grateful for it. We have something better. We have an array of philanthropists whose generosity has never been equalled. According to Dr. Rossiter Johnson, $107,360,000 were given by American citizens for educational, religious, and general philanthropic institutions during the single year of 1901. All previous records have been outdone by this aggregate, the highest total for any previous year having been $62,750,000. It is a good augury that the first year of the twentieth century should have distinguished itself so remarkably. Our Carnegies, our Rockefellers, Vanderbilts, Morgans, Pearsons, our Helen Goulds, Phoebe Hearsts, Jane Stanfords, (Mrs.) Emmons Blaines, have given us fortunes for universities, colleges, and libraries, and have thereby made us and our children their lasting debtors.

It is but natural that those familiar with the needs of the consumptive poor in this country should look for help in solving this difficult tuberculosis problem to the large-hearted American men and women who make such noble use of their wealth. There are now, perhaps, plenty of libraries and colleges, and even general hospitals, everywhere. But there is a penury of good model tenement houses; there is a penury of public baths, which should for a moderate price be at the disposal of the people winter and summer and for some hours in the evening; there is a penury of decently kept places of amusement, open all the year, where the laborer and his family may spend a pleasant Sunday afternoon and partake of nonalcoholic drinks; there is a penury of hospital and sanatorium facilities for thousands of poor consumptives, who could be cured if only taken care of in time. Sanatoria for consumptive adults, as well as seaside sanatoria for scrofulous and tuberculous children, are a crying and urgent necessity for the majority of our large American cities. The more consumptives we cure, the more bread winners we create, and the fewer will become burdens to our communities. As the conditions are now in most of our cities and towns, the majority of consumptives are doomed to a certain and lingering death; and, if they are careless or ignorant of the necessary precautions, they will infect some of their own kin and neighbors.

When you call on your philanthropic friends to help you solve this great tuberculosis problem, describe to them the sufferings of mind and body of these peopie who must suffer and die, not because their disease is incurable, but because there is no place to cure them. I

am convinced that, if our generous and wealthy fellow-citizens could but see for themselves these conditions, instead of more new libraries, universities, and colleges, we would soon have better tenements, more playgrounds and parks for children, and an abundance of sanatoria and hospitals for our consumptive poor. Thus we would come nearer to the solution of the tuberculosis problem than we have ever been before in the United States.

men.

In closing, I desire to thank you not only for the honor and privilege you have bestowed upon me by this invitation to address you, but also for the opportunity which has thus been given to me to meet so many of you noble men and women from all parts of the country, who are devoting your lives to the service of your fellowWe physicians may well be proud to be permitted to work with you. Charity and medicine are inseparable. It has been so from time immemorial, and I pray that it may forever be thus. The practice of charity and the practice of medicine must forever go hand in hand to relieve suffering mankind. As individual workers, however, we shall soon separate again, each returning to his respective field of labor. Permit me to wish you God-speed, not only in your labors among the consumptive poor, but in whatever work you may be engaged, be it in bringing comfort and relief to the needy, giving encouragement and consolation to the down-trodden, or showing to a brother or sister in despair the way to a happier, nobler, and better life. May success crown all your noble efforts!

WHAT SHALL WE DO WITH THE CONSUMPTIVES?

BY HENRY B. BAKER, M.D., LANSING, MICH.

Most subjects appear different from different points of view. Dr. Knopf speaks, I understand, from the standpoint of one interested especially in sanatoria, to which subject he has given very thorough study for several years. Although I also have studied that subject some, my daily experience during the past thirty years has been the study and actual work for the restriction of the dangerous communicable diseases. Therefore, on that phase of the subject I may be pre

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sumed to have learned something which should entitle me to have fixed opinions, based upon the knowledge thus gained.

Among sanitarians it is well understood that a disease which is known to be communicable, and its mode of spreading is known, is by reason of such knowledge a preventable disease. This is almost axiomatic. Is consumption such a disease? The answer to this last question is, emphatically, yes. It is now well known that consumption is contracted by taking into the body of the victim germs of the disease which have been derived from a pre-existing case. It is a tubercular disease, due to the bacillus tuberculosis, without which the toxin, which is the active agent in causing the disease, does not occur. The victims of the disease are, as a rule, at that age when, except for the poison of this disease, they should be in the prime of life. The most of them are between fifteen and forty-five years of age. (Diagram). Every one of them has or has had in his body the bacillus tuberculosis, without which experience he cannot be said to have consumption. How many contract consumption?

At a court trial in Detroit within a year past a prominent physician and expert bacteriologist testified, if I remember correctly, that to the best of his knowledge and belief the disease is contracted by at least 75 per cent. of all adult persons. A few years ago it was alleged that by examinations at the dead-houses in Philadelphia it was found that 60 per cent. of all dead had in their bodies evidence of having at a previous time had tubercular disease from which they had recovered sufficiently to die of some other disease. Leaving such statements out of the account, however, it is well known that until within recent years consumption has caused more deaths than any other disease whatever. Therefore, unless the fatality of the disease were much greater than that of any other disease, which it is not, it follows that more persons must have contracted consumption than contracted any other disease. This is the fact, from the remote past up to a very recent time consumption has been spread to a greater proportion of the people than has any other disease. That completely answers the question as to the extent of its spread. It has been spread to more persons than has any other disease.

Is consumption contagious? The diseases generally accepted as contagious are scarlet fever, diphtheria, and small-pox. How are they spread? There is good evidence now available, some of which I

will present to you. First, let us consider how vaccinia is communicated. Contact with the surface of the body is not sufficient. Vaccine virus may be rubbed over the body; but, unless the surface is broken by scarification or otherwise, the vaccinia is not contracted. The same is apparently true of yellow fever, which is now known to be spread by a species of mosquito, Stegomyia fasciata; and the disease does not occur in a person unless the specific cause is introduced into the body through some break in the surface. The same is true of malarial fever, which is now known to be spread by another genus of mosquitoes, the Anopheles. Diphtheria may occur in any part of the body where it is inoculated or where the germs lodge in a broken surface; but, as a rule, it occurs only in the throat. Why in the throat? Because there is where, by reason of inhalation, most germs lodge, and because there, more frequently than in any other part of the body, the germs find a break in the surface. How do we know this? Because of the fact that this inoculable disease is actually present in the throat more frequently than any other part of the body, and because statistics prove to us that diphtheria is most prevalent at such times as the throat is known to be "raw," as it is called, when the throat irritants are most abundant in the atmosphere, when the atmosphere inhaled is cold, dry, and contains an excess of ozone. The same is true of scarlet fever, which usually begins as a sore throat. Small-pox observes the same laws it is most prevalent after the throat irritants have been most active in the atmosphere. Consumption follows the same laws. All of the so-called contagious diseases which go into the body by way of the throat and air passages are most prevalent immediately after the greatest action of the throat irritants in our surrounding atmosphere, which all persons necessarily breathe.

From all the facts available, it is now plain that consumption is the most dangerous communicable disease with which sanitarians have to deal.

It is plain that its principal mode of spreading is practically the same as of some of the other dangerous communicable diseases usually called contagious; namely, by what goes out from the mouth of the consumptive. This is true of diphtheria, and probably also of scarlet fever. It is plain that consumption is generally contracted in practically the same way as most of the contagious or communicable diseases of this latitude are contracted; namely, by

the entrance into the mouth or air-passages of the specific germs of the disease. This is undoubtedly the mode of entrance of diphtheria, scarlet fever, and small-pox,- diseases which have been termed contagious. If they are contagious, then consumption is contagious. Not one of the common, so-called "contagious" diseases is usually contracted by simple contact of the unbroken surface of a human body with the surface of an infected human body. Therefore, the term "contagious," implying as it does the spread of disease by contact, should be obsolete. A much better term is the single

word "communicable."

Of all communicable diseases, consumption is now the most dangerous. More people contract that disease than any other. Therefore, anything, any statement, or any influence which belittles the importance of restricting the spread of consumption does damage, in the most vital point, to the interests of the public health and safety.

What are the essentials for the restriction of this most dangerous disease?

Improper housing and improper feeding of the poor are important evils to be done away with, because they lead to discomfort and lowered vitality, and tend to spread disease. But, if the germs of tuberculosis were generally restricted, any amount of lowered vitality because of improper housing and improper food would not cause a single case of consumption.

The essentials for the restriction of consumption are: first, the general recognition of the truth that consumption is the most dangerous communicable disease. Knowledge of that fact is the power without which consumption cannot be restricted. It is lack of action because of ignorance of this great truth-that consumption is spread from infected persons - that kills off the improperly housed and improperly fed poor. It is ignorance of that great truth that kills off the rich by tubercular disease, in spite of proper housing and proper feeding.

It is the slow but gradual gaining of that precious knowledge by the common people, and action governed by that knowledge, that is reducing the mortality from consumption, as it is being reduced in Michigan. A very great decrease in the deaths from consumption has occurred following the campaign of education which has been carried on in Michigan, more especially since 1891.

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