IN 1920

Statistics are not available to give an accurate summary of all the money being spent in the campaign against tuberculosis in the United States during a given year. From certain data that are available, however, one may estimate that the entire movement, including organizations, institutions, dispensaries, nurses, and both public and private agencies, will spend during the current year of 1920 no less than $30,000,000. This gigantic organization, for purposes of general administration, is divided up into six districts by the National Association as follows:-New England, North Atlantic, Southern, Mississippi Valley, Southwestern and Northwestern. A brief summary of the campaign in each of these districts will help to give a picture of the organization as it is at present.

1. NEW ENGLAND DISTRICT

The New England district embraces the states of Maine, New Hampshire, Vermont, Massachusetts, Connecticut and Rhode Island. The district is one of the most intensively organized industrial centers of America. Its mills, factories and transportation facilities give to the tuberculosis campaign a peculair industrial character that is more pronounced here than anywhere else in the United States. This is particularly evident in such centers as Boston, Providence, New Haven, Hartford, Springfield, Barre, and elsewhere. To be sure, there are rural problems, but for the most part the tuberculosis problems are industrial.

The campaign against tuberculosis is well organized in the New England states. There are strong state associations in each state and a considerable number of active local associations. In Connecticut the State Tuberculosis Commission acts in the capacity of state association. Among the local associations one may mention particularly those in Boston, Providence, New Haven, and Springfield as significant. There are state sanatoria in all of the states-two in Maine, one in New Hampshire, one in Vermont, four in Massachusetts, two in Rhode Island, and five in Connecticut.

Massachusetts is probably the best developed of the states. It has an excellent State Department of Health with a commissioner and staff, and eight district health officers besides a

officers. There are over fifty local dispensaries and 38 local hospitals and sanatoria in addition to the four state institutions above mentioned. The State Tuberculosis League and the 37 local societies make a reasonably complete fighting machine.

In Massachusetts is located also the Framingham Health and Tuberculosis Demonstration conducted by the National Tuberculosis Association. This demonstration is financed by a special grant from the Metropolitan Life Insurance Company and has been in operation somewhat over three years. Its purpose is to endeavor to show how an average American community can control tuberculosis by a reasonable expenditure of money. While the demonstration is not yet complete, the results achieved to date are most gratifying. A complete report of the work of the demonstration will be found in the several monographs that have already been published and will be published from time to time.

2. NORTH ATLANTIC DISTRICT

The North Atlantic district comprises the states of New York, New Jersey, Pennsylvania, Delaware, Maryland, Virginia, West Virginia and the District of Columbia. The problems of this district are somewhat more diverse than those of the New England district. The large cities furnish an intensive industrial and manufacturing problem. States such as West Virginia and Pennsylvania provide a mining problem, while others such as New Jersey and Maryland and Delaware are largely agricultural with a considerable mixture of fisheries among their principal problems.

There are strong state associations at the present time in each of the states with the exception of Delaware. In the latter state the movement is conducted largely by a State Tuberculosis Commission financed out of state funds. There are state sanatoria in all of the states-one in New York, three in Pennsylvania, two in Delaware, one in Maryland, one in the District of Columbia, one in New Jersey, two in West Virginia, and three in Virginia. In Delaware, Virginia, and West Virginia are the only three state sanatoria for the treatment of Negroes in America. The Negro problem in these states is acute. The state health work is well organized in some of the states, such as New York, Pennsylva

HIS is the true story of a man who was

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sick but got well-a man who saw death grinning at him from just around the corner, but did not dodge or run away but stood his ground and conquered the enemy. It is the story of a fair fight on the field chosen by the enemy. And along with the man and his fight there is something of one other, whose incredible zeal and loving service helped to win and to make the winning worth while.

Chaddock's qualities and abilities are (apparently) quite those of the average American. He is a worker at a trade-that of printer; he has published small country newspapers; he has run for county office; with no more schooling than that received by the average boy he has, by setting up the compositions of others and by reading his exchanges, acquired a working knowledge of the English language and its forms, giving him a certain facility of expression. Chaddock has no more inflexibility of purpose than you or I-apparently and seems as easily baffled by an unusual problem. Yet he has accomplished that which takes will power and intelligence to a degree which many persons of high learning would hesitate to claim. Chaddock would say that he had very little to do with it-that to his wife belongs the triumph. You may judge for yourself.

The Chaddocks livè in a middle-sized city in Kansas, a third of the way from the Missouri River to the Rocky Mountains, and less than 200 miles from Kansas City, and they have lived there for six years. For half of that time Chaddock worked in printing offices by the week, or, at times, ran small job printing shops of which he was part owner. With a family of wife and two children no surplus was accumulated at any time, yet, on the death of Mrs. Chaddock's mother, he gladly joined in his wife's suggestion that they take unto their hearts and household the five-year-old sister, left motherless. She is now eleven, and their home is still hers.

Three years ago Chaddock contracted tuberculosis, or found out for the first time that he had it. He had to give up all work and prepare for what? One day while still able to be up and about town he made the laborious ascent of the stairs leading to the office of his lawyer, and staggered down the hall to the door, where he stopped, a paroxysm of coughing racking his emaciated body, until danger of the threatened hemorrhage passed and strength could be gathered for the remaining few feet to be traversed. The lawyer had not seen him for some months and was greatly shocked at his appearance with the many telltale signs. After Chaddock was seated and

ABSOLUTE REST-THE MOST IMPORTANT OF THE THREE ESSENTIALS FOR MAKING A CURE.

able to speak, he talked freely of his trouble, and the lawyer, like the other fatuous ones, suggested the desert or the mountains.

This is about what Chaddock told him:

"No! My wife and I have thought this business out and we have talked it out, and we are not going to Colorado or Arizona or New Mexico; we are going to stay right here in this town, right in the house we are living in, and if I can't get well by the plan and mode of life and treatment I intend to follow I don't believe I would get well anywhereand my wife thinks the same. The people we know are here, our friends are here-if we can keep them-and if I have to go out, this is the place for it to happen. I don't think about that, though, for we are both convinced I can get well."

You are again at liberty to judge for yourself whether or not Chaddock, in his references to his wife and her faith and optimism, laid down any considerable part of the essential principles governing the problem.

She was at that time rather frail in appearance herself, yet possessed of a flaming spirit that for sheer indomitableness grips the heart. The family lived in a rented house which had several spare rooms, and these she rented out; she had learned to set type and feed a job printing press, and she took the job her hushand had given up; and she worked at that job every week-day for nearly three years, cared for the rooms and her sick husband, in the meantime not neglecting her children; and there was no single moment when she was not helping Chaddock to get well by her absolute faith in the outcome.

For the sick husband she rigged up an outdoors place on the back porch, screened in.

He lived there day and night for more than a year, lying flat on his back, all exertion strictly forbidden save that required to lift to his mouth the frequent meals of fresh eggs and milk and the rich juices of beef. These she prepared and left within reach. The roomers were entirely segregated and never saw him unless some cared to make a friendly call and chat a bit, which happened oftener than Chaddock had dared to hope. The rooms were kept scrupulously clean, the whole house frequently fumigated, and no article used by the patient was ever used by any other occupant. All of this, including earning the money required, she accomplished-but by no mere physical strength, for no flesh and blood or sinew or muscle could ever survive the hours of effort it took-there was only that something God gives to those who love enough.

Yes, there was something else, too-the cheering and heartening arrivals, almost every day throughout the long, hard winter, of a neighbor from across the street, bearing a dinner of warm, rich food. Mrs. Chaddock believes that for this neighbor there is prepared, in the house not built by hands, a place very near to the throne; and even now, as she thinks of his kindness, she seems to hear the rustle of a wing.

Chaddock did not get lonely, for his friends dropped around. True, they often remained outside the porch and talked through the screen, but what is a little matter of a screen between life and death? Outside, whence came the friends, there was life, with all it offered; inside, where Chaddock lay on his bed, all effort denied him, a shadow sometimes rested. On the days when some neighbor took the time to walk around to the rear and to his porch and say a word or two the shadow was exorcised. And it always left for the day as soon as his wife returned from her uptown work.

After a little more than a year of this he began to sit in an easy chair a part of each day, but still on his porch; the children were allowed to remain with him for hours on end; he read much; and all of the time the morning sun warmed and blest his nook. Life began to look real to Chaddock, and not as a gift of some sort that he might-barely mightget in his stocking next Christmas. And still the fresh eggs and milk, the juicy steaks and delicate fruits appeared as by magic on his little table placed easy to his hand. Presently he walked about a little each day in the yard, the gaining strength always ahead of effort and the diet one to build. To relate all the steps of his treatment would make too long a story, but let it be recorded that at no time did Chaddock allow the smallest infraction of the rules; at no time did he yield to temptation, born of the deadly ennui of the long hours and days and weeks and months, to do aught but what he had set out to do; and the regimen, though now less rigorous, is still strictly observed.

Chaddock has won out; he weighs more than he ever weighed before in his life. And,

AFTER TWO YEARS OF CURE - TAKING STRONGER, HEALTHIER, HAPPIER THAN EVER BEFORE.

to prove that the burning of sacrificial fires does not always consume, Mrs. Chaddock is plump and rosy. Chaddock is working part of the time, and the means by which he is permitted to work part of the time is another story of the unbeatable spirit. They have purchased a small job printing outfit, and have set it up in what was the parlor; they are getting a fair run of business; Mrs. Chaddock has quit her place at the uptown job office and spends all her time at home; her husband works until he is tired, then rests; and the family enjoys a life and cohesion and confidence in the future that five years ago were wholly foreign to their outlook. For, unitedly, they have met the stalking horseman on his own ground and beat him fairly.

As for Chaddock, he has a new heaven and a new earth that are all his, for he has come close to both. He has developed a latent power which bids fair to carry him farther than he would ever have gone while it remained hidden. In short, he has found himself. He has read nearly everything that has been printed on the subject of tuberculosis, and has acquired a fund of information about the disease and its treatment sufficient to make him an authority, and he is convinced that anyone with sufficient will power can be cured

right in the climate where he lives. He says there are three elements in the cure-rest, pure air and nourishing food, and the most important of these is rest, absolute absence of effort. He describes graphically the work of nature in healing the diseased and lascerated lung tissue by the illustration of a tree which has suffered a wound or abrasion of its bark, growing a new bark around and over the scar. Exercise quickens the breathing and consequent passage of air through the lungs, and also accelerates the pumping of blood through

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them by the heart, both of which irritate and inflame the infected patches. Thus rest is necessary to permit nature to build faster than the disease tears down. The pure air and rich food are but further aids to nature in the work.

Chaddock is modest and unassuming; he has the delicacy of feeling one expects from a man of decent impulses; but he cheerfully consented to the printing of his story if thereby some other person nearing despair may be encouraged to try.

YOUR president has done me the honor of asking me to address you on the subject of the development of the campaign against tuberculosis.

At no time in the history of the world has there been as much done in the treatment of those suffering with the various forms of consumption, nor has there been as much public interest taken in the disease.

Our knowledge of tuberculosis dates back beyond the Christian era.

We know to-day that pulmonary tuberculosis is curable, particularly in its earlier stages, and though this has only been accepted generally within a very few years, we have but to pick up the writings of Hippocrates (460 B.C. to 377 B.C.) to find that he taught his students that if patients with consumption are treated from the first they will get well. The father of medicine had a wonderful knowledge of the disease. He described the form of chest in phthisis, and gave us our first ideas on judicious exercise and the rest cure. Isocrates, a contemporary of Hippocrates, taught that consumption was contagious, but this expressed belief of his was not generally accepted.

Aretæus, who lived 250 years before Christ, prescribed for his patients sea voyages, moderate exercise and friction. He also laid stress on a generous milk diet.

Pliny (72-22 B.C.) taught the great value of sunshine and fresh air. He sent his patients into the pine forests. One of his most noted maxims was "Where sunshine enters, disease departs."

Celsus (30 B.C. 50 A.D.) advised for his patients a change of air and sent his patients to the country or on sea voyages.

Galen, too, who lived from 131-200 A.D., believed that impure air was an etiological factor and taught that the disease was contagious. He sent his patients to the higher altitudes that they might breathe pure fresh air.

* Address before the Samaritan Club, Toronto, Ont.

The first records of cured cases are perhaps found in the writings of Avicenna, a physician of the Arabian school who flourished 980-1037 A.D. He, too, believed in contagion and sent many of his patients to the pure air of the mountains.

The first accurate description of the tubercles found in the lungs in phthisis, we find in_the_writings of Franciscus Sylvius, 16141672. In 1672 Gideon Harvey published a work with most excellent plates illustrating them..

Scrofula, which was later recognized as a form of tuberculosis, received great attention from physicians in the seventeenth century. It was known as the "King's Evil," and the belief was general that the disease would be relieved or cured if the patient could be touched by a king. John Brown, in one of his writings, records that in twenty-two years (from 1660-1682) 92,101 persons were touched by the king for this complaint.

Sydenham (1624-1680), the father of English medicine, advised riding in the treatment of consumption. This was his favorite treatment for many other diseases. He records a number of cures which he thoroughly believed were due to horse-back exercise.

Richard Morton in 1689 declared the identity of scrofula and consumption, and was the first English writer to lay stress upon contagion.

Great advances in the recognition of the disease were made by the Paris physicians Laennec and Louis. Laennec it was who first taught the use of the stethoscope, and through his careful researches diagnosis was simplified. His work on auscultation, first published in 1819, is a classic. The first accurate description of the histology of tuberculosis was given by an English physician, Addison, in 1845, in a communication to Guy's Physical Society.

During these earlier years there was no general belief in the communicability of the disease. Kortuum, in 1789, tried inoculation experiments by rubbing tuberculous matter on the unbroken skin, but it was unsuccessful. That the disease is communicable was first proven by the brilliant researches of Villemin,