
From the human source, we may consider the expectoration 
(the sputum) as practically the one great danger. The con- 
sumptive sputum usually contains an abundance of the in- 
fection, the bacilli, and these microscopic organisms are found 
to be capable of retaining their vitality and their infectious 
Qualities for a long while, even after the sputum has been 
thoroughly dried. 
As a general proposition the statement is true that the 
breath of the patient is not infectious, and that the same may 
be said of the sputum so long as it remains moist. Later ex- 
perimental work, however, indicates a possibility of infection 
in the immediate vicinity of hard, open-mounted coughing. 
Another line of investigation has proved that the careless 
consumptive patient is a focus of infection, and a danger to all 
persons who come much in proximity to him, especially to those 
who dwell in the same rooms with him. 
The reason of this is that the expectoration of the patient, 
spit upon floors, carpets, pocket handkerchiefs, or clothing, 
becomes dried and pulverized, and, floated in the air, still 
contains the infectious germs, and cannot be inhaled without 
great danger. 
[Revised Edition of 1907.] 
Though infection may be regarded as the principal, the essential, 
cause of consumption, there are nevertheless various contributory- 
causes which have much to do with increasing the death-rate from 
this disease, and they should never be disregarded. The most impor- 
tant of these are the breathing of impure air,—that of unventilated 
sleeping rooms, living rooms, schoolrooms, and offices,—the use of 
food not sufficiently nutritious, and dwelling upon a damp soil. 
Heredity, formerly thought to be a potent cause of pulmonary con- 
sumption and other forms of tuberculosis, is now known to have but little part in the causation of the disease. Since the infectiousness of 
the disease has been shown, family groups of consumption, “house 
epidemics,” are now referred to infection rather than to hereditary 
influence. Though heredity is possible, the best authorities, the world 
over, now teach that cases of hereditary transmission of tuberculosis 
are very rare. 
Many children die in their earlier years from various tubercular 
diseases, tubercular inflammation of the brain, “consumption of the 
bowels,” etc. Many of these deaths are due to living amid infectious 
surroundings and breathing infected air. The danger to infants in 
the arms of tuberculous mothers, or in the rooms inhabited by con- 
sumptive persons, is very great indeed. It may safely be said that 
they are almost sure of contracting the infection if they occupy the 
same rooms with consumptive persons who are not exceedingly careful 
in the care of their sputum; and the danger is not by any means fully 
obviated by precautions as careful as may be carried out in the ordi- 
nary home. 
From animals the chief source of danger is from the milk of tuber- 
culous cows. A slighter degree of danger threatens from the use of 
meat from tubercular animals. 
PREVENTION. 
Two facts should encourage the patient: One is that there 
is always an intrinsic tendency to recovery in the earlier 
stages of the disease, and that, under modern treatment a 
large percentage of cases do recover; the other is that there 
is no reason for any person to think that he is doomed by 
heredity, no matter what his family history may be. 
It should be impressed upon consumptive patients and other 
persons living with them that the sputum (what they cough 
up) is dangerous and must be properly disposed of. It must 
not become dry. There are several ways in which the sputum 
may safely be cared for, but that mentioned under “B” is to 
be preferred. It is in use in most of the sanatoriums. 
A. vressed paper spit-cups, costing but little, are on the market. 
One or several can be used daily and, after it has been used, each cup 
with cover and contents are burned. 
B. Paper cups held in a metal frame may be used. After use the 
cup and contents are burned. 
C. Metal or porcelain spit-cups or spittoons, each containing a 
small quantity of disinfecting Solution 1 or 2, may be used. The final 
disposal of the sputum may be: 
1. By pouring it down the water-closet. 
2. By cremation when practicable, (a) In a small fire outdoors, 
(b) In the house heater, using a stout sheet iron box with a handle 
three feet long. Partly fill the box with sawdust, or fold a paper 
inside it; pour in the contents of the spit-cup or cuspidor; with the 
direct draft of the heater open, invert the box over the firepot, hold- 
ing the box in place a moment until the flame or the heat sterilizes 
it. When the sputum is to be cremated, but a small quantity of the 
disinfecting solution should be used in the spittoon. 
3. By setting the vessel aside, preferably in a warm place, so that 
the disinfectant may act eight or twelve hours longer. The quantity 
of disinfecting solution should be in excess of that of the sputum 
Then bury or otherwise dispose of it so that flies and the domestic 
animals cannot reach it. 
The patient should have two spit-cups or spittoons for alternate 
use. A cover should exclude flies. Cleansing can be done with wash- 
ing soda and boiling water, or soap and hot water. 
D. Knopf’s1 aluminum pocket spit-flask is very convenient, especi- 
ally when the patient is away from home, is traveling, or is confined 
to his bed. 
E. When away from his room the patient may spit into Japanese 
DSF3 Rules for the patient. paper napkins to be put immediately into a rubber tobacco-pouch until 
they can be burned. But the fingers are pretty sure to be infected, 
and as a general practice spitting into napkins or pieces of cloth is 
not to be recommended. 
F. Spitting into handkerchiefs should be avoided. If occasionally 
forced to do this, the handkerchief should be boiled before the sputum 
dries. Handkerchiefs upon which the sputum is allowed to dry, sur- 
round the user with a halo of infection, infect the pocket and every- 
thing else they touch, and lessen the patient’s chances of recovery. 
After coughing, the lips should not be wiped with the handkerchief 
used for the nose. The lips may be wiped with paper napkins to be 
burned later. 
Repress cough as much as possible. Cough gently with the mouth 
closed as much as possible. Never swallow the sputum. By so doing 
you favor the extension of the disease to the intestinal tract. 
Do not soil personal or bed clothing with the sputum nor the hands 
when avoidable. Wash the hands often. Male patients, who wear a 
moustache or beard, should kepp it closely clipped. 
Do not infect the immediate surroundings of the home, nor spit 
upon the grass or hay or anywhere else where the sputum may be 
eaten by cattle, chickens, or other animals. 
Rules for attendants. 
The floors, woodwork, and furniture of rooms in which consump- 
tive patients stay should be wiped with a damp cloth, not dusted 
nor swept in the dry way. 
Clothing may he disinfected by boiling as in ordinary laundry pro- 
cesses. Rooms may be disinfected with formaldehyde fumigation— 
large doses—supplemented with the washing of the floor with Solu- 
tion 7. This should be done every few weeks when practicable, while 
the rooms are occupied by the patient. If the floor or other surfaces 
are accidently soiled with sputum, the spots should be wet and rubbed 
with Solution 7, 1, or 2. (See Circular No. 70 for disinfection.) 
Rooms for consumptives should have no fixed carpets. A few rugs 
may replace them. They should frequently be carried into the open 
air and exposed to the action of direct sunshine several hours at a 
time. For the thorough disinfection of them steam is the best. The 
table ware of the patient, the knife, fork, cup, and spoons particularly, 
should be kept separate anu washed by themselves in scalding water 
In addition to the danger from infectious dust, if it is allowed to 
be diffused through the air, there are other possible ways of com- 
municating the infection. It may be carried directly to the mouth by 
the fingers, or indirectly by handling articles of food. After soiling 
the hands, cleanse them carefully. Guard against inoculating cuts or 
abrasions of the hands with the sputum. 
Rules for everybody. 
A. Anything tending to lower the tone of the general health may 
act as a predisposing cause of tuberculosis, as of other diseases,—in- 
sufficient nutriment, overwork, loss of sleep, worry, close and dusty 
air. Avoid these. Do not over-heat homes and places of business. From 
65° to 68° F. is much better than higher temperatures. Habituation 
will make these lower temperatures comfortable? Live iu the open 
air and sunshine as much as possible. Sleep with wide open windows 
at all seasons, protecting the body with enough clothing, and the top 
of the head if necessary in cold weather. In the morning open the 
bed and give it a prolonged airing and direct sunshine if practicable. 
In the daytime the open-window ventilation of sleeping rooms may be 
brief in cold weather, if “wide-open windows” is the rule at night. 
Wear only just enough clothing for comfort day and night. Avoid 
chest-protectors and extra heavy under-clothing, especially if you live 
indoors much. Eat temperately a sufficiency of plain, nutritious food,— 
a fairly “well balanced ration”—with a fair quantity of vegetable and 
animal oils and fats, particularly in cold weather, and limit the quan- 
tity of pastry, confectionery and other sweets. Keep clean, but use 
cold baths only when a comfortable reaction quickly follows. Undue 
exercise may be dangerous if lungs are affected. If there is prolonged 
loss of appetite, of strength, and of weight, with or without cough, and without other plain cause, there is reason to suspect tuberculo-. 
sis. If present, the sooner you know it, the quicker you can be cured. 
B. Every new case of tuberculosis comes from some earlier case. 
The germs of this disease retain their vitality and their infectivity a 
long time under favoring conditions. Therefore do not bring into 
your house clothing formerly used by consumptives unless it has been 
thoroughly disinfected; do not move into an infected house or rooms, 
until the thoroughness of the disinfection is unquestionable; do not 
put to your lips or mouth, eating or drinking utensils, pipes, wind 
instruments, money, or anything else that has been used or handled 
by consumptives; do not buy bread, milk, or other articles of food, 
not to be cooked, from consumptives; kissing, particularly np-to-lip, 
is unsafe, if one party to the act is tuberculous; thorough cooking for 
meat or a temperature somewhat below the boiling point (176° F. 
for 10 minutes) for milk will render these food-stuffs safe. 
By a strict observance of the rules which are expressed and 
suggested in the foreeoing, the principal dangers of infection 
may be avoided. 
Sanatorium Treatment.—For all persons to whom it is avail- 
able, the sanatorium treatment of tuberculosis of the lungs is 
more efficient and is usually better for the patient and his 
family than treatment at home. In the well-equipped special 
sanatorium the patient has the advantages of the constant care 
of the physician; the possibilities of the fullest outdoor life 
under congenial conditions; a specially nutritious diet; exer- 
cise regulated to the special needs of each patient; baths for 
their curative influence; medical treatment, local or systemic, 
drugs or special apparatus as needed. Our northern summers 
have a favorable reputation, but patients under sanatorium 
treatment generally gain much more rapidly in winter than 
in summer. 
The State board of health takes pleasure in calling attention to 
The Maine Sanatorium in the town of Hebron, for we believe that the 
climate of Maine is better adapted for the cure of many patients than 
that of many places wnere milder temperatures prevail, and because 
this institution is now equipped for as good and careful work as may 
be found anywhere. Its success is doubly gratifying for -the reason 
that the initiatory move which led to the founding of the Sanatorium 
was started by the board. 
DISINFECTING SOLUTIONS. 
Solution i. 
Carbolic Acid (pure liquified), 7 ounces. 
Water, 1 gallon. 
Mix. This is approximately a 5 per cent, solution. For the disin- 
fection of clothing this solution mixed half and half with water will do. 
Solution 2. 
Lysol, 5 ounces. 
Water, 1 gallon. 
Mix. This may be used as a substitute for Solution 1, one-half the 
strength sufficing for uncolored clothing. Many colors are changed 
by it. 
Solution 7. 
Solution of Formaldehyde (Formalin), 6 ounces. 
Water, 1 gallon. 
Mix. This mixture contains a little less than 2 per cent, of formal- 
dehyde. 
It is a good plan to dissolve 4 or 5 tablespoonfuls of common salt in 
each quart of Solution 1, or Solution 2, thereby increasing consider- 
ably the disinfecting power of the solution.