existence on $5,000. The case of the new Reception Hospital at Saranac Lake is well worthy of attention. It holds twenty patients. The land cost slightly over $2,000 but is in the village where land is most expensive. The main contract for the building was $15,500 and an additional contract to cover heating, lighting, fire escape, etc., amounted to $4,350. The furnishings cost $3,000. This with sundry other items, including architects' fees, gives us a total of approximately $27,000. Surely in the face of these figures Vermont should at least start an institution for her own consumptives. And now before closing let us consider one more point, which in importance should logically come first of all. "Are sanatoria for pulmonary tuberculosis really desirable?" From practically every standpoint they most certainly are. They are the best possible precaution against the spread of this dreaded disease and if properly conducted the patients therein are vastly more comfortable than elsewhere, Of course this does not refer to such persons as are able to turn their own home into practically a private sanatorium. At such an institution all are there for the same purpose and all take the treatment together, which greatly relieves the unpleasant features connected therewith. They are the best possible means of educating the general public. But their records are the strongest argument in their favor. The Adirondack Cottage Sanatorium shows an average for the past few years of twenty-five per cent discharged as apparently cured and fifty per cent with the disease arrested, giving us a total of seventy-five per cent well on the road to recovery, sixteen per cent more show improvement. A state institution, without in any sense being a home for incurables, would doubtless be compelled to open its doors to a slightly greater per cent of unfavorable cases. In the first seven months the New York State Sanatorium showed thirty-seven per cent of its patients apparently recovered and thirty-five per cent more with the disease arrested. Cannot Vermont do as much for her own unfortunates?

THE DUTY OF THE LOCAL BOARD OF HEALTH IN THE CAMPAIGN AGAINST TUBERCULOSIS.

BY ALEXANDER M. WILSON, SECRETARY OF THE BOSTON ASSOCIATION FOR THE RELIEF AND CONTROL OF TUBERCULOSIS.

Dr. Osler, lately of Johns Hopkins University and now Regius Professor of Medicine at Oxford, recently said, "Of late years there have been done in this country three pieces of work relating to tuberculosis of the first rank-that of Trudeau in the Adirondacks, enforcing on our minds the importance of the sanatorium treatment of early cases; that of Biggs and his associates in the New York board of health in demonstrating how much can be done by an efficient organization; and, thirdly, the work of Lawrence F. Flick, the director of the Phipps Institute, in demonstrating by a long and

laborious research the dangers of the house in the propagation of the disease." It is relative to the second of these notable pieces of work that I wish to direct your attention briefly; and one could not touch on this subject at all without paying tribute to the pioneer work of Biggs in New York.

. It is curious that the world waited more than a decade after tuberculosis had been shown conclusively to be a communicable disease, before any effective steps were taken by any municipality to put in practice the measures that followed as the logical conclusions to Koch's work. And that now they seem so obvious to us does not lessen the credit due to Herrmann M. Biggs, who in 1894, against the opposition of almost the entire medical profession of New York City, instituted the measures for the administrative control of this disease which have long since been approved by those same physicians, and which have placed New York in the van of the forces contending against this awful scourge.

When New York finds the site for the municipal sanatorium she stands ready to build, she will seem to have completed her armament against tuberculosis, and while some parts may need strengthening, she will present an example that may well be copied in its entirety by any city of considerable size.

In considering the problem, however, as it presents itself to the local board of health in a small city or rural community, there are several features of the New York scheme that will need modification. For example, the special tuberculosis dispensary treatment of the sick is out of harmony with the good country habit of paying for what you get, and none would for a moment consider this a proper function of a board of health in a small city. Again, the question of a sanatorium in a state like Vermont, resolves itself practically into the problem of establishing such an institution through the instrumentality of the state, although some of your cities may well follow the example of Oil City, Pa., which has started a tent colony for its own consumptives.

Hospitals for advanced cases are not in the same demand here as in the congested centres of population, where so many consumptives are among the very poor, where they are without proper care, and where they are sources of infection to large numbers of persons. A ward of the local almshouse or perhaps of the city hospital will doubtless continue to serve as the only resort to the helpless. But here a distinct duty rests with the community, and most heavily on the guardians of its health, to see that consumptives in almshouses are in separate wards or buildings, and are not spreading infection to other unfortunates.

The deed of forcibly removing from their homes consumptives who wilfully refuse to exercise the ordinary precautions and thus are a distinct menace to society, occurs quite often in the large city, although New York and Boston have, I believe, the only boards of health in the world which exercise this right.

Aside from the exceptions noted, the local officer in Vermont may, and

I am told, does in large part, carry out the measures advocated and so well executed by Dr. Biggs in New York, of course adapting them always to local conditions.

There should be free bacteriological examination of sputum-here done by the State Board of Health-so as to offer every encouragement and help toward the early recognition of the disease, for to the early case alone is there offered the prospect of recovery.

Notification of the health authorities should be compulsory on the part of the attending physician-how else shall the Board of Health know its problem so that it may intelligently attack it? This should be attended by no publicity, and the interference of the health officer should not be necessary so long as the patient remains under the care of a physician who agrees to carry out the instructions of the Board of Health. While compulsory notification has always met with opposition, it would seem that objections to it could easily be obviated where all physicians are personally known to the health officers, and where its entire innocence and beneficence can be so readily explained.

When the existence of a case of tuberculosis is thus made known to the Board of Health, then that body owes to the community and to the family of the patient the duty of making sure that the well-known precautions as to the care of the sputum and general cleanliness are carried out. The assurance of a reputable physician in attendance should be all that is necessary, but it would be well to place in his hands carefully prepared instructions on which to have his assurance based.

On the death of the patient, or in case of his removal from the dwelling, the rooms should be thoroughly disinfected and cleansed and in many instances the house should be renovated.

In the hands of the Board of Health should be the enforcement of an anti-spitting ordinance, including in its provisions the floors of cars, public meeting places, and of workrooms where large numbers of persons are congregated, as well as sidewalks. A reasonable fine should be the penalty and it should be inflicted often enough to warn a forgetful public of the dangers lurking in this filthy habit.

So much for the purely administrative duties of the health officer. If these measures are faithfully and efficiently carried out they will slowly awaken each community to the dangers from this disease and will do much toward preventing its spread; but we look to the health officer for something more than the mere discharge of his duties. He should be a leavening influence in his own community, moulding the opinions and habits of its people to accord with the teachings of science, showing them by precept and example that fresh air and a regular life are sworn foes to this disease. Leaflets such as the one prepared by your state commission should have the widest circulation. Such literature may be given out in the schools, in churches, at town meetings, wherever the people can best be reached. Five years ago the health officer in my own town of Brookline, Mass., prepared a somewhat similar leaflet of instruction regarding tuberculosis and

had it distributed by the police to every house in the town. It will only be by the most persistent work of the leaders of sanitary reform that the ignorance that has fostered this disease which Oliver Wendell Holmes well named "The Great White Plague" will be overcome. And Vermont, with its natural advantages of climate, with its population so largely rural and so well housed, with its high degree of education and culture, should assume a position of leadership among the states in eliminating a disease that is so closely identified with bad housing, unhygienic living and ignorance.

I cannot better close than by quoting from Dr. Biggs: "This is the urgent sanitary problem of the new century. In no other direction can such large results be achieved so certainly and at such relatively small cost. The time is not far distant when those states and municipalities which have not adopted a comprehensive plan for dealing with tuberculosis will be regarded as almost criminally negligent in their administration of sanitary affairs, and inexcusably blind to their own best economic interests."

IS MEDICATION OF SERVICE IN THE TREATMENT
OF TUBERCULOSIS?

BY DR. C. W. PECK, BRANDON.

It is not my purpose to discuss the entire history of the treatment of tuberculosis, but to call your attention briefly to some of the absurd and foolish measures in the treatment of this disease in the past, contrasting them with the present, for the mistakes of the past are surely the best guides for the future.

Since we have a germ disease to study and treat, we should first make ourselves familiar with the origin, development, growth and communicability of the germ as well as the best methods of managing the same, both within and without the system.

We made two grave mistakes early in the treatment of this malady after it became known to us as a germ disease. We did not study sufficiently the peculiarities of the germ, its origin, its great communicability, its almost universal prevalence in the higher and lower orders of animals, the length of time it could remain dormant in the system waiting its opportunity to attack the debilitated and weakened organs.

Again we underestimated good blood, strength, vitality and fresh air as barriers against the invasion into the system of the germs of this dis

ease.

I think even to-day we are overlooking the fact that an overburdened and obstructed portal circulation from overfeeding is an embarrassment to

the vital forces. It lowers the powers of resistance against all poisonous germs, particularly this one. Avoirdupois weight does not mean health and strength or powers of resistance from disease, as many members of the profession would make us believe at the present time. One of the great mistakes in the past has been the universal practice of giving large doses of C. L. O. indiscriminately from the beginning to the end of the disease without considering the ability or inability of the digestive organs to digest and assimilate the same.

No man of good observation and experience can doubt for a moment the great value of this remedy as a general tonic in wasting diseases when it is well borne and assimilated, particularly among children. I have no doubt many cases have improved and gotten well under its administration, whereas others have been nauseated to death by its constant and unwise

use.

Every case of consumption is as much a law unto itself in the matter of treatment as a case of pneumonia or typhoid fever, and should be studied and treated upon the same general principles, particularly in its first stages. Next came the pneumatic cabinet with its medicated air and lung gymnastics to kill the germs within the bronchial tubes. Even to this day it is hard for some members of the profession to give up the idea of fumigating a man's lungs to destroy the tubercle bacilli the same as you would fumigate a room infected with the germs of small pox or scarlet fever. I think it was in the fall of 1890 Prof. Koch discovered the so-called sure cure for consumption in the way of a lymph. Well do I remember our lamented brother Prof. Lyndsly leaving his class in bacteriology in New York and sailing for Berlin eager to grasp the long-looked-for panacea which was to rid the land of this dreadful disease, but alas! our knowledge was not sufficient, we were too ignorant of the subject, the profession had not then learned that a man is not a machine, and that germ diseases when once established in the system had to be removed by a natural process, according to the natural laws which govern them and their action within the system, and that the powers of life were the strongest barriers against the inroads of these germs, as well as the only eliminator, and when they were once established within the system no power but the power of life could dislodge them, and that all remedies of whatever name or nature must work directly or indirectly along this line.

Perhaps the next period in the treatment of this disease might appropriately be called the creosote period, which occurred about ten years ago and still rages to some extent, another fad of giving a disinfectant in the form of creosote to destroy the germs, as high as forty drops or more being given three times daily.

What a fortune a patient must have had in the way of a stomach who could stand these big doses, three times a day, confined in a close room, impure air, little or no ventilation. Could any plan be conceived which would be more injurious to a delicate individual afflicted with this disease? Contrast this form of treatment with that of good food, open air, and tonics. It