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and the proposed erection of bars and bar. but as a deliberately reasoned feature. This riers between the two, the East and the West, being so I unhesitatingly affirm in writing, is abandoned. Rather seemingly a war mix ! and stand ready to defend against all comers,
Should Samourai-ism obtain control of the that the God of all, if such a god there be, policy of the government of Japan, it will the Creator of that which is, is despicable then be called patriotism; conservative home and murderous beyond power of humanity to influences will be for the while in abeyance. express, to worsbip such a God, is an attitude, Where will it manifest itself outside of the tho abjectest of all abjections. nation's boundary? To what region can it Let the paganism of Greece or of Japan, or transport itself except to the continent_of of China, or the literature of the Hebrews; Asia ? Nowhere Japan has got into an Eu- let the concepts of beauty, purity, grace, ropean entanglement, and the yellow peril, tenderness, sympathy, charity, patience, love as heretofore understood, as a race war prob. of parents—wherever to be found, be typified lem, has disappeared. The Samourai will by the highest thought wherever and by be fully occupied in Asia; but, under no whomever written- let the rescript tbat Baron circumstances can they interfere with the Kaneko says is placed upon the walls of the western civilization.
school-room, in the place of our Ten Com. I am in doubt as to whether we should un. mandments, let the proverbs of Solomonderstand it as surely indicated, that the 750,- praotical monitions of and for life-let all 000 returned warriors will take up the im- these be utilized to the exclusion of such a moralities of the Samourai of fifty years ago, God! and less.
But, after all, will they meet with other Is it not true that Japan is so saturated than ridioule, or indifference in the civili. with the old Samourai spirit (Bushido) or zation of America ? Have we the intensity lawless blood thirst that the returned troops of nature that will imbibe it all as neceswill expect to be deemed as Samourai by sary for well-being, during our pilgrimage reason of service in the field of war, and that on earth? Why do such noble teachings the privileges and leniencies of the former and precepts of the East exist alongside regime shall be restored for them, or, being of open vice most destructive? What is it assumed, shall be tacitly ignored though that makes futile there, as here, the adminagain active ?
istrations, of the higher minds? Why is it If so, what can be done? Is it possible -one asks in vain-that God defeats, ever, for another crusade to be started in the in- that which is desirable; why is it that He is terest of humanity and higher morality? satisfied ever with the mediocre, and that Whc shall be the lion-hearted Riobard to
His process is a levelling down and not a lead it, who never shall lose the faith and levelling up? the courage that will be necessary to sus. When will mankind recognize that the tain his followers in the hours that will God, the law, Nature, is at the bottom of come from time to time, far away from all the distresses of life, all the hideoushomes and families, when the detested foe nesses of life, of all animal life. When will shall triumph ?
the individual man recognize that he is a If Japan be so sodden in vice, if China puppet at war with other puppets, and that be a close second, nothing but time can all are moved by the mechanism of the great change them, and God is responsible. What scheme. oan be done, except to keep a way from them. When will mankind recognize that its Yet that is what the western world will not helplessness as men, and its struggles for do.
self-preservation, as individuals, is the work The slow measures of trade intercourse, the of what he calls Omnipotence and Omnis. education of selected, intelligent individuals cience? And thus reasoning, when will be for the universities of western civilization apply to God, the Creator, the correct reawill do more than gunpowder. But the pro. Boning that he applies to a chain that it is cess will be slow.
no stronger than its weakest link? I could not believe until assured by my Why will he not see that if God is the own senses, that it was so, that all Japan cause of all, he at once says in effect that from high Sat-cho to low Samourai, is utterly God is no better than the best man, and is as debased. I could not believe, until assured bad as the worst man? And that the quesby my own medical senses, that it was so, tion that stares the world in the face is: that there is no active determined disapproval When will our God reform himself? in Japan and China of the gross vices that prevail among the lower classes and here and there among the highest classes existing not as a matter of immoral individual impulse, SUBSCRIBE for The Medical Fortnightly.
The Medical Society of City Hospital Alumni
President, LOUIS H. BEHRENS, 374? Olive Street
Secretary, FRED. J. TAUSSIG, 2318 Lafayette Ave.
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THE EDUCATIONAL INFLUENCE AND What was the lark-note in the dawn that
SIGNIFICANCE OF SANATORIUMS FOR heralded the break in this lengthened night CASES OF INCIPIENT TUBERCULOSIS. * of despair, disease and death-tbat foretold
the revulsion of wbich this eloquent teacher GEORGE HOMAN, M, D.
so feelingly speaks?
Truly it was the voice of one crying in
the wilderness, "Prepare ye the way,” for It is not too sweeping in statement to say
the span of a human generation was passed that there is not a burying ground in all the
before the example and teachings of Brehland that does not hold the bones of victims
mer in Silesia, as early as 1859, and others of tuberculosis, nor is it wide of the mark to abroad, and whose precepts and practice were assert that in this country during every hour
followed by pioneers in America, led to of. in twenty-four, month after month and year
ficial action through educational influences after year, from twelve to sixteen hearses
exerted on the medical profession and the move toward open graves freighted with the public. bodies of persons dead of this disease. So
That this important preliminary work was to state the case is no flight of fancy or fig. done by private institutions and the zeal of ment of the imagination for its truth is at
their managers cannot be gainsaid, the cumtested by official statistios as sober and color.
ulative effect of their example and influence less as any that can be brought to the supa preparing the ground for and justifying ac
on public and professional thought gradually port of a scientific fact. of mortality rest for credence upon data
tion by State governments when the decision long carefully gathered in many places, and
so to do had been finally reached. more especially on statistics embodied in
Among those who were earliest in this the United States census report for 1900.
movement Dr. Edward L. Trudeau probably By that official return it appears that 110,000 life, went to the Adirondack wilderness in
stands foremost, who seeking to save his owi reported deaths from pulmonary tuberculosig ocourred in this country for that year.
1873, and whose institution at Saranao Lake, Professor Osler put the matter in this dia- modestly begun in 1884 was the forerunner matic fashion in an address delivered at Phil.
of its kind in this country, and has been poadelpbia in December, 1905, before the Henry
tent in emphasizing the educational aspect
of its service. Phipps Institute:
Trudeau says on this point
in Report of Henry Phipps Institute, ad. "In more than four hundred homes of this
dress delivered October 31, 1905: country there are lamentations and woe to
"During the first years of the sanatorium's night: Husbands for their wives, wives for
existence I had much difficulty in filling its their husbands, parents for their children, ohildren for their parents. A mere repetition
few beds, and, on many occasions, it took all
my eloquence and persuasive powers to preof yesterday's calamities! and if the ears of
vent the few patients from deserting on short your hearts are opened you can hear, as I
notice. The education of the public as to speak, the beating of the wings of the angel the value of sanatorium treatment little by of death hastening to the four bundred ap- little became apparent, and of late years there pointed for tomorrow. That this appalling has always been a long waiting list” (p. 127); sacrifice of life is in large part unnecessary, He remarks further on the educational of that it can be diminished, that there is hope fice and value of such institutions: even for the poor consumptive–this repre
“But the lives that the sanatorium has sents a revulsion of feeling from an attitude of oriental fatalism wbich is a triumph of
saved and prolonged have not been all that
it has accomplished. The hundreds of pamodern medioine."
tients discharged during the past twenty * Read at the meeting of February 15, 1906.
years have been so many missionaries whic
have soattered over the land, imparting to doubted and inestimable, still this benefit others the simple but all important knowl. was overshadowed by the immense gain to edge as to protective measures and hygienic the common weal secured in having a small mode of life which they have been so prac- army of zealous apostles preaching a propatioally taught in the institution. And, be- ganda of prevention . . for such teachings sides all this, by affording a scientifio dem- go directly and precisely to the places other. opstration that a fair proportion of tuber. wise so difficult to reach, and where they are culous patients can be cured and restored most needed, namely, the workshops, factor. to lives of usefulness, the sanatorium has ies, mills, mines, tenements; in short, wherhad an influence in bringing about a new ever human beings are most densely congruattitude of hopefulness toward the disease gated there will these wholesome instructions which has inspired the building of similar and salutary admoniticns be heard and beeded institutions" (p. 129).
Re-enforcing these observations Osler, in This view is strikingly corroborated by the address before mentioned, says:
the visiting staff, Drs. Bowditch and Clapp, "The present crusade against tuberculosis, in their report of the Massachusetts Sanatorwhich is destined to achieve results we lit- iam for 1904. They say: tle dream of, has three specific objects : "During the past few years an astonishing First, educational--the instruction of the change has come over the community in reprofession and the people; second, prevent. gard to the question of tuberculosis. Marked ive—the promotion of measures wbich will apathy has changed to extraordinay zeal, and, check the progress of the disease in the
as is often the case, those who have been community; third, curative-the study of among the first to advocate certain measures methods by which the progress of the dis- which they know to be of great use, find ease in individuals may be arrested or themselves not infrequently obliged to take healed. The three are of equal inportance a rather conservative position, lest the often
The educational aspects of the prob- extravagant claims made by recent converts lem are fundamental” (p. 150).
shall result only in a reaction of sentiment There can be no doubt that, added to these in the community, and a consequent unreasanatorium demonstrations of the tractable sonable prejudice against methods of treat. nature of tuberculosis, the crowning discov. ment which, beyond a shadow of doubt in ery by Koch of the identity of the invading the minds of those who are best able to judge, organism hastened the maturing of opinion are of infinite value to thousands of sufferers, on this question-the hearty welcome and when rationally used." prompt acceptance of this truth by the The deliverance from this pioneer establishmedical professional speeding the day when ment of its kind as to general schooling inlegislators felt themselves warranted in fluences exerted are echoed by the medical considering public outlays in this direc- managements of other like institutions opened tion; and it is to the lasting bonor and dis- later, and, too, the educational note is stressed tinction of Massachusetts that she saw and in the reports of all the commissions apseized the opportunity, and thus became the pointed in various states to consider the subfirst commonwealth of which there is record ject of human tuberculosis. to devote public moneys to what is essentially Another important phase of this question an educational undertaking for the overtbrow is referred to by the trustees of the Massachu. of pulmonary tuberculosis, an anti-consump- setts sanatorium in their report for 1904, and tion school-the law authorizing the State this relates to the effect of the presence of Sanatorium at Rutland, having been passed such an institution on adjoining populations in 1895.
and property values-quite recent experience The enlightening aspect and teaching value in the State of New York baving shown lo. of sanatoriums through the people they have cal prejudices toward the proposed location helped, especially those of a public character of such an establishment which went to the -has always been recugnized by physicians length of legal proceedings to defeat the acconnected with them, and this feature bas quisition of a site for such purpose. The been constantly kept to the fore by the visit.
trustees say: ing staff of the Rutland institution, they dwell- "The question is often asked, How does ing on it in their first report with marked the presence of the sanatorium affect the emphasis.
town of Rutland, in which it is located? The In drawing attention to and commenting information obtained by inquiry may be val. on this feature the present writer in a paper uable. The report tends to show that the read before the St. Louis Medical Society on town has benefited largely, and has not September 28, 1902, remarked that while the suffered at all in health. The assessors' books advantage to the individual patient was show ... farms, small homesteads and
village houses have increased in value; they the patients sent there in the incipient stage are now at all times in demand. There, is became so depressed by seeing patients in the also an unprecedented demand for skilled later stages that they soon left the hospital in and unskilled labor."
These two classes of paThey then proceed to show that the total tients should not mingle at all. It was al. valuation of the town since 1895 bas in- ways a very hard matter to get people to creased $186,000, a gain of about 35%, and leave their homes and enter a sanitarium, and refer to the decided augmentation in popu
when they did go there and suw these people lation. They say further:
in the last stages it was discouraging. The "The public health has not suffered. most important thing in the prevention of tu. The town has thus averaged for the last berculosis was ventilation. It was a very rare twenty-five years two deaths per year from thing to see patients suffering from any form tuberculosis in a population averaging about of pulmonary trouble who did not keep them1000. During the last six years, with in- selves in a warm close room. He had had creased population, the deaths from this people tell bim that they slept in a room cause have been less than before."
with plenty of fresh air, and yet that room In support of the foregoing Trudeau stated was suffocating. The necessity for sleeping in the address already referred to, that ever in a room with
the window down from the top "since the sanatorium was opened none of
wos not appreciated by many. our employees or servants has been known Dr. Jules M. Brady said that it was the to develop consumption,” this proving that custom to refuse all advanced cases at certain the measures adopted to guard against in- sanitaria where the incipient cases were fection there were efficacious for the protec. treated. At the Baden sanitorium tion of all residing in the institution. In. Vienna, it was the rule where the dullness deed the safest place for a person disposed to had passed below the first rib to refuse such tuberculosis is in such a place.
cases, only the incipient cases being received That local prejudice is not everywhere at tbis institution. Aside from this, the key present is shown by the fact stated in a com- to the situation was to have the principles of munication received by me last year from the disease taught in the schools. A certain the secretary of the Ohio State Board of time should be set aside for that, suy twice a Health, who mentions that they had received week, and children of twelve years old and offers of more than one hundred sites for the over should be taught that this disease was State sanatorium they were proposing to due to a germ, and the simple methods of erect.
prevention. If this was done more frequent. From my personal experience in connec- ly and thoroughly it would not be long until tion with the movement begun several years the number of cases of the disease would be ago to induce the General Assembly to pro.
reduced. vide for a sapatorium in this State I am sat. Dr. Deutsch gave an account of an experiisfied that the most weighty arguments used ence he had bad several years ago in Colorawere those which most fully recognized the do. He had gone to see a distant relative of educational value of such an enterprise, and
bis who had been fighting this disease many that these prevailed where others would have years. It was now nineteen years since he been unconvincing; in fact in advancing this had entered upon this fight for health and he proposition even to non-medical persons a was now practically well. Dr. Soper's revista seemed to open to their sight which dis. marks about not classing these incipient closed the eventual: discomfiture of a dis- cases with those far advanced reminded him ease that has burdened the world for centur- of what he had seen at the Oakes Home in ies, a mortal dominion growing out of a gen- Colorado: Certainly no one who entered ever eral lack of light and knowledge, but the had any regret that he had gone into that insigns are now most hopeful, for everywhere stitution. From the steps at the entrance to there is stir and ferment and movement to. the sterilizers and the painter who painted ward multiplying these places of teaching every room as soon as a patient left it, the that suggests the coming of a day when the place spoke of cleanliness and home comwhite plague will become as
forts. It was surprising to see how those black death-both disappearing as consider. patients enjoyed life. In the summer these able factors from every truly civilized coun. patients were scattered over the mountains try.
under the care of a purse and the physician DISCUSSION.
made the rounds once a week. He had im.
pressed it upon Dr. Deutsch that unless one Dr. Horace W. Soper urged that the incip- could make these patients feel that they had ient cases should be separated from the ad- something to live for, all of the treatment was vanced cases of tuberculosis. At Mt. St. Rose of no avail. For that reason he had them in
this beautiful home in the winter, and in the speaker, "and to the fourth floor, at that." summer kept them out on the mountains. It If that institution should ever take fire was surprising in meeting these patients to nothing on earth would save those patients, see how happy they all seemed.
It was a
nc chance for them to get out. question whether a sanitorium built in the Dr. Homan's paper had as its object the escity would meet the demands of the advanced tablishment of an institution for the treator incipient cases, and even then it would ment of tuberculosis patients in this city. be worth wbile considering an outing place This was both very important and very neofor them in summer.
essary. It would be a school for the people
as well as an institution for the care of Dr. F. J. Taussig thought there was here
those unfortunate people who did not know in the city limits a point which was an ex
how to help themselves, and who were such cellent location for these patients. When one
a detrimental influence to others.
It was a had been at the Female Hospital and looked to the south and southwest over those miles pulmonalis patients in one family.
common thing to see two or three phthisis
This of country without any houses, and at the
means of educating them would be of great highest point in the city, he must feel that
value. Much could be done for tuberculosis there was an atmosphere offering the very
by proper treatment and good advice carefully best opportunities for the care of such pa
followed. Such an institution would more tients. It was unfortunate that the city had
than pay for itself in this way, besides giving not appreciated its advantages in this regard.
these people a chance for their lives.
And These patients could be cared for balf the
this scheme of Dr. Snodgras' should certainly year at least in small temporary structures
receive the aid of physicians. It was to be in that airy place, and certainly patients would be much more improved than in the hoped that the buildings would not be of a "Black Hole of Calcutta, "' or in the attic of Jeast shadow of an institution built there “”
too temporary character, for if there was the the Female Hospital, where one's head al.
would never be anything else built as long most toucted the ceiling, the worst ventilated
as these continued to stand. In behalf of the room in the building.
society the speaker thanked Dr. Homan for Dr. Cannon said that he had recently been contributing his very interesting address coninformed by a man who ought to know, that cerning a matter of which tbey would hear there was a plan to establish cottages on more in a very short time. those bills near the Female Hospital, and
Dr. Green asked what means were used in have them heated and run under the care of
sanitoria to prevent dissemination of tuber. the Female Hospital. Dr. Snodgrass was
culosis among the employes. He supposed mugh interested in this matter, and if the society would look into this matter it might improved spit cups, etc., but what other
that the patients were provided with the most render the health commissioner much aid.
means was employed. The President recalled his experience at the
Dr. Soper stated that in modern sanitor. City Hospital in 1894. He knew that Drs.
iums neither carpets nor brooms were al. Soper, Hinchey and others who were there at lowed. Brooms and feather dusters ought that time felt as he has felt; that when the to be abolished.
As to the statistics of tu. tuberole bacillus was found and a patient berculosis, the chief source of error lay in sent up to the consumptive division, that the fact that a large number of people had a that was the last to be seen of that patient. horror of having consumption in the family With propriety there might have been written and they would ask the physician not to above the door the words : "Leave all hope make the certificate read tuberoulosis. For bebind ye who enter bere.' Next to the
this reason many insurance companies had syphilitio ward it was the worst in the insti.
come to look with suspicion upon cases of tution. One day they had had some six or death from bronchitis, broncho-pneumonia, seven deaths in the consumptive division, etc. A large number of cases were recorded and it left a very bad impression. They in the death certificate as something else. thought so little of the treatment that noth- Hence these statistics did not represent nearly ing was said about it. They had a little
all the people dying from tuberculosis. thymol inhaler and the patients would inhale the fumes and then go back to bed again. Dr. Brady stated that there was a law bere Eggs and milk were ordered for the patients
, requiring every case to be reported. In every
. but they seldom got either. Afterward Dr. place where a death had occurred from this Bebrens had visited the Emergency Hospital. disease, or where a tubercular patient had “God forbid that any tuberculosis patient moved from one bouse to another the apartshould be sent to that institution," said the ments should be sterilized. As Dr. Soper