and the proposed erection of bars and barriers between the two, the East and the West, is abandoned. Rather seemingly a war mix! Should Samourai-ism obtain control of the policy of the government of Japan, it will then be called patriotism; conservative home influences will be for the while in abeyance. Where will it manifest itself outside of the nation's boundary? To what region can it transport itself except to the continent of Asia? Nowhere Japan has got into an European entanglement, and the yellow peril, as heretofore understood, as a race war problem, has disappeared. The Samourai will be fully occupied in Asia; but, under no circumstances can they interfere with the western civilization.

I am in doubt as to whether we should understand it as surely indicated, that the 750,000 returned warriors will take up the immoralities of the Samourai of fifty years ago, and less.

Is it not true that Japan is so saturated with the old Samourai spirit (Bushido) or lawless blood thirst that the returned troops will expect to be deemed as Samourai by reason of service in the field of war, and that the privileges and leniencies of the former regime shall be restored for them, or, being assumed, shall be tacitly ignored though again active?

If so, what can be done? Is it possible for another crusade to be started in the interest of humanity and higher morality? Who shall be the lion-hearted Richard to lead it, who never shall lose the faith and the courage that will be necessary to sustain his followers in the hours that will come from time to time, far away from homes and families, when the detested foe shall triumph?

If Japan be so sodden in vice, if China be a close second, nothing but time can change them, and God is responsible. What can be done, except to keep a way from them. Yet that is what the western world will not do.

The slow measures of trade intercourse, the education of selected, intelligent individuals for the universities of western civilization will do more than gunpowder. But the process will be slow.

I could not believe until assured by my own senses, that it was so, that all Japan from high Sat-cho to low Samourai, is utterly debased. I could not believe, until assured by my own medical senses, that it was so, that there is no active determined disapproval 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,

but as a deliberately reasoned feature. This being so I unhesitatingly affirm in writing, and stand ready to defend against all comers, that the God of all, if such a god there be, the Creator of that which is, is despicable and murderous beyond power of humanity to express, to worship such a God, is an attitude, the abjectest of all abjections.

Let the paganism of Greece or of Japan, or of China, or the literature of the Hebrews; let the concepts of beauty, purity, grace, tenderness, sympathy, charity, patience, love of parents-wherever to be found, be typified by the highest thought wherever and by whomever written-let the rescript that Baron Kaneko says is placed upon the walls of the school-room, in the place of our Ten Commandments, let the proverbs of Solomonpractical monitions of and for life—let all these be utilized to the exclusion of such a God!

But, after all, will they meet with other than ridicule, or indifference in the civilization of America? Have we the intensity of nature that will imbibe it all as necessary for well-being during our pilgrimage on earth? Why do such noble teachings and precepts of the East exist alongside of open vice most destructive? What is it that makes futile there, as here, the administrations, of the higher minds? Why is it -one asks in vain-that God defeats, ever, that which is desirable; why is it that He is satisfied ever with the mediocre, and that His process is a levelling down and not a levelling up?

When will mankind recognize that the God, the law, Nature, is at the bottom of all the distresses of life, all the hideousnesses of life, of all animal life. When will the individual man recognize that he is a puppet at war with other puppets, and that all are moved by the mechanism of the great scheme.

When will mankind recognize that its helplessness as men, and its struggles for self-preservation, as individuals, is the work of what he calls Omnipotence and Omniscience? And thus reasoning, when will he apply to God, the Creator, the correct reasoning that he applies to a chain-that it is no stronger than its weakest link?

Why will he not see that if God is the cause of all, he at once says in effect that God is no better than the best man, and is as bad as the worst man? And that the question that stares the world in the face is: When will our God reform himself?

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THE EDUCATIONAL INFLUENCE AND SIGNIFICANCE OF SANATORIUMS FOR CASES OF INCIPIENT TUBERCULOSIS.*

GEORGE HOMAN, M. D.

ST. LOUIS.

It is not too sweeping in statement to say that there is not a burying ground in all the land that does not hold the bones of victims of tuberculosis, nor is it wide of the mark to assert that in this country during every hour in twenty-four, month after month and year after year, from twelve to sixteen hearses move toward open graves freighted with the bodies of persons dead of this disease. So to state the case is no flight of fancy or figment of the imagination for its truth is attested by official statistics as sober and colorless as any that can be brought to the support of a scientific fact. These statements of mortality rest for credence upon data long carefully gathered in many places, and more especially on statistics embodied in the United States census report for 1900.

By that official return it appears that 110,000 reported deaths from pulmonary tuberculosis occurred in this country for that year. Professor Osler put the matter in this dra

matic fashion in an address delivered at Philadelphia in December, 1905, before the Henry Phipps Institute:

"In more than four hundred homes of this country there are lamentations and woe tonight: Husbands for their wives, wives for their husbands, parents for their children, children for their parents. A mere repetition of yesterday's calamities! and if the ears of your hearts are opened you can hear, as I speak, the beating of the wings of the angel of death hastening to the four hundred appointed for tomorrow. That this appalling sacrifice of life is in large part unnecessary, that it can be diminished, that there is hope. even for the poor consumptive-this represents a revulsion of feeling from an attitude of oriental fatalism which is a triumph of modern medicine."

*Read at the meeting of February 15, 1906.

What was the lark-note in the dawn that heralded the break in this lengthened night of despair, disease and death-that foretold the revulsion of which this eloquent teacher so feelingly speaks?

Truly it was the voice of one crying in the wilderness, "Prepare ye the way," for the span of a human generation was passed before the example and teachings of Brehmer in Silesia, as early as 1859, and others abroad, and whose precepts and practice were followed by pioneers in America, led to of exerted on the medical profession and the ficial action through educational influences public.

That this important preliminary work was done by private institutions and the zeal of their managers cannot be gainsaid, the cumulative effect of their example and influence on public and professional thought gradually preparing the ground for and justifying action by State governments when the decision so to do had been finally reached.

Among those who were earliest in this movement Dr. Edward L. Trudeau probably life, went to the Adirondack wilderness in stands foremost, who seeking to save his own

1873, and whose institution at Saranac Lake, modestly begun in 1884 was the forerunner of its kind in this country, and has been potent in emphasizing the educational aspect of its service. Trudeau says on this point in Report of Henry Phipps Institute, address delivered October 31, 1905:

"During the first years of the sanatorium's existence I had much difficulty in filling its few beds, and, on many occasions, it took all my eloquence and persuasive powers to prevent the few patients from deserting on short notice. The education of the public as to the value of sanatorium treatment little by little became apparent, and of late years there has always been a long waiting list" (p. 127).

He remarks further on the educational office and value of such institutions:

"But the lives that the sanatorium has saved and prolonged have not been all that it has accomplished. The hundreds of patients discharged during the past twenty years have been so many missionaries whe

have scattered over the land, imparting to others the simple but all important knowledge as to protective measures and hygienic mode of life which they have been so practically taught in the institution. And, besides all this, by affording a scientific demonstration that a fair proportion of tuberculous patients can be cured and restored to lives of usefulness, the sanatorium has had an influence in bringing about a new attitude of hopefulness toward the disease which has inspired the building of similar institutions" (p. 129).

Re-enforcing these observations Osler, in the address before mentioned, says:

"The present crusade against tuberculosis, which is destined to achieve results we little dream of, has three specific objects: First, educational-the instruction of the profession and the people; second, prevent ive the promotion of measures which will check the progress of the disease in the community; third, curative-the study of methods by which the progress of the disease in individuals may be arrested or healed. The three are of equal importance . . . The educational aspects of the problem are fundamental" (p. 150).

There can be no doubt that, added to these sanatorium demonstrations of the tractable nature of tuberculosis, the crowning discovery by Koch of the identity of the invading organism hastened the maturing of opinion on this question-the hearty welcome and prompt acceptance of this truth by the medical professional speeding the day when legislators felt themselves warranted in considering public cutlays in this direction; and it is to the lasting honor and distinction of Massachusetts that she saw and seized the opportunity, and thus became the first commonwealth of which there is record to devote public moneys to what is essentially an educational undertaking for the overthrow of pulmonary tuberculosis, an anti-consumption school-the law authorizing the State Sanatorium at Rutland, having been passed in 1895.

The enlightening aspect and teaching value of sanatoriums through the people they have helped, especially those of a public character -has always been recognized by physicians connected with them, and this feature has been constantly kept to the fore by the visiting staff of the Rutland institution, they dwelling on it in their first report with marked emphasis.

In drawing attention to and commenting on this feature the present writer in a paper read before the St. Louis Medical Society on September 28, 1902, remarked that while the advantage to the individual patient was un

doubted and inestimable, still this benefit was overshadowed by the "immense gain to the common weal secured in having a small army of zealous apostles preaching a propaganda of prevention.. for such teachings go directly and precisely to the places otherwise so difficult to reach, and where they are most needed, namely, the workshops, factories, mills, mines, tenements; in short, wherever human beings are most densely congregated there will these wholesome instructions and salutary admonitions be heard and heeded most.

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This view is strikingly corroborated by the visiting staff, Drs. Bowditch and Clapp, in their report of the Massachusetts Sanatorium for 1904. They say:

"During the past few years an astonishing change has come over the community in regard to the question of tuberculosis. Marked apathy has changed to extraordinay zeal, and, as is often the case, those who have been among the first to advocate certain measures which they know to be of great use, find themselves not infrequently obliged to take a rather conservative position, lest the often extravagant claims made by recent converts shall result only in a reaction of sentiment in the community, and a consequent unreasonable prejudice against methods of treatment which, beyond a shadow of doubt in the minds of those who are best able to judge, are of infinite value to thousands of sufferers, when rationally used."

The deliverance from this pioneer establishment of its kind as to general schooling influences exerted are echoed by the medical managements of other like institutions opened later, and, too, the educational note is stressed in the reports of all the commissions appointed in various states to consider the subject of human tuberculosis.

Another important phase of this question is referred to by the trustees of the Massachusetts sanatorium in their report for 1904, and this relates to the effect of the presence of such an institution on adjoining populations and property values-quite recent experience in the State of New York having shown local prejudices toward the proposed location of such an establishment which went to the length of legal proceedings to defeat the acquisition of a site for such purpose. The trustees say:

"The question is often asked, How does the presence of the sanatorium affect the town of Rutland, in which it is located? The information obtained by inquiry may be valuable. The report tends to show that the town has benefited largely, and has not suffered at all in health. The assessors' books show farms, small homesteads and

village houses have increased in value; they are now at all times in demand. There, is also an unprecedented demand for skilled and unskilled labor."

They then proceed to show that the total valuation of the town since 1895 has increased $186,000, a gain of about 35%, and refer to the decided augmentation in population. They say further:

"The public health has not suffered. The town has thus averaged for the last twenty-five years two deaths per year from tuberculosis in a population averaging about 1000. During the last six years, with increased population, the deaths from this cause have been less than before."

In support of the foregoing Trudeau stated in the address already referred to, that ever "since the sanatorium was opened none of our employees or servants has been known to develop consumption," this proving that the measures adopted to guard against infection there were efficacious for the protection of all residing in the institution. deed the safest place for a person disposed to tuberculosis is in such a place.

In

That local prejudice is not everywhere present is shown by the fact stated in a communication received by me last year from the secretary of the Ohio State Board of Health, who mentions that they had received offers of more than one hundred sites for the State sanatorium they were proposing to erect.

From my personal experience in connection with the movement begun several years ago to induce the General Assembly to provide for a sanatorium in this State I am satisfied that the most weighty arguments used were those which most fully recognized the educational value of such an enterprise, and that these prevailed where others would have been unconvincing; in fact in advancing this proposition even to non-medical persons a vista seemed to open to their sight which disclosed the eventual discomfiture of a disease that has burdened the world for centuries, a mortal dominion growing out of a general lack of light and knowledge, but the signs are now most hopeful, for everywhere there is stir and ferment and movement toward multiplying these places of teaching that suggests the coming of a day when the white plague will become as rare as the black death-both disappearing as consider able factors from every truly civilized country.

DISCUSSION.

Dr. Horace W. Soper urged that the incipient cases should be separated from the advanced cases of tuberculosis. At Mt. St. Rose

The

the patients sent there in the incipient stage became so depressed by seeing patients in the later stages that they soon left the hospital in many instances. These two classes of patients should not mingle at all. It was always a very hard matter to get people to leave their homes and enter a sanitarium, and when they did go there and saw these people in the last stages it was discouraging. most important thing in the prevention of tuberculosis was ventilation. It was a very rare thing to see patients suffering from any form of pulmonary trouble who did not keep themselves in a warm close room. He had had people tell him that they slept in a room with plenty of fresh air, and yet that room was suffocating. The necessity for sleeping in a room with the window down from the top wes not appreciated by many.

near

Dr. Jules M. Brady said that it was the custom to refuse all advanced cases at certain sanitaria where the incipient cases were treated. At the Baden sanitorium Vienna, it was the rule where the dullness had passed below the first rib to refuse such cases, only the incipient cases being received at this institution. Aside from this, the key to the situation was to have the principles of the disease taught in the schools. A certain time should be set aside for that, say twice a week, and children of twelve years old and over should be taught that this disease was due to a germ, and the simple methods of prevention. If this was done more frequently and thoroughly it would not be long until the number of cases of the disease would be reduced.

Dr. Deutsch gave an account of an experience he had had several years ago in Colorado. He had gone to see a distant relative of his who had been fighting this disease many years. It was now nineteen years since he had entered upon this fight for health and he was now practically well. Dr. Soper's remarks about not classing these incipient cases with those far advanced reminded him of what he had seen at the Oakes Home in Colorado: Certainly no one who entered ever had any regret that he had gone into that institution. From the steps at the entrance to the sterilizers and the painter who painted every room as soon as a patient left it, the place spoke of cleanliness and home comforts. It was surprising to see how those patients enjoyed life. In the summer these patients were scattered over the mountains under the care of a nurse and the physician made the rounds once a week. He had impressed it upon Dr. Deutsch that unless one could make these patients feel that they had something to live for, all of the treatment was of no avail. For that reason he had them in

this beautiful home in the winter, and in the summer kept them out on the mountains. It was surprising in meeting these patients to see how happy they all seemed. It was a question whether a sanitorium built in the city would meet the demands of the advanced or incipient cases, and even then it would be worth while considering an outing place for them in summer.

Dr. F. J. Taussig thought there was here in the city limits a point which was an excellent location for these patients. When one had been at the Female Hospital and looked to the south and southwest over those miles of country without any houses, and at the highest point in the city, he must feel that there was an atmosphere offering the very best opportunities for the care of such patients. It was unfortunate that the city had not appreciated its advantages in this regard. These patients could be cared for half the year at least in small temporary structures in that airy place, and certainly patients would be much more improved than in the "Black Hole of Calcutta," or in the attic of the Female Hospital, where one's head almost touched the ceiling, the worst ventilated room in the building.

Dr. Cannon said that he had recently been informed by a man who ought to know, that there was a plan to establish cottages on those hills near the Female Hospital, and have them heated and run under the care of the Female Hospital. Dr. Snodgrass was

much interested in this matter, and if the society would look into this matter it might

render the health commissioner much aid.

The President recalled his experience at the City Hospital in 1894. He knew that Drs. Soper, Hinchey and others who were there at that time felt as he has felt; that when the tubercle bacillus was found and a patient sent up to the consumptive division, that that was the last to be seen of that patient. With propriety there might have been written above the door the words: "Leave all hope behind ye who enter here. Next to the syphilitic ward it was the worst in the institution. One day they had had some six or seven deaths in the consumptive division, and it left a very bad impression. They thought so little of the treatment that nothing was said about it. They had a little thymol inhaler and the patients would inhale the fumes and then go back to bed again. Eggs and milk were ordered for the patients, but they seldom got either. Afterward Dr. Bebrens had visited the Emergency Hospital. "God forbid that any tuberculosis patient should be sent to that institution," said the

speaker, "and to the fourth floor, at that." If that institution should ever take fire nothing on earth would save those patients, there was nc chance for them to get out. Dr. Homan's paper had as its object the establishment of an institution for the treatment of tuberculosis patients in this city. This was both very important and very necessary. It would be a school for the people as well as an institution for the care of those unfortunate people who did not know how to help themselves, and who were such a detrimental influence to others. It was a common thing to see two or three phthisis pulmonalis patients in one family. This means of educating them would be of great value. Much could be done for tuberculosis by proper treatment and good advice carefully followed. Such an institution would more than pay for itself in this way, besides giving these people a chance for their lives. And this scheme of Dr. Snodgras' should certainly hoped that the buildings would not be of a receive the aid of physicians. It was to be too temporary character, for if there was the least shadow of an institution built there would never be anything else built as long as these continued to stand. In behalf of the society the speaker thanked Dr. Homan for contributing his very interesting address concerning a matter of which they would hear more in a very short time.

Dr. Green asked what means were used in sanitoria to prevent dissemination of tuberculosis among the employes. He supposed improved spit cups, etc., but what other that the patients were provided with the most means was employed.

Dr. Soper stated that in modern sanitoriums neither carpets nor brooms were allowed. Brooms and feather dusters ought to be abolished. As to the statistics of tuberculosis, the chief source of error lay in the fact that a large number of people had a horror of having consumption in the family and they would ask the physician not to make the certificate read tuberculosis. this reason many insurance companies had come to look with suspicion upon cases of death from bronchitis, broncho-pneumonia, etc. A large number of cases were recorded in the death certificate as something else. Hence these statistics did not represent nearly all the people dying from tuberculosis.

For

Dr. Brady stated that there was a law here requiring every case to be reported. In every place where a death had occurred from this disease, or where a tubercular patient had moved from one house to another the apartments should be sterilized. As Dr. Soper