years of age. I came in that back door yonder in an ambulance, and I went out the front door in a cab." We thanked her for her solicitude, and told her that we had already completed the first part of her come-back program, and were hoping for the best on the last, only our selection for the exit, we added, would be a taxi. This apparent optimism pleased the dear old soul mightily, and she left us, her face lit up with smiles, and we are sure, just as happy herself as she had made us. The graduation exercises were closed by the singing of "America", and that night seventyfive patients of this certain sanatorium somewhere in the Southwest, slept the sleep only given to those whose hearts have been made happier, whose souls have been vastly encouraged and uplifted. Note: The author in writing this article had in mind not only the entertainment it would furnish the T. B. family, but also, the desire to help dispel the common fallacy existing in the minds of so many folks regarding a sanatorium. To them a sanatorium is a cold, gloomy, hospitally place where doctors and nurses strut about in ghost-white uniforms and discuss "cases" in low, sepulcher like tones. As a matter of personally-known fact, the modern T. B. sanatorium to-day is the nearest substitute to home that human agency can make it. The spirit existing there is more like that in a great, big family boardinghouse. Added to this is a nurse's constant and kindly attention to the patient's every comfort and a staff of expert physicians always on the job to render every possible service in order to help the T. B. make the fight a good one. Diversion in the shape of musical and other programs is being constantly devised to entertain the patients. In one San, we know of the "cure" patients have banded themselves into a committee to call on and welcome all new comers. If a patient becomes despondent or blue in the present day San it is his own fault. And so, good people, if you have a T. B. relative don't handicap him in his fight before he starts. Don't cut his expense account to the last cent and force him to seek cheap accommodations, if you can possibly do otherwise. Such economy is not only false economy but in a great many instances nothing less than criminal economy. Give him the best possible chance to recover-to live. Send him to a San. Bill! Bill! Bill! DEDICATED TO H. C. O'LIVING I. A classy girl, and a ton of sweetsBill! Bill! Bill! A hundred shows, and midnight eats, At last you win her heart and hand II. A weeish cry in the dead of night- Eleven pounds of pure delight, The babe becomes a handsome boy, III. Sunset days in the Land of Flowers- To while away life's ebbing hours, But what's the use? Don't dodge-you can't! How Are Yeh; How Are Yeh, To-day? There's a feller that I always like to meet, When he shakes your hand you tingle to the feet, And no matter where you are, How's everything out your way? If you're down my way, stop in fer a chin Don't knock on the door, just-Why, hel-lo there, Jim! How are yeh, how are yeh, to-day? How's everything out your way? After the dark cloud passes, After the storm-drops dry, Throw open wide your windows And smile up at the sky. (To be continued) MODERN METHODS OF TEACHING HYGIENE AND SANITATION* By MISS ETHEL REDFIELD, STATE SUPERINTENDENT OF PUBLIC INSTRUCTION, BOISE, IDAHO It took a great war to bring us face to face with the fact that we had failed to make the human material with which we work in our schools physically fit for the demands of life, to say nothing of adding anything to the resource of man power of our country. We have long preached the doctrine, "health first"; we have long discussed the importance of inculcating health habits in the pupils of our schools; we have formally made a place on the school program for physical exercises, but real effort along this line has been desultory, or confined to particular places or sections, the cities and larger places alone, as a rule, providing for systematic physical education. The State which has awakened to its opportunity and its obligation to have its school system really serve the health of all can easily see the benefit of the investment of effort and money in health education. Legislation recently enacted in the several States of the Northwest puts upon our statute books a notable number of laws concerned with the conservation of health and the prevention of disease. This is a gratifying evidence that public interest and concern are aroused to the need of making the lives of our people more productive, more physiologically useful and more enduring. The spirit and the conception of responsibility that rests upon educational systems and institutions in preserving the human life of the nation has broadened and deepened in the past few years. The Northwest in playing its part in the national program of conservation of the people realizes that its wealth, organizations, all its strength and vigor must be drafted for the accomplishment of its largest task. If the health of a people constitutes its wealth, then efficiency in this regard of all the people should be the goal of effort. As I have said before, in the past, systematic physical education has been the concern of institutions, or public schools in large communities only. A survey of the efforts put forth reveals to us that the instruction offered was of varying type: (1) the systematic, regular work required of all students of the school or institution; (2) the irregular and poorly organized work, and (3) that work which was done as an elective by a part of the students. Much of the physical education work in schools has been for older students, and much of it has had to be concerned with corrective exercises. In other words, the work has been from "the top down," whether we consider the age of pupils privileged to receive its benefits or the remedial nature of the work offered in contrast with preventive work. Modern methods of teaching sanitation and hygiene imply Read before the Northwestern Conference on Tuberculosis, Boise, Idaho, October 1, 1919. a demand on the part of the people for the teaching of these things to all the children, and their support of such teaching. Modern methods call for an intelligent understanding by school authorities of the physical condition of all of the children attending our schools. This means the making of intelligent and complete health surveys. In the State of Idaho at the last Legislature there was enacted a law authorizing and empowering the Board of County Commissioners to employ a graduate trained nurse or nurses, whose duties shall be "to act as consulting expert on hygiene for all schools not already having medical inspection either by physician or visiting nurse; to assist in the care of the poor in the county who are in need of such services; to give instruction to tuberculosis patients and others relative to hygienic measures to be observed in preventing the spread of tuberculosis; to aid in making a report of existing cases of tuberculosis; to act as a visiting nurse throughout the county; to hold clinics; in cooperation with the Juvenile Court to look after child welfare work in the county, and to perform such other duties as nurse and hygienic expert as may be assigned by the County Board. Every such visiting nurse shall at the end of each month make a report in writing to the County Commissioners, which report shall show the visits made during the month then ending, clinics held, assistance rendered and the requests made for such services and such other information as the County Board may, from time to time, require." A number of the counties of the State (10), acting under the privilege extended by this statute, have employed nurses. We may hope for definite, helpful results in these countries that will be of value in giving us facts to serve as a basis for establishing a definite policy for the whole State. The practical application of the principles of sanitation by an efficient nurse will do much toward educating the people in regard to measures for safeguarding the health of community and of the children. The law on Idaho statute books which imposes upon the State Board of Education the duty of providing "an efficient system of health supervision, medical inspection and physical development work in all public schools" has been a dead letter because, since its enactment, funds have not been available for the effective administration of such a system. The modern text book on physiology and hygiene contrasts greatly with the old-type text book. The learning of the names of the bones and of the muscles of the body was an acquirement of knowledge it is well to have, but there was nothing in the old book or old type of instruction which would lead to an acquirement of health habits. The modern book devotes itself to life and the daily class discussions stimulate children to do things rather than to commit facts with a strong probability of their being forgotten. The Modern Health Crusade which furnishes the indirect motive that secures results in health education is the happiest type of organization that could be conceived of. It performs the mission of inculcating habits of personal cleanliness and of stimulating in pupils a pride in their personal appearance, as well as establishing cooperation between home and school. Children are most zealous in the performance of their "health chores," and their faithfulness in this regard is most remarkable and has been productive of most beneficial results. This testimony is brought to me by parents and teachers, everywhere the work has been introduced. One city superintendent states that he never knew of anything that functioned so well with home and school as the Modern Health Crusade. Of a school attendance in Idaho last year of about 100,000, 50,000 children were enlisted for this work, and a number of the counties were unable to introduce the work because of the short school terms which were the result of the influenza epidemic. This year standard school requirements laid down by the State Department of Education demand of all schools participation in the work of the Modern Health Crusade as a part of the regular school work. The time is coming, indeed, is at hand, when it will be considered unpardonable in a school administration not to know of the physical needs of each child and how to meet them. "If education means anything, it means opportunity for overcoming weakness, not only of mind, but of body." COMMON MISINTERPRETATIONS REGARDING TUBERCULOSIS By H. F. GAMMONS, M. D., WOODLAWN SANATORIUM It is only natural for a person suffering with tuberculosis to worry. If the tuberculosis person does not interpret the disease in all of its manifestations correctly, it is very evident that his worries may be exaggerated in some instances. A great majority of the worries about tuberculosis are due to lack of knowledge regarding the fundamentals of tuberculosis. The ordinary tuberculosis patient does not worry about his present troubles, but he does imagine that all sorts of calamities are about to occur. The big majority of worries are caused by imagination and not by fact. It is generally known to-day that the usual case of tuberculosis entering the sanatorium has had the disease for a varying number of years and that the acute attack began perhaps five, ten or fifteen years before the patient entered the sanatorium. The symptoms produced by the acute attack were probably ascribed to some other acute infection, such as the grippe or malaria or an ordinary cold, and as the resistance was increased these acute symptoms subsided. The patient does not take this fact into consideration, but as soon as the diagnosis is made he can almost see himself loosing weight and can see his finish. After a while, especially if the patient is in a sanatorium, he realizes that his worries were unfounded, and he reasons that if he has had the disease as long as the doctor has advised him, and that if he has done as well as he seems to have done while leading an ordinary life, that with the rest and other treatments he must surely improve. If he is at home he does not improve as well on account of not having the encouragement of others similarly affected. As soon as the diagnosis has been made he takes precautions against the infection of his relatives, little realizing that he has, in many instances, already infected his family and that it is best for the family to be thoroughly examined at once and later, at intervals, so that if the infection develops into disease the family can take treatment at an early date. If the patient is told by his doctor that he is an advanced case, with perhaps a cavity, he feels very much depressed, little realizing that such cases can become arrested, and that in his case the formation of the cavity may have been the starting-point of his recovery, as is so often the case. Furthermore, he does not realize that while he may have had disease scattered all over both lungs, that the signs in the chest and the constitutional symptoms show that the areas of disease are pretty well healed, but that the results of the disease in most cases will always be evident on physical examination. It may also be possible for an advanced case to have a recurrence of symptoms, due to the activation of trouble in a very small area and not to a recurrence of disease all over the lungs, as the patient imagines. Another mistake that tuberculous patients often make is to expect to become cured in a short time or, in fact, to become cured at all. It is generally considered that tuberculous patients do not become absolutely cured, but that they do become cured, in many instances, for all practical purposes and that they will remain cured if they follow the advice received at the sanatorium as regards, rest, food and fresh air, as well as the daily habits. (Concluded on page 54) The aim of this Journal is to be helpful to persons seeking health by an outdoor life, and particularly to disseminate reliable information looking to the prevention and cure of tuberculosis. It should be distinctly understood, however, that the JOURNAL OF THE OUTDOOR LIFE is not intended to supplant personal medical advice. Anyone suffering from pulmonary trouble who is not under the care and guidance of a physician is taking grave chances. THE SIZE OF THE JOB The workman who starts to build without counting the cost is very apt to become financially involved before his job is finished. This applies equally to the man who is building a house or to the tuberculosis secretary who is building a program of community effort. Yet how few secretaries, whether of state or local associations, have measured the size of their job and can tell with any degree of accuracy the materials that will be needed to build the structure they have begun! To those who are inclined to drift along in the development of their state and local programs, careful perusal of a recent government document entitled "Defects Found in Drafted Men," prepared by Colonel Albert G. Love and Major Charles B. Davenport, is commended. This report compiled from the draft records shows the physical condition of over 2,500,000 men registered and examined in pursuance of the requirements of the selective service act. It is without question the most careful and scientific statistical analysis of the data regarding defects found in this large group of men that has been prepared by any of the government agencies. The tuberculosis secretary will be amazed to read that 30 men out of every 1,000 examined were found to have frank or suspected tuberculosis. Three per cent.-in other words, a higher figure than Dr. Armstrong found in the Framingham population-were rejected because of tuberculosis. In round numbers, 82,000 men were found to have this disease in active or suspected form, and of the 82,000 all but about 1,100 were absolutely and unqualifiedly rejected from service. Localize these figures and the size of the job that confronts the average tuberculosis association will become somewhat more apparent. Government records show that the males of draft age, that is, between the years 18 to 30, constitute approximately 10 per cent. of the population of the normal American town. In other words, in a city of 100,000 population, 10,000 men may be said to fall within the draft age of 18 to 30. Of these 10,000 men 3 per cent., or 300, have frank or suspected tuberculosis, if the extended experience of the United States Army in the examination of over 2,500,000 men may be applied thus locally. Stop to think for a moment that these figures include men and men only between the ages of 18 and 30. No women are included and no children under 18, and no men over 30. Add to the 300 the incidence of tuberculosis in the other age and sex groups and the size of the job becomes even more apparent. If, therefore, the anti-tuberculosis associations of the United States during the year 1920 should make a frank effort, first of all, to discover the 3 per cent. of the men within draft age who have tuberculosis in their communities and, secondly, to provide adequate care and control for them during the year 1920, the job that they would lay out is one that would challenge their best in initia tive and resources, financial and otherwise, that can be commanded for this coming year. Many of the draft records are available; some of the data is already in the hands of state and local agencies. Much of it is of little value. No community, however, need halt nor hesitate on that account. If the job of controlling tuberculosis is worth while, the task of finding the cases must appeal to any soundheaded business man as the initial step in a well-rounded program. We know how many cases we should expect. We know how to find the cases. The resources are available for the most part. We lack two things--vision and leadership. Shall we halt because of this lack? THAT MEETING AGAIN! The proverbial man on the street said the other day: "I don't see how folks that are doing social work ever get anything done. They are attending meetings all the time." This is a somewhat exaggerated statement and can hardly apply to the tuberculosis field. Aside from the annual meeting and the sectional conferences, there are relatively few meetings to keep the tuberculosis worker from his immediate work. Of these few, however, the annual meeting of the National Tuberculosis Association is one that demands attention. This meeting offers an opportunity to meet. and confer with the leaders in public health and tuberculosis work, both medi cal and social, from all over the United States; a chance to hear discussions on the most pertinent topics, medical and sociological, dealing with the problem of tuberculosis; a chance to get the inspiration of a big going organization, the livliest public health agency in America, the National Tuberculosis Association. The dollars spent in sending paid workers of a tuberculosis association to the annual meeting of the National Association will return dividends in increased enthusiasm and increased knowledge many hundred. times the amount invested. The annual meeting this year will be held in St. Louis, April 22, 23 and 24. Plan to attend. |