In the treatment of tuberculosis, the best results have been obtained in sanatoria. In most cities, however, sanatorium treatment is not possible for many patients; consequently home treatment must be provided. This can be done most successfully when we imitate as far as possible the sanatorium method. This paper describes some of the arrangements for outdoor sleeping which may be provided for a patient taking the "cure" at home.

The Fresh Air Room.

Select the best lighted and best ventilated room, preferably one with southern exposure, for the patient to sleep in. All superfluous furniture and hangings should be removed. In doing this, however, the room need not be made cheerless; small rugs, washable curtains and one or two cheerful pictures may be allowed.

There should be some means of securing cross ventilation in all sleeping rooms, as for the ideal fresh air room this is most essential. When this cannot be arranged and when there are windows only on one side of the room and a transom is lacking, the window should be open at both upper and lower sash. This arrangement allows the bad air to escape through the opening at the top, while the fresh air enters below. The "French window" which opens from floor to ceiling by swinging inward is to be recommended for the ideal sleeping room. In ventilating a room which is used for a sitting room in the daytime, especially in stormy weather, it is sometimes necessary to protect the patient from a direct draft. For this purpose a shield may be made from an ordinary piece of hardwood board, eight inches wide (or larger) and long enough to fit in between the side casings. It can be covered with wire netting, cheese cloth or muslin. There are a variety of wind shields on the market called sash ventilators, or air deflectors.

Window Tents

In the treatment of tuberculosis the window tent was originally devised to give fresh air to patients in their own rooms. To a poor family the window tent has an economic advantage, especially if the room where the patient lies serves as a living room for the rest of the family. The fact that the well members should not shiver is of vital importance in many respects. A simple home window tent, and one which can be made easily in the homes of the poor, consists of a straight piece of denim or canvas hung from the top of the window casing and attached to the outer side of the bed. The space between this and the window casing on each side is closed with the same material properly cut and fitted. Ten to twelve yards of cloth is necessary. If made of denim, the price of the tent would be about $3.00; if of canvas, about $4.50. If this cannot be obtained, take two large, heavy cotton sheets, sew them together along the edge, tack one end to the top of the window casing and fasten the other end to the bed rail with tape. There will be enough cloth hanging on each side to form the sides of the tent, and this should be tacked to the window casings. The manufactured window tents are all constructed practically on the same principle. The difference between them is in their shape and the manner of their operation. There are two types: the awning variety, as illustrated by the Knopf and the Allen tents; and those of the box order, of which the Farlin, Walsh, Mott and Aerarium are examples.

Knopf Window Tent. The Knopf window tent[1] is constructed of four Bessemer rods furnished with hinged terminals, the hinges operating on a stout hinge pin at each end with circular washers so that it can be folded easily. The frame is covered with yacht sail twill. The ends of the cover are extended so they can be tucked in around the bedding. The tent fills half of the window opening and can be attached to the side casings three inches below the center of the sash, this space being for ventilation. The patient enters the bed and then the tent is lowered over him, or he can lower the tent himself by means of a small pulley attached to the upper portion of the window. The bed can be placed by the window to suit the patient's preference for sleeping on his right or left side. A piece of transparent celluloid is inserted in the middle of the inner side so that the patient can look into the room or can be watched.

Allen Window Tent. The Allen window tent[2] is on the same order as Knopf's, the difference being chiefly in size. The Allen tent covers the entire window and has the appearance of an ordinary window awning turned into the room, ventilation being secured from openings above the upper and below the lower sash.

Box Window Tent. The box variety of window tent consists of a light steel frame covered with canvas or cloth. The frame fits between the window casing like a wire screen frame. The bottom, through which the head is passed, can be made of flannel and can be drawn closely around the neck.

Aerarium. Dr. Bull's aerarium[3] is another device similar to a window tent. This arrangement consists of a double awning supported on a wooden or steel frame and attached to the outside of the window with a special ventilating arrangement. The head of a cot bed is put through the window and the patient's head rests out of doors. The lower window sash must be raised about two feet and a heavy cloth or curtain hung from its lower edge so that it will drop across the body and shut off the room from the outside air.

Window tents have a few advantages. The patient's prolonged rest in bed will be more endurable when he is permitted to look out on the street and watch life than when obliged to gaze at the four walls of his room. Also patients, who can be persuaded only with difficulty to sleep with the window wide open, will not hesitate when they have this tent as an inducement. Draft which the patient usually dreads, particularly in cold weather and when he perspires, need not be feared when sleeping in a window tent. Further, this limits the possible infection to the interior of the window tent, which is obviously an advantage. While, as a matter of course, the patient will have been taught to always hold his napkin before his mouth when he coughs or sneezes, this is not always done, and cannot be done when coughing in sleep. The constant exposure to air and light of the bacilli, which may have been expelled with the saliva and remain adhered to the canvas, will soon destroy them. Also the canvas of the tent is attached to the frame by simple bands and its removal from the frame for thorough cleansing, washing and disinfection is thus made easy.

Tents

Tents are frequently used for open air living. However, they are not to be recommended for those who can afford to construct open buildings of more durable material. Ordinary tents hold odors. They are often very hard to ventilate; for a strong draft is produced when the flaps are open. There is no ventilation through the canvas, as it is impenetrable by currents of air. In order to make a tent comfortable for a sick person it should have a large fly forming a double roof with an air space between, a wide awning in front where the patient can sit during the day, a board floor laid at least a few inches above the ground, and the sides boarded up two or three feet from the floor. Many modifications of the ordinary tent have been made for the purpose of obtaining a well ventilated canvas shelter.

Gardner Tent. The Gardner tent[4] is conical in shape with octagonal floor area, with an opening in the center of the roof and one at the bottom between the floor and the sides. These openings act like a fireplace and produce a constant upward current of air through the interior. "The floor is in six sections and can be bolted together. It is made of 1×4-inch tongued and grooved boards supported eight inches above the ground on 2×4-inch joists. Around the edge of the floor is a wainscoting of narrow floor boards four feet in height. There is no center pole, as the tent is supported by an eight-sided wooden frame. The roof and sides are of khaki colored duck. The lower edge of the canvas walls are fastened several inches below the floor and one inch out from the wainscoting on all sides. This leaves an opening through which a gradual inflow of air is obtained without causing a draft. The opening in the center of the roof is one foot in diameter and is covered with a zinc cap." The cap is raised or lowered by a pulley attachment.

Tucker Tent. The Tucker tent is similar to the Gardner in that it is supplied with ventilation in the wainscoting near the floor and in the center of the roof. It is rectangular rather than octagonal in shape and is made in two sizes—one, eight feet wide by ten feet long, and the other, twelve feet wide by fourteen feet long. It has a wooden floor, wooden base and canvas side, with window openings on each side. "The canvas above the base in the front is attached to awning frames so that it can be raised or removed altogether for the free entrance of air and light." The roof and fly are made of 12-ounce army duck.

La Pointe Tent. The La Pointe tent is similar to the Tucker tent. It is a canvas cottage with doors, windows and floor. The top is made of canvas, with a fly which projects two inches on all sides. The windows have a wire netting and canvas shutters, the canvas being so arranged that it can be pulled up as a curtain, or extended as an awning. Its cost is $85 to $100.

Army Tent. A simple ordinary tent is the United States Army tent. There are two different styles, one with closed corners and one with open corners. It is made of army duck with poles, stakes and guys, and costs according to size. A small tent eight feet four inches long and six feet eleven inches wide would cost $7.50, and lumber for floor about $2.00 extra. This tent is easily put up, care being taken to select a dry soil, places where the water stands in hollows after a rain should be avoided. A small trench about one foot deep around the tent will help in keeping the soil dry.

Tent Cot. For experimenting in outdoor sleeping a tent cot is a very simple arrangement. It consists of a plain canvas cot with a frame supporting a small tent. Ventilation is secured by openings at both ends; also at the side where the patient enters. These openings are covered with flaps which can be opened or closed. It is light, weighing from twenty to fifty pounds, and its position and exposure can be conveniently changed. The cost is $9.

Knopf's Half Tent. Another simple arrangement is Knopf's half tent.[5] It consists of a frame of steel tubing covered with sail duck and secured with snap buttons on the inside. It is used for patients sitting out of doors. The reclining chair is placed in the tent with its back to the interior. Its weight helps to hold down the floor bracing attached to the frame.

Sleeping Porches

One of the most important arrangements for outdoor sleeping is the sleeping porch. To be convenient, it should have an entrance from a bedroom, and, when possible, from a hall; for every outdoor sleeper should have, during cold weather, a warm apartment in connection with his open air sleeping room. The best exposure in Illinois is south, southeast or east. Sleeping out should be a permanent thing during all seasons. The sleeping porch must be kept neat and attractive. A cot placed between the oil can and the washtub on a dingy back porch is very dismal and bound to have a depressing effect on the sleeper.

It costs very little to arrange an ordinary sleeping porch provided you have the porch to begin with. If a porch is fairly deep and sheltered on two sides by an angle of the house, sufficient protection for moderately cold weather can usually be obtained by canvas curtains tacked to wooden rollers. These can be raised and lowered by means of ropes and pulleys, the bed being placed so that the wind will not blow strongly on the patient's head.

Ordinary Porches.[6] A useful porch can be built for $15 to $25 with cheap or second-hand lumber, and if only large enough to receive the bed and a chair will still be effective for the outdoor treatment. The roof can be made with canvas curtain, or a few boards and some tar paper. The end most exposed to the wind and rain and the sides below the railing should be tightly boarded to prevent drafts.

Second or third story porches are supported from the ground by long 4×4-inch posts, or when small they can be held by braces set at an angle from the side of the house. When the long posts are used they are all placed six feet apart and the space between them is divided into three sections by 2×4-inch timbers. The interior is protected by canvas curtains fastened to the roof plate and arranged so as to be raised or lowered by ropes and pulleys. These curtains are made about six feet wide and fit in between the supporting posts and rest against the smaller timbers. This arrangement keeps the curtains firm during a storm, as both rollers and canvas can be securely tied to the frames. This porch would cost between $30 and $50.

Porch de Luxe. When a bed on a porch is not in use it is often unsightly and in the way, while in winter, unless well protected, the bed clothes and bedding become damp. In order to overcome this, the Porch de Luxe[7] has recently been devised. This consists of a low-built bedstead arranged to slide through an opening in the wall of the house between the porch and bedroom.

Sleeping Cabin. To lessen the disadvantages of the high roofed, windy porch, the home-made sleeping cabin is to be recommended. This cabin is built on the porch. The frame is braced against the side of the house and rests on the floor of the porch, but the top of the cabin is much lower than the roof of the porch. The frame consists of 2×4-inch timbers. The sides and roof are of canvas curtains; these can be rolled up separately. Some of these cabins have had the roof hinged so that it can be raised in warm weather. The greatest advantage of the cabin is the control of the weather situation. The cost is $15 to $20.[8]

Knopf's Star-Nook. Another arrangement is Knopf's "Star-nook."[9] This is a wall house supported by the roof of an extension, or on a bracket attached to the wall of the building. This fresh air room consists of a roof, floor and three walls and, with the exception of the roof and the floors, is built of steel frames holding movable shutters. It is nine feet long by six feet deep, the height being eight feet at the inner side with a fall of two feet. At both ends are windows which can be opened outward. The roof can be raised entirely off the apartment by means of a crank. Also the upper sections of the front windows can be opened or closed. Sometimes new doors or windows will be needed to give access to a desired position. The "Star-nook" can be secured with safety, and when strongly supported there need be no fear in regard to its stability.

Roofs

The value of roof space for outdoor treatment in cities is gradually being appreciated. They can be made splendid sites for various kinds of little buildings. The roof of an apartment house offers a choice of situations, but there are different conditions to be considered, such as the best exposure and the most protected place, one that cannot be overlooked from neighboring buildings; also security from severe storms. Tents have been erected upon the roofs of city buildings, but they are not to be recommended for such positions unless they can be placed in the shelter of a strong windbreak. When erected upon the roof of high buildings they should be protected on two sides by walls, or by other parts of the structure upon which they are to be placed.

A cabin is most desirable for the roof. In its construction it is best to use a wooden frame for the foundation. It can then be moved and its position and exposure changed easily. This frame should be made of 2×6-inch planks laid flat on the roof. The upright frame and siding boards for the back and sides should be of 2×4-inch timbers. The front of the cabin should be left open, but arranged with a canvas curtain tacked on a roller so that it can be closed in stormy weather. Tar paper is used for the roof. When completed, the framework should be braced to give firmness. If two buildings connect and one is taller than the other with no space between, a lean-to cabin is most desirable.

With the devices just described the home treatment can be secured with little cost. Patients who are afraid of outdoor sleeping should begin in moderate weather. All shelters should be as inconspicuous as possible. In choosing a suitable position for a fresh air bedroom, it should be remembered that early morning sounds and sunlight should be eliminated, if possible. This can sometimes be done by selecting a room far from the street and by shading the bed with blinds. One's neighbor should be taken into consideration, and a position decided upon which does not overlook his windows, porches or yards, and when arranging for the rest cure in the reclining chair during the day one should always bear in mind that it is much more agreeable and conducive to the well-being of the patient to have a pleasant view to look upon.