The cure of a case of pulmonary tuberculosis is a responsibility divided between physician, patient and relatives. Let us consider how it is shared by the three.

Preceding the actual recognition of the disease it is the duty of the patient to consult a physican as soon as anything persistently out of the normal is noticed, or, in case the individual most interested is unobservant or obstinate, it should be the duty of his intimate friends or relatives to insist upon his getting medical advice. A persistent cold or dyspepsia, loss of vitality, color, or weight are frequently noted symptoms and subjects of daily comment in ordinary intercourse. The fact that they are suggestive of illness makes them so, and with the increasingly widespread knowledge of tuberculosis they attain special significance, since they are so often the actual early symptoms of the disease, or at least are physical conditions from which the disease most frequently starts.

Upon the physician rests the responsibility of an early diagnosis. When he is consulted the condition is often only too evident, but not infrequently a positive diagnosis is extremely difficult to make. If the latter condition obtains the patient must be content to be kept under careful observation until the diagnosis is established, and in the meantime be willing to follow out whatever measures are tentatively suggested. When there is reasonable certainty of diagnosis, candor on the part of the physician is imperative, and patient and relatives must not misunderstand the truth when told. Frequently people hear only what they wish to hear and a true statement becomes much altered in their wish to think and believe differently. It is said that it takes two to tell the truth one to speak it, and one to hear it. An unpleasant fact cannot be altered and any misrepresentation on the part of the physician or sympathetic relatives who are aware of the fact, usually causes more alarm, dread or suspense in the mind of the patient than the truth would cause. use. Moreover, the care of tuberculosis depends upon a daily regimen of life

likely to be revolutionary to the patient's former life and it is practically impossible to secure this without the patient's understanding co-operation. How frequent a matter of experience it is to meet a patient who has had the truth concealed from him by physician as well as solicitous relatives and who has lived for months in suspense only to find intense relief when he knows definitely what he has to fight. It may and does happen that in these months of ignorance the patient has done himself some injury by overexertion or exposure which might have been avoided if he had only known the true nature of his trouble. The patient should accept the diagnosis or else ask that sound professional opinion be called in consultation to verify or disprove it. After a patient has been told the unpalatable truth he not infrequently goes secretly to consult some other, perhaps less conscientious, physician and is given a contrary opinion which he readily accepts. He then continues his usual habit of life and afterwards realizes too late the serious mistake that he has committed.

As for the outlook in the case, if it be favorable there can be no reason for concealing it from the patient; but whether or not with less favorable cases there is necessity for candor in foretelling the probable course of the disease is a matter of opinion. My own experience is that a reasonably frank statement of the true state of affairs is better borne by the patient than the subsequent disappointment when too optimistic a view has been expressed.

After the physician has given careful instruction in the many sanitary and hygienic details relating to the treatment of this disease he may continue the supervision of the patient himself or transfer the responsibility of the supervision of detail to other shoulders by sending the patient to some sanatorium or health resort. The patient should always find in his physician an enthusiastic and encouraging though critical confidant.

The responsibility for the effective carrying out of the measures suggested rests however with the patient and his immediate relatives.

For physician to study the case and advise, for patient to know what to do is not enough-he must do what he is told to do. With him, finally, rests the responsibility for his own cure. Realizing this responsibility he should consider the future philosophically. A radical change in manner of living is usually necessary and the best possible attempt must be made to put effectively into force the instructions laid down to the smallest detail. Upon the carefulness with which these details are followed hangs in a large majority of cases, success or failure in establishing a cure. Consistent carefulness should be the patient's watchword. It is his duty to tell the doctor everything and to obey him implicitly. When the doctor makes light of a worrying symptom his estimation of it should be accepted and the worry should cease. Contentment and cheerfulness are both to be cultivated; they can be, though at first these qualities of mind may seem unattainable. They are absolutely necessary if one is to obtain a good result. Here is a case where to assume a virtue is better than to do without. Though possibly some avenues of enjoyment are closed, many are still open, and new ones, hitherto unthought of, will certainly be found. Moreover, what is at first a matter of daily effort and patience-living the outdoor life-becomes not only habit, but pleasure. If the patient must go away from home let it be done without forebodings. There is great compensation in becoming free from the extremes of sympathy or the restraint of fear which will surely make themselves evident at times in the home surroundings. Furthermore, the proper life is really much more easily lived where it is everybodys' daily business. The depression at going into a community principally made up of others winged life oneself is slight and transitory compared with the depression which is bound to force itself upon the patient who stays at home and has continually to compare himself, winged as he is, with his old comrades unhandicapped. It is in the old life that his limitations are forced upon him.

The actual fight is made by the patient, the direction of it by the physician, but upon the immediate relatives there falls no small part of the burden of the illness, and the way in which they accept it has often much to do with the final result. The occurrence of tuberculosis in a family is a calamity. The fine prospects of a young life may be blighted, the main support of the family may be temporarily or permanently rendered powerless, but faith,

hope and cheerfulness must be maintained. Whether the outlook is favorable or the reverse the family should make as light as possible of the affliction without neglecting the necessary precautions; everything possible must be done to dispel gloom from the patient's atmosphere; whether at home or away he must not be burdened with the added cares of the family which are the result of his illness, though he is often regarded as the peculiar confidant to whom the family woes should be related. I have known patients' lives made miserable by the selfish letters from home relating facts which could readily have been concealed. Emotional expression of sympathy is always harmful. This sort of sympathy often makes self-pity and that weakens a man's knees. Unremitting watchfulness is the duty of those intimately connected with the patient. They will help themselves and him by learning as much as they can about the disease and how hopeful the condition really may be. They must, however, not only face tuberculosis but must be prepared to face it for a long time. From being looked upon as a hopeless affection, tuberculosis, through the recent change in popular opinion, is now too often regarded as being speedily curable. In some instances this latter opinion is no doubt proved correct but the result only obtains where early interference has been accomplished. In most instances the desired result is only surely obtained long after the time set in the eager minds of the patient and his relatives. At the end of the successful struggle the patient needs help and consideration extended to him almost as much as at first, since too early a return to work might mean the speedy loss of all that has been so hardly gained, often at so great a cost. One cannot know what tremendous self-sacrifice has often been made to give the best chance to the dear one, but on the contrary one sometimes feels justified in thinking that much more could be done than is done to prolong a cure" or to make the way somewhat easier.

LL of us who have played "The Three

from child

hood that all things in nature come under one of the three: animal kingdom, vegetable kingdom, or mineral kingdom. So far the play was very scientific. Suppose we continue it in a scientific spirit and having picked off a gray green scale from the fence post or a green thread of scum from the watertrough we ask, "Which kingdom?" The answer comes, "Vegetable kingdom." Now in the vegetable kingdom are just four grand divisions or primary groups. They are the algae, fungi and their allies, mosses and their allies, ferns and their allies, and seed-bearing plants. It chances that both the scale and the scum belong to the first of these great divisions and this is a most interesting group.

At this time of year when flowering plants are dead and buried beneath the snow the members of this group are growing in great profusion. In this group the alga are cellular, flowerless plants having flattened leaflike expansions and small roots which serve to hold them in place but not to help nourish them. They grow in the ocean where they are called seaweeds, in lakes, rivers and in fact in any moist pace from pole to equator. They are made up of cells held together by a gelatinous matter and easily separated. A single one of these cells can live by itself and grow into a complete new plant. This is one of the ways in which they multiply; the other is by means of spores which grow in little sac-like projections from their leaves. Some of these algae grow lime-like shells over them. these one class is called diatomes because of their method of reproducing themselves by splitting into halves.

Of

Fungi, which belong to the same division with algae, are made up of thread-like cellular leaves and are distinguished by having no chlorophyl in them. Since chlorophyl is necessary, if a plant is to elaborate its own food, the fungi are all parasites or saphrophytes, that is, they live in or upon other living plants or animals, eating their tissue, or else they live in or upon dead animal or vegetable matter. The parasitic fungi such as potato scab, the fungus disease that attacks fish and the fungus diseases like tuberculosis that attack mankind are, from our point of view, destructive; but many of the fungi are very beneficial. The

saphrophytic, or scavenger fungi, are especially so because they change dead, waste animal and vegetable matter into a harmless form useful to the higher plants as food. This darknessloving class called fungi includes all mushrooms, moulds, smuts, mildews, ferments and many others; and no dark, damp place is free from them.

The third class in this division, the lichens. are allies of both algae and fungi. In fact it is a sort of partnership between algae and fungi in which the algae furnish food and the fungi produce the spore cells. The gray-green paper-like scale of lichen on the fence-post was part algae and part fungus. The gray part bearing the cups was fungus; the green part was algae.

Because of the fungus side of its character the lichen likes dampness, darkness and cold. It grows everywhere except in the torrid regions but thrives best in cold, damp regions and in the winter season. The algae side of its character requires light and air for the manufacture of its food, so the lichen spreads itself over the surface of fences, rocks and trees and bears upon its grey surface the green algae cells that absorb air and water and furnish it with nourishment.

F the fungi, none is more useful than the little yeast plant. It is a cultivated plant, as it were, and grows only in certain particular things. When planted in a solution containing starch it attacks the starch and takes water from it, converting it into sugar and freeing carbonic acid gas. The water it uses for food. In a good food supply it multiplies rapidly and when the starch is exhausted it attacks the sugar and breaks it in turn into alcohol, carbonic acid and water. It is the work of this little yeast plant that turns some of the starch of bread into sugar, liberates carbonic acid gas and leavens the loaf.

To sum up then, the first or lowest of the four grand division of the vegetable kingdom contains the three classes called algae, fungi and lichens. All three may increase by simple division of the cells but all also increase by the formation of spores. Algae cells contain chloroplyl and therefore manufacture their own food direct from inorganic or mineral matter. Fungi cells do not contain chlorophyl and therefore must live upon other plant or animal

matter.

Lichens are a fellowship between algae and fungi and therefore have some of the characteristics of both, together with some new ones arising from this partnership.

If some cannibal chieftain from the darkest interior of Africa should catch the modern, progressive spirit of "seeing other institutions," he would doubtless tour the tuberculosis sanatoriums to learn the art of producing such gains as twenty-eight pounds in twenty-seven days, or seventy-five pounds in eight to ten months. And if this primitive man, untutored in the nice distinctions of the language, were told that the patients were suffering from consumption, "a wasting away," he would probably write his tribal warriors of the people suffering from waisting away, with a hope expressed that they might all become missionaries to Africa.

As to this art of nourishing the tuberculosis patient much has been written. In the early eighties, shortly after the tubercle bacillus was discovered, a theory was advanced that the disease could be cured by starving the bacilli. Of course the patient was more starved than the germs. Then various plans to kill the germs in the body were proposed, but here, too, the body suffered more from the antiseptics than did the microbes. Again the striking results from the treatment of certain diseases of the thyroid gland, by feeding to the patient the thyroid glands of sheep, created a new way of treating disease— organo-therapy. So tuberculosis patients were fed respectively on healthy lungs, livers, muscles, glands and thyroid glands of sheep,

etc.

But the thrilling results in thyroid disease didn't occur in lung disease. There is still a difference of opinion about the results with muscle or muscle plasma (raw beef or beef juice). Some authorities assert that this muscle juice is specific. Galbraith suggests that there is some antagonism to the tuberculosis in muscle, since tuberculosis of muscle is very rare. We do know that wasting of muscle is a marked feature of the disease, and that beef juice is an excellent producer of muscle. However, it has not been proved that meat juice is in any way a specific. One authority writes that rare meat is better than

meat well cooked; that it is, because of its concentration, valuable in forced feeding; that patients can take meat juice when they can take no other form of meat; that juice from raw meat seems slightly, if at all, more beneficial than the juice from meat slightly browned; that meat juice has this additional value, that it can be administered in the form of jellies, ices, etc.

As to fatty foods, cod liver oil was for many years the regulation prescription. Its good effect is simply due to improving general nutrition. Theoretically it is a splendid fatty food, however it is so poorly borne by the stomach that it has been deservedly superseded by butter, cream, olive oil, etc. The average visitor to a tuberculosis resort nowadays is surprised at the infrequency of its use. An emulsion of mixed fats, suet and certain vegetable fats is helpful in many cases. Vegetable juice proposed by Russell may prove a valuable addition to the diet. Neither of the two preceding are specifics, but furnish concentrated and easily assimilable forms of valuable foodstuffs. The vegetable juice is rich in phosphates and the other in organic salts so helpful in the repair and building up of tissue.

Among other diet "cures" for tuberculosis is the "milk cure," skimmed fresh milk, about four ounce doses every two hours during the day, with one or two doses at night. The dose is increased to a glassful every four hours, finally totaling about three quarts during the day. To make the milk more agreeable, there are used the various devices of adding a little coffee, tea, caramel, vichy, a pinch of salt or cooking soda, or lime water. The whey cure," used in Germany and Switzerland, consists in restricting largely the diet to a pint and a quarter of fresh milk whey, which is made from the milk of the goat, sheep, ass, mare, and cow. The whey is made by treating the milk with rennet.

The grape cure" has its devotees in southern Europe during the grape season.