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for Consumptives, at Rutland, where the inmates are made to take the outdoor treatment in the dead of winter when the ground is covered with snow. The same truth has been established in other cities and states where the authorities maintain open air consumptive colonies.

But I do not wish to be understood as detracting one iota from the favorable features of the climate of Colorado and New Mexico. I merely desire to hold out hope to those who have not the means at their command to go to a climate which nature has especially adapted for consumptives. To my mind Colorado and New Mexico furnish the ideal lung climate of America. The altitude is high and the air is rare and invigorating. The sun fails to shine in Denver only fifty-two days out of 365 days in each year. The atmosphere even in winter is so dry that it is possible to walk on the sunny side of the street in zero weather without an overcoat. The cold is never penetrating. The fresh mountain air conduces to a good appetite. The cool nights enable one to gain splendid rest. In fact, nature has assembled in those regions every element favorable to abating lung disorders. But only a comparatively small percentage of the consumptives are able to leave their homes in other parts of the country and journey to the far West, pay a high price for board, and there await the processes of nature to cure them. Their circumstances force them to remain at home, but they need not die if they will adopt the open air treatment, say right here in Alabama. A longer period will be required to abate the disease, but patience and assiduous adherence to the open air life will in most cases, I believe, do the work, provided the beginning is made in time.

Having considered the disease and the method of its abatement at some length, I now reach the question of our duty here in Alabama. I say "our duty," for I regard it as the duty of every good citizen to aid in the solution of the problems which this subject presents, whether he be a physician or a layman. Our duty is a double one-involving both the prevention of the spread of the infection, and the cure-but for convenience we will consider them jointly. It is easier to prevent any evil than to cure it. The same is true of consumption. To prevent the spread of tuberculosis we must have laws, and organizations through laws, and we must have enlightenment. To secure both or either, the medical profession must lead the way, but it must have at its back the united support of an intel

ligent and sympathetic citizenship and a fearless and interested press.

In many states, laws have been enacted creating anti-tuberculosis commissions. This is the case in our neighboring State of Georgia. I have recently been in communication with Dr. Bernard Wolff, of Atlanta, secertary of the Georgia State Commission of Tuberculosis, and he has described to me the workings of the commission in his State. The functions of the Georgia commission are to gather data with reference to tuberculosis and to disseminate information, in brief and simple form for the education of the public on precautionary methods to prevent the spread of the disease, and to deal with it where it has occurred. A short time ago Dr. Wolff, in a letter to me, said: "We are preparing to send out literature on the subject of consumption very much in the vein alluded to in your letter. We are availing ourselves of every good method disseminating this information to the public, especially through the channel represented by the newspapers. We hope in this way to arouse public sentiment in favor of the movement, and we have the narrowing conviction that once the movement is under way it will accumulate enough momentum to propel itself. I am preparing a series of tracts to be published in the newspapers. They are practical, elementary and such as any intelligent layman may readily understand. If the conviction can be forced into a dense and childish public that consumption can be caught, and that being caught, it can often be cured, we may get rid of the old hereditary notion and the policy that have been the means of spreading the disease since the primal curse. We are very much hampered by the lack of funds. The State, with that easy indifference to its best interests, and that cool assumption that work for it will be done free, has made no appropriation at all to carry on the work. It is maintained by assessment among the members of the commission, whose efforts in the cause of cold drawn philanthropy spell professional suicide by the starvation route. With such a handicap the best we can do is to start the movement-to touch the button with the hope that if that great baby, the public, will get a good scare it will stop putting everything into its mouth." Dr. Wolff's views are, in my judgment, highly valuable and furnish a basis for we Alabamians to operate on. If we are to have an anti-tuberculosis commission in this State-and we should have such a body by all means-I would suggest and urge that in addition to granting it power to collect data on

the subject of tuberculosis through the medium of county and city health officers and county medical societies, and issuing from time to time educational leaflets on the manner of warding off and treating the disease, that it also be empowered to suggest to municipal governments the enactment and enforcement of certain necessary laws providing sanitary and hygienic safeguards, such as anti-spitting ordinances, proper ventilation of public buildings, particularly the public schools, and like means for the prevention of the propagation of the tubercular germ.

This commission should be supplied with a reasonable appropriation for the compilation of accurate data on the progress of tuberculosis in Alabama, and the means to be adopted to keep down the plague, for the printing and mailing of such educational tracts as it may issue from time to time and for other necessary incidental expenses which might be legitimately incurred in its regular course of operation. The commission should invite and should have the cordial co-operation of every doctor in the State, the support of the press as a whole, and the due consideration and earnest assistance of the municipal authorities and the school trustees and the boards of education in every city, town and beat in the State. The commission should hold at least two conventions yearly for the hearing of reports from its general officers and members, for the comparison of data and for the general discussion of the subject of tuberculosis in all its practical phases. From time to time the commission, with the advice of the State Medical Association, should recommend to the legislature such additional legislation as time and experience might seem to render necessary. It would in my judgment, too, be an excellent idea for the commission to agitate and press for solution the question of separate quarters at all convict farms, in all prisons and county poor houses for consumptive inmates. In fact, we need at this time a State sanitarium for free treatment of consumptives who are unable to secure treatment for themselves, or a sanitarium where they can be treated at nominal cost under State supervision. The region around Citronelle, in the southern part of the State, I am told, is admirably adapted to such a purpose, in so far as climate and natural conditions are concerned. This would be another question for the anti-tuberculosis commission to investigate and make recommendation upon.

Since the propagation of tuberculosis is brought about chiefly through poor sanitation of dwelling houses and public buildings, due more from ignorance and carelessness than otherwise, and through the careless and indifference of infected persons in depositing their sputum in public places, it is easy to see that a commission having in hand the quasi-regulation of these things could hope to accomplish very much. Even if it had no power to enforce its edicts It could, at least, educate the private citizen and the public official, and in many cases frighten both into conforming to its suggestions. However, if it accomplished nothing else, an anti-tuberculosis commission which would be able to launch a campaign of education along this line would have done lasting good. Public sentiment could be thus aroused, and, as Dr. Wolff well says, "once the movement is under way it will accumulate enough momentum to propel itself."

In conclusion, I desire to say that I am willing here and now to pledge my cordial and active support to any movement which may be inaugurated by this association looking to the creation of a committee of intelligent and earnest men to take up this momentous question and bring it to the consideration of the next legislature and seek such legislation as will give life to such a body as I have outlined, and thus legally inaugurate a vigorous campaign in Alabama against the great "white plague." I believe that such a movement would have the united support of the press and of every thoughtful citizen of the State, and would receive the favorable consideration of our law-makers.

I am deeply grateful for the kind attention which you have accorded me, and again wish to express to you the keen, sense of appreciation which I feel in having been called upon by your honorable president to make known to you the somewhat crude, but none the less sincere, views of an humble layman, who, having gone through the mill and emerged from it still alive though somewhat dilapidated, is enabled to comprehend and sympathize with you to the fullest extent in your great philanthropic work in behalf of suffering humanity.

THE MANAGEMENT OF PULMONARY TUBERCULOSIS FROM THE STANDPOINT OF THE GENERAL PRACTITIONER.

BY EDGAR ALLEN JONES, A. B., M. D., OF RATON, NEW MEXICO.

The general practitioner, the family physician, should fully recognize his obligations, his responsibilities, and his opportunities in the matter of the treatment of the cases of pulmonary tuberculosis which come under his observation; upon him rests the great responsibility of recognizing and handling the vast majortiy of all cases that receive any treatment at all. The successful handling of pulmonary tuberculosis is no great closed subject. Every man can treat cases properly if he will, and it therefore becomes the urgent duty of every physician to prepare and equip himself in every way to meet his obligations in the matter. There are no secrets; nor can it be affirmed that there are any short-cuts to success. The man possessed of patience and grit, and who is informed on the subject, can succeed. He who is unwilling to give his time and talents-his very best energies-to a work that will not return the so-called brilliant results that may be obtained in other fields of medicine, but more especially surgery, should never accept the care of any case of pulmonary tuberculosis. The history of the management of even the more favorable cases is one long succession of disappointments and discouragements, with the patient now worse, now better, and the improvement so slight, possibly, that no change can be made out from week to week; but to the man who is equipped, and who is willing to fight to the end, there is the prospect of doing much good both to the individual and to society.

It might be well to attempt to define the term success when applied to the management of cases of pulmonary tuberculosis. I can, of course, only give you my ideas in the matter. I take it that we should not expect to cure every case, or even to benefit all of them coming under our care. What can reasonably be hoped for in an advanced third stage case, further than to make the patient comfortable, and possibly to prolong his life? And yet, arrest of the disease may sometimes be secured even

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