glorious climate, regain their health. The poor ones were too often destined to die for want of proper care. It was for this class that the National Jewish Hospital for Consumptives was opened. This hospital is under the auspices of the Jewish people of the United States, but it is non-sectarian and national in its scope. The only requirement for admission is that the applicant shall be unable to pay and that he shall be in the early stage of consumption, no pay patients being accepted. The results have been excellent. Dr. Knopf knows all about this sanatorium, and he can tell you much more ably than I could of the good that is being accomplished.

Just a word in reference to a question raised by a previous speaker in reference to consumptive patients in county hospitals. In Arapahoe County all consumptives are now cared for in cottages situated on the county farm. The farm is seven miles from the city, and this is a great improvement on the former consumptive ward in the hospital.

Dr. Knopf was invited to close the discussion.

Dr. S. A. KNOPF.- It was with a purpose that I have incorporated in my paper a little item with reference to conclusions on communicability. If I had not done so, there would have been nothing but agreement; and I do not like discussion when every one agrees with me. To be serious, I have had a long, bitter, and sad experience before succeeding to have tuberculosis considered a communicable and not a dangerous contagious disease. I am not going to relate all my experiences in this matter: I will only tell you of two instances.

A little sewing woman had been treated by me for incipient tuberculosis. I succeeded with her as any doctor can. One day she came to me, after I had virtually discharged her as cured, saying, "O doctor, I am in trouble." "What is the matter, my child?" I asked. "My sister has lost her best job. The other day she mentioned your name, and said that you had cured me of consumption. When they heard that she had had a consumptive sister, that settled her occupation in that family."

Another case was that of a man who had a somewhat persistent but not tuberculous cough, who was discharged because his employer was afraid of consumption.

I brought this matter of phthisio-phobia (exaggerative fear from consumptives), started by the Treasury Department, before the New York Academy of Medicine; and this body after careful deliberation passed the following resolutionon, on Feb. 6, 1902

Whereas the Treasury Department of the United States upon recommendation of the Surgeon-general of the Marine Hospital Service has recently decided to classify pulmonary tuberculosis with dangerous contagious diseases, be it

Resolved, That the New York Academy of Medicine deeply deplores this decision, which is not based on either clinical experience or scientific experiments.

Resolved, That the Academy considers the exclusion of non-pauper tuberculous immigrants and consumptive aliens visiting our shores unwise, inhuman, and contrary to the dictates of justice. Be it furtrer

Resolved, That, while the Academy is convinced of the communicability of tuberculosis and urges all possible precautions against the spread of the disease occasioned by sputum and tuberculous food, the Academy is opposed to all measures by which needless hardship is imposed upon the consumptive individual, his family, and his physician.

If

If there are any medical men in this audience, they will testify that I have always upheld the fact that the patient-should be most carefully watched, and that the sputum was the most dangerous factor in contagion. I do not believe in frightening people into obedience, but in educating them to observe sanitary laws. If you call tuberculosis a dangerous contagious disease, what is the result? All well people will cry out for isolation of all consumptives. If you take away every consumptive, what does that mean? That means that you must isolate about 20 per cent. of the population. a patient is absolutely careless, ignorant, or vicious, and will not obey sanitary laws, then he must be isolated. If he is obedient to those laws, we must treat him with sympathy and kindness, and consider him as a fellow-man, afflicted, it is true, with a terrible disease, that may, nevertheless, be overcome by such obedience and proper treatment. Consumption should not be considered as a dangerous contagious disease for another reason. If a man thinks he has tuberculosis and knows that he will be ostracized when others know it, he will not go to a physician for examination, because he fears that, if he does, he will lose his job. He may be ostracized from society, and so will put off consulting any one till it is so late that the disease cannot be cured. Therefore, I repeat, I prefer to educate people, not

to frighten them.

My distinguished confrère said that he thought people ought to be examined every two years. There we differ. Two years is not often enough. If we are to examine people, it should be every six months. The service of the United States military and sanitary officers in Cuba has been mentioned with reference to yellow fever. The United States may well be proud of that. And in Havana, where we have only been guests for a few months, more has been done to prevent tuberculosis than in any state or city of this Union. They have a visiting committee, they have dispensaries, they have hospitals for the advanced cases and sanatoria for incipient cases; and they have created all of these within a very short time, just because the United States government was at the head of it. Our individual state governments and municipal governments do not seem to do much. We shall never get rid of tuberculosis till we have a federal board of health which shall be at the head of such work.

It was not my intention to speak of the causes of tuberculosis, as

that was not the subject of my paper; but any one who is familiar with consumption knows that tailors, printers, glass-workers, drapers, and people working at similar trades are particularly exposed to it. Any place where one is exposed to dust, or in dark workshops, is especially dangerous, if one is predisposed to tuberculosis. But there is one class that has not been mentioned, the great class of clerks. Will you believe me when I tell of the danger in our great offices and banking houses in New York? The great bankers in those offices reinhale the very breath of their clerks over and over again. There is as much foul air in banking houses as in tailors' shops, and we have as many unfortunate consumptive clerks as laboring men. Let us have office inspectors as well as factory inspectors.

If

Child labor! To think that at this day, in the beginning of the twentieth century, there should be such a thing as child labor! there is anything that we should be ashamed of, it is that that should exist; and I plead with you ladies, who have so much influence over men, to make your influence felt wherever you go, protesting against this crime of the century, child labor.

Concerning Boston, I must express my admiration. Boston is the only city in the United States which removes the tuberculous patient, when it is evident that he does not carry out instructions given by the physician, and when it is evident that, owing to his environment, he will constitute a source of danger. With the work of the sanatorium in Denver, of which Mrs. Pisko spoke, I am very familiar. They have had most excellent results, and have cured a great many. Their work is interesting from the fact that they do not return the patients. It is a well-known fact that, if you cure a patient in Colorado, if he goes back to his old environment, ten to one he will have a relapse, and will die ultimately of tuberculosis. Their work has my greatest admiration, and all I wish is that we had enough Mrs. Lincolns and Mrs. Piskos, so that tuberculous poor would be well cared for.

QUESTION. You spoke of a colony, an agricultural colony. Do you mean a colony or a farm? To me the idea of a colony means a place where people colonize, marry, and raise families. Is that your

idea?

DR. KNOPF.-I think I mean both. I believe it would be a wise thing to have a farm, and, when the patients are cured, to colonize them, after they are cured!

QUESTION. What is your opinion of the rulings of the Boston Board of Health?

Dr. KNOPF.I believe in them for two reasons. By having a great number of cases reported to the board of health we may find the underlying causes of tuberculosis. It is the duty of the Board of Health to find out the causes. I am most emphatically in favor of reporting cases; but I do not believe that, if the physician reports his case and says, I am responsible for hygienic conditions, that the health officer should have a right to send an inspector and say, We

will do thus and so. I think the latter should not interfere with a patient whose physician does not wish to have interference.

Mr. E. P. BICKNELL. When in Boston, a few months ago, I was talking with Mrs. Lincoln about a pavilion for the tuberculous poor on an island in the harbor; and I understood that the erection of a pavilion by the salt water had been opposed.

Dr. KNOPF.- I do not believe in any specific curative quality of any climate. I believe there is no such thing as a specific climate for consumption. Hygienic and dietetic treatment under medical supervision is what is wanted: climate helps. You can cure your consumptive here in Michigan if you have a place where the air is relatively pure, and where you have a proper institution. Experience has taught us, however, that inland sanatoria with relatively dry atmosphere offer a better adjuvant in the treatment of pulmonary tuberculosis; and, as a whole, I am willing to indorse what my Boston friends have done. If the question had been to place a sanatorium for children, I should emphatically have indorsed the island plan, particularly if near the seacoast.

Adjourned at 12 M.

ELEVENTH GENERAL SESSION.

Monday night, June 2.

The Conference was called to order at 7.45 P.M. by the President. Prayer was offered by the Rev. Charles B. Newnan, of the Central Christian Church.

Mr. L. L. Barbour introduced Dr. Goenaga, a delegate from Porto Rico, superintendent of an asylum for the insane in San Juan. Dr. Goenaga presented a report (page 182).

The subject for the evening was the "Care of the Insane," Miss Julia C. Lathrop, Chicago, chairman. The first paper presented was by Dr. Frederick Peterson, president of the State Lunacy Commission of New York, and was read in his absence by Mr. A. Johnson (page 166).

The following resolution, read by General Brinkerhoff, was offered by Miss Julia S. Tutwiler, of Alabama :

Since petty crime is caused by poverty, poverty by lack of thrift, often by lack of opportunity to place safely small savings, be it

Resolved, That this Conference, collectively and individually, endeavor to bring about the establishment of postal savings-banks such as have proved so beneficial in England and Canada.

Referred without debate to the Committee on Resolutions.

A paper by Dr. C. B. Burr, of Flint, Mich., was read (page 174).

DISCUSSION ON THE CARE OF THE INSANE.

Mr. F. B. SANBORN, Concord, Mass. I have listened with interest and pleasure to the papers that have been read. I need hardly say that they presented little that was new to me; but I noticed in both a distinct advance in the state of mind existing in gentlemen occupying similar positions thirty-eight years ago, when I began to look into the subject of insanity. I have seen in that time a complete annihilation of certain theories in regard to the treatment of the insane that were then held almost universally. I expect to live to see the partial destruction of theories now prevalent; and it is pleasant to see that the changes now taking place are in the direction of wisdom, and are really owing to a proper care for public interests, and, what is quite as important, to the comfort and welfare of the insane.

Here, for instance, is my good friend Dr. Peterson, whom I first met some eighteen years ago as an assistant physician at the Poughkeepsie Insane Asylum, but who is now the able president of the New York State Lunacy Commission. He introduces this annual debate on one of the most serious questions of public charity with some views that would have been novel but three years ago and are still unfamiliar to many. He pronounces with much weight of authority and reason against those mixed asylums, miscalled "hospitals," where the curable and the incurable are herded together in enormous structures, objectionable as architecture, dangerous from risk of fire, and apt to be unsanitary as well as inadequate for the best classification of patients. He declares, also, for a much greater localization of the treatment of the insane than has been fashionable in New York for the past fifteen years. And in this, as well as in the other matter, he voices a tendency which is showing itself in some quarters where it was least to be expected.

On the other hand, the statements of Miss Lathrop, so admirably illustrated by her stereopticon views, have to do with a matter by no means new, but very ancient in Europe, though little considered as yet in America,-the care of the insane in private dwellings, of which Belgium and Scotland give the earliest examples, although France, in her opinion, has improved on those models in her recent experiments. It may interest the Conference to know that the European friends of this system of treatment for a large class of the insane are to hold a congress on the subject at Antwerp, from the Ist to the 7th of September next, concerning which Dr. Peeters, director of the famous colony of Gheel in Belgium, writes me thus, under date of May 18, 1902:

You are doubtless aware that we shall hold in September of this year an International Congress concerning the Family Care of the Insane, and I have requested the secretary to send you a programme and an invitation. I know what you have done in advocacy of this system, and I hope to see you at Antwerp. If you cannot come, you would confer a favor by sending us a report, in