CHAPTER XXIVToC

Country Club House for New York Social WorkersCOUNTRY CLUB HOUSE FOR NEW YORK SOCIAL WORKERSGiven by the founder of Caroline Rest Educational Fund

COUNTRY CLUB HOUSE FOR NEW YORK SOCIAL WORKERSGiven by the founder of Caroline Rest Educational Fund

The first and most important step in securing hygienic rights for workingmen is to make sure that they know the rights that the law already gives them. Men still throw out their chests when talking of their rights. The posting of the game laws in a club last summer, and the instruction of all the natives of the countryside in regard to their rights as against those of outsiders, meant that for the first time in their history the game laws were enforced. All the natives, instead of poaching as has been their wont, joined together in protecting club property from intruding outside sportsmen. Poachers were caught and served with the full penalties of the law. Over winter fires these people's heroism will grow, but their respect for law will grow also, and it is doubtful if the game laws can be violated in that section so long as the tradition of this summer's worklives. And so it would be in a factory, if employees once realized that by uniting they could, as citizens, enforce health rights in the factory.

The hygiene of the workshop is not the same problem as the hygiene of the home and schoolhouse, because there are by-products of factory work that contaminate the air, overheat the room, and complicate the ordinary problems of ventilation. Certain trades are recognized as "dangerous trades." The problem of adequate government control of factories is one for a sanitary engineer. It has to do with disease-bearing raw material that comes to a factory, disease-producing processes of manufacture. There is need for revision of the dangerous-trade list. Many of the industries not so classed should be; many of the so-called dangerous trades can be made comparatively harmless by devices for exhausting harmful by-products. Industrial diseases should be made "notifiable," so that they can be controlled by the factory or health department. It is those trades that are dangerous because of remediable unsanitary and unhygienic conditions which demand the employer's attention. Complaints should be made by individuals when carelessness or danger becomes commonplace.

The manner in which many organizations have tried to better working conditions is similar to the manner in which Europeans are trying to help defective school children. Here, as there, is the difference betweendoing thingsandgetting things done. Here more than there is the tendency to exaggerate legislation and to neglect enforcement of law. Instead of harnessing the whole army of workingmen to the crusade and strengthening civic agencies such as factory, health, and tenement departments, houses are built and given to men, clubs are formed to amuse factory girls, amateur theatricals are organized. All this is called "welfare work." "What is welfare work?" reads the pamphlet of a large national association. "It is especial considerationon the part of the employer for the welfare of his employees." In the words of this pamphlet, the aim of this association "is to organize the best brains of the nation in an educational movement toward the solution of some of the great problems related to social and industrial progress." The membership is drawn from "practical men of affairs, whose acknowledged leadership in thought and business makes them typical representatives of business elements that voluntarily work together for the general good." As defined by this organization, welfare work is something given to the employee by the employer for the welfare of both. It is not something the employee himself does to improve his own working conditions.

We are told that employees should assume the management of welfare work.Should they install sanitary conveniences? Of course not.Would they know the need of a wash room in a factory if they never had had one? No.Should they manage lunch rooms? A few employers have attempted unsuccessfully to turn over the management of the lunch rooms to the employees, the result being that one self-sacrificing subofficial in each concern would find the burden entirely on his shoulders before working hours, during working hours, and after working hours. Employees cannot attend committee meetings during working hours, and they are unwilling to do so afterwards, for they generally have outside engagements. Furthermore, the employees know nothing about the restaurant business. If they did, they would probably be engaged in it instead of in their different trades. All experiments along this line of which we have heard have failed. The so-called "democratic idea," purely a fad, never has been successfully operated.Many employers would introduce welfare work into their establishments were it not for the time and trouble needed for its organization. The employment of a welfare director removes this obstacle. Successful prosecution of welfare work requires concentration of responsibility. All of its branches must be under the supervision of one person, or efforts in different directions may conflict, or special and perhaps pressing needs may escape attention. Pressure of daily business routine usually relegates welfare work to the last consideration, but the average employer is interested in his men and is willing to improve their condition if only their needs are brought to his attention.

We are told that employees should assume the management of welfare work.

Should they install sanitary conveniences? Of course not.

Would they know the need of a wash room in a factory if they never had had one? No.

Should they manage lunch rooms? A few employers have attempted unsuccessfully to turn over the management of the lunch rooms to the employees, the result being that one self-sacrificing subofficial in each concern would find the burden entirely on his shoulders before working hours, during working hours, and after working hours. Employees cannot attend committee meetings during working hours, and they are unwilling to do so afterwards, for they generally have outside engagements. Furthermore, the employees know nothing about the restaurant business. If they did, they would probably be engaged in it instead of in their different trades. All experiments along this line of which we have heard have failed. The so-called "democratic idea," purely a fad, never has been successfully operated.

Many employers would introduce welfare work into their establishments were it not for the time and trouble needed for its organization. The employment of a welfare director removes this obstacle. Successful prosecution of welfare work requires concentration of responsibility. All of its branches must be under the supervision of one person, or efforts in different directions may conflict, or special and perhaps pressing needs may escape attention. Pressure of daily business routine usually relegates welfare work to the last consideration, but the average employer is interested in his men and is willing to improve their condition if only their needs are brought to his attention.

First Lessons in Industrial HygieneFIRST LESSONS IN INDUSTRIAL HYGIENE

FIRST LESSONS IN INDUSTRIAL HYGIENE

Welfare Work That CountsWELFARE WORK THAT COUNTS

WELFARE WORK THAT COUNTS

This method of promoting the welfare of the worker may have been a necessary step in the development of industrial hygiene. Undoubtedly it has succeeded, in many cases, in bringing to an employer's consciousness the needs of his workmen, in accustoming employees to higher sanitary standards, and in teaching them to demand health rights from their employers. In many cases, however, "welfare work" has miseducated both employer and employee. The fact that "the so-called democratic idea, purely a fad, has never been successfully operated," is due to the interpretation given to "democratic idea." The two alternatives in the paragraph above quoted are lunch rooms, wash rooms, as gifts from employers to employees, or lunch rooms and wash rooms to be furnished by employees at their own expense. The true democratic idea, however, is that factory conditions detrimental to health shall be prohibited by factory legislation, and this legislation enforced by efficient factory inspectors, regardless of what may be given to employees above the requirement of hygiene.

Until employees are more active as citizens and more sensitive to hygienic rights, it is desirable that welfare directors be employed in factories to arbitrate between employer and employee, to raise the moral standard of a factory settlement, to organize amusements.

Welfare work at its best is a method of dividing business profits among all who participate in making these profits. Too often welfare secretaries teach employees how to be happy in the director's way, rather than in their own way. This adventitious position increases suspicion on both sides,disturbs the discipline of the foreman, weakens rather than strengthens the worker's efficiency, because it depends upon other things than work well done and the relation of health to efficiency. In a small factory town the owner of a large cotton mill has recognized the financial benefit of physically strong workers, and is trying the experiment of a welfare director. The man himself works "with his sleeves up." The social worker has an office in the factory. A clubhouse is fitted up for the mill hands to make merry in. A room in the factory is reserved for a lunch room, with plants, tables, and chairs for the comfort of the women. Parties are given by the employer to the employees, which he himself attends. He has thrown himself into whatever schemes his director has suggested. The director complained that the reason the new lunch room was not more popular was because a piano was needed. A second-hand one would not do, for that would cultivate bad taste in music. This showed the employer that soon everything would be expected from the "big house on the hill." An event which happened at the time when the pressure was greatest on him for the piano, convinced him that his employees could supply their real needs without any trouble or delay. The assistant manager was about to leave, and in less than a week five hundred dollars was raised among the workers for his farewell gift. Walking home that night late from his office the owner was attracted by the sound of jollity, and saw a little room jammed full of mill people enjoying the improvised music of a mouth organ played to the accompaniment of heels. He resolved henceforth to train his employees to do his work well and to earn more pay,—and to let them amuse themselves. From that time on he refused to be looked upon as thedeus ex machinaof the town. He decided that the best way to give English lessons to foreigners was to improve the school. His beneficence in supplying them with pure water at the mill didnot prevent a ravaging typhoid epidemic because the town water was not watched. He saw that the best way to improve health was to strengthen the health board and to make his co-workers realize that they were citizens responsible for their own privileges and rights.

Emergency hospitals and Y.M.C.A. buildings are sad substitutes for safety devices and automatic couplers. Christmas shopping in November is less kind than prevention of overwork in December. Night school and gymnastic classes are a poor penance for child labor and for work unsuited to the body. The left hand cannot dole favors enough to offset the evils of underpay, of unsanitary conditions, of inefficient enforcement of health laws tolerated by the right hand.

Just because a man is taking wages for work done, is no reason why he should forfeit his rights as a citizen, or allow his children, sisters, neighbors, to work in conditions which decrease their efficiency and earning power. What the employee can do for himself as a citizen, having equal health rights with employers, he has never been taught to see. Factory legislation is state direction of industries so far as relates to the safety, health, and moral condition of the people,—and which embraces to-day, more than in any other epoch, the opinion of the workers themselves. No government, however strong, can hope successfully to introduce social legislation largely affecting personal interests until public opinion has been educated to the belief that the remedies proposed are really necessary. Until schools insist upon a better ventilation than the worst factories, how can we expect to find children of working age sensitive to impure air? Where work benches are more comfortable than school desks, where drinking water is cleaner and towels more sanitary, however unsanitary they may be, than those found in the schoolhouse, the worker does not realize that they menace his right to earn a living wage as much as does a temporary shut-down.

Employers are by no means solely to blame for unhealthy working conditions. A shortsighted employee is as anxious to work overtime for double pay as a shortsighted employer is to have him. Among those who are agitating for an eight-hour day are many who, from self-interest or interest in the cause, work regularly from ten to sixteen hours.

Would it help to punish employees for working in unhealthy places? The highest service that can be rendered industrial hygiene is to educate the industrial classes to recognize hygienic evils and to coöperate with other citizens in securing the enforcement of health rights.

If the historian Lecky was right in saying that the greatest triumphs of the nineteenth century were its sanitary achievements, the Lecky of the twenty-first century will probably honor our generation not for its electricity, its trusts, and its scientific research, but for its crusade against the white plague and for its recognition of health rights. Thanks to committees for the prevention of tuberculosis,—local, state, national, international,—we are fast approaching the time when every parent, teacher, employer, landlord, worker, will see in tuberculosis a personal enemy,—a menace to his fireside, his income, and his freedom. Just as this nation could not exist half slave, half free, we of one mind now affirm that equal opportunity cannot exist where one death in ten is from a single preventable disease.[13]

Dr. Trudeau's "Little Red Cottage" at Saranac--birthplace of Out-of-door Treatment in AmericaDR. TRUDEAU'S "LITTLE RED COTTAGE" AT SARANAC—BIRTHPLACE OF OUT-OF-DOOR TREATMENT IN AMERICA

DR. TRUDEAU'S "LITTLE RED COTTAGE" AT SARANAC—BIRTHPLACE OF OUT-OF-DOOR TREATMENT IN AMERICA

Of no obstacle to efficient living is it more true than of tuberculosis, that the remedy depends upon enforcing rather than upon making law, upon practice rather than upon precept, upon health habits rather than upon medical remedies, upon coöperation of lay citizens rather than upon medical science or isolated individual effort. Without learning another fact about tuberculosis, we can stamp it out if we will but apply, and see that officers of health apply, lessons of cleanliness and natural living already known to us.

Perhaps the most striking results yet obtained in combating tuberculosis are those of the Massachusetts General Hospital in Boston. To visit its tuberculosis classes reminds one more of the sociable than the clinic. In fact, one wonders whether the milk diet and the rest cure or the effervescing optimism and good cheer of the physicians and nurses should be credited with the marvelous cures. The first part of the hour is given to writing on the blackboard the number of hours that the class members spent out of doors the preceding week. So great was the rivalry for first place that the nurse protested that a certain boy in the front row gave himself indigestion by trying to eat his meals in ten or fifteen minutes. It was then suggested that twenty hours a day would be enough for any one to stay out of doors, and that plenty of time should be taken for meals with the family and for cold baths, keeping clean, etc. Interesting facts gathered by personal interviews of two physicians with individual patients are explained to the whole class. Next to the number of hours out of doors, the most interesting fact is the number of hours of exercise permitted. A man of forty, the head of a family, beamed like a school child when told that, after nearly a year of absolute rest, he might during the next week exercise ten minutes a day. A graduate drops in, the very picture of health, weighing two hundred pounds. An apparently hopeless case would brighten up and have confidence when told that this strong, handsome man has gained fifty pounds by rest, good cheer, fresh air, all on his own porch. One young man, just back from a California sanatorium where he progressively lost strength in spite of change of climate, is now returning to work and is back at normal weight.

Outdoor Life Chart.OUTDOOR LIFE CHART.

OUTDOOR LIFE CHART.

Fighting Tuberculosis In The Mountains--SaranacFIGHTING TUBERCULOSIS IN THE MOUNTAINS—SARANAC

FIGHTING TUBERCULOSIS IN THE MOUNTAINS—SARANAC

Every patient keeps a daily record, called for by the following instructions:

Make notes of temperature and pulse at 8, 12, 4, and 8 o'clock, daily; movements of bowels; hours in open air; all food taken; total amount of milk; total amount of oil and butter; appetite; digestion; spirits; cough (amount, chief time); expectoration (amount in 24 hours, color, nature); exercise (if allowed), with temperature and pulse 15 minutes after exercise; sweats; visitors.

The following simple instructions can be followed in any home, even where open windows must take the place of porches:

Rest out of doors is the medicine that cures consumption. Absolute rest for mind and body brings speedy improvement. Itstops the cough and promotes the appetite. The lungs heal more quickly when the body is at rest. Lie with the chest low, so the blood flow in the lungs will aid to the uttermost the work of healing. The rest habit is soon acquired. Each day of rest makes the next day of rest easier, and shortens the time necessary to regain health. The more time spent in bed out of doors the better. Do not dress if the temperature is above 99 degrees, or if there is blood in the sputum. It is life in the open air, not exercise, that brings health and strength. Just a few minutes daily exercise during the active stage of the disease may delay recovery weeks or months. Rest favors digestion, exercise frequently disturbs digestion. When possible have meals served in bed. Never think the rest treatment can be taken in a rocking-chair. If tired of the cot, shift to the reclining chair, but sit with head low and feet elevated. Do not write letters. Dictate to a friend. Do not read much and do not hold heavy books. While reading remain in the recumbent posture.

Fighting Tuberculosis In Day Camps--BostonFIGHTING TUBERCULOSIS IN DAY CAMPS—BOSTON

FIGHTING TUBERCULOSIS IN DAY CAMPS—BOSTON

Once having learned the simple facts that must be noted and the simple laws that must be followed, oncehaving placed oneself in a position to secure the rest, the fresh air, and the health diet, no better next steps can be taken than to observe the closing injunction in the rules for rest:

There are few medicines better than clouds, and you have not to swallow them or wear them as plasters,—only to watch them. Keeping your eyes aloft, your thoughts will shortly clamber after them, or, if they don't do that, the sun gets into them, and the bad ones go a-dozing like bats and owls.

The Back Of A Street-Car Transfer, Sundays, New York CityTHE BACK OF A STREET-CAR TRANSFER, SUNDAYS, NEW YORK CITY

THE BACK OF A STREET-CAR TRANSFER, SUNDAYS, NEW YORK CITY

Important as are sanatoriums in mountain and desert, day or night camps within and near cities, milk and egg clinics, home visiting, change of air and rest for those who are known to be tuberculous, their importance is infinitesimal compared with the protection that comes from clean, healthy environment and natural living for those not known to be tuberculous. This great fact has been recognized by the various bodies now engaged in popularizing the truth about tuberculosis by means of stationary and traveling exhibits, illustrated lectures, street-car transfers, advertisements, farmers' institutes, anti-spitting signs in public vehicles and public buildings, board of health instructions in many languages, magazine stories, and press reports of conferences. This brilliant campaign of education shows what can be done by national, state, and county superintendents of schools, if they will make the most of school hygiene and civics.

An Example In Coöperation That Anti-tuberculosis Crusaders Should FollowAN EXAMPLE IN COÖPERATION THAT ANTI-TUBERCULOSIS CRUSADERS SHOULD FOLLOW

AN EXAMPLE IN COÖPERATION THAT ANTI-TUBERCULOSIS CRUSADERS SHOULD FOLLOW

Is it not significant that America's national movement is due primarily to the organizing capacity of laymen in the New York Charity Organization Society rather than to schools or hospitals? Most of the local secretaries are men whose inspiration came from contact with the non-medical relief of the poor in city tenements. The secretary of the national association is a university professor of anthropology, who has also a medical degree. The child victim's plea—Little Jo's Smile—was nationalized by an association of laymen, aided by the advertising managers of forty magazines. The smaller cities of New York state are being aroused by a state voluntary association that for years has visited almshouses, insane asylums, and hospitals. These facts I emphasize, for they illustrate the opportunity and the duty of the lay educator, whether parent, teacher, labor leader, or trustee of hospital, orphanage, or relief society.

Three fundamental rules of action should be established as firmly as religious principles:

1. The public health authorities should be told of every known and every suspected case of tuberculosis.2. For each case proved by examination of sputum to be tuberculous, the public-health officers should know that the germs are destroyed before being allowed to contaminate air or food.3. Sick and not yet sick should practice habits of health that build up vitality to resist the tubercle bacilli and that abhor uncleanliness as nature abhors a vacuum.

1. The public health authorities should be told of every known and every suspected case of tuberculosis.

2. For each case proved by examination of sputum to be tuberculous, the public-health officers should know that the germs are destroyed before being allowed to contaminate air or food.

3. Sick and not yet sick should practice habits of health that build up vitality to resist the tubercle bacilli and that abhor uncleanliness as nature abhors a vacuum.

Fighting Tuberculosis With A National OrganizationFIGHTING TUBERCULOSIS WITH A NATIONAL ORGANIZATION

FIGHTING TUBERCULOSIS WITH A NATIONAL ORGANIZATION

All laws, customs, and environmental conditions opposed to the enforcement of these three principles must be modified or abolished. If the teachers of America will list for educational use in their own communities the local obstacles to these rules of action, they will see exactly where their local problem lies. The illustrations that are given in this book show in how many ways these rules of action are now being universalized. Three or four important steps deserve especial comment:

1. Compulsory notification of all tuberculous cases.2. Compulsory removal to hospital of those not able at home to destroy the bacilli, or compulsory supervision of home care.3. Examination of all members of a family where one member is discovered to be tuberculous.4. Special provision for tuberculous teachers.5. Protection of children about to enter industry but predisposed to tuberculosis.6. Prohibition of dry cleaning of schools, offices, and streets.7. Tax provision for educational and preventive work.

1. Compulsory notification of all tuberculous cases.

2. Compulsory removal to hospital of those not able at home to destroy the bacilli, or compulsory supervision of home care.

3. Examination of all members of a family where one member is discovered to be tuberculous.

4. Special provision for tuberculous teachers.

5. Protection of children about to enter industry but predisposed to tuberculosis.

6. Prohibition of dry cleaning of schools, offices, and streets.

7. Tax provision for educational and preventive work.

Compulsory notification was introduced first in New York City by Hermann M. Biggs, M.D., chief medicalofficer: 1893, partially voluntary, partially compulsory; 1897, compulsory for all. Physicians who now hail Dr. Biggs as a statesman called him persecutor, autocrat, and violator of personal freedom fifteen years ago. Foreign sanitarians vied with American colleagues in upbraiding him for his exaggeration of the transmissibility of consumption and for his injustice to its victims. As late as 1899 one British expert particularly resented the rejection of tuberculous immigrants at Ellis Island, and said to me, "Perhaps if you should open a man's mouth and pour in tubercle bacilli he might get phthisis, but compulsory notification is preposterous." In 1906 the International Congress on Tuberculosis met in Paris and congratulated New York upon its leadership in securing at health headquarters a list of the known disease centers within its borders; in 1906 more than twenty thousand individual cases were reported, ten thousand of these being reported more than once. To know the nature and location of twenty thousand germ factories is a long step toward judging their strength and their probable product. To compulsory notification in New York City is largely due the educational movements of the last decade against the white plague, more particularly the growing ability among physicians to recognize and to treat conditions predisposing to the disease. As in New York City, the public should provide free of cost bacteriological analysis of sputum to learn positively whether tuberculosis is present. Simpler still is the tuberculin test of the eyes, with which experiments are now being made on a large scale in New York City, and which bids fair to become cheap enough to be generally used wherever physical examinations are made. This test is known as Calmette's Eye Test. Inside the eyelid is placed a drop of a solution—95 per cent alcohol and tuberculin. If conjunctivitis develops in twenty-four hours, the patient is proved to have tuberculosis. Some physicians still fear to use this test. Others question its proof. The "skin test" is also being thoroughly tried in several American cities and, if finally found trustworthy, will greatly simplify examination for tuberculosis. Dr. John W. Brannan, president of Bellevue and Allied Hospitals, New York City, is to report on skin and eye tuberculin tests for children at the International Congress on Tuberculosis, mentioned later.

Fighting Tuberculosis By Organized Coöperative Dispensary WorkFIGHTING TUBERCULOSIS BY ORGANIZED COÖPERATIVE DISPENSARY WORK

FIGHTING TUBERCULOSIS BY ORGANIZED COÖPERATIVE DISPENSARY WORK

Fighting Bone Tuberculosis at Sea Breeze, where Eye and Skin Tuberculin Tests are Being MadeFIGHTING BONE TUBERCULOSIS AT SEA BREEZE, WHERE EYE AND SKIN TUBERCULIN TESTS ARE BEING MADE

FIGHTING BONE TUBERCULOSIS AT SEA BREEZE, WHERE EYE AND SKIN TUBERCULIN TESTS ARE BEING MADE

Compulsory removal of careless consumptives is yet rare. One obstacle is the lack of hospitals. In New York ten thousand die annually from tuberculosis and fifty thousand are known to have it, yet there are only about two thousand beds available. So long as the patients anxious for hospital care exceed the number of beds, it does not seem fair to give a bed to some one who does not want it. On the other hand, it should not be forgotten that patients are taken forcibly to smallpox and scarlet-fever hospitals, not for their own good, but for the protection of others. The last person who should be permitted to stay at home is the tuberculous person who is unable, unwilling, or too ignorant to take the necessary precautions for others'protection. A rigid educational test should be applied as a condition of remaining at home without supervision.

The objections to compulsory removal are two: (1) it is desired to make sanatorium care so attractive that patients will go at the earliest stage of the disease; (2) an unwilling patient can defeat the sanitarian's effort to help him and others. The alternative for compulsory removal is gratuitous, and, if need be, compulsory, supervision of home care, such as is now given in New York City. In Brighton, England, Dr. Newsholme treats his municipal sanatorium as a vacation school, giving each patient one month only. Thus one bed helps twelve patients each year. Almost any worker can spare one month and in that time can be made into a missionary of healthy living.

Family examining parties were begun in New York by Dr. Linsly R. Williams, for the relief agency that started the seaside treatment of bone tuberculosis. Many of the crippled children at Sea Breeze were found to have consumptive fathers or mothers. In one instance the father had died before Charlie had "hip trouble." Long after we had known Charlie his mother began to fail. She too had consumption. Family parties were planned for 290 families. Weights were taken and careful examination made, the physician explaining that predisposition means defective lung capacity or deficient vitality. Of 379 members, supposedly free from tuberculosis, sixteen were found to have well-marked cases. (Of twenty Boston children whose parents were in a tuberculosis class, four had tuberculosis.) In one instance the father was astonished to learn not only that he was tuberculous, but that he had probably given the disease to the mother, for whom he was tenderly concerned. Of special benefit were the talks about teeth and nourishment, and about fresh air and water as germ killers. One examination of this kind will organize a family crusade against carelessness.

Fighting Tuberculosis in Small CitiesFIGHTING TUBERCULOSIS IN SMALL CITIESNew York State Charities Aid Association

FIGHTING TUBERCULOSIS IN SMALL CITIESNew York State Charities Aid Association

Tuberculous teachers ought to be excluded from schoolrooms not merely because they may spread tuberculosis, but because they cannot do justice to school work without sacrifices that society ought not to accept. A tuberculous teacher ought to be generous enough to permit public hospitals to restore her strength or enterprising enoughto join tuberculosis classes. It is selfish to demand independence at the price which is paid by schools that employ tuberculous teachers.

Fighting Bone Tuberculosis With Salt Water And Salt AirFIGHTING BONE TUBERCULOSIS WITH SALT WATER AND SALT AIR

FIGHTING BONE TUBERCULOSIS WITH SALT WATER AND SALT AIR

Predisposition to tuberculosis should be understood by every child before he is accepted as an industrial soldier. Many trades now dangerous would be made safe if workers knew the risk they run, and if society forbade such trades needlessly to exhaust their employees. A perfectly sound man is predisposed to tuberculosis if he elects to work in stale, dust-laden air. Ill-ventilated rooms, cramped positions, lack of exercise in the open air, prepare lungs to give a cordial reception to tubercle bacilli. Rooms as well as persons become infected. Fortunately, opportunities to work are so varied in most localities that workers predisposed to tuberculosis may be sure of a livelihood in an occupation suited to their vitality. Destruction of germs in the air, in carpets, on walls, on streets, is quite as important asdestruction of germs in lungs. Why should not tenants and workers require health certificates stating that neither house nor working place is infected with tubercle bacilli? Some cities now compel the disinfection of premises occupied by tuberculous personsaftertheir removal. Landlords, employers, tenants, and employees can easily be taught to see the advantage of disinfecting premises occupied by tuberculous casesbeforedetection.

Fighting Feather Dusters Is One Object Of Sea-Air Hospitals For Bone TuberculosisFIGHTING FEATHER DUSTERS IS ONE OBJECT OF SEA-AIR HOSPITALS FOR BONE TUBERCULOSIS

FIGHTING FEATHER DUSTERS IS ONE OBJECT OF SEA-AIR HOSPITALS FOR BONE TUBERCULOSIS

Dry cleaning, feather dusters, dust-laden air, will disappear from schoolrooms within twenty-four hours after school-teachers declare that they shall disappear. We have no right to expect street cleaners, tenement and shop janitors, or overworked mothers to be more careful than school-teachers. Last year I said to a janitress, "Don't you realize that you may get consumption if you use that feather duster?" Her reply caused us to realize our carelessness: "I don't want any more than I've got now." Shall we some day have compulsory examination and instruction of all cleaners, starting with school cleaners?

FIGHTING TUBERCULOSIS IN OPEN TENTSFIGHTING TUBERCULOSIS IN OPEN TENTS

FIGHTING TUBERCULOSIS IN OPEN TENTS

Taxing is swift to follow teaching in matters of health. Teachers can easily compute what their community loses from tuberculosis. The totals will for some time prove a convincing argument for cleanliness of air, of body, and of building wherever the community is responsible for air, building, and body. The annual cost of tuberculosis to New York City is estimated at $23,000,000 and to the United States at $330,000,000. The cost of exterminating it will be but a drop in the bucket if school-teachers do their part this next generation with the twenty million children whose day environment they control for three fourths of the year, and whose habits they can determine.

The first meeting in America of the International Congress on Tuberculosis was held at Washington, D.C., September 21 to October 12, 1908. For many years theproceedings of this congress will undoubtedly be the chief reference book on the conquest of tuberculosis.[14]

How many aspects there are to this problem, and how many kinds of people may be enlisted, may be seen from the seven section names: I. Pathology and Bacteriology; II. Sanatoriums, Hospitals, and Dispensaries; III. Surgery and Orthopedics; IV. Tuberculosis in Children—Etiology, Prevention, and Treatment; V. Hygienic, Social, Industrial, and Economic Aspects; VI. State and Municipal Control of Tuberculosis; VII. Tuberculosis in Animals and Its Relation to Man.

Fighting Tuberculosis In Cheap Shacks, $125 Per Bed, Otisville, New YorkFIGHTING TUBERCULOSIS IN CHEAP SHACKS, $125 PER BED, OTISVILLE, NEW YORK

FIGHTING TUBERCULOSIS IN CHEAP SHACKS, $125 PER BED, OTISVILLE, NEW YORK

How many-sided is the responsibility of each of us for stamping out tuberculosis is shown by the preliminary programme of the eight sessions of Section V. These topics suggest an interesting and instructive year's study for clubs of women, mothers, or teachers, or for advanced pupils.

I. Economic Aspects of Tuberculosis

1. The burdens entailed by tuberculosis:a.On individuals and families.b.On the medical profession.c.On industry.d.On relief agencies.e.On the community.f.On social progress.2. The cost of securing effective control of tuberculosis:a.In large cities.b.In smaller towns.c.In rural communities.

1. The burdens entailed by tuberculosis:

a.On individuals and families.b.On the medical profession.c.On industry.d.On relief agencies.e.On the community.f.On social progress.

2. The cost of securing effective control of tuberculosis:

a.In large cities.b.In smaller towns.c.In rural communities.

II. Adverse Industrial Conditions

1. Incidence of tuberculosis according to occupation.2. Overwork and nervous strain as factors in tuberculosis.3. Effect of improvements in factory conditions on the health of employees.4. Legitimate exercise of police power in protecting the life and health of employees.

1. Incidence of tuberculosis according to occupation.

2. Overwork and nervous strain as factors in tuberculosis.

3. Effect of improvements in factory conditions on the health of employees.

4. Legitimate exercise of police power in protecting the life and health of employees.

III. The Social Control of Tuberculosis

1. Outline of a comprehensive programme for:a.National, state, and municipal governments.b.Departments of health and departments of public relief.c.Private endowments.d.Voluntary associations for educational propaganda.e.Institutions, such as schools and relief agencies, which exist primarily for other purposes.2. A symposium on the relative value of each of the features in an aggressive campaign against tuberculosis:a.Compulsory registration.b.Free sputum examination.c.Compulsory removal of unteachable and dangerous cases.d.Laboratory research.e.Hospital.f.Sanatorium.g.Dispensary.h.The tuberculosis class.i.Day camp.j.Private physician.k.Visiting nurse.l.After-care of arrested cases.m.Relief fund.n.Climate.o.Hygienic instruction,—personal and in class.p.Inspection of schools and factories.q.Educational propaganda.

1. Outline of a comprehensive programme for:

a.National, state, and municipal governments.b.Departments of health and departments of public relief.c.Private endowments.d.Voluntary associations for educational propaganda.e.Institutions, such as schools and relief agencies, which exist primarily for other purposes.

2. A symposium on the relative value of each of the features in an aggressive campaign against tuberculosis:

a.Compulsory registration.b.Free sputum examination.c.Compulsory removal of unteachable and dangerous cases.d.Laboratory research.e.Hospital.f.Sanatorium.g.Dispensary.h.The tuberculosis class.i.Day camp.j.Private physician.k.Visiting nurse.l.After-care of arrested cases.m.Relief fund.n.Climate.o.Hygienic instruction,—personal and in class.p.Inspection of schools and factories.q.Educational propaganda.

IV. Early Recognition and Prevention

1. Importance of discovering the persons who have tuberculosis before the disease has passed the incipient stage.2. Examination of persons known to have been exposed or presumably predisposed.3. Systematic examination of school children during their course and on leaving school to go to work.4. Professional advice as to choice of occupation in cases where there is apparent predisposition to disease.

1. Importance of discovering the persons who have tuberculosis before the disease has passed the incipient stage.

2. Examination of persons known to have been exposed or presumably predisposed.

3. Systematic examination of school children during their course and on leaving school to go to work.

4. Professional advice as to choice of occupation in cases where there is apparent predisposition to disease.

V. After-Care of Arrested Cases

1. Instruction in healthful trades in the sanatorium.2. Training for professional nursing in institutions for the care of tuberculous patients.3. Farm colonies.4. Convalescent homes or cottages.5. Aid in securing suitable employment on leaving the sanatorium.6. How to deal with the danger of a return to unfavorable home conditions.

1. Instruction in healthful trades in the sanatorium.

2. Training for professional nursing in institutions for the care of tuberculous patients.

3. Farm colonies.

4. Convalescent homes or cottages.

5. Aid in securing suitable employment on leaving the sanatorium.

6. How to deal with the danger of a return to unfavorable home conditions.

VI. Educational Methods and Agencies

1. Special literature for general distribution.2. Exhibits and lectures.3. The press.4. Educational work of the nurse.5. Labor organizations.6. Instruction in schools of all grades.7. Presentation and discussion of leaflets awarded prizes by the congress.

1. Special literature for general distribution.

2. Exhibits and lectures.

3. The press.

4. Educational work of the nurse.

5. Labor organizations.

6. Instruction in schools of all grades.

7. Presentation and discussion of leaflets awarded prizes by the congress.

VII. Promotion of Immunity

1. Development of the conception of physical well-being.2. Measures for increasing resistance to disease:a.Parks and playgrounds.b.Outdoor sports.c.Physical education.d.Raising the standards of living: housing, diet, cleanliness.3. Individual immunity and social conditions favorable to general immunity.

1. Development of the conception of physical well-being.

2. Measures for increasing resistance to disease:

a.Parks and playgrounds.b.Outdoor sports.c.Physical education.d.Raising the standards of living: housing, diet, cleanliness.

3. Individual immunity and social conditions favorable to general immunity.

VIII. Responsibility of Society for Tuberculosis

1. A symposium of representativea.Citizens.b.Social workers.c.Employers.d.Employees.e.Physicians.f.Nurses.g.Educators.h.Others.

1. A symposium of representative

a.Citizens.b.Social workers.c.Employers.d.Employees.e.Physicians.f.Nurses.g.Educators.h.Others.

Cash prizes of one thousand dollars each are offered: (1) for the best evidence of effective work in the prevention or relief of tuberculosis by any voluntary association since 1905; (2) for the best exhibit of a sanatorium for working classes; (3) for the best exhibit of a furnished home for the poor, designed primarily to prevent, but also to permit the cure of tuberculosis.

Boston fights Tuberculosis with a Comprehensive PlanBOSTON FIGHTS TUBERCULOSIS WITH A COMPREHENSIVE PLANA-D, F, H-J, private hospitals and agencies reporting cases to the official center;E, home care;K, L, M, day camp and hospitals for incipient and advanced cases

BOSTON FIGHTS TUBERCULOSIS WITH A COMPREHENSIVE PLANA-D, F, H-J, private hospitals and agencies reporting cases to the official center;E, home care;K, L, M, day camp and hospitals for incipient and advanced cases

A white-plague scrapbook containing news items, articles, and photographs will prove an interesting aid to self-education or to instruction of children, working girls' clubs, or mothers' meetings. Everybody ought to enlist in this war, for the fight against tuberculosis is a fight for cleanlinessand for vitality, for a fair chance against environmental conditions prejudicial to efficient citizenship.

So sure is the result and so immediate the duty of every citizen that Dr. Biggs wrote in 1907:In no other direction can such large results be achieved so certainly and at such relatively small cost. The time is not far distant when those states and municipalities which have not adopted a comprehensive plan for dealing with tuberculosis will be regarded as almost criminally negligent in their administration of sanitary affairs and inexcusably blind to their own best economic interests.

[13]The best literature on tuberculosis is in current magazines and reports of anti-tuberculosis crusaders. For a scientific, comprehensive treatment, libraries and students should haveThe Prevention of Tuberculosis(1908) by Arthur Newsholme, M.D. A popular book isThe Crusade against Tuberculosis, by Lawrence F. Flick, of the Henry Phipps Institute for the Study, Treatment, and Prevention of Tuberculosis.

[14]Those desiring copies this year or hereafter will do well to write to The National Association for the Study and Prevention of Tuberculosis, 105 East 22d St., New York City. The congress is under the control of the National Association and is managed by a special committee appointed by it. Even after a national board of health is established, the National Association for the Study and Prevention of Tuberculosis will continue to be a center for private interest in public protection against tuberculosis. One of its chief functions is the preparation and distribution of literature to those who desire it.

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