E

ARLY last November certain members of the staff of the National Tuberculosis Association, anticipating the spirit of Christmas and the inevitably accompanying craving for what is technically known to the grocery trade as "table luxuries," were told of a convalescing tuberculosis patient who was reinforcing her family exchequer through the sale of pecans. The orders for the pecans having been placed and the nuts found to be as represented (a most rare occurrence), considerable interest on the part of the purchasers was aroused in the person of Mrs. J. O. Darsey, the distributor. And in the course of the customary correspondence attendant with sending, remitting and receiving receipts for bills, the story of Mrs. Darsey's fight for health against almost overwhelming odds was brought to light. It was an inspiring story, modestly told, but every line of it breathes of a spirit inherently hopeful and courageous. It is the story of a recovery that must appear miraculous to those who do not know the power of those two attributes-courage that can lift a human soul out of despair and hope that can save it from death.

It was in March, 1911, while nursing her tuberculous father, who was slowly grieving his life away over the death of a beloved wife, that Mrs. Darsey first became aware of a severe, steady pain in her side. She ignored it, as so many others have done, for her help was in constant demand in the disorganized, motherless household where five growing boys required continual attention. That was twelve years ago, in days when people knew but little about tuberculosis. In spite of the family's devoted care, Mrs. Darsey's father died.

Mrs. Darsey continued to ignore the warning of her own ill health, and performed her housework and cared for her family, until she broke down with a pleural attack and was confined to her bed for three weary, painracked months. The family doctor belonged to the old school of medical practitioners, and may have wished to conceal the truth from his patient or he may not have been able to make a correct diagnosis. Be that as it may, he stated that he doubted that active tuberculosis was present, but prescribed a strict regime of fresh air, fresh milk and raw eggs. And under this prescription recovery apparently seemed close at hand when, accompanying a slight cold, a cough appeared and the sputum examination disclosed the presence of the tubercle bacillus.

For five months longer Mrs. Darsey fought her battle for health at home. Then, one day, there arrived the notice of admission to the new Georgia state tuberculosis sanatorium, and Mrs. Darsey, accompanied by her husband,

set out on the journey. The institution was located nearly one hundred miles from Cairo, and a more depressing, forbidding-looking front than the place presented at that time it would be difficult to imagine. It had been opened six months earlier, with only a small appropriation for its maintenance, and so little interest was shown in its development that the patients suspected that at least some of the state legislators were unaware of its very existence. Mrs. Darsey was placed in a shack with nine other patients, where she reflected, after she had been put to bed, that the only redeeming feature of her new home was the spirit of comradeship and helpfulness which appeared to exist among the occupants of the little, make-shift cottage.

Seated in the train, on his way back to Cairo, Mr. Darsey fully expected that a telegram notifying him of his wife's death would be awaiting him upon his return, and for many weeks afterwards he dreaded the arrival of the daily mail. In the little shack at the "san," however, the ten participants in the fight for health, assisted by a cheerful, smiling nurse and a kindhearted, overworked doctor, fought their quiet battle with all the courage they could commandeer. It is difficult to understand in these days of specialized medical service and complete sanatorium equipment, how the institution could have achieved any results for its patients with so inadequate a medical and nursing staff; for the superintendent of the sanatorium was at the same time head physician, house and shack physician, and supervised the farm and sanatorium buildings as well. The head nurse, in addition to what should have been her chief occupation, was also housekeeper and supervisor of the kitchen and dining-room servants. Yet patients and staff all pulled together in the effort to conquer the invisible enemy.

Three months after entering the sanatorium, Mrs. Darsey took her first meal in the main building, and at the end of six months her allotted time at the institution expired. Improved, but not sufficiently so to resume her home duties, she decided to assist in the work of the sanatorium in order to remain under medical supervision. There were times when she became so homesick that she doubted if she could continue to bear the struggle, the strict regime, the monotony of life and, above all, the separation from her family. At thought of them, however, she would summon every atom of her will power and resolve more firmly than ever to make a winning fight. After all, she thought, the members of her family were all quite capable of caring for themselves-there was no real cause for worry

there-but she knew perfectly that if she lost courage she would never see any of them again. And in her determination to "stick it out" her loved ones helped much, for they begged her to remain as long as she needed to, so that she might fully recover.

It was two years and eight months after her arrival at the "san" that Mrs. Darsey returned home. Home! Only those who have experienced it can know the joy there is in such a homecoming. Friends and relatives crowding about! Everyone declaring that they could not believe that she was the same person who had left the town so worn and ill! And the cat, and Jim the faithful collie, purring or joyously barking, each in the manner of his kind, leading the way like heralds in the vanguard of a returning hero!

one

So, for five years, the Darsey home remained a happy and contented household, no dreaming that the days of sickness and suspense would return. But in 1918, after nursing several influenza cases, Mrs. Darsey herself contracted the disease and came closer to death than she had ever been. For four months she remained in bed. Later her husband-"Dad," his wife affectionately calls him -carried her to the porch every day until once again she was permitted to get up and, like a baby, could learn how to walk alone. And here let us allow Mrs. Darsey to describe in her own words the reason for the debt of undying gratitude which she feels toward the husband who, she is certain, made her second recovery possible.

"He wanted so much to keep me," she says, "to have me well and strong again, that he thought of nothing but to serve me. Yet, in addition to caring for me, he cooked, milked, churned, fed the chickens and turkeys, washed dishes, swept floors and even did our laundry occasionally. The responsibility of the actual farm work, too, was on his shoulders-yet he never complained, though his patience must often have been sorely tried."

The following August, Mrs. Darsey again went to the sanatorium where many changes and improvements had taken place during the five years she had been absent. After making the examination the doctor leaned back in his

Before I got this old T B

I never had a minute

To think about this funny world And funny people in it,

chair and scrutinized his patient earnestly. "Your recovery," he said, "depends entirely upon how you take the cure-you will have to fight, and fight hard for two whole years." She repeated this verdict to some of the patients and a few of them laughed. "He might just as well have told you," said they, "that that is the length of time you have to cash in your checks for the undertaker!"

But Mrs. Darsey resolved once more to regain her lost health with every resource at her disposal, and so for two years she continued the cure at home, kept it up faithfully, resisting every temptation to do anything but the lightest handwork, in the knowledge that recklessness meant only additional labor and concern for those who cared for her.

At this writing Mrs. Darsey is about again -well on the road to recovery, able to do light chores and to be happy at her work. Like so many other tuberculosis patients she has the added problem of making a living to consider, which is her reason for building up a small trade in the sale of Georgia paper-shell pecans and sugar-cane syrup. The work of weighing and wrapping is light, and she has found it most interesting. When she is not busy filling her orders she corresponds with some of her old "san" friends, and she requests that if any of them should see this story in the JOURNAL OF THE OUTDOOR LIFE they drop her a line, for she continues to be interested in their problems and welfare.

Recently, Mrs. Darsey attended a convention of the W. C. T. U. in Cairo, at which she met some acquaintances who had not seen her for years. They gasped at the change in her appearance. "How is it possible that you could make such a wonderful cure," they exclaimed, "and why can't others do the same?" "Perhaps," replied Mrs. Darsey thoughtfully, "perhaps they don't fight hard enough." And as a summing up of the requirements for making a good recovery, Mrs. Darsey gives this advice to tuberculosis patients: "The essentials in the cure are rest, fresh air, good food and grit, grit-even sand and rocks if necessary-with them you will come out victorious!"

But now the greatest fun I know
Is this to watch the passing show
And see the puppets come and go.

Before I got this old TB
I never had the time

To read books I wished to read,

To put a thought in rhyme,

But now each day I store my mind

With thoughts the best that poets find; I e'en write poems (of a kind).

Before I got this old 1 B

I lived just for myself

And never gave a thought for those
With neither health nor pelf,

But now I tend a friendly hand
To every sad heart in the land,
For Pain has made me understand.

So since I got this old T B
I've though a lot and read,
And this is what occurs to me
Here in my little bed:

Each mortal has of joy his ration,
The greatest loss in all creation
Still has, if sought, its Compensation.

The Crusade in the Curriculum

The Crusade system has now been introduced as a curriculum activity by the departments of education of fifteen states. The Crusade is either made mandatory or is recommended for adoption by local school systems. In many other states, county or city school systems have placed the Crusade in the curricula. It has been adopted as a system based on practice in distinction from precept. It is, we believe, the only practice system yet devised capable of adoption on a wide scale. The adoption of the Crusade, however, does not discourage informative instruction in hygiene or physiology.

It is gratifying to note the number of state departments of education that are publishing teachers' manuals incorporating the Modern Health Crusade. Such states are: Maine, Vermont, Alabama, Mississippi, Indiana, Iowa, Kentucky and Ohio. The Crusade Directors of several of the state tuberculosis associations have been employed in the preparation of these manuals, and Miss Osborne, while doing field work for the National Association, was able to serve the North Dakota Department of Education in this way. The Ohio "Course of Study in Hygiene," written by Miss Virginia Lewis, Crusade Director of the Ohio Public Health Association, makes the Crusade the motif for the course from the first to the eighth grades.

Course in Hygiene

The purpose of the National Tuberculosis Association has not been to develop the Crusade as an organization but to contribute it to the schools as a system practicalizing instruction in hygiene. In view of the movement to incorporate the Crusade in the state manual for teachers, the National Association decided to write a course in hygiene based on the Crusade and to offer it to the state departments of education as a guide in preparing their manuals. The pressure of work of our Crusade service makes it impossible for members of the staff to devote the time required, but through the generous cooperation of the Iowa Tuberculosis Association we were able to secure the services of its Crusade Director, Miss Theresa Dansdill, for three months. The crusade course of hygiene now in preparation will be offered to the state educational authorities in manuscript form. It may also be published jointly by state departments and the National Association.

Nutrition

During the last two years the executive office has been exchanging ideas with pediatricians and especially those prominent in nutrition work for school children, regarding the service that the Crusade could render in the campaign against malnutrition.

A plan has been developed by which a Crusade course for the special benefit of undernourished children can be added to the Crusade system, which, of course, has been directed chiefly to the problem of the normal child. Mr. DeForest has written a nutrition edition of the Crusade chore record, and a circular of instructions to teachers and nutrition workers. It is found that the weight chart for the individual, used in nutrition work, combines very simply with the scoring chart for chores. More than thirty persons whose experience and position should make their opinions authoritative, including a committee appointed by the National Child Health Council, have been consulted regarding this new printed matter. It is our plan not to tie up the nutrition work of the Crusade with any one of the "schools" of nutritionists to the exclusion of the good points in other schools. Care has been taken to avoid controversial points on diet and technique. Our object has been to increase popular attention to nutrition, to make the highly practical machinery of the Crusade available, and to stimulate also the use of the best publications on nutrition by various authorities. The importance of close medical supervision is emphasized in the Crusade nutrition material. Special nutrition clinics and classes are recommended for childrer. requiring special medical observation.

The nutrition edition of the Crusade chore record and a special circular of instruction to teachers and nutrition workers are now in type. Preliminary orders for more than 40,000 copies of this material have been received. We expect to be able to fill a large demand for this material at the opening of the next school term. With this nutrition material there is no intention, however, to displace the Crusade work for the majority of children who are not "malnourished.'

Millions Enrolled

During the last year the National Association has sold 6,000,000 pieces of Crusade material. As a number of the state asso ciations print their own material, the total volume of educational publications circulated under the Modern Health Crusade is extremely large. More than twenty-four million chore records have been used since the first chore record was published. In requisitioning supplies the state associations have responded in a very gratifying way to our request that all orders be placed with us by specified dates twice a year, relieving the National Association of the responsibility of carrying a stock.

Tournaments and Contests

Great interest has been shown in the Crusade tournaments and the silver cup contests. In the two tournaments decided since the last annual meeting 233 banners and pennants have been won by the schools

in states ranging from Maine to Texas and Idaho. The inter-state cup, which was held the previous year by Iowa was won by Idaho. The inter-city cup was won by the District of Columbia. In this connection President Harding gave the Crusade notable recognition by formally presenting the cup to the school authorities of Washington. In his address of presentation he expressed great interest in the anti-tuberculosis campaign.

Field Work

In field work for the Crusade during the last year Miss Osborne made addresses and conducted institutes on Crusade methods for teachers and health workers in Ohio, Indiana, Iowa, Nebraska, North Dakota, Montana, Colorado, Utah, Idaho, Oregon and Washington. Due to shortage of funds it has been necessary to discontinue field work for the Crusade. Although Miss Osborne's connection with the National Tuberculosis Association has been discontinued, we wish to express our appreciation of the valuable services she has rendered.

Miss Louise Strachan has been employed as Assistant Crusader Executive, in place of Miss Terry, who resigned December 1st. Miss Strachan has had extensive experience in health work following her college graduation. She was the Crusader Executive for New York State and Assistant Sales Manager for the Christmas Seals. She relieves Mr. De Forest of a large part of the correspondence connected with the Crusade and also serves in writing articles and in public speaking.

The Crusade service has co-operated with the National Child Health Council and its committees. Time has been given for a number of conferences.

In reporting the progress of the Crusade mention should be made of the endorsement and thorough co-operation given the movement by the National Education Association and the National Congress of Mothers and Parent Teacher Associations and the General Federation of Women's Clubs. The growing interest in the Crusade is evinced by the hundreds of letters received at the executive office coming from many foreign countries as well as all parts of this country.

Statistical Service

During the past year the personnel grouped under the heading of research, statistics and library, which was known as the Research Service, has been re-grouped under other services. Miss Towner, the Librarian, was taken over by the Common Service Committee for the joint library, and Miss Conklin, who had been doing editorial work, was assigned to the Publicity and Publications Service. Miss Whitney's title was changed from "Research Secretary" to "Statistician," and a separate Statistical Service was organized under her direction.

Sanatorium Follow-Up Study

The Sanatorium follow-up study, which was inaugurated in the Spring of 1921, required the entire services of one person, and Miss Dorothy E. Wiesner was added to the Statistical Service staff in June, 1921, to do this work.

All the sanatoria in the country were asked to co-operate in this study, which sought to determine the mortality of patients after leaving the sanatoria, their physical condition, if living, and their economic status. Over 100 sanatoria agreed to cooperate, but only 57 actually did so, returning to us their records.

The number of patients discharged from the 57 sanatoria number 8,817, and returned cards have been received from 3,500. The tabulation of this material has involved a great deal of detailed clerical work, and has necessitated the addition of temporary clerical help. A preliminary report of the results of this follow-up study was presented at the meeting of the American Sanatorium Association, held in connection with this meeting.

Miss Whitney's field work for the National Child Health Council has already been reported. Mention of her Cleveland study will be included with a later reference to the Committee on Indigent Migratory Consumptives.

Statistical Information Supplied

The Statistical Service last year prepared, from data submitted from the various registrars, a table showing the tuberculosis death rates in every state for which data were available during the past 10 years. Copies of this report were sent to all state secretaries.

The Statistical Service is responsible for preparing and checking up all figures used by the other services of the National Tuberculosis Association, especially the Publicity and Publications Service. This routine function is becoming of increasing importance, as it not only safeguards the statements made, but oftentimes provides additional information of value.

Requests from the field are constantly received for specific statistical information, which is prepared by this Service.

Realizing the value of graphic presentation of the facts about tuberculosis, the Service is now preparing a series of charts showing certain phases of the tuberculosis problem. Copies of these are on exhibition at the annual meeting, and it is possible that if there is sufficient demand reproductions of them may be made for wall charts.

1921 Mortality from Tuberculosis

Although complete figures for the registration area in 1921 are not yet available, we have the figures from the Metropolitan Life Insurance Company for that year, and