Routzahn. This volume is the first in a projected survey and exhibit series under the editorship of Shelby M. Harrison, director of the department.

In his introduction Mr. Harrison says: "The material here presented is drawn from the experience and observation of Mr. and Mrs. Routzahn over a long period, during which they directed the planning, preparation and use of many exhibits, advised with many who were struggling with practical exhibit problems, and visited and studied literally hundreds of exhibits in their various stages of development. With but few exceptions the suggestions offered have been tested in practice either by the authors or by others whose work they observed."

As this quotation indicates, the book is intrusively practical. Its 235 pages are chuck full of meat. Padding and vaporizing are conspicuous by their absence. Everything in it is plainly said by those who know. It is because they know that they can make it plain. But to make doubly sure that the subject matter is gotten through the readers "concrete" head, there are some 60 illustrations of bad and good-mostly good-exhibit items.

Notwithstanding the modesty of the title, one wonders, after reading this comprehensive and apparently exhaustive discussion, what is left for the D E F's-to say nothing of the X Y Z's--of exhibits. The authors prefer to confine themselves to the "planning" part. But it's the sort of planning that doesn't let up till the thing is done, as far as an ordinary non-exhibit layman can see. Not alone the simple panel form of exhibit-what may be called the still-flat type-is covered, but the motion-device, the three-dimension contrivance, and the living exhibit, which is sometimes the best of all.

For tuberculosis workers, special interest attaches to this book because Mr. Routzahn did what may be regarded as the pioneer organized exhibit work in America as a member of the staff of the National Tuberculosis Association. Every tuberculosis worker who wants to know better how to get his work "across" to the public, should have this counsellor and guide ready at hand.

JOHN DANIELS.

A New Patient's Handbook* In the foreword of a new book entitled, "Information for the Tuberculous," by Dr. F. W. Wittich, Professor Leonard G. Rowntree, Chief of the Department of Medicine of the University of Minnesota, says, "There are three great outstanding features in the treatment of tuberculosis which should receive the most serious consideration from the patient and the family." The considerations to which Dr. Rowntree refers are the physician, the sanatorium and auto-treatment. Dr. Wittich, who has the last few years made a conspicuous

"Information for the Tuberculosis." By F. W. Wittich. A. M., M.D. Published by C. B. Mosby Company, St. Louis, price $1.00 postpaid if ordered through the JOURNAL OF THE OUTDOOR LIFF

success of the development of the tuberculosis clinic and the department of tuberculosis under the direction of Professor Rowntree of the University, has borne in mind these considerations throughout the development of his interesting book.

There are many books on tuberculosis. So many are there in fact that the attitude of some tuberculosis patients is that there seems to be a surfeit of information. Any intelligent physician can make a prognosis immediately of the patient who refuses to inform himself about this tuberculosis, and that prognosis is a reasonably short and fatal termination of the disease. The patient who wants to know and who without a morbid introspection honestly seeks to cooperate to the fullest extent with his physician or sanatorium stands every chance to win even though in many cases his disease is far advanced when discovered.

To such a patient Dr. Wittich's book will make a strong appeal. The first part of the book deals with the nature of tuberculosis, taking up the anatomy of the lungs, the tu bercle bacillus, problems of infections, disinfection, etc. The second part deals more essentially with treatment and prevention taking up the questions of rest, exercise, diet, temperature, climate, tuberculin, drugs, value of sanatorium treatment, controlling the cough, precautions to be observed, etc. Many questions that are arising daily in the experience of every tuberculosis patient are answered by this compact handbook of 150 pages.

Dr. Wittich speaks not only from the standpoint of a physician but from the standpoint of a patient, which gives his advice a sympathetic turn of great value to his readers.

Health First Readers

The Health First Reader, recently published by the Anti-Tuberculosis League of Kenton County, Covington, Ky., is a contribution to the cause of health promotion and disease prevention in childhood which has already made a distinct impression and which is bound to have a widely covering influence.

The Reader is made up not of preachments or self-evident lessons, or even of simple prose, but of "public health rhymes" written by William S. Groom, secretary of the League, and illustrated by pictures in bright colorsboth rhymes and pictures being of a sort to interest children.

Here is a sample. The picture shows Fred wrapped in a blanket before the fire, taking a hot footbath and looking exceedingly repentant. The verses below go thus: "Fred has a cold in his chest and head,

His throat is sore and his nose is red; Just hear him cough! Just hear him sneeze! For he got wet up to his knees.

He can't go out and he's quite sad,

For he was a heedless little lad; Had he changed his shoes that were soaked with rain,

He need not have suffered all this pain."

It

The State of Kentucky is publishing an edition of 125,000 copies of the Reader. has been adopted as a textbook in the schools of Cincinnati. Inquiries and commendation from many quarters are being received by the League. Sample copies, together with prices for quantity orders, may be obtained from Mr. Groom. The National Association recommends the Reader's circulation.

The New Haven Board of Health has issued a series of A B C's of health. "A," for example, is "Apply plenty of elbow grease in cleaning up out-of-the-way nooks and corners. This is the best kind of germicide." "Q" is "Quit over-eating." "R" is "Rout the rat." "Z" is "Zest in the execution of these simple things will make you a better citizen." Copies of this alphabet may be secured on application to the New Haven Board of Health, New Haven, Conn.

Another Cure-All

From St. Joseph, Mo., comes the report of a "successful remedy for tuberculosis." This time it is "Dr. Florian J. Kaiser, Specific Physical Culturist and Lung Specialist" whose "system of specific physical culture restores to health by developing out of the disease,"whatever that may mean. The public is invited to call for free consultation, etc., according to the advertisement, which further adds that "in diseases of heart, stomach, liver, bowels, etc., this method is equally effective as in diseases of the lungs."

British Columbia

A large and much needed addition to the King Edward Sanatorium at Kamloops, B. C., is being built by the Provincial and Dominion governments at a cost of $200,000. The addition will provide increased accommodations for returned tuberculous soldiers and will include a 100-bed infirmary, new service building, and equipment for a vocational training school. During the past year more patients have been treated at the sanatorium than in any previous year, there being 52 soldiers among the number. The report of the medical superintendent, which is included in the Eleventh Annual Report of the Anti-Tuberculosis Society of British Columbia, shows that the results in the treatment of soldiers are somewhat better than in the average civilian case, for the reason that as soldiers are under constant medical supervision the disease is detected earlier.

In the spring a whirlwind campaign carried on by the Rotary Club of Vancouver netted $75,000 for a tuberculosis dispensary. The building is being erected at a cost of $50,000, and the remainder of the money will be used to equip and maintain it for one year. It is expected that the dispensary will be opened in January.

THOMAS CRAWFORD GALBREATH

T. B. By T. G.

The accompanying illustration of Thomas Crawford Galbreath will remind readers of the JOURNAL of a remarkable book of Mr. Galbreath's entitled, "TB, Playing the Lone Game Consumption." The first edition of this book was printed in September 1915, and the second edition in December, 1915. A third edition is just coming from the press. In spite of the high cost of paper and other materials, the price of the book has been kept to 25c.

There is no more human story of a brave man's fight against tuberculosis and of his victory over himself, and over his discase, than that which Mr. Galbreath has given in this little autobiography. To the tuberculosis patient who has not read it, the book will come as an inspiration spurring him on to do his best in the fight against tuberculosis.

After all, two-thirds of the victory over tuberculosis rests with the patient himself. His determination, his backbone, his knowledge of the subject, and his desire to make the most of every opportunity counts for vastly more than anything that the doctor can do. For the patient who wants to live and who wants to win, Galbreath's book represents a quarter's investment that is worth a million dollars worth of health.

Standard Tuberculosis Examination

Standardization of all war measures makes for efficiency, and the elimination of every unnecessary motion, be it in making a piece of machinery or in examining a recruit for tuberculosis, helps win the war, says Major Henry Farnum Stoll, in a recent issue of the

Journal of the American Medical Association. Major Stoll, who is an instructor in tuberculosis examinations at the Army Medical School, says that as a rule in the examination of the lungs from five to ten minutes is wasted because the examiner has given no thought to the development of a system calculated to save time, while yet being thorough. Such a system has been worked out in detail by Major Stoll, the routine examination suggested covering fourteen successive steps.

Personal Notes

Dr. Harry L. Rockwood who has been superintendent of the Cleveland Tuberculosis Sanatorium at Warrensville, Ohio, is serving as acting health commissioner of Cleveland, succeeding Dr. Richard A. Bolt, who is a member of the Red Cross Anti-Tuberculosis Commission to Italy.

Dr. William C. Woodward, who for 24 years has been health commissioner of the District of Columbia, has succeeded Dr. A. J. McLaughlin as commissioner of health of Boston.

Dr. Edson W. Glidden, 2nd, has been appointed Assistant Medical Director of the War Risk Insurance Bureau, Medical Department, in charge of the tuberculosis department. This will be of interest to those who realize the large number of tuberculous exsoldiers and sailors who are being cared for by this Bureau. Dr. Glidden was for several years assistant superintendent at the Lakeville Tuberculosis Sanatorium, Middleboro, Mass., and has also been associated with Dr. David R. Lyman of the Gaylord Farm Sanatorium, at Wallingford, Conn.

Hospital Notes

The city tuberculosis hospital of Kansas City, Mo., which has been either closed or used for other purposes during the past year because of lack of funds, will be reopened for tuberculosis cases.

A district tuberculosis hospital for Seneca, Wood, Hancock and Crawford Counties (Ohio), has been assured by the action of the Commissioners of the four counties in appropriating $100,000 for the purpose.

The sanatorium for Crow Wing and Aitkin Counties (Minn.), was opened in August with Dr. H. F. Gammons in charge as superintendent of the institution. The sanatorium is situated at Brainerd and has accommodations for 26 patients.

The plans for the Crane Sanatorium at Rutland, Mass., have recently been revised. The present plans will permit the construction of one unit of the sanatorium so as to be ready this fall.

The Capital Issues Committee has disapproved the issue of a $600,000 loan by the county of Essex, Mass., for the erection of a tuberculosis hospital.

Ground has been broken for three new county tuberculosis hospitals in New York

state. Broome County is to have a 75-bed hospital, located at Chenango Bridge, several miles from Binghamton. The Rockland County Hospital will be located near Summit Park and is to cost approximately $90,000. Construction is under way for the Nassau County Hospital on a site of 97 acres near Farmingdale.

Vocational Training in Canada

Vocational training in Canadian sanatoria where returned soldiers are being treated for tuberculosis had its inception in October, 1916. Since that time, according to an article in a recent issue of Reconstruction, the work has developed successfully under the direction of the Invalided Soldiers' Commission of the Department of Soldiers' Civil Reestablishment. The patients in the sanatoria are divided into the following classes: Class A-Bed cases suffering from the disease in an acute stage and who remain in bed until their temperature is practically normal. Class B--Porch cases who go to meals three times a day and rest in chairs in the fresh air the remainder of the day. Class C-Exercise cases who commence by taking a fifteen minutes' walking exercise daily, gradually increasing to two hours' walk each morning and a similar walk in the afternoon. Patients in Class A are sometimes able to undertake light hand work, such as lace-making, drawing, weaving, etc. Patients in Class B are able to do more of the same kind of work as that assigned to Class A patients, and as their strength increases they are given heavier work such as reed basketry. Class C patients are prepared for work by proper physical exercise and as soon as possible take up arts and crafts work, such as basketry, carving, toy-making, art metal work, picture frame making, engraving, etc. Others are trained as chauffeurs, which occupation is recommended medically as an ideal employment for lung sufferers. At most of the sanatoria special buildings have been erected to house the vocational work. Some men study the ordinary subjects of a school education. Others are learning shorthand and typewriting. All this work is in the nature of occupational therapy. The industrial re-education of men who are prevented from returning to their previous civil occupations is another problem which is being handled in the same manner as the whole problem of the re-education of the disabled. Each case is considered on its merits having regard to the physical limitations and the previous experience and natural aptitudes of the man himself.

Washington Expands Work

By January 1st, 1919, thirteen counties in Washington will have established the visiting tuberculosis nursing service. In all but two the salaries and expenses of the nurses are paid out of the county funds, but in two the anti-tuberculosis leagues have funds enough

to finance the nursing work. The Washington Association for the Prevention and Relief of Tuberculosis has presented the need for the work in each instance and has been responsible for selecting and recommending nurses to the various boards of commissioners. Training in public health nursing and previous successful experience in public health work are insisted upon in each case. Several more counties are considering starting the work as soon as properly qualified nurses can be recommended to them.

On May 1st, Mrs. Elizabeth S. Soule, R.N., was added to the staff of the Association as supervising and survey nurse. She acts in an advisory capacity to the county tuberculosis nurses and makes surveys of existing conditions in counties where the Association believes the nursing service immediately necessary. Mrs. Soule was assistant in the course for public health nurses given by the Association last summer at the University summer school. She has recently been appointed state director of public health nursing by Mrs. J. S. McKee, chairman of the Woman's Committee of the State Council of Defense. The appointment was made as the result of a request from the War Program Committee of the Council of National Defense.

Feeling the importance of the Modern Health Crusader work, the state association has engaged a worker for that field. Miss Hilda J. Solibakke, who has had considerable educational experience, will devote her entire time to promoting the organization of Modern Health Crusader Leagues throughout the schools in Washington. Already about thirtyseven hundred children have been enrolled and requests for the work have come more rapidly than they could be advantageously handled. There is no question of the value and popularity of the Crusader work when sympathetically presented to teachers and children.

Reconstruction of the Tuberculous Soldier

recon

"The four most important factors of tuberculosis are rest, fresh air, nourishing food and psychology," writes Lieut.-Col. E. H. Bruns, M.D., in a recent issue of the Journal of the American Medical Association. This fourth factor, psychology. Colonel Bruns explains as the ability to outline to the patient the plan of treatment leading up to struction and rehabilitation and to keep that constantly before him. Such a course would "stimulate hope and desire for recovery, secure his confidence and cooperation, and save him from laziness and dependence." Light mental and physical work to occupy his mind is recommended for the patient as soon as he is able to be up and on his feet. The thought that this is a promotion and the beginning of his climb to complete restoration and usefulness will have an excellent mental result. An experience of nine years in handling tuberculosis soldiers at Fort Bayard, N. M.,

leads Col. Bruns to conclude that in spite of difficulties to be encountered in reconstructing tuberculous soldiers, the need of this phase of the treatment is imperative.

As regards the men of our new national army the policy of the Surgeon General is to transfer all tuberculous soldiers to army tuberculosis hospitals. Officers trained in reconstruction work will be assigned to each institution and there will be workshops for vocational training. A bill now before Congress provides that after a patient is discharged and returns to civil life the Federal Board of Vocational Education will attend to his further rehabilitation, looking out for his welfare as far as employment is concerned.

Association Items

The anti-tuberculosis society of Columbus, Ohio, is offering prizes for the best posters made by (1) pupils in high schools, (2) pupils in intermediate schools, (3) pupils in elementary schools. The contest closes on November 23, after which there will be an exhibit of the posters in the Columbus Public Library.

The Anti-Tuberculosis Committee of the Minneapolis Associated Charities at its annual meeting in September voted to expend $5,000 of its budget during the coming year for a children's preventorium to be located at Glen Lake in connection with the county sanatorium. The Committee also voted $5,000 toward assistance to the Red Cross in caring for returned tuberculous soldiers, and $2,500 for tuberculosis dispensaries to be located at settlement houses.

A tuberculosis survey of Rochester, N. Y. is being made by the local tuberculosis committee for the purpose of locating cases of tuberculosis and securing proper care for these cases. The city is divided into districts, with the Rochester Dispensary as a center, according to the September issue of Health News. The canvassing is being done by volunteer workers, under the direction of Miss Mathilda Kuhlman, supervising tuberculosis nurse of the State Department of Health. It is the intention of the committee to employ a sufficient number of nurses in addition to the three now on duty to supply the needs as demonstrated by this survey.

News From France

So far as scientific knowledge of tuberculosis goes Americans working with the French can perhaps learn rather than teach, but when it comes to organizing and administering an anti-tuberculosis campaign which shall result in the establishment of a public health system, the United States can make a contribution. Dr. George E. Vincent, President of the Rockefeller Foundation, who has just returned from a trip of inspection of war work in France, makes this comment in an article entitled "The Franco-American Fight on Tuberculosis," which appears in a recent issue of

the New York S. C. A. A. News. The French people, says Dr. Vincent, have made a few brilliant isolated successes in anti-tuberculosis work, as in the hospital at Bligny, an institution which is not equalled by more than one or two sanatoria in the United States, and in the Leon Bourgeois Dispensary, but these are not widely known in France and are not parts of either a local or national system. It is because Americans have worked out a certain measure of team work in public health administration that the anti-tuberculosis workers who have gone from the United States are proving a valuable factor in the anti-tuberculosis campaign undertaken by the commission of the Rockefeller Foundation and the Tuberculosis Bureau of the American Red Cross. The program of demonstration, relief, public education and special training for nurses has been successfully launched. As an instance of the response on the part of the French to American educational methods, Dr. Vincent cites an evening meeting at the town of Montfort in Brittany where a population of 2,400 furnished an audience of 1,350 people who seemed deeply interested and who dispersed with cries of "Vive l'Amerique."

Industrial Fatigue

"How Industrial Fatigue May be Reduced" is the title of a report by the Committee on Industrial Fatigue organized under the Committee on Labor of the Council of National Defense. The Committee has been active in conducting investigations in factories that are manufacturing war supplies, for the purpose of determining whether unnecessary fatigue is present and discovering the conditions under which a maximum continuous output may be obtained. Given adequate equipment, adequate administration of the plant and a proper spirit among the employes, fatigue is said to be the greatest single obstacle to a maximum output. It diminishes output not only directly, but indirectly by increasing sickness and absences of employees.

Certain ways of detecting fatigue have been studied, different tests being applicable to different cases. The falling off in the amount of output, a decrease in the amount of power used, the amount of spoiled work turned out, the number of accidents to workers, all these may be considered as indications of fatigue on the part of the workers. In addition certain laboratory tests of muscles, nervous system, sight, etc., are applicable to industrial workers.

Among the ways of reducing fatigue suggested in the report are the introduction of recess periods, the introduction of variety into work, the proper supervision of ventilation and other sanitary conditions within factories, the avoidance as far as possible of over time and Sunday work. Copies of this report -Public Health Reports Vol. 33, No. 33, may

be obtained from the Superintendent of Documents, Government Printing Office, Washing

ton.

Follow-Up Service in Indiana

The Indiana Society for the Prevention of Tuberculosis has issued a bulletin explaining the plan of follow-up service for tuberculous soldiers in that state. As Indiana does not employ full time health officers it has been deemed advisable that the responsibility should rest, first on the local tuberculosis society; or if no such society exists, or if aid is desired in the handling of the cases, secondly with the home service sections of the civilian relief committees of the local Red Cross chapters. The aims of the service to be rendered by the tuberculosis associations are set forth as follows: 1. To make available to each man an increased opportunity for recovery by care in a modern tuberculosis sanatorium. 2. To see that members of tuberculous soldiers' or exempted men's families are protected from infection through ignorance or carelessness. 3. To make available community nursing so that if sanatorium care is unavailable something may be done for the instruction of the man and his family. 4. To provide for the examination of every member of the family. 5. To provide up-to-date literature on tuberculosis. The bulletin issues a reminder to the local associations that they have a separate and distinct mission and that the home service sections of the Red Cross are organized and well equipped to care for the multitudinous details of finance, of the maintaining of family, of the operations of war risk insurance, etc.

Open-Air Schools*

Within the compass of one hundred and thirty pages Dr. MacDonald has brought together a considerable fund of material concerning the history, development, construction and administration of open-air schools. The book, as the author states in his preface, has been frankly designed to promote the open-air school idea in Canada. Social workers are

accustomed to think that open-air schools are hardly adaptable to climates where zero weather in winter is an every day occurrence and where, not infrequently, one finds the temperature down as low as thirty to forty below zero. On the other hand the open-air schools in Montreal, Toronto and other Canadian cities, as Dr. MacDonald clearly shows, have demonstrated that it is perfectly feasible to teach children out of doors in almost any climate.

There has been so much written and said about open-air schools in the last few years that it is difficult to find anything new. The

"Open-Air Schools" by Neil S. MacDonald, Ph.D. Published by McClelland, Goodchild & Stewart, Toronto, Canada. For sale by JOURNAL OF OUTDOOR LIFE. Price, $1.25.