may entirely heal, we are now taught that it is necessary to remain in bed, immobilize, for months on end, even years. Few of us have the inclination to do that; fewer still the opportunity or the means. Few of us but have dependents or are ourselves perhaps dependent on others whom we are loath to burden longer than is absolutely necessary. In the majority of instances, I believe it is safe to say that after a six or nine months' course of instruction here, if the doctors' and nurses' instructions have been carefully followed, or in other words, if one has really "taken treatment," it is entirely possible for a patient after leaving the sanatorium to take up again, possibly to a limited extent, the thread of life's activities. But is the mind equally ready for the change back to or approaching old conditions? Too often is it not a fact that after taking the "rest cure" we are firmly convinced that we can never work again? This is not a condition of fact but merely a frame of mind, and on sober second thought is easily disposed of. Is there a person here who if given the choice of living one year of activity, of usefulness and helpfulness to others, or of five years of slothful dependence on others, would not choose the former? "It matters not how long we live, but how." In adopting a course of action it is necessary, certainly, to go over the whole situation thoroughly and especially to depend on the advice of one's physician. Patients ready to leave the sanatorium should consider themselves fortunate in being able to obtain advice that is really worth while along these lines, from the specialists employed to look after their welfare. We do not want to "take the measure of an unmade grave" either by returning to work too soon, or, after the return to work is made, by working too hard. The point I am trying to bring out is that after the turning point for the better is reached in the checking of our disease very few of us can wait on a complete arrest before again taking up the burden of making a living. Of course, circumstances alter cases, and where one is in position to go after a complete "arrest" he should undoubtedly take advantage of the opportunity. There is a certain percentage of cases unfit for work of any kind. This is unavoidable as conditions are now, but workers in the tuberculosis field are looking forward to the time when diagnosis will be made of all tuberculosis in the incipient or at least in the moderately advanced stage. Reconstruction and rehabilitation will then be the watchwords of anti-tuberculosis fighters, more than now, because less time will be required in the supervision and care of the ofttimes dangerous advanced case. Advice is sometimes given to the discharged sanatorium patient to "go after a light outdoor job." Do any of you know of a "light outdoor job" unless it is at this institution? The sanatorium can, of course, make use of a comparatively small number of former pa tients and those once employed refuse to die. Some of you have been farmers. You will agree with me that there is nothing light about farm work. If one owns his own farm he may manage very well by hiring men to do the hardest work, but when I speak of "job" I refer to working for wages. I believe it is most satisfactory for one to go back to an occupation in which he has been trained, whether that be farming, clerking, bookkeeping or banking. To do otherwise means that one must put forth considerable effort in learning new work, effort that should be conserved towards the upbuilding of one's strength. In the course of time we will have vocational education for the tuberculous, just as we now have vocational education by the government for the disabled soldier and sailor. As a matter of fact, an experiment along this line has already been begun, I believe, in New York State. Then it will be possible, through government subsidy or through private benevolence, for the arrested or apparently arrested case of tuberculosis to learn a profession or trade best suited to his individual strength, mentality, and personal preference. However, nothing of the kind is now offered generally, and we must struggle along as best we can, some of us handicapped by having been trained in occupations requiring much physical exertion, but all free to seek advice and encouragement from the doctors and nurses who have so ably assisted us on the up-grade road to better health. I have used the pronouns "our" and "we" purposely for the reason that I speak from personal experience. Four years ago I was myself a patient in this institution, and I believe that the one big thing that has enabled me to do seven and eight hours' work practically every day since that time is the advice and assistance I have received from the physicians and nurses of this sanatorium. They have helped me to "keep in the game"; to fight not just now and then but to fight every day, every week, every month of the year. I have been fortunate in that I have been allowed to remain at the institution. But any of you, all of you, when you get back to the old job, whether it is bookkeeping, housekeeping or what not, and have an inclination to overlook that needed after-dinner rest, when you find that you are going to the movies too often, or doing the thousand and one things that the tuberculous person who wants to live and let live and perform his share of the world's work ought not to do, then remember that it is time to step on the train and take a trip back to the old sanatorium and have a heart-to-heart talk with the superintendent or with one of his assistants. you will put the matter plainly before your adviser, believe me, you will be told in plain language just how to get back into the right path, and also the consequences of not getting into that path. If It is not the work that is going to hurt you. It is what you will do or fail to do when you are not at work. Then, too, there is a great deal in believing that you can do a thing. If one who has tuberculosis believes and knows that he can make himself useful to society he will come mighty near accomplishing his purpose, or I miss my guess. This fear of a breakdown which comes to many, causes some few to throw up their hands and say: "I can never work-why, I am a sick man-an invalid." Such poppycock talk makes me tired. Did you ever read The Tempest by one Billie Shakespeare? In it one of the characters, poor old Trinculo, receives a great fright. A monster is about to devour him. He regains his courage and this is the way he speaks of the thing that frightened him so: "By this good light, this is a very shallow monster! I afear'd of him! A very weak monster! The man i' the moon! A most poor, credulous monster! Well drawn, Monster, in good sooth!" In a good light our fears of what can be done and what cannot be done often turn out to be mere monsters easily overcome. On the gates of Busyrane appeared these inscriptions: "Be bold," first gate; "Be bold, be bold and evermore be bold," second gate; "Be not too bold," third gate. In conclusion, I wish again to invite your attention to the great possibilities for helping others that the ex-patient of the sanatorium has. Possibly I have stressed too much that word ex-patient. It is not that I think all of you will leave to-morrow, but because some of you will be leaving perhaps to-morrow, or next week or next month, and because I know that all of you will eventually be ex-patients, that I have brought this word into such prominence. We all know that advice based on personal experience bears more weight than any other. You have had experience and, I may, add, expert instruction, sufficient to enable you to give helpful advice not only to those whom your powers of observation will enable you to judge as being tuberculous, but even to those ministering to the public good. You may, perhaps, help avoid a waste of effort and of money that, rightfully used, could be put to great accomplishment. Not only can you say to the friend or neighbor who, because of your training here, you know to be tuberculous: "Old man, you need a rest and a physical examination. Go to your doctor, now, before it is too late," but you can say to the physician: "Doctor, my friend whom you recently examined and whom you pronounced to be asthmatic (or billious, or bronchitic, or having stomach trouble ... ad infinitum) looks to me as if he had tuberculosis. Don't you think you had better go over his chest again, or send him to a specialist?" You can say to the school teacher: "Teacher, if you would let a little (or perhaps a lot) of fresh air into this schoolroom these children would not be so drowsy and hard to interest in their lessons," or "Teacher, if the parents of these children are not taught that it is a crime to expose children to mumps, measles or other contagious diseases, 'to have it over with,' in this way laying the foundation for a possible future tuberculosis, this kind of thing will never be stopped," and so on, and so on. Even better than this, you could take a stand on the question of better health supervision or, in other words, a bigger and better organized health department for this state to meet the requirements of a constantly increased population and to keep up with the standards of public health work as set by certain northern states and by certain foreign countries. May you all succeed not only in "piling up together again" your own lives, but also in assisting others in doing this. LAMENT OF A "COLD-FEETER" Cold feet a slippy blanket- Coat collar turned up round my ears To thwart the wintry breeze. Breath freezin' on my blankets, My coat, and on my hair I wisht I had a hide of fur And wuz a Polar Bear! I alluz liked the winter-time- To coast and slide and sport on skiis And sleigh and skate and run. But when you're out "a-curin," And have to set right still This awful cold's not such a joke- WINIFRED BICKNELL. The aim of this Journal is to be helpful to persons seeking health by an outdoor life, and particularly to disseminate reliable information looking to the prevention and cure of tuberculosis. It should be distinctly understood, however, that the JOURNAL OF THE OUTDOOR LIFE is not intended to supplant personal medical advice. Anyone suffering from pulmonary trouble who is not under the care and guidance of a physician is taking grave chances. THE TREND OF THE TUBERCULOSIS CAMPAIGN The recent annual meeting of the National Tuberculosis Association held at Atlantic City, June 14th to 18th, is significant in the manner in which it has pointed out the trend of the tuberculosis movement. Briefly stated, the conference showed that the three most vital topics at present before tuberculosis workers are first, the relation of the tuberculosis campaign to other public health movements; second, the degree to which the tuberculosis movement should be expanded to meet the growing demands put upon it; and third, the profit that may be derived from the lessons taught by the war experience of this and other countries. Taking up the first line of thought, namely, the relation of the tuberculosis campaign to other public health movements, there was hardly a session, whether purely for business, or discussion, or of a social nature, where this subject did not come up. It was uppermost in the minds of everyone. while there was a field for private health organizations, there was little or no field for the tuberculosis movement as such, and that all tuberculosis work should be put under some centralized public health agency. As a variation of this view, again the feeling was expressed that the tuberculosis movement might become a section or a part of some centralized private agency with a national scope, such as the American Red Cross, the American Public Health Association, the International Health Board, or some new body to be formed. From this point of view, the general discussion, however, tended toward the idea that the anti-tuberculosis campaign. in this country as a distinct entity has still a very definite piece of work to perform and that this piece of work, viz., the reduction of mortality and morbidity from tuberculosis, can best be performed by specialized tuberculosis agencies, the community leadership and initiative being supplied by the private associations There were many varying points of under the state and national organizaview. There were, for example, those tions. The Association, both through who insisted that there should be no its speakers and through its official specialized tuberculosis movement at all resolutions, went on record as urging and that the only thing to do was to a Division of Tuberculosis in the United merge the tuberculosis campaign with States Public Health Service and as the public health movement and to abol- in every way strengthening centralish all private organizations and put ized control. Definite resolutions urgeverything under the U. S. Public Health ing closer cooperation with all public Service in one grand autocratic spree of and private health agencies were also centralized control. adopted. Health insurance was vigorThere were others who contended that ously discussed and generally favored. Even the plan for a National Health Council formed for the definite purpose of co-ordinating the big private health agencies as a national scope was advanced and vigorously supported by the retiring president, Dr. David R. Lyman. But with all of these expressions of interest and cooperation in the broader phases of the public health movement, there seemed to be a very distinct feeling that if the public is to be aroused to the magnitude and appreciation of a million open cases of tuberculosis in our country, plus another million arrested and closed cases, such an awakening can come only through an aggressive, active, specialized tuberculosis movement. The second line of thought generally expressed at the Atlantic City meeting has a close relationship to that previously discussed. In the sociological, clinical and pathological sections, in the Advisory Council, the nurses' meetings, and every where throughout the conference, the feeling was evident that this is not the time for standing still; it is a time for expanding the tuberculosis movement to the utmost degree possible. This expansion, as indicated by the discussions at Atlantic City, should take form in two ways: first, by an enlargement of the present program through the provision of additional hospital, nursing, dispensary and other similar agencies; and second, through the broadening of the scope of the tuberculosis movement to bring into its field such related activities as child welfare, school hygiene, industrial welfare, etc. Never before in the history of the National Association has so much emphasis been laid upon the fact that tuberculosis control envelopes the correction of a host of environmental factors involved in other related public health movements. Professor John R. Commons made a strong plea for health insurance as an aid in preventing sickness from tuberculosis rather than as a palliative to cure those who are already sick. Walter S. Ufford clearly brought out the fact that relief as ordinarily conceived does not relieve and that the tuberculosis movement must be more far-reaching in its endeavor if it would produce the result desired. The futility of the insti tutional program that fails to recognize after-care, and occupational and vocational therapy was also clearly stressed. In a discussion on the Red Cross Seal campaign for the coming Christmas season, budgets aggregating nearly $6,500,000, or practically three times the last seal sale, were presented by the various states as indicating the need for a greater expansion of work in every part of the country. Over and above the discussions with regard to the relation of the tuberculosis campaign to other public health movements and the necessity for an expanding campaign, and indeed the motive back of these expressions, was the feeling evidenced in every hand that the tuberculosis movement must profit by the experience of the war. In the fact that nearly 70,000 cases had been discovered by draft boards as unfit because of tuberculosis, and that to this number must be added another 20,000 rejected by army surgeons as similarly unfit, and to this toll should be added still another 10,000 as unable to serve in the ranks because of this one disease, the lessons derived from the war become obvious in two directions. There is first of all the need for more machinery to discover cases of tuberculosis, and again and again this need was emphasized throughout every section of the meeting. There is secondly the need for more definite. treatment of those who are discovered so that they can be restored to working efficiency. So impressive were the numerous lessons brought out by the various speakers from the experience of the last four years that the Association pledged itself definitely to "take immediate steps to secure the cooperation of all other great health organizations, especially the American Medical Association, and the state and territorial health officers in placing before the American people a united demand for universal military service as a public health measure." In addition to this the Association resolved that it would cooperate in every practical way with the National Physical Education Service in the promotion of physical education in the schools. COMMUNICATIONS* "What My Experience With Tuberculosis Has Taught Me." It may be of interest to others who are taking the treatment-what my experience has been since then. My improvement and recovery has been gradual and consistent. Nine hours of the 24 I spend in bed, also one hour in bed after dinner, the other 14 hours I am up and about and able to take care of most of my business duties, which consist of managing a motion picture theatre. I practically lead the normal life of an average healthy person, with the exception that I am on my guard. I walk at a leisurely gait. I do not run after street cars. I do not lift heavy weights. I very seldom indulge in any of the so-called dissipations which tax the vitality. The oustanding features of my recovery are: From March to Oct., 1916, when I took the treatment, from the standpoint that fresh air was the most important element in the treament, I did no make any progress. In Aug., 1916, when I had a severe setback, I was spending about 23 out of 24 hours outof-doors. From Oct., 1916, when I started on the theory that rest was by far the most important element in the treatment, and made no attempt to secure 100 per cent. fresh air, but instead tried to secure 100 per cent rest in my room in a comfortable bed, with the window open, (I did not use a window tent) my improvement was steady and consistent. I am of the opinion that a great many put forth too much effort and strain to secure the maximum amount of fresh air at the expense of bodily rest and comfort. Some of the things that I attribute my recovery to are: The clear explanations of Dr. Lawrason Brown, in his book, "The Rules for Recovery from Tuberculosis." Why such prolonged absolute rest was needed also, his assurance that one need not fear any ill effects upon other organs or functions of the body, from the long rest in bed required to bring about a recovery from Tuberculosis. Also the statement of Dr. John B. Hawes, in his book, "Consumption and What to do About it," who says, "One of the best known authorities who has had consumption himself has said, that if he had to take the treatment all over again, he would go to bed and stay there for six months or more until all symptoms disappeared." Dr. Hawes says, "These are wise words." I took Dr. Hawes' advice literally. I spent six months in bed, took all my meals in bed. I did not move a finger unless it was necessary to do so. I have since read in one of the issues of this JOURNAL, that in taking the rest treatment for Tuberculosis that talking was considered as exercise, arguments as violent Editor's Note:-See advertisement on page 223. exercise. I avoided all unnecessary talking, although after the first month in bed I was free from fever, but other symptoms were present. From Oct., 1916, until March, 1917, I spent in bed. The following 6 months I spent in slowly increasing my walking exercises. Not until Oct. 1917 did I begin taking street car rides. Another thing that helped a great deal was a philosophical attitude towards the disease. At first I studied every symptom, examined critically my sputum whenever I raised anywhether less or more, what its appearance and color signified etc. Finally I took stock of myself, and came to the conclusion that it must stop. I stopped analyzing and dwelling on my symptoms to the best of my ability, whenever I would raise any sputum. I would close my eyes so I would not see how much I raised etc. I would only glance at it once a day to see whether it was blood-streaked, so as to know whether I needed to take extra precautions. The fact of my not looking and studying my sputum saved me a great deal of mental anxiety. Speaking of symptoms, at one time for several days some of the most unusual, and what seemed to me most alarming, symptoms appeared. Shortly after a decided change for the better set in. I would have saved myself a great deal of mental sufferings if at that time I had learned not to worry at every different symptom. Hoping that my experiences may prove of 645 14th Ave., Detroit, Mich. APROPOS OF EXPERTS First, let me define the meaning of the word "expert" as used here. An "expert" is a patient having had two years of continuous residence in any tuberculosis sanatorium. Anyone not handicapped with a brain is qualified to become an expert. I look back with a keen sense of pleasure to my first few days here. In my journeys to the washroom I was giving the experts a chance to size me up, to pass upon my condition and to determine the length of time that I could reasonably hope to dodge the undertaker. On the morning of the fourth day the "Chief Expert" pronounced his opinion quite audibly and in my presence. It was: "Another croaker; I give him three weeks." I went back to bed feeling that the bright, cheerful atmosphere of the place was to be of immense benefit to me. At the end of two months I was still able to drag myself up to the kitchen for "seconds" |