VOLUME XIX

No. 11

Upon the entrance of any patient into a sanatorium there is an implied contract between the party of the first part, i. e., the patient, and the party of the second part, i. e., the sanatorium. There are several delicate points touched upon in this contract; relations of each to other. Unfortunately, these matters are not taken up in a printed form, to which, in the presence of witnesses, each high contracting party subscribes his name and affixes his seal. I shall attempt, in a poor, weak way, to mention some of the relations and obligations that should mutually, even though tacitly, be understood as existing between the party of the first part and the party of the second part as they become linked in a project that holds possibilities of so much of weal and woe to that individual who shall be hereinafter known as the party of the first part, except as otherwise mentioned.

Firstly, the party of the first part, being of sound mind, and of legal age, or acting through lawful guardians, and believing that he is suffering from a disease which, if neglected, can cause legal and total, complete and indisputable death, otherwise known as a trip across the Jordan, and having, as a result of information variously acquired, a further belief that the party of the second part can afford greater opportunities for curing and arresting such disease than any other agent or agency known to the party of the first part, does hereby agree to wholeheartedly cooperate with the party of the second part, and all lawful representatives thereof, to the end that such desirable result be consummated as rapidly as possible. It is clearly understood that the party of the first

part is truly desirous of remaining external to Sir Conan Doyle's "summerland" as long as possible and will leave no stone unturned or effort unmade in pursuance of such declared purpose. He accepts the statement

of the party of the second part, "prolongation of life to the uttermost is the avowed avocation of this institution," as a valid statement of purpose, and desires to avail himself to the fullest extent of the benefits arising from such.

Secondly, the party of the second part, in consideration of the promise to wholeheartedly cooperate in efforts to be made to arrest and ultimately cure, if that be possible, the tuberculous disease from which the party of the first part is now suffering, does hereby agree to use all accepted and thoroughly proven methods for the treatment of such party, it being understood that, for the most part, such applicant can do more for his own improvement than others, in applying principles of rest. The Sanatorium agrees to furnish food, shelter, nursing and medical attention, heat in winter and such amelioration of summer heat as is practicable, orderly and janitor service, entertainment as considered desirable, instruction in the character of his disease, and various and sundry other services as we from time to time shall consider advisable.

This then is the implied contract that should be borne in mind by John Doe and Richard Roe when entering a Sanatorium for Tuberculosis.

Assistant Medical Director, State Sanatorium for Tuberculosis, Norton, Kansas.

"Radio music, estatic, high,
Falling clearly from the sky."

N a journal I picked up some time ago called Radio I encountered an article that gave me quite a thrill:

"There is radio music in the air, every night, everywhere. Anybody can hear it at home on a receiving set, which any boy can put up in an hour. One of these sets costs less than a phonograph. With it can be heard grand operas, orchestras, phonographs' music, market reports, press summary, sermons, and speeches. All that is needed is a hundred-foot clearspan of copper wire, a couple of batteries and a cabinet set that can be bought from a radio dealer in every town.

"No better investment can be made as to a means for making a home more attractive to the entire family. Radio brings fathers and sons together on a common basis of mutual interest. The women can easily run in during the afternoon and have a constant source of entertainment for their guests. Any phonograph selection will be played by request to the operator in charge of the sending station. No home is complete without radio."

We have been watching for development of radio for some time but few of us, it seems to me, have realized just to what an extent it had developed as a power for good. If radio can add something to the opportunity for enjoyment of people who are perfectly well and who are able to attend as much as they choose of the multifarious entertainment that is offered upon every hand to-day, think what it will do for the housebound invalid. That's where I got my thrill. Why, radio simply means that life, liberty, and the pursuit of happiness has been extended to one more group of that body politic which, while doubtless created equal, has subsequently, in spots at least, lagged behind somewhat. Radio as it is developing to-day is nothing short of another emancipation proclamation. Radio is going to provide the tuberculous invalid with that touch with the outside world he stands so sorely in need of and which his need for rest, absolute or relative, and the necessity for keeping out of crowds, has so far denied him.

That this new way out is being eagerly seized upon by those most alert to what it offers is evidenced by reports received from sanatoria and patients chasing the cure in various parts of the country. Thus we read in the March issue of The Mount McGregor Optimist, published at the Metropolitan Life Insurance Company Sanatorium at Mount McGregor, N. Y., that "a home-made radio telegraph-telephone set has been installed * * *

*Q. S. T. is the code signal calling all radio stations.

and clear concerts have been heard from Chicago, Pittsburg, Schenectady and Newark," while the April number of The Grapevine, published by the patients at La Vina Sanatorium, La Vina, California, informs us that a receiving set has been operated for some time by a small group of patients in the infirmary and that an audian detector, two or three steps of amplification and a loud speaker that will have "the tone and volume equal to a large phonograph" are to be installed. In Northern California, we learn through the columns of The Tea Bee, hailing from the Colfax School for the Tuberculous at Colfax, California, that at the new Standard Oil Company Sanatorium located at that place "consideration is being given to equipping the san with a radio service." The columns of The Stethoscope, published and printed by the citizens of Arroyo Sanatorium conducted by Alameda County at Livermore, Cal., indicate that they have been experimenting with radio for some time and with satisfactory results.

Some idea of what is available to the amateur through broadcasting can be had from the partial list of stations published in the March issue of Popular Science. These sources of radio are located in all sections of the country and offer an amazingly varied bill. To mention a few items: A station in Newark sends out a children's hour program every Friday at 7.15 p. m. Others send out sermons, lectures, grand opera, news items, stock reports, market quotations, weather forecasts and government time signals.

In Health News, issued by the New York State Department of Health, we read that the Boston Metropolitan Chapter of the American Red Cross, at the invitation of the Radio Research Corporation, is talking health to the radio-listening world within a radius of 1000 miles of Boston, and the Survey in an issue as far back as December, 1921, mentioned a health lecture given by Dr. Charles A. Powers over the wireless in Colorado. Since the article mentioned in Popular Science appeared, press dispatches have announced that our fellow health worker, Dr. C. C. Pierce of the United States Public Health Service at Washington, is sending out fifteen-minute health talks from the Anacostia, D. C., station three times a week and that Tufts College has announced a course of lectures by radio. This latter plan was described as constituting a wireless collegeif this proves to be so in every sense it is worthy the consideration of certain other seats of learning that might be named. Politicians have taken to the new game as ducks to water and it is not long since the Democrats were horrified to note a Republican Senator mending his fences over the Naval Radio at Washington. Up to this time all had gone as merry as a wedding bell and the next and only

other item of radio bad news that has come to my eye was the announcement that Representative Vincent Brennan of Ohio wants to broadcast the Congressional Record by wireless.

As to whether the amateur outfits are getting anywhere, a recent article in The Wireless Age (New York) tells of an amateur station in Scotland receiving messages from amateurs in this country and of signals from Roswell, New Mexico, being received by amateurs on the Atlantic Coast. The amateurs here at La Vina, with a very simple equipment, hear music and messages constantly, the former presumably from Los Angeles and the latter from the radiophone service to Catalina Island. Our watches are set daily to compare with the time signals sent out from the Government station at San Diego. It is stated that amateurs with more expensive sets have shoved their messages through from the Pacific Coast to Hawaii.

The radio experts of the Bureau of Standards of the Department of Commerce have prepared detailed instructions for making an amateur receiving station that will catch messages sent from medium power transmitting stations within an area about the size of a large city. They say that the cost of such apparatus can be kept down to $6.00 and that an especially efficient short-range outfit can be installed at a cost of not over $15.00. I believe $25.00 would cover the expense our boys have gone to so far.

It is not the purpose of this article to do more than to suggest that radio offers one more "way out" for the immured invalid, and so all scientific detail has been omitted. However, it should be stated here that radio sets are like so many other things-the less expensive ones are of necessity more limited in their performance. For instance a cheap crystal set such as is contemplated in the figures quoted above is of very limited utility, whereas a set with the more expensive appurtenances, especially vacuum amplifying tubes and a loud speaker, is virtually without limit in its range. Experts place the cost of an ideal receiving set at about $400. Sets may be built to cost anything from that down to next to nothing. That radio has come to stay is amply proven,

it seems to me, when one learns that owners erecting apartments in New York, Philadelphia, and elsewhere are advertising radiotelephone service as part of their up-to-date equipment.

For the benefit of those not living near large towns it may be mentioned that aside from what may be had from the Bureau of Standards, any electrical device dealer will send catalogues of radio material, and the addresses of manufacturers of radio instruments and institutes teaching radio can be secured from the advertising columns of the journals mentioned in this article. The newspapers are running columns of radio questions and answers and splendid articles on wireless are appearing in the better-grade popular magazines as for instance one entitled The Unfolding Marvels of Wireless by French Strother in The World's Work for April. This article is based upon technical information supplied by Major General George O. Squier, Chief Signal Officer of the United States Army and by Dr. Louis Cohen, consulting engineer. So there would seem to be no reason why anyone should be dumb when the company begins to toss about such words as, antenna, condenser, detector, electrical oscillation, frequency, inductance, pontentiometer, wave train and what not.

Incidentally, it is a matter of no little pride that the greatest subsequent invention since wireless was given to the world, the threeelectrode vacuum tube, was the work of an American, Dr. Lee De Forest, and it should be of more than passing interest to readers of the JOURNAL OF THE OUTDOOR LIFE to know that he is a brother of Mr. Charles M. DeForest of the National Tuberculosis Association, who is credited with an invention of equal rank in the fight for health, The Modern Health Crusade.

How far radio will carry us no one can say but he was indeed a far-seeing gentleman who predicted that as even tin is a receiver, sardines on delicatessen shop shelves may yet spend their evenings listening to the shrill laughter and scientific hemming and hawing that fills the intervals between the operatic spasms the night air will soon be filled with.

In considering plans and methods for the prevention of tuberculosis in childhood, it is important to have in mind the various ways by which the infecting tubercle bacillus reaches the child. These are chiefly three:

1. First, through the air. Tubercle bacilli coughed into the air by a consumptive may be breathed in by another individual. Such organisms may find a lodging and begin to grow in one of three places, the adenoid region, the tonsils, or the inner surface of the bronchi. Continued growth in the tonsils spreads to neighboring glands chiefly in the neck, and we find the enlarged tuberculous glands of the neck, formerly called scrofula. This condition is technically known as tuberculous cervical adenitis.

Infection of the adenoid tissue may travel directly down the lymphatic chain into the chest, infecting the posterior bronchial glands.

Infection of the bronchi spreads to adjacent groups of the glands and thence along the blood vessels into the lungs.

2. Second, infection through the mouth. This is commonly through milk from tuberculous cows. The tubercle bacillus passes into the stomach and intestines, passes through the intestinal wall and lodges in the abdominal lymph-glands. From here it is carried by lymph-channels to various structures, especially to the bones and joints. From such a distribution arises Potts disease, tuberculosis of the spine, and the great number of deformities caused by tuberculous hips, knees, ankles, and other joints.

3. Third, infection by direct contact. Infants crawling on a dirty floor may come in contact with virulent tubercle bacilli. Some cut, wound or abrasion of the skin offers a point of entrance for the organism and tuberculosis of the skin follows with extension to nearby tissues.

A campaign of prevention, then, must take cognizance of these various methods by which the disease is spread.

To combat the air-borne infection, children must be kept absolutely separated from open cases of tuberculosis, and this includes not only the consumptive, but all those with discharging tuberculosis sores. This is a very important and often difficult matter. For example, if a consumptive father or mother lives in a house with children, safety demands that either the patient or the chil

• A paper read before the Sociological Section of the National Tuberculosis Association, Washington, D. C., May 5, 1922.

dren be removed. Usually the easier way is to place the consumptive in a sanatorium and arrange to have the children cared for in the home. Such children should then be under careful observation for one or more years. The open-air school offers a suitable opportunity for observation of children of school age. Younger children should be taken regularly to the clinic or to a private physician for periodic examination.

The question becomes more acute when a consumptive woman gives birth to a child. There is a popular idea that such babies are always weakly. This is a mistake. In the great majority of cases such infants are as well and strong at birth as any others. So great is their susceptibility, however, that even a few days spent with the mother is enough to make certain the death of the child from this disease, usually within a few months. To save such a child it must be removed from its mother the day it is born and so long as she expectorates tubercle bacilli, it should never come near her. This sounds like cruelty, but the alternative is plain.

In Sweden there is an organized plan for sending the children from tuberculous families to selected country boarding-homes. Commonly these children remain as boarders troughout their whole childhood. The plan seems highly practical and greatly to be commended. It is carried out under the auspices of the National Tuberculosis Society by a so-called "Care of Children" Committee.

Children under the age of four, and especially the new-born, should not go to an institution except for a short time as an emergency measure, or during acute illness. A very high death-rate among young children in every foundling home is well known. They do not respond well to institutional care as a rule. They need a home. For this reason it is important to emphasize here the desirability of a plan of nursing homes for infants and the younger children taken from tuberculous families. For older children the preventorium fills a very distinct need. Here they may be placed under ideal hygienic surroundings and watchful care until they regain good nutrition and blooming health. A certain amount of school work may be done here.

The prevention of tuberculous infection by food is largely a question of milk supply. No community health problem is of more constant importance than this. Dairy herds must be frequently inspected and the tuber