fessional and lay workers have been able to keep up public interest in this large and many-sided question. In this connection it is of interest to note that in Massachusetts, where the first state sanatorium for consumptive poor in the United States was established only three and one-half years ago, the results have been so encouraging in the way of cure, improvement, and hygienic education of patients that there has already been a strong pressure on the legislature to duplicate the institution in another part of the state,- a striking contrast to the indifference of the public during the years of agitation that preceded the first appropriation of state funds for this purpose. The trustees very wisely, I believe - have preferred to enlarge the existing institution from one hundred and eighty to two hundred and fifty patients, and by this action have exemplified for the hundredth time that pioneers in great movements are, in the end, the most conservative guides.

The second great difficulty, the advanced and hopeless stage at which many cases begin the active fight for recovery, is also growing less because of the earlier recognition of the disease by bacteriological methods and by serum diagnosis, the increased number of physicians who are skilled in this special field, the spread among the masses of the knowledge that in its early stages it is a most curable disease, and, lastly, because of the increasing number of sanatoria and the propaganda made for them by discharged patients.

I wish especially to accentuate the point that a large proportion of cures may be effected without expatriation, without exhausting journeys, without breaking up of families, without great travelling expense, without a complete isolation from those who are dear to us, without the brooding homesickness that comes with the rupture of domestic ties and banishment to distant lands and strangers. The corollary of this position is the one that finally each country may solve its own tuberculosis problem at home, this being true of even the smaller political units, such as states, counties, and large cities. To make this possible, the state, municipalities, and private philanthropy must vie with each other in the friendly rivalry of providing :

a. Institutions beyond city limits for the incipient and presumably curable cases of tuberculosis, of which the Bedford Sanitarium of the Montefiore Home is a good example.

b. Institutions within the city limits for advanced and presumably

incurable cases, like the Blackwell's Island Institution in charge of Commissioner Folks, of the Department of Charities, New York City.

c. A series of separate wards in the city hospitals to act as clearing houses for cases of doubtful diagnosis and prognosis.

d. A system of financial aid to the families of adult patients to encourage early treatment.

Institutions of the first type, sanatoria, if possible, should be placed within forty or fifty miles of the great cities. Besides the general consideration in favor of such action, that cases may be cured there, the following should be remembered:

First. Largest number of cases likely to come from there.

Second. Convenience of access for physicians and laymen who will be charged with the medical and administrative supervision. Third. Nearness to base of supplies.

Fourth. Special force of the example for the whole anti-tuberculosis movement, when such institutions are placed near great cities.

Much may be said in favor of establishing farm gardens and dairies in connection with sanatoria for consumptive poor. They give healthful employment and diversion to the patients, they give them training in and taste for agricultural pursuits, and diminish the probability of their return to city tenements, with its attendant danger of relapse. In addition such employment helps maintenance of discipline among the usually large number of ambulant cases, and very materially assists an economical administration by supplying the institution with the products of the patients' own labor. The cases for such work must be carefully selected by the medical officer of the institution, as also the amount and character of the work assigned to each one, and the effect upon him watched. This method has been tried on a small scale at the Massachusetts State Sanatorium, but nowhere, I believe, on so large a scale as at the Bedford Sanitarium of the Montefiore Home, Westchester County, New York, with which I have the honor to be connected. Two years ago, when the institution accommodated only twenty-five patients, the following farm products were raised by the patients under the supervision of a skilled farmer:

30 tons of hay, 160 barrels of potatoes, 160 barrels of apples, 70

bushels of onions, 350 bushels of corn, 1,000 heads of cabbage, 25

bushels of beets, 40 bushels of carrots, 100 bushels of turnips, and about twenty other kinds of vegetables.

Since the opening of the new buildings one year ago the number of patients has increased to nearly one hundred and fifty, the number capable of doing work has grown in proportion, and there has been a considerable surplus of farm products over and above the immediate needs of the institution. These facts appear to me to be of great importance, and worthy of a wide dissemination among those interested in both the economic and medical aspects of sanatorium management.

THE PROGRESS OF STATE CARE OF DEPENDENT
CHILDREN IN THE UNITED STATES.

BY C. D. RANDALL, COLDWATER, MICH.

This is the story of the state: the commonwealth has reached down its strong hand and lifted up the helpless children of the poor. To-day, brighter than ever before, the sacred words stand out in letters of living light: "He shall . defend the children of the poor." This is the "children's age."

...

In 1871 Michigan assumed guardianship, care, control, and supervision of her dependent children. Was the movement a wise one? Would the idea progress, and would other states do likewise? Would the state do better than had been done? Could a great state, dealing with the high responsibilities incident to statehood, become the parent, the guardian of children, and discharge all duties attendant as tenderly and successfully as private or sectarian charity had? These were some of the questions of that hour. states have answered them in the affirmative. Michigan and other

The story of the kindness, generosity, and sacrifice of individual and church charity for children in all civilization is well known, and the great good done can never be fully told. vide for all. Many yet suffered for an agency strong enough to supply But they could not promeans and wise enough to devise methods to guarantee to all dependent and ill-treated children their natural right to protection and education. The state alone could do that.

And state guardianship, care, control, and supervision have met the demand, and have given us the most humane and economical system of child-saving known. It is thirty-one years since Michigan,

the pioneer in this new field, proclaimed the doctrine that it was the duty and safety of the state to care directly for her dependent children. The success that has attended this movement in Michigan has been told at length in various sessions of this convention, and need not be repeated now.

briefly the progress that has been

This story of the state is to tell made, in this country, in state care. If any progress has been made, in any modern form of child-saving, it is probably confined to the state movement. Surely, the system which has prevailed most in this country, that of the county poorhouse, does not progress. That is happily dying out. The subsidy system is limited to only two or three of our principal states, and is nowhere popular with the people. The states having the district system are anxiously seeking means to reduce child dependence. But the state system has progressed.

Leaving out of consideration the states that have in part inaugurated state care, without state homes, we find that, since Michigan established the State Public School for Dependent Children, over one-fourth of our states have assumed state guardianship, care, control, and supervision of dependent children with state homes.

In all there are now twelve state homes for these children, one established each two and one-half years since Michigan began her work.

Here is presented the roll of honor of the states which have adopted the state system with state homes: :

The Kansas home was first established for children of soldiers, and has not changed its name.

It will be noted that the state system has received its greatest ac