is so hard for the profession to understand that the human family are born, developed, sicken and die by a purely natural process, unless perhaps the doctors kill them. Something mysterious either in the disease or the treatment seems to be the universal want to satisfy the people and many of the profession, not content to work with nature and through nature's laws. They seem to forget that a better physician than any of us proportioned the oxygen in the pure air so necessary to the oxidization of the blood, to invigorate the nervous system, to aid in the process of digestion, to eliminate waste and poisonous germs and keep the system in a normal condition. A better chemist than any of us long ago gave us that perfect and invaluable mixture called milk, so well adapted to the human stomach of all ages. The great originator of all germ life never intended we should be slain by the thousands by so inferior a germ as the tubercle bacilli, and we never should have been had we adhered to the original plan of pure food, pure air, and pure laws. The science of medicine is now slowly but surely working out the great problem of life-saving between the poisonious germs of our overcrowded cities and the human family. We are in command of the germicides. We know their value and their action outside the human system in the way of arresting the communication of these germs from one individual to another. The best methods of applying them and the education of the people to cooperate with these methods are still somewhat an open question. We are coming to learn that we must depend entirely upon the vital forces of the individual for the internal treatment of this disease. The indiscriminate use of any remedy save pure air is as liable to do harm as good. It is no longer a question of treating all cases alike but one of applying the proper remedy at the right time to the right individual. The natural tendency at the present time is towards the open air treatment to the exclusion of all others. Twenty-five or thirty years ago we all gave cod liver oil to every body with a cough and paid no attention to the condition of the individual and did not sufficiently study our cases. Next came the pneumatic treatment in the same blind way. Then the creosote rage seized us and we gave that to every body, thinking we could disinfect the individual by filling his system with creosote if he could not improve on medicated air in the cabinet, never one stopping to think these methods were unreasonable and impossible. Now we are all inclined to the fresh air treatment exclusive of all others in the same blind way. We run in schools like fish. A medical rut once established by a real or supposed superior mind seems large enough for the whole profession to move in. Some distinguished medical man tells us a weak and debilitated stomach can digest twelve eggs and six quarts of milk a day, and all hands try it.

Undoubtedly the best system of treatment yet established by the profession for this disease is the open air treatment, which is quite correct when properly directed, but should we abandon medication? Should we give up everything to the open air alone, as the tendency now is? In the open air treatment we surely aid nature to throw off, so to speak, the poisonous germs. Can we do no more? Are there no other aids to nature? Is med

icine so disappointing that we are losing our faith in its ability to aid us in the healing art after all these long years of study and experience? At last we have discovered the correct principles of assisting nature. May we not do something by proper alimentation, may we not do harm by indiscriminate and overfeeding, may we not do something with tonics, with C. L. O. even, long since condemned? Is not the whole problem to be solved by a wise and scientific application of any remedy given according to its physiological action which will improve the vital forces? One of the great questions for us medical men to settle is, How do sick people get well? Is there but one way and that by assisting nature to do the work? Is there any process but a vital process which enables the poor victim of a tubercular deposit to eliminate these germs? May we not improve the whole system of treatment of all diseases, tubercular in particular, by a more careful and thoughtful study of our patients' condition and needs, and the application of all or any remedy for each individual case, giving each and every case a careful consideration and analysis, taking the fresh air as a basis, assisted by tonics, alteratives, stimulants or narcotics when physiologically required?

To recapitulate:

May I not say all sick people who recover do so through the action of their vital forces and no other? All remedies should be given to aid directly or indirectly these forces. Is not every particle of food given over and above what is digested and assimilated, a detriment and a hindrance to the action of the vital forces?

ADDRESS ON TUBERCULOSIS.

BY HON. HENRY BALLARD, BURLINGTON.

1

Now, the Doctor has said that I must talk about a legal question—that I am to talk about "Compulsory Notification" in tuberculosis, as it is stated in the program for this meeting. That is, the right of the state, through its Board of Health, to know how many cases of tuberculosis there are in the state of Vermont all the time. Now is n't this a right that the state can properly claim, and ought to require, that it can call upon the physicians or upon other citizens to give information to the State Board of Health, that a record may be made of the fact that such and such persons are victims or subjects of tuberculosis? That question reaches back to the fundamental principles in our government: The right to inquire of a citizen as to his condition; is he suffering from any contagious disease or otherwise, which makes him a menace and source of danger to others with whom he comes in contact?

Now, when this act was drawn-and I had the honor along with Dr. Lewis, of Burlington, of drawing up the act-I took it to the Legislature two years ago last fall and introduced it, and after a hearing had been had

before the joint health committee, it became a law, without one single voice. being raised, or one vote against the act, and it is now on the statute book as Dr. Lewis and myself drew it, without the dotting of an "i" or the crossing of a "t" in respect to it.

Now, then, the act creating the tuberculosis commission provides, in the first place, for the appointment by the governor of five members, three of whom shall be legally qualified physicians at least, and two others besides, and the purpose is, as set forth in the act, to inquire in respect to the prevalence of tuberculosis in Vermont, and the need of a state sanitarium for consumptives, and to make a report at the next session of the Legislature. At the same time that this act was passed, another act was passed, and it is now the law of the state, and has been ever since, which provides that "Every physician engaged in the practice of medicine in the state of Vermont, shall immediately upon passage of this Act, submit to the secretary of the State Board of Health, the names and addresses of all persons under his treatment for tuberculosis, and thereafter each case within one week after applying for treatment." That the secretary of the State Board of Health shall keep a record of all cases reported to him, not for publication, but for such purposes as are necessary for the State Board of Health in the discharge of its duties; and immediately after being notified of each case, shall send printed circulars containing proper information in regard to the disposal of sputum, and such other information as may be necessary for the welfare of the person afflicted and for the protection of others. Failure on the part of a physician to conform to this act will constitute a misdemeanor, punishable by a fine of not less than five or more than fifty dollars.

This act was passed at the same session of the Legislature, and it has been the law of our state ever since and is the law now.

Dr. Holton has told me before, and again to-day, that there have been reported to him not one half as many cases of tuberculosis as there have been deaths from the same disease during that time. The physicians of the state have not done their duty under this law, and now, why not? Why not? I say. What is the objection or reason, if any, for not complying with this law? Has the state the right to ask for this? The state does not ask for it for the general public, but for the use of the State Board of Health, and it does not go beyond that. Now then, that, as I say, reaches to the fundamental principle of our government. Benjamin Franklin said, more than a hundred years ago, that "the public health is public wealth." Nothing is truer than that. The well man is self-supporting, self-sustaining; he supports himself, and whatever he earns over and above his own support, is added to the value of the state. The well man is a producer. The invalid is a burden-he has to be carried and supported by somebody. Therefore the state is interested in the health of every one of its citizens,—and for that matter, every individual is interested in the health of every other individual. The invalid is a burden that has to be supported by the state or by his friends, and that takes so much from them and so much from the wealth of the state.

Therefore the state is interested in the health of every one of its citizens. man, woman or child.

Queen Victoria's eminent prime minister, Disraeli, said, that "the health of the people is the first duty of the statesman." Public health is public wealth! A sick person, an invalid, is a burden. Therefore it is for the interest of every citizen to keep himself well, and to endeavor to keep everybody else well; that is his contribution to the public good. Public health is public wealth. It is the first duty of the statesman, as Disraeli said the health of the people.

Now, then, I say the state has the right to take steps to find out how many are sick and how many well. In a matter of this kind, when over a hundred thousand-yes, over one hundred and twenty thousand persons die every year (according to the last census) in this country of this disease, and medical science has reached the conclusion that it is a preventable disease and a curable disease, and yet, according to the last census, and those that preceded the registration in regard to it, does not cover the entire country. There probably are over one hundred and sixty thousand dying every year in this country. And who are those that die of this disease? Are they the old people? No; the consumptive seldom dies an old person. The best statistics that we have on this subject are those of New Hampshire. For eighteen years that state has kept a record of all deaths from all diseases, including consumption, and this fact was shown: That the majority of those that died between the ages of twenty and thirty years, forty-one per cent and a fraction died of consumption. Of all those that died between the ages of thirty and forty years, thirty-one per cent and a fraction died of consumption. It is a disease that feeds and fattens on the young. Just think of it! Is it not a startling fact that so many young men and women from twenty to thirty and thirty to forty years of age, die of this disease? It is the most expensive disease that one can die of, for the reason that the death is long and lingering, the average time of sickness being from two or three to eight or ten years. The sufferer with tuberculosis is an invalid that has to be carried and supported for a long time. For this reason the state has an enormous interest in the health of its people.

In respect to this disease, here and in all civilized countries-for tuberculosis is a disease of civilization-those that live outdoors, live the life of barbarians like the native Indians or islanders of the sea, seldom, if ever, have tuberculosis. You have never heard of an Indian dying of tuberculosis until he got civilized by the habits of living like a white man in houses and closed rooms, getting into the white man's saloon and getting into a condition where he would take it. But look at the Indian! Look at his habits, his outdoor life in the open air. How does he carry himself? "Straight as an Indian" is a proverb. How does he keep his mouth? As everybody ought to except when talking or eating, shut, shut close. There is a good deal in breathing right. But how is a man to live and do the way the Indians do in these respects? Stay outdoors all that he can and keep the mouth shut, breathe through the nose. What is the nose for? Has it any more or

greater purpose than for breathing correctly? Why the Scripture is authority for this-I don't know but I am the one that discovered the Scripture authority for this. In the second chapter of Genesis, the seventh verse, if my memory serves me right, you will read, "And the Lord God formed man from the dust of the ground, and breathed into his nostrils (not the mouth) the breath of life, and man became a living soul." How much there is in that verse! It begins with the mystery of the creation of man and ends with the suggestion of his immortality. But this life begins with breathing the air; breathing it into the nostrils. Now that is the way to breathe. You never saw an Indian with his mouth open except when talking or eating-he always breathes through his nose. And this is one of the things which I always talk to the people, and I think it is one of the most important things. By so doing you keep the dust out of your lungs, as the nose is lined with a moist membrane and has a growth of fine hair on it, which filters and strains the air, and I would advise all doctors to tell their patients who have any suspicion of lung trouble to breathe in this

way.

Now then, this right of notification as to tuberculosis is based on the right of the government to take steps to find out what it has a right to knoweverything that affects the good of the people.

Now, when this act was drawn-the first one-we drew a second act, which passed in the same way, with no opposition. It provided that “every physician engaged in the practice of medicine in the state of Vermont, shall immediately submit to the secretary of the State Board of Health, the names and addresses of all persons under his treatment for tuberculosis, and thereafter each case that comes to him, within one week after applying for treatment." The secretary of said board keeps a record, not for publication but for such purposes as is necessary in the discharge of their duties; and then he communicates with those persons, sending them circulars and giving them proper information in regard to the disposal of sputum, and such other facts, hygienic or otherwise, as are necessary for the welfare of the person infected and for the protection of the community in which he lives. You will readily see that the second act supplements the other. There was not a vote against it. It is the legal duty of every physician to notify the State Board of Health in accordance with the provisions of this second act. Well now, the physicians have not done their duty in respect to this. Dr. Holton said he had not half as many names reported to him as had died of tuberculosis during the same period of time. Now then, in regard to compulsory notification; the law requires it and all physicians should obey the law. You physicians that have a patient, sick with tuberculosis, should send the name quietly and promptly to the secretary of the State Board of Health. What is he to do with it? He is to make a record of it, and then he can send to that person printed matter, pamphlets and literature to educate him, to give him the means of educating himself how to live so as to rid himself of this disease and to avoid giving it to others. The Legislature last fall supplemented the acts of two years before. Our