JAMES ALEXANDER MILLER, M.D.

President

CHARLES J. HATFIELD, M.D. Secretary

A tuberculosis dispensary should have one or all of these five functions: To diagnose doubtful cases; to serve as a clearing-house for hospitals and sanatoria; to supervise patients in their homes; to educate patients, their families and the community; and to administer medical relief.

It would be difficult to find a real agreement on the precedence of one or more of these particular functions. Some dispensaries devote more attention to medical relief or to diagnosis, while others are more primarily hospital and sanatorium admission bureaus, and still others are essentially devoted to the home care of patients. The all-around tuberculosis dispensary should, however, be the center of the anti-tuberculosis campaign for the district which it serves.

From it should radiate the educational influence for patients and families who come to it for assistance and advice. At its various sessions, the physicians should receive instruction as to the best methods of diagnosis and treatment of tuberculosis. Through its doors should pass the nurses and physicians who go into

the homes of the patients who are unable to come to the dispensary.

In other words, a tuberculosis dispensary is not brick and mortar, nor tables and chairs, nor filing-cases and records. It is the physician and the nurse or the physicians and nurses who make up the staff, these are the dispensary. In a very true sense a good physician and a nurse who drop into the country school for an hour to examine the nearby villagers, as is being done in Michigan at present, are the most real exemplifications of a tuberculosis dispensary. They may not fulfil all the functions, but they are a dispensary, nevertheless.

It cannot be denied, however, that only as the institutions in this class of tuberculosis agencies realize that certain high standards of service and administration must be maintained, will they accomplish what they should in the community. The three articles in last month's JOURNAL on dispensary method and procedure and the forthcoming handbook of the National Association on this same subject are indications that serious thought is being

An anti-tuberculosis worker in a Southern state recently proposed to the editor of the JOURNAL OF THE OUTDOOR LIFE that a copy of this magazine be placed in the hands of every school-teacher in that state, if possible at the expense of the state. The value of such a contribution to the teaching force of the state would be inestimable, so this worker reasoned. We are inclined to agree with him and we are hopeful that his plan will be consummated.

The JOURNAL is more than a magazine. It is more than an institution. It is an educational agent, a monthly visitor into the homes and into the offices of those who are and should be interested in tuberculosis, its treatment and prevention.

It comes to the patient with a message of hope, cheer, confidence and helpful suggestion and instruction. It comes to the worker with a message of inspiration, showing what the other fellow is doing; with a message of helpfulness in passing along suggestions from various parts of the anti-tuberculosis field; and with a message of enthusiasm designed to give to the worker new ideas, new vision and new purposes.

The JOURNAL is an educator for the patient, the physician, the nurse, the secretary and the social leader who are interested in tuberculosis. If you will but realize the force of the JOURNAL and what it means in your community, you also will help to spread its message.

A Suggestion for the Undecided

That is the question that worries you who are convalescent. You may be back home or soon to graduate from the sanatorium and are wondering how you are going to meet the strenuous life that is sweeping past. So you are greatly interested in the ways others have put the double cross on old "T. B."

Soliciting magazine subscriptions has done the trick for me and will do as much for many another with a minimum tax on strength and with hardly any funds required.

Just four years ago I discovered I had the "bug" or, to be more exact, the "bug" had me good and hard. Within a week I had withdrawn from a salaried position I had held for years, and never to return, as developed later. My largehearted employers continued my salary until recovery was on the way, and I was wondering what to do next.

The small farm is about the first thing that is suggested to the health-seeker with a growing family, but it costs money to get the farm and to make it produce, and you may have a white elephant on your hands after all.

While taking the cure, I had plenty of time for ideas to be born, play tag through my brain and go on their way, when in a flash I recalled that certain magazines were constantly advertising the fact of big returns from subscription-getting. I knew also that a young man who had taken my subscriptions for a few years back was making good money. If he could, I knew I could do as well or better.

Investigation showed me that little or no capital is required, and that the commissions are immediate and surprisingly large. After three years of it, I cannot think of anything that would have brought me such large returns and a permanently established business with subscribers in all parts of the country.

Neither you nor I can ever be one of those hustling young canvassers who "hit the pavement" from breakfast to bedtime and who ring all the door-bells in town, incidentally making several thousand dollars a year. If we had the legs of an ostrich, the stomachs of a camel, and the wind of a candidate for office, we might make it. But I can assure you it is worth while.

You have the mails, telephone, friends, and grit, and can get a lot of subscriptions now going elsewhere. Your renewals from year to year to build up the business for a permanent income,

indefinitely.

Space will not permit a detailed explanation of the best way to go about it. But I shall be very glad to take the time to advise any “T. B." sufferer who writes me, how to get the right start, what to avoid and many little points I had to discover for myself.

If such requests are numerous, I shall prepare a printed leaflet of instructions, and any help I can give a fellow "T. B." who would like to get started in this line is his for the asking. H. C. QUINTARD, Stamford, Conn.

A Lettuce Bed

Now, in this beautiful spring weather is the time to work in the garden and plant in the soft, warm soil. Choose a sunny corner of your back yard where the soil is richest and have a stronger member of the family spade it up for you. Rake it free from stones and sticks. Ask a neighbor who has hens to give you a small box of material from the hen-house to fertilize your garden with. Rake this well into the dirt and make rows about two or three inches deep and a foot apart. Plant lettuce seed. "Early Curled Simpson" is a special variety which is crisp and tender. When the lettuce is up and has a good start, water it well, often, and keep free from weeds. The plants should be thinned out so the lettuce may head up. The extra plants can be planted in other vacant spots.

When the lettuce is ready for use tell your friends and neighbors and send postals to your relatives, telling them about your lettuce, its quality, etc. Sell it five or ten cents a head, according to size. Lettuce is a vegetable which is favorable to many, and it will sell very easily. Neighbors will gladly patronize you.

When one lot is gone plant more seed and in a a month's time you will have it to sell again, and so on till late in the summer. The larger the garden, the better. Other vegetables of small variety may be planted.

By this plan considerable profit can be earned. A few cents for seeds is all the capital needed. A. C., JR.

Getting Publicity

TO THE EDITOR:
The "Helping Yourself" department of OUT-
DOOR LIFE must be very interesting to many
readers, as it is to me, and it has suggested to

my mind a plan that, while perhaps not helping ourselves financially, it would do our souls good to know that we are helping so many others. My own experience has shown me the great benefit to be derived. A year ago last winter I read an article in one of the Curtiss publications, on T. B. dealing principally with symptoms, and it was due to my having read this article that a couple of months later when I raised pink sputum I went immediately to a T. B. specialist. This doctor told me I had an incipient case and recommended my going to a sanatorium. This I did, and feel now that I have as good chances for a long and healthy life as the average man, and perhaps better, due to the training in "how to live" I received while there, and which so many lack. How many there are, though, who do not recognize the early symptoms.

The newspapers of our country are the best mediums for distributing news to the people. Couldn't some of these public-spirited organs be persuaded to see the great benefit to the people of an educational campaign on T. B., carried on through their papers? If they would contribute two or three inches of a double-column space for a period of seven, fourteen, or more days to articles written by some one who knows, on:the symptoms of T. B.; the necessity of early and prompt action; the importance of consulting a competent physician; the disillusioning of the commonly supposed horrors of T. B. sanatoria

and health resorts; the great financial saving of getting busy early in the game; informing the people of the free state, county, and often city sanatoriums, of which so many people are ignorant, etc. Then another campaign could be conducted dealing with sanitary and hygienic methods for the prevention of T. B. Acquaint the people with the commonness of the disease, and of how easy and pleasant it is to live a life foreign to the acquiring of it.

There are, of course, indefinite numbers of different campaigns, but each campaign would bring wonderful results. Papers are every day giving space to "Beauty Hints," "Movie Queens," etc. Why not to the above?

If every sanatorium patient could persuade his home-town paper to print the articles, think what a vast territory could be covered. My idea would be to have a standardized form of campaign, written up by the National, State, or Local Anti-T. B. Associations, and bearing their signature. It would be up to the patient to get the space from his paper and to follow through the publishing of the campaigns.

Perhaps some of the papers would be interested enough to pay a little for the articles. If so, all the better. The patient could pay the association for the printing, stationery, etc., and possibly make a little for himself.

TO THE EDITOR:

When I entered the Loomis Sanatorium as a patient suffering from pulmonary tuberculosis my first instruction was to take my temperatures at the rectum, as they considered mouth temperatures unreliable. I received many other instructions in the course of my residence there, but none which I value more.

That mouth temperatures are not only unreliable but at times positively misleading I then proved by test. Had I gone at once to the sanatorium, where this and other information is not only given, but stamped indelibly upon the memory by daily practise and example, my health would be another thing to-day. I, like many another, took cheap advice and went to the country upon a farm, equipped with such information concerning the "cure" as a busy doctor could impart to me in fifteen minutes' conversation. I did well upon the farm, and should have been a cure. I reached that dangerous point where I felt well enough to overdo, did overdo and was helped to my downfall by mouth temperatures. In short, I made the pleasing discovery that when my temperatures ran rather high all I had to do was to take a half-hour's walk and they would be all right again. The only trouble was that I kept getting higher and higher temperatures and of course I could not be walking them off all the time, so finally I went to

Loomis before I was all in. There I woke up. I hope that the JOURNAL OF The Outdoor Life will print this and that some poor fellow who is now in my old plight will see it and wake up before it is too late.

As soon as I was given sufficient measure of liberty at Loomis I bought a second thermometer and took simultaneous oral and rectal readings. Before going on exercise I found that the mouth temperatures would be about half a degree lower than the rectal. After an hour's walk the mouth temperature would have dropped a degree and a half and the rectal temperature would have risen a similar amount, the two thermometers being then nearly four degrees apart! After half an hour's rest the readings became again what they were at first. A few repetitions of this test convinced me it was no fluke. Well, there you have it. Mine is not a freak case. I induced a porch mate to try it and his results tallied with mine. That was years ago, but before writing this I repeated the test and got readings three degrees apart, which came together again after resting.

My first tests were in the middle of winter. As during the whole test I was out of doors either on the porch or on the street, and as I was buttoned up in my fur coat in precisely the same way all the time, I lay the effect to the walking and not to facial exposure. I should think it was

the blood's being drawn away from the face to the muscles, but whatever the reason the result is the important thing to bear in mind. In summertime such tests will be less dramatic, but plentifully convincing at that.

Respectfully contributed by
JUNIUS T. HANCHETT,
Antrim, N. H.

TO THE EDITOR:

In your issue of May, I note a communication from one of your subscribers, Miss Janet McCallum, Montclair, N. J., in which she says that the first and most important move for the eradication of tuberculosis is to educate the doctors.

This certainly appeals to me. I have fortunately made a successful fight against tuberculosis and I attribute a great part of it to the scientific training which I received at Saranac Lake, N. Y.

As this T. B. "struck home" with me, I have given it particular attention in the past two years and have observed a great many cases which have resulted fatally, and the fact that a large percent of the patients are dead is, in my opinion, a direct result of the ignorance of the physician on the correct diagnosis and the correct treatment of the disease. Many of these physicians are prominent men and undoubtedly good in other lines, but they are almost worse than no one in the treatment of tuberculosis.

Almost daily, I meet and know people with tuberculosis and it seems to me a crime to see them doing things under the advice of the physician which is all wrong.

In my opinion, the percentage of physicians who are competent to handle tuberculosis is very small, and Miss McCallum certainly struck the key-note when she said the first and most important step is to educate the doctors.

A movement along this line for the education of a higher percentage of a medical fraternity and to specialize on tuberculosis will undoubtedly

do more to lower the death rate than anything else that can be done.

Educate the doctors is the correct move.
Yours truly,
A. H. BOWMAN,
Louisville, Ky.

TO THE EDITOR:

The question of "J. H. B" and your answer in this month's number of OUTDOOR LIFE, brings to mind a decision of the supreme court of N. Y. County upon the subject of tuberculosis. I refer to Sobol vs. Sobol-150 N. Y. Supplement Reports, decided within the last two years.

In that case the wife sued for an annulment of the marriage on the ground that the defendant, her husband, knowing that he had tuberculosis, concealed that fact from her (I believe, intentionally), and that she was thereby deceived into marrying him. The decision of Justice Blanchard, in granting the decree of annulment, maintained that the concealment, etc., of the fact of tuberculosis and its existence in that case was sufficient to permit relief. Physicians testified to the danger of infection from contact.

That case will not be appealed to a higher court as it was not defended by the husband. It is regrettable, as an important question is involved.

The annulment could not be granted under any provision of the law except that a fraud has been perpetrated. Tuberculosis is not a disease which "physically incapacitates" a party, so no annulment can be had on that ground.

It seems that legally there is no bar to the marriage of such individuals and your reply is correct, taking into consideration that a jury would not give damages for breach of promise of marriage where it appears that the jilted party is tubercular.

Referring again to the case above mentioned, I am sure that many, both doctors and lawyers, will not agree with the reasoning of the learned justice.

Very truly yours,

STUDENT.

TO THE EDITOR:

1. (a) What is the timothy, or hay, bacillus? (b) How does it affect people?

(c) What is its relation to tubercule bacillus? 2. How long a time does it take a tubercle bacillus to reproduce or double when placed under the most favorable conditions-e. g., on a culture media in an incubator?

3. What are the clear crystal spots which

often are seen in a bacillus making it appear like a chain of links?

M. C., Denver.

1. The timothy grass bacillus does not produce disease in man. It is similar to the tubercles bacillus in the way it stains, being what is called an acid-fast bacillus. Certain theories have been set forth suggesting that on account of this