I

culin test freely used. Suitable laws must cover the various phases of this subject. Recent figures indicate that bone and gland tuberculosis in young children is very largely caused by the bovine bacillus, at least 75 to 80 per cent. (Mitchell). Here comes also the question of eating from dishes contaminated by tubercle bacilli. recall one instance of a boy one year old who spent much time on his father's bed. The father had far advanced consumption and amused himself by changing his pipe from his own lips to the child's mouth. The sad sequel was that this father and child died within twenty-four hours of each other and both were buried in the same grave.

The prevention of direct inoculation of the skin comes again to the question of the separation of children from open cases. It includes also such care of the sick as to insure absolute cleanliness of the patient and the surroundings. As a matter of fact, unless such care and cleanliness prevail, it is never safe for the well to be about those who are sick with any infectious disease.

There are two medical facts which every social worker in the tuberculosis field should recognize; namely, first, that infants are highly susceptible to this infection; second, that the mortality rate for tuberculosis in infants is 100 per cent.

It may seem difficult to hold this consistent with the fact that tuberculosis workers are told that a sanatorium is a safe place and that they need not fear catching tuberculosis. As a matter of fact, one's immunity to tuberculosis ordinarily increases with each succeeding year and adults have very little to fear from re-infection unless they are in very close contact with an expectorating patient. But it is very different with infants and young children. Their immunity is slowly established and easily broken down. It is important that this conception of immunity as gradually increasing in each individual should be understood. It may be stated that in childhood immunity is never complete.

When a child becomes infected with tuberculosis his vital tissues become at once the seat of a struggle between the forces of life and death. The natural defences of the body bury the invading bacilli deep in lymphatic glands and surround them with dense scar tissue. The ability to segregate such invading bacilli is a measure of the immunity of the individual. It should be understood that, when for any reason such immunity breaks down, the bacilli may again become free wanderers through the lymph spaces of the body, liable to cause serious disease at any time.

Although a child may seem very well and strong, an attack of acute disease, prolonged nutritional defect, or unhygienic surroundings may break down his resistance at any time and tuberculosis become active.

When a child recovers from measles or scarlet fever, he commonly obtains such immunity that he is free from that discase so

long as he lives. When a child apparently recovers from tuberculosis, we now know that it is merely the beginning of "trenchwarfare." The tubercle bacillus still lurks in secret, waiting a favorable moment to attack its victims again.

This leads us directly to the question of those conditions which are most likely to break down the immunity of the child and pave the way for frank tuberculosis. The principal causes are:

1. Malnutrition. This is a very large subject which I shall not attempt to discuss here, except merely to say that the modern movement to meet this condition in the schools is of very great importance and hopefulness.

2. Acute disease, especially measles, influenza, pneumonia, whooping cough. 3. Diseased tonsils, teeth and adenoids. 4. Rickets.

5. General bodily ptosis. This is perhaps best known as "bad posture," it commonly covers numerous physiologic defects and is often associated both in children and adults with tuberculous disease.

This list connects the tuberculosis problem in children directly to the general health resources of a community. Where these things are neglected, tuberculosis will flourish along with rheumatism, valvular heart disease and other grave maladies. One of the essentials, therefore, in the campaign against tuberculosis in children is a general hospital equipped to care for children, and specialists in children's diseases.

For children actually ill with tuberculosis, the most important provision is a proper sanatorium. At this point I wish to insist that a proper sanatorium is a real hospital and that it is for the sick only. I am strongly opposed to the boarding-house idea of sanatorium. It should be a hospital or nothing. Sick children should be sent to the sanatorium, children needing good care, but who are not actually ill, may be sent to the preventorium, or to the open-air school. This may seem a simple point, but as a matter of fact it is very important. The opposite is frequently done and has serious results affecting the health of the children in question. At this point especially, social workers will do well to avail themselves of the experience of the medical profession. The decision as to whether the child is ill and needs hospital care, or is not ill and needs good hygiene and observation only, should always be left to the physician.

The children's pavilion at the sanatorium, in order to meet the medical needs of these cases, should have in addition to regular equipment, the following items:

1. Isolation rooms for care of contagious disease. This is very important.

2. School rooms for those able to attend. 3. Porches for sun treatment.

4. X-ray equipment for deep therapy treatment of glandular tuberculosis.

(Concluded on page 383)

W

HEREVER chronic diseases are treated

there are of necessity idle bodies and idle minds abide. The need of providing occupations for patients suffering from tuberculosis and other forms of chronic disease has been long recognized, and attempts have been made to introduce occupations which would primarily have a therapeutic value and, secondarily, with the hope that some gainful vocation might be provided which would be permanently useful to the individual convalescent. Unfortunately these occupations are necessarily limited in variety and nature and most of them have been largely successful in giving an outlet to the patient's desire to accomplish something while curing.

Many of the essentials of tuberculosis treatment are not difficult for the patient to comprehend. This is particularly true of rest, fresh air and exercise. There is usually not a lack of appreciation of the value of wholesome food, but one meets frequently a decided lack of knowledge of how food should be selected and prepared. This condition is in considerable measure the result of our modern ways of living. A generation or two ago it was the common thing for a girl to be taught at home the essentials of cooking. That day seems to have passed, and the modern girl, while she may have a smattering of training in this line in her school days, tends promptly to forget it when she becomes a business woman. Many girls enter business life at seventeen years of age, and from then on have little occasion to study this wholesome

art.

Believing firmly in the broadest possible education of tuberculosis patients in ways of maintaining health and with equal firmness believing that proper food well prepared is a prime requisite in keeping well, we began about a year ago to prepare for the installation of a modern cooking school in our sanatorium. It was believed that if this undertaking should succeed we should have the same equipment and, in general, the same plan of study that would prevail in any intensive short course cooking school. For this purpose we chose a space, 20 x 28, in a southeast corner of our large occupational therapy workroom. This room was shut off from the remainder of the space by a plastered partition, and in it we have installed the following equipment:

5 cooking laboratory desks, capacity 2, each desk having a small electric stove.

A sink with drain board and towel racks.
Refrigerator.

A demonstrator's desk.

A demonstrator's electric range with oven.
A blackboard.

The

The course is given by the head dietitian of the Sanatorium. There are two classes of ten each in attendance on alternate days. The sessions are of two hours duration and, briefly, are conducted in the following manner: first portion of the hour is given over to a talk on the foods to be considered in the day's lesson. Salient points of previous lessons are reviewed and a brief demonstration of the essentials of the day's lesson is made, emphasis being placed on the composition, nutritive value in comparison with the cost, digestibility and the general rules for preparation. The remainder of the time is used for the preparation of the day's food by each pupil. Depending upon the nature of the food it is prepared individually or in groups of two working together. At the outset two of the pupils are delegated to be housekeepers for that day, and it becomes their duty to see that everything in the diet kitchen is in order before the kitchen is closed for the day. The actual cost of materials used is paid for by the pupils.

The course covers a period of eight weeks and the subjects treated are as follows: Beverages, cereals, soups, eggs, milk and milk products, meat, fish, vegetables, salads, bread, hot breads, cake, gelatine desserts, pastry, frozen desserts and table service.

While the primary object of this course in cooking is to bring immediately to the patients a comprehensive knowledge of the selection, preparation and cooking of foods, it is obvious that the influence of these courses does not stop there, but that it will be life-long and will be carried to many other individuals with whom the student associates. Furthermore, it has all the advantages that accompany other forms of occupational therapy.

While the present course comprehends in

One thing about coming to a San impresses me; it is good in the way that one learns to take precaution for other people against the disease. I suppose there are people who can stay at home and have the same care, but that is not always possible with the average home or, as in my case, if you are minus one.

Sometimes under advice, if a patient seems to need another altitude, he or she is transported to another San. And the change is most beneficial.

I have discovered "the pleasantest nurse" is really what might be termed a head nurse in my wing, but there is such a nice spirit about the "bosses" that I did not discover this for quite a while. Of course I knew Dr. Rolleen was the head, but he shows no sign of bossiness, at least not to me.

Your last letter was perfect; do write me again soon.

Supper arrives!
So farewell my lady!

Your Kath.

Dear Helen:

February 22.

I did not dream it would be twenty-one days before I could get a letter off to you again. Have had a sojourn in bed which was not wholly satisfactory, at least to me. Over-exerted, I presume, and got a lot of new lines on that chart. Now I am as spry as ever, and have learned that a slight hemorrhage is often a help in my trouble.

While I was in bed, lying there alone one night, I looked out and saw the snow coming down. Later it became clear and a glorious winter moon sailed along independent apparently of the blue that formed its background. There seemed to be something beyond poor little me, and yet I seemed such a part of it that I felt I could never be wholly destroyed. I think God touched me that night. Bob's question was answered.

Now please do not worry about me, will Reprinted by permission "The Crusader" of the Wisconsin Anti-Tuberculosis Association.

you? I am really better and back on the pavilion again, and gossiping.

Ever with love, Your Kath.

March 4. Dear Helen: You expedient person, keeping up a correspondence with the powers that be! All the time I thought you knew nothing about me. Well, I'll forgive you, and say I am deeply grateful for the way you do things, even if I do not always approve.

I have some real gossip for this letter. I believe "the pleasantest nurse" and Dr. Rolleen are engaged. I see them occasionally talking in the hall, in a way which is more than science, yet very dignified, and I have discovered on the third finger of her left hand a ring appearing now and then. It is not exactly what one might call an engagement ring, just a narrow band of gold, very inconspicuous. There is a lot of sentiment under her bib and tucker, for it was displayed in a glimpse on the day she hugged the shoes Bob and Betty sent. I am glad if this is so, for Dr. Rolleen is one of the realest men I have seen for a long while, and as I have been bestowing my blessing for the past seven years on friends, I think I shall know how to give it in this direction.

It is still cold and clear. As I looked out from my pavilion this morning, I saw the funniest picture. Evidently one of the ambulant patients (the walking around kind) was trying to trip the light fantastic on snow shoes, and she took a sprawl. Imagine if you can, being graceful with a tennis racket tied to each foot. Ever, Kath.

Dear Helen:

March 16.

A sad thing happened yesterday. You remember the mother I told you about, the Swede with the five children. They took her home. It seems she felt the end coming and begged to go. Poor little mother! She left it too late, I guess, but how could she help it with babies clinging to her skirts, and a man earning about thirty dollars a week? The little girl engaged to the plumber just came in to say good-by to me. She is being discharged. Won't there be a grand reunion! Sinks, bathtubs, and washers will be but a scrap heap, as compared to the redemption of those lines of XXXXXXX in the letters.

We had lots of fun making up limericks the other day. Here are some of them: There was a young man of great gumption Who laughed at the foolish assumption That a germ in the lung Meant a requiem sung,

And so he got well of consumption.

A youth who a temperature ran
Was persuaded to go to a San,

Where they opened his eyes
To his foe in disguise,

Sent him out feeling like a new man.

There was a most obstinate man
Who wouldn't fit into the plan,
And so, sad to tell,
He couldn't get well,

But died; then his folks blamed the San.
A certain young man most perverse
Would rail at each doctor and nurse,
Disobeyed every rule

And behaved like a fool,
And so he went home in a hearse.

A maiden exceedingly pale,

With a cough and as thin as a rail,
To a San found her way,
Put on flesh day by day,

And now she is rosy and hale.

With you so many thousand feet below me, I suppose there is Spring in the air. The snow has gone here, but the trees are not budding yet. However, it is pleasant to lie on the pavilion, with that intense cold gone.

Do you remember the teacher I told you about who had the sixty-five little hoodlums to teach? She has left for another San, different altitude. I had a letter from her yesterday, and she seems very happy where she is. I hope she will get well, for it would be awful hard on her poor little mother to lose her.

I have met so many people "en pavilion" that some day I hope their stories will be known, just to show how brave the world is after all. I am not exactly worrying about my master's degree, for I see a big part of education exists right here, if one can take it.

I wish that you could arrange to come up some day. It would be about a ten-hour trip, coming and going, but we would have three hours together, and it would mean a