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chain of events that signallized this young that they received after they entered adolesman's melancholy experience with tuberculosis

Since presumably they might develop we are at once impressed by the fact that the disease from infection acquired after this same infection that in babyhood first made it- time, provided this infection occurred or could self felt in the lymph nodes of the neck was occur, and since it must be granted by all that undoubtedly part and parcel and perhaps so far as sources are concerned the opportunprogenitor of the infection that later bobbed ity for adult infection exists, it implies further up in the kindey and still later manifested it- that for some reason or other adults cannot self in the lungs with such telling effect. Here become infected even though they establish we should say is a striking instance of the contact with tubercle bacilli. fact that adult disease is the outcropping of Pursued more rigidly, it implies further childhood infection; and every probability of that, no matter what their opportunities of the case would justify our opinion.

contact, children can be infected only once. I lately saw a girl of fourteen who had a For if infection can occur in children again scar on her neck that showed the overgrowth and again, why cannot the same thing happen of tissue that not uncommonly accompanies in adults? And if it should happen in adults the healing of a tuberculous sinus that why can these not develop manifest tuberruptures spontaneously. Her story was culosis from comparatively recent infections? follows: At the age of one she developed It must be perfectly certain that if adults do "lumps” in her neck. These grew to the point acquire more recent infections then in some where they "broke down” and the skin was cases,—and no one can estimate how many, broken through and the contents of the swell- these would surely eventuate into manifest ing were discarged through the opening. Her tuberculous disease. It must be just as certain neck healed slowly; and all through childhood that if adults, who have been infected in childshe had had no further trouble. She had, on hood, develop manifest tuberculosis only on the contrary, been an unusually healthy and the basis of their early infection, then somevigorous youngster. But now upon her en- thing has happened to them because of their trance to young womanhood more trouble childhood experience that prevents later inwas beginning to develop. A "lump," red, fections ; for if later infections were possible, painful and beginning to soften, with every then, we repeat, they would on occasion go sign of being tuberculosis of a lymph node, on to outspoken disease. And if an early had recurred beneath the old scar. After infection prevents reinfection in adults, it twelve years of freedom from symptoms she must of necessity exercise the same effect in again had manifest tuberculosis at the identical the child who is already once infected. If this spot where she had had it before. To aver is true, and there seems to be no escape from or even suppose that this new manifestation the argument, then tuberculous infection can ocwas the result of renewed infection from cur once and once only during the life of man. without would strain the imagination im- This would be an astounding statement,measurably more than to conclude that an really astounding, especially when we come old infection, contracted years before in to consider its full bearing on the whole tuberinfancy, had started on what we might call culosis problem. If such a state of affairs its second lap. And if a second lap is pos- really exists, it would mean that once we had sible, why not a third and fourth, or as many detected by Pirquet test or otherwise that an as you please? And must every lap be so individual,-an infant, a child, or any other spectacular as to arouse the grandstand to person,-harbored tubercle bacilli, we need the point of notice and acknowledgement? never again worry about the possibility of his

Every observer of tuberculosis patients subsequent coming in contact with tubercle could bring forward several instances similar bacilli in the world at large. For if he can be to those just cited to support the belief that infected only once from without he can brave adult tuberculosis develops on a basis that is the perils of contact with consumptives anylaid down in childhood: and we must admit where and under any conditions. And our that this is frequently the natural course of programme for the control of tuberculosis events in human beings. But in thus ackuowl- would be enormously simplified. edging the reality and not uncommon occur- Can this be true? Well, in the absence of rence of this sequence of early infection and definite information one way or the other, a much later outbreak of manifest disease there is no compelling reason to believe that from it, we are far from accepting blindly it is impossible. We have learned to say that and unreservedly the doctrine that as a type an individual who has once acquired syphilitic disease the roots of adult tuberculosis always infection is refractory to subsequent reinfectreach down and back to an infection that was tion, even though his infection is quiescent and acquired in the first years of life.

is not making itself felt by symptoms of illNow just what does this doctrine mean and ness. But do the same conditions obtain so what does it imply?

far as tuberculous infection is concerned ? In the first place, it means exactly what it A discussion of this possibility would take says, and it is of little use to repeat this. But us into the very heart of the scientific aspects in addition to its plain statement it implies a of tuberculosis. It would be a discussion of great deal more.

much that we do not know as well as of a It implies that grown men do not develop little that we do know, and belongs properly manifest tuberculosis because of infection to the next essay.

(Some Puzzles of Infectionto be continued in the April number.)





101 LAKE Ave., SARANAC. Dear Sid: I'll say I was glad to get youre letter, old

It come yesterday an, believe me, you wasent none to promped about ansering, was you. However, I gess you haven't none to much on your hands now, eh Sid. It sure does keep a fella humpin' to get the necessarys of life, these days, what with prohibition an 1 thing or a other. But they haven't got no prohibition hear, Sid. Not so you could notice it. I have not had no busts hear so far, but I aint sayin' how long my teetotelness is goin' to last. This here buisness of layin' on your back in one of them colapsible chairs till you don't know wether your layin' down or standin' on the back of your neck half the time, aint exacly condusive to a_quite an' sobber life. I'll say it ain't, Sid! For a man like I to half to lay a round an' twidle my thums, ain't no easy job, not withstandin' opinions to the otherwise.

But the other night, old man, when I was so dam fed up with the hole buisness an' was just figgerin' whether I could make a quick exit from this world off tears by lettin' Toughy Home, next door, rap me gentle behind the ear or wether I could do a better job off it with a safety razer blade, when old Tibb says "How about a little party to-night, Kelly ?"

"What's doin'?" I says.

“Oh," he says, "we can take a little toot down to the Arlington and maybe have a little shoot or two, just to make us sleep good.”

"What kind of a place is this Arlington joint?" I asks.

"Oh," he says, “it's a kind of Salvation Army and Y. M. C. A. all rolled into one. They's refreshments on the side an' I can give you a nock down to a coupla lady friends of mine who'll be glad of youre company an' they'll be only to glad to make things plesent for you an' interduce you to all the fellas--you know--bar-tenders an' them kind what'll give you a sociable time.”

“Yes," I says. “I've met them kind before. So they take a drink?"

“Sure," says he. “I've never saw no one like them girls for puttin' down the Coca Cola."

"Oh," I says. “Do they sell Sarsparilla to, at this here joint?"

“Sure,” says he. “Anything you wantGinger Ale, Oxo, Lemen Sour,-the hole buisness an' the sky's the limit.”

“Can you get a shot of good old 2 per cent near beer with a good kick to it?" I asks.

"Oh my God, no!" he says, horrified like. "Woodrow wouldn't never stand for that.”

"But I thought this here was supposed to

be a free country," I says. “The land of the free an' the home of the brave, etc."

"An' so it is,” says he. "So it is. I bet they aint a nother country in the world where the goverment officials an' the politicians is as free as they are right hear. They can't nobody never question the freedom of the good old U. S. A. No sir."

"Well," I says, "the proof of the puddin' is where its eaten.

"Why, man,” says he. "If its proof you want, why just go and read the words of the Star Spangled Banner. They ain't nothin' clearer than them."

Well, Sid, I aint posted good enough on America history to be abel to argu with him -specialy when he starts bringin' in old documents wrote by Geo. Washington an' them guys, so I never said nothin' but just let him rave.

But that aint what I started to tell you about, old man, but the time I had down to this here place I was tellin' you about.

Well, me an' Tibb started out that night and first off, he takes me into a hotel hear they call the Grand Union. Honest Sid, it should ought to of been called the Grand Reunion. When we gets inside, it looks like all the Wops an' Frenchmen an' Greeks, an' a hole lot that looked like they was a little bit of each, had met there to discuss the Peace question. An' believe me, Sid, it was sure a Grand Union all right. Well, we goes up to the bar and after we had united with 3 or 4 beers, Tibb nocks me down to the bar tender.

"What'll it be?” he asks me, shakin' hands.

“Glad to meet you," I says. "Make it a slow gin rickey a la mule."

"Up here chasin' the cure?" says he, pleasant like.

“Yes,” I says, “an' I seem to be chasin' it into some dam funny places.”

"This is the right place to come, Mr. Kelly," says the bar tender. “There wasn't never 110 bugs we couldn't fix at this here hotel.”

"What and the hell are you tryin' to tell me," I says. "I never heard of no booze cure."

“Aw say," he says, "you can't work when your drunk, can you?"

"No," I says.

"Well, neither can the bugs," says he. "Keep 'em soused an' your all 0. K.” "That ain't a 1/2 bad way of lookin' at it,"

“Do you claim you can keep 'em under control at a reasonable price?"

"No one can't do no better,” he says, "than right hear at the Grand Union. In Union there is strength.”

"You said somethin'," I says, gettin' a whiff of his breath. “And that aint no idle dream."

Well, Sid, we stuck a round for about 12 hour chewin' the rag and watchin' the foreign delegates to the Peace conference arguin' the question out among thereselves. Some of

I says.

them birds must of thougt they wasn't gettin' there money's worth of entertainment an' they started into settle the conference with there hands an' feat.

"Come on, Tibb," I says. “This aint no place for us.'

So we lit out, Sid, an' there ain't nothin' for it but we should go over to the Arlington an' meet these hear dames who I was tellin' you about and who was friends of Tibbs. I wasn't none to keene about makin' a reglar spree out'n it, but Tibb was set on doin' the thing up right an' he says

it's stricktley aganst his principels to go to bed before 4 A. M. once he gets started. You know, Sid, I wasn't never one off them kind that's all ways tootin' a round every night, lappin' up the fire water like a cat drinks milk, an' I didn't have no particuler desire to give a first class immitation of a house on fire. You know I was never much on that stuff, old man.

But I might as well tell you rigt hear, Sid, in case you might be thinkin' I drunk to much, that they ain't no drink made what I can't stand 3 or 4 of without turnin' a hare an' I didn't have no more than 3 or 4 of each kind, this night, so you see, old man, I couldn't of had to much like what Tibb had. But when I was at the Grand Union, Sid, I was feelin' hungry, so I boughten a sandwich off'n the lunch counter guy an' I didn't feel rigt for the balance of the night. They must have been some kind off dope in the bread or somethin', Sid, because I got feelin' funny an' kind of light headed like. Of course I never said nothin' to the guy about it because he'd probabely say it was the liquer I had took, not knowin' how much I can hold without it not havin' no affect on me, and what is the cense off arguin' with a fella like that anyways.

It don't make no diference now.

Well, old man, first off, Tibb takes me into the back room, were they is one of them roller rink pianoes doin' its dammest in responce to some drunken guy who had, in a mad momment, slipped a nickle in the slot an' then fied to escape the terible consequences. They was tabbles set all a round a dancing floor in the middle off the room, an' Tibb heads strate for 1 of the tables where they's 2 dames settin' alone an' lookin' like they was waitin' for a coupel bottles of Scotch to come floatin there way or maybee they was hopin' some kind friend might deposit five dolars for 'em with the bar tender. Anyway they brightens up considerable when they sees us comin' an' Tibb performs the interductions like he was

presentin' me at court. But them dames wasn't queenly--not a bit, Sid. As soon as we was nocked down to each other one of them eyes me an' says:

"Hello, sweet petootie.”

"Hello, liver an' onions," I says. "Who hit you in the face?"

"No one hit me in the face," she says. "What do you mean?"

"Oh," I says. “It must be natural then. It don't hurt you, does it?" "Your a fresh guy,” she says.

"You was picked to soon."

“Maybe,” I says, “but I wasn't left on the tree till I was over ripe anyway, like some folks I know not so very far away.”

Well, Sid, we wasn't gettin' on just as good as we might have done an' Tibb, he notices it too, an' he starts talkin' to my dame an' I an' his girl gets up and starts a one step. You know, Sid, I ain't no star on these here dance steps but I was feelin' just like I could of did anything after I had ate that sandwhich an' I didn't do to bad neither. Tibb's dame was not so worse at all, Sid. She had a voice on her like a subway guard, but her looks was 0. K.

Well, Sid, we hung around prety late, an' that there sandwhich I et had me doped so I can't remember nothin' much about what we done later on. I got a kind of vage reccoletion of comin' home alone an' when I come to, propper, I was home in bed. I didn't have no cloths off, thoug, Sid, but I was all 0. K. The bed cloths was puled up over my head an' my overshoes had not improved the white bed-spred none. Also my good overcoat was a trifle crushed from me sleepin' in it all night an' that there good fur cap what Gert give me last year had a big patch burnt off'n it bigger'n a silver $. But I ain't worry'n. From what old Tibb says, I must of had a prety fare time, after all things is done an' said, an' I bet some of them there bugs in my sistem got run in for bein' drunk an' disorderly before the night was done.

Well, old man, I must close. Don't show this here letter to Gert, Sid, or I wouldn't never hear the end to it. Give her my love and tell her I ain't bein' overfed on cookies etc. up here. Does she still do that sort of cookin', Sid? Well, write soon an’ give me the Yours allways,

Jim. P.S.-I ain't goin' to buy no more sandwhiches off’n that guy. I'll say not, Sid!



A competent doctor named Bliss,
Had a case with tu-ber-cu-lo-sis.

He told the whole truth,

And now a bright youth
A nice shiny coffin will miss.

From Va. Health Bulletin.





This article is in substance a cir- 2. Take an interest in Framingham health cular issued to the people of Framing- affairs, and have enough respect for health in ham entitled, "What has the Health

Framingham, to insist that only ihe best local

administration, both as to organization and perDemonstration done thus far für Fram

sonnel, is good enough for Framingham. ingham? How can the benefits be made

TWENTY-TWO POINTS permanent ?"

Probably many citizens do not know what A PERMANENT HEALTH BASIS have been the direct benefits thus far to the

town from the Health Demonstration. If The object of this bulletin, which you are

you are one of these, your attention is respecturged to read carefully, is not to boast of things accomplished, but to give you the in

fully urged to the following points : formation which is your right as a citizen of 1. Framingham, The Health Town" Framingham, regarding the work of the Health

Constant inquiries from all parts of the Demonstration, and to inspire you to demand Union demonstrate that Framingham has been the best of permanent results from this work

given a greater prominence throughout the for Framingham.

country than any other town of its size in the Framingham itself has done much to make United States. the “Health Town" a reality. It has provided nurses for tuberculosis and infant welfare

2. Free Medical Examinations work, physicians, dentists, and nurses for the

Over 6,000 citizens have been thoroughly exschools and factories, unusual baby clinics, re- amined, and 4.000 referred to their local phymarkable domestic science teaching, sicians for treatment, thereby heading off much elaborate civic and educational program, early disease. (Cost, $12,000.) neighborhood committees for health and pa

3. Tuberculosis Controlled triotic endeavors, etc. The whole country knows of Framingham's

Two hundred and fifty mostly early cases

have been brought under advice or treatment, cooperation in the health movement. It is the right of every citizen of Framingham to know

in many of which the disease is arrested and the details of the work which the Health

the patients at work, further infection being Demonstration has started and is carrying on

guarded against. (Cost, $3,850.) here. It is the privilege of Framingham citi- 4. Cooperation in Tuberculosis Treatment

to insist that organization for health Financial and other aid has been given in be perfected in Framingham, in order that the

many cases including equipment, food, milk, work may have permanent value for the towni.

transportation, etc. Local charitable activities The aim of the Demonstration has been to

have been advanced by provision of workers show the world that unnecessary sickness and

for investigation of charity cases, contribudeath, particularly tuberculosis, can be elimin

tions to the Associated Charities, etc. Nursing ated by medical and nursing care, personal assistance has been provided for the town hygiene, and adequate health administration.

tuberculosis nurse in caring for the cases under The best benefits, the permanent benefits of

treatment in Framingham. this work are still to come, and they depend not so much upon the Health Demonstrations

5. An Expert Medical Consultation Service as upon the people of the “Health Town."

This expert service is being used by nearly All Framingham people and agencies, con

all the Framingham physicians, for tubercusciously or unconsciously, are working either losis, influenza, and other diseases, thereby ento increase the death rate, or to decrease the couraging the early diagnosis, proper treatment, death rate.

and reporting of sickness. (Cost, $6,000.) The people of Framingham have a right to 6. Assistance for the Draft Board insist that the work which has been started, which has already materially decreased pre

Expert medical diagnostic aid has been fur

nished the drait board since the beginning of ventable deaths in Framingham, should be placed a responsible permanent basis.

the war, assisting the board in the maintenFramingham has led the world as a health ex

ance of an enviable record, practically no cases periment; it should continue to lead as a health

hitherto unrecognized being returned from the example.

cantonments for pulmonary disease. To this end there two

lings that you

7. Medical Care for Special Groups of Cases can do:

Groups of children discovered in the exam1. Practice the principles of personal hygiene. ination work, with nose and throat and glandu




lar abnormalities, have been followed up, defects being removed whenever possible. 8. A Post-Graduate Medical Lecture Course

A lecture course for the medical club has been financed, doctors of international reputation being secured to address and hold clinics for the Framingham physicians. (Cost, $600.)

9. Influensa During the epidemic, nurses and equipment were provided for the hospitals, a consultation service for the physicians, an examination service for returning factory employes, educational material for the factories and the press, etc. Federal, state, and local authorities were conferred with regarding the control of the epidemic, vaccines and sera secured, etc.

10. X-ray Equipment A model x-ray equipment, available to all physicians has been added to one of the hospitals, for use in tuberculosis and other di

(Cost, $500.)

11. The Health of the Infant An iníant welfare nurse was provided for over a year, financial aid given in Baby Week expert assistance secured from the Federal Government, etc. (Cost, $2,000.)

12. A Summer Camp About 400 pre-school age children have been provided with summer camp facilities covering a period of two years, diseases and defects discovered being followed up for correction and treatment. (Cost, $4,500.)

13. The Health of the School Child Equipment for a school dental clinic was provided through a fund secured by the Health Station from private sources, the cost of equipment and dental nurse's salary guaranteed for prophylactic dental work, the equipment and supplies provided for school lunches in one school building, financial aid given for the Community House in the Italian section, Health Crusader clubs formed among the school children, etc. (Cost, $2,700.)

14. The Health of the Factory Worker Factory health conditions have been effected by the provision of medical examinations for the industrial age group, of expert medical consultation service for the factory clinic work, by the distribution of free educational literature, etc.

15. Domestic Science Il’ork Popular domestic science and food economy classes have been financed in cooperation with the Framingham Normal School staff. (Cost, $150.)

16. Local Milk Conditions These have been carefully studied, with the cooperation of the Federal Government officials, and plans developed for the improvement of economic and sanitary aspects of milk handling in Framingham.

17. A Study of Icalth Dangers A careful analysis of healtl. dangers in

Framingham has been undertaken with the cooperation of national experts, in the school, factory, and general sanitary conditions, resulting in recommendations for improvement.

18. Patriotic Endeavors Assistance has been given numerous patriotic activities, such as the Red Cross, the Liberty Loan Campaigns, the War Savings Stamps Campaign, the United War Work Campaign, etc., by means of educational displays, literature, newspaper articles, field canvassing, preparation of maps and selection of district committees, etc.

19. Health Education An extensive health educational campaign has been carried on through the use of leaflets, special bulletins, exhibits, health letters in the press, dissemination of propaganda with the cooperation of neighborhood committees, etc.

20. Civic Activities Financial and other aid has been given various civic and social activities wherever their programs touched matters of health. (Cost, $1,700.)

21. Summary of Cost What has been the cost of these health efforts to the Demonstration? How much has the Demonstration directly devoted to the welfare of Framingham? The following figures approximately recapitulate the expenditures for the indicated activities. These do not, of course, include the cost of office maintenance, rent, the salary of executives, the expense of publications, the preparation of exhibits, the employment of experts for service and investigative work, etc.

Further, many of these expenses are for initial equipment or for experimental and investigative work. It was necessary to make these expenditures to find out the facts; that does not mean that to have the work continued it would cost the permanent health organization more than a small fraction of this total for routine activities. The town has already aided generously in the work and is now spending approximately 80 cents per capita for health. This expenditure covers all kinds of health work, including tuberculosis. Consequently, it is possible for Framingham to show other communities that an adequate health program can be carried out at moderate expense to the community. Medical Examinations

. $12.000.00 Expert Medical Consultation Service. 6,000 00 Children's Health Camp..

4,500.00 Special Search for Tuberculosis Cases 3,850.00 School Health Work (including private contribution)

2,700.00 Infant Welfare Work.

2,000.00 Civic Health Activities.

1,700,00 Publicity for Framingham in outside communities and states....

1,000.00 Medical Club Expenses.

600.00 X-ray Equipment

500.00 Domestic Science Instruction.


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