Charles L. Minor, of Asheville, North Carolina, discusses the phychological handling of the tuberculous patient in the American Review of Tuberculosis for October. In no disease is the relation between mind and body so close and so important as in pulmonary tuberculosis. This fact must be recognized as an important factor both for prognosis and treatment, and the complete confidence of the patient obtained. A proper personal atmosphere is important for the welfare of the patient and is often better obtained in an institution than in the home, especially in a cottage sanatorium where a group of patients, socially and financially compatible, are all educated to a proper attitude toward each other and toward themselves. It is essential that the patient be seen for proper psychic treatment as well as supervision. At first twice a week, and after thorough acquaintance is established week, should be enough. When office visits become feasible a fifteen minute interview twice a week and an hour for physical examination once a month

once

a

is sufficient. The study of the mental side of the case will become so fascinating that the handling of the case becomes a pleasure rather than a task.

The tuberculous are by no means always or even often abnormal, as has been implied by some writers, though there is a good deal of neurasthenia and hysteria among them and they are apt to have a rather labile temperament. When one considers the terrifying effect for a person ignorant of the real nature of tuberculosis of first learning that he is suffering from this disease, it is no great wonder that it causes a fearful upset of his mental poise and easily produces in any but the most phlegmatic or the most selfcontrolled a temporary neurasthenia. There is no such school of character as tuberculosis bravely met and rightly faced. No doctor could want a more splendid work than to have a part in teaching these patients to master the bitter sorrow of sickness. He must be hopeful in order to inculcate hope. While there are many that cannot be saved there are also many who can be restored to working efficiency for long periods or for good, and even in the long drawn out chronic cases life can be made useful and filled with interests and happiness if the patients are but taught to face it aright. A foolish optimism which refuses to see the truth is a miserable thing, that only doubles the sorrow of the patient when he comes to a realization of the facts. But a wise optimism can yet give him hope and a power to fight whose value cannot be overestimated in its effects on the success of our physical efforts. Finally the physician's endeavors should be directed not merely to curing the curable patients, but to heartening the apparently hopeless ones to fight to the end.

Minor, Charles L.: Psychological Handling of the Tuberculous Patient, Am. Rev. Tub., 1918, Vol. II, No. 8.

No. 5

The fact that one-half of the human race has no knowledge of medicine, surgery, hygiene or sanitation, and that the city of New York has seven times as many physicians as there are medical missionaries in the entire foreign mission field, has caused the leaders of the Centenary movement of the Methodist Episcopal Church to pledge $2,288,624 for a great medical campaign, as a part of its program for world reconstruction. The entire Centenary program, which will carry schools, orphanages, hospitals and churches all around the world, calls for the expenditure of $140,000,000, of which $35,000,000 will be raised by the Methodist Episcopal Church, South, leaving $105,000,000 as the share of the parent body.

Under the guidance of the Medical Department of the Board of Foreign Missions of the Methodist Episcopal Church, forty-five more hospitals and twenty-four dispensaries will be added to the present system of twenty-six Methodist hospital centers in foreign lands. A number of other buildings and doctors' residences will also be erected, the whole costing $1,513,930. Fifty-nine more missionary physicians

and surgeons, thirty-two new missionary nurses, and 166 additional native doctors, nurses and other medical assistants, will be employed in the foreign fields, involving the expenditure of $774,694 a year. The entire sum to be spent on both buildings and staff, $2,288,624, does not include the medical undertakings of the Southern branch of Methodism.

Missionaries themselves will benefit by the Centenary medical and hospital program, for it includes a department to guard the health of the men and women who have gone out to work in foreign countries. Everyone who returns to the United States on furlough will receive careful medical examination by the special examiner of the board stationed in various cities. A study of health conditions in each foreign land will be made, and eventually a system of quarterly physical reports from every missionary on the foreign field will be developed; in this way the efficiency of missionary workers will be kept at top notch.

All these Centenary plans for the alleviation of human suffering and the cure of disease in foreign lands are en

No. 5

one-half of the human owledge of medicine, or sanitation, and that ork has seven times as as there are medical he entire foreign mis_sed the leaders of the ment of the Methodist to pledge $2,288,624 al campaign, as a part for world reconstruc

Centenary program, - schools, orphanages, arches all around the

the expenditure of which $35,000,000 will - Methodist Episcopal eaving $105,000,000 as Darent body.

lance of the Medical he Board of Foreign Methodist Episcopal more hospitals and ensaries will be added system of twenty-six al centers in foreign er of other buildings sidences will also be e costing $1,513,930. - missionary physicians

and surgeons, thirty-two new missionary nurses, and 166 additional native doctors, nurses and other medical assistants, will be employed in the foreign fields, involving the expenditure of $774,694 a year. The entire sum to be spent on both buildings and staff, $2,288,624, does not include the medical undertakings of the Southern branch of Methodism.

Missionaries themselves will benefit by the Centenary medical and hospital program, for it includes a department to guard the health of the men and women who have gone out to work in foreign countries. Everyone who returns to the United States on furlough will receive careful medical examination by the special examiner of the board stationed in various cities. A study of health conditions in each foreign land will be made, and eventually a system of quarterly physical reports from every missionary on the foreign field will be developed; in this way the efficiency of missionary workers will be kept at top notch.

All these Centenary plans for the alleviation of human suffering and the cure of disease in foreign lands are en

tirely separate from the medical work carried on by the Methodist Episcopal Church in the United States, where it maintains forty-eight hospitals, through which more than 90,000 patients pass annually. The property value of these institutions, coupled with their endowments, is $15,626,343. The largest of these, Wesley Memorial Hospital, of Chicago, treats annually almost 7,000 patients. The smallest number treated by any of these hospitals is 75, and is recorded by the Sunnyside Methodist Sanitarium for Tuberculosis, in Silver City, N. M.

The Deaconess Hospital in Boston, Mass., is co-operating with the Government this year in the care of wounded or sick soldiers, taking as many as fifty at a time. A temporary ward building, like those used in France, was erected in field adjoining the hospital, and the United States Government accepted the institution for service.

Since the beginning of the year at least 1,000 different United States sailors have been cared for in the Methodist Episcopal Hospital in Brooklyn, Ν. Y. For the benefit of Jack Tar this institution has provided special recreation rooms, equipped with games, phonographs and libraries. Automobile parties for convalescent sailors are also arranged, and concerts are given two or three times a week.

A recently formed organization, the Methodist Hospital Association, whose president is E. S. Gilmore, superintendent of the Wesley Memorial Hospital, Chicago, will devote itself to the further development of Methodist hospitals in the United States.

A tremendous task awaits those medical missionaries who will set out to "house-clean" the unhealthy portions of the world. Just across the border from our own United States, avoidable disease is spreading rapidly through Mexico, for the lack of sanitation and medical care. The comparatively small

number of state hospitals and physicians serve chiefly the wealthy people in the large cities. Thousands of people in the country districts become the victims of patent medicines and medical quacks, or else go without service of any sort. At present the Methodist Church has one hospital in Mexico, at Guanajuato, serving a population of 1,100,000. The native hospital nearest it is 200 miles away. The Centenary will put about $70,000 into the extension of hospital work in Mexico.

In South America, where the state hospitals are inadequate to care for even 10 per cent of the population, the board will establish hospitals, nurses' training schools and organizations of visiting nurses in the capital cities of five of the republics. Infant mortality is a special South American problem, the percentage in some states being as high as seventy-five.

Africa offers a tremendous field for the development of medical work, as so far a mere beginning has been made. The Methodist Episcopal Church has two physicians and two small hospitals, one in Rhodesia and one in Portuguese East Africa. In the latter place the missionary doctor is the only medical man for an area containing 3,500,000 people. Ignorance, superstition, poverty and neglect, added to the ailments common in tropical climates, make the death rate appalling. The Board proposes to increase the number of hospitals from two to six, each to have missionary physicians and an adequate staff.

Another fertile field of ignorance and superstition is found in China, where surgery, public sanitation, and personal hygiene are comparatively new "fads." The value of bathing and deep breathing is just beginning to dawn on the Chinese. It is reported that 60 per cent of the diseases which are brought to the mission hospitals have been caused by lack of cleanliness.

Hospitals on the various islands of