Think of this and remember that this awful waste both of human life and material wealth is as needless as it is cruel, for ignoring entirely the question of whether or not we can cure the disease, we know that it can absolutely be prevented.

Neither are we to suppose that residence in Vermont affords any special immunity from this disease, for our death rate is a little above that of the country at large, which is 13.5 per every 10,000 of the population, while in this state it is a trifle over 14 per 10,000. With a sanatorium assured in the near future there is much to hope for, but this is no reason for inaction. As physicians, we need to learn ourselves and to teach our patrons the urgent need of early recognition of this insidious disease. Upon this very point depends our success in individual cases, and it is not too much to say that in the past, the great majority of cases when absolutely recognized as tuberculous, have been too far advanced for cure even with the environment of a sanatorium. These cases can be helped, made more comfortable, and life can be prolonged; and more important than all else, they can be instructed in sanitary matters so that they shall not continue to be a menace to others.

We must strive to teach the people that a sanatorium is not intended as a hospital, that its true function is educational, and that the cure of tuberculosis depends not upon drugs but upon a well-regulated, rigid routine of daily life under constant supervision, not for a few weeks but for months and possibly years, and that the duties which they owe to others in these matters are quite as important as those which they owe to themselves.

THE SANITARIUM.

BY D.. D. GROUT, M. D.

It seems to me that this subject is important; it touches our lives and the lives of others we know and love; reaches out to future generations. I will only attempt in these few moments to speak upon two phases of this topic.

First, I would like to impress upon you for a moment-for I believe it is necessary-the importance, the vital importance that this is to you, to myself, and to all of us, and to insist that we should all be doing something to alleviate, in some small degree, this plague which has so long afflicted man. In the second place, I would like to urge upon your attention the fact that we absolutely must have, in order to bring to a successful issue this campaign which we are waging and in which we are all interested, the aid of a state institution devoted to this particular purpose—the treatment of tuberculosis, in other words, we must have a state sanitarium.

It ought not to be necessary to urge one of these topics in an audience like this, but my experiences in the past two years have shown me that it is necessary. I think the majority of the members of the medical profession are broad-minded, and are always ready to branch out in any way that is to cur interests, in a limited way; but the medical profession is conservative.

You know this open air treatment which we all of us advocate was advocated by an eminent authority two hundred and fifty years ago. It was believed in just as thoroughly then as it is to-day; yet it has taken all these years for the medical profession to realize it! An English physician advocated life in the open air, and exercise, particularly by riding. He says: "In a word, I have put very many to this exercise; and I can truly say I have missed cure in very few cases. . . . It is in this way more certainly cured than many diseases: Long persisted in, according to the case of the patient, and length of the disease."

Yet, despite the eminent prestige of his great name, an eminent authority, and demonstration by actual trial, the medical profession, with its usual conservatism, for two centuries and a half placed its faith in drugs.

It is true that about 1840 another great Englishman revived this theory, and instituted an open air sanitarium; but even that did not impress the medical profession, until at last a great discovery was made. Since that time the progress made by the profession in this matter has been rapid and brilliant.

Now, as I said, this is important; but however important it may seem to you, however much you may believe in it, however much you may be in sympathy with this work, you don't begin to realize the real importance and true significance to you and to the men and women of to-day. None of us can. It touches at so many points and reaches out to so many things. It not only affects us, but it affects our children, and their children, to endless generations. It has always been the same; the demon of tuberculosis reaps an annual harvest of, it has been estimated, 150,000 human lives. What does 150,000 lives per year mean? This is no dramatic figure-it is by Dr. Osler. It means that to-day we hear in over 400 homes of our country lamentations: husbands for their wives, wives for their husbands, parents for their children. When we remember that this is a repetition of yesterday, and of every day in the year, and every year in the decade, you must admit that this subject is an important one.

Now, about a sanitarium. Why do we need a sanitarium? Well, for various reasons; one is that it is in deference to the universal trend of public opinion. It is usually safe to defer to public opinion when it becomes universal. Some one has said, "You can fool all the people some of the time, and some of the people all the time, but you can't fool all the people all the time." We can transpose that saying, and say that when all the people all the time demand a thing, it is pretty safe to do something. We want the sanitarium, ladies and gentleman, while it can benefit us, and if not us, our children, or someone in whom we are interested. There are

a few people, I will admit, who don't believe that a sanitarium is necessary for any such purpose. It has been the rule, at least with me, when I find myself holding to an opinion which is utterly opposed to nine tenths of my fellow men, who are perhaps better qualified than I, is n't it just right that I should revise my opinion? Now, these few may be wrong and the nine others right. Is n't that reasonable?

In deference to the demand of public opinion we want this sanitarium, and in a short time. There are already ten states that have built large state institutions, or have taken the initial steps to obtain them.

Another thing. The open air treatment is now frankly accepted as the only form of treatment that offers any hope under heaven, that I know of, to the poor sufferer from tuberculosis. It has been accepted by everyone; but the open air treatment, to get the best and most successful results, cannot be administered in the average home. To-day, with the present lack of knowledge of tuberculosis matters possessed by the average family, the adequate carrying out of the open air treatment cannot be done; it cannot be taken in the average home adequately. It means the entire overturning of the beliefs and prejudices of a people, born with them, and it is no small thing, ladies and gentlemen, to overcome the accumulated prejudices of two thousand years, which have been drilled into us all these years and centuries! Nothing will illustrate this better than to look at the old method of treatment.

You know how persistently it was insisted upon that a person with weak lungs should be shielded from cold and draughts; that consumptive patients were kept in the house, hot and close, and sheltered from the only thing that could give them hope-the pure air and the sunshine. To-day, we do not believe these things.

Dr. Frank Hills of the state institution of New Hampshire has written an article on tuberculosis, and one paragraph of it expresses my view of it. He says:

"The open air treatment of tuberculosis is the established fact.

It

does n't mean, however, that a patient is to be restored by a few weeks' sojourn in a fashionable resort. . . . . . It means rather a systematic and regular life. It means constant watchfulness."

VERMONT SOCIETY OF TUBERCULOSIS

The second annual meeting of the Vermont Society for the Prevention of Tuberculosis was held Wednesday evening, June 21, 1905. The meeting was called to order by Dr. Don D. Grout of Waterbury, vice president. Sixty were present. In the absence of Dr. Lewis, secretary of the association, H. L. Stillson was elected secretary pro tem. H. L. Stillson, as treasurer, reported $9.00 received and disbursed. This was accepted and adopted. Dr. Holton called on A. M. Wilson of Boston, who gave an account of the work done in that city. Mr. Wilson then addressed the society as follows:

This is an unexpected honor. About two years ago, some public spirited men and women, many of them physicians, got together and organized a society which they called the Boston Association for the Relief and Control of Tuberculosis. That society at once secured a secretary and undertook to ascertain the conditions with regard to tuberculosis in Boston. The conditions are notably bad in Boston, and there is a very high death rate from this disease; higher even than in New York City. Quickly they saw that they must do something more than the work of investigation through a paid secretary; that there was need of direct educational work, and so they secured a woman to act as a visitor among the consumptive poor of the city. The board of health is quite efficient, but moves slowly; is conservative as well as efficient, and while it does give a certain amount of instruction to consumptives reported to it, the society thought it was not quite enough, so the services of a trained visitor were secured. This visitor sees, in the course of a month, about sixty new cases of tuberculosis, and instructs the patient and the family as to the proper precautions to take to prevent the infection of others. Paper handkerchiefs and sputum cups are supplied and their use explained, and in case of poverty steps are taken to attend to the patient, and if need be he is sent to a private hospital or to one of the public institutions. Lately we have added another visitor, who undertakes to secure employment for discharged cases from the sanatoria. Patients are constantly coming back to Boston who were engaged in unhealthful indoor occupation before their health broke down and they were sent to the sanatorium, who would certainly suffer a recurrence of the disease if they should return to their old occupations. For instance there comes back to us from the state sanatorium a tailor. His whole life has been spent in that work, and he is unfitted for other work, yet if he returns to his shop the time and money spent in curing him will be wasted. We make every effort to place these men in the country, if possible, and have succeeded in placing a good many on farms about Massachusetts and in New Hampshire. They are perfectly safe people to have about, after the training of the institution. It is somewhat amusing the way some of them revolutionize the life of those with whom they go to stay. There was one enthusiastic fellow, who when he came back to Boston slept out on the roof of his tenement.

He did this regardless of the weather through all of last winter. We got him a place this spring in a garden in Concord, Mass., and he is now sleeping in an unused chicken coop from which he has removed the windows. He gets up in the morning, takes a cold plunge, and walks a quarter of a mile for his breakfast. Although in this case the disease has never been arrested, yet the fellow is able to support himself and to contribute toward the support of his family. We have helped a number out in this way.

The society has also done considerable work in the way of educating the people in general as to how to keep from getting the disease. In the first year about seventy-five lectures on the prevention of tuberculosis were given to audiences ranging from small groups of twenty to large gatherings of even 500 people. Probably about 10,000 people were reached in this way in the year, and this work has been continued even more actively in the present year.

In Boston and New York, the laborers are almost universally members of labor unions, and attend meetings very faithfully. We got the officers of the central labor union interested, and through them got admission to the various local unions. We have given addresses before about one half the labor unions in the city. We usually get one of the younger physicians to address a labor union, talking about twenty or thirty minutes. I have been into such meetings, and after a thirty minute talk have been kept there answering questions of another half hour, so great is their interest in the subject. There is hardly a workingman in the state of Massachusetts who has not had some friend or acquaintance who has been treated at the state sanatorium. We have about 325 patients in the state sanatorium. They remain in the institution an average of six months. That would make 650 graduating in the year, and their influence has reached practically all the people in the state. At any gathering we address there will be two or three persons who have had friends in the sanatorium, and they are always ready to corroborate what we say of the treatment there. Some of the patients taken into the sanatorium cannot be cured, but the same story comes from all of them; of the better way men live there, of the outdoor life in the daytime and the open windows at night that is so large a part of the treatment, and I think the educational propaganda in Boston, and throughout Massachusetts, owes much to the influence of the hundreds of patients who have come back from the institution at Rutland. So that the story we tell them of keeping windows open is not new to them. We are preaching it on every occasion. We have sometimes held as many as three or four meetings in an evening, in different parts of the city, always giving out leaflets of instruction to be carried home. We got into the public schools a year ago and gave out 50,000 of these leaflets to the children of the gramniar grades. Parents have read these leaflets, and have sent inquiries to us wanting to know where they could be treated for tuberculosis, and we have found many early cases in this way. In several instances that I can point out, men and women have got to the sanatorium through reading these leaflets.