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have soattered over the land, imparting to doubted and inestimable, still this benefit others the simple but all important knowl. was overshadowed by the 'immense gain to edge as to protective measures and hygienic the common weal secured in having a small mode of life which they have been so prac. army of zealous apostles preaching a propatically taught in the institution. And, be ganda of prevention .. for such teachings sides all this, by affording a scientifio dem- go directly and preoisely to the places other. opstration that a fair proportion of tuber- wise so difficult to reach, and where they are culous patients can be cured and restored most needed, namely, the workshops, factor. to lives of usefulness, the sanatorium has ies, mills, mines, tenements; in short, wherhad an influence in bringing about a new ever human beings are most densely congre. attitude of hopefulness toward the disease gated there will these wholesome instructions which has inspired the building of similar and salutary admoniticns be heard and beeded institutions" (p. 129).

most." Re-enforcing these observations Osler, in This view is strikingly corroborated by the address before mentioned, says:

the visiting staff, Drs. Bowditoh and Clapp, “The present crusade against tuberculosis, in their report of the Massachusetts Sanatorwhich is destined to achieve results we lit. ium for 1904. They say: tle dream of, has three specific objects: “During the past few years an astonisbing First, educational--the instruction of the change has come over the community in re. profession and the people; second, prevent. gard to the question of tuberculosis. Marked ive—the promotion of measures wbich will apathy has changed to extraordinay zeal, and, check the progress of the disease in the as is often the case, those who have been community; third, curative—the study of among the first to advocate certain measures methods by which the progress of the dis which they know to be of great use, find ease in individuals may be arrested or themselves not infrequently obliged to take healed. The three are of equal importance a rather conservative position, lest the often ... The educational aspects of the prob. extravagant claims made by recent converts lem are fundamental” (p. 150).

shall result only in a reaction of sentiment There can be no doubt that, added to these in the community, and a consequent unrea. sanatorium demonstrations of the tractable sonable prejudice against methods of treat. nature of tuberculosis, the crowning discov. ment which, beyond a shadow of doubt in ery by Koch of the identity of the invading the minds of those who are best able to judge, organism hastened the maturing of opinion are of infinite value to thousands of sufferers, on this question—the hearty welcome and when rationally used." prompt acceptance of this truth by the The deliverance from this pioneer establishmedical professional speeding the day when ment of its kind as to general schooling in. legislators felt themselves warranted in fluences exerted are echoed by the medical considering public outlays in this direc- managements of other like institutions opened tion; and it is to the lasting honor and dis- later, and, too, the educational note is stressed tinction of Massachusetts that she saw and in the reports of all the commissions apseized the opportunity, and thus became the pointed in various states to consider the subfirst commonwealth of which there is record ject of human tuberculosis. to devote public moneys to what is essentially Another important pbase of this question an educational undertaking for the overthrow is referred to by the trustees of the Massachu. of pulmonary tuberculosis, an anti-consump- setts sanatorium in their report for 1904, and tion school-the law authorizing the State this relates to the effect of the presence of Sanatorium at Rutland, having been passed suoh an institution on adjoining populations in 1895.

and property values-quite recent experience The enlightening aspect and teaching value in the State of New York baving shown lo. of sanatoriums through the people they have cal prejudices toward the proposed location helped, especially those of a publio character of such an establishment which went to the

-has always been recugnized by physicians length of legal proceedings to defeat the acconnected with them, and this feature has quisition of a site for such purpose. The been constantly kept to the fore by the visit trustees say: ing staff of the Rutland institution, they dwell. “The question is often asked, How does ing on it in their first report with marked the presence of the sanatorium affect the emphasis.

town of Rutland, in which it is located? The In drawing attention to and commenting information obtained by inquiry may be val. on this feature the present writer in a paper uable. The report tends to show that the read before the St. Louis Medical Society on town has benefited largely, and has not September 28, 1902, remarked that while the suffered at all in health. The assessors' books advantage to the individual patient was un- show ... farms, small homesteads and village houses have increased in valuo; they the patients sent there in the incipient stage are now at all times in demand. There, is became so depressed by seeing patients in the also an unprecedented demand for skilled later stages that they soon left the hospital in and unskilled labor."

many instances. These two classes of paThey then proceed to show that the total tients should not mingle at all. It was al. valuation of the town since 1895 bas in. ways a very hard matter to get people to creased $186,000, a gain of about 35%, and leave their homes and enter a sanitarium, and refer to the decided augmentation in popu. when they did go there and saw these people lation. They say further:

in the last stages it was discouraging. The "The publio health has not suffered... most important thing in the prevention of tu. The town has thus averaged for the last berculosis was ventilation. It was a very rare twenty-five years two deaths per year from thing to see patients suffering from any form tuberculosis in a population averaging about of pulmonary trouble who did not keep them1000. During the last six years, with in- selves in a warm close room. He had had creased population, the deaths from this people tell him that they slept in a room cause have been less than before."

with plenty of fresh air, and yet that room In support of the foregoing Trudeau stated was suffocating. The necessity for sleeping in the address already referred to, that ever in a room with the window down from the top "since the sanatorium was opened none of wos pot appreciated by many. our employees or servants has been known Dr. Jules M. Brady said that it was the to develop consumption,” this proving that custom to refuse all advanced cases at certain the measures adopted to guard against in. sanitaria where the incipient cases were fection there were efficacious for the protec. treated. At the Baden sanitorium near tion of all residing in the institution. In Vienna, it was the rule where the dullness deed the safest place for a person disposed to had passed below the first rib to refuse such tuberculosis is in such a place.

cases, only the incipient cases being received That local prejudice is not everywhere at this institution. Aside from tbis, the key present is shown by the fact stated in a com. to the situation was to have the principles of munication received by me last year from the disease taught in the schools. A certain the secretary of the Ohio State Board of time should be set aside for that, say twice a Health, who mentions that they had received week, and children of twelve years old and offers of more than one hundred sites for the over should be taught that this disease was State sanatorium they were proposing to due to a germ, and the simple methods of erect.

prevention. If this was done more frequentFrom my personal experience in connec- ly and thoroughly it would not be long until tion with the movement begun several years the number of cases of the disease would be ago to induce the General Assembly to pro reduced. vide for a sapatorium in this State I am sat. Dr. Deutsch gave an account of an experiisfied that the most weighty arguments used ence he had bad several years ago in Colorawere those which most fully recognized the do. He had gone to see a distant relative of educational value of such an enterprise, and his who had been fighting this disease many that these prevailed where others would have years. It was now nineteen years since he been unconvincing; in fact in advancing this bad entered upon this fight for health and he proposition even to non-medical persons a was now practically well. Dr. Soper's revista seemed to open to their sight which dis marks about not classing these incipient closed the eventual. discomfiture of a dis- cases with those far advanced reminded him ease that has burdened the world for centur- of what he had seen at the Oakes Home in ies, a mortal dominion growing out of a gen- Colorado. Certainly no one who entered ever eral lack of light and knowledge, but the had any regret that he had gone into that insigns are now most hopeful, for everywhere stitution. From the steps at the entrance to there is stir and ferment and movement to the sterilizers and the painter who painted ward multiplying these places of teaching every room as soon as a patient left it, the that suggests the coming of a day when the place spoke of cleanliness and home comwhite plague will become as rare as the forts. It was surprising to see how those black death-both disappearing as consider patients enjoyed life. In the summer these able factors from every truly civilized coun. patients were scattered over the mountains

under the care of a purse and the physician DISCUSSION.

made the rounds once a week. He had im

pressed it upon Dr. Deutsch that unless one Dr. Horace W. Soper urged that the incip. could make these patients feel that they had ient cases should be separated from the ad. something to live for, all of the treatment was vanced cases of tuberculosis. At Mt. St. Rose of no avail. For that reason he had them in

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this beautiful home in the winter, and in the speaker, "and to the fourth floor, at that." summer kept them out on the mountains. It If that institution should ever take fire was surprising in meeting these patients to nothing on earth would save those patients. see how happy they all seemed. It was a there was nc chance for them to get out, question whether a sanitorium built in the Dr. Homan's paper had as its object the escity would meet the demands of the advanced tablishment of an institution for the treat. or incipient cases, and even then it would ment of tuberculosis patients in this city. be worth while considering an outing place This was both very important and very neofor them in summer.

essary. It would be a school for the people

as well as an institution for the care of Dr. F. J. Taussig thought there was here

those unfortunate people who did not know in the city limits a point which was an ex.

how to help themselves, and who were such cellent location for these patients. When one

a detrimental influence to others. It was a had been at the Female Hospital and looked

common thing to see two or three phthisis to the south and southwest over those miles

pulmonalis patients in one family. This of country without any houses, and at the

means of educating them would be of great highest point in the city, he must feel that

value. Much could be done for tuberculosis there was an atmosphere offering the very

by proper treatment and good advice carefully best opportunities for the care of such pa.

followed. Such an institution would more tients. It was unfortunate that tbe city had

than pay for itself in this way, besides giving not appreciated its advantages in this regard.

these people a chance for their lives. And These patients could be cared for half the

this scheme of Dr. Snodgras' should certainly year at least in small temporary structures

receive the aid of physicians. It was to be in that airy place, and certainly patients

hoped that the buildings would not be of a would be much more improved than in the

too temporary character, for if there was the “Black Hole of Calcutta,” or in the attic of

Jeast shadow of an institution built there the Femule Hospital, where one's head al.

would never be anything else built as long most touched the ceiling, the worst ventilated

as these continued to stand. In behalf of the room in the building.

society the speaker thanked Dr. Homan for Dr. Cannon said that he had recently been contributing his very interesting address coninformed by a man who ought to know, that cerning a matter of which tbey would hear there was a plan to establish cottages on more in a very short time. those hills near the Female Hospital, and

Dr. Green asked what means were used in have them heated and run under the care of

sanitoria to prevent dissemination of tuberthe Female Hospital. Dr. Snodgrass was

culosis among the employes. He supposed mușh interested in this matter, and if the

that the patients were provided with the most society would look into this matter it might

u improved spit cups, etc., but what other render the health commissioner much aid.

means was employed. The President recalled his experience at the Dr. Soper stated that in modern sanitor. City Hospital in 1894. He knew that Drs. iums neither carpets nor brooms were al. Soper, Hinchey and others who were there at lowed. Brooms and feather dusters ought that time felt as he has felt; that when the to be abolished. As to the statistics of tu. tuberole bacillus was found and a patient berculosis, the chief source of error lay in sent up to the consumptive division, that the fact that a large number of people bad a that was the last to be seen of that patient. horror of having consumption in the family With propriety there right have been written and they would ask the physician not to above the door the words: “Leave all hope make the certificate read tuberoulosis. For bebind ye who enter here.” Next to the this reason many insurance companies had syphilitio ward it was the worst in the insti. come to look with suspicion upon cases of tution. One day they had had some six or

death from bronchitis, broncho-pneumonia,

death from bronchitis, broncho seven deaths in the consumptive division, etc. A large number of cases were recorded and it left a very bad impression. They in the death certificate as something else. thought so little of the treatment that noth. Hence these statistics did not represent nearly ing was said about it. They had a little all the people dying from tuberculosis. thymol inbaler and the patients would inhale the fumes and then go back to bed again. Dr. Brady stated that there was a law bere Eggs and milk were ordered for the patients, requiring every case to be reported. In every but they seldom got either. Afterward Dr. place where a death bad occurred from this Bebrens bad visited the Emergency Hospital disease, or where a tubercular patient had "God forbid that any tuberculosis patient moved from one house to another the apart. should be sent to that institution," said the ments should be sterilized. As Dr. Soper

facted oter they outside the belt ba ito

bad said, many of these were reported as the occurrence of the disease among the em. anemia, bronchitis,eto. If these places were ployes. all looked after it would do much to prevent Dr.

Dr. Homan, in closing, agreed with Dr. the development of the disease among other Soper as to the danger that lay in sweeping members of the family.

He thought the modern broom and feather Dr. W. C. Mardorf thought that while the duster the deadliest weapons that could be trend of the paper was most admirable, the brought to bear against human life. It was establishment of a sanitorium for the cure not in the poorer districts that consumption of incipient tuberculosis in St. Louis under was oontracted, but in the first class hotels. present conditions was not the most imme. clubs and office buildings with acres of car. diate or feasible way of taking up a most im. peting, where with broom and the duster the portant problem. The difficulty of obtain employes kept the germs moving from place ing money for medical institutions had been to place. This was where these employes repeatedly shown, and any such hospital as contracted the disease. It was true they lived might be obtainable would accommodate but in the poorer distriots, but it was in such a very small percentage of the cases of early buildings that they acquired the infeotion. tuberculosis: these must be large in number. So far as the new city institution was confor if it was true that there were ten to fifteen cerned, he had suggested that some twelve deaths from tuberculosis in St. Louis every years ago, while serving as health commisday, multiplying this by the number of days sioner, and he was glad to see that it was to average stay in sanatorium per patient would materialize at last. This would probably be give some little idea of the size of building for the convalescents or the more advanced required. The average patient did not want cases. For early cases the high hills of tbe to go to a tuberculosis hospital anyway, nor Meramac are probably as good or better for was a change of climate always within reach, St. Louis people than the Adirondacks or and for these it was necessary to find some Colorado, as this was a home olimate. In means of help at home, especially in the

this connection Dr. Homan stated that it early stage, when the manifestations of dis was planned to lay the corner stone of the ease were least impressive and treatment was new State institution for incipient consumpof most avail. The importance of early di. tives at Mt. Vernon about the 24th of May. agnosis could be overestimated; many of the The profession should go down there by the profession did not realize the comparative train load, not only to give countenance and ease of curing this disease in its early stages,

encouragement to the movement and the men and the little value of drugs in its treatment. having it in charge, but to show the people The number of patients being sent away only of the State and the members of the legislato die who might have been as well or better ture that their support was still needed, mor. treated at home was appalling. Fresh air ally and financially. was a necessity, but most houses were so built

Dr. Green referred to a pampblet he had that they did not permit fresh air to enter

received from the new St. Regis Hotel, in without a draught. The architects should be

New York, in whiob there was a very elabor. impressed with this thing, and the board of

ate system of ventilation, and also a means of bealth could do good work in having incor.

removing dust and debris. The ventilating porated in the building laws provision for

system consisted in drawing in fresh air proper ventilation. Not enough stress was

through cheese cloth screens by suction, the laid upon the value of fresh air and suitable

air then being passed over heated coils and diet, and the inadequacy of drugs.

carried to the rooms. Furthermore, a system Dr. Homan, in reply to the question asked of tubes was provided through which the dust by Dr. Green, said that the prevention of the of the rooms could be sucked up by a suotion communication of the disease lay in the pump and conveyed to a receptacle in the proper care of and prompt destruction of the basement. Some such method as that, where ntum. That summed up the whole thing the fresh air was filtered through obeese cloth

and the cleaning of the rooms done by suoDr. Green added that in a sanitorium, of tion might well be imitated in buildings of course, it was possible to enforce an ideal ar- the future. rangement for the disposal of the sputum and, as Dr. Soper had suggested, it was advisable to do away with sweeping, instead, NEVER advise an elastio stocking in cases mopping all the foors with a damp cloth. of varicose veins where thrombosis exists. He had asked this question merely because The pressure may detach a part or whole of he was desirous of knowing what methods of the thrombosis, propelling it into the genwere observed at Saranac Lake in preventing eral circulation.

Each one of these propositions is to be

THE MEDICAL FORTNIGHTLY

voted on separately, and in order for a propo

sition to carry, two-thirds of the voters of the Issued Tenth and Twenty-Fith of Every Month. city of St. Louis voting thereon must assent Under the Editorial Direction of

thereto.
FRANK PARSONS NORBURY,

The medical profession is particularly inter-
THOS. A. HOPKINS
CARL E. BLACK.

ested in propositions 2 and 3, and your comWith the following staff of Department Editors

mittee wishes to suggest that the members of 0. E. LADEMANN, Internal Medicine.

this society exert themselves in behalf of these JOHN MCHALE DEAN, Surgery. R. B. H. GRADWOHL, Pathology and Bacteriology.

measures W. H. VOGT, Obstetrics and Gynecology.

No class of citizens are in a position to know WALDEMAR FISCHER, Ophthalmology. A. LEVY, Pediatrics.

as much as the medical profession about the W. T. HIRSCHI, Therapeutics. A. F. KOETTER, Otology.

crying needs provided for in propositions 2 HERMAN STOLTE, Laryngology and Rhinology.

and 3. Our opinion should be appreciated by F. P. NORBURY, Nervous and Mental Diseases. T. A. HOPKINS, Genito-Urinary Diseases.

the people, but if not, this committee feels it ROBERT H. DAVIS, Dermatology.

to be a duty of this society to publicly express itself. We therefore suggest that at the

proper time, an appeal might be made to the EDITORIAL

voters of St. Louis in behalf of these two

measures; this appeal to be made in an open THE coming election on the question of bond

letter, published in not less than two of the ing St. Louis for various improvements is in

daily papers, and signed the St. Louis Medical several points of such in

Society of Missouri, with the names of its terest to our profession

President and Secretary. This committee Medical Aspects and our patients that it

knows of no member of this society better of the Proposed would seem that every

qualified to prepare such a letter than our Bond Issue. physician should support

President, and therefore suggests that this duty and urge support of

be entrusted to him. all points of the proposition, but especially of

Last year a committee was appointed to ef

fect a non-partisian ward organization of the those relating to hospital construction and reconstruction, sewers and parks.

physicians of the city. The purpose of this The following report bearing on this sub

organization was to render more effective the ject was presented at the meeting of the St.

efforts of our profession in furthering those Louis Medical Society, May 12th, and unani

measures conducive to the health and general mously adopted :

welfare of the public. If this organization is The Committee on General Welfare wishes in a condition to carry out the purpose for to call attention of the society to the fact that

which it was created this committee would an election will be held on Tuesday the 12th recommend to its consideration the election of

e 12. day of June, 1906, when ordinance No. 22,366 will be submitted to the voters. This ordinance provides for an issue of bonds of the city of St. Louis not to exceed $11,200,000.00.

Antitoxin for the Poor. Nine propositions are to be voted on.

We are in receipt of the following letters 1. $3,500,000 for a free bridge.

from Dr. H. J. Scherck, Chief Dispensary 2. $ 800,000 for the construction, reconstruc- Physician of the City Health Department: tion, and extension of hospitals, and the pur- The enclosed copy of a communication adchase of sites for the same.

dressed by the health commissioner to me is 3. $1,000,000 for the construction, recon- of such public interest both to citizens and to struction, and extension of and an addition to the medical profession that I take this opporthe Insane Asylum, and for the purchase of tunity of sending it to you. sites for the same.

There are a great number of people who 4. $230,000 for the Fire Department. cannot afford to purchase antitoxin when any

5. $2,000,000 for buildings for Jail, Police of their family are stricken with diphtheria. and Health Departments and Police Courts. When assurances are given that people are

6. 1,000,000 for bridges and viaducts. too poor to purchase antitoxin, and I am noti

7. $500,000 for King's Highway improve fied, a physician of my staff will be immediment and extension.

ately sent to the address and he will. adminis8. $1,500,000 for construction and exten- ter the antitoxin, with the assistance of the sion of sewers.

attending physician, 9. $670,000 for purchase, construction and Antitoxin will not be distributed to physilaying out of parks.

cians generally for two principal reasons:

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