that they are all personally as well as collectively involved in the catastrophies that we foresee, and in order to aid such a frame of public opinion it is necessary for us to abandon our present standpoint and come out upon a broad field and reckon with tuberculosis in all its manifold relationship and ramification; then alone, have we attained our highest sense of good and a standard of usefulness that means an aroused state, and a people that demand an adjustment.

This brings us to the correlative factors involved in this latter conception of the tuberculosis problem. We will review a few of the typical lines of contact.

1. The questions of Eugenics, Heredity and Race Betterment.

Hereditary diathesis subjecting the individual to a more readily susceptible attitude toward infection, and hereditary immunity must be considered under this head. Until the factors that have caused the almost universal immunization of our race are thoroughly understood we have still missed an important basic bar to progress.

2. Infant Welfare: When we find that infants are subject to a civilization which gives a new-born child less chance of living than a man of ninety, and calls for the lives of three million two hundred thousand infants annually which is a rate of one every ten seconds, it is little wonder that we have a universal implantation of this disease traceable mostly to childhood days.

3. Cancer Research: Cancer protein is one of the basic depreciators of health. The research along this line pointing to a specific ferment that allows of safe operation in its presence, may point the way for better work in our line.

4. Venereal Diseases: Syphilis together with Cancer and Tuberculosis form the formidable triumvirate of basic decimators of normal resistance. Gonorrhoea probably forms an important item in so disorganizing cell protoplasm at certain stages that it means interference with proper cell maturity or continuation in the particular region infected. not entirely clear in my mind but what Syphilis may be the underlying factor of all serious cell disturbance caused by the disease itself or in its para-syphilitic form either in the individual or his offspring.

It is

5. The Housing Problem: It has taken several thousand years to immunize our population to housing, and now we find that this is one of the sources of harboring infection. Fifty-nine per cent of Tuberculosis among persons occupying one and two-room houses, while no less than ninety-three per cent of all cases are found in houses with four or fewer rooms.

occurs

There are in the United States today over half a million rooms with no windows at all. 6. School Supervision and Hygiene: Among the fifty-thousand deaths among school children last year sixty-seven per cent were due to preventable diseases. Medical inspection of schools will be a great factor in eliminat

ing many subnormal tendencies toward disease. These representative headings give food for thought, there are many other factors in social life that have as direct a bearing upon our campaign, such as Prison Reform; Reform in Method of Commitment of the Insane; curbing the tendencies of societies whose propaganda is to depreciate animal experimentation, vaccination, use of vaccines and serums, and under a final heading I would like to give a few remarks on Quackery and Isms which uncurbed is a most prolific source of undermining our nation's health; as, lulled to sleep by false premises many of the first signs of irregularity in cell life which form the foundation of serious disease are overlooked.

The Elimination of Quackery and Isms: This is a division of our work that must come to the front; not only the patent medicine fakir but the many Cults and Isms that lead people astray, must be censored and combatted. The entrusting of human lives and welfare, must only be to such men and methods who show that they have spent the adequate time and effort that will enable them to judge conditions in the light of modern science. No man with a correspondence school knowledge of the principles of Medicine, with perhaps hardly a grammar school education, should be allowed to pronounce questions of diagnosis and treatment. Even a six or nine months' special study of some principle of medical science elaborated into a system or cult is not sufficient. We should endeavor to have anyone who interrogates the human system obtain as thorough a knowledge of that system as modern science can give and then with light of this, if he conscientiously sees fit to multiply the value of some single therapeutic measure, he can at least calculate its limitations.

In order that we may enlist the co-operation of good sound business talent we must make our work not only practical, but we must see that instead of infringing on, or duplicating the work of other associations we take the broader view and try to harmonize kindred interests, and avoid waste by concentrating our efforts, make all duplication line up under one classification, and where we find an allied interest with special wants our system should be flexible enough to create a committee, a department, or, if necessary, turn over our whole working energy for the time being to the essential at hand.

While it is true that many of the problems involved in the kindred sciences cannot at once be thoroughly appreciated, and perhaps may take a generation of education, still it is also true that we to whom is given the glorious privilege of standing on this level of time, watching the dawn of the beautiful morning, are entrusted also the important duty to see that the creatures of earth may sooner be enabled to enjoy the full day because of this slowly and relentlessly appearing dissimulation of darkness being aided by our efforts.

JAMES ALEXANDER MILLER, M.D., President

CHARLES J. HATFIELD, M.D., Secretary

When self-interested physicians and laymen complain that the money spent in the anti-tuberculosis campaign is not producing results and that we are apparently attacking the problem of the prevention of tuberculosis from the wrong angle, few of those who are seriously interested in the campaign against this disease pay any attention. But when such an eminent authority as Karl Pearson asserts that the fundamental line of attack which the American and British campaigns against tuberculosis have adopted are wrong, it is time. for serious minded men and women to give the subject consideration.

It is all the more gratifying, therefore, after the strictures of Pearson against Newsholme have been carefully considered, to hear a voice from the Far East assure us that we are on the right track. This comforting assurance comes to American anti-tuberculosis workers through Dr. Victor G. Heiser, whose remarks before the North Atlantic AntiTuberculosis Conference are given on another page of this journal. Dr. Heiser shows that by following substantially the same methods that are being used in New York, New Jersey, Ohio, Wiscon

sin, and elsewhere in this country, the state of Victoria (Australia) has practically rid itself of the problem of tuberculosis. If hospitals, visiting nurses, dispensaries, educational campaigns and strict enforcement of the laws will secure for Victoria a millennium of this nature, why will not the same measures produce a similar result in any state of the United States? Despite theoretical objections, it is plainly evident that the methods of campaign being furthered by the National Association for the Study and Prevention of Tuberculosis fundamentally sound.

are

On the other hand, it is equally eviIdent that the campaign in America lags because of a fundamental weakness of this democracy, that law is treated too lightly. There is enough law on the statute books of New York State, for example, to secure the effective control of the tuberculosis problem. What is needed is a more rigorous enforcement of the law. For this purpose, two things are vitally necessary: first, more money, and second, a public opinion that will reckon health as an asset greater than material property. The lesson which one

We

I notice among health seekers away from home that they like to leave the impression among certain of their friends that they are not sick, at least most of them dislike very much to have their mail addressed in care of some sanatorium or hospital; but if they want to be sure of getting their mail there is nothing else for them to do. Right here is where Mr. T. B. Schemer steps in and fills a real need and incidentally makes a little money to buy those big cigars he likes to smoke. all know that this particular man should not smoke, but just the same he often does, and those smokes have to be paid for. In case Mr. T. B. S. does not want to spend his money on cigars, it will come in handy for postage stamps, of which he is a large user. I have also known him to buy a pound of Park & Tilford's occasionally. I never heard of his asking the doctor how much candy a sick girl should eat, but just the same I know some of his money goes that way. I am straying too far from my proper topic and so I guess we better leave our friend to spend his money to suit himself.

Here is how you can get the cash. Go to a good printer and have him print you some stationery something like this:

to leave off the 300 Rooms and the $2.50 per day, it will not detract from the value of the letterhead. For the envelopes, here is a good form for them:

From

In order to get a good price on the printing you should buy at least 2,000 of each, letterheads and envelopes. You can have the letterheads padded 25 sheets to the pad. Put up the envelopes in packages of 25 and sell for 15c per package of envelopes or pad as the case may be, or both for 25c. Of course, your first sale to most everyone will be envelopes and pad for 25c, but after that many will buy pads separately, as they use the paper faster than the envelopes as a rule. Don't pay over $2.00 per 1,000 for your printing, in a one-color job, and if you don't know where to buy it at the right price, send me a self-addressed, stamped envelope and I will be glad to tell you. If you use two colors it will cost more, but one color is enough.

It is your move now. If you are a real live wire you are just the man I wrote this article for. You can make over 150 per cent on every sale, and you can make plenty of sales if you just push your proposition a little

To readers of the JOURNAL OF THE OUTDOOR LIFE, a new book, entitled "The Work of Our Hands,"* will be especially appealing. The book is by Dr. Herbert J. Hall, Medical Director of a well-known sanatorium for nervous diseases at Marblehead, Mass., and by Miss Mertice M. C. Buck, teacher to the handicapped in a number of New York City institutions. In brief, the book is a study of occupations for invalids and is based in a large measure upon the experience of the authors.

While the book does not give very much space to occupations and work for consumptives, it is full of suggestions for patients, superintendents of institutions, visiting nurses and others who are engaged with the peculiarly difficult problems of gr ded exercise and remunerative employment. The first part of the book, following an excellent historical introduction, is by Dr. Hall and deals more particularly with the theory and principle of work for invalids. Such subjects as workshops in general hospitals; manual work for patients in state and county hospitals; sanatorium treatment for people of small means; teacher and pupil; the trained nurse and the work cure; the well-to-do patient at work; the industrial problem of the tuberculous (Dr. Hall wrongly says "tubercular"); and handicapped labor and the law, are taken up and reviewed in concise and helpful chapters.

The second part of the book is by Miss Buck. For years she has taught and worked with invalids and the handicapped in settlements. hospitals and sanatoria, and her contri

"The Work of Our Hands," by H. J. Hall, M.D., and Mertice M. C. Buck: Moffatt-Yard & Co., 1915. May be ordered from the Journal of the Outdoor Life for $1.50, postpaid.

bution is, therefore, all the more valuable. She has three introductory chapters-"Teaching of the Handicapped”; “Methods of Teaching," and "Readjustment"-which are of particular value to superintendents of institutions and visiting nurses. Then follow a number of chapters, each taking up work with the hands used successfully in the treatment of such disease as organic nervous diseases. hysteria, epilepsy, chorea, severe mental diseases, neurasthenia, and psychastenia. She also deals with boder-line mental cases, the aged and infirm, and the cripples. Many of her experiences with these groups can be adapted with a little ingenuity to the tuberculosis patient.

Among the interesting helpful occupations for invalids cited by Dr. Hall and Miss Buck only a few can be enumerated here. Making cement flower pots from moulds furnished by artistic experts is a lucrative and therapeutic occupation originated at Marblehead and later tried for cardiac cases at the Burke Convalescent Home and elsewhere. Weaving with hand-looms and on distinctive patterns which cannot be done by machine is a light and profitable industry. Making of baskets and other articles with rafia, reed, etc., is a very common occupation. Sewing of all kinds, blacksmithing, manufacturing by machinery of brooms, brushes, pails, shoes, etc., carpentry and cabinet and furniture making, masonwork in brick concrete and stone and farming and gardening-these are some more of the principal occupations mentioned. In general, the book, while it does not purport to be and is not a catalogue of industries, is, nevertheless, a helpful handbook for any invalid or convalescent or for those who have such patients in their care.

TO THE EDITOR:

Is there any merit in the use of hydrocyanic acid in the treatment of tuberculosis as suggested in the inclosed newspaper account of the alleged discovery of a Japanese physician? B. T., Mankato, Minn.

We are not familiar with the method of treatment to which you call our attention. The newspaper article does not impress us very favorably. It is very unlikely that a cure for tuberculosis will ever be found along the lines here suggested. In the past many such cures founded on similar evidence have been exploited, only to be soon buried in oblivion.

TO THE EDITOR:

1. Is hoarseness the sign of laryngeal tuberculosis?

2. Will the horseness wear away as the patient gets better?

3. Does spitting blood once in a great while indicate anything dangerous, and do you think it comes from the lungs?

4. What can one do to make it safe for others to be near you?

5. What is the matter when cheeks burn and there is no fever?

M. G. K.

1. It may be, but not necessarily. 2. Usually, but this, of course, depends upon the cause of the hoarseness.