VOL. II.

No. 3

In the elder days of Art
Builders wrought with greatest care

Each minute and unseen part;

For the Gods see everywhere.

Let us do our work as well,

Both the unseen and the seen;
Make the house, where Gods may dwell,
Beautiful, entire and clean.

In these lines the poet has special reference to the moral or spiritual life, but they are equally applicable to the physical life. It is now realized that it is the life lived rather than the place in which the life is lived, which counts in the complete recovery from tuberculosis. Evolution is a slow process, and education as a part of the evolution of the human race is also a slow process. This is true as regards tuberculosis, though the past quarter century has seen greater advance in the knowledge of the nature and treatment of the disease than the preceding centuries. In this time it has been learned that pulmonary tuberculosis, taken early, is curable; that it is transmitted from one person to another; that, as shown by autopsies, many early cases get well without any knowledge of the existence of the disease; that the process of cure is slow and depends on attention to the details of life; that competent medical supervision is one of the most important elements in recovery, and that for recovery to be permanent a continuance of attention to the details of life after leaving a health resort is almost as important as is such attention while undergoing the "cure." The statistics of those sanatoriums which have been at work sufficiently long to have their results of value, as the Adirondack Cottage and Sharon Sanatoriums in this country, show that when the disease has again

become active in those "apparently cured" it has usually been due to a return to unsuitable surroundings or improper modes of life.

Tuberculosis differs materially from such diseases as typhoid fever, pneumonia, etc. In these diseases, which are self-limited, recovery from an attack is for all time. Tuberculosis, on the other hand, is not self-limited, and "Eternal vigilance is the price of safety." The home life after returning from a health resort should be for a long time, varying with individual cases, a continuance of the life while undergoing the cure." The return to the former life should be gradual and under medical supervision, and herein lies the value of the advice of the lines quoted above. It is not what the patient's physician knows of his doing which counts for or against permanent recovery, but what is actually done, and if the god of health is to be and remain with one the temple must receive proper attention. The tubercle bacillus, with its toxins, is a wary enemy and is ever ready to take advantage of any lack of watchfulness on the part of its host.

As during the cure, fresh air is essential, so after return home it is necessary and is to be obtained in the same way as while at a health resort. Sitting out and sleeping with the windows open will attract some attention, and invites criticism, but what of that? The poet, Longfellow, has Michael Angelo say to a younger brother artist

"work right on through censure and applause, Or else abandon Art."

and the god of health says to the returned health seeker, "Follow my precepts through censure and applause else I will not remain

with you." He demands full service and he cannot be served in theatres, at card parties, dances, or even in the family circle if the air is close and impure. A closed sleeping room he abhors, and poor air in any place is as a stench in his nostrils. The presence of the patient in such places may be kept from his physician, but just as surely it makes the temple impure and unworthy.

Pure air is, however, but one of the elements of success, and the most frequent causes of failure in my experience have been due to physical stress. I have seen patients well on the road to recovery fail because of the strain of domestic life, business and overexertion. I have recently seen two mothers who failed because of devotion to sick children, doing work which others could have done for them. I have seen a young man with every hope for complete success fail because, while watching a ball game in which a team on which he had formerly played was engaged, he took the place of a disabled man and pitched part of the game. A hemorrhage, inhalation of blood into previously healthy lung tissue, septic infection of this inhaled blood, rapid breaking down of the lung itself and death in a few weeks was the result. Another young man with arrested disease at the right apex went hunting with a gun which “kicked" badly, and in one day lost that which it took him a year to regain. Mental stress, though more insidious, is nevertheless very effective in retarding or defeating the complete cure.

The return to the ordinary life must be very gradual. Even when the patient does his best to continue the life under which he has apparently recovered he will of necessity be so placed that he will have some falling off in the thoroughness of the, for him, ideal life to which he has been accustomed, especially if he has been in a sanatorium, and these essential changes are all he should have for some time.

Another "Meanest Man." The meanest man I ever knew," said Representative Ryan, of Buffalo, was a chap who came to the house of a doctor, who is trying to build up a practice on the East Side in Buffalo, one night during the Christmas holidays. It was snowing and very cold. 'Doctor,' he said, 'what are your terms?' One dollar for an office visit and two dollars for a call,' the doctor replied. Have you a

One of the leading elements of value in sanatorium treatment is the education received. and if this element is not to be lost it must be used after the return home. By using this education as to the mode of life, a cured case can gradually resume the essentials of a useful life, if he will omit all excesses, and in a few years, if he went under treatment early in the disease, his former affliction will be but a remembrance, and if he makes proper use of his education as to the proper mode of life obtained during his illness he may live longer and be of more value to himself and to the community in which he lives than would have been the case had he not been thus afflicted. Every person cured of tuberculosis, if he lives as he should live, is a missionary in his locality in the crusade against tuberculosis. The fact of his cure is a great incentive to others similarly afflicted to undergo prompt treatment, and when the cures become more common, as they almost daily are becoming, woe unto the physician who allows a case, while under observation, to become advanced before the disease is recognized. He also instills into his associates, by precept and example, the good and not the "horrible example," the proper methods of life as regards ventilation, dark and damp rooms, excesses and the general hygiene of life, and he should always remember that the same manner of living which cures tuberculosis will prevent its contraction.

In closing I would state, for the encouragement of those undergoing treatment for pulmonary tuberculosis, that of a considerable number of patients I have had return from health resorts with the disease arrested, only one has relapsed, and that one was one of the mothers above mentioned. As I daily meet healthy fathers, mothers, young men and women who have had pulmonary tuberculosis, I can but think of the wonderful work accomplished by the open air treatment in America.

horse?' 'Yes.' 'Well, hitch up and I'll go along with you. I need you out in West Seneca.' The doctor had his horse brought around and the man got in the buggy with him. They drove about four miles out into the country. Here's the place,' said the man, as they reached a farm house. Then he handed the doctor two dollars. You needn't go in,' he said. A liveryman wanted to charge me five dollars to bring me out here. but I thought I would rather give you two.'

Dust plays a very important role in various diseases, especially those of the respiratory

organs.

In certain occupations, as mining, stone and marble cutting, and grinding and polishing of metals, the workman is almost constantly breathing in fine particles of the material upon which he is working, and in time the accumulation of this dust in the bronchial glands and lungs is sufficient to cause well-recognized lesions of the organs as well as marked constitutional symptoms from which the patient may suffer for a prolonged period. In addition to this well-recognized class of cases can be added such trades as milling (grist), upholstering, leather working, cigarmaking, cobbling, printing, rag-picking, wool and flax carding and the like, where the workers, generally speaking, are surrounded by and inhale an atmosphere laden with dust of various kinds.

In most of these occupations not only is the mortality from tuberculosis markedly increased, but the general death-rate is very high, so we see that dust, in addition to carrying germs, may in itself cause much damage to the system by constantly irritating, if not actually destroying or invading, the various tissues, thereby rendering them more susceptible to the attack of infective organisms.

It has been suggested that there are certain symptom-complexes, "due to the inhalation of dust contaminated by sputum," closely resembling neurasthenia, rheumatic and articular troubles, which may truly be called dust-disease or dust-fever. Whether this be true, or whether these symptoms are early manifestations of tuberculous infection it is difficult to say, but the fact remains that dust is a predisposing factor in the cause of a large amount of the general ill-health of society at large.

In its relation to tuberculosis, dust plays a most important part, both out-of-doors and in. Sunlight, air and water are potent factors in destroying the tubercle bacilli that are at some time present almost everywhere in the streets of towns and cities, and while the majority of them are probably killed by these agents, numerous experiments by investigators in many parts of the world have shown that samples of dust gathered from the sidewalks, streets and exterior of buildings, not only

contained tubercle bacilli, but that these organisms were sufficiently virulent to cause tuberculosis in the animals inoculated with them. Since, then, these germs are present. even if in comparatively small numbers, there is some danger of infection from breathing the dust-laden air of these streets.

Tuberculous patients expectorate on the sidewalks or streets, the sputum drying-perhaps out of direct sunlight - becoming pulverized and stirred up by the general traffic and the winds to such an extent that its inhalation by scores of persons in inevitable. Foodstuffs exposed at the street stands and stores become contaminated, and the danger is increased especially in the case of fruit and candies, which are often bought and eaten on the spot without any semblance of first removing dust or small particles of dirt attached thereto.

In addition to these natural causes of the spread of dust, there is to be found in many places just where he should not be the

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street-sweeper, who industriously scratches and scrapes and brushes in the midst of the passing crowd in his endeavor to remove from sight such objects as are in themselves less harmful than the dust stirred up in the removal thereof, which objects could well be left till night to be taken away.

In one large city the dust created by the combined efforts of the sweepers, carters and rag-pickers is so great as to cause a veritable moving cloud in their wake, and this all occurs at the very time of day that the streets are the most crowded. According to one observer, some dust thus stirred up is disseminated, especially on windy days, over an area many times greater than that from which it was collected, and, in addition to the damage it causes to the respiratory organs, it settles upon the unprotected confections which, being bought and eaten chiefly by children, increases the risk of tubercular infection through the digestive system.

If the streets were properly sprinkled, the dangers from dust would be reduced many fold, but the public at large seem to care less for dust on their clothes and in their lungs than for mud on their shoes. In Japan. where the out-door shoe is not worn in the house, the people are not confronted with an

other mode of infection so prevalent in the civilized countries of Europe and America, namely, the shoe which, on the streets, so often comes in contact with freshly expectorated tuberculous sputum that adheres to it and is taken by it into the home or workshop, here to become dried and drop off onto the floor or carpet, or the dark closet. and later to be stirred up in the form of fine dust by the broom. In like manner, also, the long skirt, sweeping the sidewalk as the coarse brush does the street, not only collects the dust therefrom, but also becomes contaminated with sputum deposited there by the filthy habits of the careless. On entering the house this skirt drags over the carpets and rugs, there depositing a portion of the collection from the streets. After being hung up for a time, usually in a dark wardrobe or closet which has never seen the sunshine, the skirt is removed and brushed either in the house, out the window or perhaps on the back porch, or in the back yard for the benefit of the neighbors. At the same time the doormat is probably being beaten on the front steps, and the rug, too, is being deprived of those remaining particles of shoe and skirt conveyed dirt, now dried, which the crawling baby has failed to get on its hands and (therefore) into its mouth and nose.

Anyone passing by at this moment has ample opportunity of inhaling unlimited numbers of dust particles, attached to many of which may be many other germs as well as tubercle bacilli. If this passerby be in good health the probability is that no harm will result, but suppose it be a poorly nourished sweatshop worker, or a child overburdened by the long hours of confinement in a factory or one living almost entirely in the filth and dingy atmosphere of the tenement, then this dust is indeed apt to find good soil for the germs it conveys.

One observer employed a number of women to wear long skirts (germ-free) through a city street for one hour. At the end of this time a thorough bacteriological examination was made and each skirt was found to have picked up tubercle bacilli and other organisms. This and many similar investigations have proved beyond a doubt that the long skirt is a most important factor in carrying germs of disease.

What holds true of the dust in streets is also true in railroad trains. Here we find all classes of travelers, with practically all kinds of infectious diseases. They expectorate on

the floors, seats and sides of the car. The heat soon dries this sputum and ere long it is pulverized and dusted about by the busy porter, whose idea of hygiene consists in sweeping up banana skins and keeping all the ventilators as tightly closed as possible. The plush cushions and tapestries, especially in sleeping cars, afford splendid resting places for these fine particles which are again beaten out and served up to the passenger by the porter during that "pernicious process happily described as dusting."

Railway stations and other places of gathering all afford sources of danger from the promiscuous spitting and subsequent drying and stirring up of virulent matter, but not nearly to the same extent as do the prisons of our most enlightened countries, where in some cases more than fifty per cent of the deaths are due to tuberculosis.

Worse still is the condition in some workshops and factories. Here there is usually a minimum of pure air and sunshine, while the quantities of dust are often such that by the end of the day the employe can write his name on his hat. It can be easily seen that even a single employe suffering from tuberculosis can endanger the health of many by spitting on the floors, or worse still, into dark corners, the very best place possible for the preservation of tubercle bacilli. By and by the constant tramping gets this expectoration pulverized and scattered about, after it has dried, or the janitor sweeps and scatters it around for the benefit of all. There is but one inevitable result another and still another becomes infected, and in turn aids in the spreading of the disease.

It matters not what climate the workshop is in, if it isn't run on hygienic principles and kept dust-free and uncontaminated. A striking example of this was noted a few years ago in a small Swiss town, 3,000 feet above the sea amidst extremely healthful surroundings, where there were located celebrated watch factories. Here tuberculosis caused as many deaths per 1,000 as it did in Berlin, and in this country it is just as true that a dusty atmosphere in Denver acts just as it does in New York.

All these things are bad enough, but they do not equal the dangers that are constantly met in the home. Even in the best regulated houses the long skirt will enter and bring with it the germs above mentioned. The fine Brussels carpet will harbor the germs as well as

the rag one, and when it is beaten and cleaned, without a previous disinfection, somebody is liable to be the worse for the beating. The danger to health is always increased with the number of carpets.

The condition is sufficiently serious at all times, but where affairs are complicated by having a tuberculous patient within the home, the picture is much graver.

The following conditions exist in thousands of homes to-day: One member contracts tuberculosis in some way, and while sick at home expectorates on the hearth, floor, porch, yard and into handkerchiefs where the sputum, becoming dried, is dusted about when the handkerchief is again removed from the pocket, or spreads the germs when sent to the laundry. Towels and bed linen are also infected. In fact some patients expectorate every place except the right one-i. e., into a sputum cup.

Dust taken from practically any part of the room will most probably contain virulent organisms. One investigator found large numbers of tubercle bacilli in the dust taken from the top of the dining-room door of a house in which a short time previously a patient had died of tuberculosis. On the other hand, some years ago a thorough examination was made of samples of dust collected from each cottage of one of our large tuberculosis sanatoriums. In only one instance were tubercle bacilli found, and this was in dust from one of the cottages where a patient had been re

ported for expectorating on the floor. This shows what care and precaution will do in preventing the spread of these germs, and it has become almost proverbial that the safest place from tuberculous infection is a tuberculosis sanatorium.

The danger from careless expectorating about the house might be minimized by the proper use of disinfecting solutions, mopping, and the removing of dust with damp cloths.

Instead, however, of ameliorating the conditions - bad as they are from the combined accumulation of the germs of the sick chamber and those brought in from without - the broom and duster, in the hands of the wellmeaning but ignorant housewife, spread broadcast such clouds of germ-laden dust that she finds it necessary to protect her hair and cover the furniture, but not once does she think of the lungs of herself and family.

Perhaps she does not realize the existence of these organs.

Day by day this process goes on and finally another member of the family and another contract the disease. This family perhaps moves out of this house and the house is occupied by another family, some member of which is sooner or later stricken by the infected dust. This process often goes on for long periods, family after family being stricken down, and thus it is that tuberculosis has been known in times past as an hereditary disease, whereas in reality it is a family disease, or, more strictly speaking, a house disease.