is what he has to say on the subject of the consumptive and his neighbors:

"We need more and better institutions for incurables, more and better education for the people on the subject, and above all a saner, more sympathetic attitude toward the individual who is afflicted with tuberculosis."

He very justly goes on to say:

"The surest way of avoiding tuberculosis is simply to be careful always to maintain a high degree of physical health."

May I be permitted to add by way of explanation, that nature has been most kind to provide us with a mucous membrane in the nose which is bactericidal (that is to say, germ killing) and that the large white blood corpuscles, when the blood is in good condition, act likewise as defenders against the invasion of the micro-organism. To quote Dr. Baldwin once more:

"The person whose dread of the sight of a tuberculous patient is based on æsthetic reasons is another, but I think similar, problem. In this great world war those emotions have to be controlled and are being controlled by many brave women nurses near the battle-fields. The same unselfish kindness and disregard of the unpleasant sights and sounds can be cultivated toward the wounded in the great army of the tuberculous. It is less dramatic, perhaps, but no less helpful in the campaign on prevention and the war against tuberculosis. The road

is made easier for the sufferers, too. Life holds so little for those who carry about them the marks of the disease, that whatever we do to lessen the distress softens the bitterness like a balm for the wounded."

If tuberculosis develops in either parent after marriage they should seek the advice of a competent physician, for if birth control ever has a raison d'être, it seems to me that it is when the parents are actively tuberculous, and particularly the mother. In such instances prophylaxis not only means the prevention of a child coming to this world destined to invalidism, but it also means the saving of the life of the mother who so often succumbs as the result of the strain of the child-bearing period when she is herself afflicted with tuberculosis.

If there are already children in the family, they can be protected by scrupulous care and may remain healthy and strong. This care must consist not only in avoiding the above-mentioned sources of infection, but by developing the child into a physically strong being which can resist the invasion of the tubercle bacillus. The mother should make an open-air baby of each of her children, feed them carefully and plentifully, keep their skin scrupulously clean, following the warm bath for the babies with a rapid rubbing with her hands dipped in cold water. open-air kindergarten and the open-air school are the only proper places to educate a child predisposed or exposed to tuberculosis. Teach

The

such a child breathing exercises; do not bundle it up, but dress it comfortably, according to the season. At the time the girl grows into womanhood do not compress the organs in the chest and abdomen by tight lacing. It goes without saying that the mother, no matter in what station of life she may move, should also dress sensibly and never again wear the trailing skirt which collected from the sidewalk tuberculous sputum and dirt containing the germs of diphtheria, pneumonia, and consumption, to be later on deposited on the carpets of the children's play

room.

A child born with a tuberculous predisposition should always sleep, if not in the open, at least in a window-tent or in a bed moved near the open window. Mother and teacher must watch such a child, and for that matter all children, to see that they do not overdo in physical and mental exercises. Our Boards of Education-and you women should always be represented on such boards-should see to it that the mental training of our children is not carried on to such an extent as to impair their healthy, vigorous physical development. To my mind, in many schools there are too many useless studies, too much cramming, and too much homework, but not enough play, outdoor life, and outdoor instruction. Let singing, recitation, geology, botany, and physical training alike for boys and girls, weather permitting, be taught always in the open, and last but not least, let the open-air school become the rule and the indoor school be the exception-at least for the lower grades. You would be surprised how much less tuberculosis and other infectious and communicable diseases of childhood we would have and how much better the youths would be prepared for civic, and if necessary, for military duty, and how much higher type of American men and women this change in our old-fashioned curriculum in the public schools would bring about.

The smaller children should be taught simple and practical lessons concerning the prevention of tuberculosis. I would suggest that the following rules, which I compiled for my popular essay on tuberculosis,' might be read and explained from time to time to the children by teacher or parent.

Children can be helpful to fight consumption by obeying the following rules.

Do not spit except in a spittoon, a piece of cloth, or a handkerchief used for that purpose alone. On your return home have the cloth burned by your mother, or the handkerchief put in water until ready for the wash. Never spit on a slate, floor, playground or sidewalk. Do not put your fingers into your mouth. Do not pick your nose nor wipe it on your hand or sleeve.

Do not wet your fingers in your mouth when turning the leaves of books.

Do not put pencils in your mouth nor wet them with your lips.

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Do not hold money in your mouth. Do not put anything in your mouth except food and drink.

Do not swap apple-cores, candy, chewinggum, half-eaten food, whistles, bean-blowers, or anything that is put in the mouth.

Peel or wash your fruit before eating it. Never sneeze or cough in a person's face. Turn your face to one side or hold a handkerchief before your mouth.

Keep your face, hands and finger-nails clean. Wash your hands with soap and water before each meal.

When you don't feel well, have cut yourself, or have been hurt by others, do not be afraid to report to the teacher.

Keep yourself just as clean at home as you do at school. Clean your teeth with toothbrush and water, if possible after each meal; but at least on getting up in the morning and on going to bed at night.

Do not kiss any one on the mouth nor allow anybody to do so to you.

Learn to love fresh air and learn to breathe deeply and do it often.

To the more advanced pupils, a tuberculosis alphabet, such as the following, might be given for occasional study, and some little prizes offered at least once a year as an inducement to the pupils to compile similar alphabets from the knowledge gained through the instructions received in school.

A is for Anybody who can help prevent consumption; a child just as well as a grown person.

B is for Breathing, which you should learn to do deeply. Take deep breaths in fresh air often.

C is for Coughing, which you should never do in any one's face, nor should you sneeze in in any one's face. Turn away your head and hold your hand before your mouth. D is for Don't. Don't swap apple-cores, candy, chewing-gum, half-eaten food, whistles, bean-blowers, or anything you put in the mouth.

E is for Eating no fruit that has not been washed, or peeled, or anything that is not clean.

F is for Fingers, which should not be put in the mouth nor wet to turn the pages of books. G is for Giving a good example to your fellowpupils and playmates by being always neat and clean, just as much so at home as at school.

H is for Handkerchiefs, which should be used only to wipe your nose and not your slate, desk, or shoes.

I is for Illness of other kinds besides consumption, which obeying these rules will also prevent, such as measles, colds, grippe, diphtheria, and pneumonia.

J is for Joints, where children have tuberculosis more often than in their lungs.

L is for Learning to love fresh air and not for learning to smoke.

M is for Mouth, which is meant to put food and drink into, and not for pins or money or

anything not good to eat.

N is for Nose, which you should never pick nor wipe on your hand or sleeve.

O is for Outdoors, where you should stay just as much as you can. Always play outdoors unless the weather is too stormy.

P is for Pencils, which you should not wet in your mouth to make them write blacker. Qis for Questions which you should ask your teacher if you don't understand all these rules.

R is for Roughness in play by which you may hurt yourself or your comrades. If you have cut yourself, have been hurt by others, or feel sick, don't fear to tell the teacher.

S is for Spitting, which should never be done except in a spittoon or a piece of cloth or handkerchief used for that purpose alone. Never spit on a slate, on the floor, the playground, nor the sidewalk.

T is for Teeth, which you should clean with toothbrush and water after each meal, or at least when you get up in the morning and on going to bed at night.

U is for Unkind, which you should never be to a consumptive or anybody else.

V is for Vessels, like drinking cup and glasses, which should not be used by one child after another without being washed in clean water each time.

W is for Washing your hands with soap and water before cach meal, even if it is only lunch.

X is for X-rays, which sometimes help to discover consumption and other forms of tuberculosis.

Y is for You, who should never kiss any one on the mouth nor allow anybody to do so to you.

Z is for Zeal in carrying out these rules.

When entering into manhood and womanhood our young people should be instructed what is necessary for them to know in order to be physically and morally strong and well fitted for their divine mission of parenthood.

For the masses at large, besides individual and family hygiene, outdoor life and physical training, we must also have hygienic factories, workshops, stores, and offices, and must prevent overwork and malnutrition. It is obvious that these reforms must be obtained through legislation. But, alas, woman is not as yet a legislator. Nevertheless, you women of influence and power can do a great deal even before you are legislators. Make your influence felt so that dark bedrooms, congestion, overcrowding in cities and country, unsanitary workshops and sweatshops shall be done away with. Oppose with all your might that curse of child life known as child labor which is still permitted in many states be it said to the disgrace of our nation. Do not patronize industrial concerns when you know

that their policy is to underpay and grind down your unfortunate sisters and brethren.

Our great Surgeon-General W. C. Gorgas was recently asked what he regarded the most important health sermon he could think of. I know that I cannot honor my illustrious friend, teacher and superior officer better than by quoting for you his exact answer to this question. "I believe that all health officers should turn their attention to those measures which would tend to increase the wages of the poorest class of laborers. I favor that, as one of the basic cures of existing health evils, because it will have the effect of producing more thoroughly good sanitation than any more direct measures they adopt. How can the laborer earning $500 a year learn the benefits of good sanitation? He and his family must sleep in one little squalid room; the wife must cook and wash and the family must eat in the other room. It does not matter how much you would teach the process of sanitation, nor how much learning he receives on the subject of preserving health and preventing disease, it wouldn't do any good, because he hasn't the facilities to carry them out. But give him a better wage so that he can add another room and remove the congestion and the breathing of the whole family in one sleeping-room, and then you go to the very foundation of the health problem."

There is little for me to add to this message except to say that it should have been addressed not only to the health officers, but to all physicians, not only to them, but to all the men and women of the nation. Let me say, in passing, that our dear Major-General Gorgas is a singletaxer and I, too, consider myself an humble disciple of Saint Henry George. Higher wages, better feeding and better housing will do away with much disease and misery. I venture to say that it will even help to combat alcoholism, for let it be remembered that the overcrowded, underfed and badly housed laborer often seeks comfort and consolation in the cup so that he may forget his misery. But even as things are now, a great deal can be done by those of you who really wish to help in the prevention of both the direct and indirect causes of tuberculosis. The underfed children of the poor should be able to obtain a substantial luncheon at school which can be furnished for very little cost; paying even ever so little for it will prevent pauperization.

- Besides seeing that the underfed children receive at least one good meal while attending school, we should provide also more playgrounds, small parks and breathing-places for them. Where land is expensive, as for example in our great city of New York, there are the thousands of acres of roofs that could be transformed into playgrounds and also serve as breathing-places for children and tired-out mothers. Those of you who are guests here and come from large cities should work for the establishment of public baths and see to it that swimming is made a part of the curriculum of every school, and catastrophes like the Slocum disaster of twelve years ago will be accompanied by less loss of life. If more sanitary comfort stations are installed in our

great cities there will be less diseases of all kinds.

Now as a last word, what can you do toward the cure of the disease? Bear in mind that although I have said tuberculosis is curable, it is not curable in all stages. It is when the disease is recognized in the early stages that the tuberculous patient has the best possible chance of recovery. Let every mother remember the early symptoms: a long-continued cough, loss of flesh, a little fever in the afternoon, a little chill in the morning, frequent hoarseness, easy tiring, great susceptibility to catching colds, increased irritability, little streaks of blood in the sputum. These symptoms are often indicative of an approaching pulmonary tuberculosis. When in addition to some of these symptoms, even if no cough is present, you notice swelling of the glands or joints, lameness or difficulty in walking, pain or pressure over the enlarged joints, running of ears, frequent nasal catarrhs, flabby skin, and a general anæmic appearance, the child is probably suffering from a local tuberculosis. Early discovery and timely and judicious treatment may prevent it from becoming a cripple for life.

Any one-father, mother, relative or friend-noticing the just-mentioned symptoms in any individual, should endeavor to bring about a careful examination which may be the saving of a valuable life.

I must add a word in explanation of what I mean by judicious treatment. By this is understood the utilization of God's fresh, pure air for 24 hours out of 24 hours, plenty of good, nutritious food, careful hygiene of the skin, mouth and intestinal tract by means of a liberal use of good, pure water inside and outside, and all this under careful medical supervision. This may be in the home when it is suitable for that purpose; if not, in a sanatorium or special hospital. The purer the air, the better is the climate suited for the treatment of tuberculosis. Almost anywhere in the temperate zone the pure air necessary can be found within relatively short distance from large centers of population.

For children with local or joint tuberculosis, there is perhaps even a better chance for cure than for lung tuberculosis. Here, too, sun, air, good food and proper surgical treatment are the main factors for the accomplishment of a successful cure. There is as yet no specific treatment and all advertisements making such claims should be regarded with suspicion. It is wisest to avoid all patent medicines or patented devices claiming a sure cure for tuberculosis.

What else can the women of intelligence and influence do in any community toward the cure and prevention of a tuberculous patient? Insist upon the enforcement of good bovine laws to assure pure milk free from tuberculosis for rich and poor. Aid the community in which there are not sufficient tuberculosis dispensaries, special hospitals, preventoria and sanatoria for tuberculous adults and children, to establish these institutions and see that they are well equipped, well managed and the patients well taken care of. There should be no uncared-for tuberculous patients in any civilized community. The untrained and uncared-for tuberculous individual,

whether he lives in a palace or in a tenement house, in a first-class hotel or a lodging-house, will constitute a center of infection. There are not nearly enough institutions for the care of the tuberculous in the majority of our cities and towns. Melbourne in Australia has given us the example by the community taking care of all tuberculous patients who cannot be or are not properly taken care of at home. By enforcing all reasonable, humane and sanitary precautions to prevent the further spread of tuberculosis, this disease, heretofore considered the most prevalent and most fatal, has been eradicated in the city of Melbourne. Of course Australia is a country where woman does not reign supreme, but where she is the equal of man. She labors and works for the good of the community side by side with man. I hail the day when her position in this country will be the same. But in the meantime she can do much by promoting all movements which tend to better the condition of the laboring class, and thus help both

directly and indirectly in the combat of tuberculosis.

I have only been able to give you some hints as to how you can help. But I am aware that you are all familiar with the opportunity for service which is offered in almost every field of human endeavor to the woman who truly wishes to be helpful. One of our greatest philanthropists, a man who has given away millions for the betterment of his kind, the venerable Andrew Carnegie's favorite saying is "Service to man is the highest service to God. "To modify this for the occasion, I would wish to say that the service which the modern woman, the woman of highest ideals, imbued with the desire for service to her fellows, is destined to render to mankind, is nothing less than the salvation of the human race. Woman once in the council of city and state, there will be less social injustice, disease and pestilence; woman once in the council of nations, there will be, it is hoped, no more desolation and no more war.

The patients who have undergone treatment in tuberculosis sanatoria and have been discharged, must always bear in mind that they have forced upon them an obligation which they should willingly acknowledge. They owe it (1) to themselves (2) to those who have had to make sacrifices in order that an opportunity might be given them to regain their health, and (3) to the community in which they live. The extent of the obligation which every patient will assume depends entirely upon the conscience that each one possesses. There are some who are willing to stand by and allow a fellow-sufferer to assume theirs.

What I mean by this obligation is the part that every one of you should take in the antituberculosis campaign. During the past year 1400 people in the State of Connecticut died from tuberculosis of the lungs, and it is estimated that there are now 14,000 active cases of the disease. Think, then, of the total number throughout the country who are suffering from this dread malady. You, who are undergoing treatment and learning some of the salient points regarding tuberculosis, are fitted to take an active part in this battle against its ravages, and all should step forward to do your part.

It is too idealistic to hope that tuberculosis will ever be eradicated from the face of the A lecture to the patients of the Gaylord Farm Sanatorium.

earth, but it is not looking for the impossible to seek for a greater cut in the much too high deathrate and for a lessened number of new cases. This fight is one not only for physicians and nurses, but for every member of the community. Vital statistics show that while the death-rate for this disease has materially dropped in the past ten years, there has been practically no decrease in the number of cases reported, and it is along this line of prevention that we must now bend out energies to make the anti-tuberculosis campaign a success. The loss, as figured out in dollars and cents for one year, taking the entire death-rate of this country as its basis (and this reveals the fact that 130,000 persons die every year from tuberculosis) amounts to over $1,000,000,000, to say nothing of the suffering and privations which the families of many of its victims have to undergo. And it is wholly with the idea that each one of you may help to prevent such loss and suffering in the future that I present these facts to you.

Let me take up the obligation the discharged patient owes himself. At the sacrifice of considerable time and money he has or should have learned during his stay in the sanatorium, how he must live in the future if he is to resume his place in the world and keep his health. I understand fully that all cannot have the same ar