at mealtime. The experts then classed me as an impostor and I was added to the list of starvation cases.

At the end of the third month, having heard that I was to take tuberculin, the experts cheered up a little and I was solemnly warned by each one that I was taking the shortest cut to the Happy Land. I asked them what tuberculin was, and their reply though rather vague was roughly this: "They shoot dead bugs into you, and the live bugs get sore when they see the nice easy time the dead ones have, so they lay down and croak too. But, if some bug comes along and blows the trumphet, and causes a resurrection, you will shoot the chutes in record time.'

At the end of five months, they washed their hands of me entirely. One of them ad

mitted disappointment at my still being able to climb in and out of bed, when by all the rules the "bugs should be sitting up barking at me every move I made.

One of them volunteered the information to me last week that he knew a guy who heard of another guy who took eighteen shots of tuberculin and then his heart blew up. He asked me then how many I had taken and when I said thirteen, I could see by his expression that he was figuring that at a nickel a week he could save enough to shoot a quarter for flowers for me. I try to cheer them up by saying that my foot may slip yet, but I can see that as a profitable subject for predictions I am a failure.

Imagination here would be a curse if a person were not blessed with a saving sense of humor.

TO THE EDITOR:

In reply to a question in the May issue, you stated that the tearing of adhesion, or on any physical exertion, there was danger of the renewal of the disease.

1. Suppose the lungs were healed and enough of the lungs remained to function properly, and the person was in good physical condition, and say that the blood was in a nearby normal condition, say that it contained about forty per cent. of blood corpuscles and sixty per cent. of plasma, that the specific gravity was 1055. that in male there were five million and in female four million red bloodcells to the cubic millimeter of blood, that the red cells contained between eighty-five and ninety-five per cent. of hemoglobin, that also each cubic millimeter of blood contained between five and ten thousand white cells or leucocytes and about two hundred thousand bloodplaques, could the renewal of activity of phthisis take place under such condition? In replying quote authority.

2. John B. Fraser, M.D., C.M., of Toronto, Canada, working on the new Biochemic theory, that germs is a result of disease, rather than the old theory that germs produced disease, has fed millions of different germs to healthy individuals at different times, such as, incubated dihptheria, typhoid, meningitis, and tuberculosis germs, without producing disease. The experiment has been carried on since 1912. That being true which undoubtedly it is, and he can easily be communicated with, mere theories must fall, and facts stand.

3. I also noted in the May issue as well as at several other times, that pleurisy is caused by tuberculosis activity you say, that being a specific and definite statement, it should stand, but how about people who have had

pleurisy but never phthisis, do you not think such replies should be given with further expanation, for it does not hold good evidently in all cases.

4. In Dec., 1917, you replied to someone asking what effect the moving from little above to say three or five thousand feet above sea level would have on the blood, with a general answer that it would increase the hemoglobin, suppose the condition of the blood before moving was such as I have indicated heretofore at sea level or before moving, what would your reply be?

5. What if anything do you know about a purely milk diet of five or six quarts of certified milk daily, continued for six weeks and then alternating two weeks at a time for six months. Give a compete chemical analysis of milk when cows are fed on green grass if you can. A person whom I know cured himself at the instance of a homeopath of phthisis about eighteen years ago, on a purely milk diet, after they had nearly succeeded in killing him in the different sanatoriums he tried. If I remember correctly it took him about six months and he has not been ill a day since. A homeopath whom I know, and who has made a special study of milk, his object being to improve the blood knowing that the blood is the thing that cures, has given me the analysis. I desire to compare his with yours.

C. A.

1. We know from wide experiments that tubercle bacilli may remain within the body, viable, not only where disease has existed but in glands where there is apparently no disease, and that at any time these can be thrown into either the blood or lymphatic circulation to be deposited somewhere within the body and start up new areas of disease.

This can also occur in the case of adhesions on the surface of the lung being torn, and the spread of infection may be directly into surrounding tissue or through lymphatic drainage centres. The authorities for the reactivation of disease by physical overexertion are so numerous as to include 90 to 98 per cent. of all those who practice the treatment of pulmonary tuberculosis.

2. As far as the Editor of the Question Box is concerned, he is fully conviced that germs cause disease, and he would himself not be willing to feed on any of the organism you mention in the belief or hope that disease would not follow.

3. Generally, 60 to 70 per cent. of the cases of pleurisy with effusion have definite demonstrable tuberculosis. Some authorities have found as high as 100% of such cases showing tubercle bacilli in the sediment from the fluid in cases of pleurisy with effusion.

4. The work which has been done by men in Colorado shows that there is a temporary if not permanent increase in hemoglobin and in the rapidity of the heartbeat on going from sea level or moderate elevation to an altitude of perhaps 5000 feet.

5. You might write the U. S. Department of Agriculture for the milk analysis, which, being done by competent authorities, will undoubtedly be satisfactory to you. The milk diet may be very good for one who can tolerate so much milk continuously without digestive disturbances, as milk contains everything necessary to support life, but there are many who could not tolerate it. However, the question of proper rest is more important than the matter of diet.

TO THE EDITOR:

On page 183 of your June issue inquiry is made as to blood in eggs and since eggs are so extensively used in the diet of consumptives it seems to me worth while to write you about this matter.

After the yolk of the egg is formed it passes down the oviduct of the hen and on the way the white is secreted about is by one gland, then the skin-like covering it added by a second gland, and finally the shell gland enclosed the whole within a hard layer. Occasionally there is rupture of one of the many minute blood vessels that are in the walls of the oviduct and a small clot of blood may be deposited within the white of the egg. Such a clot may be found in a perfectly fresh egg, and it damages the egg in no way except esthetically. Eggs supplied to high-grade hotels are candled as they are gathered. The bloodclot shows as a dark spot, and the eggs with clots in them are thus prevented from reaching the table. Of course only the very occasional egg has a blood clot in it, but if one is found the egg need not be thrown away nor should it be concluded that the egg is not fresh.

Some hens are subject to the hemorrhages that cause the clots. I do not know about the

1. Is sunlight thrown in the throat by means of metallic mirrors for T.B. of the throat a success or not? If so, how are they used?

2. Under what conditions is it safe to go from a low altitude to an extreme high altitude?

3. Is an operation for plural infection more successful than autogenous vaccine?

4. Why wouldn't it be possible where there is only a spot on the lungs to open the chest and burn the spot and cure the burn? I would volunteer for the job. C. E. S.

1. This treatment has been rather extensively used and with quite good results, especially in the West. The sunlight is reflected by means of a large mirror into the back of the mouth, from where it is reflected by means of a small hand mirror into the larynx. Any physician can teach you how to accomplish this.

2. In the presence of tuberculosis this question should only be decided by the physician in attendance.

3. If you mean an operation to withdraw pus from the pleural cavity, we would say without question that the operation is more successful than vaccine. However, the question as to whether an operation is advisable should be decided by the physician.

4. In acute conditions confined to a single lobe of one lung, or in acute extensive disease involving an entire lung, operations somewhat similar to your idea have been performed. The procedure is very delicate and not without many obstacles and dangers. Your physician can probably refer you to surgeons who are performing these operations, or you might again address the Editor of the Question Box.

TO THE EDITOR:

1. When adhesions have followed pleurisy (assuming that the T.B. activity is arrested),

1. Before I broke down with tuberculosis about four years ago, I sang a great deal. Would it be safe for me to take up singing again now that I am an arrested case? I was a moderately advanced case and had a hemorrhage in the fall of 1915, but have had none since.

2. I am about fifteen pounds over-weight; could I play golf or take some chest exercise or stomach-muscle exercise to reduce?

3. Can you be classed as a "cured case" and still get up slight negative sputum? My

sputum is negative and still I notice rarely that there appears a slight trace of what appears to be blood no larger than a pin's point in whitish-looking sputum I get up. My physician told me that when the sputum was negative that all trace of blood would disappear. I run absolutely no symptoms and have been working for two years every day. G. C. M.

1. This depends very largely upon the character and extent of the disease while you were ill, and can best be answered by the physician who understands your case in detail.

2. Probably yes, but advise consulting the physician.

3. This condition can exist in a case that is "apparently arrested" or "apparently cured."

Michigan State Sanatorium

"Follow-up work is considered very important at the Michigan State Sanatorium. It keeps the patient in touch with the institution; shows him we are still interested in his welfare and enables us to present something definite as to the results in treatment" says Dr. Pierce, Medical Superintendent of the sanatorium in his latest biennial report. The occupations of discharged patients included 108 housewives, 32 students, and 14 farmers; the rest represent a total of 37 occupations. A training school for nurses is maintained at the sanatorium and during the past eight years, 52 young women, arrested cases, have attempted the work and thirteen of the number have been able to finish the course. During the two years covered by the report 724 patients have been admitted to the sanatorium, a daily average of 128 patients has been maintained, and there has been constantly a waiting list of from 20 to 70 patients. The building of a hospital unit, to provide for 125 additional patients is recommended by the trustees.

Boston Consumptives' Hospital

Certain significant conclusions are drawn in the annual report of the Boston Consumptives' Hospital for the year ending January 31, 1919, which reflect conditions in many of the tuberculosis hospitals throughout the country. The record of the recent influenza epidemic shows that only nine cases appeared among the patients, and of these only one terminated fatally. This experience corresponding with that of several other tuberculosis hospitals would seem to give further evidence that persons suffering from pulmonary tuberculosis in an advanced form possess a rather general immunity against infection with influenza. During the past year a total of 989 patients were treated at the hospital or 195 fewer than during the previous year. This condition, according to the report, may be largely attributed to the fact that many patients left the instiution against advice to go to work, being_attracted by the high wages offered. The nurses of the out-patient department of the hospital during the year made over 53,000 visits to consumptives in their homes to in

Eudowood Sanatorium Eudowood Sanatorium (Towson, Md.) during 1918 treated 301 patients. According to the annual report issued on January 1, 1919, 205 had been discharged at the close of the year. Forty-six per cent. of these patients were at the time of admission in the advanced stage of tuberculosis. The conditions on discharge showed that 108, or 53 per cent. were greatly benefited by their treatment; 56, or 27 per cent. died, and 41, or 20 per cent. were more or less uninfluenced by their stay. Fifty-six, or 27 per cent. of the patients were physically able to return to work immediately on discharge. The superintendent mentions a growing tendency on the part of patients in the earlier stages to remain longer on advice than formerly (54 remained in the Sanatorium Department an average of 101⁄2 months) and a decided restlessness among the advanced cases, the very ones who for the benefit of community health should remain in an institution practically indefinitely. Dr. Sloan advocates providing at least 1,000 beds in the State for the care of acute and chronic cases, and believes that the State Board of Health should be empowered to hold these carriers indefinitely upon the advice of the hospital directors. It is Dr. Sloan's opinion that in the next five years, owing to prohibition, we shall see greater results from the tuberculosis campaign than we have seen in the past fifteen or twenty years.

Hospital Notes

Culminating as the result of various conventions for the last several years the Mount Franklin Country Club property at El Paso, Texas, has been taken over by the Southern Baptist Convention for use as a tuberculosis sanatorium. The property consists of 143 acres and the work of transforming the country club buildings into a sanatorium has been started. Although the institution is to be operated by the Southern Baptist Church patients of any creed will be admitted.

At a recent meeting of the board of directors of the Springfield Lake Sanatorium at East Akron, Ohio, it was decided that in future preference would be given to incipient cases of tuberculosis and that advanced cases would be admitted only when vacancies occurred. The appropriation for the Sanatorium has been increased from $112,000 to $120,000 for the coming year.

The new building for soldiers and sailors at the Boehne Tuberculosis Camp at Evansville, Indiana was dedicated on Sunday, April 20th.

It is expected that the construction of the new Grand Rapids Municipal Tuberculosis Hospital will be started in July. The institution will be located on a site of 23 acres, on Fuller Avenue.

Sites are being considered for the two State sanatoria for Idaho which were authorized by the last legislature. The Hotel Heigho at New Meadows which was constructed in 1912 at a cost of $52,000 is reported as one of the possibilities. Directors of the two sanatoriums has been named by the Governor. J. K. White, Commissioner of Public Welfare is Secretary of the Board.

ASSOCIATION REPORTS

Saranac Lake

In connection with other towns which are widely known as resorts for persons suffering from tuberculosis, Saranac Lake has had to meet important and peculiar problems. The Saranac Lake Society for the Control of Tuberculosis summarizes, in its Twelfth Annual Report, the work which it has accomplished since its organization in 1907, when the Free Bureau of Information and Nurses' Registry was established and the Society consolidated with the District Nursing Association. The Free Information Service which is maintained for the mutual benefit of health seekers and the community in general, provides upon request reliable and impartial advice. During 1918 over 11,000 persons took advantage of this service. There is available at all times an up-to-date list of boarding house vacancies in the village of Saranac Lake. All calls for district nursing service are received through the Society office and a nurses' registry is maintained for the benefit of the public. The educational work of the Society has been largely confined to the distribution of pamphlets, circulars of information for healthseekers.

Columbia, S. C.

A surplus in the bank and a record of successful work in caring for patients at its tuberculosis camp is reported by the Richland Anti-Tuberculosis Association of Columbia, S. C. The association organized two years ago, now has a membership of over 300, and owns a tract of 12 acres on which is located the Ridgwood Camp which is maintained by the Association.

During the past year the camp has cared for 48 patients, 31 of whom were charity cases. Plans are now under way for establishing a small camp for colored patients, for whom there are at present no accommodation in the county.

Alameda County

During 1918 the clinics of the Alameda County (California) Anti-Society for the Pre

vention of Tuberculosis were visited by 1,117 patients desiring examination or attention for tuberculosis. The total visits of these patients to the clinics were 3,017 while 2,276 visits to the patients in their homes were made by the Society's visiting nurses. At the recent annual meeting of the Society, Judge Charles E. Snook was elected president for the coming year.

Dallas

Because of the rapid growth of its work during the past year the Dallas Tuberculosis Association has established new headquarters in the Wilson Building for the association and for the clinic which was opened in March in March, 1918. The children's fresh air camp another one of the activities of the association was operated during the summer months with marked success, according to the second annual report of the association which contains also a report from the Director of Woodlawn Hospital.

A Health Clinic on Wheels

The

Residents of small towns in Cook County, Illinois are more favored than most folk-a health clinic comes almost to their very doors. The Chicago Tuberculosis Institute is responsible for launching this novel health measure, and great success is reported for the first traveling clinic. The details of arranging and equipping the machine were carefully worked out, most of the equipment having been made specially in order to fit space. The inside of the car is 6 feet by 9 feet. driver's cab is built extra large so that by pulling down the curtain it is used as a dressing room. By means of folding doors, when the rail gate is let down another dressing room is provided in the rear. The clinic will travel over the county outside of Chicago, making regular stops at the county towns every three or four weeks. Various towns have offered the use of their fire stations, public schools, town halls and other buildings to be used as waiting rooms for patients until the arrival of the car. Preliminary arrangements for holding the clinic are worked out in detail with the assistance of the nurses, through whom the cooperation of the physicians and local authorities is secured. The Institute has 18 nurses covering the towns and county outside of Chicago in addition to four employed by the County Board,—all working under the direction of Miss Harriet Fulmer. Starting on May 27th the clinic was held in six towns in three days,-a clinic in the morning and one in the afternoon. One hundred and eight people came for examinations. To those in charge of the work it was gratifying to have six of the local physicians of the different towns call to see the clinic. The doctor in charge is Dr. Leo Jacobson and the nurse is Miss Mary Weis

mann.

Expedient Rehabilitation

Patients at the Wisconsin State Sanatorium were called upon recently to answer a

questionnaire which those in charge of the institution had prepared with the idea of finding out the views of the patients in regard to rehabilitation. The questions were as follows:

1. Your every day work before coming to the Sanatorium?

2. What do you expect to do after leaving? 3. How do you spend your time at the Sanatorium? (tatting, etc.)

4. How do you like to spend your time at the Sanatorium?

(a) Exercise as at present?

(b) Work classes-as Basket Weaving or printing?

(c) Educational classes-as Correspondence or University Extension work in Agriculture, etc? Great care was taken in order to obtain a spontaneous individual expression of opinion. No opportunity was given for the patients to discuss the matter. One hundred and twenty-five answers were received, and, according to a recent article in the Badger Outlook, the answers in some cases were a complete surprise. The following interesting conclusions were reached:

Generally the patients wanted "something to help us when we get out."

The men had more definite desires and views than the women.

Every woman signified a preference for educational work.

It was shown that the patients for the most part expected after leaving the sanatorium to go back to their former occupations. The reply to question 3 showed how most of the patients were employing their spare time at the sanatorium. It was noted that a large number of men were musically inclined and that an unusually large number were doing fancy work. It was surprising to find from the answers to question 4 that very few patients desired vocational classes as first choice. The answer to question 4 (c) showed that 113 persons named some educational subject as first choice. The replies showed that each patient wanted something in the way of education which would have a direct bearing on his occupation after leaving the institution. As a direct result of the questionnaire it has seemed advisable at the Wisconsin State Sanatorium to organize the classes which are mostly in demand. A class in radio-telegraphy has been started. The Sanatorium is fortunate in having the cooperation of the University of Wisconsin and it is thought that before long the I work will be carried on with the assistance of the Extension Division of the University.

Nutrition Classes in New York City Experiments recently conducted in one of the New York City Public Schools show that the chief factor in nutrition classes is instruction in health habits. As a basis for the experiment nearly 900 children were weighed and measured. The heights and