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CARRY ON” BY GEORGE A. STOCK, M.D., STATEN ISLAND, N. Y.

It seems to me that in recent years the crusade against tuberculosis has been, indeed, a most difficult task and that there is a decided lack of public interest in the problem. This may be due to the fact that our energies have been directed toward war-time activities or perhaps that we have nothing new or sensational to offer or to add to our present methods of handling the tuberculous as has been the case in other infectious diseases of shorter duration. But the fight against tuberculosis is still the world's conflict and there is none comparable to it in magnitude or fatality. The tubercle bacillus is still the same unrelenting, uncompromising enemy of both man and beast, working every conceivable form of misery, poverty, sorrow, destruction and death. Tuberculosis is potential dynamite acting without the "bang," and its destruction is not so spectacular.

The recent world-war has revealed to us that from humanitarian and economic viewpoints we must readjust and reconstruct all our armaments in the fight against the great white plague. Untoward post-war conditions can only be compensated for by sincerely taking advantage of everything science really knows of recognized methods of treatment.

The post-mortem table has never perhaps given more decided proof of the curability of a disease than it gives of tuberculosis of the lungs. Specific therapy should logically form the basis of treatment and cure, but it has as yet shown no results that would entitle it to this advanced position. "No single element in the cure, neither air, nor food, nor medicine affords any guarantee of success; it is only the satisfaction of all the physiologic and hygienic demands of the organism, from the greatest to the least significant that can bring about this result." We must pin our faith on the leucocyte--the scavenger of the blood—and no chemical nor pharmaceutical laboratory, no mechanical nor electrical appliance has, as yet, succeeded in producing a single one. Rest, food, fresh air and the proper regulation of one's living are the factors that will place one in the most favorable position for the manufacture of his own anti-bodies with which to combat the disease.

Ofttimes the saddest story one hears is the story of patients “chasing climate" instead of “chasing the cure” which is within his grasp. It is not a question of where you are, but what you do. Did you ever stop to think how certain reputed climates would be teeming with millions if there were any virtue per se in such climates as a panacea for tuberculosis? As stated before, there is no specific for tuberculosis. Present methods, while not ideal, will bring about results if skillfully administered and intelligently received, and are not to be despised because they are homely

and devoid of the spectacular and are not taken out of a bottle.

The nature of the disease is such that we cannot expect an improvement in a few days or weeks, or sometimes even months, and ofttimes a patient must necessarily become worse before he can begin to improve. Success comes to him only who devotes himself to his task with unceasing patience, to him who strives with an iron determination toward the goal, and to him who is able to minimize the import of temporary discouragements, which qualifies are, in truth, necessary for success in any department of human endeavor. There must exist between physician and patient a mutual bond of sympathy and implicit obedience. Directions in detail should be followed most religiously. This is easy when the patient knows he needs these things, but not so easy when he imagines he does not, for an apparently insignificant indiscretion then may overthrow all that has been accomplished in months past.

Food is one of the most important factors in our fight against tuberculosis, and yet it is the object of most bitter attack by many in sanatoriums and hospitals. Institutional food is often described by all kinds of uncomplimentary adjectives, but if patients will eat it, it will do the work. I have never yet heard of a sanatorium that did not supply an abundance of the best food that judicious and conservative buying could purchase. I recently met hundreds of persons who in no uncertain manner repeatedly showed their derision and contempt for most delicious pink roast beef with all the regulation “trimmin's," preferring salt pork, beans, corn bread and molasses-a typical pellagra diet. The reason for all this adverse criticism of institutional food is quite apparent. The patients are ill, there is undoubtedly a toxic psychosis in many, a distorted viewpoint, and many have gastro-intestinal disturbances. As a rule most patients give a history of great loss of weight while at home, living and eating almost as they pleased. This argues all the more in favor of the simple diet of institutions where many after entering almost immediately gain in weight. Best tasting foods are not necessarily the best for body-building and blood-making. Eating should not be regarded as a palate-satisfying recreation, but as one of the best medicines we have in both treatment and prevention.

The fight against tuberculosis is not an easy task, but there is no such word as "can't.” It is the duty of everyone to take an active interest, on the one hand, in restoring the sick to health and, on the other hand, in protecting the general public-a protection the absence of which may very well spell death itself.

(Continued on page 311)

Official Organ of the National Tuberculosis Association

PUBLISHED MONTHLY BY

JOURNAL OF THE OUTDOOR LIFE PUBLISHING COMPANY

381 FOURTH AVEXUE, New York City JAMES ALEXANDER MILLER, M.D.

H. R. M. LAXDIS, M.D.

CHARLES J. HATFIELD, M.D.
President
Vice-President

Secretary
PHILIP P. JACOBS, Ph.D.
Treasurer and Managing Editor

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 dis tinctly understood, however, that the JOURNAL OF THEOUTDOOR 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.

AGAIN THE "SCIENTIST' '

In the June number of the JOURNAL men, sometimes not even licensed physicians, OF THE OUTDOOR LIFE there appeared an

and is affirmatory of the present practice of editorial entitled, "Beware of the Scien

the better and more intelligent class of medical

practitioners. tist,” warning public health workers "Christian Scientists are law-abiding citizens, against the propaganda of the Christian notably scrupulous in the observance of the Science Church, particularly in favor of

quarantine laws. So careful are they that there a bill before the Minnesota Legislature

is not record of a case where the spread of

contagion could be taxed to their negligence. last spring

On the other hand, they are alert to their During the month of August the editor rights and immunities under the constitution, of the JOURNAL OF THE OUTDOOR LIFE

and will endeavor to secure protection in the was waited upon personally by Mr. Al

way duly provided. Many educators are quite

in accord with the objection to compulsory bert F. Gilmore, representing the Chris- medical inspection of school children. One tian Science Committee on Publication well-known western school man put the case for the State of New York. Mr. Gil- quite tersely in these words: 'It is not the

province of the school to medicate but to more endeavored to point out to the edi

educate the child.' tor that he had grossly misunderstood "Christian Scientists are interested only in the attitude of the Christian Scientist and promoting the welfare of the people, and their requested that a letter stating their cor

point of view in health matters appeals to a

vast number of good citizens. They are rect position be published. The editor

desirous, however, of defending themselves explained to Mr. Gilmore that he had not

against restriction of their rights from any the slightest desire to give a false im- direction." pression, and that THE JOURNAL OF THE OUTDOOR LIFE would be only too glad to

To publish the letter without further state the facts as they should be stated.

comment would be giving a false impresThe following is Mr. Gilmore's letter:

sion to the readers of the JOURNAL OF

THE OUTDOOR LIFE. In order that they "It is very probable that in the interest of may have a correct impression, Section truth you wish to correct the false impression 1 of the act to prohibit compulsory medconveyed in the article in your June issue en

ical examination, etc., is quoted as foltitled "Beware of the Scientist.” A careful perusal of the bill presented in the Minnesota

lows: Legislature last winter, which you discuss, discloses the fact that while provision is made

"Section 1. That medical examination and whereby compulsory medical examination may treatment, including dental and physical, of be avoided by those who make due application, persons residing in this state, who object yet the bill specifically reserves without quali- thereto, and in case of minors whose parents fication or restriction the quarantine rights of or guardians object thereto, be, and the same the Departments of Health of the State. As are, prohibited; provided this Act shall not a matter of fact the purpose of the bill was apply to the insane nor to examinations to correct abuses by incompetent and inefficient ordered by the court under existing laws or judicial procedure; and provided further that evidence to prove or disprove the statewhere the regularly constituted health authori

ment of Mr. Gilmore that "there is not ties have reasonable ground to believe a person is afflicted with a contagious, infectious,

a record of a case where the spread of or venereal disease and such person, or those contagion could be taxed to their negliin control of him, is notified thereof, then gence.” We do believe, however, that nothing in this Act contained shall exempt unless well - established principles of such person from quarantine regulations where

health regulation by means of exercise the quarantine laws of the State are applicable, or from submission to examination by a regu- of the police power in the quarantine of lar licensed physician or surgeon selected by dangerous or suspectedly dangerous perhim or in case of a minor by his parents or sons is upheld and furthered, there is guardian, whereupon a certificate by such physician or surgeon showing the results of

every likelihood that epidemics of infecsuch examination shall be furnished to said

tious diseases will be spread. health authorities."

Mr. Gilmore stated to the editor:

“Christian Scientists have no conflict Attention is directed to the phrase in with the work of the anti-tuberculosis italics.

associations.” When, however, he was No one denies that the Christian Sci- asked what he meant by continually opentist has rights, the same as any other posing public health legislation such as American citizen, but everyone will agree that for the creation of a health departthat he has no rights that are different in- ment in New Mexico, or the establishherently from those of a member of any ment of a county nursing bill in South other religious sect or a man who has no Dakota, he replied: "Of course, we want religious affiliation whatever. It must be to do the work in our own way.” apparent to anyone that if in the enforce- The JOURNAL OF THE OUTDOOR LIFE ment of the quarantine laws for infec- has no conflict with the religious tenets tious diseases the health officer is de- of the Christian Science Church. It pendent upon his action for a report from does believe that this continuous propaa physician selected by the suspected ganda against matters that relate to the case, a person who has no responsibility improvement of the community and pubwhatever under law to the community or lic health is vicious, anti-American, and to the individual, the possibility of secur- will lead, if it is allowed to continue, to ing quarantine is extremely remote. The serious

consequences, particularly in JOURNAL OF THE OUTDOOR LIFE has no some of the Western states.

YOU'LL WIN

I
Crickets chirpin', bees a' hummin'

All the live-long day,
Scented blossoms, on the breezes

Borne along our way,
Fillin' all the air with sweetness,

Till your very soul
Jes' wakes with love and joy and life,

Glad of Nature's toll.

III
If you have a heartache, if

You're lonesome jest a bit;
Don't fol' your hands and mope around

And think how hard you're hit.
Jes' reach for God's own sunshine,

And look up in the blue;
Why, all the good that's in the world

Is jest awaitin' you.

II
Butterflies are all about,

Glintin' in the sun,
Hither, thither, never weary,

Chase 'em as we run
Up and down the meadow

Where old “Bossy” roams,
Looks at us wi big,

oft eyes, On her way ter home.

IV
So like the cheerful cricket,

And golden bees and flow'rs,
Jest chirp your best and blossom out

In this old world of ours.
You'll soon fergit you're lonesome
And your chances kinder' slim,

you wear a smile and a sunshine belt
And love and laugh-You'll win.

MARION R. DE LUCA,

ESSAYS ON TUBERCULOSIS

(Continued from page 301)

sues.

the animal's general health, while very large doses will invariably kill within a day or two. This is in marked contrast to what happens when we similarly inoculate a non-tuberculous animal. We have already seen that not the least symptom of illness follows as the direct result of primary infection : and, to add emphasis to this statement, I would say that I have yet to find a quantity of bacilli' sufficiently large to cause illness in a guinea pig treated in this way. I do know that for days after the intravenous inoculation of a first large dose of a milky suspension of living bacilli, the animal remains as well as before it was infected.

Now we do know that under these circumstances the animals that fall acutely and violently ill are highly resistant or immunized animals, while those that remain well for a while are animals with only their native reacting capacity, with which is associated only a modicum of defense to the invading bacillus. We have, therefore, no other recourse than to link fulminant and acute symptoms of illness with heightened powers of resistance and acute, inflammatory reaction of tis

We thus catch up with the statement made a few pages back that the sickest animal may be the most resistant; that it is ill because it is resistant; and that to view severity of illness in terms of lack of resistance is altogether fallacious and not borne out by the plain facts of the case. And we think once more of the possibility "of an acme of resistance resulting in the exhaustion and annihilation of the defender."* For we know that those experimental animals that survive their acute illness will go on and far outlive the controls which do not at once fall sick and that they may indeed successfully resist their virulent infection.

Thus we have, on the one hand, animals receiving their first infection. And we find: in general, reactions delayed and slow-no early deviation from health or limitation of function, no immediate reaction of inflammation, a comparatively late development of focal tuberculous changes, a tendency to progression of lesion and disease, and death.

In direct contrast we have the already tuberculous animal experimentally reinfected. And here we find : immediate and even fatal acute illness, immediate inflammatory response of tissues, accelerated and abortive development of tuberculous changes that tend to be

more diffuse, retrogression, and evidences of healing.

One of the youngest of our subdivisions of biological science, allergy, is one of the most fundamental and has rapidly grown into one of the broadest and most far-reaching. In tuberculosis its ramifications, insinuate themselves everywhere; to such an extent, indeed, that we can hardly think of a single phase without being obliged to reckon with allergy. Whenever we discuss the conversion of benign tubercle into manifest disease, whenever we wrestle with the obscurities of pathology, of symptomatology, of tuberculin in diagnosis and treatment, of general treatment, of prevention, of resistance, of prognosis, so far as these are a part of tuberculosis, we must pay attention to the remarkable circumstance that tubercle changes the native reactions of the normal body to tubercle bacilli.

The present essay has aimed to set before the reader only a very few of the numerous phases and applications of allergy. It has studiously avoided selecting and displaying any features that were not strictly necessary to the purpose at hand. This purpose has been to lay bare as concisely, yet as clearly as possible, how and undii what conditions the body and particularly its tissues vary their methods of reacting to the tubercle bacillus. Other manifestations and functions of allergy must await description and discussion until we arrive at a more advanced stage of our journey. For the present our concern is to prepare the ground for an analysis of such questions as the fruition of childhood infection into adult tuberculosis and the healing and disappearance of lesions. In such an analysis a consideration of the finer details of allergy will have their place. Here it would tend only to confuse the reader, who should carry away from a reading of this essay only two or three important truths: an appreciation of the actuality of changed reactions to irritation by tubercle bacilli, a conception of what features characterize these reactions, and a knowledge of what event in an animal's experience brings them about.

In this essay, too, we have implied, rather than urged or attempted to demonstrate, any relations other than coincidental association between the state of allergy and that of increased resistance. To go further than this is unjustifiable until we have examined those conditions that give immunity to tuberculous infection its being as well as those that govern it, which are matters that will form the burden of the next essay.

See August number, p. 250

“CARRY ON"

(Concluded from page 307) “Before this disease came upon you, you pro- That is only the apparent failure which must fessed a religion or philosophy of life that precede the figure of the Angel.” spelled 'cheerfulness.' Was it only a fair- "Life's attar of roses is as rare as it is day religion? Can it not meet its Calvary precious, and it takes the sunshine of many with trust? Is there no to-morrow of the summers and the braving of many thorns ages when that character developed through to produce a single drop. But that drop the trials of to-day will mean a blessing when once produced is worth all that it richer to you for the buffeting? The sculptor costs and the perfume of it will last forbreaks and mars the block of fair marble. ever."

EDITORIAL NOTE The accompanying letter from a reader of the JOURNAL has been written at the request of the editor. It outlines the experience of a man who has been able to make a comfortable living while lying flat in bed on account of tuberculosis most of the time. Mr. Dixon's experience speaks volumes for his backbone, pluck, perseverance and energy, to say nothing of his carefulness and ability in getting business. These are all qualities that the ordinary tuberculosis patient may capitalize in himself to some degree or other. It is hoped that Mr. Dixon's experience will stimulate others to further effort.

COMMUNICATIONS

MAKING A SUBSCIPTION AGENCY PAY TO THE EDITOR:

abled-bodied newsdealers and canvassers who One of the most important problems con

are physically able to do other work, and other fronting the discharged sanatorium patient is,

vast sums are lost to any agent by the subI believe, the problem of suitable employment.

scriptions being sent direct to the publishers by This being especially true of those who find it

the subscriber. Invalids and partly disabled necessary to earn their own support and with persons have an equal or better chance in this involvement limiting the nature and amount of

field for one reason if no other, that being that work they can perform.

all disabled persons who make an effort to earn I am, fortunately, well on the way toward

their support have the sympathy of the public. solving this difficulty in my own particular

My experience is very few people are unwillcase, and it has been suggested to me that my

ing to help those who honestly try to help experience might be helpful as a guide to fel

themselves. low "cure chasers" in similar circumstances. In beginning this work I first arranged to If this be the case I shall be very glad to pass handle subscriptions for all magazine, jorunals my experiences on to others.

and city newspapers published and secured Some two years ago, with 9/8's involvement from a large agency a few hundred catalogs —so a doctor who tried to pass the matter off listing all current Club and Special Offers. lightly told me—and a bank account frantically Then I made a list of all my friends and struggling to keep on the proper side of the acquaintances, mailing to each a catalig toledger, I was summarily consigned by a sana- gether with a letter explaining my situation torium to my family. The necessity for earn- and the work I had tak up, asking them to ing something pronto with which to combat order their magazines through me and to give the H. C. of L. became immediately apparent. me a list of the names and addresses of their After carefully considering the few possibili- reading friends. They were very generous in ties that offered I decided to make a try at this, and on receipt of these lists I immediately magazine subscribtion work by mail.

mailed to each address a catalog and letter After two years of endeavor in this field making the same request. My third month in I find it admirably suited to persons able to this work netted me $125. After two years I exercise but little or none and that it affords have a mailing list about as large as I can take possibilities for a great many persons disabled

care of. for other work. Publishers of the many pub- I may as well state here that I have done lications pay annually to agents in commissions practically all of this work in bed, as I have a sum that runs well into the millions of dol- been rigidly "on the cure” and now have only lars, practically a!! of this amount going to one hour exercise daily. A few weeks ago I

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