The children of consumptives require special attention because of the transmission of vulnerable anatomical elements which render them peculiarly liable to the disease; this predisposition may certainly be overcome, in addition to proper food, by pure air, methodical gymnastics and systematic hardening of the skin secured by bathing, and no school should be without these hygienic advantages. If it be found that school children are starving for want of food it is clearly our duty to make suitable provisions to prevent permanent dependency. No effort should be spared to increase the resisting power of the individual. Indeed, we are altogether too apt to underrate the question of soil or predisposing factors in our crusade against the disease. There is abundant statistical material to indicate the influence of dustproducing occupations as a predisposing factor to tuberculosis and other pulmonary diseases, and it is clearly the duty of the State to formulate efficient laws in regard to factory sanitation and the occupations in general which are injurious to health. It is certainly the duty of the State to see that every patient who has no home, or whose environment offers less favorable conditions for his recovery, is provided with proper care and shelter. It may be truly said. that hospital treatment of consumptives offers the best chances for recovery and the ultimate extermination of the disease, and the State, until a comprehensive system of industrial insurance has been adopted, must. shoulder the responsibility in the case of patients unable to bear the financial burdens. Every city of any size should provide facilities for the isolation and proper treatment of the patients, supplemented by general State sanatoria. Since the identification of the disease is the first and most important step in its treatment and prevention, the establishment of dispensaries for the recognition of incipient cases among the dependent classes seems urgently called for. Such dispensaries should become the feeders for municipal and State sanatoria, and when properly conducted, with special reference to social service, will be a most important factor in the combat against tuberculosis. In all such cases it is desirable to sift charity from abuse; and it devolves upon the State to determine the financial condition of the applicant and also prevent destitution of the family while the bread-winner is incapacitated for work. It is also the duty of the State to suppress quackery, for no class falls more readily a prey to unscrupulous mountebanks than our consumptives. The Federal Government is already performing an important duty by exercising a watchful care over the subject of tuberculosis among animals. The preventive measures urged by the Bureau of Animal In dustry are of far-reaching significance, although primarily intended to protect the pocketbooks of our farmers and stockraisers. Large sums are annually, and very properly, expended to quarantine our seaports against cholera, yellow fever and smallpox because these diseases, if permitted to gain a foothold, occur in epidemics, are rapidly fatal, and hence strike terror into a community. It is to be hoped that similar opportunities will be afforded the Public Health Service to cope with tuberculosis, which claims more victims than all these diseases combined. In the actual care and treatment we also have a right to expect a more active participation on the part of the Federal Government. It is a notorious fact that thousands of helpless cases of consumption are annually dumped upon our States and Territories which have become famed as health resorts; and the hospitals, sanatoria and almshouses of the Carolinas, California, Colorado, Arizona and New Mexico are filled with indigent dying consumptives. It is claimed by Mr. Frank D. Witherbee, in "Charities," November 6, 1904, that in Phoenix, Arizona, public and private charity is taxed to the uttermost, and that three-quarters of the money expended on the inmates of the almshouse goes to alien consumptives. It is cruel and worse than useless to send a consumptive away from home without sufficient means to secure the ordinary comforts and advantages of climatic treatment, and the Federal Government should not tolerate it. But until this is prevented, the Public Health and Marine Hospital Service should be authorized to study the problem, which studies may form the basis for a more permanent and enlightened amelioration of the sufferings of this unfortunate class of victims. It is very evident that the great problem which confronts most of our sanatoria today is, what shall be done with the class of indigent patients whose disease has been arrested, but who need suitable employment and surroundings for their permanent recovery? While it is hoped that the opportunities of a co-operative system will broaden out in time in connection with the State sanatoria, it cannot be denied that certain sections in the far West offer suitable advantages for a permanent cure, and the question arises whether the Federal Government would not be justified in engaging in extensive live-stock raising and employ young men of this class to do the work? The Government needs horses and mules, beef and mutton, butter and dairy products for the public services. It has many valuable reservations, susceptible of cultivation with or without reclamation, and there is no good reason why such Government farms should not prove self-supporting. The results of the Government Sanatoria for consumptives at Fort Bayard, Fort Stanton and Fort Lyons have been so gratifying that substantial and permanent results may be hoped for by an expansion of the system to at least the civilian employees of the Government, along the lines indicated, or by the establishment of colonies for arrested cases. PNEUMONIA. Pneumonia ranks next in frequency to consumption as a cause of death. During the census year of 1900 there were 105,971 deaths from pneumonia in the United States. The records of the Health Department show that during the past 12 years there were 5,947 deaths from this disease in the District of Columbia, 2,632 white and 3,315 colored. The undue prevalence of pneumonia and tuberculous diseases of the respiratory system is general. The colored population shows a peculiar susceptibility, which is, in all probability, caused by environment and sociological factors rather than by racial differences. At all events, an attempt will be made, on page 120, to account for the undue mortality among our colored population. Pneumonia, like tuberculosis, is an infectious disease, and is caused by a microbe, first discovered by General George M. Sternberg in 1880, and subsequently demonstrated to be the essential factor in the causation of the disease. This germ, known as a micrococcus, is found in a considerable number in the mouth and saliva of perfectly healthy subjects, and in very great numbers in the phlegm which fills the air cells of the affected part of the lung, and is coughed up during the disease in the form of rusty sputum. The rusty appearance is due to the presence of blood corpuscles issuing from highly inflamed lung tissue. The danger in pneumonia depends upon the extent of lung tissue involved, the amount of toxins generated and absorbed, the condition of the heart and kidneys, and the general power of resistance of the patient. In the causation of the disease we are evidently dealing with several factors, viz., the presence of the micrococcus, individual predisposition and an exciting cause. Since the germ has been found in the mouths of perfectly healthy persons, and was in fact discovered by General Sternberg in his own saliva, we may conclude that the invasion of the microbe alone is not sufficient to produce the disease. If, therefore, an attack of pneumonia results, the patient must have furnished a suitable soil for the rapid multiplication of the germs, and the structural changes which are brought about by their agency. As in tuberculosis, so in this disease debilitating factors and depressing influences, such as malnutri tion, alcoholism and insanitary surroundings are important predisposing causes. But in addition to all this there must be an exciting cause. A careful study of the seasonal prevalence shows that pneumonia, like tuberculosis, bronchitis and congestion of the lungs is very much influenced by temperature, humidity and prevailing winds. The following chart of the Health Department shows deaths from pneumonia during 1906, arranged by months, compared with the average monthly deaths for the past ten years. This chart shows that the disease is especially prevalent during the colder months of the year, and reaches a minimum in June, July, August and September. It is well known that cold, and especially damp cold, winds are often the cause of catching cold, probably because they abstract bodily heat in proportion to their velocity, and if this takes place to an unusual degree, or with great abruptness, the capillaries of the skin contract, the blood is driven into the internal organs, and congestion results, usually in the weakest spot. As an additional effect of sudden changes in temperature, we have the suppression of the cutaneous function and consequent retention of effete matter in the blood. We can readily appreciate how all this may be aggravated by the habitual presence of alcohol in the blood current, which diminishes oxidation of the waste products, and also by overcrowding, because the effect of deficient air supply is not only to reduce the quantity of carbonic acid by expiration, but also to diminish the normal oxidation of effete matter. In any event, the conditions referred to favor the accumulation of effete matter, render the blood current sufficiently impure to lose its germicidal properties, and thus constitute a suitable fluid for the rapid multiplication of the pneumococcus invader. It is also evident that other depressing influences, such as previous illness, especially an attack of measles or of influenza, vastly increase the vulnerability of the tissues and chances of infection. This disease is doubtless communicable from sick to well persons, as shown by the occurrence of epidemics in prisons, institutions, etc.; indeed, its infectiveness is no longer a matter of doubt, and calls for prompt disinfection of the sputum and avoidance of close contact, in the manner already described in the care of tuberculous patients. While precautionary measures for the destruction of the germs are of great importance in stamping out the sources of infection, our aim must also be directed towards the correction of predisposing and exciting This we can do by clothing adapted to climate and seasons, proper housing conditions as regards heating and ventilation, proper food and temperate habits. The disease, unfortunately, is increasing in this country, and the increase is doubtless influenced by the increased causes. |