work without tuberculin, it is usually necessary, in order to secure prompt results, to do as was done with the Willard Hospital herd and ruthlessly destroy every animal.

"A slower method is to weed out promptly every unthrifty animal, and all that show unequivocally even suspicious symptoms of tuberculosis, and to employ disinfectants freely on the stall, stable, and yards. With tuberculin, on the other hand, in a herd that is not universally infected, it is easy to pick out the tuberculous animals, and to place the sound ones in a herd by themselves, which may be tested again and again at long intervals until we are satisfied that no trace of infection is in any way connected with them.

"With tuberculin, success can be made more prompt and certain, and with a limited destruction of the herd, while without it, a shadow rests upon all the survivors for a considerable length of time. With tuberculin, an animal can be taken from even an infected herd with a reasonably certain guarantee of soundness, whilst without it, the survivors of a herd which is infected to even a slight extent cannot for years, or so long as infection survives in the herd, be considered as safe to purchase.

"While, therefore, we admit the possibility of successfully dealing with tuberculosis without the tuberculin test, and avail of it when circumstances demand it, we cannot close our eyes to the fact that for intelligent, scientific and effective work, the tuberculin test is by far the preferable resort, though never to the exclusion of professional skill and sound judgment in other directions."

We believe that this demonstration will encourage the State to proceed in the work of exterminating tuberculosis among cattle and in doing this, the spread of tuberculosis in the human family is certain to be greatly diminished. In the light of experience and investigations of recent years, it is unquestionably shown that milk and flesh of tuberculous animals are a great source of infection to man. And it is the duty of the State Boards of Health to demand in the strongest terms possible the destruction of this infection. The fruit of our educational work is plainly seen in the better and growing appreciation by cattle men of the nature and danger of tuberculosis, as shown by the more frequent reports of the disease, and the constantly increasing number of applications for the tuberculin test by men who know that we have no funds with which to indemnify them for cattle condemned.

During the past year several owners of small herds were induced to have their herds tested at their own expense, and in this way several tuberculous animals were detected and destroyed. We find cattle owners who are willing to bear the expense of testing their own cattle, are invariably willing to destroy any found diseased. We again see the result of our educational work brought about by the distribution of our circulars of information and instruction; one veterinarian alone having sent us several reports of private tuberculin tests, which he believes he has obtained through our circulars, which he has distributed to his patrons. We have received many calls for these circulars from veterinarians and health officers, which they desire to distribute to inquiring dairy

men.

During the last season, our inspector, Dr. Cooper Curtice, has spent some time in Buffalo investigating a report in one of our agricultural papers, that traffic was being carried on there, by the stock men, in tuberculous cattle shipped there from other States. It transpires, that a cow tagged "Condemned," by the Bureau of Animal Industry Officials, was recently sold in Buffalo, and afterwards died with what was reported to be tuberculosis. The investigation of our inspector shows that she died of some other disease. He also learned that she was only condemned for beef, because she was in an advanced stage of pregnancy. and not because she was diseased.

The Bureau of Animal Industry Officials inspect all cattle imported for breeding purposes from Canada, and accept the certificates of tuberculin inspections from Canadian veterinarians, who have had the endorsement of the Provincial Government. If the cattle are not accompanied by such certificate, they are held for ninety-four days and inspected here.

The inspection and condemnation of an animal recently shipped from Canada in advanced tuberculosis, would throw in question the integrity of at least one of the Canadian inspectors, and cast suspicion upon the accuracy and efficiency of the Canadian work, and until further observations have proven the Canadian inspectors inaccurate or unfaithful in their work, their inspections for tuberculosis must be regarded as correct and of much value to the cattle industry in this State. The main bulk of milch cows sold in Buffalo, do not pass through the hands of the Bureau officers for tuberculin inspection. Such cattle come largely from Iowa, Indiana, Illinois, Ohio and elsewhere. If destined for Massachusetts or Pennsylvania they are inspected in Buffalo, by inspectors designated by authorities from those States, although cattle owners are obliged to pay for the inspection.

These inspectors are for this purpose practically State agents. They certify to the health of the cattle sent into those States, and reject all tuberculous cattle, refusing to tag them. This procedure results in the exportation of sound cattle, and the throwing of the tuberculous into the New York herds.

The accusation that owners willfully dispose of these tuberculous cattle in opposition to the laws of the State, and all humane sentiment, we are not yet able to prove in any given instance, but it is a matter of common report among those closest to the transaction.

Of all cattle thus examined, from 7 to 10 per cent. are said to be rejected, and so far as can be learned, none are killed. Cattle thus submitted to the State are almost always apparently in good condition, about to calve, or are fresh in milk, and really form a dangerous class which the State has been striving to keep from the channels of traffic. The rejected cattle go one by one, or in groups of two and three, to dairies or breeders' herds, and introduce disease into those herds much faster than would be the case were there no inspection for Massachusetts, Pennsylvania, Vermont and other States.

Veterinarians who make these inspections we think would be willing to report these cases, were there a general law covering them, and demanding of all veterinarians that such cases should be reported. At present none wish to risk the loss of other business which would follow the reporting of these cattle under present conditions. We learn that the Interstate-commerce Law interferes with our demanding that the authorities of other States test all cattle coming to this State, and send with them a certificate of health.

It is obviously impossible with the small amount of money at our disposal, to keep at Buffalo and other places, inspectors to examine and tuberculin test the cattle designed for dairy or breeding purposes. Under existing laws, it seems to us a matter for the Bureau of Animal Industry to take charge of, and we believe it is a matter of much greater importance from a sanitary standpoint, as well as of value to the cattle industry, than the inspection of beef cattle now so carefully carried on by their department.

Under the law, we are permitted to kill all tuberculous cattle and if in the possession of the owner for a period of less than three months they cannot ask for appraisal or indemnity. We are looking for just such cattle, and any such found will be promptly destroyed.

The conditions before mentioned are becoming known to dairymen and dealers in our State, many of whom will not purchase cattle that have not passed the tuberculin test, and when all dairymen and breeders

have attained intelligence enough to do this, no cattle will then be brought into the State, without having first been tested, for if tested in this State and rejected, they must be a total loss to their owners, or be sent back to the State from whence they came.

CONTRIBUTION OF DR. BENJAMIN LEE, OF PHILADELPHIA, TO THE DISCUSSION OF THE QUESTION, PHASE VII, "HOW MAY TUBERCULOSIS BE PREVENTED?"

The Pennsylvania Society for the Prevention of Tuberculosis was organized April 10, 1892, and incorporated 1895. The following is the report for the year ending April 13, 1898. The Publication Committee calls attention to the statement of the illustrious Pasteur that "It is in the power of man to cause all parasitic maladies to disappear from the world." Thoroughly believing this doctrine, the Society for the Prevention of Tuberculosis has worked quietly with but one end in viewnamely, the education of the community in a knowledge of the true nature of consumption, and of the means now considered necessary to control or conquer this disease.

The Society for the Prevention of Tuberculosis has worked quietly with but one end in view-namely, the education of the community in a knowledge of the true nature of consumption and of the means how considered necessary to control or conquer this disease.

The means by which this end is sought to be obtained are: 1st, By the publication and distribution of pamphlets; 2d, by constant efforts to induce those in influential positions to use their earnest efforts to prevent the spread of the disease; and 3d, by striving to obtain the requisite conditions whereby those early afflicted may be restored to usefulness, or when far advanced, the safeguarding that will prevent the communication of infection to others.

During the past year one new pamphlet has been published, Tract No. 4. "How Storekeepers and Manufacturers Can Help to Prevent the Spread of Tuberculosis;" 5,000 copies of this have been issued and 20,000 copies of earlier tracts have been reprinted and extensively circulated and copied. The chief effort of the managers, however, has been directed towards the establishment of the greatly needed Municipal Hospital for Tuberculous patients, and also for a sanatorium in the high regions of the State.

The former of these is needed for two reasons-1st, the comfort and last retreat of the poorest members of our community who after months and years of struggle find themselves at last penniless, absolutely unfit for work and refused admission to the general hospitals of the city.

The hospitals of the city cannot admit all the cases of tuberculosis that apply to them; their wards would be crowded to the detriment of the acute cases of other diseases. The Home for Incurables is full and has always a long waiting list. The Free Hospital Fund for Poor Consumptives has undertaken, as far as its means permit, to pay for consumptive patients who are received in a special ward of St. Agnes Hospital. The Rush Hospital will take cases for a limited time, and the City Mission, by a few beds at 411 Spruce Street and its fine Home at Chestnut Hill-this latter only for women-provides for a number of sufferers. At the Philadelphia Hospital certain wards are reserved for consumptives, but even with these the accommodation is not nearly sufficient for the size of our city.

For their own sake, such patients should have better air and sanitary conditions than are possible in an almshouse hospital; for the sake of the community they should be treated by such methods as will not only tend to cure certain cases but will prevent the contagion from spreading. We feel convinced that a State sanatorium in the highlands would save many valuable lives and also that a good City Hospital set apart for

tuberculous patients would not only give comfort to them but add greatly to the safety of the (apparently) healthy part of the community.

A most desirable location in Luzerne county has been offered the Society for the site of a sanatorium, and strong efforts are being made to obtain State aid to erect the building. In December, 1896, a committee was appointed by the Society to make a report on a suitable site for such an institution. Accordingly a committee of four members visited White Haven, in Luzerne county, Glen Summit and Bear Creek and neighboring localities within a radius of from twenty to thirty miles. The place which appeared to present the greatest advantages was situated quite near White Haven, a borough composed of educated and progressive people, and in touch with all the great railroad systems of the State. This is an important matter, as it would diminish the sense of isolation on the part of the patients, attendant upon removal to a wilderness or a dense forest remote from civilization and difficult of access. The point selected is about 1,225 feet above the level of the sea, and 250 feet above the Lehigh river. Green Mountain rises gently from the borough of White Haven until at an elevation of 100 feet above the town it forms a plateau, a few hundred feet in width, stretching westward indefinitely. It is on this plateau that it is proposed to locate the sanatorium. The prevailing winds of this locality are northwest, and the sanatorium would be protected from them by Green Mountain, which rises rather abruptly from the plateau some 400 feet, and passes westward continuously with the plateau. It thus affords admirable shelter from the wind. The sun exposure is all that could be desired. The outlook is to the south and the plateau is bathed continuously with sunshine, from daylight to dark. The view is out over a wide stretch of wilderness, east, west and south. From the top of Green Mountain there is a charming prospect towards every point of the compass. The soil is porous, and the drainage good. With the exception of a clearing on the plateau which is occupied as a farm, the mountain side is wooded. It is the natural home of the pine, though the extensive lumbering operations which brought White Haven into being, have long since brought about an almost entire disappearance of this beneficent tree, whose varied products, by some strange chemistry of nature, have ever been found to be so healing in affections of the respiratory tract.

For purity of atmosphere the locality is up to a high standard, and is pronounced practically free from miasmic and malarial influences.

The condition of dry atmosphere is fairly present. The fogs are not frequent, nor are they extensive or continuous. They mostly originate in the condensation which takes place in the moisture arising from the river, but they do not last long nor do they usually reach to the plateau. The tract consists of several hundred acres, and it has been offered free of expense and encumbrance to the Society, on the simple condition that they shall raise the funds for building and equipping the institution. The matter having been brought to the notice of the Board of State Charities, from the fact that it is intended to make this more especially a refuge for the consumptive poor of our large cities, that body recommended an appropriation of $30,000, provided a like amount could be raised by private subscriptions. The Committee on Appropriations of the Legislature, however, reported the bill negatively. The movement having once been inauguarted, however, will not be suffered to drop.

The first difficulty in carrying out the objects of the Society is the immense number of persons suffering from tuberculosis. Even if we consider only those who actually die of this disease each year, we find that for the State of Pennsylvania it is an army equal in numbers to that of its National Guard. What consternation would ensue, what measures would not be undertaken if we might suppose the disease to cease for ten years and then be restored in its full measure of mortality!

The second element of difficulty is the apathy of our people. They have not begun to grasp the idea that tuberculosis is one of the preventable diseases. They look upon the mortality from phthisis as a part of an inevitable tribute to death that must be paid because it always has been paid with such a remarkable regularity that one is able to foretell very closely just how many will die of phthisis in the year. We know now, and we were morally certain at the opening of the year, that in Philadelphia about 2,350 would die of phthisis in 1898. But in Philadelphia the rate has fallen gradually so that, whereas, fifteen years ago about 14 per cent. of all deaths were from phthisis now only about 10 per cent. was from that cause. The reason is that, as in other warfare, "To know the enemy is half the battle." So the fuller knowledge of the way in which the disease is propagated from the sick to the well enables us in some measure to avoid distributing broadcast the germs of the disease, and, on the other hand, to avoid receiving them with a strange indifference which does not seem to exist in our relations to other diseases. An institution for the scientific treatment of tuberculosis is a great object lesson on the means of prevention of the spread of the disease as well as its cure. The sanatoriums in the Adirondack Mountains, at Chestnut Hill in Philadelphia, in England, the Isle of Wight, and on the continent of Europe, by exerting a strict supervision of their patients, teach them how the disease can be managed and the dangers of its communication destroyed. So it would be with an institution of this kind if established in any locality. Those who go out relieved or cured would aid in all measures calculated to diminish the disease.

The Society has made a strong effort to limit the evil of expectoration in public places. The Board of Health was requested by this society to consider the advisability of issuing circulars or public notices to be properly distributed, warning against the uncleanly, unnecessary, unhealthful and reprehensible practice of spitting, especially by consumptives, in public places, thoroughfares and conveyances. The Board of Health published "The Spitting Habit," and thousands of copies were widely distributed; accordingly every street car in Philadelphia is now provided with a sign authorized by the Board of Health forbidding the practice of spitting upon the floor.

The State Live Stock Sanitary Board of Pennsylvania has now been in operation for about two and a half years and much of its work has been in connection with the suppression of tuberculosis of cattle. Since its establishment it has caused the condemnation and destruction of over 3,500 tuberculous cattle. This work is justified both from the standpoint of public health and from the standpoint of agriculture. In the first place the ingestion of the meat or milk of tuberculous animals may produce tuberculosis in the consumer, and in the second place this disease is quite contagious among cattle and causes very great losses to farmers. Inspections of tuberculous herds have been made by the State Veterinarin in all parts of Pennsylvania under the supervision of the State Live Stock Sanitary Board. Herds have been found in which the percentage of tuberculosis has been extremely high. In one herd of fiftysix cattle recently examined fifty-three were afflicted with tuberculosis and killed. The average percentage, however, is steadily falling and while the proportion of infected cattle in infected herds was as high as 30 per cent. in the beginning of the work it has been reduced to about 10 per cent., showing that the herds in which infection is most extensive are being discovered and disposed of. In some parts of the State there is very little, if any tuberculosis of cattle, and the same condition prevails in many herds in districts in which tuberculosis is most abundant. The absence of tuberculosis seems to depend upon freedom from exposure and the prevalence of tuberculosis depends upon care that the animals receive and the conditions to which they are subjected and the length of time that the outbreak has remained undisturbed. Many cases