“A HISTORY. TC SA i 8 a ‘ NVANLND i) UBERCULO Sh ASSOCIATION WP UO) slic Gai) dah Lat RC one va Aik. Cornell University Library Ithaca, Nem York Date Due ! RC Ahistory of the National tuberculosis if 19 A HISTORY OF THE NATIONAL TUBERCULOSIS ASSOCIATION THE ANTI-TUBERCULOSIS MOVEMENT IN THE UNITED STATES By S. ADOLPHUS KNOPF, M.D. — NATIONAL TUBERCULOSIS ASSOCIATION 370 SEVENTH AVENUE NEW YORK CITY 1922 y Ee AS \\a bs COPYRIGHT, 1922, BY THE NATIONAL TUBERCULOSIS ASSOCIATION PRINTED IN U. S. A. WM. F. FELL CO: PRINTERS PHILADELPHIA woe “fn Jot SAS EO 3 Vids Wied yy PREFACE , “HE completion of fifteen years of the active work of the National Tuberculosis Association in January, 1920, seemed to me an opportune time for recording in some more or less permanent form a history of the beginning of the great anti-tuber- culosis movement in the United States and a record of the progress made. This is the reason for this volume. My own personal interest in tuberculosis work, extending over a quarter of a century, and my intimate acquaintance with the National Tuberculosis Association from its inception to its pres- ent development, led me to suggest to the Association that such a history should be written. The committee appointed to under- take the matter asked me to write the history and submit it to them for criticism, modification, and approval. The committee was composed of Dr. Hermann M. Biggs, Chairman, Dr. Henry Barton Jacobs, Dr. George M. Kober, Dr. Charles J. Hatfield, and the author. Each member of the committee has read and ap- proved the manuscript and offered helpful suggestions which have been incorporated in the text. Their suggestion that my own biography should be added was very flattering, but I have not complied with it for the following reasons: First, not having been an officer of the Association I was not entitled to appear among those who have held such positions; and secondly, there is nothing of sufficient importance in my own life to be worth recording. I have been a humble soldier in the war against tuberculosis which has been led by great generals. In the early days I had my trials and tribulations like all those who endeavor to do pioneer work. I have been amply rewarded for my work by the good will and friendship of my teachers and col-_ leagues and that of the officers and directors of the Association who have granted me the privilege of writing the history and have been helpful in making its publication possible. I have acceded to the request of my colleagues of the Historical Committee to add iii iv PREFACE to the tuberculosis bibliographies of the presidents, vice-presi- dents, secretaries, and treasurers a list of my own publications on tuberculosis. I hope the readers will bear with the length of it, as an excuse for which I may say that I have scarcely written on any other subject than tuberculosis. Thus my bibliography rep- resents in a measure my life’s work. I am particularly indebted to Dr. Philip P. Jacobs, the Publicity Director, for his helpful co-operation in writing the chapter on the Sixth International Congress, the biographies of Dr. Flick and Dr. Fulton, and several other chapters in Part I. He has also been most helpful in the preparation and editing of the entire work and in facilitating its printing and publication. The arrangement of the material and the rereading of the page proof were done by Dr. Philip P. Jacobs and his able assistant, Miss Eleanor B. Conklin. To both I desire to express my grateful appreci- ation. It would be ungracious on my part if I did not also express my grateful appreciation of the valuable information furnished by the relatives, friends, and pupils of our departed presidents and vice- presidents. I wish to extend my thanks to Professor John H. Finley, who helped me in writing the biographical sketch of Grover Cleveland, ex-president of the United States and honor- ary vice-president of the Association; to Mrs. Douglas Robinson, who sent me valuable data concerning her brother, Theodore Roosevelt, ex-president of the United States and honorary vice- president of the Association; to Lady Osler, Mrs. William C. Gorgas, Mrs. John H. Lowman, Mrs. Theodore B. Sachs, Mrs. George M. Sternberg for biographical notes and photographs of their late husbands; to Mrs. Mathilda Janeway Wisner for an excellent photograph, data, and notices of her father, the late Dr. Edward G. Janeway. To Dr. Edward R. Baldwin I am indebted for the bibliography of Dr. Edward Livingston Trudeau; and to Dr. David R. Lyman for a photograph of and a touching tribute to his teacher and friend, the late Dr. John P. Foster. Lastly I wish to express my grateful appreciation to Mr. George B. Christian, secretary to the president, and to Mr. Judson C. Welliver, the president’s private secretary, for their helpfulness in obtaining interesting data for the biographical sketch of Warren PREFACE v G. Harding, president of the United States and honorary vice- president of the National Tuberculosis Association. In preparing the history, I wrote first an introductory part, out- lining in a general way the beginning and development of the tuberculosis movement in general and the National Tuberculosis Association in particular, and including a section on the Sixth International Congress and a chapter on the work of the various state associations. The remaining parts of the book deal with the proceedings of the various annual meetings of the Association, the biographies of the officers, lists of their contributions to tuber- culosis literature, a description of the war work in tuberculosis of the Surgeon Generals of the U. S. Army, the U. S. Navy, and the U. S. Public Health Service, a list of books, pamphlets, and leaflets issued by the Association, and lastly, the tuberculosis bibliography of the author. In this way the history has become not a mere chronicle of events alone, but a record of the men who brought these events to pass. S. ADOLPHUS KnopF, M.D. New York, April 1, 1922. TABLE OF CONTENTS PREPACK a cnviating BAe eee Sea aide. ad or ee ears ied iam chee LIST OF ILLUSTRATIONS 5:5. cocci Saees nenee Léa wa ea eee eres PART I CHAP. Ear.y History AND DEVELOPMENT I. Beginnings..................05- ts ogee nen lau tg ate eas ae II. Organization of the National Tuberculosis Association....... Til. Barly Problemsis «sic acpnccin sine acid hci oa nattend sence gine dhoN IV. Development of the Association’s Program................. V. Organization and Methods................ 0.0 cece eee eee VI. The Tuberculosis Christmas Seal..............00..0.00005 VII. The Framingham Demonstration..................-...... VIII. The State Tuberculosis Associations... ................... IX. The Sixth International Congress......................005 X. The Double-Barred Cross.......... 0.00.00 cece eee ees PART II Tse ANNUAL MEETINGS OF THE NATIONAL TUBERCULOSIS ASSOCIATION Introductory Noté:.s seins aawe darken pie awe ae eee eee XI. First Annual Meeting............0.... 0. ccc eee XII. Second Annual Meeting..............060 00.0 cece XIII. Third Annual Meeting... ...........0. 0.00 ccc cece eee XIV. Fourth Annual Meeting................ 0.00. c eee ee XV. Fifth Annual Meeting. ...............0 0c ccc eect c eee e nee XVI. Sixth Annual Meeting. .........0.0.000 6c c cece eee eee XVII. Seventh Annual Meeting.............. 0... eee XVIII. Eighth Annual Meeting.................... 0. cece e ee ees XIX. Ninth Annual Meeting................ 0... c cece eee ee XX. Tenth Annual Meeting.............. 0.2.00 cece eee eee . XXI. Eleventh Annual Meeting................ 0.0.0.0. cece XXII. Twelfth Annual Meeting.......................0 00s eens XXIII. Thirteenth Annual Meeting..............0..0 00.00 cece eee XXIV. Fourteenth Annual Meeting.... ..................000005 XXV. Fifteenth Annual Meeting............... 00.0000. XXVI. Sixteenth Annual Meeting.............. 0... cece eee eee ee XXVII. Seventeenth Annual Meeting................. 00. e ee eee eee vii viii CHAP. XXVIII. XXIX. XXX. XXXI. XXXII. XXXII. XXXIV. XXXV. XXXVI. XXXVII. XXXVI. XXXIX. XL. XLI. XLII. XLII. XLIV. XLV. XLVI. TABLE OF CONTENTS PART III BIOGRAPHIES OF THE OFFICERS OF THE ASSOCIATION PAGE Tntroductory Notes cscs sem cee en sosige needs ae ceawed aaee 271 Grover Cleveland, Honorary Vice-president of the National Tuberculosis Association from 1905 to 1908............. 273 Theodore Roosevelt, Honorary Vice-president of the National Tuberculosis Association from 1905 to I919............. 277 Sir William Osler, Bart., M.D., LL.D., Honorary Vice-presi- dent of the National Tuberculosis Association from 1905 to 1999 ices esi tmchaagrsw dees Seaceeehiera nen een u se ge 284 Colonel George E. Bushnell, M.C., U.S.A., Honorary Vice- president of the National Tuberculosis Association from DOUG sos sated od gh acid Bhat Bala ce aseretes avec ts ened a DU ene CES hata Sete 295 Major General William C. Gorgas, M.C., U.S.A., Honorary Vice-president of the National Tuberculosis Association in LO2O wastes duvins ew sees Be ake Rana ay Guana ad 302 Warren G. Harding, Honorary Vice-president of the National Tuberculosis Association, 1921............0 000 ccc ce eeee 308 Edward Livingston Trudeau, M.D., President of the National Tuberculosis Association from 1904 to 1905............. 313 Hermann M. Biggs, M.D., LL.D., President of the National Tuberculosis Association from 1905 to 1907............. 323 Frank Billings, M.D., Sc.D., President of the National Tuber- culosis Association from 1907 to 1908.................. 330 Vincent Y. Bowditch, M.D., President of the National Tuber- culosis Association from 1908 to 1909.................. 332 Edward G. Janeway, M.D., President of the National Tuber- culosis Association from 1909 to I910.................. 336 William H. Welch, M.D., LL.D., President of the National Tuberculosis Association from 1910 to I9II............. 341 Mazyck P. Ravenel, M.D., President of the National Tuber- culosis Association from I91I to I1912.................. 347 Homer Folks, LL.D., President of the National Tuber- culosis Association from 1912 to 1913...............005 351 John H. Lowman, M.D., President of the National Tubercu- losis Association from 1913 to 1914............0.. 00005 355 George M. Kober, M.D., LL.D., President of the National Tuberculosis Association from 1914 to 1915............. 360 Theodore B. Sachs, M.D., President of the National Tuber- culosis Association from 1915 to April, I916............. 366 Edward R. Baldwin, M.D., President of the National Tuber- culosis Association from 1916 to 1917.............--0 371 Charles L. Minor, M.D., President of the Nation! Tuber- culosis Association from 1917 to 1918.................. 376 CHAP. XLVII. XLVIII. XLIX. L. LI. LIT. LIT. LIV. LV. LVI. LVII. LVIII. LIX. LX. LXI. LXII. LXIII. LXIV. LXV. LXVI. LXVII. LXVIII. TABLE OF CONTENTS ix PAGE David R. Lyman, M.D., President of the National Tubercu- losis Association from 1918 to I91I9..... 2.2... 22 eee 379 Victor C. Vaughan, M.D., President of the National Tuber- culosis Association from 1919 to 1920...............055 382 Gerald B. Webb, M.D., President of the National Tubercu- losis Association from 1920 tO 1921.......00.0... eae 386 James Alexander Miller, M.D., President of the National Tuberculosis Association from 1921 to 1922............. 390 General George M. Sternberg, M.C., U.S.A., Treasurer of the National Tuberculosis Association from 1904 to I912..... 393 William Henry Baldwin, Treasurer of the National Tubercu- losis Association from 1912 tO 1919. .........000ee eee 398 Henry Barston Platt, Treasurer of the National Tuberculosis Association from 1919... 0.0.0... cece cece eee e nn eee 401 Henry Barton Jacobs, M.D., Secretary of the National Tuber- culosis Association from 1904 tO 1920............---05- 402 Livingston Farrand, M.D., Executive Secretary of the Na- tional Tuberculosis Association from 1905 to 1914....... 406 Charles J. Hatfield, M.D., Executive Secretary and Managing Director of the National Tuberculosis Association from - TOUAY Gains aetis end Na Sawa eS Ranta ee Maa 410 Philip P. Jacobs, Ph.D., Publicity Director of the National Tuberculosis Association... 6.0.0.0... 2... c eee ee eee eee 413 Donald B. Armstrong, M.D., Second Assistant Secretary of the National Tuberculosis Association since 1916..¢..... 416 John S, Fulton, M.D., Secretary General of the Sixth Inter- national Congress on Tuberculosis..................... 419 Lawrence F. Flick, M.D., Vice-president of the National Tu- berculosis Association from 1905 to 1908............... 421 John P. C. Foster, M.D., Vice-president of the National Tuberculosis Association from 1907 to 1908............. 428 Edward Thomas Devine, Ph.D., LL.D., Vice-president of the National Tuberculosis Association from 1909 to I9IO..... 430 Henry Sewall, M.D., Ph.D., Sc.D., Vice-president of the National Tuberculosis Association from 1909 to I910.... 432 George Dock, M.D., Sc.D., Vice-president of the National Tuberculosis Association from 1910 to IQII............. 434 John M. Glenn, A.M., LL.D., Vice-president of the National Tuberculosis Association from 1911-1912 and 1919-1920.. 436 G. Walter Holden, M.D., Vice-president of the National Tuberculosis Association from 1911 to I912............. 437 Robert H. Babcock, M.D., LL.D., Vice-president of the National Tuberculosis Association from 1912 to I1913..... 440 Mabel T. Boardman, A.M., LL.D., Vice-president of the National Tuberculosis Association from 1913 to 1914..... 443 x? TABLE OF CONTENTS CHAP. PAGE LXIX. Lee K. Frankel, Ph.D., Vice-president of the National Tuber- culosis Association from 1914 tO 1915...............00- 445 LXX. W. Jarvis Barlow, M.D., Vice-president of the Natjonal Tu- berculosis Association from 1914 to I9I5............... 448 LXXI. Christen Quevli, M.D., Vice-president of the National Tuber- culosis Association from 1915 to 1916................05 450 LXXII. Watson S. Rankin, M.D., Vice-president of the National Tu- berculosis Association from 1916 to 1917............ +. 451 LXXIII. Frederick L. Hoffman, LL.D., Vice-president of the National é Tuberculosis Association from 1917 to 1918............. 453 LXXIV. Lawrason Brown, M.D., Vice-president of the National Tu- berculosis Association from 1918 to 1919............... 456 LXXV. Alfred Meyer, M.D., Vice-president of the National Tuber- culosis Association from 1916 to I91I9.............00055 461 LXXVI. Philip King Brown, M.D., Vice-president of the National Tuberculosis Association from 1920 to 1921..... ee ace. 463 APPENDIX I Anti-Tuberculosis Work Done During and After the World War by the Surgeon Generals’ Offices of the U. S. Army, the U.S. Navy, and the U.S: Pubhe Health Sérviteis.ccscsccs adios oe mevinies daar waeaea’s 467 APPENDIX II List-of Publications of the National Tuberculosis Association.......... 476 APPENDIX III Bibliography of the Author, S. Adolphus Knopf, M.D........... menial: 479 LIST OF ILLUSTRATIONS FACING PAGE “The Little Red Cottage” where Trudeau began his Sanatorium....... 10 National Association Offices... 0.0.0.0... ccc cece cece eee n eee enee 36, 42 Mrs. Harding buys Christmas Seals from a Modern Health Crusader... 62 Grover Cleveland s.cn4s sekcsutedsumeseins tei eee caaeda eos wees 4 274 Theodore Rodsevelt sec o.v624 cdi te oad Gahadabasaagoaweehataeawetedie 278 Sire Willies tei SNE 5 ioc soi dhanisre ek ace s05 ossue oy irae nledbe anese ys Rnelabar visu ceigd by arenas 284 American Delegation at the Tomb of Louis in 1905................... 288 George. E. Bushell socaueivid eevee dene ve Rar an tae cue Sarees eee 296 William? C, Gorgas» i:ay.cn cdagiexde ees eehedeaatSaeot ameateney eters 302 WatrenG: Harding 05 ¢0 045 es cswees pone omnes teMee OL as eemeree me Le 308 Edward Livingston Trudeau.......... 0.0... eee eee eect eens 314 Monument to Edward Livingston Trudeau.................0-.00 0 320 Hermann: M; Bisesa. cscs ces age ees etn ay oe CS Ee SS ee oe See 324 Frank: Billings). ... APRIL 1, 1921,! the staff of the National Association consisted of 19 members of the administrative force and 33 members of the clerical force. The present executive force is organized into six services as follows: 1. Administrative Service—The head of the Administrative Service is Dr. Charles J. Hatfield, Managing Director, and imme- diately under him is Mr. Frederick D. Hopkins, the Administra- tive Secretary. All of the problems of administration of the Asso- ciation, including the business management of the office, the hand- ling of supplies, and the general supervision of all other services fall under the administrative service. In addition to Dr. Hatfield and Mr. Hopkins, the administrative service has the following members: Mr. S. M.Sharpe, Business Manager; Mr. L. B. Whit- comb, Purchasing Agent; Miss Grace Douglass, Office Secretary, and Miss Amelia T. Dutcher, Administrative Assistant. 2. Field Service-—The field service is the outgrowth of the original exhibit started by the National Association in the winter of 1905. Following the extensive educational campaign and the demand for organization the Association was called upon to an increasing degree not only to organize, but also to help promote programs of work in different parts of the country. In 1918, at the specific request of certain states, the Association extended its field service by establishing five branch or regional offices in dif- ferent parts of the country. In the summer of 1920 it was found necessary to discontinue these offices because of lack of funds. The service, therefore, at present consists simply of Mr. Arthur J. Strawson, Supervisor of Field Service, stationed at the home office. The field service fulfils the valuable function of not only keeping the executive office in closer touch with the various state and local activities, but also in bringing to bear upon state and local activities the very facilities of the executive office. 1For staff on January 1, 1922, see Chapter X XVII. 47 48 A HISTORY OF NATIONAL TUBERCULOSIS ASSOCIATION 3. Modern Health Crusade Service—The Modern Health Crusade Service conducts the Crusade. The service prepares literature and works out the plans for national supervision and conduct of the movement. As at present organized the service consists of Mr. Charles M. De Forest, Crusader Executive; Miss M. Grace Osborne, Assistant Crusader Executive; and Miss Mil- dred Terry, Assistant Crusader Executive. 4. Medical Service—The medical service is one of the newest developments of the Association. It is an outgrowth of the de- mand on the part of state and local associations that more atten- tion be given to the medical problems involved in tuberculosis control. The service is headed by Dr. H. A. Pattison. Mr. T.B. Kidner, Institutional Secretary, serves the field as adviser to sana- toria in matters of construction and maintenance, and also occu- pational therapy and vocational training. Miss Mary E. Mar- shall, Secretary for Nursing, is specifically entrusted with the responsibility for standardizing and stimulating tuberculosis nursing service. Dr. Benjamin K. Hays, a fourth member of the service, is in charge immediately of the educational work in cer- tain of the Army and U. S. Public Health Service Hospitals. 5. Research Service.—The research service is designed to an- swer the numerous questions that pour into the executive office from individuals and organizations in every part of the world. The personnel of the service at the present time consists of Miss Jessamine S. Whitney, Research Secretary, who works particu- larly on statistical research; Miss Eleanor B. Conklin, Research Secretary, whose particular responsibility is editing and review- ing; and Miss Isabel L. Towner, Librarian, who is responsible for cataloguing, indexing, and handling all of the library files and records. 6. Publicity and Publications Service.—The publicity and pub- lications service is charged directly with the distribution of educa- tional and publicity material, the conduct of the Christmas Seal Campaign, the conduct of membership and financial appeals, the handling of the free publications of the National Association, and the editing and management of all periodicals. Philip P. Jacobs, Ph.D., Publicity Director, is head of this service. In addition to Mr. Jacobs, the service consists of Mr. B. G. Eaves as Campaign ORGANIZATION AND METHODS 49 Secretary, Miss Helena V. Williams and Miss Elizabeth Cole as Assistant Publicity Secretaries. The service has a varied respon- sibility: It not only puts out the newspaper publicity, but it organizes campaigns and furnishes educational material, such as motion pictures, slides, scrap-books on methods of anti-tubercu- losis work, etc., and in addition edits the monthly Bulletin, the Journal of the Outdoor Life and the Transactions, and handles the business details of these publications and the American Review of Tuberculosis. The managing editor of the Review, Dr. Allen K. Krause, with offices in Baltimore, and the abstract editor, Dr. George Mannheimer, are on the staff of this service. In addition to the six services, the National Association is responsible for the Framingham Community Health and Tuber- culosis Demonstration. Dr. Donald B. Armstrong, Associate Secretary of the Association, is the Executive Officer, and Dr. P. Challis Bartlett, the Medical Director, with offices in Framing- ham. The methods of work of the Association may be briefly sum- marized as follows: 1. Correspondence and Personal Conference—By this means direct questions concerning problems of work as between states and local committees are taken care of. 2. Conferences and Meetings.—Besides its annual meeting, the Association holds six sectional conferences in each of the six dis- tricts into which the country has been divided and in addition several special conferences and institutes where groups of workers may receive intensive training and discuss specific problems. 3. Distribution of Newspaper Publicity, Literature, Motion Pic- tures, etc—By this means the Association endeavors to interest the public concerning the treatment and prevention of tubercu- losis. 4. Field Visits and Conferences Through the Regional Secretaries and Members of the Home Office Staff—This work is designed to take up the specific problems of interest in each state and to help a local group in settling its difficulties and solving its problems. 5. Publications—The Association has three monthly publica- tions: the monthly Bulletin, published primarily for workers in the field; the Journal of the Outdoor Life, a popular journal for 4 50 A HISTORY OF NATIONAL TUBERCULOSIS ASSOCIATION laymen and anti-tuberculosis workers; and the American Review of Tuberculosis, a medical journal for physicians and those inter- ested in the scientific phases of tuberculosis. In addition, the Association publishes an annual volume of Transactions and fre- quent monographs on certain specific topics of vital interest to people engaged in the tuberculosis field. 6. Research.—The Association is constantly engaged in medical and social research, both through its home office and through its members and workers in the field at large. The results of this research are published in monographs, in the Transactions, in the various journals of the Association, and elsewhere. 7. Clearing-house.—The Association acts as a general clearing- house for information on several phases of the tuberculosis move- ment. Its staff consists of specialists in various kinds of work who help in the solution of problems dealing with institutions, education, organization, medicine and other phases of the cam- paign. 8. Modern Health Crusade.—The Association has organized and is the national director of the Modern Health Crusade, a move- ment for the training of children in proper health habits. 9. Publicity—By means of newspaper publicity, and through the promotion of the use of exhibits, motion pictures, lantern slides, etc., the Association stimulates educational work in various parts of the field. 10. Experimental and Demonstration Work.—The Association has for three years been conducting a demonstration on the con- trol of tuberculosis at Framingham, Mass., with the idea of trying to show how a normal American town may best control tubercu- losis within its own limits. PROGRAM AND POLICIES The National Association has always conceived its function in relationship to the other agencies in the field to be that of a ser- vant rather than that of a master or autocrat. While most of the tuberculosis agencies throughout the country owe their existence directly or indirectly to the National Association, the Association has no branch organizations. In 1921 the by-laws of the Associa- tion were amended to provide for definite representation of State ORGANIZATION AND METHODS 51 associations on its directorate, thereby giving to these organiza- tions a more controlling interest in the national program and policies. The thousand or more State and local associations are affiliated with it, but are entirely autonomous. The National Association has endeavored through the Christmas Seal Sale and in other ways to secure funds for the support of State and local work and because of this has sought to secure the wisest possible expenditure of such funds, but it has always deemed it the func- tion of the State and local organization to determine the general way in which its funds should be spent. The program of the National Association in general includes the organization of a local unit for the control of tuberculosis to cover every section of the United States. Such local communities will not be uniform either as to their administrative control or as to their size. Some of them will cover large areas, some of them relatively small areas. On the other hand, the National Associa- tion realizes that tuberculosis is essentially a local problem, and that the people must be reached through local channels. The National Association may furnish the ideas for organization, the standards of work, suggestions regarding program and methods, but the ultimate achievement of the work must be local. Recognizing that tuberculosis in its various social ramifications reaches almost every avenue of industrial and community life, the National Tuberculosis Association has adopted as a general policy the broadest possible codperation with public health and social agencies that are seeking to relieve human suffering and promote community betterment. With this idea in mind, formal policies of codperation have been worked out between such groups as the American Red Cross, the Conference of State and Territorial Health Authorities, the National Organization for Public Health Nursing, and others. In line with this policy, the Association has become a member of the National Health Council and the National Child Health Council. In April 1921, it moved into new quarters and became associated in certain common services with the American Social Hygiene Association, the National Committee on Mental Hy- giene, and the National Organization for Public Health Nursing, all these organizations occupying adjoining offices on the same 52. A HISTORY OF NATIONAL TUBERCULOSIS ASSOCIATION floor. These joint services are being developed under the direc- tion of a Common Service Committee consisting of representa- tives of the four organizations and the National Health Council. FINANCIAL SUPPORT The financial support of the National Tuberculosis Association is derived from three sources: (a) A percentage of the sale of Tuberculosis Christmas Seals, usually amounting to 5 per cent. of the gross sale; (b) membership dues and donations; and (c) sale of supplies. The Association receives no government subsidy or appropriation, except where it does a special piece of work and is compensated therefor. Any reputable physician in good medical standing and any lay- man who is interested in the control of tuberculosis and is not engaged in an enterprise foreign to the ideals of the Association is welcomed to membership in the National Association. The membership dues are $5.00 per year. Members of the Association are entitled to receive a number of valuable publications, includ- ing the Journal of the Outdoor Life, a monthly magazine and the official organ of the Association and the monthly Bulletin of the Association, as well as various publications which are issued from time to time, such as the Transactions, Tuberculosis Direc- tory, and various special volumes and studies. Members are also entitled to receive the American Review of Tuberculosis, an- other monthly publication of the Association, at the reduced price of $3.00 per year (price to non-members, $6.00 per year). Checks should be drawn to the order of Henry B. Platt, Treasurer, and should be sent to 370 Seventh Avenue, New York City. An active organization doing such extensive humanitarian work as ours cannot and should not depend for a considerable portion of its entire financial support on the small annual dues of its mem- bers. We must look to our well-to-do fellow-citizens for sub- stantial help to carry on our work effectively. We should have a larger number of life members to assure a permanent income to the Association, but bequests of larger and smaller amounts are also needed. It would be ungracious to close this historical review without paying our tribute and expressing our gratitude to the men and ORGANIZATION AND METHODS 53 women who have made the Association what it is to-day. In 1904 the Association started with a membership of 26; to-day we have 25 life members and over 3,500 regular members. Among the life members, many of whom have contributed $5,000 or more, we have such names as Finley Barrel, Chicago; George Blumen- thal, New York; F. A. Clark, New York; Harvey Edward Fisk, New York; Henry C. Frick,* New York; Edward S. Harkness,* New York; Emma Gale Harris, Chicago; Henry L. Higginson,* Boston; Mrs. H. Knickerbacker, New York; Ejnar Larsen, Wayne, Neb.; Henry C. Lea, Philadelphia; Adolph Lewisohn, New York; Cyrus H. McCormick, Chicago; V. Everit Macy, New York; Martin Maloney, Philadelphia; Louis Marshall, New York; Samuel Mather, Cleveland; Francis E. May, Chi- cago; Henry Phipps, New York; John D. Rockefeller, New York; Jacob H. Schiff,*¥ New York; L. F. Swift, Chicago; Rodman Wanamaker, Philadelphia; Felix M. Warburg, New York. Prior to June, 1904, there were in the United States 23 tuber- culosis associations and committees, to-day there are over 1,100 associations. Before our Association was organized, there were in the United States 96 sanatoria and special hospitals, 24 tuber- culosis dispensaries, no open-air schools, no preventoria. There are now nearly 700 sanatoria, special hospitals and camps; over 550 tuberculosis dispensaries; at least 3,000 open-air schools and fresh-air classes, and more than 15 preventoria. In 1904 there existed no tuberculosis nurses, to-day we have about 3,500 spe- cially trained tuberculosis nurses. From the humblest citizen to our greatest philanthropist, from the lowliest medical or social worker to the highest authority on tuberculosis, all, who by their affiliation with us, their financial help or personal service, have shown their interest in our work, deserve our most heartfelt thanks. What has been said in the preceding pages of our various achievements and what the statistics just given show of the growth of the anti-tuberculosis movement in the United States since the formation of our society, indicate that much has been done. There is, however, more todo. Let every one who is able * Deceased. 54 A HISTORY OF NATIONAL TUBERCULOSIS ASSOCIATION to help bear in mind that tuberculosis is a disease of all people, rich and poor, the educated and uneducated; that it is not con- fined to climates or races, but that it is universal; and that every one should be interested in combating it. Even those with no means can help by acquainting themselves with the simple pre- cautions to prevent the disease and by imparting what they know to others who do not know. Personal service is as essential as financial aid in fighting the great white plague. Pasteur, to whom the world owes so much as the father of modern preventive and curative medicine, has pointed out our duties in the following words: ‘‘En fait de bien da répandre, le -devoir ne cesse que la ov le pouvoir manque.’”’ (In doing good the duty ceases only when the power fails.) CHAPTER VI THE TUBERCULOSIS CHRISTMAS SEAL HE compelling force of an idea is nowhere better illustrated than in the history of the tuberculosis Christmas seal. The seal grew out of one woman’s interest in a small tuber- culosis hospital in Wilmington, Del. From that original idea and interest have developed the funds which have made the tuberculosis campaign in the United States what it is to-day. Starting with an initial sale of $3,000, the Christmas seal idea has produced over $20,000,000, largely for the benefit of the non- official local, state and national tuberculosis associations. It was in 1907 that Jacob A. Riis received from a friend in Copenhagen a letter bearing on its back a peculiar seal. He wrote to his friend for further information and then published an article in the Outlook on the Norwegian tuberculosis Christmas seal. In Wilmington, Del., Miss Emily P. Bissell with Dr. John Black was struggling to maintain a tuberculosis shack of eight beds on the banks of the Brandywine. As she read the article in the Out- look, an inspiration came to her that here was a good way to secure money for the tuberculosis camp. She interested Howard Pyle, the famous artist, who produced an attractive design. She then approached the Philadelphia North American, which has a wide circulation in Wilmington and surrounding territory, and secured its support of the idea. With Miss Bissell’s en- thusiasm and the Philadelphia North American's backing, this initial Christmas seal sale produced the sum of $3,000. The success of this first seal sale gave to Miss Bissell the idea of a wider extension of the Christmas seal plan. She had always been an enthusiastic supporter of the American Red Cross and at that time was secretary of the Delaware Chapter. She took the matter up with Washington headquarters and found the officials at first inclined to be unresponsive and fearful of ventur- ing into a nation-wide Christmas seal project. Miss Bissell, however, urged upon them the necessity for a peace-time pro- gram and pointed out that interest was being aroused in tubercu- 55 56 A HISTORY OF NATIONAL TUBERCULOSIS ASSOCIATION losis by the recently formed National Association for the Study and Prevention of Tuberculosis and by the organization for the International Congress on Tuberculosis. She even offered to finance the initial production of a national Christmas seal. Asa result, in 1908 the first nation-wide seal sale was held. The sale was conducted very largely under the direction of women’s clubs and Red Cross chapters. About $135,000 was realized from this sale. The Red Cross was at once convinced of the immediate possibilities of the seal. In 1909 the second seal sale was held and over $200,000 was realized. Up to this time the American Red Cross had considered the seal as peculiarly its own. The National Tuberculosis Associa- tion at that time was struggling for existence. It was not as widely known as the Red Cross. Its program was still far from being fixed and its organization was faulty. For the most part it was passing through that necessary early stage of extensive edu- cation and had not yet arrived at the second stage of intensive organization. In r910, however, Dr. Livingston Farrand, then executive secretary of the National Tuberculosis Association, approached the American Red Cross and suggested a liaison arrangement be- tween that organization and the National Tuberculosis Associa- tion. As a result of these negotiations the two organizations entered into what was virtually a partnership arrangement which, because of the far-seeing vision of its framers, has proved to be the most effectual policy in the development of the tuberculosis movement in the United States that could possibly have been devised. Because of their historical significance, copies of letters under date of June 25 and August 6, 1910, creating this initial agreement and signed by Ernest P. Bicknell, then National Director of the American Red Cross, are quoted in full: Dr. Livingston Farrand, iia Executive Secretary, National Association for the Study and Prevention of Tuberculosis, 105 East 22nd Street, New York, N. Y. Dear Dr. Farrand: Pursuant to my promise to you when in New York the other day I am writing to elaborate somewhat the idea which I had as to a co-operative ar- THE TUBERCULOSIS CHRISTMAS SEAL 57 rangement between your Association and the Red Cross in the conduct of the Christmas stamp campaign. In deciding upon retaining 1214 per cent. as the Red Cross proportion of the gross sale of Christmas stamps this year, we went into the matter of expenses and the probabilities of the sale with a good deal of care. Last year we sold, in round numbers, twenty-five million stamps. This year, if we sell ten million stamps, the 12% per cent. will just cover our outlay. It may not cover the time of our regular force devoted to the work of the campaign but will cover our actual expenditures for printing, postage, express charges and extra services. Should we sell as many stamps this year as we sold last, our 121% per cent. would bring us a profit of probably $18,000 after all expenses have been deducted. Our study of the outlook does not lead us to expect a sale so large as that of last year. It will probably be considerably smaller and may be very much smaller. Several factors enter into our conclusion that the sale this year will show a falling off. One factor is the probability that there will be a large number of rival stamps in the market. Weare told that in a number of States the State Federation of Women’s Clubs are considering the issuing of stamps of their own, the proceeds to be used in promoting such interests as the Wo- men’s Clubs may be pursuing at the time. As the Women’s Clubs in the past have been a strong help in the sale of our Red Cross stamps, their defection would very seriously hurt our sale in any State in which they issued a stamp of their own. In the State of Kentucky, for instance, the State Tuberculosis Society wrote us that the Federation of Women’s Clubs was likely to issue its own stamp in which case the Tuberculosis Society would feel that it must cast in its lot with the Federation and discontinue the sale of Red Cross stamps. This is but an illustration of what may possibly occur in several states. Another factor is the passing of the vogue of the Christmas stamp. We cannot positively assert that the tide has reached its height and begun to ebb, but there are some indications that it has. The most important indication is to be found in the fact that in 1909 some of our more important agencies sold fewer stamps than in 1908 and are expressing doubt as to the success of the campaign this year. The increase last year in total sales over the year before was due in part to a sustained interest and in part to the awakening of new interest in territory which was not reached in 1908. Last year, however, we entered most of the territory of the country from which large returns could be expected and I feel that we cannot reasonably expect any great growth this year through entering new fields. The issuance of a multiplicity of rival stamps, many of them purely local in character, will not only interfere directly with our sale but will tend to surfeit the public with the whole stamp business. A third factor to be considered is the recent ruling of the Post Office Depart- ment which is that non-postage stamps must not be affixed to the face of any envelope or mailed package. This fact must be emphasized in our advertising and is an item which adds somewhat to the complexity of the situation. Many people will overlook this prohibition and their letters will be returned to them or forwarded to the dead letter office. The result will be discontent, 58 A HISTORY OF NATIONAL TUBERCULOSIS ASSOCIATION newspaper complaint and something of a lessening of enthusiasm on the part of those in charge of the sale of stamps in the various localities. Other factors may occur to you, but I need not weary you further on this point. I speak of it somewhat fully in order that you may understand quite fully why we are not expecting so large a sale of stamps this year as last. Whether these diverse influences will slightly or greatly affect the sale is a matter largely of conjecture. I should hope that the active participation of your organization in the cam- paign through its direct and indirect influence might serve in some measure to stem the receding tide. If we enter into a co-operative arrangement, such as I have mentioned, we shall, of course, hope for your very active and enthusi- _ astic support in every practicable way. I should be glad if you will write me something of the methods and machinery by which you feel that you could help in the campaign. The publicity work which we have heretofore main- tained has consisted broadly of two forms. One is made up of the various posters, placards and envelope slips which are distributed to the agents in such quantities as may be ordered. The other consists of newspaper articles, pub- licity circulars, containing miscellaneous collections of stories and items which the agents in turn may give out to their local press as they see fit, lantern slides for use in motion picture shows, etc. The printing of the posters, placards, envelope slips, etc., can probably better be carried out and the distribution made by the Red Cross as heretofore. In the miscellaneous publicity matter for the press, it seems to me that you can be of very great assistance. Through your publicity channels, which are extensive, you can give wide circulation to such matter as we prepare, as well as that which you prepare yourself. On this side of the work we should hope for especial benefit from our relations with you. Last year our publicity circulars were put up in the form which the word “‘circular’”’ suggests. This year we have thought it wiser to issue publicity stuff in the form of galley proofs. Upon this point, however, we shall be glad to have your judgment and fo put our matter into uniform shape with yours or into such shape as your experience indicates to be the best. , I probably have failed to cover some points which may arise in your mind but no doubt have given you in general a fair idea of what we are thinking of. At your convenience I shall be glad to hear from you as fully as may’be. Yours very truly, (Signed) Ernest P. BICKNELL, National Director. * * * * * * * * * * a * * * * * * * * August 6, I910. Dr. Livingston Farrand, Executive Secretary, National Association for the Study and Prevention of Tuberculosis, 105 East 22nd Street, New York. Dear Dr. Farrand: I am now prepared to propose to your association that the Red Cross will divide equally with you the net profits of the Christmas seal sale in the season of 1910. The Red Cross will first pay all its expenses in connection with the conduct of the work and then divide equally with you the remainder. THE TUBERCULOSIS CHRISTMAS SEAL 59 From you we will expect the heartiest of co-operation, to be made as practi- cal and effective as possible. We shall hope that you will not only use your active influence in getting the tuberculosis agencies throughout the country enthusiastically lined up for the Red Cross Christmas seals, but shall hope to have a great deal of valuable help from your publicity department. I may add that we are hearing from a good many important tuberculosis organizations which are applying for the agency for the seals this year and that the prospects for a good year seem to be promising. I should be glad if you will have all the tuberculosis societies in the country notified of this arrangement for the division of net proceeds if the plan meets with your acceptance. In sending out a notice, it would perhaps be well for you to call attention to the fact also that the Red Cross percentage is only 12% per cent. this year as against 20 per cent. last. If you care to mention the fact, you might state that there will probably be greater profit to the tu- berculosis societies this year in handling the Red Cross seals than in getting ‘out seals of their own and that in addition to this inducement there is also the advantage that the National Tuberculosis Association is to share in the profits. I am taking the liberty of sending a copy of this letter to Kingsbury. for his information. Yours very truly, (Signed) Ernest P. BICKNELL, National Director. * * * * * * * * * * * * * * * * * * * A copy of a letter from Dr. Farrand to Mr. Bicknell under date of April 26, 1911, following the sale of 1910, is also of vital interest in showing the further development of Christmas seal relations and policy: April 26, 1911. Mr. Ernest P. Bicknell, 715 Union Trust Building, Washington, D. C. Dear Mr. Bicknell: Referring to our conversation the other day I wish to say that I have con- ferred with the Executive Committee of the National Association and we are ready to take over, as you suggested, the responsibility for the appointment of agents for the sale of Red Cross Christmas seals for the coming year. As soon as may be, I think it would be advisable for us to have a conference upon details and methods of conducting the campaign for this season. A number of suggestions of value have naturally come in from various agents during the year which call for attention. There is one matter of chief importance which I think we ought to consider with care. There was, as you know, last year a very considerable amount of dissatisfaction, well or ill grounded as the case may be, on the part of some of the important agents in different parts of the country. As nearly as I can analyze the reasons for this dissatisfaction they were based upon a feeling 60 A HISTORY OF NATIONAL TUBERCULOSIS ASSOCIATION that the business administration of the campaign was not as satisfactory as it might have been. I do not sympathize with this attitude to any great extent, although I am bound to say that in certain instances the point was well taken. I feel nevertheless that in order to retain and increase the interest of all con- cerned something must be done to meet and allay these sentiments. In view of this situation I should like to offer for the consideration of the National Red Cross the following propositions: ‘It is obvious that the ultimate responsibility for and control of the Christ- mas seals should rest in the National Red Cross. It seems equally obvious that the co-operation of The National Association for the Study and Preven- tion of Tuberculosis is essential to results in any way approaching the possi- bilities of the situation. The co-operation last year showed the good results which can be obtained and we all feel sure that this success can be heightened in the future. It is also clear, I think, that negotiations with the state and local tuberculosis associations who become the agents for the sale of the Red Cross seals can best be carried on by the National Association on account of our more or less constant and intimate relations. Would it not be better therefore if the entire administration of the Christ- mas seal campaign were placed in the hands of the National Association acting as National agent for the Red Cross? Without going into the matter in its details it would seem to me a desirable and workable proposition. My idea would be that the National Red Cross having decided upon a seal should delegate the entire administration of the campaign to the National Association, reserving the right to approve or disapprove all matters of general policy and expenditure and to be the body of ultimate authority throughout. On the other hand the details of administra- tion, dealings with individual agents, ordering, printing and shipping seals and advertising material, when once approved by the Red Cross, to be carried out by the National Association. The financial responsibility and distribu- tion would remain, presumably, as at present. Should such a proposition be favorably considered by the National Red Cross it would seem to me probably the part of wisdom to open a special office for the period of the campaign in Washington for handling the work. The preliminary negotiations with agents and publicity campaign could probably best be administered from the New York office of the National Asso- ciation. I think this would be the most satisfactory and most workable plan that could be devised. Will you not take it up with your Board and give it careful consideration? May I add that I think the sooner we can plan our campaign for next season the better? We are taking up now the question of agents in a preliminary way and hope to have the matter practically settled in the early summer. The sooner all such questions as the design of the seal, contracts for printing, the kind of advertising material to be prepared and the many details to be decided upon can be settled the more successful, I feel sure, the campaign will be. I might add that at a meeting of the Board of Directors of the National THE TUBERCULOSIS CHRISTMAS SEAL 61 Association held last week I was empowered to act in this matter and can therefore say that we are ready to assume the added responsibility should the Red Cross view the proposition with favor. Yours very truly, (Signed) Lrvincston FARRAND, Executive Secretary. As will be noted from the correspondence under the agreement between the American Red Cross and the National Tuberculosis Association, the latter organization became the general agent of the Red Cross for the sale of Christmas seals with the privilege of appointing such other state or local agents as it might desire, and with full power and responsibility for controlling the expenditure of the funds derived from the Christmas seal sale. In other words, the policy of the American Red Cross in the Christmas seal sale from the beginning until the termination of this agree- ment was to act always in the capacity of general sponsor for the seal sale, leaving to the National Tuberculosis Association the widest possible latitude in the achievement of results from the funds derived through this method. It is a matter of interesting record that the sponsors of the Christmas seal sale both in the American Red Cross and the National Tuberculosis Association considered it in its earlier days largely a fad which would soon die out and would have to be replaced by some other means of raising money. The reason why the Christmas seal outlived that dangerous fad period of develop- ment and has become a permanent institution in American com- munities is organization, spelled in large letters. From 1910 until 1919 the American Red Cross and the National Tuberculosis Association maintained their virtual partnership in the Christmas seal sale. Each year an annual conference of state and other interested executives was held, usually at Washington, and plans for the Christmas seal sale of the ensuing year were perfected. The increasing development of the seal sale meant an increasing investment of funds for the printing of the seals and advertising matter. The Red Cross assumed this financial re- sponsibility each year, reimbursing itself out of the returns of the seal sale. In 1918 no national Christmas seal sale was conducted. In 62 A HISTORY OF NATIONAL TUBERCULOSIS ASSOCIATION July of that year the American Red Cross approached the Na- tional Tuberculosis Association with the suggestion that the seal sale be discontinued for the following Christmas.. After a series of conferences, in September an agreement was reached whereby the Red Cross appropriated the sum of $2,500,000 to the tuberculosis movement in the United States to be distri- buted by the National Tuberculosis Association to the states and through the states to the local associations. This sum was in lieu of the seal sale which was not conducted that year. In 1919, the “last Red Cross seal sale was held. It is significant to note that in that year the seal design bore both the emblem of the American Red Cross and the double-barred cross of the National Tuber- culosis Association. The sale of 1919 aggregating $3,872,622 terminated the arrangement with the American Red Cross begun in 1910. The tuberculosis movement in the United States will never be able to repay the American Red Cross for the assistance it gave through the loan of its name, its funds, and the support of the Red Cross Seal during those critical years of development from I9gI0 to 1919. In 1920 the first strictly tuberculosis Christmas seal, featuring the double-barred cross emblem alone, was issued. Although confronted by a radical change in policy and by’ unfavorable financial conditions, the power of the penny Christmas seal is shown in the fact that the total result in 1920 reached the sum of $3,662,312 for the United States. In 1921 the seal sale totaled over $3,500,000. It is interesting to record here the ways in which the Christmas seal has helped to develop tuberculosis work. It would be difficult or almost impossible to record all of the many ways, but a few of the more significant will be of value. First of all, the Christmas seal has always been and still is the greatest means for spreading the educational message of the tu- berculosis campaign that has ever been devised. Because the penny Christmas seal reaches everyone, rich and poor, there is afforded an opportunity for bringing the message of tuberculosis to all kinds of groups. The Christmas seal furthermore furnishes the opportunity for widespread publicity. Every year at Christ- mas time the educational campaign of the tuberculosis movement MRS. HARDING BUYS CHRISTMAS SEALS FROM A MODERN HEALTH CRUSADER THE TUBERCULOSIS CHRISTMAS SEAL 63 is condensed into a few weeks of intensive effort to bring to the men, women and children of the country the message of their responsibility for the control of this preventable disease. Secondly, the Christmas seal has provided the funds that have made organizations possible. The National Tuberculosis Asso- ciation has always operated upon this axiom in organization, viz., that an association without funds or program is of no value. Some associations have had programs but no funds with which to execute them. Some have had funds but no program. In both instances the Christmas seal has been the means for providing proper organization. In the former instance where state and local associations have had a program and no funds, the Christ- mas seal has in hundreds of instances, both on a state-wide basis and in local communities, furnished the original funds with which to start a proper association and to employ the necessary full- time service. The businesslike organization of the tuberculosis campaign is due almost entirely to this policy of supplementing a local program with funds through the Christmas seal. Simi- larly there have been many instances where communities have had funds but no vision nor program. Here the state tubercu- losis association through the Christmas seal sale has been able to furnish the necessary leadership and guidance with which to develop a practical program. Thirdly, the Christmas seal has been the most potent means available to the tuberculosis movement for the development of correct standards of organization and work. With the develop- ment here and there throughout the country of local groups inter- ested in education, nursing, hospitals, sanatoria, open air schools, and various other phases of tuberculosis work, the greatest danger that has confronted the tuberculosis movement has been the establishment of agencies without an appreciation of their func- tions and methods. This, to a certain degree, is still a problem. The Christmas seal has helped to standardize work of this sort in two ways—first, by giving to the state and national associations that authority through contractual relations that would more or less compel the organizations in question to adopt approved standards; and secondly, by providing the means for developing 64 AHISTORY OF NATIONAL TUBERCULOSIS ASSOCIATION standards and bringing them to the agencies interested in tuber- culosis. Fourthly, the Christmas seal has been the means of attracting to the tuberculosis movement the most diversified interests of the community. Labor unions and industrial and religious organiza- tions, school children, women’s clubs and societies, bankers and bakers, in fact all the elements of American community life have contributed not only financially but in many other ways to mak- ing the Christmas seal sale a success. The Christmas seal, in other words, furnishes an opportunity for everyone, rich and poor, high and low, to participate in the community program for the prevention of tuberculosis. In the conduct of the Christmas seal sale the policy of relations between the National Tuberculosis Association and the state and local groups has been the deciding factor in the success of the seal sale. As is implied in the correspondence passing between Mr. Bicknell and Dr. Farrand, the original policy of the Christmas seal sale was that the money derived from the sale of seals shall so far as possible remain in the community where the seals are sold. There have been varying degrees of modification of this policy. The National Tuberculosis Association at the present time makes a fixed contract with each of the state associations whereby a definite percentage from the gross sale of seals is paid into the treasury of the National Association. Arrangements be- tween state and local associations vary in different states. In some the percentages are high and in some they are low. They range anywhere from Io per cent. over and above the percentage to the National Association to as high as 40 per cent. or even 50 per cent. In unorganized territory where there is no associa- tion and no agency for expending the funds in approved ways, it is customary in most instances for the state association to take all of the proceeds and spend them for the benefit of the local com- munity or hold them in trust for an organization to be developed. Thus, out of every dollar’s worth of seals sold in city or town, a percentage goes to the support of both national and state work as well as local work. The returns from the Christmas seal by years, beginning with 1907, are as follows: THE TUBERCULOSIS CHRISTMAS SEAL $3,000 . » » 135,000 . . «250,000 . . -300,000 $550,932 760,000 . . 1,050,000 . .. 1,780,000 no sale . » 3,872,622 . « -3,662,312 It will be of interest to record typical seal sales, that of 1919 and 1920, by states, showing the gross amount received in each state and the per capita sale. facts: The following table gives these A TABLE SHOWING COMPARATIVE RESULTS OF THE CHRISTMAS SEAL SALE, 1919 AND 1920 1920 Seal Sale 1919 Seal Sale 1920. Per Per State Population | Total Sale |Capita| Total Sale | Capita in Dollars | Salein] in Dollars | Sale in Cents Cents TOTAL s i3.403: 4s as 105,710,620 | $3,662,312.57| 3.4 | $3,872,622.78] 3.6 Alabama......... 2,348,174 68,730.15| 2.9 40,717.85] 1.7 Arizona.......... 334,162 18,802.13} 5.6 23,113.47| 6.9 Arkansas......... 1,752,204 22,459.40| 1.3 47,973-93| 2.7 Brooklyn & Queens| 2,487,398 90,539.86] 3.6 78,347.14 Es California........ 3,426,861 199,343.18] 5.8 156,261.07} 4.5 Chicago (Cook Co.) 3,053,017 91,050.85] 3.0 101,356.08] 3.3 Colorado......... 939,629 43,021.25| 4.6 71,470.67| 7.6 Connecticut....... 1,380,631 78,518.72| 5.7 82,324.94] 5.9 Delaware......... 223,003 13,204.59] 5.9 26,693.15] 11.9 Dist. of Columbia. . 437,571 19,907.39] 4.5 19,836.34 4.6 Florida........... 968,470 25,731.68| 2.6 21,995.07] 2.2 Georgia.......... 2,895,832 22,578.20 8 2,030.06 ae Idaho «506 ess vee: 431,866 19,374.16] 4.5 20,024.90) 4.6 Illinois _ (Excl. Cook Co.)...| 3,432,263 141,295.98] 4.1 135,767-74| 3.9 Indiana.......... 2,930,390 131,685.67] 4.5 115,705.68] 3.9 TOW! s:— snicg egies ccavsvans 2,404,021 71,744.40] 3.0 91,845.95] 3.7 Kansas.......... 1,769,257 43,190.58] 2.4 57,825.39] 3.2 Kentucky........ 2,416,630 25,488.88] 1.0 36,779.63] 1.5 Louisiana......... 1,798,509 30,032.20] 1.7 51,523.36] 2.8 Maine........... 768,014 22,748.99} 3.0 32,290.51] 4.2 Maryland........ 1,449,661 57,094.36] 3.9 57,642.61] 3.9 Massachusetts..... 3,852,356 122,918.79| 3.2 141,604.77| 3.6 Michigan......... 3,668,412 123,805.22] 3.4 78,231.54] 2.1 Minnesota........ 2,387;125 104,175.39] 4.4 143,659.56} 6.0 5 66 A HISTORY OF NATIONAL TUBERCULOSIS ASSOCIATION A TABLE SHOWING COMPARATIVE RESULTS OF THE CHRISTMAS SEAL SALE, 1919 AND 1920 Continued 1920 Seal Sale 1919 Seal Sale 1920 _ Per Per Suite Population | Total Sale |Capita| Total Sale | Capita in Dollars |Salein} in Dollars | Sale in Cents Cents Mississippi........ 1,790,618 $8,595.44] 0.5 $32,184.03 1.7 Missouri.......... 3,404,055 90,672.58 | 2.7 117,091.48 | 3.4 Montana......... 548,889 19,729.16 | 3.6 21,564.72 3.9 Nebraska......... 1,296,372 19,751.79 | 1.5 31,257.78 2.4 Nevada.......... 77,407 4,217.16] 5.4 4,551.23 5.8 New Hampshire... 443,083 24,023.31 | 5.4 52,908.85 | 11.9 New Jersey....... 3,155,900 136,796.37 | 4.3 126,323.06 4.1 New Mexico...... 360,350 7,374.80 | 2.0 13,443.25 3.7 New York State (Excl. of N.Y.C.)..] 4,765,179 | 392,864.50] 8.2 374,867.49 | 7.8 New York City (Excl. of Brooklyn and Queens) ....| 3,132,650] 152,002.91] 4.9 263,526.66 8.4. North Carolina....) 2,559,123 36,728.38 | 1.4 42,407.18 1.6 North Dakota. .... 646,872 15,659.14] 2.4 17,263.04] 2.6 ONIO) sjeidieistesuaons 51759,394 | 197,529.25] 3.4 197,063.84 | 3.4 Oklahoma........ 2,028,283 53,533-32 | 2.6 57,277.18 2.6 Oregon. .......... 783,389 38,763.09 | 5.0 33,290.76 4.2 Pennsylvania (Excl. of Allegheny Co.)..| 7,534,209] 283,369.18 | 3.7 289,129.18 3.8 Pittsburgh (Alle- gheny Co.)...... 1,185,808 84,989.45 | 7.2 46,126.86 3.8 Rhode Island...... 604,397 32,508.79 | 5.4 39,895.63 6.6 South Carolina.... 1,683,724 22,738.92 | 1.3 28,057.27 1.6 South Dakota..... 636,547 34,587.60 | 5.4 38,716.44 6.0 Tennessee........ 2,337,885 26,857.32 LI 69,202.00 2.9 TLOXAS (3. enna vies 's 4,663,228 92,592.40 | 2.0 96,891.35 2.0 Utah s.2:secs.s oees 449,396 27,373.03 | 6.1 11,255.10 2.5 Vermont,........ 352,428 | 8,288.89 | 2.3 6,790.77 1.9 Virginia chaedh Setoletas 2,309,187 54,075.35] 2.3 34,311.60 1.4 Washington....... 1,356,621 62,533.65] 4.6 57,939.06 4.2 West Virginia..... 1,463,701 38,154.07 | 2.6 25,194.42 1.7 Wisconsin........ 2,632,067 | 100,659.00] 3.9 97,752.48 | 3.7 Wyoming......... 194,402 7,964.20 | 4.1 11,318.66 5.8 If one were to recite the various influences and factors that have contributed most to the success of the campaign against tuberculosis in the United States, he could not help but place at the head of any such list the Tuberculosis Christmas Seal. . CHAPTER VII THE FRAMINGHAM DEMONSTRATION O HISTORY of the tuberculosis movement in the United N States would be complete that did not chronicle the origin, development and results to date of the unique Framingham Community Health and Tuberculosis Demonstra- tion at Framingham, Mass. For over four years, with the co- operation of its citizens, Framingham has been developing a program to show to the world the effectiveness of the methods of control of tuberculosis. It may not be amiss as a matter of historical interest to state here how the Framingham Demonstration originated. To do this we must go back to the year 1908, when the interest of the officers of the Metropolitan Life Insurance Company in the tuberculosis problem was first aroused. The late Dr. John Henry Huddleston was mainly responsible for a meeting to which all the New York employees of the Metropolitan Life Insurance Company and its officers were invited. The occasion was the tuberculosis exhibition in the Museum of Natural History, New York City, which had been brought from Washington, D. C., largely through the efforts of Dr. Alfred Meyer of New York. Later it was also sent to Philadelphia through the efforts of Dr. Lawrence F. Flick. It had attracted great throngs of visitors dur- ing the Tuberculosis Congress in the capital city and in Philadel- phia, but the crowds which visited the exhibit in New York were even greater. Various organizations, corporations and schools visited the museum in bodies, and each meeting was addressed by one or two physicians specially interested in tuberculosis. The Metropolitan Life Insurance Company’s meeting at which Mr. Haley Fiske, now the president, then the vice-president of the Company, presided, was attended by no less than 1200 agents and clerks of the Company. Officers and employees listened atten- 67 68 A HISTORY OF NATIONAL TUBERCULOSIS ASSOCIATION tively to the various addresses made by Mr. Fiske, Dr. John Henry Huddleston, Dr. Augustus S. Knight, one of the medical directors of the Company, and others. In the course of the address by the author of this history the suggestion was made that the time had come when life insurance companies should take a deeper interest in the tuberculosis problem, and very profitably might begin by taking care of their own tuberculous employees. The suggestion was taken up by Mr. Fiske and his fellow officers, and on June 20, 1914, a model sanatorium for the tuberculous employees of the company was dedicated at Mount McGregor, N. Y. This institution has been in operation ever since and has done a splendid life-saving service. Thus as far back as 1908 the Metropolitan Life Insurance Com- pany had evinced an active interest in the prevention of tuber- culosis. In 1911 the Company began an intensive educational and nursing campaign among its policyholders which has resulted in the saving of millions of dollars and thousands of lives. Be- cause of the fact that about one in every five people in the United States is insured in this Company, the Metropolitan has con- sistently extended its service and support to enterprises that did not reach its policyholders directly but that affected them through the general population. In line with and as an outgrowth of this broad interest, Dr. Lee K. Frankel, third vice-president of the Company, proposed to his board an experiment to demonstrate if it was possible to con- trol tuberculosis in a limited area. This proposal was accepted and on May 3, 1916, Dr. Frankel wrote Dr. E. R. Baldwin, then president of the National Tuberculosis Association, the following letter: “The Metropolitan Life Insurance Company is much interested by reason of the fact that over 16 per cent. of the deaths in its Industrial Department are due to tuberculosis. In 1915 the Company paid claims of over $4,000,000 on the lives of 14,325 policyholders dying from this disease. “The Company believes that an intensive experiment might well be made in the United States to determine whether it is possible to substantially reduce the mortality and morbidity of tuberculosis in the hope that the disease may eventually be eradicated. “To this end, we are prepared to place at the disposal of The National Asso- ciation for the Study and Prevention of Tuberculosis the sum of One Hundred THE FRAMINGHAM DEMONSTRATION 69 Thousand Dollars ($100,000) for the purpose of conducting a community ex- periment over a period of three years in the control of tuberculosis, on condi- tion that the Association selects a community of approximately five thousand (5,000)* inhabitants, preferably in New York or Massachusetts, in which conditions would be favorable for such an experiment and that a special com- mittee of the Association be appointed, on which the Company shall be repre- sented, to whom full power shall be given to institute the necessary preliminary survey and to conduct the experiment along the lines finally determined upon by this committee. “We would further suggest that in making the experiment, stress should be placed on . Periodic medical examination of all members of the community. - Medical and nursing care of all cases of tuberculosis. . Sanatorium or hospital care for such cases as may need it. . A tuberculosis clinic or dispensary. . Co-operation of local and state health officers, employers, labor unions, school authorities, etc. “Tt is our hope that this experiment will be a practical contribution towards the study of the etiology of tuberculosis and that the results obtained may indicate a method for the prevention and elimination of the disease. “I shall be glad to be advised by you of the acceptance of the Company’s offer.” nb wh The Company’s offer was enthusiastically accepted at the annual meeting of the National Tuberculosis Association in May, 1916, by the following resolution: “The National Association for the Study and Prevention of Tuberculosis expresses its hearty appreciation of the generous proposition of the Metro. politan Life Insurance Company to contribute $100,000 for conducting a com- munity experiment in the control of tuberculosis. In undertaking this trust the Association hopes that the results of the experiment may be commensurate with the desires which inspired the offer.” A National Committee consisting of the following was ap- pointed: Dr. Edward R. Baldwin, chairman, Saranac Lake, N. Y.; Dr. Charles J. Hatfield, secretary, Philadelphia, Pa.; Dr. Lee K. Frankel, New York City, N. Y.; Dr. Charles L. Minor, Asheville, N. C.; Mr. Homer Folks, New York City, N. Y.; Dr. Arthur K. Stone, Framingham, Mass.; Dr. Eugene R. Kelley, Boston, Mass.; Dr. Stephen J. Maher, New Haven, Conn.; Dr. William Charles White, Pittsburgh, Pa.; Dr. Victor Safford, Boston, Mass.; Dr. F. C. Smith, New York City, N. Y.; ‘ * Subsequently this population limit was raised to fifteen or sixteen thousand. 70 AHISTORY OF NATIONAL TUBERCULOSIS ASSOCIATION Mr. Theodore F. Rice, Framingham, Mass.; Dr. Enos H. Bige- low, Framingham, Mass.; Mr. Henry S. Dennison, Framing- ham, Mass. Dr. Donald B. Armstrong was selected as executive officer in July, 1916. For several months he worked with the committee in the selection of a town. Framingham was finally chosen because it was an average American town of about 16,000 population, with average conditions as to mortality and other factors. In December, 1916, Dr. Armstrong moved to Framingham and the Demonstration itself was launched. The Demonstration started out to find, if possible, a solution to these four community problems: (a) to discover and place under adequate medical, nursing, and relief supervision all cases of tuberculosis, incipient and advanced, active and arrested; (b) to ascertain with some degree of definiteness the responsible social and economic factors in disease causation, particularly as regards tuberculosis; (c) to utilize in the most efficient way the existing means for discovery and treatment of tuberculosis and to find out what percentage of disease is preventable; (d) to find and or- ganize the best community health machinery for preventing sick- ness and death from tuberculosis: In order to evaluate the results and methods of the Demonstra- tion after the initial three-year period of work, the Surgeon Gen- eral of the United States Public Health Service, at the request of the National Tuberculosis Association, appointed the following group as a Committee on Appraisal: Dr. Allan J. McLaughlin, U.S. Public Health Service, chairman; Prof. C.-E. A. Winslow, Yale University, New Haven, Conn., secretary; Dr. Edgar T. Sydenstricker, U. S. Public Health Service; Dr. Charles V. Chapin, Health Commissioner, Providence, R. I.; Dr. Victor G, Heiser, Rockefeller Foundation, N. Y. City; Miss Helen R. Stewart, National Organization for Public Health Nursing; Mr. George J. Nelbach, State Charities Aid Association, New York; Dr. Emery R. Hayhurst, State Department of Health, Ohio; Dr. Thomas A. Storey, American School Hygiene Association; Dr. Samuel McClintock Hamill, University of Pennsylvania, Philadelphia, Pa.; Dr. Louis Hamman, Johns Hopkins Medical School, Baltimore, Md.; Dr. Lawrason Brown, Trudeau Sana- THE FRAMINGHAM DEMONSTRATION 71 torium, Saranac Lake, N. Y.; Dr. H. R. M. Landis, Phipps Institute, Philadelphia, Pa. The Appraisal Committee reported favorably on the results of ' the Demonstration and recommended its continuation for a limited period, a recommendation which has been adopted. The report of the Committee summarizes the results of the Demonstration as follows: “1, THE EXTENT OF TUBERCULOSIS “The first step, a determination of the actual .prevalence of tuberculosis infection, has been accomplished with a high degree of success, giving us for the first time a fairly complete picture of the amount of tuberculosis actually existing in a typical American community. “2, THE CONSULTATION SERVICE “The most important of all the practical contributions made by the Demon- stration is the working out of a plan for medical consultation service, which is clearly the most promising means yet devised for securing a reasonably com- plete knowledge of the amount of tuberculosis existing in a given community. The consultation service plan has attracted wide attention throughout the country. ‘3. TUBERCULOSIS TREATMENT “The machinery adopted for the treatment of cases of tuberculosis after they have been discovered has been modeled along generally accepted lines. The work has been accomplished efficiently and successfully. “4. STANDARDS OF DIAGNOSIS ‘The officers of the Demonstration have prepared a scheme of diagnostic standards for tuberculosis which has attracted wide attention. “5. DEATH CERTIFICATION ANALYSIS “The careful analysis of death certificates, showing that the actual deaths from tuberculosis in Framingham were 22 per cent. in excess of the reported deaths from this disease, also constitutes a valuable contribution. “6, SANITARY STUDIES “From the standpoint of general environmental causes effecting the spread and development of tuberculosis, the staff of the Demonstration has conducted valuable studies of schools, factories, and municipal health conditions. “7, GENERAL SICKNESS PREVALENCE “The medical examination drives have yielded some of the most complete data in regard to the prevalence of disease of all sorts in a random section of the population that have ever been collected in this country. » 72. AHISTORY OF NATIONAL TUBERCULOSIS ASSOCIATION “8, THE TUBERCULOSIS DEATH-RATE “From the standpoint of mortality, the tuberculosis death-rate has fallen from 93 per 100,000 in 1917 to a rate corresponding to 76 for the first five months of 1919. This is an encouraging showing, in view of the fact that the tuberculosis death-rate in similar Massachusetts communities has in general materially increased. “9g, THE TOWN’S RESPONSE “The town of Framingham has responded with vision and effectiveness to the remarkable opportunities offered by the establishment of the Demonstra- tion. The Local Board of Health, the School Committee, the Civic League, and many of the employers of labor, have met the challenge to make Framing- ham the model ‘‘Health Town” with constructive responses of a high order. “to. LOCAL HEALTH DEVELOPMENT ‘‘Even more important from the practical standpoint has been the notable development of public health work in Framingham along a wide variety of lines. “tr, THE HEALTH AND SCHOOL DEPARTMENTS “The local health department has grown to be a strong and effective one, and the system of medical inspection of school children, organized under the Department of Education, represents one of the best examples of such service to be found in the United States. “12, THE COMMUNITY BENEFITED “Tt seems clear that if the Framingham Demonstration should cease on January 1, 1920, the local community will have benefited materially and many important contributions will have been made to the practical control of tuber- culosis. “13, NEED FOR LOCAL CO-ORDINATION “Tt seems to us if the Demonstration is to be continued that it might be of service to organize in Framingham a Health Council which would include the Health Officer, or a Board of Health representative as Chairman, with repre- sentatives of the School Committee, the Civic League, the Framingham Hos- pital, the Red Cross, the medical society, and the Demonstration,—this council to serve as a clearing-house for the co-ordination of health activities and the planning of the most effective public health machinery for the com- munity as a whole. We deem it to be of great importance to transfer the work to them (the local agencies) as rapidly as possible. “14. THE FOUNDATION LAID “The foundation has been well laid; a program for the control of tubercu- losis by early diagnosis and hygienic care has been organized on ideal lines; local sentiment both in the medical and lay circles has been successfully de- THE FRAMINGHAM DEMONSTRATION 73 veloped in support of the campaign; and all conditions are favorable to its success. “15. CONTINUATION VITAL , “These statistical calculations have led us to the conclusion that the Fram- ingham Demonstration should be continued for a period of at least five years in order to render the attainment of definite results of reasonable certainty. It would furnish for the first time a definitely established working program for the practical control of tuberculosis.” The Framingham Demonstration endeavors as one of its dis- tinct aims to show to other communities how tuberculosis may be controlled. Framingham is, in other words, a community labo- ratory where methods that can be universally applied are tested. Dr. Armstrong in a recent article has emphasized this phase of the work under the pertinent title ‘‘Framingham Yardsticks.” Since this article shows in brief some of the most significant achievements of the Demonstration from the point of view of methods, it is quoted in full as follows: “TI, HOW MUCH TUBERCULOSIS IS THERE? “The examination of thousands of men, women and children in Framing- ham shows that approximately 1 per cent. were suffering from active tu- berculosis. “In a city of 100,000 people this would mean, therefore, about 1,000 active cases. “II. HOW MANY CASES SHOULD BE UNDER CARE? “In Framingham intensive medical work among infants, in schools, in factories and elsewhere, brought to light 9 or 10 active cases for every annual death. “In a city of 100,000, therefore, with a death-rate, say, of 100 per hundred thousand, or 100 deaths a year, there should be 900 or 1,000 active cases under care. (Variations in the death-rate may, of course, affect this ratio.) . “III. WHAT PERCENTAGE OF CASES SHOULD BE REPORTED IN THE EARLY STAGE? “Before the Demonstration started in Framingham, the physicians of Framingham reported only 45 per cent. of the cases in the early stage; now about 75 per cent. of the cases are being reported as early-stage tuberculosis. “TV. WHAT ARE THE MINIMUM INSTITUTIONAL NEEDS? “In Framingham the minimum bed requirement has been from one to two beds for every annual death in the community. This hypothetical city of 100,000, with 100 deaths a year, will need, therefore, at least 100 hospital or 74 A HISTORY OF NATIONAL TUBERCULOSIS ASSOCIATION sanatorium beds to care for its adult and child tuberculosis cases needing in- stitutional care. In fact, 200 beds will more nearly meet the needs disclosed by intensive search for tuberculosis. “V. WHAT PERCENTAGE OF CASES SHOULD BE GIVEN HOSPITAL OR SANATORIUM TREATMENT ? “In Framingham the cases during any one year needing and being bene- fited by institutional care constitute about 33 per cent. of the total number of active cases under observation or treatment. This, of course, includes many early cases, given the educational and hygienic advantages of perhaps only a few months’ stay in a sanatorium. “VI. WHAT CONSTITUTES A COMPREHENSIVE EDUCATIONAL PROGRAM? “‘An educational program should fight: “a. Infection—by promoting respiratory hygiene, by improving milk supplies, by improving general sanitation, etc. ‘b, Disease—by lessening stress or strain, mental or physical; by im- proving economic, social and nutritional conditions; by promoting construc- tive personal hygiene. “c, Death—by popularizing and making adequate provision for insti- tutional and home treatment. “VII. WHAT COMMUNITY MACHINERY IS NECESSARY? ‘ta, Medical machinery to find tuberculosis cases—a school or factory physician for every 3,000 individuals, a clinic and consultation service, etc. ““b, An adequate nursing service—tuberculosis nurses (or general public health nurses—at least I to every 2 or 3,000 people), infant welfare, school, factory and home nursing, arrested case follow-up, etc. ““c, Adequate institutional equipment. “d. An educational program. ‘‘e. Proper community organization, adequate legislation, general sani- tation, research, etc. “VIII. WHAT WILL IT COST? “It is impossible to separate the cost of tuberculosis work from the cost of general health work. In Framingham for all kinds of health work, including tuberculosis, before the Demonstration there was being spent 40 cents per capita per year. Now the community is spending over $2.00 per capita per year from both public and private sources. “Tn our city of 100,000, therefore, an adequate health budget would be at least $200,000 a year. Probably $100,000 of this should come from public sources through taxation, and another $100,000 from private sources, to carry on civic, social, industrial and other non-official activities. THE FRAMINGHAM DEMONSTRATION 75 “TX. WHAT RESULTS MAY BE HOPED FOR? “Tn Framingham it is too early, of course, to announce final conclusions. It may be said, however, that the Demonstration is now finding fewer cases, and in particular it is finding fewer advanced cases—which would indicate a beginning reduction in tuberculosis morbidity. “As to mortality, the death-rate has declined during the Demonstration from a pre-Demonstration rate of 121 per 100,000 to a current rate of 35 or 40 per 100,000 (corrected for residence and certification errors)—a reduction of over two-thirds in 5 years. “In the city of 100,000, with 100 deaths a year, this would mean a saving of 65 or 70 lives a year, which represents, when measured in money terms alone, thousands and thousands of dollars. The same methods, if successfully applied throughout our country, will mean a saving of over 80,000 lives a year,—many more than were lost by this country in the great war. “That is the Framingham story in a nutshell. Of course, it is not yet complete, and the future may alter these tentative conclusions. However, if they are suggestive to your community, if you think a similar procedure can be applied with advantage and want more detail as to method, write the Community Health Station, Framingham, Mass.” It is significant to note in closing this chapter that the idea and methods of the Framingham Demonstration have stimulated the National Child Health Council to establish a similar demonstra- tion on child welfare with a fund of $200,000 granted by the American Red Cross. This most conspicuous illustration is one of a great many instances where agencies and communities, throughout the United States and the world, are being benefited by the application of the methods tested and verified by the Framingham Demonstration. CHAPTER VIII THE STATE TUBERCULOSIS ASSOCIATIONS HISTORY of the National Tuberculosis Association should A logically include a brief survey of the work of the various state associations. For many years the National Association’s work was largely that of organizing state bodies. Within the last four or five years, however, it has been the stimulation and standardization of tuberculosis work throughout the state organizations. At the present time there is a state association in every state and in the District of Columbia. The local associations in New York City, Brooklyn, Pittsburgh, and Chicago are treated by the National Tuberculosis Associa- tion in the same relation as state associations, and are designated as “affiliated associations.” This section, therefore, will deal with the history of the work in each of the 48 state associations, the District of Columbia, and the four affiliated associations. For purpose of convenience the state and affiliated associa- tions are grouped alphabetically. The information contained in this section has been compiled from reports received by the author and from records on file in the office of the National Tuberculosis Association. The information concerning deaths and death-rates is taken entirely from the records of the United States Census Bureau for the Registration Area of the United States in order that the figures may be uniform and comparable. While figures are available from state registrars for most of the states, they are not as comparable, one with another, as those from the Regis- tration Area. Where no death-rate figures are given, it may be assumed that none are available, the state not being included in the Registration Area. 76 THE STATE TUBERCULOSIS ASSOCIATIONS 77 ALABAMA TUBERCULOSIS ASSOCIATION The active campaign against tuberculosis in Alabama is about seven years old. As early as 1906 a standing committee on tuberculosis of the Medical Association of the State of Alabama, with Dr. Glenn Andrews as chairman, had been formed, and through the in- fluence of this committee legislation was secured in 1907 declar- ing tuberculosis to be an infectious disease, and making it report- able. Up until 1914, however, comparatively little had been done, chiefly for the reason that funds were not available for a state-wide campaign. A local association had been formed in Montgomery in 1908, and in Birmingham in 1910. The work of these organizations, however, was largely local and centered chiefly about the super- vision of sanatorium and hospital care for a limited number of tuberculous patients. With the inauguration of a state-wide Christmas seal sale in 1914, the real campaign against tuberculosis in Alabama began. Educational work was conducted on a state-wide basis, and local communities were stimulated to organization. At the close of 1921 there were 4 sanatoria in the state, with a bed capacity of 115, 5 dispensaries, and 17 local associations. There are 15 county public health nurses and a state supervising nurse, with 2 other state nurses on part time. The Modern Health Crusade has been introduced widely throughout the state. The state association has an executive secretary and a Crusader executive, and an additional staff. In 1915 a State Tuberculosis Commission was created for the purpose of promoting county and district hospitals. The Com- mission has codperated with the State Tuberculosis Association and has been instrumental in stimulating a wide interest in the institutional care of the tuberculous. The unfavorable financial conditions of recent years have hindered the development of work along this line. The problem of tuberculosis control in Alabama is seriously complicated by the large Negro population. The State Tuber- culosis Association has stimulated such an interest among the 78 A HISTORY OF.NATIONAL TUBERCULOSIS ASSOCIATION Negroes, however, in their own health that early in the year 1922 a state-wide Negro tuberculosis association was organized, closely affiliated with the Alabama Tuberculosis Association. The headquarters of the Alabama Tuberculosis Association are at 308 North Twenty-first Street, Birmingham, Alabama, and the acting secretary is Mrs. H. E. Pearce. ALASKA There is no organized tuberculosis work in Alaska. As a disease, tuberculosis presents a most serious menace, particularly to the native population. Through a few of the mission centers and government agencies, particularly through the Bureau of Education, a certain amount of literature has been distributed and some talks on tuberculosis have been given. Medical and nursing care is available for a very limited number of patients. For the most part, however, the problem of tuberculosis is un- touched in Alaska. The distance and inaccessibility of the terri- tory for a large part of the year has made it extremely difficult for the National Tuberculosis Association to undertake work there. ARIZONA ANTI-TUBERCULOSIS ASSOCIATION As early as 1909 an Arizona Association for the Study and Prevention of Tuberculosis had been formed. The association, however, existed largely on paper, and did no active work of education or organization on a state-wide basis until it was com- pletely reorganized in 1916. At that time, at the instance of the National Tuberculosis Association, a new association, now known as the Arizona Anti-Tuberculosis Association, was formed and a full-time executive secretary was employed. The immedi- ate stimulus in reorganizing the association was the Christmas seal. While Christmas seals had been sold in more or less desultory fashion in Arizona for several years, after the reorganization of the work and the employment of a full-time executive the seal sale was multiplied more than three times, and a sufficient fund was given to begin a real campaign of organization and educa- tion. THE STATE TUBERCULOSIS ASSOCIATIONS 79 The tuberculosis problem in Arizona is peculiar in that the state is widely known throughout the world as a health resort for the tuberculous. A very considerable percentage of the population have tuberculosis or have come to the state because of some member of their family who has the disease. The migratory indigent consumptive is everywhere present and presents a serious relief and health problem. The paucity of population also, combined with the fact that much of the wealth of the state is controlled by individuals who have their business headquarters outside of Arizona, has made it very difficult for a State Association to get a firm foothold. In spite of these obstacles, however, local centers have been developed in Phoenix, Tucson, Prescott, and other cities, and at the present time there is an increasing amount of institutional, nursing, and dispensary provision for indigenous tuberculosis as contrasted with the institutions that are in existence purely for the care of private cases largely from outside of the local com- munities in which the sanatoria are located. The state association has conducted a public health survey in coéperation with the State Board of Health and has stimulated the establishment of the Modern Health Crusade and the em- ployment of full-time county health officers. There are at present 35 public health nurses working at full time. Ten years ago there were no nurses of this character in the state. The problem of tuberculosis in Arizona may best be visualized by a report of a survey in Phoenix of 481 tuberculosis cases. Fifty-seven of these cases were absolutely indigent, 82 were receiving some support from relatives, friends, fraternal organiza- tions, or other groups, and many of the patients were working when they should have been resting. Fifteen were tuberculous husbands supported by their wives. Thirty-three were living upon savings which were rapidly being exhausted. Most of the patients had been sent to Arizona by eastern physicians and social agencies. The majority of them at the time of arrival were in an advanced stage of the disease, and without sufficient funds to provide for proper care. The headquarters of the Arizona Anti-Tuberculosis Associa- 80 A HISTORY OF NATIONAL TUBERCULOSIS ASSOCIATION tion are at 300 East Adams Street, Phoenix, Arizona, and the executive secretary is Mr. T. C. Cuvellier. ARKANSAS TUBERCULOSIS ASSOCIATION The first state association on record in Arkansas is the Arkansas Association for the Relief and Control of Tuberculosis, formed in 1908. The Association was developed largely out of the State Committee for the Sixth International Congress on Tuber- culosis. As a state-wide body, however, it never functioned. It was not until 1917 that the real state-wide campaign against tuberculosis in Arkansas began. At that time, as a result of a field survey by the National Tuberculosis Association and the stimulus of the Christmas seal, a full-time executive was em- ployed. Since that date there has been a rapid development of interest and enthusiasm in the state of Arkansas in tuberculosis and public health. There are now seven local centers of work. The state sanatorium was established in 1907, and now has 145 beds. In addition to this institution there are 2 sanatoria with 32 beds, 3 free clinics, and about 25 tuberculosis and public health nurses, including those employed by the Red Cross. The state association carries on a vigorous campaign of educa- tion through the Modern Health Crusade, exhibits, motion pictures, and in other ways. The aroused interest in tuberculosis work has been the means for improving public health conditions throughout the entire state of Arkansas. It is not too much to say that a great part of the revival of interest in public health in the state of Arkansas is due to the activities and energy of the Arkansas Tuberculosis Association. Arkansas has a large Negro population, and in the northern part of the state there are many mountaineers. This popula- tion composition, together with the rural and scattered condition of the people, makes it difficult to carry on a progressive work in many of the counties. The state association, however, has penetrated practically every portion of the state and has local representatives and committees allied with it in some way in practically every community. The headquarters of the Arkansas association are at 201 THE STATE TUBERCULOSIS ASSOCIATIONS 81 Donaghey Building, Little Rock, Arkansas, and the executive secretary is Miss Erle Chambers. CALIFORNIA TUBERCULOSIS ASSOCIATION Among the earliest efforts at organization of tuberculosis work in California were the Southern California Anti-Tuberculosis League, formed in 1903, with Dr. F. M. Pottenger as president, and the Tuberculosis Committee of the State Medical Society, formed in the same year. These organizations operated largely in southern California and San Francisco. Their principal work was the distribution of a limited amount of literature. The California Association for the Study and Prevention of Tuberculosis, of which Dr. George H. Kress was the secretary for several years, was formed in 1907 largely out of the interest stimulated by the International Congress Committee. This latter organization carried on a state-wide propaganda and stimulated considerable interest by the distribution of litera- ture, holding of meetings, and the work that was accomplished in Los Angeles through its clinic. It was in 1914, however, that the most progressive step in state tuberculosis work was taken, when the Association was re- organized and a full-time executive secretary was employed. The increase in the Christmas seal sale immediately justified the employment of the state executive, Mrs. E. L. M. Tate-Thomp- son, in 1915. Asa result largely of Mrs. Thompson’s persever- ance and energy, the State Legislature enacted a law providing for a State Bureau of Tuberculosis in the Department of Health and for a state subsidy for counties which built tuberculosis hospitals along lines approved by the State Bureau. Up to this time it had been almost_impossible to secure local provision for tuberculosis cases, primarily because of the fear of communities that the establishment of county hospitals would bring in an influx of indigent migratory consumptives. The experience of the last six years demonstrates clearly that such fears were largely groundless. Mrs. Thompson was appointed as the head of the State Bureau of Tuberculosis, and retained her position also as head of the State Tuberculosis Assotiation, in which dual capacity she has 6 82 A HISTORY OF NATIONAL TUBERCULOSIS ASSOCIATION developed a work of unusual significance. At the present time there are 28 counties in the state operating subsidized tubercu- losis hospitals, with a bed capacity of 1,900. All of these hospi- tals are supervised and inspected by the State Bureau and must maintain adequate standards in order to retain the state subsidy. Twelve cities are operating tuberculosis clinics. There are 9 summer camps, 4 preventoria, and open-air schools in 4 cities. There are nearly 60 tuberculosis nurses, besides a much larger number of nurses doing general public health work, including tuberculosis. The educational work of the state association has covered a wide range, including lectures, distribution of printed matter, Modern Health Crusade, motion pictures, billboards, etc. The state association has greatly stimulated occupational therapy by the employment of teachers to visit sanatoria under the supervision of the State Bureau. The traveling motor clinic, organized in 1920, toured the rural districts of the state. The State Tuberculosis Association has also greatly stimulated all the public health work of the state, particularly that relating to medical examination of school children. When it is recalled that in 1915, outside of San Francisco and Los Angeles, there was not a single decent place in the entire state for consumptives without means to receive examination or treatment, the present status of the work in California exhibits a phenomenal progress. The State Tuberculosis Association may justly take the credit for most of this progress. The tuberculosis death-rate in California has steadily declined in spite of the influx of migratory consumptives and the fact that southern California particularly is widely used as a resort for the tuberculous. The death-rate from tuberculosis in 1907, when the first state association was formed, was 2,198. In 1914 it had declined to 195.0, and in 1920 to 159.6. The headquarters of the California Tuberculosis Association are at 418 Griffith McKenzie Building, Fresno, California, and the executive secretary is Mrs. E. L. M. Tate-Thompson. THE STATE TUBERCULOSIS ASSOCIATIONS 83 COLORADO TUBERCULOSIS ASSOCIATION The Colorado State Committee of the International Congress was incorporated in April, 1908, and virtually became a State Tuberculosis Association. As early as 1910 the Association employed a full-time secretary. For several years the work was carried on with vigor. A state law requiring the reporting of tuberculosis was enacted notwith- standing a great deal of opposition. The educational campaign was extended throughout the state. The Christmas seal sale was gradually increased. In 1918 the Association was reorganized with a new executive. Its work since that time has been state-wide; it has been instru- mental in stimulating the organization of committees and inter- ested groups in the larger centers throughout the state. There are now ten well-organized branch associations. The Denver Tuberculosis Society, the first and largest of these, was formed in 1917. Its outstanding achievements are: obtaining the construction of a municipal tuberculosis sanatorium; inaugu- rating in the schools the Modern Health Crusade; weighing and measuring; follow-up work in the homes; school luncheons; establishing nutrition classes and an open-air school; and carry- ing on country-wide propaganda against the migration of the indigent tuberculous. Colorado is another state in which the indigent migratory con- sumptive is a most serious problem. As in Arizona and Cali- fornia, this fact has retarded the development of local institu- tional provision. While there are a number of private sanatoria in Denver and Colorado Springs, there is very little local pro- vision elsewhere. The Association, however, has stimulated the establishment of four dispensaries and is creating interest in public health nursing throughout the state. The Modern Health Crusade has been extended into nearly every county in the state, enlisting half of the school children in its ranks. Educational publicity has been carried on through the distri- bution of several hundred thousand circulars and folders, by newspaper articles, and by many health talks. 84 A HISTORY OF NATIONAL TUBERCULOSIS ASSOCIATION The Association has been instrumental in stimulating a demand for reorganization of the State Health Department. While its efforts have not yet proved successful, the constantly increasing interest in public health will surely accomplish the desired result. In 1918 less than $10,000 was available for tuberculosis edu- cational work in the entire state. In 1922 expenditures of the state and local associations will total over $43,000. These figures epitomize the progress of the tuberculosis campaign in Colorado. The death-rate from tuberculosis in Colorado in 1908 was 256.2, and in 1920 it was 225.4. The headquarters of The Colorado Tuberculosis Association are at 409 Barth Building, Denver, Colorado, and the executive secretary is Miss G. IJ. Pelton. CONNECTICUT STATE TUBERCULOSIS COMMISSION In Connecticut, the anti-tuberculosis campaign is conducted by the State Tuberculosis Commission. Connecticut has never had a state tuberculosis association in the sense in which this term is used in most other states. Public tuberculosis work was started in 1902 by the New Haven County Anti-Tuberculosis Association, the establishment of the Gaylord Farm Sanatorium at Walling- ford, and the Wildwood Sanatorium at Hartford. Out of the interest generated by the establishment of these two sanatoria, and the report of a special investigation commission appointed by Governor Woodruff in 1907, the legislature in 1909 created the Connecticut State Tuberculosis Commission primarily for the establishment of a series of joint state and county tuberculosis hospitals. Dr. J. P. C. Foster was the first chairman of this Commission. With the development of interest in tuberculosis work through- out the state, the State Commission by legal enactment and common consent assumed such a place of leadership that it be- came the logical agency through which the National Tuberculosis Association worked. For several years, therefore, the State Tu- berculosis Commission has served as the agent for the sale of Christmas seals and has stood in the same relationship to the National Tuberculosis Association as a state association. THE STATE TUBERCULOSIS ASSOCIATIONS 85 While the primary business of the Commission has been the construction and administration of the splendid series of five state sanatoria, as required by statute, it has also been the leader in conducting of campaigns of education on tuberculosis. Through the money derived from the Christmas seal sale it has been able to stimulate the organization of local tuberculosis work in about thirty or more different centers throughout the state. Clinics, nurses, open-air schools and educational agencies have developed in practically every city and town of the state. The codperation of working men in the Employees’ Tuberculosis Relief Associa- tions has been particularly helpful in stimulating tuberculosis work in the large industries so prominent throughout the state. In addition to the 5 state sanatoria, which include one sea-side hospital for crippled children, there are 6 special tuberculosis hospitals or wards of general hospitals, 23 clinics, 1 day camp, 5 preventoria, 9 open-air schools and classes, and 40 public health nurses giving either full- or part-time to tuberculosis nursing. The death-rate from tuberculosis in 1909 was 152.5. In 1920. the death-rate had been reduced to 119.4. The headquarters of the Connecticut State Tuberculosis Com- mission are at the State Capitol, Hartford, Connecticut, and the field secretary is Hubert M. Sedgwick. The chairman of the Commission is Dr. Stephen J. Maher, of New Haven. DELAWARE ANTI-TUBERCULOSIS SOCIETY Out of the Delaware Anti-Tuberculosis Society grew the Red Cross seal, and out of the Red Cross seal grew the tuberculosis Christmas seal. The Delaware Anti-Tuberculosis Society was organized through the interest of Miss Emily P. Bissell and Dr. John Black, of Wilmington. Their first work was the erection of a little sanatorium of eight beds on the banks of the Brandywine, which to-day has developed into Hope Farm, a sanatorium of 60 beds. The needs of this sanatorium prompted Miss Bissell to undertake the first Christmas seal sale. In 1909 the Delaware State Tuberculosis Commission came into existence. Since that time there has been a certain amount of division of responsibility, and a definite amount of codperation 86 A HISTORY OF NATIONAL TUBERCULOSIS ASSOCIATION between the Delaware Anti-Tuberculosis Society and the Com- mission. The joint work of the two bodies has resulted in the establishment of the first state sanatorium for Negroes, three tuberculosis dispensaries, and a number of public health nurses. The educational campaign has been extended into every corner of the state. ' The death-rate from tuberculosis in 1920 was 146.0. The headquarters of the Delaware Anti-Tuberculosis Society are at 911 Delaware Avenue, Wilmington, Delaware. The headquarters of the Delaware State Tuberculosis Commis- sion are at 213 West Seventh Street, Wilmington, Delaware, and the secretary is Dr. Albert Robin. DISTRICT OF COLUMBIA TUBERCULOSIS ASSOCIATION Among the earliest active local tuberculosis associations in the United States is the District of Columbia organization. It was established originally as the Committee on Prevention of Consumption of the Associated Charities of the District of Columbia. It changed its name later. to the Association for the Prevention of Tuberculosis of the District of Columbia, now popularly known as the District of Columbia Tuberculosis Association. Among the earliest efforts of the Association were the distribu- tion of educational literature, the institution of public lectures, the successful advocacy of legislation for the compulsory regis- tration of tuberculosis cases, and the free examination of sputum by the Health Department. The Association has contributed to practically every stage of the development of tuberculosis and public health work in the District of Columbia, including the establishment of a tuber- culosis hospital, the opening of various tuberculosis clinics, the open-air schools, nutrition classes, and similar activities. The Modern Health Crusade has been made an integral part of the school curriculum and has attracted the attention of leaders in the capital from the president down. The death-rate from tuberculosis in Washington has been reduced from 279.5 in 1902 to 151.6 in 1919. The headquarters of the District of Columbia Tuberculosis THE STATE TUBERCULOSIS ASSOCIATIONS 87 Association are at 923 H Street, N. W., Washington, D. C., and the executive secretary is Mr. Walter S. Ufford. FLORIDA PUBLIC HEALTH ASSOCIATION The State Public Health Association in Florida is among the youngest of the state organizations. It was organized-in March, 1916. The Christmas seal is immediately responsible for the state association. An effort was made to employ a full-time executive secretary in 1917, but partly due to war conditions, this endeavor was abandoned after four months’ trial. After the armistice a full-time executive was secured. It would be difficult to estimate the progress that has been made in Florida in knowledge of tuberculosis and public health within the last four years. Through the State Board of Health and the State Federation of Women’s Clubs there had been a certain amount of interest in tuberculosis prior to the formation of the Florida Public Health Association. It was the putting of the state-wide work on a business basis with a full-time executive that pushed the entire campaign forward by leaps and bounds. At the present time there is one county tuberculosis hospital, and provision is being made for others. There are two perma- nent and one traveling clinic. There are more than a dozen public health nurses in different parts of the state. The Modern Health Crusade and other methods of education are being extended rapidly. The work in Florida is still in its beginnings, and it has been hampered by unfavorable financial conditions. The problem is further complicated by the large number of Negroes in the state. oo The death-rate from tuberculosis in 1920 was 104.1. The headquarters of the Florida Public Health Association are at 507 Dyal-Upchurch Building, Jacksonville, Florida, and the executive secretary is Mr. R. H. Hixson. GEORGIA TUBERCULOSIS ASSOCIATION Among the earliest tuberculosis activities in Georgia was the formation of a committee on tuberculosis in the Georgia Medical 88 A HISTORY OF NATIONAL TUBERCULOSIS ASSOCIATION Association, and the appointment of a State Commission to ‘Snvestigate the extent of tuberculosis in Georgia and the means of stamping out the disease,’’ both of which came into existence in 1904. The Georgia Anti-Tuberculosis and Sanatoria Society grew out of the Medical Society’s committee in 1909, but because of lack of funds it did very little in the way of state-wide work. In 1913, on the death of one of Georgia’s most philanthropic citizens, Captain W. G. Raoul, there was created the Raoul Foundation, with an endowment fund of $50,000, the income from which was to be expended annually for the prevention of tuberculosis in the state. The Raoul Foundation functioned as a state tuberculosis association until the fall of 1921, when a re- organization was effected and the Georgia Tuberculosis Associa- tion formed, the Raoul Foundation becoming one of its financial contributors and backers. In Atlanta an active group of workers, led by Captain Raoul, as early as 1907, began a pioneer campaign in that city and demonstrated clearly the possibilities of organized tuberculosis work. The Raoul Foundation, extending the work begun in Atlanta, with the assistance of the National Association, made an extensive survey of the ravages of tuberculosis in this state, conducted state-wide educational campaigns, and developed a state organization. The Foundation was the chief factor in securing legislative provision for full-time county health officers and better health administration. Meanwhile, the tuberculosis campaign was pushed throughout the state with great vigor. The result of this extensive activity is shown not only in the institutional provision available, but in the wide-spread interest in public health to-day as contrasted with 1913. There is a state sanatorium with 100 beds, and a local sanatorium in Atlanta with 190 beds. There are 7 clinics, 2 open-air schools, and more than 103 public health nurses, all of them doing some kind of tuberculosis work. The headquarters of the Georgia- Tuberculosis Association are at 602 Chamber of Commerce Building, Atlanta, Georgia, and the executive secretary is Mr. James P. Faulkner. THE STATE TUBERCULOSIS ASSOCIATIONS 89 HAWAII The campaign against tuberculosis was inaugurated in Hawaii in 1909 as a result of the interest of James A. Rath and some of his associates connected with the Palama Settlement in Hono- lulu. The interest, stimulated by the Anti-Tuberculosis League of Hawaii, grew steadily until in 1920 the territorial Government took over the entire activities of the League and expanded the work in the form of nursing, institutional and educational pro- vision. The League has now gone out of existence, but the entire tuberculosis campaign is being carried on in a much broader and extensive form than ever before. IDAHO ANTI-TUBERCULOSIS ASSOCIATION Through the accidental interest of the energetic proprietor of a leading department store in Boise, Mr. Henry L. Falk, the Idaho Anti-Tuberculosis Association developed. During the Christmas season of 1914 a customer at Mr. Falk’s store asked for Christmas seals. Not knowing what they were, he wrote to one of his buyers in New York and ascertained where they could be had. He then sold them to some of his customers. The following year, in 1915, the National Tuberculosis Asso- ciation, capitalizing the interest created, formed the Idaho Anti- Tuberculosis Association and conducted, with the codperation of Mr. Falk, a mail sale campaign of the Christmas seal to provide the initial funds with which to start the organization. The next year an executive secretary was employed. In spite of large territory, sparse population, and difficulties of communication, in the past three years the Idaho Association has secured legislation for two tuberculosis hospitals; secured the lo- cation at Boise of Public Health Service Hospital No. 52. for ex- service men; placed the Modern Health Crusade in the curriculum of the public school system, enrolling 80,000 children and thereby winning the National Crusade Cup in 1921; organized and fi- nanced 18 county associations; put on nursing demonstrations and school inspections in 22 of the 44 counties of the state. While in 1916, when the work of the Association began there 90 A HISTORY OF NATIONAL TUBERCULOSIS ASSOCIATION was relatively little interest in community health, at the present time there are 12 county nurses, 9 school nurses and 3 other gen- eral public health nurses. The interest in community health surveys, the Modern Health Crusade, poster contests and other methods of bringing tuberculosis to the attention of the public has been greatly stimulated. There is hardly a community in the state where the message of the Idaho Anti-Tuberculosis Asso- ciation has not been carried in some way or other. The headquarters of the Idaho Anti-Tuberculosis Association are at 222 Boise City National Bank Building, Boise, Idaho, and the executive secretary is Mrs. Catherine R. Athey. ILLINOIS TUBERCULOSIS ASSOCIATION [Note: The work of the Illinois Tuberculosis Association and the Chicago Tuberculosis Institute will be treated under separate sections.] As early as 1905 an Illinois State Association for the Prevention of Tuberculosis, with Ernest P. Bicknell as secretary, was formed. Two years earlier the Committee on the Prevention of Tubercu- losis of the Visiting Nurse Association of Chicago had been or- ganized. In 1904 a Committee on Tuberculosis of the Illinois State Med- ical Society was formed, primarily for the purpose of securing a state sanatorium through legislative enactment. Out of these early beginnings, and particularly from the work of the Visiting Nurse Association and the enthusiasm of the late Dr. Theodore B. Sachs, the Chicago Tuberculosis Institute was formed on May 1, 1906. For nearly five years this association served both in the capacity of a local and state organization. In June, 1910, at the stimulus of the National Tuberculosis As- sociation, the Illinois Association for the Prevention of Tubercu- losis was completely reorganized and an executive office was es- tablished in Chicago with Frank E. Wing as executive secretary and Arthur J. Strawson as assistant secretary. The president of the Association was Dr. W. A. Evans. Since 1910 the Illinois Association has carried on a progressive campaign of education and organization throughout the state. The office was later moved to Springfield where it now is. Dr. George Thomas Palmer, who has served as president of the THE STATE TUBERCULOSIS ASSOCIATIONS 91 Illinois Tuberculosis Association since October, 1913, has been largely instrumental in the development of the state program. The interest of the Association centered first of all on the passage of legislation making possible municipal and county tuberculosis hospitals in the “‘down state”’ sections outside of Chicago. Asa result of the activities of the Association following the passage of this legislation there are now in existence, or already provided for in the State of Illinois, outside of Chicago and Cook County, 62 tuberculosis hospitals with a bed capacity of 3,814. In addi- tion there are 38 tuberculosis clinics, open-air schools, and over 100 public health nurses working largely in the rural sections of the state. Most of the hospital and other provision for the care of the tu- berculous has been secured by referendum campaigns. With very few exceptions, whenever the question of taxation for the establishment of a tuberculosis hospital and provision of other agencies for this disease has been put up to voters it has been passed by a large majority. In 1916, 8 communities voted for tuberculosis sanatoria, in 1918 there were 33, and in 1920 there were 6, a total of 47 provided for at such general elections. In this respect Illinois leads the country. The creation of health promotion week, an educational cam- paign focusing attention on health during the session of the legis- lature, and the Sanatorium Pilgrimage, a tour of interested execu- tives and physicians from one institution to another throughout | the state, have been unique contributions to tuberculosis methods. In 1920 the death-rate from tuberculosis in Illinois was 100.6. _ The headquarters of the Illinois Tuberculosis Association are | at 516 East Monroe Street, Springfield, Illinois, and the manag- ing director is Mr. Joseph W. Becker. CHICAGO TUBERCULOSIS INSTITUTE [Note: The Chicago Tuberculosis Institute is recognized by the National Tuberculosis Association as an affiliated association, and as such is treated in the same category with state associations.] The Chicago Tuberculosis Institute was organized in May, 1906, to carry on the work of the Committee on the Prevention of Tuberculosis of the Chicago Visiting Nurse Association. * 92 AHISTORY OF NATIONAL TUBERCULOSIS ASSOCIATION Dr. Theodore B. Sachs had in 1903 begun to lecture on tuber- culosis, and had made a survey of the prevalence of tuberculosis in some of the congested districts of Chicago, the results of which were widely published. Following the organization of the Institute, one of its first activities was the establishment of a tuberculosis camp, known as Camp Norwood, in which 20 tuberculous women were success- fully treated in the open air during the winter of 1906-7. Camp Norwood was under the immediate direction of Dr. Theodore B. Sachs and Dr. Ethan A. Gray. Directly following this came the erection of Edward Sana- torium at Naperville, Illinois. This institution, made possible through the generosity of Mrs. E. L. Gaylord, was placed under the direction of Dr. Sachs, and was intended for the care of people of moderate means. Later Dr. Sachs placed the sanatorium under the general authority of the Chicago Tuberculosis Insti- tute as its sanatorium department. He remained in full charge of the institution until his death in 1916. The opening of the sanatorium marked an interesting epoch. It was more than an attempt to provide institutional care. It was a definite protest against the all too prevalent view of the day that climate, and especially the southwestern climate, was necessary in the treatment of tuberculosis. At the Edward Sanatorium, the Chicago Tuberculosis Institute, under the leadership of Dr. Sachs, definitely proved, as had already been proved by Bowditch, Trudeau, King, Flick, and others on the Atlantic seaboard, that tuberculosis could be cured anywhere if proper medical supervision and the other requisites of hygiene and diet could be provided. The Institute next established a chain of seven tuberculosis dispensaries under the direction of Dr. E. A. Gray. They were transferred to the control of the Municipal Sanitarium Board in I9IO. In 1908 the Chicago Tuberculosis Institute secured the passage of the original Glackin law, under which the city of Chicago was given permission to vote on the question of the establish- ment of the Municipal Tuberculosis Sanitarium. Immediately following the passage of the law the Institute conducted a whirl- THE STATE TUBERCULOSIS ASSOCIATIONS 93 wind campaign the slogan of which was ‘Vote ‘Yes’ for the tuberculosis hospital!’ The proposition was carried by a large vote and assured a sufficient fund from taxation to make possible the Municipal Sanitarium. It took nearly seven years of self- sacrificing and diligent work, the burden of which fell chiefly upon Dr. Sachs and Mr. Frank E. Wing, before the Municipal Sanitarium was opened in 1915. There are few institutions in the United States that owe their existence more distinctly to the personal interest and clear vision of a non-official agency than the Chicago Municipal Tuberculosis Sanitarium. With the Municipal Sanitarium, and under its supervision, there has been provided a chain of ten municipal tuberculosis dispensaries, a staff of tuberculosis nurses, and other facilities. Chicago has also led the way, under the Tuberculosis Institute and the Elizabeth McCormick Memorial Fund, in the open-air school campaign. In recent years the work of the Institute has been extended to Cook County, outside of Chicago, where it now maintains a corps of 15 nurses and a clinical director. Twenty-four towns are now organized and codperate with the Institute in the various phases of its work. The death-rate from tuberculosis in Chicago in 1906 was 191.9. As a partial indication of the activity of the Chicago Tubercu- losis Institute and the agencies which it has brought into existence, the death-rate from tuberculosis has declined in 1920 to 97.4. The headquarters of the Chicago Tuberculosis Institute are at 8 South Dearborn Street, Chicago, Illinois, and the superin- tendent is Mr. James Minnick. INDIANA TUBERCULOSIS ASSOCIATION The first attempt at the organization of tuberculosis work in Indiana was the establishment of the Anti-Tuberculosis Society of Indiana in October, 1904, which followed the enthusiasm generated by a lecture given by Dr. S. A. Knopf. The organiza- tion, however, never functioned and soon passed out of existence. In 1907 the Indiana Association for the Prevention of Tubercu- losis was formed, and carried on for a time a more or less desultory campaign, chiefly in Indianapolis. A number of county organi- 94 A HISTORY OF NATIONAL TUBERCULOSIS ASSOCIATION zations, existing largely on paper, were formed throughout the state. In 1914 the National Tuberculosis Associations assisted in the reorganization of the Indiana Association, establishing the work on a firm business basis. Since that date the Association has made phenomenal progress. At the present time there are 89 city and county tuberculosis associations in the state, covering practically every community. Besides the State Sanatorium there are 5 county and municipal tuberculosis hospitals with a bed capacity of 564. There are 28 permanent tuberculosis clinics and 8 infant welfare clinics. There are 18 open-air schools or open-window rooms, and one preventorium. Fully 250 tuberculosis and public health nurses are working in the state either under official or non-official auspices. The Indiana Association, through its-legislative program, has made a distinct contribution, to tuberculosis work in the state. The Association has been responsible for practically all of the legislation relative to the control of tuberculosis in Indiana, and assisted materially in bringing about the creation of the Bureau of Tuberculosis in the State Board of Health. The death-rate from tuberculosis has shown a distinctly favorable downward trend, from 171.3 in 1907 to 108.8 in 1920. The headquarters of the Indiana Tuberculosis Association are at 1134 K. of P. Building, Indianapolis, Indiana, and the execu- tive secretary is Mr. Murray A. Auerbach. IOWA TUBERCULOSIS ASSOCIATION The history of tuberculosis work in Iowa illustrates the value and significance of a non-official agency in the public health movement. As early as 1905, an Jowa Association for the Study and Prevention of Tuberculosis was formed, but its activities were very limited, and after a brief career it ceased to exist except on paper. Meanwhile, in 1907, the legislature made provision for an an- nual appropriation of $5,000 for a lecturer on tuberculosis, under the State Board of Control, and primarily for the develop- ment of an educational campaign against the disease. While the work of this department was well done, the Board, largely be- THE STATE TUBERCULOSIS ASSOCIATIONS 95 cause it was an official body, was limited in its power to criticize or commend. It was not until 1915 that the present State Association was organized, and the work of the Association, starting with a shoe string, has developed into one of the most vigorous and effective organizations in the entire State of Iowa. At the present time there are 29 local associations, The State Association codper- ates with more than 15 different state-wide civic and social or- ganizations, and has especially helpful codperative arrangements with such public agencies as the Board of Control of State Insti- tutions, the Board of Health, Department of Public Instruction, Housing Commission, Bureau of Animal Husbandry, State Uni- versity, State Agricultural College, State Teachers’ College, Governor’s Office and Legislature. Six sanatoria, including a well run state sanatorium, with a bed capacity of 417, 13 clinics and dispensaries, 2 open-air schools and nearly 200 tuberculosis nurses make up in part the present fighting equipment against tuberculosis. Iowa has been a leader in the development of the Modern Health Crusade. The silver loving cup, awarded by the National Tuberculosis Association, was won in the year 1920. At the present time Iowa and Idaho are in close competition for the per- manent retention of this cup. According to the 1920 report of the Association, no less than 1,300,000 pieces of printed matter have been distributed. The propaganda of the Association has extended into many avenues of social, civic and political life in the state covering schools, rural and farm organizations, industries, women’s clubs, churches and many other similar organizations. The headquarters of the Iowa Tuberculosis Association are at 518 Century Building, Des Moines, Iowa, and the executive secretary is Mr. T. J. Edmonds. KANSAS STATE TUBERCULOSIS ASSOCIATION As was the case in a number of other states, in Kansas the State Tuberculosis Association grew out of the International Congress Committee. In the fall of 1908, a group of people interested in tuberculosis 96 A HISTORY OF NATIONAL TUBERCULOSIS ASSOCIATION formed the Kansas Association for the Study and Prevention of Tuberculosis. The State Association has always worked in very close relation- ship with the State Board of Health, largely because the primary enthusiasm and interest in the organization came from the State Health Officer, Dr. S. J. Crumbine and his associate, Dr. Charles H. Lerrigo. The advantages of this close relationship have been many. Because of the rural nature of the state and the absence of large centers of population the emphasis has been laid primarily upon nursing and general community welfare. There are only two local sanatoria in Kansas besides the State Sanatorium, which serves practically the entire population. There are 5 dispensaries and a traveling clinic covering rural dis- tricts. There are 8 special tuberculosis nurses, and in addition there are a large number of general public health nurses. The Modern Health Crusade and other educational methods approved by the National Association have been vigorously pushed. The death-rate in Kansas has always been low due largely to the character and constitution of the population. There has, however, been a significant decline from 58.7 in 1914 to 48.2 in 1920. The headquarters of the Kansas State Tuberculosis Associa- tion are at 601 Mills Building, Topeka, Kansas, and the executive secretary is Dr. Charles H. Lerrigo. KENTUCKY TUBERCULOSIS ASSOCIATION Organized tuberculosis work in Kentucky dates back to 1905 when the so-called Kentucky Anti-Tuberculosis Association was formed. While the name of the Association indicates that it was a state-wide organization it functioned almost exclusively in Louisville and Jefferson County. About the same time a local association was formed at Lexington. Out of the Louisville Association grew the Hazelwood Sanator- ium, the first institutional provision for the care of the tubercu- lous in the state, and later the Louisville Municipal Sanatorium, provided for in 1908. THE STATE TUBERCULOSIS ASSOCIATIONS 97 In 1909 the Kentucky Association for the Study and Preven- tion of Tuberculosis was organized and opened an office in Louis- ville. Thus began the first real state-wide campaign against tu- berculosis. Out of the activities of this Association grew the Kentucky Board of Tuberculosis Commissioners, established by act of legislature in 1912. With the establishment of this Board, the State Association, assuming that its work was completed, passed out of existence and turned over its work and property to the Board. By 1919, however, it became apparent to the Na- tional Tuberculosis Association that the state movement against tuberculosis, outside of a few of the larger centers, was not pro- gressing as it should. In March of that year, accordingly, the entire work was reorganized. The present Kentucky Tubercu- losis Association is a development from that reorganization. Probably the most distinct feature of the campaign against tu- berculosis in Kentucky at the present time is the close relation- ship, amounting almost to amalgamation, of the State Association with the State Board of Health. The public health leaders in Kentucky consider this intimate relationship as extremely ad- vantageous. From the perspective of National Association; and in view of the inhibitions that such a close relationship compels, there is doubt in the minds of other leaders as to whether the union of the non-official state tuberculosis association with the state board of health is a wise and desirable procedure. At the present time there are 5 sanatoria in Kentucky with a bed capacity of 396. There are 4 clinics and dispensaries and 3, open-air schools and classes. More than 50 county and rural public health nurses outside of the city of Louisville are giving considerable attention to tuberculosis. Within the city of Louisville there are some 20 more nurses. Although Kentucky has a large Negro population the death- rate from tuberculosis has shown a consistent decline from 229.5 in I9QII to 152.9 in 1920. The headquarters of the Kentucky Tuberculosis Association are at 532 West Main Street, Louisville, Kentucky, and the execu- tive secretary is Dr. J. S. Lock. 98 A HISTORY OF NATIONAL TUBERCULOSIS ASSOCIATION LOUISIANA ANTI-TUBERCULOSIS LEAGUE The Louisiana Anti-Tuberculosis League was formed in De- cember, 1906, and was one of the first state associations in the south. For many years its activities centered largely about the city of New Orleans, but a number of local associations were formed prior to 1911 in various parishes and in the city of Shreve- port. As was the case with several of the state organizations estab- lished before the International Congress, one of the first problems of the Louisiana Anti-Tuberculosis League was the provision of institutional care for cases needing treatment. In March, 1908, the tuberculosis camp of the Louisiana Anti- Tuberculosis League was opened. In the same year a tubercu- losis clinic was established. The value of these two pioneer agencies in Louisiana can hardly be fully estimated. They have served as stimuli both to communities in Louisiana and other communities in the south. At the present time there are a number of local associations in the state, but only a few of them are actively functioning. Be- sides the sanatorium of the Anti-Tuberculosis League, now known as Camp Hygeia, there is an excellent and up-to-date sanatorium, recently opened at Shreveport, a camp for Negroes and a camp for whites, with a certain amount of provision for both whites and Negroes in the State Charity Hospital at New Orleans. There are twelve public health nurses serving tuberculous cases and two special tuberculosis nurses, besides a number of other nurses. A State Commission was provided by act of legislature in 1912. This Commission has plans for the establishment of one or more state sanatoria. The League has recently purchased a property at Greenwell Springs with the intention of giving it over to the Commission for a tuberculosis hospital. The death-rate from tuberculosis in Louisiana in 1918 was 185.8, and in 1920 it was 141.2. The tuberculosis problem is seriously complicated by the large number of Negroes in Louisiana. The headquarters of the Louisiana Anti-Tuberculosis League are at 730 Common Street, New Orleans, Louisiana. THE STATE TUBERCULOSIS ASSOCIATIONS 99 MAINE PUBLIC HEALTH ASSOCIATION The first attempt at organization of tuberculosis work in Maine, was in 1901, when the Maine State Sanatorium Association was formed, with Dr. Estes Nichols as medical director, and Dr. A. G. Young, of the State Board of Health as secretary. The asso- ciation was formed primarily to establish a tuberculosis sanato- rium which was opened in Hebron in 1904 and which the Sana- torium Association operated until 1915 when it was taken over by the State at a nominal sum. Largely through the influence of the original sanatorium group, the Central Maine Association for the relief and control of Tuber- culosis, in 1911, opened a second sanatorium at Fairfield, Maine. In 1915 this sanatorium was taken over by the State at a nominal sum. A third state sanatorium at Presque Isle, was opened in 1920. In 1908 largely as a result of the interest generated by the Inter- national Congress, the Maine Society for the Study and Preven- tion of Tuberculosis was formed. This organization did very little active work. It did lead, however, to the organization of the Maine Anti-Tuberculosis Association, in Lewiston in I9gII, with Bishop Robert Codman as president and Dr. A. D. Downes, as secretary. Although its funds were limited, an executive secre- tary was engaged and a state-wide campaign was started. Local tuberculosis activity had been developed in the mean- time at Bangor, Lewiston, Waterville, Portland and in sections of Aroostook and Washington Counties. In 1918 the association was re-christened and reorganized as the Maine Public Health Association, the general feeling being that the sparseness of the population made it undesirable to en- courage a number of specialized state associations and that the entire tuberculosis and public health work would be furthered by one organization. At the present time the State Association has a number of di- visions such as tuberculosis, child welfare, cancer, prevention of blindness, social hygiene, dental hygiene, mental hygiene, etc. In addition to the three state tuberculosis sanatoria at Hebron, Fairfield, and Presque Isle, with a total bed capacity of 297, there 100 A HISTORY OF NATIONAL TUBERCULOSIS ASSOCIATION are the three private sanatoria and a hospital for tuberculous ex-service men, three tuberculosis dispensaries, four fresh-air schools, and twelve local associations. The death-rate from tuberculosis in Maine has shown a steady decline from 149.6 in I910 to 103.8 in 1920. The headquarters of the Maine Public Health Association are at 318 Water Street, Augusta, Maine. The executive secre- tary is Mr. Walter D. Thurber. MARYLAND TUBERCULOSIS ASSOCIATION As has been pointed out elsewhere in these pages (see pp. 10 and 14), the campaign against tuberculosis in Maryland was among the earliest and best conceived of any of the state movements. In 1902 the legislature of the state of Maryland passed a law authorizing the appointment of a tuberculosis commission to investigate the means of preventing tuberculosis in the state and the feasibility of establishing a state sanatorium. The men appointed by this commission were among the leaders in civic, social, and public health work of the state; such men as the late Sir William Osler, Dr. William H. Welch, Dr. Henry Barton Jacobs, Dr. John S. Fulton, Dr. William S. Thayer, and others. As a result of a survey conducted by this commission, the first well-developed effort of its kind, the Maryland Associa- tion for the Prevention and Relief of Tuberculosis was formed at the suggestion of the commission in December, 1904. The Association selected an executive secretary and began its active work in 1905. One of the earliest activities was the development of the tu- berculosis exhibit, which had been created by the commission in 1904, and was the first of its kind. As has been noted in other pages of this history (see p. 22), the national meeting, out of which the National Tuberculosis Association grew, was held in connection with this exhibit. Under the leadership of the Maryland Association some of the pioneer tuberculosis nursing work of the country was developed. By 1907 the Association was supporting three special tubercu- losis nurses, and its traveling exhibit had been seen by over 100,000 persons. Local associations had been established in THE STATE TUBERCULOSIS ASSOCIATIONS 101 two counties, a special tuberculosis dispensary had been located in one of the congested districts in Baltimore, and a considerable amount of other progressive work had been carried on. In connection with the development of the state program in Maryland, mention should be made of the pioneer work of the Hospital for Consumptives of Maryland, popularly known as the Eudowood Sanatorium, located at Towson. This institu- tion had been established in 1896 for white patients in the early stages of tuberculosis who were unable to pay for their full cost of maintenance in private institutions. It has been a pioneer in the development of the farm colony idea, and has contributed much to the interest in tuberculosis work throughout the state of Maryland. There are at the present time 15 local associations in Mary- land, a state sanatorium and 6 local sanatoria and hospitals with a combined bed capacity of 501, a preventorium, 13 clinics and dispensaries, 5 open-air schools, and approximately 175 public health and tuberculosis nurses. Of the 23 counties in the state, 14 are undertaking active educational work. The Maryland Association was one of the earliest to develop the railroad car exhibit, and later to work out the automobile clinic and exhibit. In 1919 the Association established a preventorium for children, and in 1921 secured the site for a Negro open-air health school, the first institution of its type to be proposed in this country. The death-rate from tuberculosis in Maryland, in spite of the large Negro population, has shown a constant decline from 208.1 in 1906 to 165.8 in 1919, and 146.7 in 1920. The headquarters of the Maryland Tuberculosis Association are at 704 North Howard Street, Baltimore, Maryland, and the executive secretary is Mr. A. E. Sinks. MASSACHUSETTS TUBERCULOSIS LEAGUE Although the campaign against tuberculosis in Massachusetts dates in point of development back at least to 1898, the Massa- chusetts Anti-Tuberculosis League was not formed until 1914. In 1898, as is pointed out in Chapter XX XVII, Dr. Vincent Y. Bowditch secured from the legislature of Massachusetts an ap- 102 A HISTORY OF NATIONAL TUBERCULOSIS ASSOCIATION propriation for the first state sanatorium, located at Rutland. The state sanatorium grew out of Dr. Bowditch’s experience at the Sharon Sanatorium, established seven years earlier in 1891. The interest of men like Dr. Bowditch, Dr. Edward O. Otis, Dr. James J. Minot, and others brought about, in 1903, the organization of the Boston Association for the Relief and Control of Tuberculosis. In the same year a group of workers in Cambridge formed the Tuberculosis Aid and Education Association of Cambridge, now known as the Cambridge Anti-Tuberculosis Association. For more than ten years the Boston Association served as a state association much in the same way as the Chicago Tuber- culosis Institute had done in Illinois. Local associations sprang up in various parts of the state, particularly in the larger centers of population. In 1914, however, it became apparent that there was necessity for closer codrdination as well as need for covering the territory more adequately. Out of this need grew the Massachusetts Anti-Tuberculosis League in February, 1914. Meanwhile, in 1907, largely as a result of the activity of the Boston group, a State Commission had been appointed to erect three tuberculosis hospitals in different parts of the state. In 1906 the State Medical Society created a group of its local organizations on the prevention of tuberculosis. All of its activi- ties were later merged either in the State Department of Health, or in the new State Anti-Tuberculosis League. Credit for the present existing machinery for the control of tuberculosis in Massachusetts belongs, therefore, not entirely to the State League, but to various agencies. Much of it owes its existence to the Boston Association and to the other asso- ciations at Cambridge, Lawrence, Salem, New Bedford, Holyoke, Springfield, Fall River, and Brookline, all of which had been active for several years previous to the organization of the State League. Credit also belongs to the State Department of Health, includ- ing its district health officers and nurses, to the visiting nurses’ associations, and to such men as the late Dr. William J. Gallivan, who were active in securing progressive health legislation before the State League was organized. THE STATE TUBERCULOSIS ASSOCIATIONS 103 The work of the Massachusetts Tuberculosis League during its early history was conducted through the codperation of the Boston Association, the League having no independent paid staff or offices of its own. Since 1918 the League has assumed full responsibility for state-wide activities, and has organized a large portion of the state on the county and district unit plan, and has increased its local Seal Sale Committee from 91 to 350. At the present time there are in Massachusetts 4 state sana- toria, 6 county hospitals, 40 municipal and private institutions with a combined bed capacity of 4,356, which will be increased to approximately 5,000 when the county hospital program is completed. The county hospital law is mandatory and must be complied with not later than 1925. There are 56 tuberculosis dispensaries, I preventorium, 35 open-air schools registering 3,120 pupils, and about 800 public health nurses. The passage of legislation making it mandatory for communi- ties with a population of 10,000 or over to establish tuberculosis dispensaries, the provision of 4 state hospitals, the establish- ment of the Framingham Demonstration, and the reorganiza- tion of the State Department of Health are among the high lights of achievement to which the campaign against tuberculosis in Massachusetts has contributed very largely. The mortality from tuberculosis in Massachusetts has been declining in recent years. In 1905 the death-rate was 192.7; in I910 it was 162.7; in 1915 it was 141.6, and in 1920 it was 113.8. The headquarters of the Massachusetts Tuberculosis League are located at 80 Boylston Street, Boston, Massachusetts, and the executive secretary is Mr. R. V. Spencer. MICHIGAN TUBERCULOSIS ASSOCIATION In February, 1908, the Michigan Association for the Prevention and Relief of Tuberculosis was formed, a group of physicians headed by Dr. Victor C. Vaughan, Jr. and Dr. A. S. Wharton of the University of Michigan Medical School being the leaders in the formation of the new organization. As early as 1905 the Grand Rapids Tuberculosis Society had 104 A HISTORY OF NATIONAL TUBERCULOSIS ASSOCIATION been formed, and by 1908 it had already secured a municipal tu- berculosis sanatorium. The Detroit Society for the Study and Prevention of Tubercu- losis had been organized in 1905. Except for these two centers, relatively little work in tuberculosis prevention had been done throughout the state. The state sanatorium was established in 1907. Since that time 19 county sanatoria and one private sanatorium have come into existence or are provided for. There are 24 permanent local clinics and about as many irregular local clinics. The State Board of Health in codperation with the State Association main- tains a traveling clinic. There are 4 preventoria, 35 open-air schools, 12 special tuberculosis nurses, and approximately 150 other public health nurses. The State Association has brought into existence local organ- izations in about 60 different communities. Most of the state is now covered with associations and in some of these full-time executives are employed. One of the most significant achievements of the Michigan Asso- ciation was the famous Michigan survey conducted from 1915 to 1917 by the State Board of Health in codperation with the State Association, under an appropriation of $50,000. This survey was the first state-wide effort of its kind, and brought to light, in the rural communities particularly, a large amount of tubercu- losis that was previously unknown. The State Association followed up the survey in 1918-1920 with a series of traveling clinics working in codperation with the State Board of Health. In this way many of the rural communities of the state have been able to secure expert diagnostic facilities which otherwise would have been impossible to them. The death-rate in Michigan, as in most of the states bordering on the Great Lakes, has always been low, but as a result of the ex- tensive activity of the State Association and the State Board of Health it has shown a steady decline from 99.3 in 1908 to 83.6 in 1920. The headquarters of the Michigan Tuberculosis Association are at 209 Shiawassee St., West, Lansing, Michigan, and the executive secretary is Mr. Theodore J. Werle. THE STATE TUBERCULOSIS ASSOCIATIONS 105 MINNESOTA PUBLIC HEALTH ASSOCIATION One of the first expressions of tuberculosis activity in Minne- sota was in 1901, when at the instance of a group of physicians, headed by Dr. H. Longstreet Taylor, the legislature passed an act providing for the establishment of a State Commission on Tuber- culosis, one of the earliest bodies of its kind. The Commission was created primarily for the purpose of studying the advisability of a state sanatorium, which was opened in 1905. The Associated Charities of Minneapolis at about the same time began to take a considerable amount of interest in tuberculosis, largely because of its contact with families in which the disease was present. In 1903, the Anti-Tuberculosis Committee of the Associated Charities of Minneapolis was formed and began a work which has been of great significance not only to Minnesota but to the entire country. The Minnesota Association for the Prevention and Relief of Tuberculosis was organized in 1906, but for two years it remained in a somewhat dormant condition. In 1908 it was reorganized and an executive secretary was secured. In July, 1914, the association was again reorganized under the name of the Minnesota Public Health Association although its program was and has been very largely a tuberculosis one. As a result of the activities of the original state association, in 1913 the legislature passed a law providing for state aid in the erection and maintenance of county tuberculosis hospitals. The stimulus of state subsidy, together with the supervising oversight accorded to the State Commission as a result of the subsidy, has greatly helped in the establishment of county and district hospi- tals. At the present time hospitalization is available for practi- cally every section of the state. Fhere are 14 such local institu- tions besides the state sanatorium, with an aggregate bed capacity of 1,164. The Association has developed 87 local affiliated organizations. There are a very large number of public health nurses working in coéperation with the county hospitals and in other ways. The death-rate from tuberculosis in Minnesota has declined from 109.1 in I9I0 to 89.5 in 1920. 106 A HISTORY OF NATIONAL TUBERCULOSIS ASSOCIATION The headquarters of the Minnesota Public Health Association are at 300 Shubert Building, St. Paul, Minnesota, and the execu- tive secretary is Dr. William F. Wild. MISSISSIPPI TUBERCULOSIS ASSOCIATION The first attempt at organization of tuberculosis work in Mis- sissippi was in 1907, when the Mississippi State Anti-Tuberculosis League was formed. The Association, however, while starting out with a laudable purpose and with a certain amount of educa- tional activity, did not long survive. It was not until 1913 that another effort at organization was made when the Mississippi Anti-Tuberculosis Committee was formed with headquarters at Jackson. The present Mississippi Tuberculosis Association is a rechristening of this earlier organization. Considering the sparsity of population, the large Negro element and the lack of great industrial centers, Mississippi has made a record of itself in the development of tuberculosis work since 1913 of which it may well be proud. Much still remains to be done, but the progress indicates favorable development in the future. The national campaign of education, developed out of Christ- mas seal funds by the State Association, gradually bore fruit until in 1918 the Mississippi State Tuberculosis Sanatorium came into existence with Dr. Henry Boswell as superintendent. With the opening of the sanatorium, the need for such an institution be- came more and more apparent. In connection with the State Association, therefore, Dr. Boswell began a campaign before the meeting of legislature in 1919, which resulted in the hitherto un- precedented appropriation by the Mississippi Legislature of $1,000,000, for the enlargement of the state sanatorium and the extension of its work throughout the state. The completed plan of the institution provides for 1,000 beds. Less than five years ago there was not a single bed for the care of the tuberculous patients in Mississippi. The State Association has also aroused interest locally and now has 22 affiliated county tuberculosis committees. Besides the state sanatorium there is a county hospital. The state also main- tains an excellent traveling clinic and the State Association main- tains a state nurse. There are about 20 public health nurses. THE STATE TUBERCULOSIS ASSOCIATIONS 107 All told, the stimulus that the tuberculosis campaign has given to public health work in Mississippi is truly remarkable. The death-rate from tuberculosis in Mississippi in 1920 was 127.8. The headquarters of the Mississippi Tuberculosis Association are in the Merchants Bank Building, Jackson, Mississippi, and the executive secretary is Mrs. R. S. Phifer, Jr. MISSOURI TUBERCULOSIS ASSOCIATION The earliest attempt at community organization for tubercu- losis prevention in Missouri was in St. Louis. The local Society for the Prevention of Tuberculosis was organized in that city in May, 1904. Three years later, in 1907, the Missouri Association for the Relief and Control of Tuberculosis was formed. A state sanatorium had been assured by an act of legislature of 1905, furthered largely by Dr. James Stewart. In 1910, a State Commission, supported by private funds, was appointed by the Governor and conducted a vigorous state-wide campaign on tuberculosis, the first effort of its kind. Following this campaign the work of the State Association lapsed somewhat until in the fall of 1911 when a reorganization was effected. In 1918 the association’s offices were moved from Columbia to St. Louis. The Missouri Tuberculosis Association conducts a unique and vigorous campaign of education centering largely . about the public schools and the school machinery of the state. The Modern Health Crusade has been used since 1918 as the basis for this educational campaign. Legislation has been secured providing for: the strengthening of the State Board of Health in- cluding the establishment of a Division of Child Hygiene; state aid to county hospitals; municipal and county public health nurses; improving sanitary conditions in the lead and zinc mining districts as a means of lessening tuberculosis; and instruction in physical education in the public schools of the state, including the preparation of teachers, nurses and medical health super- visors for such service. In St. Louis, the local tuberculosis society has developed its campaign independently of the State Association. There are few cities in the country where greater interest in tuberculosis has been 108 A HISTORY OF NATIONAL TUBERCULOSIS ASSOCIATION aroused than in St. Louis. A splendid corps of municipal tuber- culosis nurses, a municipal sanatorium, a series of municipal tuberculosis clinics, a system of open-air schools and a developing plan on municipal control of tuberculosis, speak volumes for the educational work accomplished by the St. Louis Society. In Kansas City, St. Joseph, Columbia and Springfield the local societies have been active in establishing open-air schools and tu- berculosis visiting nurse service; in Jasper County, a county tuberculosis hospital has been established and nurse service maintained. In the state as a whole, the present machinery for the control of tuberculosis consists of 1 state sanatorium, I county hospital, 2 municipal hospitals, 1 night and day camp and I preventorium. Tuberculosis clinics are found in Kansas City, St. Joseph, Spring- field, and St. Louis, 11 in all. There are 3 open-air schools and about 150 nurses outside of St. Louis giving whole or part time to tuberculosis work. Besides the larger cities of the state, several small cities conduct the physical examination of school children and maintain baby clinics. The death-rate from tuberculosis in Missouri has declined from 154.6 in I91I to 106.9 in 1920. The headquarters of the Missouri Tuberculosis Association are located at 706 Pontiac Building, St. Louis, Missouri, and the executive secretary is Dr. W. McN. Miller. MONTANA TUBERCULOSIS ASSOCIATION In 1908 a Montana Association for the Prevention and Study of Tuberculosis was formed, but its existence was largely on paper as it never functioned in a state-wide capacity. When the Na- tional Tuberculosis Association, therefore, in 1915 conducted a Christmas seal sale by mail for the benefit of a Montana Associa- tion it secured a welcome response and enough funds to assure the organization. In June, 1916, a new association was organized and a sufficient fund was provided, together with a program, to assure continuity of work. Montana is a state of huge distances and of difficult travel. Many of its counties are isolated for months at a time. It is THE STATE TUBERCULOSIS ASSOCIATIONS 109 largely agricultural with a certain amount of mining industry. In view of these circumstances, the development of tuberculosis work in Montana is doubly significant. In 1913 the state sanatorium was begun by act of legislature. It has now increased its capacity to 138. Itis the only sanatorium in the state except for a federal institution exclusively for Indians. Besides the sanatorium there are 4 clinics, 3 full time health officers and about 30 public health nurses. The State Association has 4 local organizations. These figures, however, do not indicate the enormous amount of interest aroused by the Modern Health Cru- sade, poster and essay contests, exhibits, etc. throughout the state. The State Association works in close codperation with the State Board of Health and has hundreds of representatives in the women’s clubs, rotary clubs, parent-teachers associations and similar organizations centered throughout the state. The un- favorable financial situation during the past four years has had some effect upon the development of active work in Montana, but this has not been so serious as to retard the work altogether, as will be noted from the figures and facts quoted above. The death-rate from tuberculosis in Montana has declined from 107.3 in I916 to 75.1 in 1920. The headquarters of the Montana Tuberculosis Association are at the State Capitol, Helena, Montana, and the executive secre- tary is Mrs. Sara E. Morse. NEBRASKA TUBERCULOSIS ASSOCIATION The Nebraska Association for the Study and Prevention of Tuberculosis, out of which the present association has grown, was formed in December, 1907. Its secretary, Mrs. K. R. J. Edholm, has served in that capacity since June, 1908. The present equipment for the prevention of tuberculosis in Nebraska consists of a state sanatorium, established in 1912, one county pavilion, two clinics, two open-air classes, three special tuberculosis nurses, and a very considerable number of city and county school nurses and Red Cross nurses who devote a certain amount of attention to tuberculosis. Under the direction of the Nebraska Association, and partially 110 A HISTORY OF NATIONAL TUBERCULOSIS ASSOCIATION financed by the National Association, a thorough survey of the Winnebago Indians was made in 1919 and 1920. The survey has been published by the Nebraska Historical Society. The death-rate from tuberculosis in Nebraska was 43.0 in 1920. The headquarters of the Nebraska Tuberculosis Association are located at 483 Brandeis Theatre Building, Omaha, Nebraska, and the executive secretary is Mrs. K. R. J. Edholm. NEVADA PUBLIC HEALTH ASSOCIATION The Nevada Public Health Association was organized in 1916, on much the same basis as the associations in Idaho, Montana and Wyoming. All of these associations were formed out of funds secured through the Christmas seal sale by the National Association. ; The entire population of the State of Nevada, according to the 1921 census, was only 77,000, less than the population of a city like Trenton, New Jersey, or Syracuse, New York. The problem of developing a state-wide interest in public health and tuber- culosis under such circumstances will readily be seen to present peculiar difficulties. It is gratifying, however, to note that in the last five years the State Association has developed an unusual amount of interest in tuberculosis. A very considerable number of patients have been taken care of, chiefly in California institu- tions. The Modern Health Crusade has been extended through- out the schools. The mining camps have spread information about health and disease. At least six public health nurses have been secured for state or local work. At present there is a deter- mined effort ‘to secure some definite state provision for tubercu- losis patients and for the development of a better state public health system. It is not too much to say that all this interest and activity can be traced to the Nevada Public Health Association. The headquarters of the Nevada Public Health Association are at Reno, Nevada; and the secretary is Mrs. Martha O. Davis. NEW HAMPSHIRE TUBERCULOSIS ASSOCIATION The earliest history of tuberculosis activity in New Hamp- shire is that of a commission appointed by joint resolution of the legislature in 1901. The report of this commission led to the THE STATE TUBERCULOSIS ASSOCIATIONS 111 establishment of the New Hampshire State Sanatorium in 1909. In many respects the New Hampshire Commission report of 1902 ranks with the now famous Maryland Commission report of about the same time. In 1904 the New Hampshire Society for the Prevention of Consumption was formed. The membership was largely medical. As the society lacked funds it soon passed out of existence. As early as 1901 a local sanatorium at Concord (the Pem- broke Sanatorium) had been established, the first institution for the treatment of tuberculosis in the state. After the New Hampshire Society for the Prevention of Con- sumption had ceased to be active, the New Hampshire Red Cross took an interest in the development of tuberculosis work, and for several years fostered interest both in the Pembroke Sanatorium and to a certain degree in educational effort. In 1916, at the instance of the National Tuberculosis Asso- ciation, the work of the state was reorganized and the present New Hampshire Tuberculosis Association was formed. The remarkable development of tuberculosis activity in New Hamp- shire since that time is due largely to the activity of the state association. Besides the state sanatorium and the Pembroke Sanatorium there is only one other institution that makes provision for tuberculous patients in. the state. The total bed capacity for tuberculous patients is 207. There are 20 tuberculosis clinics. At the present time there are 12 nurses whose entire time is de- voted to case finding and. educational work, both in the homes and the community, and about 170 public health nurses engaged in various forms of public health work throughout the state. Many of these give valuable assistance to the tuberculosis nurse and coéperate in every way. The constructive educational campaign being carried on throughout the state utilizes every device for the promotion of its work. The Modern Health Crusade is particularly active. Through the state association, facilities are available for the advice, diagnosis and treatment of patients in any part of the state. 112. A HISTORY GF NATIONAL TUBERCULOSIS ASSOCIATION Since 1916 the death-rate from tuberculosis in New Hamp- shire has shown a drop from 114.5 to 97.0 in 1920. The headquarters of the New Hampshire Tuberculosis Asso- ciation are located in the Manchester City Mission Building, Merrimac and Beech Streets, Manchester, New Hampshire, and the executive secretary is Dr. Robert B. Kerr. NEW JERSEY TUBERCULOSIS LEAGUE The first organization for the prevention of tuberculosis in New Jersey was the Anti-Tuberculosis Committee of the Oranges, established in 1904. The New Jersey Association for the Prevention and Relief of Tuberculosis was established in 1906, with headquarters in Newark. For seven years the association conducted a more or less active campaign until, in 1913, it became necessary to reorganize the work. By that time local associations had been formed in most of the larger cities in the state. The state asso- ciation became, as in the case of Massachusetts, a league of societies as its name implies. It has, since reorganization, gone beyond the original limits set for the League, and developed a large amount of unorganized territory in the localities where it has not been possible up to this time to organize local associa- tions. There are 38 local associations definitely affiliated with the League, indicating that the state is fairly well served, espe- cially in view of the fact that most of the local associations have full-time executives. Under the county hospital laws of 1910 and 1912 the League has developed 9 county hospitals and 4 city sanatoria. In addi- tion there is the state sanatorium and one private sanatorium, with a total bed capacity of 1,688. There are 18 clinics and dispensaries, 5 camps, 2 preventoria, and 40 open-air classes. Eighty-four towns and cities have public health nursing service, the number of nurses being considerably in excess of the number of towns. The legislative activity of the State League, besides that already mentioned, has resulted in the prevention of public spitting, the abolition of the roller towel and public drinking THE STATE TUBERCULOSIS ASSOCIATIONS 113 cup, better housing laws, improved factory conditions, and the compulsory reporting of tuberculosis. The educational campaign of the State League and its affiliated local groups has been broad and extensive and, furthermore, has been intensive enough to reach practically every group in the population. The mortality from tuberculosis in 1906 was 196.0, and in 1920, 114.0. The headquarters of the New Jersey Tuberculosis League are at 45 Clinton Street, Newark, New Jersey, and the secretary is Mr. Ernest D. Easton. NEW MEXICO TUBERCULOSIS ASSOCIATION The first state association in New Mexico was the New Mexico Society for the Study and Prevention of Tuberculosis, formed in 1909, a development of the International Congress Committee. This society, however, never functioned as a state-wide organiza- tion and, except for a small amount of activity centered largely in Albuquerque, its headquarters did very little work. In 1917, at the instance of the National Association, the society was reorganized under the name of the New Mexico Public Health Association with an executive office in Albuquerque. The tuberculosis problem in New Mexico is complicated by three outstanding factors; first, the indigent migratory consump- tive; second, the large Mexican population, and third, the scat- tered character of the communities. Considering these three conditions, the development of tuberculosis work in New Mexico since 1917, under the leadership largely of the State Association, has been remarkable in many ways. One of the first tasks of the Association was to secure, in co- operation with the United States Public Health Service, legisla- tion providing for a State Department of Health with a full-time health officer. The outgrowth of this legislation has been the se- curing of full-time county health officers in several of the coun- ties of the state. A traveling clinic, in 1919, covered many of the Spanish-speak- ing districts of the state, and for the first time brought the message of tuberculosis and its prevention to these villages. 8 114 A HISTORY OF NATIONAL TUBERCULOSIS ASSOCIATION The Modern Health Crusade has, during the last year, been presented to over 20,000 children. There has also been a very considerable amount of education on tuberculosis in other ways. New Mexico is a health resort state. It has no provision for the local care of tuberculous patients. There are 18 sanatoria but they are all private institutions. Through the activity of the State Association and the State De- partment of Health, however, there are nearly 20 public health nurses now working in New Mexico. The public health interest centers largely about tuberculosis and child welfare. The headquarters of the New Mexico Tuberculosis Association are at Albuquerque, New Mexico. NEW YORK STATE TUBERCULOSIS ASSOCIATION [Note: The work of the New York City and Brooklyn Tuberculosis organ- izations will be treated under separate sections.] The campaign against tuberculosis in New York State, outside of Greater New York, has since 1907 been conducted by the Com- mittee on Prevention of Tuberculosis of the State Charities Aid Association recently reorganized into the Committee on Tuber- culosis and Public Health: In July 1907 the Russell Sage Foundation, at that time recently established, made available a sum of money to the State Charities Aid Association for the development of a state-wide campaign against tuberculosis in New York with a view to demonstrating the possibility of organization on a state basis. Up to that time none of the state tuberculosis associations in the United States had had sufficient funds with which to organize a proper cam- paign. The first task of the new committee, under the immediate direction of John A. Kingsbury and the general supervision of Homer Folks, the general secretary of the State Charities Aid Association, was to reach, with an exhibit and an educational campaign, the larger cities of the state. By 1908 it became apparent that the immediate need of the state was local hospital provision. i In 1909 a law was enacted providing for county tuberculosis hospitals. Then began a campaign which had for its slogan ‘‘ No uncared-for tuberculosis in New York State.” The following out THE STATE TUBERCULOSIS ASSOCIATIONS 115 of that slogan has resulted, by January 1, 1922, in the establish- ment of county hospitals in 37 counties. In addition the City of Buffalo has provided 2 municipal institutions. Municipal pro- vision has also been secured in Albany, and the capacity of the State Sanatorium at Raybrook has been doubled. The total bed capacity of New York State, outside of New York City in 1907 was 324. On January 1, 1922, the total bed capacity in New York State was 3,360. Along with this progres- sive growth in institutional provision has gone a corresponding development in dispensaries, nurses, open-air schools, preventoria and similar agencies. By this time there are 68 sanatoria, 40 dis- pensaries, 232 nurses, 49 open-air schools, and 4 preventoria. Furthermore the archaic public health law of New York, at the instance of the State Tuberculosis Committee, was completely revised and an up-to-date department of health was created, placing New York State in a leading position for the entire coun- try. The significance of this public health law with its district supervisors and its entire machinery for relaying the state health facilities to the local health departments can hardly be over- estimated in the prevention of tuberculosis. . As might have been expected, the State Tuberculosis Commit- tee has been obliged to organize its work extensively throughout the state. During the formative period of this work it formed a large number of county and local committees, over 300 all told. More recently, however, the development has been along intensive lines, particularly in the formation of strong county associations with full-time paid executives. At the present time there are 52 such associations, and in addition there are other local commit- tees. The New York State Committee’s campaign is probably the most striking example of the way in which a non-official voluntary association can by intensive effort secure institutions, nurses, dis- pensaries and other machinery for the control of tuberculosis. The amount of money spent by the state committee and its affili- ated agencies is relatively small when compared with the millions of dollars invested from public funds and the hundreds of thou- sands of dollars being spent each year from the same sources. The death-rate from tuberculosis in New York State, outside 116 A HISTORY OF NATIONAL TUBERCULOSIS ASSOCIATION of Greater New York, has steadily declined.* In 1907 it was 152.7. In 1915 it was 135.9. In 1920 it was 112.4. The headquarters of the Committee on Tuberculosis and Public Health of the State Charities Aid Association (New York State Association) are at 105 East 22d Street, New York City, and the executive secretary is Mr. George J. Nelbach. NEW YORK TUBERCULOSIS ASSOCIATION [Note: This section will treat of the work of the New York Tuberculosis Association covering the boroughs of Manhattan, Bronx and Richmond of Greater New York. The next section will treat of the work of the boroughs of Brooklyn and Queens.] Organized tuberculosis work in New York City dates back to the year 1902 when the Committee on Prevention of Tuberculosis of the Charity Organization Society of New York was formed (see page 18). The work was carried on under this committee until 1919 when the New York Tuberculosis Association was formed, taking over the activities of the committee. Among the first local tuberculosis associations to develop an active program for prevention of tuberculosis was the New York Committee. Its first secretary was Paul Kennaday. A hand- book on the prevention of tuberculosis was published by the com- mittee as its first annual report. This document was one of the first attempts in this country to point out the social incidence of tuberculosis. , In 1904, a directory of institutions and societies dealing with tuberculosis in the United States and Canada was published, the first of a series since continued by the National Tuberculosis As- sociation. The New York Committee continued its activities, working with various groups such as the medical society, labor union, industrial organizations, department of health and similar groups. Through its codperation with the city administration, the institutional facilities of New York were greatly expanded, first in the provision of a sanatorium at Otisville, then in the establishment of a large * These rates are not directly available from the mortality records of the U.S. Census Bureau. They were obtained by using the deaths in N. Y. State outside of N. Y. City as given by the Census Bureau and the estimated mid- year populations for the given years, THE STATE TUBERCULOSIS ASSOCIATIONS 117 hospital for moderately advanced cases at Staten Island, and later in the development of an admirable system of tuberculosis clinics, public and private, under the Association of Tuberculosis Clinics. The Committee was also responsible for the introduction of open-air classes in the schools, and the New York Association still exercises a degree of supervision over this valuable adjunct for the building up of children. The Committee codperated with the department of health in the securing of more than 150 tuberculosis and public health nurses, and in other ways stimulated the increased budgets for the city departments dealing with tuberculosis. The Committee also took an active part in state legislation, particularly the modification of tenement house laws and the de- velopment of New York’s Health Department. In 1919, following the first attempt at a Greater City Christmas seal sale, the New York Tuberculosis Association was organized with Dr. James Alexander Miller as its president. One of the most significant activities of the Association since its development has been the establishment of a vocational work- shop largely for ex-service men who have had sanatorium treat- ment. The shop follows the lines of activity successfully devel- oped by the Altro Manufacturing Company, conducted by the Committee on the Care of Jewish Tuberculous. The New York Association has also succeeded in developing strong work in the outlying boroughs of the Bronx and Richmond. The traveling exhibit of former years has been expanded into a full and complete health exhibit with social workers, lecturers, and even a physician in attendance to answer requests for infor- - mation with real knowledge as against the usual method of having only ordinary attendants at such exhibits. The educational work being carried on among labor unions and industrial organizations is particularly worthy of mention as well as the work in the schools. A notable movement in the anti-tuberculosis field in New York City is that of the auxiliaries or committees of women attached to many of the tuberculosis clinics which not only have undertaken to provide funds for emergency relief, but, especially in the cases of the New, York Society for the Prevention and Relief of 118 A HISTORY OF NATIONAL TUBERCULOSIS ASSOCIATION Tuberculosis and the Woman's Auxiliary to the Bellevue Tuber- culosis Clinic, have stepped into the breach and have organized day camps and nurseries, have supported educational classes, and strengthened the clinic work wherever it needed support. These auxiliaries under the leadership of the New York Tubercu- losis Association, have been confederated into an organization known as the Associated Tuberculosis Auxiliaries. In connection with the work of the New York Tuberculosis Association mention should be made also of the activities of the New York Association for Improving the Condition of the Poor, under the leadership of Bailey B. Burritt. This Association, while largely a relief agency, has been instrumental in developing a unique contribution to tuberculosis methodology, namely, the Home Hospital. Here the tuberculous patient and his family may receive treatment under home environment, with intensive med- ical and nursing care approximating that secured in a sanatorium. The death rate from tuberculosis in Greater New York has de- clined from 240.6 in 1902 to 127.8 in 1920. The headquarters of the New York Tuberculosis Association are at 10 East 39th Street, New York City, and the Director is Mr. J. Byron Deacon. COMMITTEE ON THE PREVENTION OF TUBERCULO- SIS OF THE BROOKLYN BUREAU OF CHARITIES [Note: This section will treat of the work in the boroughs of Brooklyn and Queens of the city of Greater New York.] Organized tuberculosis work in Brooklyn dates back to 1905, when the Committee on the Prevention of Tuberculosis of the Brooklyn Bureau of Charities was formed. It is interesting to note that in Brooklyn, as in Manhattan, the original tubercu- losis committee was a branch of the leading relief organization of the city. This committee relationship in Brooklyn is. still maintained. There is no independent \tuberculosis association as in Manhattan. The Brooklyn Committee has made a number of signal con- tributions to tuberculosis work in that borough, and in the country at large, notably the development of the Medford Sana- torium, through the active participation, financial and other- THE STATE TUBERCULOSIS ASSOCIATIONS 119 wise, of the Brooklyn Federation of Labor; the perfection of the ferry-boat day camp service in codperation with the city de- partment of health; organization of one of the first health centers in the city, and the early use of health places as a means of educa- tion on tuberculosis. In 1919, following the Greater New York Christmas seal sale, to which reference has been made in the preceding section, a committee covering the Borough of Queens was organized under the supervision of the Brooklyn Committee. In 1921 the Queens Committee became an independent asso- ciation known as the Queens County Tuberculosis Association. This organization is now developing an extensive educational campaign throughout this large and diversified borough of Greater New York. The death-rates from tuberculosis given in the preceding sec- tion for New York city apply to Greater New York and include Brooklyn and Queens. The same relative decline in this borough has been marked as in the whole city. The headquarters of the Committee on the Prevention of Tu- berculosis of the Brooklyn Bureau of Charities are at 69 Scher- merhorn Street, Brooklyn, New York. Dr. Thomas J. Riley is the general secretary and Mr. Nels A. Nelson is the secretary. NORTH CAROLINA TUBERCULOSIS ASSOCIATION In 1906 a North Carolina Association for the Prevention of Tuberculosis was organized. With no money and without a very definite program, the Association soon passed out of exist- ence. In 1913, at the suggestion of the National Tuberculosis Asso- ciation, a Red Cross Seal Commission for North Carolina was formed. Out of the energetic activity of that commission a new state association, known as the North Carolina Tuberculosis Association, was organized in 1920. The Red Cross Seal Com- mission, from its beginning in 1913, was closely related to the State Bureau of Tuberculosis and the State Sanatorium, of which Dr. L. B. McBrayer was the head, and has naturally developed its program in close codperation with these official agencies. The formation of the independent association in 1920 grew 120 A HISTORY OF NATIONAL TUBERCULOSIS ASSOCIATION out of the feeling that an independent association could be more effective and more representative of the state as a whole. The tuberculosis program in North Carolina has shown dis- tinct advance, particularly in the development of educational work for Negroes, public health nursing, the admirable state sanatorium, and medical education. The traveling clinic of the state association has also been a distinct feature of the work. At the present time, beside the state sanatorium, with a capa- city for 200 white patients and a state sanatorium for Negroes in process of erection, there are two county sanatoria with a bed capacity for 48 white and colored, and two other county sanatoria in process of erection, to cost $100,000 and $150,000 respectively, both maintained by tax, six private sanatoria, one general hospital with a tuberculosis pavilion, four tuberculosis clinics, and 45 public health nurses doing tuberculosis work. The death-rate from tuberculosis in North Carolina in 1916 was 147.2. In 1920 it had declined to 116.5. The headquarters of the North Carolina Tuberculosis Asso- ciation are at Sanatorium, North Carolina, and the executive secretary is Dr. L. B. McBrayer. NORTH DAKOTA TUBERCULOSIS ASSOCIATION The original stimulus for organization of the North Dakota Anti-Tuberculosis Association came from a group of people who had been interested in tuberculosis work at the International Congress. In 1909 the North Dakota Anti-Tuberculosis Association was formed. Its first activity was to urge the establishment of a state sanatorium, which was opened in 1911. The activity of the state association has resulted since then in the expansion of the state sanatorium to a bed capacity of 140, and in the estab- lishment of two open-air schools. and several open-window rooms, and about 35 public health nurses. The traveling clinic of the association is also a feature of its work. The original group of workers in North Dakota, as in most states, was hardly a dozen people. Today the entire state is aroused and active in the fight against tuberculosis. The headquarters of. the North Dakota Tuberculosis Asso- THE STATE TUBERCULOSIS ASSOCIATIONS 121 ciation are in the Tribune Building, Bismarck, North Dakota, and the executive secretary is Miss Carrie Haugen. OHIO PUBLIC HEALTH ASSOCIATION The Ohio Society for the Prevention of Tuberculosis, formed in the fall of 1901, is, next to the Pennsylvania Society for the Pre- vention of Tuberculosis, the earliest state association still in ex- istence. In 1902 a state commission was formed which presented a report to the legislature and was discharged from office in 1903. The original Ohio Society existed for a number of years without a very active program. In the fall of 1908 it was reorganized on a firmer financial basis and has since that time been a leader in the development of the tuberculosis and public health program in the state of Ohio. In 1911 the Society was incorporated. In 1920 it was entirely reorganized under the name of Ohio sPublic Health Association. In Ohio, largely as a result of the activity of the state associa- tion, the tuberculosis campaign has developed intensively in most parts of the state. There are 12 district sanatoria serving practi- cally all of the populous counties of the state. In addition there are 51 clinics, 20 camps, 650 public health nurses most of whom do tuberculosis work, and 69 local associations. Among the principal achievements of the Ohio Association have been the establishment of the Ohio State Sanatorium, the passage of the county and district hospital law and the subsequent estab- lishment of institutions, the establishment of a Division of Tuber- culosis in the State Department of Health, the first in the United States, a very remarkable development in public health nursing, the establishment of a department of public health and sanitation in the state university, the reorganization of the state and local health departments of the state and the subsequent increase in the number of full-time local health officers, and the general devel- opment of the program along broad public health lines. The death rate in Ohio has shown an interesting decline from 150.8 in 1910 to 102.8 in 1920. The headquarters of the Ohio Public Health Association are at 122 A HISTORY OF NATIONAL TUBERCULOSIS ASSOCIATION 83 South 4th Street, Columbus, Ohio, and the executive secretary is Dr. Robert G. Paterson. OKLAHOMA PUBLIC HEALTH ASSOCIATION The earliest recorded attempt at tuberculosis organization in Oklahoma was the formation of the Oklahoma City Anti- Tuberculosis League in 1908. No records are available regard- ing the later history of this association, which seems to have gone out of existence shortly after its formation. In 1910 the Oklahoma State Anti-Tuberculosis Association was formed. This association existed for seven years, conduct- ing a somewhat cursory campaign of education throughout the state. In 1917 it became necessary to reorganize the work. Through the field staff of the National Tuberculosis Association the pres- ent tuberculosis association was formed, with an entirely new board and a new executive secretary. Without any immediate capital, but with a Christmas seal sale ahead, the Association undertook a vigorous campaign of education and organization which resulted in the first year in securing nearly $40,000. Since that time the Association has steadily progressed. In 1919 the name of the Association was changed to the Oklahoma Public Health Association. Its educational work has been unique and has set an example for many other public health associations. The development of the Modern Health Crusade, the use of posters, publication of bulletins, newspaper publicity, films and lantern slides, and the use of exhibits are only a few of the many educational methods employed. Demonstration public health nurses engaged in welfare and school nursing surveys have been furnished to about 25 com- munities for periods of from two weeks to two months each. The public health surveys, conducted in eight of the largest cities in the state in 1918-1919, received national recognition for their remarkable thoroughness. Almost entirely as a result of the activity of the Oklahoma Association there are now in the state Io local associations, 65 county public health committees, 3 state sanatoria, I county THE STATE TUBERCULOSIS ASSOCIATIONS 123 sanatorium, I state sanatorium for tuberculous ex-service men, 2 county clinics, a summer camp, 2 open-air schools, and nearly 40 nurses working in whole or in part in the tuberculosis campaign. The headquarters of the Oklahoma Public Health Association are at 315 Oklahoman Building, Oklahoma City, Oklahoma, and the acting secretary is Miss Helen M. Hastings. OREGON TUBERCULOSIS ASSOCIATION Out of the State Committee for the International Congress an Oregon State Association for the Study and Prevention of Tuber- culosis was formed in December, 1908. Like several similar or- ganizations its existence was soon terminated because of lack of funds. , Even before 1908, the Portland Open Air Sanatorium for the treatment of tuberculosis had been established in 1905. Dr. Woods Hutchinson, who was State Health Officer of Oregon from 1903 to 1905, interested Mr. A. L. Mills of Portland and some others in the establishment of a camp for tuberculosis patients. Out of this plan developed the Portland Open Air Sanatorium, the pioneer sanatorium in the entire Pacific Northwest. The in- fluence of this institution has radiated far and wide in that part of the United States. In 1909, the Visiting Nurses’ Association of Portland estab- lished a tuberculosis division and for nearly six years it served as a pioneer, the only tuberculosis association in the entire state of Oregon. For two or three years prior to 1915, the State Federation of Women’s Clubs had conducted a seal sale, and had carried on a certain amount of tuberculosis relief work. In 1915 a state asso- ciation was organized under the direction of the National Tuber- culosis Association. The difficulties of finance delayed rapid progress, but the association has steadily gone forward until in 1922 there are 16 local associations besides the original Visiting Nurses’ Association in Portland, a state tuberculosis hospital, 2 private tuberculosis hospitals, 1 clinic, 1 open-air school and 3 open-air classes, and 16 county public health nurses. The State Association has also secured a Bureau of Public Health Nursing in the State Board of Health. Too much cannot be said of the 124 A HISTORY OF NATIONAL TUBERCULOSIS ASSOCIATION pioneer work of the association in rural counties with sparse popu- lation aggregating as large an area as whole states like Connecti- cut. Figures do not indicate the full achievement of the State Association. The organization has made itself felt in every part of the state, and has brought public health to the front in a strik- ing way. The death-rate from tuberculosis in Oregon in 1920 was 89.1. The headquarters of the Oregon Tuberculosis Association are at 1010 Selling Building, Portland, Oregon, and the executive secretary is Mrs. Saidie Orr-Dunbar. PENNSYLVANIA TUBERCULOSIS SOCIETY [Nofe: This section discusses tuberculosis work in Pennsylvania outside of Allegheny County and Pittsburgh which is treated separately in the follow- ing section.] The Pennsylvania Society for the Prevention of Tuberculosis, formed in 1892, is the first tuberculosis association on record anywhere in the world. It grew out of the interest and experi- ence of Dr. Lawrence F. Flick, of Philadelphia (see Chapter LX). The institutional care of the tuberculous had received earlier consideration in Philadelphia and Boston than in any other parts of the United States. The hospital for diseases of the lungs at Chestnut Hill, Philadelphia, dates back to 1876. The formation of the Pennsylvania Society, however, was a definite move on the part of Dr. Flick and his associates to spread information about tuberculosis in the poorer districts of Philadelphia. For nearly twenty years the work of the Pennsylvania Society was concentrated largely in Philadelphia. Since 1908 its program has been increasingly state-wide. At the present time there are about 100 local associations outside of Allegheny County. There are in Pennsylvania 24 sanatoria and special tuberculosis hospitals, with a capacity of 3,924. Three of these are state sanatoria, with a combined bed capacity of over 2,000. The State Department of Health conducts 90 tuberculosis clinics, with the codperation of tuber- culosis and other agencies. Besides the nurses connected with these clinics, there are about 1,000 other public nurses in the state. There are 20 open-air schools and classes. THE STATE TUBERCULOSIS ASSOCIATIONS 125 In 1921 the Pennsylvania Society codperated with the State Department of Health in securing the passage of a bill authoriz- ing county tuberculosis hospitals, reversing the policy that had existed in the State Department of Health for nearly fifteen years. Referendum campaigns in the fall of 1921 resulted in the establishment of seven hospitals. Henry Phipps Institute for the Study and Prevention of Tuberculosis, established in 1903, also through the interest of Dr. Flick, has exercised a. marked influence upon the develop- ment of tuberculosis work throughout the state, as well as in the city of Philadelphia. Through its clinical and pathologic research its influence has been cast throughout the United States; in fact, throughout the country. The result of organized tuberculosis work in Pennsylvania is exhibited in the decline in death-rate from 150.9 in 1906, 133.7 in 1910, and 105.0 in 1920. The headquarters of the Pennsylvania Tuberculosis Society are at 10 South 18th Street, Philadelphia, Pa., and the executive secretary is Mr. Arthur M. Dewees. TUBERCULOSIS LEAGUE OF PITTSBURGH The Tuberculosis League of Pittsburgh was organized in Feb- ruary, 1907, first under thename of Pittsburgh Sanatorium and then under its present name, after consolidating with the Pitts- burgh Association for the Prevention of Tuberculosis. For vari- ous reasons, the Pittsburgh League, covering Allegheny County, operates independently of the state association and in direct affili- ation with the National Association. The Tuberculosis League operates a hospital, a central dispen- sary and five division dispensaries, a research laboratory, an edu- cational division in conjunction with the public school system; is the center of education for the undergraduate medical students of the University of Pittsburgh; provides special training and post- graduate training in codperation with the hospitals and Public Health Nursing Association for this district, and operates an open- air school in conjunction with the board of education. Under the auspices of the League the second open-air school in the United States was formed, and the first open-air school in an 126 A HISTORY OF NATIONAL TUBERCULOSIS ASSOCIATION orphanage. One of the first attempts in training undergraduate nurses in tuberculosis was made at the hospital of the League. The death-rate from tuberculosis in Pittsburgh in 1908 was 146.2 and in 1920 was 120.0. The headquarters of the Tuberculosis League of Pittsburgh are at Bedford and Wandless Streets. The medical director is Dr. William Charles White, and the superintendent, Miss Alice E. Stewart. ‘ PHILIPPINE ISLANDS ANTI-TUBERCULOSIS SOCIETY At a meeting of the Philippine Islands Medical Association, in the spring of 1908, a committee consisting of Dr. Richard P. Strong, now with the League of Red Cross Societies, and Dr. Harry T. Marshall, now Dean of the University of Virginia, was appointed to confer with the National Tuberculosis Association relative to the possibilities of codperation in an educational cam- paign in the Islands. Out of the work of this committee grew the Philippine Islands Anti-Tuberculosis Society formed in Ig10. The Society was fortunate in securing close coéperation and pa- tronage of the United States Public Health Service, and for sev- eral years was actively directed by Dr. Victor G. Heiser, now with the International Health Board. The unusually high caliber of medical men connected with the association in its initial stages has given it a firm foundation. In recent years the general direction and supervision of the Society has been largely under native auspices. The tuberculosis work is subsidized from government sources, and is also supported in part from voluntary contributions. Christmas seals have been sold in the Philippine Islands for several years past. The general plan of campaign now being employed covers prac- tically all of the approved methods used in continental United States. In 1920 the Society showed its progressive interest by sending Dr. Carmelo Pefiaflor, one of the members of its staff, to this country for a period of study. At the present time there are in the Philippine Islands four insti- tutions for the care of the tuberculous, with a combined bed capa- city of 285, and ten tuberculosis despensaries. THE STATE TUBERCULOSIS ASSOCIATIONS 127 The headquarters of the Philippine Islands Anti-Tuberculosis Society are in the Fajard Building, Manila, Philippine Islands, and the secretary is Dr. Antonio Hernandez. ANTI-TUBERCULOSIS LEAGUE OF PORTO RICO As in the Philippine Islands, the activities of the United States Public Health Service furnished the indirect inspiration for the establishment of an association. In the spring of 1906 the Anti- Tuberculosis League of Porto Rico was formed. Its chief purpose was the establishment of a sanatorium which was opened in 1907 at San Juan. There are now two sanatoria, providing 75 beds. The interest of the League, unlike that in the Philippine Islands, ‘however, has been centered largely on institutional care. During its early years, with a small government subsidy, a small amount of educational work was carried on throughout the island, but within recent years the League has had practically no terri- torial program. An effort is now being made to reorganize the League. RHODE ISLAND TUBERCULOSIS ASSOCIATION Before a state association was formed in Rhode Island, active anti-tuberculosis work had been started in Newport with the formation of the Newport Association for the Relief and Control of Tuberculosis. Dr. Henry Barton Jacobs, of Baltimore, who was one of the founders of the National Tuberculosis Associa- tion, was largely instrumental in the establishment of this local organization in Rhode Island. At the time of the formation of the National Association, in 1904, it was one of the few local associations in the entire country that had a paid executive secretary. The Rhode Island Anti-Tuberculosis Association was formed in the fall of 1907, and since that date has had an enviable repu- tation as a state-wide organization. The activity of a group of physicians, largely in Providence, was responsible for the formation of the state association. Definite legislation on tuberculosis in Rhode Island dates back to 1894, when an act was passed authorizing the State Board of Health to investigate the causes and prevention of tuberculosis, 128 A HISTORY OF NATIONAL TUBERCULOSIS ASSOCIATION and appropriated $1,000 for the purpose. In 1901 another thou- sand dollars was appropriated for a similar purpose. In 1902 a commission was formed to consider the establish- ment of a state sanatorium, which was opened in 1905. In the same year the St. Joseph’s Hospital of Providence opened an annex for tuberculosis patients. From these facts it will be seen that there was a considerable amount of early interest in tuberculosis in Rhode Island. One of the most significant contributions of Rhode Island to the tuberculosis movement was the establishment of the first open-air school in 1908. The state association has been influential also in promoting an extensive educational campaign extending into every section of the state and well organized through the various industries of the state. At the present time there are 21 local tuberculosis associations in Rhode Island. Besides the state sanatorium and the state hospital for advanced cases, located at Wallum Lake, there are five other institutions, providing a total bed capacity of 604. There is also a preventorium of 50 beds for children predisposed to tuberculosis. The state has nine dispensaries and clinics. There are 112 public health nurses in Rhode Island, representing practically every community in the state. Because of its small area, this state has been intensively organized. The death-rate from tuberculosis in Rhode Island has declined from 198.5 in 1907 to 131.3 in 1920. The headquarters of the Rhode Island Tuberculosis Asso- ciation are at 109 Washington Street, Providence, Rhode Island, and the executive secretary is Mr. Willis E. Chandler. SOUTH CAROLINA TUBERCULOSIS ASSOCIATION Previous to the formation of the South Carolina Tuberculosis Association, in March, 1917, there had been in existence a num- ber of local associations in various parts of the state. The Richland Association at Columbia built a camp for incipient cases in 1914, and carried on some educational work. The Greenville Association also had established a camp. In 1913 a state-wide Christmas seal sale was held under the THE STATE TUBERCULOSIS ASSOCIATIONS 129 direction of a Red Cross Seal Commission. For three years funds were accumulated in this way, and in 1917 a full-fledged state association took the place of the commission. In spite of unusual financial difficulties, inherent both in the sparsity and character of the population as well as in the cotton and tobacco situation of recent years, the South Carolina Association has been able to maintain its executive office and has stimulated an increasing amount of local interest in tuberculosis. The presence of the state sanatorium and well-developed work in such centers as Columbia, Charleston, and Greenville, are evidences of its activity. The present institutional facilities of the state represent practically 100 per cent gain over those in existence five years ago. Besides a state sanatorium for white and colored patients, there are three county hospitals and one private sanatorium, the Aiken Cottage Sanatorium, operated largely for northern patients, and opened in 1896 (see p. 10). There are three per- manent clinics, two open-air schools, and over 90 public health nurses doing some form of tuberculosis work. The death-rate from tuberculosis in South Carolina in 1916 was 146.1, and in 1920 it was 120.0. The headquarters of the South Carolina Tuberculosis Asso- ciation are at 209-210 Liberty Bank Building, Columbia, South Carolina, and the field secretary is Miss Chauncey Blackburn. SOUTH DAKOTA PUBLIC HEALTH ASSOCIATION The present South Dakota Public Health Association and, in fact, practically all of the present tuberculosis and public health movement in the state, with the possible exception of the state sanatorium, owes its existence directly or indirectly to the en- thusiasm of one woman, a Mrs. E. P. Wanzer, of Armour. In 1913 Mrs. Wanzer was interested in the Christmas seal sale and was made chairman of a temporary Red Cross Seal Commission created by the National Association. At that time the State of South Dakota never had seen a public health nurse. No cam- paign for health education had ever been carried on in the state. The entire appropriation for the State Board of Health amounted to only $600. With relatively little instruction, but with a great 9 130 A HISTORY OF NATIONAL TUBERCULOSIS ASSOCIATION deal of enthusiasm and with the wide acquaintance and splendid codperation of the women’s organizations of the state, Mrs. Wanzer began a campaign which in its historical development is one of the most remarkable of any state campaigns in the United States. Considering that the entire population of South Dakota is only a little over 635,000, and considering the large area of the state, the difficulties of organization will be readily appreciated. Probably the principal contribution of the South Dakota Asso- ciation has been in the number of public health nurses. There are now 32 nurses doing community work throughout the state. There is a state sanatorium and two other sanatoria with a com- bined capacity of 285. The Modern Health Crusade has been or- ganized in practically all of the schools. The message of tuber- culosis and public health has been carried largely by the women’s clubs and allied organizations into almost every village, town, and hamlet, even in the remotest portions of the state. With this message has gone the Christmas seal. In 1920 the per capita sale of seals in South Dakota amounted to 5.4. The State Board of Health has now been completely reorganized and is gradually coming up to the standard of similar bodies in neighboring states. Out of the Red Cross Seal Commission of South Dakota the South Dakota Public Health Association was formed in 1920. The work is now on a firm foundation, strongly entrenched and well supported. The headquarters of the South Dakota Public Health Associa- tion are at Huron, South Dakota, and the managing director is Mr. H. M. Cass. TENNESSEE ANTI-TUBERCULOSIS ASSOCIATION Tuberculosis work in Tennessee dates back to 1906 when the Nashville Anti-Consumption League was formed following the American exhibit of the National Tuberculosis Association. The League, however, soon passed out of existence for lack of funds. Other local associations were formed from time to time, but none of them maintained an active program. In 1912 the Tennessee Anti-Tuberculosis Association was es- tablished with headquarters at Nashville. In 1916 it became necessary to reorganize the association. Since this latter date state-wide work has developed rapidly. THE STATE TUBERCULOSIS ASSOCIATIONS 131 There are now three county hospitals and three other tuberculosis sanatoria with a total number of 465 beds. There are five tuber- culosis dispensaries and 15 others furnishing opportunity for diagnosis. There are three open-air schools and over 50 public health nurses. The State Association works in close codperation with the Peabody College for Teachers, and has been influential, through that institution, in developing public health instruction for nurses and others. In 1920 the State Association formed the Tennessee Colored Anti-Tuberculosis Society which has, since that time, been doing valuable educational work among the Negroes throughout the state. The new county hospital at Memphis (The Oakdale Memorial Sanatorium) and the Pine Breeze Sanatorium at Chattanooga, a semi-private institution for local patients, are two of the finest institutions of their type in the south. The death rate from tuberculosis in Tennessee was 199.1 in 1917 and 164.6 in 1920. The headquarters of the Tennessee Anti-Tuberculosis Associa- tion are at 309 Church Street, Nashville, Tennessee, and the ex- ecutive secretary is Mr. James P. Kranz. TEXAS PUBLIC HEALTH ASSOCIATION Out of the state committee for the International Congress the Texas Anti-Tuberculosis Association was formed in the fall of 1908, with headquarters at Austin. For about four years the as- sociation did little or no active work. In 1912 an executive secre- tary was secured and the first attempt at a state-wide campaign against tuberculosis was begun. A county hospital law was passed at the instance of the organization in 1913. In 1917 the work was reorganized under the name of the Texas Public Health Association. Since that date the association has conducted a broad educational campaign on tuberculosis and public health and has succeeded in organizing many of the larger local centers in this, the largest state of the union. The difficul- ties of organization in Texas may be visualized when one considers that it takes 36 hours to travel from El Paso to Austin. 132. A HISTORY OF NATIONAL TUBERCULOSIS ASSOCIATION ‘The problem of the indigent migratory consumptive is an acute one in Texas. In 1909 an attempt was made to arrive at a solu- tion of the problem by securing an appropriation of $10,000, to return indigent migratory cases to their homes, but this did not produce the desired effect. The State Association has been and is still co6perating with the American Legion in the building of a tuberculosis hospital for ex- service men. The state operatés a sanatorium with 360 beds. _ When the plans for the American Legion Sanatorium are com- pleted the capacity of the state institution will be increased to 600 beds. Besides the state sanatorium, there are now five county tuberculosis hospitals, six clinics, 13 local associations, and a very large number of public health nurses doing tuberculosis work. Because of the large Mexican and Negro population in Texas, special secretaries for each of these groups have been provided by the State Association. The headquarters of the Texas Public Health Association are at 616 Littlefield Building, Austin, Texas, and the executive secre- tary is Mr. D. E. Breed. UTAH PUBLIC HEALTH ASSOCIATION The Utah Public Health Association grew out of a ‘‘nest-egg”’ secured by the National Tuberculosis Association in a Christmas seal sale in the fall of 1915. One-thousand dollars was secured in this way and with this little fund the Utah Association was formed in the fall of 1916, and an executive secretary was secured. The multiplication of the original $1,000 has made the present organ- ization possible. The progress of the work in Utah may be indicated by the seal sale in 1921 which amounted to $28,000. While the State of Utah had had, for several years prior to the formation of a state association, an active health officer in the person of Dr. T. B. Beatty, the development of tuberculosis and public health work since 1916 has clearly shown the wisdom and need for a non-official agency.. The amount of interest aroused in Utah by newspaper publicity, posters, the Modern Health Crusade and other forms of educa- tional propaganda is almost incredible when compared with that THE STATE TUBERCULOSIS ASSOCIATIONS 133 of 1916. Besides the methods just mentioned, the Association has used health clowns, motion pictures, clean school contests, and its monthly journal to good advantage. At the present time, the only bed contribution in the state of Utah is a tuberculosis ward in the Salt Lake County Hospital, accommodating 25 patients. There is now on foot an extended agitation to secure a state sanatorium at the next session of the legislature. There are 53 public health and school nurses. In 1921 the State Association, in codperation with the State Board of Health and the United States Public Health Service, or- ganized a traveling clinic which is touring every part of the state examining for tuberculosis and children’s diseases especially, and conducting an educational campaign along public health lines. The death rate from tuberculosis in Utah has declined from 50.7 in 1916 to 39.1 in 1920. The headquarters of the Utah Public Health Association are in the State Capitol. Building, Salt Lake City, Utah, and the ex- ecutive secretary is Mr. James H. Wallis. VERMONT TUBERCULOSIS ASSOCIATION That Vermont should have taken an early interest in tubercu- losis might logically be presumed by those who know of the pioneer health activities of the State Board of Health under the leadership of the late Dr. Henry D. Holton. ‘In 1902 a commission of five was appointed by the Governor to investigate the extent of tuberculosis, and for several years this commission, with an annual appropriation from the legisla- ture, carried on an extensive educational campaign throughout the state. In this same year tuberculosis was made a reportable disease by act of the legislature, one of the earliest state laws of this character in the country. The Vermont Society for the Study and Prevention of Tubercu- losis was also formed in 1902, but no records are available to indicate that it ever functioned in any capacity. Four years later, in 1906, the Vermont State Anti-Tubercu- losis Society was organized, but, like its predecessor, it appar- ently has no history of activity. In 1907 the Vermont Sanatorium at Pittsford was opened. * 134. A HISTORY OF NATIONAL TUBERCULOSIS ASSOCIATION This sanatorium is a gift to the state of Vermont from the late Senator Redfield Proctor. The Proctor family, whose large marble quarry interests are centered in Vermont, have been very generous in furthering tuberculosis work in that state. For several years prior to 1916, and after the establishment of the Vermont Sanatorium, the Vermont Red Cross Chapter was practically the only agency in the state attempting to do tuberculosis work on a state-wide basis. Because of lack of funds this organization accomplished very little. In 1916, at the instance of the National Tuberculosis Asso- ciation, the Vermont Tuberculosis Association was formed, and sufficient funds were secured at once to appoint an executive secretary. Since that date the Association has steadily advanced the tuberculosis work of Vermont. At the present time, besides the sanatorium mentioned with a bed capacity of 47, and a county sanatorium of 46 beds, there are 15 clinics, a preven- torium, and 5 nurses doing tuberculosis work: The association employs a physician who has had special training in the diag- nosis of tuberculosis, and has an arrangement of part time with two other physicians who are specially qualified for this work. The educational campaign is carried on by lectures, distribution of printed matter, the Modern Health Crusade, a monthly story paper for children, motion pictures, etc. In 1920 the preliminary results of a preventorium established by the state association moved two citizens to offer 45 acres and $50,000 for a new preventorium, providing the people of the state contributed a like amount for the general work of the Vermont Association. As a result, nearly $55,000 was raised. This assured the new preventorium, which will be opened in 1922. The State of Vermont appropriates $50,000 annually for the care of indigent tuberculous patients in hospitals. The National Tuberculosis Association has for several years, ending with 1921, conducted a study of tuberculosis among the granite workers of Barre, which study has contributed greatly to a better knowledge of the prevention of tuberculosis in this dominant industry of the state. THE STATE TUBERCULOSIS ASSOCIATIONS 135 The death-rate from tuberculosis in Vermont has steadily declined from 113.4 in 1910, to 110.8 in 1916, and 81.8 in 1920. The headquarters of the Vermont Tuberculosis Association are at 139 Church Street, Burlington, Vermont, and the secretary is Mr. Harold W. Slocum. VIRGINIA TUBERCULOSIS ASSOCIATION The Virginia Anti-Tuberculosis Association was formed in October, 1909, largely as a result of the interest of Captain W. W. Baker and some of his associates, of the State Board of Health, in tuberculosis. Previous to the formation of the State Association the Anti- Tuberculosis League of Norfolk had been organized in 1906, and was at that time conducting an active work. The State Associa- tion’s program remained somewhat indefinite for a number of years until in 1915, under the leadership of Miss Agnes D. Ran- dolph, it began to arouse general interest throughout the state in tuberculosis. Since that date the tuberculosis campaign in Vir- ginia has shown steady progress. A state sanatorium had been established in 1909, but after the formation of the State Association it was considerably expanded until its present bed capacity is 300. In addition to this Ca- tawba State Sanatorium there are two other state sanatoria, one of which is exclusively for Negro patients, one of the pioneer insti- tutions of its type in this country. With the private tuberculosis hospitals and other institutional facilities the bed capacity for tuberculosis in Virginia is 750. There are 17 open-air schools, 172 public health nurses, (exclusive of Metropolitan whole time nurses) 7 dispensaries and clinics, and 19 local associations affili- ated with the State Association. At the present time there is a Division of Tuberculosis in the State Board of Health which has been coéperating with the State Association in the development of traveling clinics and diagnostic facilities for rural districts. Virginia has also been successful in developing a very large amount of organization and active work among the Negroes of the State. The establishment of the Piedmont Negro State Sana- torium has been of great value in arousing interest. The Negro 136 A HISTORY OF NATIONAL TUBERCULOSIS ASSOCIATION ‘Organization Society donated $5,000 as the initial gift in ne establishment of this institution. Mortality from tuberculosis work in Virginia has declined from a death-rate of 167.6 in 1913 to 142.9 in 1920. The headquarters of the Virginia Tuberculosis Association are located at 611 Chamber of Commerce Building, Richmond, Vir- ginia, and the executive secretary is Mr. Irving Lewis Spear. WASHINGTON TUBERCULOSIS ASSOCIATION The Washington Tuberculosis Association formed in September, 1907, as the Washington Association for the Prevention and Re- lief of Tuberculosis, represents the first organized activity against tuberculosis in the Pacific Northwest. The Association has set an example for the neighboring states of Oregon, Idaho, Utah, Nevada and Montana in the steady development of work against tuberculosis. The first few years of work were largely spent in laying foundations and in general education. In 1910 a more intensive program was begun and three years later, in 1913, an act was passed as a result of the State Associa- tion’s activity, authorizing counties to erect sanatoria for the care of the tuberculous and to employ public health nurses, whose first duty was to be the care and instruction of tuberculous cases. An appropriation of $50,000 was made with this act to provide state subsidies of $3.00 a week (in 1919 raised to $5.00) for local patients of such hospitals. This was one of the earliest state subsidy acts in the country. The energetic leadership of the present executive secretary, Mrs. Bethesda Beals Buchanan, who has been with the Associa- tion since 1910, has contributed largely to its present develop- ment. The program has always been educational but has cen- tered about the formation of county anti-tuberculosis leagues and assisting them to secure the establishment of institutions and the county nursing service. As a result of this program there are at the present time in Washington 30 such county leagues, There are 4 county sanatoria, I municipal sanatorium and 1 private sanatcrium. There are 24 clinics.and dispensaries operating in ‘connection with the sanatoria or under the Association and leagues, THE STATE TUBERCULOSIS ASSOCIATIONS 137 and 117 nurses in the various phases of public health work. Prac- tically all of this work has been established since 1913. As a further indication of the development of interest in tuber- culosis work it is interesting to note that in 1910 only 618 cases of tuberculosis were reported although 1,197 deaths from the disease were recorded in that year. In 1920, 6,888 cases were reported and 1,320 deaths. The value of educational propaganda is indi- cated in these figures. The mortality in the state of Washington has always been low, due largely to the racial and age composition of the population. In 1913 it was 102.4 and in 1920 it was 98.4. The headquarters of the Washington Tuberculosis Association are at 601-603 Thompson Building, Seattle, Washington, and the executive secretary is Mrs. B. B. Buchanan. WEST VIRGINIA TUBERCULOSIS ASSOCIATION The West Virginia Anti-Tuberculosis League was formed in the fall of 1908, and grew out of the interest of a group of women headed by Dr. Harriet B. Jones, of Wheeling, whose enthusiasm had been aroused at the International Congress. Too much cannot be said of the self-sacrificing, enthusiastic service of Dr. Jones in the development of state tuberculosis work in West Virginia. One of the first acts of the new state association was to secure a resolution at a special session of the state legislature, called for this purpose, appointing a committee of five to make a study of tuberculosis in the state and to report on a state sanatorium. It was not until January, 1913, however, that the state sana- torium was opened at Terra Alta. Meanwhile the state association, under the leadership of Dr. Jones, kept steadily promoting interest in tuberculosis work. Active groups in Wheeling, Charleston, and New Martinsville were formed early in the movement, and contributed largely to the success of the state organization. In 1913 an appropriation of $9,900 for a two-year campaign against tuberculosis was secured from the legislature. With this money Dr. Jones and her associates toured the most remote sections of the state, penetrating into districts where the message of tuberculosis and health education had never before reached. 138 A HISTORY OF NATIONAL TUBERCULOSIS ASSOCIATION Thousands of miles were covered on foot and in automobile, and a very considerable portion of the population was reached. In 1920 it became necessary to reorganize the association. Since that time the work has developed on a broader basis, with more funds and greater interest. At the present time there are 39 local committees, 2 state sanatoria, 1 of which is for Negroes, 2 local sanatoria, 8 tuber- culosis clinics, I preventorium, 3 open-air schools and classes, and 36 nurses doing tuberculosis work. The headquarters of the West Virginia Tuberculosis Asso- ciation are at Room 412, Davidson Building, 910 Quarrier Street, Charleston, West Virginia, and the executive secretary is Mr. George C. Rowell. WISCONSIN ANTI-TUBERCULOSIS ASSOCIATION Active interest in tuberculosis in Wisconsin began about 1903 when a state tuberculosis commission was appointed by act of legislature, to investigate the prevalence of tuberculosis and to re- port on the desirability of establishing a state sanatorium. The report of this commission was a noteworthy document and was widely circulated. ; In 1905 the legislature made an appropriation for the establish- ment of a sanatorium which was opened in 1907. In the same year, 1907, tuberculosis was included in the list of diseases to be reported by physicians. In June, 1908, the Wisconsin Anti-Tuberculosis Association was organized from the state committee of the International Congress. Since that date Wisconsin has carried on one of the most active and unique campaigns against tuberculosis and for the promotion of public health of any state in the Union. The leader in this campaign, since the beginning, has been Dr. Hoyt E. Dearholt. Following a general campaign of education in which the Christ- mas seal played a prominent part (Wisconsin had its own Christ- mas seal before the Red Cross seal became generally known), in I91I the State Association secured a law authorizing the estab- lishment of county hospitals and providing for a state subsidy. Unlike most of the state associations in the country, the Wis- consin Anti-Tuberculosis Association has always proceeded upon THE STATE TUBERCULOSIS ASSOCIATIONS 139 the policy that a strong centralized association is preferable to the ordinary procedure of strong local associations witha relatively strong state body. The State Association has, therefore, made itself much more felt in local communities throughout the state than has been the case in many other parts of the country. There are 62 affiliated organizations. Out of the leadership of the Wisconsin State Association and as a result of the county sanatorium law of 1911 there have been opened in that state, besides the state sanatorium, a state con- valescent forestry camp and 14 county sanatoria. In addition there is one semi-philanthropic sanatorium and one private sanatorium. The total bed capacity of Wisconsin is 1,400. The State Association operates a demonstration and traveling clinic and conducts public health courses for graduate nurses and social workers. Through demonstrating nurses sent from the office of the State Association, Wisconsin communities became familiar with the public health nurse.* The contributions of the Wisconsin Anti-Tuberculosis Association to educational methods have been many. It was one of the first states to utilize the motorcycle and automobile for campaigning in rural districts. Its early rural surveys opened the eyes of the country to the prevalence of: tuberculosis in rural districts. Its chil- dren’s work, through the Modern Health Crusade health stories and the Christmas seal sale, and in other ways, has been widely imitated. The close codrdination of the state association with the exten- sion work of the University of Wisconsin has been a remarkable factor in contributing to the success of the state program. The decline of the tuberculosis death-rate in Wisconsin has been steady. In 1908 the death rate was 109.3. In 1915 it was 95.8. In 1920 it was 85.6. The headquarters of the Wisconsin Anti-Tuberculosis Associa- tion are at 558 Jefferson Street, Milwaukee, Wisconsin, and the executive secretary is Dr. Hoyt E. Dearholt. * The employment of a nurse or health instructor in every county is now compulsory. 140 A HISTORY OF NATIONAL TUBERCULOSIS ASSOCIATION WYOMING PUBLIC HEALTH ASSOCIATION The Wyoming Public Health Association is a direct outgrowth from the Christmas seal sale. The association was formed in 1916, following a Christmas seal sale conducted by the National Tuberculosis Association the preceding year. With a population of no more than that of the city of Syracuse or Scranton, Wyoming, in both 1916 and 1917 won the National per capita banner for the sale of Christmas seals, selling over a million in 1917. Wyoming was the last state in the Northwest Division (perhaps in the U.S.) to form and organize a public health association. It is the youngest in anti-tuberculosis work. When the association was started there was practically no in- terest in tuberculosis work. The State Board of Health was largely apathetic, and in the state at large tuberculosis was not supposed to be a problem of sufficient moment to be given consid- eration. The Wyoming Public Health Association has clearly demon- strated that tuberculosis is not only a serious problem, but the most serious disease problem of the state. Surveys have clearly established this fact. Asa result of these surveys, the Christmas seal sale, the Modern Health Crusade and other methods of edu- cation, there are now five public health nurses doing tuberculosis work, and a number of other nurses will soon be actively engaged in different parts of the state. The State Board of Health has been completely reorganized, and a full-time health officer has been secured. Legislation is being considered to make provision for tuberculous patients. The largest financial interests in the state are taking an active part in the tuberculosis campaign. What it means to arouse interest in a state with so sparse a popu- lation as that of Wyoming and an area equal to all of the New England states is difficult for one who has not lived in Wyoming to appreciate. The steady development of interest in tubercu- losis and public health in that state is highly gratifying to those who have been in close touch with it. The headquarters of the Wyoming Public Health Association are located at Industrial Club, Box 637, Cheyenne, Wyoming, and the executive secretary is Miss Etta M. Dobbin. CHAPTER IX THE SIXTH INTERNATIONAL CONGRESS By PHILIP P. JACOBS, Pa.D. S HAS been pointed out elsewhere in these pages, the Na- A tional Tuberculosis Association really grew out of dis- cussions centering around an International Congress on Tuberculosis. The confusion incident to the proposals of Clark Bell and Dr. Daniel Lewis and the discussions pro and con con- cerning the merits of their respective congresses crystallized a growing desire for a national association that might represent the United States properly in any such international gathering. After The National Association for the Study and Prevention of Tuberculosis was formed in 1904, one of the first acts of the board of directors was to take up the question of an international meet- ing of some sort to be held in the United States. In 1905 Dr. Hermann M. Biggs, Dr. Lawrence F. Flick, Dr. William Osler, Dr. Henry Barton Jacobs, and others represented The National Association for the Study and Prevention of Tuber- culosis at the Fifth International Congress on Tuberculosis held in Paris; Medical Inspector Henry G. Beyer, of the U. S. Navy, representing the United States Government. Acting as spokes- man for the United States organization, Dr. Flick presented its invitation to the International Congress to meet in this country in 1908. The invitation was seconded by Dr. Henry Barton Jacobs on behalf of the Association. But asa rule of the Congress prevented it from accepting any invitation which did not come from the government of the country extending the invitation, Dr. Jacobs cabled to Dr. William H. Welch to secure from Mr. Roose- velt, the President of the United States, such an invitation and transmit it through the American Embassy in Paris. Immedi- ately on receipt of the cable Dr. Welch went to Washington and 141 142 A HISTORY OF NATIONAL TUBERCULOSIS ASSOCIATION secured the invitation to meet in the United States in 1908, which was accepted unanimously. To the board of directors of the infant national association, struggling hard to raise a budget of $10,000, the assumption of such responsibility as an International Congress indicated great faith in the giving public of the United States. It was estimated by various members of the board that to bring an International Congress here, to house it properly, and to conduct it in a manner compatible with the dignity of this country would cost at least * $100,000, and probably considerably more. In December, 1905, Dr. Flick proposed to the board of directors a plan for raising the money and for organizing the Congress. Briefly stated, Dr. Flick’s plan included, among other features: 1. That 20 men be secured to give $5,000 each, these men to act as patrons of the Congress and to become life members of the association. 2. That the interest on this $100,000 be allowed to accumulate and be set aside for prizes of various kinds to be awarded in con- nection with the Congress. 3. That the Congress be held in Washington and that it ex- tend over a period of at least three weeks. The board of directors approved of the general plan outlined by Dr. Flick and appointed him as a committee of one to take action at once to put the plan of raising money into effect. Dr. Flick associated with himself in this initial effort, as members of his committee, Dr. Vincent Y. Bowditch, of Boston, Dr. Alfred Meyer, of New York, Dr. Lawrence Litchfield, of Pittsburgh, and Dr. Joseph Walsh and Dr. Charles J. Hatfield, of Philadelphia. By the end of the year 1906 this committee had collected between $30,000 and $35,000, chiefly in large contributions. The committee, which was enlarged from time to time by the addition of representative men and women, held meetings at monthly intervals beginning with December 18, 1906. During the fall of 1906 Dr. John S. Fulton, of Baltimore, secretary of the State Board of Health of Maryland, was engaged as secretary- general of the Congress. Most of the administrative work de- volved upon Dr. Fulton. At the meetings of the committee the general policies were worked out and the outlines of the Congress THE SIXTH INTERNATIONAL CONGRESS 143 were decided upon. Committees of various kinds were appointed. The executive committee of the Congress consisted of Dr. Flick, as chairman, Dr. Livingston Farrand, at that time the executive secretary of The National Association for the Study and Preven- tion of Tuberculosis, Dr. Joseph Walsh, of Philadelphia, and Dr. John S. Fulton, the secretary-general. Volume V of the Transactions of the Sixth International Con- gress contains a complete list of all of the officers, committees, and sub-committees. It will not be necessary to give them in detail in this place. In the spring of 1907 it became necessary to expand the scope and membership of the original committee, headed by Dr. Flick. It also became necessary to elect a president of the Congress. Dr. William H. Welch was elected president, but he found it impos- sible to serve. After a considerable amount of discussion it was decided by the board of directors of The National Association for the Study and Prevention of Tuberculosis, under whose auspices the entire Congress was conducted, to select the Honorable Theo- dore Roosevelt, then President of the United States, as President of the Congress. Dr. Edward Livingston Trudeau, of Saranac Lake, Dr. Robert Koch, of Berlin, Dr. Louis Landouzy, of Paris, and Dr. C. Theodore Williams, of London, were elected honorary vice-presidents. On May 12, 1908, President Roosevelt sent his acceptance of the presidency of the International Congress in the following letter: THe Waite House, Washington, May 5, 1908. Sir: It is with great pleasure that I accept the presidency of ‘‘The Inter- national Congress on Tuberculosis” which is to meet in this city on September 21, 1908, and extend its session to October 12, 1908. Official duties, however, may prevent my presiding at the initial meeting of the Congress, in which case I will deputize Secretary Cortelyou. The importance of the crusade against tuberculosis, in the interest of which this Congress convenes, cannot be overestimated when it is realized that tu- berculosis costs our country two hundred thousand lives a year, and the entire world over a million lives a year, besides constituting a most serious handicap to material progress, prosperity, and happiness, and being an enormous ex- pense to society, most often in those walks of life where the burden is least bearable. Science has demonstrated that this disease can be stamped out, but the 144 A HISTORY OF NATIONAL TUBERCULOSIS ASSOCIATION rapidity and completeness with which this can be accomplished depend upon the promptness with which the new doctrine about tuberculosis can be in- culcated into the minds of the people and engrafted upon our customs, habits, and laws. _ The presence in our midst of representatives of world-wide workers in this magnificent cause gives an unusual opportunity for accelerating the educational part of the process. The modern crusade against tuberculosis brings hope and bright prospects of recovery to hundreds of thousands of victims of the disease, who under old teachings were abandoned to despair. The work of the Congress will bring the results of the latest studies and investigations before the profession at large _and place in the hands of our physicians all the newest and most approved methods of treating the disease—a knowledge which will add many years of valuable life to our people and will thereby increase our public wealth and happiness. The International Congress on Tuberculosis is in the interest of universal peace. By joining in such warfare against a common foe the peoples of the world are brought closer together and made to better realize the brotherhood of man; fora united interest against a common foe fosters universal friendship. Our country, which is honored this year as the host of other nations in this great gathering of leaders and experts, and as the custodian of the magnificent exhibit which will be set up by the entire world, should manifest its apprecia- tion by giving the Congress a setting worthy of the cause, of our guests, and of ourselves. We should endeavor to make it the greatest and most fruitful Congress which has yet been held, and I assure you of my interest and services to that end. With expressions of appreciation for the compliment conferred in extending the invitation to become president of the Congress. Very respectfully, (Signed) THEODORE ROOSEVELT. The dates of the Congress were definitely fixed for September 28 to October 12,1908. For some time there was doubt as to the actual housing arrangements for the meeting, but after consider- able negotiation arrangements were made through a special appro- priation of the Congress of the United States of $40,000 for the use of the National Museum Building, at that time just nearing completion. All of the sessions and the exhibit of the Congress were held in this building. For about a year and a half prior to the Congress itself, under the leadership of Dr. Fulton and his staff, an extensive organiza- tion and educational campaign was carried out. In every state of the Union special committees were formed, for the most part under the patronage of the health departments and the governors THE SIXTH INTERNATIONAL CONGRESS 145 of the states. A vigorous publicity campaign was conducted, with a favorable response from the newspapers of the country. A considerable amount of printed matter, consisting of posters, circulars, booklets, and similar material, was distributed. The aims of the Congress were presented by word of mouth to all of the leading medical and health organizations at that time in existence. In foreign countries similar committees were organized and similar propaganda was conducted. In preparation for the Congress itself an elaborate exhibit representing tuberculosis work throughout the world was pre- pared. No similar exhibit has ever been gathered together either in this country or elsewhere. The greater part of the main floor of the large National Museum Building was given over to the purpose. Arrangements for the exhibit itself were perfected by the late Dr. Henry G. Beyer, U.S.N., who served as director of the exhibit. Much of the detail work in arranging and managing the exhibit was carried on by E. G. Routzahn, at that time director of the traveling exhibit of the National Association and at the present time associate director of the Department of Surveys and Exhibits of the Russell Sage Foundation. A complete description of all of the exhibits, with a list of winners of prizes, will be found in Volume V of the Transactions of the Sixth International Con- gress. As a matter of historical record, however, it will be sig- nificant to mention in this place that, after the close of the Inter- national Congress, most of the exhibit was shipped intact to New York and set up in the American Museum of Natural History, where for a month hundreds of thousands of people viewed it. Following the exhibit in New York, it was also shown in Philadel- phia. Regarding the Congress itself, the eight volumes of Transac- tions, authorized by the general committee and prepared jointly by the Committee on Printing and Publication, the Editorial and the Executive Committees, give such voluminous details that only a comparatively brief mention need be made in this place. The Congress opened in the Assembly Hall of the new National Museum on the morning of September 28. The Secretary of the Treasury, the Honorable George Bruce Cortelyou, called the meeting to order and formally announced the names of the hon- 10 146 A HISTORY OF NATIONAL TUBERCULOSIS ASSOCIATION orary vice-presidents. The opening ceremonies were of a most impressive character. Following addresses of welcome by Secre- tary Cortelyou, and the Honorable Henry B. Macfarland, Presi- dent of the Commissioners of the District of Columbia, repre- sentative delegates from the following participating countries responded, outlining in brief the organization of the campaign against tuberculosis in their respective countries: Dr. Fermin Rodriguez, Jr., of Argentina; Dr. Hermann von Schrétter and Dr. Laislaus Detre, of Austria-Hungary; Professor Josef Denys, of Belgium; Mr. Sylvino Gurgel do Amaral, of Brazil; Dr. Arthur Newsholme, of the British Government; Dr. Frederick Montizambert, of Canada; Dr. L. Sierra, of Chile; Dr. Shinfwe P. M. Jee, of China; Dr. Juan J. Ulloa, of Costa Rica; Dr. Joaquin L. Jacobsen, of Cuba; Dr. Bernard Bang, of Denmark; Dr. C. W. Richardson, of Ecuador; Dr. J. B. Piot (Bey), of Egypt; Professor Dr. Louis Landouzy, of France; Professor Robert Koch, of Germany; Mr. Lambros Coromilas, of Greece; Dr. Ramon Bengoechea, of Guatemala; Professor N. Ph. Tende- loo, of Holland; Dr. Antonio Stella, of Italy; Professor Dr. S. Kitasato, of Japan; Dr. Eduardo Liceaga, of Mexico; Dr. F. Harbitz, of Norway; Dr. M. J. Echeverria, of Panama; Mr. Sylvino Gurgel do Amaral, of Portugal; Dr. S. Irimescu, of Rumania; Dr. A. Wladimiroff, of Russia; Dr. Paul G. Woolley, of Siam; Dr. Camilo Calleja, of Spain; Hon. Conrad Ceder- crantz, of Sweden; Professor Fritz Egger, of Switzerland, and Mr. Luis Melian Lafinur, of Uruguay. The Congress itself was organized into seven sections, as fol- lows: Section 1.—Pathology and Bacteriology, with Dr. William H. Welch of Baltimore, as president. Section 2.—Clinical Study and Therapy of Tuberculosis— Sanatoriums, Hospitals, and Dispensaries, with Dr. Vincent Y. Bowditch of Boston, as president. Section 3.—Surgery and Orthopedics, with Dr. Charles H. Mayo, of Rochester, Minnesota, as president. Section 4.—Tuberculosis in Children—Etiology, Prevention, and Treatment, with Dr. Abraham Jacobi, of New York, as president. THE SIXTH INTERNATIONAL CONGRESS 147 Section 5.—Hygienic, Social, Industrial, and Economic Aspects of Tuberculosis, with Mr. Edward T. Devine, of New York, as president. Section 6.—State and Municipal Control of Tuberculosis, with Surgeon-General Walter Wyman, U/S.P.H.S., Washington, as president. Section 7.—Tuberculosis in Animals and Its Relations to Man, with Dr. Leonard Pearson, of Ithaca, as president. Simultaneous meetings of the various sections were carried on throughout the duration of the Congress. In addition there were a number of special lecturers and special addresses. Two gen- eral meetings, the opening and the closing ceremonies, were also held. In conjunction with the Congress a series of public lectures was given in Washington, Philadelphia, Baltimore, New York, and Boston. It was originally planned by the committee to have these special lectures given by world-famous experts in all of the large cities of the country, but for reasons of economy this plan could not be carried out. The names of the special lecturers and the titles of their addresses follow: Dr. Shibasaburo Kitasato, “Tuberculosis and Its Prevention in Japan’; Dr. Andres Mar- tinez Vargas, ‘‘ Tuberculosis of the Heart, of the Blood, and of the Lymph-Vessels’’; Professor Gotthold Pannwitz, ‘‘Social Life and Tuberculosis”; Professor A. Calmette, ‘‘On the Modern Pro- cedures for the Early Diagnosis of Tuberculous Infection’; Dr. Arthur Newsholme, ‘‘The Causes of the Past Decline in Tuber- culosis and the Light Thrown by History on Preventive Measures for the Immediate Future’; Dr. C. Theodore Williams, ‘‘The Evolution of the Treatment of Pulmonary Tuberculosis”; Dr. A. Wladimiroff, ‘‘The Biology of the Tubercle Bacillus’; Pro- fesseur L. Landouzy, ‘‘Cent Ans de Phtisiologie, 1808-1908”’; Prof. N. Ph. Tendeloo, ‘‘Collateral Tuberculous Inflammation’’; Prof. Bernard Bang, ‘‘Studies on Tuberculosis in Domestic Animals, and What We May Learn from Them Regarding Hu- man Tuberculosis”; Dr. Maurice Letulle and M. Augustin Rey, “The Fight against Tuberculosis in Large Cities—The Sanitary Dwelling as a Factor in the Prevention of Tuberculosis—The City Antituberculous; Scientific Methods of Construction”; Dr. 148 A HISTORY OF NATIONAL TUBERCULOSIS ASSOCIATION R. W. Philip, ‘‘The Antituberculosis Program: Codrdination of Preventive Measures.” At the Congress itself practically all of the leading nations of the world were represented, and in the case of such nations as Great Britain, Germany, France, Italy, and others, representa- tives from the various provinces were also in attendance. The total number of delegates and representatives attending the Congress was considerably over 5,000. The total attendance at the various meetings aggregated nearly 100,000 people. The medal of the Congress presented to each member was re- produced in handsome bronze from a design prepared by Victor Brenner. It represents the figure of a beautiful woman, in one hand holding the hour-glass of time, standing on the conquered dragon representing disease. On the reverse is the American eagle, with the stars and stripes; and underneath appear the words, ‘‘International Congress on Tuberculosis, Washington, 1908,” and the double-barred cross, the insignia of the tubercu- losis campaign. It was only through the generosity of the Congress of the United States and the influence of President Roosevelt and Secre- tary Cortelyou that a building large enough to house the Congress could be secured in the city of Washington. The incomplete con- dition of the New National Museum made it possible to use to good advantage the large floor area for exhibits. _In connection with the Congress The National Association for the Study and Prevention of Tuberculosis prepared a memorial volume entitled, ‘‘The Campaign Against Tuberculosis in the United States.’ The expense of publication was met from a spe- cial grant of the Russell Sage Foundation. The book was pre- pared for the Association by Philip P. Jacobs. It outlined, in the form of a directory, the facilities for fighting tuberculosis at that time in existence in this country, consisting of sanatoria, hospitals, day camps, dispensaries, clinics, associations, and committees, special provision for the care of the criminal and insane, legisla- tion, both state and national, and other features of interest. The National Association also had an exhibit showing in graphic form the extent of the tuberculosis movement in this country at the time of the Congress. THE SIXTH INTERNATIONAL CONGRESS 149 The closing session of the Sixth International Congress was held on the morning of October 5, 1908. The Secretary of the Treasury, Hon. George B. Cortelyou, presided. The Committee on Resolutions, of which Dr. Livingston Farrand was the secre- ‘tary had, during the sessions of the Congress, considered numer- ous resolutions. To summarize the work of the Congress in a few brief statements of purpose was found to be a difficult task; but the following resolutions, adopted unanimously by the Congress, accomplished the task in a commendable manner: Resolved, That the attention of the state and central governments be called to the importance of proper laws for the obligatory notification, by medical attendants, to the proper health authorities, of all cases of tuberculosis coming to their notice, and for the registration of such cases, in order to enable the health authorities to put in operation adequate measures for the prevention of the disease. Resolved: That the utmost efforts should be continued in the struggle against tuberculosis to prevent the conveyance of tuberculous infection from man to man as the most important source of the disease. Resolved: That preventive measures be continued against bovine tubercu- losis, and that the possibility of the propagation of this to man be recognized. Resolved: That we urge upon the public and upon all governments (a) the establishment of hospitals for the treatment of advanced cases of tuberculosis, (b) the establishment of sanatoriums for curable cases of tuberculosis, (c) the establishment of dispensaries, day camps, and night camps for ambulant cases of tuberculosis which cannot enter hospitals or sanatoriums. Resolved: That this Congress indorses such well-considered legislation for the regulation of factories and workshops, the abolition of premature and injurious labor of women and children, and the securing of sanitary dwellings, as will increase the resisting power of the community to tuberculosis and other disease. Resolved: That this Congress indorses and recommends the establishment of playgrounds as an important means of preventing tuberculosis through their influence upon health and resistance to disease. Resolved: That instruction in personal and school hygiene should be given in all schools for the professional training of teachers. Resolved: That whenever possible such instruction in elementary hygiene should be intrusted to properly qualified medical instructors. Resolved: That colleges and universities should be urged to establish courses in hygiene and sanitation, and also to include these subjects among their entrance requirements, in order to stimulate useful elementary instruction in the lower schools. 150 A HISTORY OF NATIONAL TUBERCULOSIS ASSOCIATION On recommendation of the Committee on Resolutions also, an invitation from the Italian Ambassador, Baron Des Planches, to hold the next International Congress in Rome in 1911, was ac- cepted. At the closing session brief addresses were given by representatives of practically all of the foreign countries, and in, addition by His Excellency, Theodore Roosevelt, President of the Congress, and President of the United States; Dr. Lawrence F. Flick, chairman of the General Committee; and the Honorable Henry B. MacFarland, president of the Commissioners of the District of Columbia. The report of the treasurer of the Congress shows that the entire amount collected by the General Committee amounted to $102,841.35. The total expenditures were approximately $150,000, as originally estimated by Dr. Flick. The National Association for the Study and Prevention of Tuberculosis was relieved of the entire responsibility for raising and distributing this sum, and except for a few hundred dollars, was not obliged to expend any of its comparatively limited resources on the Congress itself. This fact enabled the Association to reap the utmost benefit from the Congress without any direct financial burden. ; Of the influence of the Sixth International Congress on Tuber- culosis work much might be written. It has proved unquestion- ably to be the most significant milestone in the progress of this great movement in the United States. The educational and organization campaign centering around the preparation for the Congress paved the way for the develop- ment of state and local associations throughout the entire coun- try. The state committees in many instances became the nuclei around which permanent state associations were later formed. The individuals interested in the Congress from various local com- munities in turn received from the Congress itself such an inspira- tion that hundreds of them immediately began to develop com- munity effort in their respective towns and cities. The extensive education that the publicity preceding and during the Congress afforded laid the foundation for much of the later constructive development in the tuberculosis campaign. The conclusions reached by the Congress, both as evidenced in THE SIXTH INTERNATIONAL CONGRESS 151 the resolutions and as brought out in the various discussions, formed the basis for the programs of national, state, and local tuberculosis associations for nearly a decade. For example, the emphasis laid upon hospital care for advanced cases as a preven- tive agency at once changed the trend of thought from cure to prevention as the most desirable measure of procedure. For years after the Congress this emphasis proved of the greatest value in securing additional hospital provision. The discussions in regard to tuberculosis in children focused the attention of work- ers in almost every department of the tuberculosis campaign upon this phase of the work, and has had the greatest influence in shap- ing the tuberculosis movement. While no significant new discovery was announced at the Con- . gress, the accumulation of experience, pathological, clinical, and social, from every part of the world, unquestionably stimulated and inspired the workers in The Nationa! Association for the Study and Prevention of Tuberculosis and gave to them a new vision. The present campaign against tuberculosis is in itself a testimony to the vision created by the Sixth International Con- gress. CHAPTER X THE DOUBLE-BARRED CROSS T ITS second annual meeting in 1906 the National Tu- A vercutsis Association adopted the double-barred cross as its official emblem. A historical statement regarding this emblem, quoted from an article by Philip P. Jacobs, Ph.D., in the Journal of the Outdoor Life for April, 1922, may not be amiss in these pages: The double-barred cross was adopted as the emblem of the tuberculosis movement at the International Conference on Tu- berculosis held in Berlin in 1902. The proposer of the emblem was Dr. G. Sersiron, of Paris. Some persons in connection with the Conference had been discussing the desirability of an emblem for several years. Dr. Sersiron made the definite proposal to adopt the Lorraine Cross. The emblem was adopted without any hesitation and with practically no opposition. The Lorraine Cross itself, to which the tuberculosis emblem, as will be noted, is closely related, dates back to the Patriarchal or Jerusalem Cross carried by the patriarchs of Jerusalem and Constantinople. This form of cross was and still is used by the Greek Catholic Church as its emblem. The double-barred cross as a symbol of various movements, religious, political, fraternal and otherwise has been in use for centuries. The medieval crusades of the eleventh, twelfth, thirteenth and fourteenth centuries familiarized Europe with the double-barred cross as it was seen upon the Greek Churches of Asia Minor and Turkey. Godfrey, Duke of Lorraine, who was a leader of the first Crusade, saw the cross in vogue in Jerusalem and adopted it as his standard when he was elected ruler of Jerusalem in 1099. Apparently on his return to France the double-barred cross be- came the emblem of the then rising house of Lorraine. It has remained in France as the Lorraine Cross to this day, but is dis- tinguished from the Patriarchal Cross by having the lower bar nearer the base. Many people will recall that one of the divisions of the A. E. F. used the Lorraine Cross as its insignia, not adopt- ing the tuberculosis emblem, but utilizing the Lorraine emblem 152 THE DOUBLE-BARRED CROSS 153 which was very much in vogue in certain sections of France where this division happened to be quartered. The Masonic Order has used the double-barred cross also as an emblem for many centuries. It seems likely that they in turn also adopted it from the Jerusalem Cross and not from the House of Lorraine. When the tuberculosis movement adopted the cross, in 1902, no effort was made to standardize its form or its proportion. In 1906 the National Tuberculosis Association, by a special le---- 5 od aes 3 --- > | __| a = es ee a. THE DOUBLE-BARRED CROSS, SHOWING THE TRUE PROPORTIONS All the Angles in the Points are of 45 Degrees. The Width of the Cross is the Unit of Measurement. resolution, adopted the double-barred cross as the emblem of the campaign against tuberculosis in the United States. For about six years no effort was made to standardize its form. Every- where crosses were used of all sorts and shapes, some with long points and some with short points. In 1912 a definite effort was made to standardize the. double- barred cross and a committee was appointed for that purpose. In 1913 the committee made its report at the annual meeting of the National Tuberculosis Association. After a careful study * 154 A HISTORY OF NATIONAL TUBERCULOSIS ASSOCIATION of the history and the artistic merits of numerous designs the committee reported in favor of a double-barred cross with equal cross arms, the upper standard being shorter, and the lower standard longer than the cross arms, and the ends of both arms and standards to be pointed instead of square. The committee was influenced in its decision by the following reasons. 1. Because the design selected is farthest removed from any design having a religious significance. 2. Because it is farthest removed from the well-known emblem used by the American National Red Cross. 3. Because its wide-spread use in this country by many anti- tuberculosis associations over a long period of years has associated it in the minds of the public with the tuberculosis movement. In the first report the committee did not recommend any definite proportions, but it was given power to work these out and later to submit the details and specifications to all anti- tuberculosis agencies. -The committee’s final choice of design is shown in the accompanying illustration. The width of the standards and arms (they are all of the same width) is taken as the standard unit. It will be noted, from figure 1, that the length of the lower standard below the cross arms is 7 units; the arms are 3 units on either side; the point above the arms is 21% units; and the distance between the arms is 1% units. As the width of the cross remains the constant, standard unit, these measure- ments hold good for crosses of any size. With the separation of the National Tuberculosis Association from the American Red Cross in relation to the Christmas seal sale, it became increasingly necessary for the tuberculosis move- ment to popularize the double-barred cross. It also became necessary to conserve the emblem so that it would not be used by unscrupulous vendors of patent medicines and organizations that were not approved by the National Tuberculosis Association. Accordingly in February, 1920, the emblem was protected by registry in the United States Patent Office with the number 137345. The National Tuberculosis Association has made liberal ar- rangements whereby permits for the use of ‘the emblem may be secured from its representative directors in the states. Such permit must specify the particular kinds of printed matter on which the cross is to be used, and must give samples and must pass muster with the representative director who files a copy of the permit with the state association and with the National Tu- berculosis Association. In this way any reputable tuberculosis agency, association, dispensary, sanatorium or other agency can use the double-barred cross. PART II THE ANNUAL MEETINGS OF THE NATIONAL TUBERCULOSIS ASSOCIATION INTRODUCTORY NOTE This part of the history records the principal happenings at each of the seventeen annual meetings. It includes the resolu- tions adopted, the officers and directors elected, and a brief finan- cial summary for each meeting. CHAPTER XI FIRST ANNUAL MEETING “Tee first annual meeting of The National Association for the Study and Prevention of Tuberculosis was held in Washington, D. C., May 18 and 19, 1905. The sessions were held at the New Willard Hotel, the headquarters of the Asso- ciation, the local arrangements being in the hands of a committee consisting of Dr. George M. Kober, chairman, Dr. D. Percy Hickling and Dr. William C. Woodward. The following list of officers and directors held office at this meeting: President, Dr. Edward L. Trudeau, Saranac Lake; vice-presidents, Dr. William Osler, Baltimore, Md.,and Dr. Hermann M. Biggs, New York, N. Y.; treasurer, Dr. George M. Sternberg, Washington, D. C.; secretary, Dr. Henry Barton Jacobs, Baltimore, Md.; directors, Dr. Norman Bridge, Los Angeles, Cal.; Dr. S. E. Solly, Colorado Springs, Colo.; Dr. John P. C. Foster, New Haven, Conn.; Dr. George M. Sternberg, Washington, D. C.; Dr. Arnold C. Klebs, Chicago, IIl.; Dr. Robert H. Babcock, Chicago, Ill.; Dr. John N. Hurty, Indianapolis, Ind.; Dr. William H. Welch, Baltimore, Md.; Dr. William Osler, Baltimore, Md.; Dr. Henry Barton Jacobs, Baltimore, Md.; Dr. John S. Fulton, Baltimore, Md.; Dr. Henry M. Bracken, St. Paul, Minn.; Dr. William Porter, St. Louis, Mo.; Dr. Edward O. Otis, Boston, Mass.; Dr. Vincent Y. Bowditch, Boston, Mass.; Mr. Frederick L. Hoffman, Newark, N. J.; Dr. S. Adolphus Knopf, New York, N. Y.; Dr. Edward L. Trudeau, Saranac Lake, N. Y.; Mr. Edward T. Devine, New York, N. Y.; Dr. Charles L. Minor, Asheville, N.C.; Dr. Charles O. Probst, Columbus, Ohio; Dr. Lawrence F. Flick, Philadelphia, Pa.; Dr. Maz¥ck P. Ravenel, Philadelphia, Pa.; Dr. Howard S. Anders, Phila- delphia, Pa.; Dr. Leonard Pearson, Philadelphia, Pa.; Dr. M. M. Smith, Austin, Texas; Maj. George E. Bushnell, M.D., Fort Bayard, N. M.; Gen. Walter Wyman, M.D., Washington, D. C. Executive secretary, Dr. Livingston Farrand. In preparing the program the executive committee had pro- vided for three sections; a sociological, a clinical and climatolog- ical, and a pathological and bacteriological. Each of these sec- 157 158 A HISTORY OF NATIONAL TUBERCULOSIS ASSOCIATION tions held two sessions, and in addition there were two general meetings of the Association, one on the morning of May 18 and the other on the evening of the same day. The regular business of the Association was transacted on the morning of May 18, fol- lowing the presidential and vice-presidential addresses, and on the evening of May 18, following the public address of Mr. Talcott Williams. The president of the Association, Dr. Edward L. Trudeau, presided at both general meetings. A summary of the transactions follows: On motion of Dr. Lawrence F. Flick, of Philadelphia, it was voted that the presi- dent appoint a committee on resolutions, to consist of five mem- bers, to which all resolutions should be referred before being brought before the Association for action. The president ap- pointed as members of the committee on resolutions, Dr. William H. Welch, chairman, Dr. Edward G. Janeway, Dr. DeLancey Rochester, Mr. Edward T. Devine, and Dr. H. R. M. Landis. The secretary announced that six directors retired by expira- tion of term of office and that one vacancy existed by resignation. The secretary presented the nominations of the board of directors for the vacant directorships as follows: Dr. William S. Carter, of Galveston, in place of Dr. William Osler, resigned. For directors to serve for a term of five years: E. P. Bicknell, of Chicago; Dr. Vincent Y. Bowditch, of Boston; Dr. John S. Fulton, of Balti- more; Dr. Arnold C. Klebs, of Chicago; Henry Phipps, of New York; Dr. C.O. Probst, of Columbus. There being no other nomi- nations, on motion of Dr. DeLancey Rochester the secretary cast a ballot for the names presented, and the gentlemen were de- clared elected. The committee on resolutions made its report through the chairman, Dr. William H. Welch, the following resolutions being recommended for adoption: Resolved, That the sincere thanks of The National Association for the Study and Prevention of Tuberculosis be tendered to Mr. Henry Phipps for his noble benefaction in connection with the study, prevention and cure of tuberculosis. WHEREAS, Dr. William Osler, one of our founders and a potent factor in the development of our organization, has been called to another field of labor, be it Resolved, That we express our appreciation of his valuable service. FIRST ANNUAL MEETING 159 Resolved, That we elect him an Honorary Vice-President as a mark of our appreciation and esteem. The National Association for the Study and Prevention of Tuberculosis hails with gratification the establishment and successful operation of national sanatoria for the treatment of tuberculous patients belonging to the army, the navy, and the Marine Hospital and Public Health Service, and trusts that their usefulness may be enlarged in every possible manner in the study and preven- tion of tuberculosis. ‘ Resolved, That in the interest of preventive medicine and the cause of indus- trial hygiene this Association respectfully recommends to the Chief Executive of the Nation the desirability of instituting an inquiry through the proper offi- cers of the government as to the sanitary conditions existing in all government offices and workshops where a large number of persons are employed, especially with a view of recommending, if necessary, measures for the prevention of tuberculosis therein. Resolved, That the attention of all municipal and State authorities be espe- cially directed to the enormous economic importance to every community of the tuberculosis problem and the wisdom of and the necessity for the provision of adequate funds and the enactment of proper regulations for combating the prevalence of this disease. Resolved, That the officers of the Association be directed to request the directors and officers of insurance associations to unite themselves with this Association and to consider the advisability of giving financial aid to sanatoria for the treatment and prolongation of life of those insured in their companies. Resolved, That the directors and officers of insurance associations be invited to attend the next meeting of this Association. Inasmuch as President Roosevelt in his last message to Congress has em- phasized the importance and the possibility of making the national capital a model city in sanitary and social matters, and Inasmuch as the President has suggested the formation of a “Special Com- mission on Housing and Health Conditions in the National Capital,’’ to be composed of unpaid prominent citizens of Washington, provided with money for necessary expenses by congressional appropriation, served by a competent paid secretary for the twelve or sixteen months which would be requisite for the work, therefore be it Resolved, That the National Association for the Study and Prevention of Tuberculosis earnestly recommends to the Congress of the United States the early passage of legislation providing for the appointment of such a commission either by the President of the United States or the Commissioners of the District. This resolution met with opposition and was referred back to the board of directors. 160 A HISTORY OF NATIONAL TUBERCULOSIS ASSOCIATION At a meeting of the board of directors held on the evening of May 18 the following officers were elected for the ensuing year: president, Dr. Hermann M. Biggs; first vice-president, Dr. Law- rence F. Flick; second vice-president, Dr. Vincent Y. Bowditch; secretary, Dr. Henry Barton Jacobs; treasurer, Gen. George M. Sternberg. In addition to the president and secretary and the vice-presidents, Mr. E. T. Devine and Drs. Foster, Klebs, Ravenel, Trudeau, and Welch were elected members of the execu- tive committee. The meeting closed with a testimonial banquet to the president, Dr. Edward L. Trudeau, on the evening of May 19. The summarized report of the treasurer, Gen. George M. Sternberg, is as follows: Receipts to April 30, 1905........----2.00005 $10,367.15 Ex pend ures iis sisnvdes cua Mad erase Saad haa one ths 3,364.96 Balance on hand April 30, 1905.............. $7,002.19 The following is a list of papers read before the respective sections at the meeting of May 18-19, 1905: The winning fight—Talcott Williams. Health as an investment— Homer Folks. A working program—Edward T. Devine. The progress of the sanatorium movement in America— William H. Baldwin. Infection in transportation—H. M. Bracken, M.D. The therapeutic value of Marmorek’s anti-tubercular serum—Arthur J. Richer, M.D. The natural and artificial protection of man against tuberculosis—F. Figari, M.D. The serum diagnosis of tuberculosis—Hugh M. Kinghorn, M.D. Studies in agglutination—Mazyck P. Ravenel, M.D., and H. R. M. Landis, M.D. The properties of the serum of immunized rabbits—E. R. Baldwin, M.D., H. M. Kinghorn, M.D., and A. H. Allen, M.D. An histological study of thejlesions of immunized rabbits— Joseph L. Nichols: M.D. Two experiments in artificial immunity against tuberculosis—Edward ‘L. Trudeau, M.D. Examination of the blood in pulmonary tuberculosis, with special reference to prognosis— J. T. Ullom, M.D., and Frank A. Craig, M.D. Tuberculosis of the thoracic duct and acute miliary tuberculosis—Warfield T. Longcope, M.D. FIRST ANNUAL MEETING 161 Vicarious action of the bowels for the kidneys in tuberculosis—Lawrence F. Flick, M.D., and Joseph Walsh, M.D. Note on the stability of the cultural characters of tubercle bacilli; with special reference to the production of capsules—Theobald Smith, M.D. The vitality of tubercle bacilli in sputum—David C. Twichell, M.D. Studies in mixed infection in tuberculosis—Mazyck P. Ravenel, M.D., and J. Willoughby Irwin, M.D. The thyroid in tuberculosis— William B. Stanton, M.D. Landry’s paralysis complicating pulmonary tuberculosis—D. J. McCarthy, M.D. Impalpable sputum, as a usually overlooked danger in tuberculosis—Norman Bridge, M.D. Result of the open-air treatment of surgical tuberculosis—W. S. Halsted, M.D. The influence of the event of the tuberculous upon native population—Charles F. Gardiner, M.D. Sanatorium provision with industrial opportunities for indigent consumptives —Herbert M. King, M.D., and Henry B. Neagle, M.D. Detention institutions for ignorant and vicious consumptives—John P. C. Foster, M.D. What cases are suitable for admission to a state sanatorium for tuberculosis, especially in New England?— Herbert C. Clapp, M.D. Six years’ experience at the Massachusetts state sanatorium for tuberculosis at Rutland, Mass.— Vincent Y. Bowditch, M.D., and Henry B. Dunham, M.D. Tent colonies in management of tuberculosis—J. W. Pettit, M.D. Sanatorium treatment in an appropriate climate—Maj. G. E. Bushnell. The treatment and care of advanced cases of pulmonary tuberculosis—S., Adolphus Knopf, M.D. Home treatment of tuberculosis, either in favorable or unfavorable climates— Edward O. Otis, M.D. The after treatment of pulmonary tuberculosis—J. A. Wilder, M.D. Clinical suggestions from the study of 500 cases of pulmonary tuberculosis— Henry P. Loomis, M.D. Clinical studies at Mount St. Rose— William Porter, M.D. History and work of the Bedford sanitarium for consumptives— Alfred Meyer, M.D. Report of the Committee on the Influence of Climate in Pulmonary Tubercu- losis. Report of the Committee on Clinical Nomenclature. Report of the Committee on Early Diagnosis of Tuberculosis. Report of the Committee on an Educational Leaflet for Distribution Among the People. Il CHAPTER XII SECOND ANNUAL MEETING HE second annual meeting of The National Association for The Study and Prevention of Tuberculosis was held at the New Willard Hotel, Washington, D. C., Wednesday, Thurs- day, and Friday, May 16, 17, and 18, 1906. In preparing the program the executive committee had pro- vided for two new sections, a Surgical section and one on Tuber- culosis in Children, in addition to the three previously existing. Each of the older sections held two sessions and the newly formed sections one each. In the absence of Dr. Hermann M. Biggs, the president of the Association, Dr. Lawrence F. Flick, vice-president, occupied the chair. The opening meeting on the evening of May 16 was a joint session of the National Association with the Association of American Physicians, at which the president of the latter society, Dr. Frank Billings, presided, the address on that occasion being by Dr. Simon Flexner, of New York. At the business meeting of the Association, held on the evening of May 17, following the vice-presidential address of Dr. Flick, the six directors whose terms of office expired by limitation were reélected, namely, Drs. H. M. Bracken, Minnesota; W.S. Carter, Texas; Henry Barton Jacobs, Maryland; E. O. Otis, Massa- chusetts; Edward L. Trudeau, New York; and William H. Welch, Maryland. By the amendment to the by-laws providing for the enlarge- ment of the board of directors to 60, the following new directors were nominated by the board and elected by the Association: Mr. Redfield Proctor, Jr., Vermont; W. T. Sedgwick, Massachusetts; Rowland G. Hazard, Rhode Island; Homer Folks, New York; Dr. Walter B. James, New York; Dr. Edward G. Janeway, New York; Dr. Alfred Meyer, New York; John Seely Ward, Jr., 162 SECOND ANNUAL MEETING 163 New York; Charles M. Lea, Pennsylvania; Dr. Joseph Walsh, Pennsylvania; Otis H. Childs, Pennsylvania; Dr. John J. Black, Delaware; Robert Garrett, Maryland; William H. Baldwin, District of Columbia; Samuel Gompers, District of Columbia; Dr. George M. Kober, District of Columbia; Dr. C. F. McGahan, South Carolina; Dr. T. D. Coleman, Georgia; Dr. John H. Lowman, Ohio; Charles W. Fairbanks, Indiana; Dr. Frank Billings, Illinois; A. A. Sprague, 2d, Illinois; David R. Francis, Missouri; C. E. Perkins, Iowa; James J. Hill, Minnesota; Dr. Sherman G. Bonney, Colorado; Dr. Henry Sewall, Colorado; Dr. W. H. Flint, California; and Benjamin I. Wheeler, Cali- fornia. The following resolutions, having been endorsed by the com- mittee on resolutions, were unanimously adopted: Resolved, That the National Association for the Study and Prevention of Tuberculosis adopt the double red cross as the official emblem of the Associa- tion. Resolved, That in the interests of clearness and uniformity of nomenclature the Association employ in its official publications the term tuberculous to refer to lesions or conditions caused by the tubercle bacillus, and the term tubercular to describe conditions resembling tubercles, but not caused by the tubercle bacillus. WHEREAS, Recent experience in Europe and in this country has shown that outdoor life in pure air has the same curative effect in surgical tuberculosis as in tuberculosis of the lungs, therefore, be it Resolved, That, in the opinion of the members of this Association, hospitals and sanatoria should be established outside of cities, either in the country or on the seashore, for the treatment, from its incipiency, of tuberculosis of bones, joints, and glands in children. At a meeting of the board of directors held on Friday, May 18, the following officers were elected for the ensuing year: Dr. Hermann M. Biggs, president; Dr. Lawrence F. Flick and Dr. Vincent Y. Bowditch, vice-presidents; Dr. Henry Barton Jacobs, secretary; General George M. Sternberg, treasurer. The follow- ing directors were elected to serve on the executive committee for the ensuing year: W. H. Baldwin, Homer Folks, Drs. Vincent Y. Bowditch, Lawrence F. Flick, J. P. C. Foster, E. C. Janeway, 164 A HISTORY OF NATIONAL TUBERCULOSIS ASSOCIATION Arnold C. Klebs. Dr. Edward L. Trudeau was elected an Hono- rary Member of the Association. There are no available records of the second annual report of the treasurer. Prior to the first meeting of the National Association in Wash- ington, there existed in the United States 23 tuberculosis associa- tions, to which were added during the year 1905 no less than nine. To the 24 dispensaries were added three during the same period, and 1o sanatoria and special hospitals to the already existing 96. A list of officers and directors for 1905 to 1906 follows: President, Dr. Hermann M. Biggs; honorary vice-presidents, Theodore Roose- velt, Grover Cleveland, and Dr. William Osler; vice-presidents, Dr. Lawrence F. Flick, and Dr. Vincent Y. Bowditch; treasurer, Gen. George M. Sternberg; secre- tary, Dr. Henry Barton Jacobs; directors, Dr. Howard S. Anders, Philadel- phia; Ernest P. Bicknell, Chicago; Dr. Hermann M. Biggs, New York; Dr. Vincent Y. Bowditch, Boston; Dr. Henry M. Bracken, St. Paul; Dr. Norman Bridge, Los Angeles; Maj. George E. Bushnell, Fort Bayard, N. M.; Dr. William S. Carter, Galveston; Otis H. Childs, Pittsburgh; Edward T. Devine, . New York; Dr. Lawrence F. Flick, Philadelphia; Homer Folks, New York; Dr. John P. C. Foster, New Haven; Dr. John S. Fulton, Baltimore; Frederick L. Hoffman, Newark, N. J.; Dr. John N. Hurty, Indianapolis; Dr. Henry Barton Jacobs, Baltimore; Dr. Edward G. Janeway, New York; Dr. Arnold C. Klebs, Chicago; Dr. S. A. Knopf, New York; Dr. Charles L. Minor, Asheville; Dr. Edward O. Otis, Boston; Dr. Leonard Pearson, Philadelphia; Henry Phipps, New York; Dr. William Porter, St. Louis; Dr. Charles O. Probst, Columbus, O.; Dr. Mazyck P. Ravenel, Philadelphia; Dr. S. E. Solly, Colorado Springs; Gen. George M. Sternberg, Washington; Dr. Edward L. Trudeau, Sar- anac Lake; Dr. Victor C. Vaughan, Ann Arbor; Dr. Joseph Walsh, Philadelphia; Dr. William H. Welch, Baltimore; Gen. Walter Wyman, Washington. Executive secretary, Dr. Livingston Farrand. _ The following is a list of papers read before the respective sec- tions at the meeting of May 16-18, 1906. Immunity in tuberculosis—Simon Flexner, M.D. The influence of a tuberculosis sanatorium on the value of surrounding property —William H. Baldwin. Tuberculosis nostrums—Samuel Hopkins Adams. Tuberculosis among the Oglala Sioux Indians— James R. Walker, M.D. Tuberculosis among the Negroes—Thomas Jesse Jones, Ph.D. Effective methods of educating the public— Paul Kennaday. SECOND ANNUAL MEETING 165 Insurance of industrial workingmen as an instrument of tuberculosis preven- tion— Arnold C. Klebs, M.D. Localized tuberculous leptomeningitis—D. J. McCarthy, M.D. The liver in tuberculosis— Josephus T. Ullom, M.D. The kidneys in tuberculosis—Joseph Walsh, M.D. The clinical and pathological comparison of cavities—H. R. M. Landis, M.D. Tuberculosis of the placenta— Alfred Scott Warthin, M.D. Notes on some common errors in the technique of sputum staining for tubercle bacilli— Charles L. Minor, M.D., and Paul Ringer, M.D. Concerning Bacillus X—Stephen J. Maher, M.D. Further notes on the serum diagnosis of tuberculosis—Hugh M. Kinghorn, M.D., and David C. Twichell, M.D. The technique of tuberculo-opsonic test—Hugh M. Kinghorn, M.D., and David C. Twichell, M.D. Studies on immunity in tuberculosis, II]. Experiments with leucocytes. Lymph gland and bone marrow extracts of immunized animals—E. R. Baldwin, M.D., and J. Woods Price, M.D. The scope and aim of state sanatoria for tuberculosis—Vincent Y. Bowditch, M.D. The therapeutic use of tuberculin combined with sanatorium treatment of tuberculosis—E. L. Trudeau, M.D. The treatment of tuberculous laryngitis with watery extract of tubercle bacilli, with observations upon the action of specific inoculations in the treatment of tuberculosis—F. M. Pottenger, M.D. Review of the work upon the opsonic index (Wright and Douglas) in tubercu- losis—Nathaniel Bowditch Potter, M.D. Heematological studies in tuberculosis—Arnold C. Klebs, M.D., and Henry Klebs, M.D. On the use and abuse of pulmonary gymnastics in the treatment of tubercu- losis—Charles L. Minor, M.D. Use and abuse of pulmonary gymnastics—Edward O. Otis, M.D. Diet in tuberculosis—Herbert Maxon King, M.D. Statistics of diet in sanatoria for consumptives—Irving Fisher, Ph.D. Diet in pulmonary tuberculosis—Sherman G. Bonney, M.D. Climate as a factor in the treatment of tuberculosis—Frederick I. Knight, M.D. The relative value of home treatment of tuberculosis—Lawrence F. Flick, M.D. A suggestion in the treatment of hemoptysis—Lawrason Brown, M.D. Manifestations of syphilis associated with pulmonary tuberculosis—John H. Pryor, M.D. What may be accomplished with apparently hopeless cases of tuberculosis— Sherman G. Bonney, M.D. A contribution to climatic phthisiotherapy—E. S. Bullock, M.D. The hot morning bath for the tuberculous—Norman Bridge, M.D. Tuberculous peritonitis— Richard Douglas, M.D. The treatment of tuberculosis of the bones and joints—Joel E. Goldthwait, M.D. 166 A HISTORY OF NATIONAL TUBERCULOSIS ASSOCIATION Tuberculous glands of the neck, based on five hundred cases—C. H. Mayo, M.D. The portals of entry and sources of infection in tuberculosis in children— David Bovaird, Jr., M.D. Treatment of tuberculosis in early life—J. P. Crozer Griffith, M.D. The protection of infants and young children from tuberculous infection— John Lovett Morse, M.D. The therapeutic value of sea air in non-pulmonary tuberculosis in children— John W. Brannan, M.D. Report of the Committee on Clinical Nomenclature. CHAPTER XIII THIRD ANNUAL MEETING HE third annual meeting of The National Association for the Study and Prevention of Tuberculosis was held at the New Willard Hotel, Washington, D. C., Monday, Tuesday, and Wednesday, May 6, 7, and 8, 1907. The president of the Association, Dr. Hermann M. Biggs, occu- pied the chair at the general meeting. Over 300 members of the Association were present at the various sessions. At the general meeting on the morning of May 6, following the addresses of President Biggs and Vice-President Flick, the follow- ing committee on resolutions was appointed: Dr. Victor C. Vaug- han, Ann Arbor, chairman; Dr. Edward R. Baldwin, Saranac Lake; Dr. S. A. Knopf, New York; Dr. John H. Lowman, Cleveland; Dr. William S. Thayer, Baltimore. The following committee to present nominations to fill vacan- cies on the board of directors was appointed: William H. Bald- win, Washington, Chairman; Dr. Frank Billings, Chicago; Dr. Lawrason Brown, Saranac Lake; Major George E. Bushnell, Fort Bayard; Dr. Charles R. Grandy, Norfolk; Dr. F. M. Pottenger, Los Angeles; Dr. Henry Sewall, Denver. At the regular business meeting of the Association held on the evening of May 7 the following directors were unanimously elected for terms of five years: Dr. Hermann M. Biggs, New York; Dr. Frank Billings, Chicago; Dr. R. W. Corwin, Pueblo, Colo.; Edward T. Devine, New York; Dr. Lawrence F. Flick, Philadelphia; David R. Francis, St. Louis; Robert Garrett, Baltimore; Charles M. Lea, Philadelphia; Dr. C. F. McGahan, Aiken; W. C. Nones, Louisville; Dr. Maz¥ck P. Ravenel, Phila- delphia; Gen. George M. Sternberg, Washington. The following resolution presented by the Advisory Council was adopted: 167 168 A HISTORY OF NATIONAL TUBERCULOSIS ASSOCIATION WHEREAS, In order to deal intelligently and effectively with the tuberculo- sis problem in any community a knowledge of the extent and location of the disease on the part of the health authorities is indispensable, therefore be it Resolved, That The National Association for the Study and Prevention of Tuberculosis regards the compulsory notification and registration of tubercu- losis as a necessary measure; and that where it does not already exist, legisla- tion providing for such compulsory notification and registration of tuberculosis, with adequate provision for its enforcement, should be enacted. At the meeting of the board of directors, held on the evening of Tuesday, May 7, the following officers were elected for the ensuing year: Dr. Frank Billings, president; Dr. Mazyck P. Ravenel and Dr. John P. C. Foster, vice-presidents; Dr. Henry Barton Jacobs, secretary, Gen. George M. Sternberg, treasurer. The following directors were elected to serve on the executive committee for the ensuing year: William H. Baldwin, Washing- ton; Dr. Hermann M. Biggs, New York; Dr. Vincent Y. Bow- ditch, Boston; Dr. Lawrence F. Flick, Philadelphia; Dr. John P. C. Foster, New Haven; Dr. Edward G. Janeway, New York; Dr. Arnold C. Klebs, Chicago. The board adopted unanimously the following resolutions on the death of Dr. S. E. Solly, a former member of the board: WHEREAS, The Directors of The National Association for the Study and Prevention of Tuberculosis have learned with sincere sorrow of the death of their colleague, Dr. S. E. Solly, of Colorado Springs, and WHEREAS, By his great medical ability and no less by his unusual personal charm he had both endeared himself to them and proven a wise counsellor in their deliberations, be it Resolved, That in his death they have lost a member whose place cannot easily be filled; one whose distinguished professional attainments did honor to this body to which he belonged and whose remarkable gifts of heart equally with those of mind made him ever welcome in their midst; and further be it Resolved, That the Secretary be directed to send a copy of these resolutions and assurances of our deep sympathy to his bereaved family; that a copy be spread on our minutes and that they be published in Colorado Medicine, the official organ of the Colorado State Medical Society, in the Journal of the American Medical Association, in the Medical Record, and in the Journal of the Outdoor Life, the official organ of The National Association for the Study and Prevention of Tuberculosis. The summarized report of the treasurer,.Gen. George M. Stern- berg is as follows: THIRD ANNUAL MEETING 169 Balance on hand April 30, 1906............... $4,085.30 Receipts.............. Pirro Med ae eee ane Aw 10,812.13 Expenditures. ............0.. cece eeeceeees 12,281.79 Balance on hand April 30, 1907............... $2,615.64 e At the meeting of 1906 there were reported to exist in the United States 32 tuberculosis associations, to which 22 were added during 1906-1907. To the 27 dispensaries 9 were added during the same period; and 12 sanatoria and special hospitals to the existing 106. A list of officers and directors for 1906 to 1907 follows: President, Dr. Hermann M. Biggs; honorary vice-presidents, Theodore Roose- velt, Grover Cleveland, and Dr. William Osler; vice-presidents; Dr. Lawrence F. Flick and Dr. Vincent Y. Bowditch; treasurer, Gen. George M. Sternberg; secretary, Dr. Henry Barton Jacobs; directors, Dr. Howard S. Anders, Phila- delphia; William H. Baldwin, Washington; Ernest P. Bicknell, Chicago; Dr. Hermann M. Biggs, New York; Dr. Frank Billings, Chicago; Dr. John J. Black, New Castle, Del.; Dr. Sherman G. Bonney, Denver; Dr. Vincent Y. Bowditch, Boston; Dr. Henry M. Bracken, St. Paul; Dr. Norman Bridge, Los Angeles; Maj. George E. Bushnell, Fort Bayard; Dr. William S. Carter, Galveston; Otis H. Childs, Pittsburgh; Dr. T. D. Coleman, Augusta, Ga.; Edward T. Devine, New York; Charles W. Fairbanks, Washington; Dr. Lawrence F. Flick, Philadelphia; Dr. W. H. Flint, Santa Barbara, Cal.; Homer Folks, New York; Dr. John P. C. Foster, New Haven; David R. Francis, St. Louis; Dr. John S. Fulton, Baltimore; Robert Garrett, Baltimore; Samuel Gompers, Washington; Rowland G. Hazard, Peace Dale, R. I.; James J. Hill, St. Paul; Frederick L. Hoffman, Newark; Dr. John N. Hurty, Indianapolis; Dr. Henry Barton Jacobs, Baltimore; Dr. Walter B. James, New York; Dr. Edward G. Janeway, New-York; Dr. Arnold C. Klebs, Chicago; Dr. S. A. Knopf, New York; Dr. George M. Kober, Washington; Charles M. Lea, Philadelphia; Dr. John H. Lowman, Cleveland; Dr. C. F. McGahan, Aiken, S. C.; Dr. Alfred Meyer, New York; Dr. Charles L. Minor, Asheville; Dr. Edward O. Otis, Boston; Dr. Leonard Pearson, Philadelphia; C. E. Perkins, Burlington, Iowa; Henry Phipps, New York; Dr. William Porter, St. Louis; Dr. Charles O. Probst, Columbus; Redfield Proctor, Jr., Proctor, Vt.; Dr. Mazck P. Ravenel, Philadelphia; W. T. Sedgwick, Boston; Dr. Henry Sewall, Denver; Dr. S. E. Solly, Colorado Springs; A. A. Sprague, 2d, Chicago; General Geo. M. Sternberg, Washington; Dr. Ed- ward L. Trudeau, Saranac Lake; Dr. Victor C. Vaughan, Ann Arbor; Dr. Joseph Walsh, Philadelphia; John Seely Ward, Jr., New York; Dr. Wiliam H. Welch Baltimore; Benjamin I. Wheeler, Berkeley, Cal.; General Walter Wyman, Wash- ington, Executive secretary, Dr. Livingston Farrand. 170 A HISTORY OF NATIONAL TUBERCULOSIS ASSOCIATION The following is a list of papers read before the respective sec- tions at the meeting of May 6-8, 1907: Report on the International Congress on Tuberculosis—Lawrence F. Flick, M.D. The campaign against tuberculosis in the United States—Livingston Farrand, M.D. Address of the chairman of the Advisory Council— William H. Baldwin. Compulsory notification and registration of tuberculosis—Hermann M. Biggs, M.D. The class method of treating consumption in the homes of the poor—Joseph H. Pratt, M.D. Country treatment of city cases—B. H. Waters, M.D. A working program for a small city—Oscar H. Rogers, M.D. Schools and tuberculosis—John H. Lowman, M.D. The detection and treatment of cases of tuberculosis among factory employees in Providence—Frank T. Fulton, M.D. Address of the chairman of the Clinical and Climatological Section—George Dock, M.D. Some experience with tuberculin—L. Rosenberg, M.D. Varieties of tuberculosis according to race and social condition—Woods Hutchinson, M.D. Phagocytosis, etc., in sputum as a measure of resistance in tuberculosis—Albert H. Allen, M.D. Bacteriological examination of the feces as a means of early diagnosis in tu- berculosis—Myer Solis Cohen, M.D. Split products of the tubercle bacillus and their effects upon animals—Victor C. Vaughan, M.D., and Sybil May Wheeler. Further notes on the technique of the tuberculo-opsonic test—Hugh M., King- horn, M.D., David C. Twichell, M.D., and Norman M. Carter, M.D. Homologous bacteria as a vaccine in tuberculosis—Albert H. Allen, M.D. The pleural pressure after death from tuberculosis—W. B. Stanton,M .D. Disseminated focal necroses due to tubercle bacilli—A. S. Warthin, M.D. Localized tuberculosis of the liver—A. S. Warthin, M.D. The leucocytes in various complications of pulmonary tuberculosis— Frank A. Craig, M.D. Occult blood findings in tuberculous ulceration of the intestines—H. R. M. Landis, M.D. The living pathology of tuberculosis of the bones in early life—Thomas Morgan Rotch, M.D., and Arial W. George, M.D. Recent advances in the knowledge of tuberculosis in early life—Charles Hunter Dunn, M.D. The present status of the transmissibility of bovine tuberculosis as illustrated by infants and young children—Henry L. K. Shaw, M.D. THIRD ANNUAL MEETING 171 Are tuberculous infants and children in the first five years of life liable to be sources of infection?—Samuel S. Adams, M.D. The treatment of surgical tuberculosis by hyperemia (Bier)—Dr. V. Schmieden. Present status of the opsonic theory and the treatment by tuberculins—Rufus I. Cole, M.D. The advantages and limitations of the x-ray in the treatment of surgical tu- berculosis—Henry K. Pancoast, M.D. Report of the Committee on Clinical Nomenclature. Report of the Committee on Medication in Tuberculosis. Report of the Committee on Mixed Infection in Tuberculosis. CHAPTER XIV FOURTH ANNUAL MEETING ° |: fourth annual meeting of The National Association for the Study and Prevention of Tuberculosis was held at the Auditorium Hotel, Chicago, Ill., on Friday and Saturday, June 5 and 6, 1908. The president of the Association, Dr. Frank Billings, occupied the chair at the general meeting. At the general meeting on the afternoon of Friday, June 5, fol- lowing the addresses of President Billings, Vice-President Flick, and the executive secretary, the following committee was ap- pointed by the president to present nominations to fill vacancies on the board of directors: Dr. Norman Bridge, Los Angeles, chairman; Dr. Henry M. Bracken, St. Paul; Alexander M. Wil- son, Chicago; Dr. John L. Dawson, Charleston, S. C.; Dr. Herbert Maxon King, Liberty, N. Y. The following committee on resolutions was appointed: Dr. John H. Lowman, Cleveland, chairman; Dr. Henry B. Favill, Chicago; Dr. Gerald B. Webb, Colorado Springs; Dr. Thomas D. Coleman, Augusta; Dr. Hugh M. Kinghorn, Saranac Lake. At the regular business meeting of the Association, held on Saturday, June 6, at 12.30 P. M., the following directors were unanimously elected for terms of five years: Dr. Edward R. Baldwin, Saranac Lake; C. B. Boothe, Los Angeles; A. B. Cum- mins, Des Moines; Samuel Gompers, Washington; James J. Hill, St. Paul; Frederick L. Hoffman, Newark; Dr. John N. Hurty, Indianapolis; Dr. S. A. Knopf, New York; Dr. Rudolf Matas, New Orleans; Dr. Charles L. Minor, Asheville; Redfield Proctor, Jr., Proctor, Vt.; Dr. Victor C. Vaughan, Ann Arbor. W. K. Bixby, St. Louis, was elected a director to fill the unexpired term of C. E. Perkins, deceased. At a meeting of the board of directors, held at the Auditorium Hotel on Saturday afternoon, June 6, the following officers were 172 * FOURTH ANNUAL MEETING 173 elected for the ensuing year: Dr. Vincent Y. Bowditch, president; Homer Folks and Dr. Charles L. Minor, vice-presidents; Dr. Henry Barton Jacobs, secretary and Gen. George M. Sternberg, treasurer. The following directors were elected to serve on the executive committee for the ensuing year: William H. Baldwin, Washing- ton; Dr. Hermann M. Biggs, New York; Homer Folks, New York; Dr. John P. C. Foster, New Haven; Dr. Edward G. Jane- way, New York; Dr. Edward O. Otis, Boston; Dr. Leonard Pearson, Philadelphia. Following the joint meeting of the Advisory Council and the Sociological Section of the Association, Alexander M. Wilson, of Chicago, was elected chairman of the Advisory Council for the next annual meeting. The summarized report of the treasurer, Gen. George M. Sternberg, is as follows: Balance on hand April 30, 1907............ ‘,.. $2,615.64 Receipts: stsa4neus¢ sees aaaecenr seme ears s 21,720.39 Expenditures... . 0... .. ec ccc eee e eee een eeeee 18,236.32 Balance on hand April 30, 1908............... $6,099.71 At the meeting of 1908 there were reported an addition of 50 associations to the already existing 54; 28 dispensaries were added during the year to the existing 36; and 30 special hospitals and sanatoria were added to the existing 118. A list of officers and directors for 1907 to 1908 follows: President, Dr. Frank Billings; honorary vice-presidents, Theodore Roose- velt, Grover Cleveland, and Dr. William Osler; vice-presidents, Dr. Maz¥ck P. Ravenel and Dr. John P. C. Foster; treasurer, Gen. George M. Sternberg; secre- tary, Dr. Henry Barton Jacobs; directors, Dr. Howard S. Anders, Philadel- phia; William H. Baldwin, Washington; Ernest P. Bicknell, Chicago; Dr. Hermann M. Biggs, New York; Dr. Frank Billings, Chicago; Dr. John J. Black, New Castle, Del.; Dr. Sherman G. Bonney, Denver; Dr. Vincent Y. Bowditch, Boston; Dr. Henry M. Bracken, St. Paul; Dr. Norman Bridge, Los Angeles; Maj. Geo. E. Bushnell, Ft. Bayard; Dr. William S. Carter, Galves- ton; Otis H. Childs, Pittsburgh; Dr. T. D. Coleman, Augusta, Ga.; Dr. R. W. Corwin, Pueblo, Colo.; Edward T. Devine, New York; Charles W. Fairbanks, Washington; Dr. Lawrence F. Flick, Philadelphia; Dr. W. H. Flint, Santa Barbara, Cal.; Homer Folks, New York; Dr. John P. C. Foster, New Haven; 174 A HISTORY OF NATIONAL TUBERCULOSIS ASSOCIATION David R. Francis, St. Louis; Dr. John S. Fulton, Baltimore; Robert Garrett, Baltimore; Samuel Gompers, Washington; Rowland G. Hazard, Peace Dale, R. I; James J. Hill, St. Paul; Frederick L. Hoffman, Newark; Dr. John N. Hurty, Indianapolis; Dr. Henry Barton Jacobs, Baltimore; Dr. Walter B. James, New York; Dr. Edward G. Janeway, New York; Dr. Arnold C. Klebs, Chicago; Dr. S. A. Knopf, New York; Dr. George M. Kober, Wash- ington; Charles M. Lea, Philadelphia; Dr. John H. Lowman, Cleveland; Dr- C. F. McGahan, Aiken, S. C.; Dr. Alfred Meyer, New York; Dr. Charles L. Minor, Asheville; W. C. Nones, Louisville; Dr. Edward O. Otis, Boston; Dr. Leonard Pearson, Philadelphia; C. E. Perkins, Burlington, Iowa; Henry Phipps, New York; Dr. William Porter, St. Louis; Dr. Charles O. Probst, Columbus; Redfield Proctor, Jr., Proctor, Vt.; Dr. Mazyck P. Ravenel, Madi- son, Wis.; W. T. Sedgwick, Boston; Dr. Henry Sewall, Denver; A. A. Sprague, 2d, Chicago; Gen. Geo. M. Sternberg, Washington; Dr. Edward L. Trudeau, Saranac Lake; Dr. Victor C. Vaughan, Ann Arbor; Dr. Joseph Walsh, Philadelphia; John Seely Ward, Jr., New York; Dr. William H. Welch, Baltimore; Benjamin I, Wheeler, Berkeley, Cal.; Gen. Walter Wyman, Washington. Executive secretary, Dr. Livingston Farrand; assistant secretary, Philip P. Jacobs, Ph.D. The following is a list of papers read before the respective sec- tions at the meeting of June 5-6, 1908: Report on the International Congress on Tuberculosis—Lawrence F. Flick, M.D. The campaign in the United States—Livingston Farrand, M.D. With a state sanatorium secured, what next?—Symposium. Tuberculosis in hospitals for the insane—H. A. Tomlinson, M.D. Tuberculosis in prisons—H. C. Sharp, M.D. The orphan asylum and its duties toward its wards—Ethan A. Gray, M.D. Employment for arrested cases of tuberculosis—Charles J. Hatfield, M.D. Tuberculin tests— Arnold C. Klebs, M.D. Clinical study of the effect of tuberculin treatment on the serum agglutination of tubercle bacilli—Hugh M. Kinghorn, M.D., and David C. Twichell, M.D. Immunity production by inoculation of increasing numbers of bacteria, be- ginning with one organism. Preliminary report—Gerald B. Webb, M.D., and William W. Williams, M.D. The heart in pulmonary tuberculosis—Lawrason Brown, M.D. The changes in the lungs in systemic blastomycosis as contrasted with those of tuberculosis—E. R. LeCount, M.D. Acute pylephlebogenous miliary tuberculosis of the liver, with clinical picture of acute infectious jaundice; primary tuberculosis of mesenteric glands— ° Alfred Scott Warthin, M.D. The clinical application of bacterial vaccines in cases of pulmonary tubercu- losis—Sherman G. Bonney, M.D. FOURTH ANNUAL MEETING 175 Explanation of seeming paradoxes in modern phthisio-therapy, with particu- lar reference to sun, air, water, and food as remedial agents—S. Adolphus Knopf, M.D. The municipal anti-tuberculosis work in Boston—Edwin A. Locke, M.D. Hemoptysis in pulmonary tuberculosis—F. C. Smith, M.D. The tuberculo-opsonic index, the von Pirquet tuberculin skin test, and the conjunctival tuberculin test in the diagnosis of tuberculosis— Mary C. Lincoln, M.D. , Tuberculous abscesses: their management— Edwin W. Ryerson, M.D. Children of the tuberculous—Theodore B. Sachs, M.D. Vertebral auscultation in the diagnosis of bronchial adenopathy, preliminary report—Ethan Allen Gray, M.D. Report of the Committee on Clinical Nomenclature. CHAPTER XV FIFTH ANNUAL MEETING HE fifth annual meeting of The National Association for the Study and Prevention of Tuberculosis was held at the New Willard Hotel, Washington, D. C., on May 13, 14, and 15, 1909. In the absence of the president, Dr. Vincerit Y. Bowditch, the first vice-president, Mr. Homer Folks, occupied the chair at the general meetings. On the afternoon of Friday, May 14, a public meeting was held in codperation with the Washington Association for the Preven- tion of Tuberculosis and the Washington Academy of Sciences. Addresses were made on that occasion by Mr. Homer Folks, chairman, Right Honorable James Bryce, Hon. Joseph G. Can- non, Dr. William Osler, and Dr. William H. Welch. At the opening meeting on Thursday, May 13, following the address of the vice-president and the report of the executive secretary, in accordance with the regular procedure of the Asso- ciation a committee was appointed by the chair to present nomi- nations to fill vacancies on the board of directors, as follows: Dr. Henry M. Bracken, St. Paul, chairman; Dr. William C. White, Pittsburgh; Dr. Charles R. Grandy, Norfolk; William H. Bald- win, Washington; Dr. Joseph H. Pratt, Boston. The following committee on resolutions was also appointed by the chair: Dr. George M. Kober, Washington, chairman; Dr. John S. Fulton, Baltimore; Dr. S. A. Knopf, New York; Dr. Joseph Walsh, Philadelphia; Alexander M. Wilson, Boston. At the regular business meeting of the Association, held on Friday, May 14, at 12.30 P. M., the following directors were unanimously elected for terms of five years: Dr. Robert H. Bab- cock, Chicago; Dr. W. F. Drewry, Petersburg, Va.; John M. Glenn, New York; Dr. Edward G. Janeway, New York; Dr. George M. Kober, Washington; Dr. John H. Lowman, Cleve- 176 FIFTH ANNUAL MEETING 177 land; R. B. Mellon, Pittsburgh; Dr. E. A. Pierce, Portland, Ore.; Dr. Joseph Y. Porter, Key West, Fla.; Professor W. T. Sedgwick, Boston; Dr. W. R. Steiner, Hartford, Conn.; Dr. Joseph Walsh, Philadelphia. The following resolutions were reported favorably by the com- mittee and were unanimously adopted by the Association: Resolved, That The National Association for the Study and Prevention of Tuberculosis urges the centralization of the health activities of the United States Government. Resolved, That The National Association for the Study and Prevention of Tuberculosis hails with gratification the efforts of the George Washington Memorial Association to provide in the capital of the nation a permanent home and meeting place for the national, patriotic, scientific, educational, literary, and art activities, including a great hall and rooms for large con- gresses, Resolved, That the need of such a building was emphasized during the Inter- national Congress on Tuberculosis, which was held in Washington during September and October, 1908. Resolved, That this Association indorses the project, and while pledging cordial codperation also recommends the undertaking as worthy of popular support. Wuereas, Detailed knowledge of population, births, and deaths is a funda- mental need of civilized governments; and WHEREAS, The government of the United States, through its Census Bureau, can furnish the necessary information concerning population only, the power and the duty of recording births and deaths belonging to the States; and WHEREAS, The government of the United States has assumed obligations to furnish to foreign governments authoritative information concerning the deaths of aliens in this country, the several States being party to these treaty obligations the Government of the United States does not discharge, and can- not discharge except through the proper exercise by the States of their reserved rights; and WHEREAS, The government of the United States has more than once been advised by foreign governments of its default in these obligations, and has more than once called the attention of State governments to the existing foreign obligations; and Wuereas, Only 16 of the States are able to furnish reliable accounts of current mortality, while none can furnish reliable accounts of births; by these defaults burdening their citizens, their courts, their boards of health, education, charity, and labor with expensive and inferior substitutes for official and authoritative records, and by the default in mortality registration, exposing the 12 178 A HISTORY OF NATIONAL TUBERCULOSIS ASSOCIATION government of the United States in the réle of a defaulter in foreign relations: therefore, be it Resolved, That The National Association for the Study and Prevention of ’ Tuberculosis codperate with other agencies in extending and strengthening the practice of registration of deaths and births in all parts of the United States. At a meeting of the board of directors held on Friday afternoon, May 14, the following resolution was adopted by the board: It having been demonstrated that typhoid fever, scarlet fever, tuberculosis, and certain other infectious diseases of man may be contracted by the use of impure (infected) milk, the board of directors of The National Association for the Study and Prevention of Tuberculosis desires to express its approval of all efforts to secure for the public generally, and especially for children, a pure milk supply. The board of directors, at its meeting on May 14, elected the following officers for the ensuing year: Dr. Edward G. Janeway, New York, president; Mr. Edward T. Devine, New York, and Dr. Henry Sewall, Denver, vice-presidents; Dr. Henry Barton Jacobs, Baltimore, secretary; Gen. George M. Sternberg, Wash- ington, treasurer. The following directors were elected to serve on the executive committee for the ensuing year: William H. Baldwin, Washing- ton; Dr. Hermann M. Biggs, New York; Edward T. Devine, New York; Homer Folks, New York; Dr. George M. Kober, Washington; Dr. John H. Lowman, Cleveland; Dr. Joseph Walsh, Philadelphia. Following the meeting of the Advisory Council on the evening of May 13, Dr. Heiry M. Bracken, of t. Paul, was unanimously elected chairman of the Advisory Council of the next annual meeting. The summarized report of the Treasurer, Gen. George M. Sternberg, is as follows: Balance on hand April 30, 1908.............0. $6,099.71 ReCel ptSi se wa osiaie ga sas vas Sas oo ee os a 24,256.62 Expenditures ies secgsst scene ne van ec huw nares 26,087.69 Balance on hand April 30, 1909............005 $4,268.64 At the meeting of the Association in 1909 there were reported FIFTH ANNUAL MEETING 179 an addition of 41 anti-tuberculosis associations to the already ex- isting 104. To the 64 previously existing dispensaries were added 85 during the period 1908-1909; and 36 sanatoria and special hospitals were added to the previously reported 148. A list of officers and directors for 1908 to 1909 follows: President, Dr. Vincent Y. Bowditch; honorary vice-presidents, Theodore Roosevelt, and Dr. William Osler; vice-presidents, Mr. Homer Folks, and Dr. Charles L. Minor; treasurer, Gen. George M. Sternberg; secretary, Dr. Henry Barton Jacobs; directors, Dr. Howard S. Anders, Philadelphia; Dr. Edward R. Baldwin, Saranac Lake; William H. Baldwin, Washington; Ernest P. Bicknell, Chicago; Dr. Hermann M. Biggs, New York; D. Frank Billings, Chicago; W. K. Bixby, St. Louis; Dr. John J. Black, New Castle, Del.; Dr. Sherman G. Bonney, Denver; C. B. Boothe, Los Angeles; Dr. Vincent Y. Bowditch, Boston; Dr. Henry M. Bracken, St. Paul; Dr. Norman Bridge, Los Angeles; Maj. George E. Bushnell, Fort Bayard; Dr. William S. Carter, Galveston; Otis H. Childs, Pittsburgh; Dr. T. D. Coleman, Augusta, Ga.; Dr. R. W. Corwin, Pueblo, Colo.; Albert B. Cummins, Des Moines; Edward T. Devine, New York; Dr. Lawrence F. Flick, Philadelphia; Dr. W. H. Flint, Santa Barbara, Cal.; Homer Folks, New York; Dr. John P. C. Foster, New Haven; David R. Francis, St. Louis; Dr. John S. Fulton, Baltimore; Robert Garrett, Baltimore; Samuel Gompers, Washington; Rowland C. Hazard, Peace Dale, R.I.; James J. Hill, St. Paul; Frederick L. Hoffman, Newark, N. J.; Dr. John N. Hurty, Indianapolis; Dr. Henry Barton Jacobs, Baltimore; Dr. Edward G. Janeway, New York; Dr. Arnold C. Klebs, Chicago; Dr. S. A. Knopf, New York; Dr. George M. Kober, Washington; Charles M. Lea, Philadelphia, Dr. John H. Low- man, Cleveland; Dr. C. F. Mc Gahan, Aiken, S. C.; Dr. Rudolf Matas, New Or- leans; Dr. Alfred Meyer, New York; Dr. Charles L. Minor, Asheville; W. C. Nones, Louisvile; Dr. Edward O. Otis, Boston; Dr. Leonard Pearson, Philadel- phia; Henry Phipps, New York; Dr. Charles O. Probst, Columbus, O.; Redfield Proctor, Jr., Proctor, Vt.; Dr. Mazjyck P. Ravenel, Madison, Wis.; W. T. Sedg- wick, Boston; Dr. Henry Sewall, Denver; A. A. Sprague, 2d, Chicago; Gen. Geo. M. Sternberg, Washington; Dr. Edward L. Trudeau, Saranac Lake; Dr. Victor C. Vaughan, Ann Arbor; Dr. Joseph Walsh, Philadelphia; John Seely Ward, Jr., New York; Dr. William H. Welch, Baltimore; Gen. Walter Wyman, Washington. Executive secretary, Dr. Livingston Farrand; assistant secretary, Philip P. Jacobs, Ph.D. The following is a list of papers read before the respective sec- tions at the meeting of May 13-15, 1909: “Tuberculosis legislation— Victor C. Vaughan, M.D. Relation of the public school to the anti-tuberculosis movement—A. B. Po- land. 180 A HISTORY OF NATIONAL TUBERCULOSIS ASSOCIATION Boston’s outdoor school— James J. Minot, M.D., and Miss Isabel F. Hyams. The organization of local tuberculosis campaigns by a state association—John A. Kingsbury. After-care of local committees— Homer Folks. Economic and efficient construction—Arnold C. Klebs, M.D. Improved organization and management—A. H. Garvin, M.D. On the construction of an efficient and economic diet in tuberculosis—Herbert Maxon King, M.D. Work for patients as an economic factor—Lawrence F. Flick, M.D. Work for patients as an immediate and ultimate therapeutic factor—Frederick I. Hills, M.D. Clinical diagnosis of pulmonary tuberculosis— James Alexander Miller, M.D. The laboratory methods of diagnosis in tuberculosis— Randle C. Rosenberger, M.D. Diagnosis of intestinal tuberculosis— Joseph Walsh, M.D. Studies of tuberculin reaction with a new index to dosage in tuberculin treat- ment— William Charles White, M.D., D. A. L. Graham, M.B., and K. H. Van Norman, M.D. Some hematological studies in tuberculosis—G. B. Webb, M.D., and W. W. Williams, M.D. The value of the tuberculo-opsonic test in the diagnosis of pulmonary tubercu- losis—Hugh M. Kinghorn, M.D., David C. Twichell, M.D., and Norman Carter, M.D. The tuberculo-opsonic index in its relation to the temperature curve in active tuberculosis and its value in diagnosis in suspected or arrested cases— Herbert Maxon King, M.D. The heart in one hundred and ten cases dying of tuberculosis— William B. Stanton, M.D. Primary location and development of tuberculosis in the lungs— Joseph Walsh, M.D. The amount of lung involvement at the onset of pulmonary tuberculosis— Harry Lee Barnes, M.D. Some results of the injection of Beck’s bismuth paste in the treatment of tu- berculous sinuses— William S. Baer, M.D. Chloroform rather than ether anesthesia in tuberculosis— Joseph Walsh, M.D. Address of the chairman of Section on Tuberculosis in Children—John H. Low- man, M.D. The diagnosis of tuberculosis in young children— Henry L. K. Shaw, M.D., and Arthur T. Laird, M.D. A study of the symptomatology of pulmonary tuberculosis among children— Henry I. Bowditch, M.D. Treatment of surgical tuberculosis—John. W. Brannan, M.D. CHAPTER XVI SIXTH ANNUAL MEETING HE sixth annual meeting of The National Association for the Study and Prevention of Tuberculosis was held at the New Willard Hotel, Washington, D. C., on May 2 and 3, 1910. The president of the Association, Dr. Edward G. Janeway, occupied the chair at the general meeting held at noon on Mon- day, May 2. Following the address of the president and the report of the executive secretary, in accordance with the regular procedure of the Association, the following committee was ap- pointed by the chair to present nominations to fill vacancies on the board of directors: Dr. Walter R. Steiner, Hartford, chair- man; Dr. Henry M. Bracken, St. Paul; Dr. John S. Fulton, Baltimore; Dr. Charles O. Probst, Columbus, Ohio; Frank E. Wing, Chicago. The following committee on resolutions was also appointed by the chair: Homer Folks, New York, chairman; Dr. Hermann M. Biggs, New York; Dr. G. Walter Holden, Denver; Dr. John H. Lowman, Cleveland; Gen. George M. Sternberg, Washington. At the regular business meeting of the Association held on the evening of Monday, May 2, the following were unanimously elected directors of the Association for terms of five years: Wil- liam H. Baldwin, Washington; William K. Bixby, St. Louis; Jeffrey R. Brackett, Boston; Dr. Thomas D. Coleman, Augusta, Ga.; Dr. George Dock, St. Louis; Dr. G. Walter Holden, Denver; Dr. Alfred Meyer, New York; Julius Rosenwald, Chicago; Dr. F. F. Wesbrook, Minneapolis; Alexander M. Wilson, Philadel- phia; Gen. Walter Wyman, Washington. Dr. John L. Dawson, Charleston, S. C., was elected a director to fill the unexpired term of the late Dr. Charles F. McGahan. Dr. Elmer E. Heg, Seattle, Wash., was elected a director to fill the unexpired term of the late Dr. John J. Black. 181 182 A HISTORY OF NATIONAL TUBERCULOSIS ASSOCIATION The following resolutions were reported favorably by the com- mittee on resolutions and were unanimously adopted by the Asso- ciation: Wuereas, Hundreds of thousands of human lives are lost annually from tuberculosis and other preventable diseases, and WG8EREAS, There is great need of some agency of national scope whose func- tions shall be the investigation of problems of public health, the dissemination of information relating thereto, and such other duties pertaining to public health as may properly fall within the field of Federal authority, and WHEREAS, The work of this character which should be undertaken by a national agency is beyond the resources of private effort and should have not only the larger resources, but the dignity and prestige of Federal authority, and WaeErEAs, A bill has been introduced in Congress by Senator Owen and Representative Craeger establishing a Federal Department of Health in which are to be brought together all Federal agencies now dealing with these subjects and by which should be undertaken such new duties relative to public health as the national government might properly undertake, therefore, Resolved, That we very heartily endorse the general principle of the Owen- Craeger bill and place on record our conviction that its enactment would be of great service in the prevention of tuberculosis, and of other infectious and pre- ventable diseases. 1. Resolved, That a thorough, efficient, and continuous official supervision of dairies and herds and of the milk from the dairy to the consumer is of the first importance in securing a clean and pure milk supply, which is essential to public health. 2. Resolved, That the production and handling of milk under such satis- factory sanitary conditions as to insure its complete reliability (¢. e., the pro- duction of what is known as certified milk) at the present time unfortunately increases its cost to such an extent as to make the use of such milk for general consumption impracticable. 3. Resolved, That the efficient pasteurization of the general milk supply (excepting certified milk) when supplementing dairy inspection and applied to milk from inspected dairies and done under official supervision is desirable for the destruction of the ordinary micro-organisms of fermentation and putre- faction and as an additional protection against possible infection by typhoid fever, scarlet fever, diphtheria, tuberculosis, and possibly some other specific infectious diseases. 4. Resolved, That pasteurization of milk for sale should not be permitted except under official supervision and on conditions definitely prescribed by competent sanitary authorities; and should not be permitted as a method for the preservation of old or dirty milk. 5. Resolved, That milk intended for infant feeding should be considered SIXTH ANNUAL MEETING 183 apart from that intended for general consumption; and should be certified milk when obtainable. 6. Resolved, That in the opinion of this Association it has been proven, apparently, that a small percentage of the cases of non-pulmonary human tu- berculosis, especially tuberculosis of the lymph-nodes in children under five years of age, is due to infection by tubercle bacilli of bovine origin. Wuereas, The State of Nebraska has recently passed a law making it obligatory for hospitals and sanatoria receiving tuberculous patients supported by the public to use treatment of immunization (vaccine therapy); and WHEREAS, In the opinion of the members of this Association the present state of knowledge of specific immunization and vaccine therapy in tubercu- losis does not justify any state in enacting such legislation; therefore Resolved, That The National Association for the Study and Prevention of Tuberculosis deplores the above named act of the State Legislature of Nebraska as most unwise, and wholly unjustifiable. Be it further Resolved, That the Executive Secretary of the Association transmit a copy of these resolutions to the Governor of the State of Nebraska and the Speakers of the Senate and the House of Representatives of that State. WHEREAS, The Board of Medical Examiners of the State of Oklahoma re- fuses to grant licenses to physicians afflicted with tuberculosis; and Wuereas, All applicants for such a license must subscribe and swear to a so-called tuberculosis affidavit in which they must not only declare that they are not suffering with tuberculosis in any form but also swear that they have not, within the last three years, lived in the house with or nursed any one suffer- ing from said disease; Wuereas, In the opinion of the members of this Association such action of the State Board of Medical Examiners of Oklahoma is not based on sound scientific or economic considerations; and WHEREAS, It is the conviction of the members of this Association that neither the careful tuberculous physician nor the well trained tuberculous patient pursuing his occupation should be considered a menace to society, be it therefore Resolved, That this Association deplores the action of the State Board of Medical Examiners of Oklahoma as unjustifiable and prejudicial to the best interests of the community, and Resolved, That the Executive Secretary transmit a copy of these resolutions to the President and Secretary of the Oklahoma State Board of Medical Exam- iners and to the Governor of that State. Resolved, That this Association observes with great interest and satisfaction the marked progress throughout the United States and particularly in the District of Columbia during the past year, of the playground movement; and expresses the earnest hope that the National Congress will make adequate 184 A HISTORY OF NATIONAL TUBERCULOSIS ASSOCIATION appropriations for continuing and extending in the District of Columbia these opportunities for healthful open-air exercise and play. Resolved, That we urge upon municipalities a study of housing conditions with special reference to tenement and cheap lodging houses and urge a vigorous effort to improve congested districts, believing that such improvement will decrease the tuberculosis death-rate. At a meeting of the board of directors held on Tuesday after- noon, May 3, the following officers were elected for the ensuing year: Dr. William H. Welch, Baltimore, president; Dr. George Dock, St. Louis, and Dr. Victor C. Vaughan, Ann Arbor, vice- presidents; Dr. Henry Barton Jacobs, Baltimore, secretary; General George M. Sternberg, Washington, treasurer. The following directors were elected to serve on the executive committee for the ensuing year: William H. Baldwin, Washing- ton; Dr. Hermann M. Biggs, New York; Homer Folks, New York; Dr. John N. Hurty, Indianapolis; Dr. Edward G. Jane- way, New York; Dr. George M. Kober, Washington; Dr. Joseph Walsh, Philadelphia. Following the meeting of the Advisory Council on the evening of May 2, Dr. William Charles White, of Pittsburgh, was unani- mously elected chairman of the Advisory Council for the next annual meeting. The summarized report of the Treasurer, Gen. George M. Sternberg, is as follows: Balance on hand April 30, 1909............... $4,268.64 IR6Cei pts sss: 2.26 2s sel ea acate 2 sua gle Ra tebe ea 24,948.76 Disbursements: sc siiawn sac ex waan wow ee wae ee ac 28,696.26 Balance on hand April 30, 1910............... $521.14 At the meeting of the Association in 1910, there was reported a membership of 2,107. The number of anti-tuberculosis associa- tions was 297; dispensaries 222; sanatoria and special hospitals 298, with a capacity of over 15,000 beds. This marvelous gain has to be ascribed to the interest which was aroused in the move- ment by the International Tuberculosis Congress which was held. in Washington in 1908. SIXTH ANNUAL MEETING 185 A list of officers and directors for 1909 to 1910 follows: President, Dr. Edward G. Janeway; honorary vice-presidents, Theodore Roose- velt and Dr. William Osler; vice-presidents, Mr. Edward T. Devine and Dr. Henry Sewall; treasurer, General George M. Sternberg; secretary, Dr. Henry Barton Jacobs; directors, Dr. Robert H. Babcock, Chicago; Dr. Edward R. Baldwin, Saranac Lake; William H. Baldwin, Washington; Ernest P. Bick- nell, Chicago; Dr. Hermann M. Biggs, New York; Dr. Frank Billings, Chicago; W. K. Bixby, St. Louis; Dr. John J. Black, New Castle, Del.; Dr. Sherman G. Bonney, Denver; C. B. Boothe, Los Angeles; Dr. Vincent Y. Bowditch, Boston; Dr. Henry M. Bracken, St. Paul; Dr. William S. Carter, Galveston; Otis H. Childs, Pittsburgh; Dr. T. D. Coleman, Augusta, Ga.; Dr. R. W. Corwin, Pueblo, Colo.; Albert B. Cummins, Des Moines; Edward T. Devine, New York; Dr. W. F. Drewry, Petersburg, Va.; Dr. Lawrence F. Flick, Philadelphia; Dr. W. H. Flint, Santa Barbara, Cal.; Homer Folks, New York; David R. Francis, St. Louis; Dr. John S. Fulton, Baltimore; Robert Garrett, Baltimore; John M. Glenn, New York; Samuel Gompers, Washington; Rowland G. Hazard, Peace Dale, R. I.; James J. Hill, St. Paul; Frederick L. Hoffman, Newark; Dr. John N. Hurty, Indianapolis; Dr. Henry Barton Jacobs, Baltimore; Dr. Edward G. Janeway, New York; Dr. Arnold C. Klebs, Chicago; Dr.S. A. Knopf, New York; Dr. George M. Kober, Washington; Charles M. Lea, Phila- delphia; Dr. John H. Lowman, Cleveland; Dr. C. F. McGahan, Aiken, S.C.; Dr. Rudolf Matas, New Orleans; R. B. Mellon, Pittsburgh, Pa.; Dr. Alfred Meyer, New York; Dr. Charles L. Minor, Asheville; W. C. Nones, Louisville; Dr. Edward O. Otis, Boston; Henry Phipps, New York; Dr. E. A Pierce, Portland, Ore.; Dr. Joseph Y. Porter, Key West, Fla.; Dr. Charles O. Probst, Columbus, O.; Redfield Proctor, Jr., Proctor, Vt.; Dr. Mazyck P. Ravenel, Madison, Wis.; W. T. Sedgwick, Boston; Dr. Henry Sewall, Denver; A. A. Sprague, 2d, Chicago; Gen. George M. Sternberg, Washington; Dr. Walter R. Steiner, Hartford, Conn.; Dr. Edward L. Trudeau, Saranac Lake; Dr. Victor C. Vaughan, Ann Arbor; Dr. Joseph Walsh, Philadelphia; Dr. William H. Welch, Baltimore. Executive secretary, Dr. Livingston Farrand; assistant secretary, Philip P. Jacobs, Ph.D. The following is a list of papers read before the respective sec- tions at the meeting of May 2-3, I9gI0: Insurance against tuberculosis—Lee K. Frankel. Budget and program for a local anti-tuberculosis campaign—James Jenkins, Jr. The question of enployment—A. M. Forster, M.D. The enforcement of anti-spitting laws—Robert J. Newton. The school child and tuberculosis: a plea for preventoria—Henry Farnum Stoll, M.D. Medical and board of health supervision of boarding houses and sanatoria for the treatment of tuberculosis—David P. Butler, M.D. 186 A HISTORY OF NATIONAL TUBERCULOSIS ASSOCIATION State phthisiophilia and state phthisiophobia, with a plea for justice to the consumptive—S. Adolphus Knopf, M.D. The teaching of tuberculosis—A plea for its specialization in medical schools— A. P. Francine, M.D. Prognosis of tuberculous lesions involving the whole of or more than one lobe— Joseph Walsh, M.D. The responsibility for relapse of tuberculous patients after discharge—W. L. Dunn, M.D. Early changes in the larynx in pulmonary tuberculosis—Charles L. Minor, M.D. Gastric disturbances in pulmonary tuberculosis—H. R. M. Landis, M.D. Some results of sanatorium treatment of pulmonary tuberculosis in children— Henry S. Goodall, M.D. The diagnostic value of local tuberculin reactions—Theodore B. Sachs, M.D. The relation of the cutaneous to the subcutaneous tuberculin test—Thomas DeWitt Gordon, M.D. An individual quantitative basis for dosage in tuberculin treatment—William Charles White, M.D., and K. H. Van Norman, M.D. Cutaneous and conjunctival tuberculin tests in pulmonary tuberculosis—a report of 1,000 cases—Louis Hamman, M.D., and Samuel Wolman, M.D. The diagnosis of tuberculosis of the bronchial glands—Henry Farnum Stoll, M.D. A contribution to the study of pulmonary tuberculosis in its relation to al- buminuria—John Ritter, M.D. Stereoscopic radiography as diagnostic aid in pulmonary tuberculosis—Emil G. Beck, M.D. Artificial lymphocytosis in tuberculosis—Gerald B. Webb, M.D., William Whitbridge Williams, M.D., and A. F. Basinger, M.D. A study of the leucocytes in pulmonary tuberculosis (a preliminary investiga- tion)—Myer Solis-Cohen, M.D., and Albert Strickler, M.D. The gross pathology in fatal cases of tuberculosis of the lungs—Joseph Walsh, M.D. The relative importance of the bovine and human types of tubercle bacilli in different forms of human tuberculosis—William H. Park, M.D., and Charles Krumwiede, Jr., M.D. The bovine type of tuberculosis associated with three cases of tuberculosis in man—Marshall Fabyan, M.D. The reaction curve of the human and the bovine type of the tubercle bacillus in glycerin bouillon—Theobald Smith, M.D. CHAPTER XVII SEVENTH ANNUAL MEETING HE Seventh Annual Meeting of The National Association for the Study and Prevention of Tuberculosis was held at the Brown Palace Hotel, Denver, Colorado, on June 20 and 21, III. The Colorado members entertained the Association at luncheon on June 20, and also acted as hosts on the occasion of a mountain trip over the Moffat Road on the afternoon and evening of June 21. On Tuesday, June 22, many of the members visited Colorado Springs as guests of that city, and had an opportunity of inspect- ing the various sanatoria of the vicinity. The president of the Association, Dr. William H. Welch, called the Association to order on the morning of June 20. Following the address of the president and the report of the executive secretary, in accordance with the regular procedure of the Asso- ciation, the following committee was appointed by the chair to present nominations to fill vacancies on the board of directors: Dr. Henry M. Bracken, St. Paul, chairman; Dr. Dunning S. Wilson, Louisville; Dr. H. Wirt Steele, Baltimore; Dr. R. W. Corwin, Pueblo; Dr. Ethan A. Gray, Chicago. The following committee on resolutions was also appointed by the chair: Dr. S. Adolphus Knopf, New York, chairman; Dr. Mazyck P. Ravenel, Madison; Dr. Frank E. Wing, Chicago; J. Byron Deacon, Philadelphia; Dr. Will Howard Swan, Colorado Springs. At the regular business meeting of the Association, held on the evening of Tuesday, June 20, the following members were unani- mously elected directors of the Association for the term of five years: Dr. Joseph S. Ames, Baltimore; Miss Kate Barnard, Oklahoma City; Ernest P. Bicknell, Washington, D. C.; Dr. Vincent Y. Bowditch, Boston; Dr. John S. Fulton, Baltimore; 187 188 A HISTORY OF NATIONAL TUBERCULOSIS ASSOCIATION Dr. Charles Lyman Greene, St. Paul; Dr. Elmer E. Hegg, Seattle; Dr. Henry Barton Jacobs, Baltimore; Dr. Theodore B. Sachs, Chicago; Dr. Thomas D. Tuttle, Helena; Dr. Gerald B. Webb, Colorado Springs; Dr. William Charles White, Pittsburgh. Dr. James Alexander Miller, New York, was elected a director to fill the unexpired term of the late Dr. Edward G. Janeway. The following resolutions were recorded favorably by the com- mittee on resolutions, and were unanimously adopted by the Association: WHEREAS, It has pleased Divine Providence to remove from our midst our late President, Dr. Edward G. Janeway, and WHEREAS, By his great diagnostic skill, and deep interest in all that apper- tains to the anti-tuberculosis movement in this country, he has been of inval- uable service to our cause; be it Resolved, That we the members of The National Association for the Study and Prevention of Tuberculosis deeply deplore the loss of our late President, who by his life and devotion to anti-tuberculosis work, should forever be an example for us to follow. Be it further Resolved, That a copy of these resolutions be spread on the minutes of the Annual Meeting of The National Association for the Study and Prevention of Tuberculosis, that a copy of them be transmitted by the Executive Secretary to the family of the late Dr. Janeway, and also to the medical and lay press. WHEREAS, It has been demonstrated experimentally by bacteriologists of high standing in this and other countries and by two governmental com- missions, that the bovine tubercle bacillus causes serious and fatal tuberculosis in human beings; and WHEREAS, Milk from tuberculous cattle appears to be the medium through which transmission of bovine tuberculosis to human beings most commonly takes place; be it Resolved, That The National Association for the Study and Prevention of Tuberculosis recognizes the danger to mankind from tuberculosis of cattle; and be it Resolved, That this Association recommends that all cows furnishing milk for human consumption be subjected to the tuberculin tests, and that all animals which react to this test be excluded from dairy herds; and be it further Resolved, That where these measures cannot be efficiently carried out, the Association recommends the efficient pasteurization of milk as a safeguard against the transmission of bovine tuberculosis to mankind. Wuereas, The care of advanced cases of tuberculosis has been found from experience to be particularly difficult in institutions located at a considerable distance from the homes of patients; and SEVENTH ANNUAL MEETING 189 WuHEREAS, The municipality and the county have in most cases been found to be satisfactory units for the care of advanced cases; and WHEREAS, The stamping out of tuberculosis depends so largely upon segre- gation of advanced cases; therefore be it Resolved, That The National Association for the Study and Prevention of Tuberculosis approves a plan whereby municipalities and counties shall be encouraged to erect satisfactory institutions for treatment of advanced cases; and be it further Resolved, That this Association approves a plan whereby municipalities and counties shall be encouraged to establish dispensaries for the discovery, treat- ment and prevention of cases of tuberculosis. WHEREAS, The National Association for the Study and Prevention of Tuber- culosis has enjoyed the bountiful hospitality of the Colorado members of the Association, be it Resolved, That we hereby tender to the chairman and members of the various committees, to the Colorado medical profession and to the laity at large who have so liberally contributed to our entertainment, our most hearty thanks and appreciation. At a meeting of the board of directors held on Wednesday, June 21, the following officers were elected for the ensuing year: Dr. Mazyck P. Ravenel, president; John M. Glenn, New York, and Dr. G. Walter Holden, Denver, vice-presidents; Dr. Henry Barton Jacobs, Baltimore, secretary; Gen. George M. Sternberg, Washington, treasurer. The following directors were elected to serve on the executive committee for the ensuing year: William H. Baldwin, Washing- ton; Dr. Hermann M. Biggs, New York; Edward T. Devine, New York; Dr. S. A. Knopf, New York; Dr. George M. Kober, Washington; Dr. Walter R. Steiner, Hartford; Dr. William Charles White, Pittsburgh. Following the meeting of the Advisory Council on the evening of June 20, Dr. Charles O. Probst, of Columbus, Ohio, was unani- mously elected chairman of the Advisory Council for the next annual meeting. The summarized report of the Treasurer, Gen. George M. Sternberg, is as follows: Balance on hand April 30, 1910............... $521.14 Réceipts..:4 ccc 208ecs4ae dk dese s ee tad ee ae 33,080.59 Disbursements. ...........0 00sec ee eee eee eee 31,058.60 Balance on hand April 30, 1I911.............-- $2,543.13 190 A HISTORY OF NATIONAL TUBERCULOSIS ASSOCIATION At the meeting of the Association in I91I the Secretary re- ported a membership of 2,270; number of associations, 431; number of dispensaries, 286; and sanatoria and special hospitals, 393, with a capacity of 22,720 beds. A list of officers and directors for 1910 to 1911 follows: President, Dr. William H. Welch; honorary vice-presidents, Theodore Roose- velt and Dr. William Osler; vice-presidents, Dr. Victor C. Vaughan and Dr. George Dock; treasurer, Gen. George M. Sternberg; secretary, Dr. Henry Bar- ton Jacobs; directors, Dr. Robert H. Babcock, Chicago; Dr. Edward R. Baldwin, Saranac Lake; William H. Baldwin, Washington; Dr. Hermann M. Biggs, New York; Dr. Frank Billings, Chicago; W. K. Bixby, St. Louis; C. B. Boothe, Los Angeles; Dr. Henry M. Bracken, St. Paul; Jeffrey R. Brackett, Boston; Dr. William S. Carter, Galveston; Otis H. Childs, Pittsburgh; Dr. T. D. Coleman, Augusta, Ga.; Dr. R. W. Corwin, Pueblo, Colo.; Albert B. Cummins, Des Moines; Dr. John L. Dawson, Charleston; Edward T. Devine, New York; Dr. George Dock, St. Louis; Dr. W. F. Drewry, Petersburg, Va.; Dr. Henry B. Favill, Chicago; Dr. Lawrence F. Flick, Philadelphia; Dr. W. H. Flint, Santa Barbara; Homer Folks, New York; David R. Francis, St. Louis; Robert Garrett, Baltimore; John M. Glenn, New York; Samuel Gompers, Washington; Rowland G. Hazard, Peace Dale, R.I.; Dr. Elmer E. Hegg, Seattle; James J. Hill, St. Paul; Frederick L. Hoffman, Newark; Dr. G. Walter Holden, Denver; Dr. John N. Hurty, Indianapolis; Dr. Henry Barton Jacobs, Baltimore; Dr. Edward G. Janeway, New York; Dr. S. A. Knopf, New York; Dr. George M. Kober, Washington; Charles M. Lea, Philadelphia; Dr. John H. Lowman, Cleveland; Dr. Rudolf Matas, New Orleans; R. B. Mellon, Pittsburgh, Pa.; Dr. Alfred Meyer, New York; Dr. Charles L. Minor, Asheville; W.C. Nones, Louisville; Dr. Edward O. Otis, Boston; Dr. E. A. Pierce, Portland, Ore.; Dr. Joseph Y. Porter, Key West, Fla.; Redfield Proctor, Jr., Proctor, Vt.; Dr. Mazyck P, Ravenel, Madison, Wis.; Julius Rosenwald, Chicago; W. T. Sedgwick, Bos- ton; Dr. Henry Sewall, Denver; Gen. George M. Sternberg, Washington; Dr. Walter R. Steiner, Hartford, Conn.; Dr. Edward L. Trudeau, Saranac Lake; Dr. Victor C. Vaughan, Ann Arbor; Dr. Joseph Walsh, Philadelphia; Dr. William H. Welch, Baltimore; Dr. F. F. Wesbrook, Minneapolis; Alexander M. Wilson, Philadelphia; Gen. Walter Wyman, Washington. Executive secretary, Dr. Livingston Farrand; assistant secretary, Philip P. Jacobs, Ph.D. The following is a list of papers read before the respective sec- tions at the meeting of June 20-21, I9II: Dr. Edward G. Janeway, late president of the National Association for the Study and Prevention of Tuberculosis; his contributions and activities— S. Adolphus Knopf, M.D. SEVENTH ANNUAL MEETING 191 The responsibility of the state in the tuberculosis problem—Homer Folks, LL.D. The responsibility of the county in the tuberculosis problem—Hoyt E. Dear- holt, M.D. The responsibility of the city in the tuberculosis problem—Clyde E. Ford, M.D. Open-air schools—Leonard P. Ayres, Ph.D. Four months in the open air—a study of sixty children—O. W. McMichael, M.D. Methods of school ventilation (by the Chicago Commission on Ventilation)— W. A. Evans, M.D. Health of school children—Helen Marsh Wixson. School health and hygiene exhibits—John B. Hawes, 2d, M.D. The relief of families in which tere is tuberculosis—H. Wirt Steele. The past and future of the tuberculosis nurse—Edna L. Foley. Tuberculosis as a factor in the increased cost of living—Edward F. McSweeney, Boston. An economic study of 500 consumptives treated in the Boston Consumptives’ Hospital—Edwin A. Locke, M.D., and Cleaveland Floyd, M.D. A survey of Dunn county, Wisconsin—Hoyt E. Dearholt, M.D. A county organized and equipped to control tuberculosis—George J. Nelbach. The control of tuberculosis in the smaller towns—George R. Pogue, M.D. A study of three small cities—J. Byron Deacon. Report of traveling tuberculosis car of Missouri Association for the Relief and Control of Tuberculosis—Miss Winifred Doyle. Boston’s hospital school for tuberculous children—Edwin A. Locke, M.D., and Timothy J. Murphy, M.D. The present attitude toward climate—Alexius M. Forster, M.D. Experience with pulmonary tuberculosis during the past year—a clinical résumé—S. G. Bonney, M.D. The albumin reaction in the sputum in pulmonary tuberculosis—Lawrason Brown, M.D., and W. H. Ross, M.D. Sputum examinations with special reference to the antiformin method— Frederick Tice, M.D. Bedside service in tuberculosis—William Porter, M.D. The treatment of secondary anemia of tuberculosis by the hypodermic injec- tion of iron—LeRoy S. Peters, M.D., and E. S. Bullock, M.D. Hypotension and tachycardia in the tuberculous—John Ritter, M.D. Studies on mixed infection in pulmonary tuberculosis. The isolation of the streptococcus and pneumococcus from the blood—Roswell T. Pettit, M.D. Secondary infection in pulmonary tuberculosis (a study based on sputum ex- aminations)—James L. Whitney, M.D. The effect of tuberculin treatment upon the leucocytic picture—Myer Solis- Cohen, M.D., and Albert Strickler, M.D. Prognosis in pulmonary tuberculosis—H. S. Mathewson, M.D. 192. AHISTORY OF NATIONAL TUBERCULOSIS ASSOCIATION Report of 34 cases of tuberculosis treated with tuberculins and 18 with mercury at the Marine Hospital Sanatorium, Fort Stanton, N. M.—L. D. Fricks, M.D., William Keiller, M.D., F. Simpson, M.D., and F. C. Smith, M.D. Investigations into the nature of tuberculin sensitiveness—Edward R. Baldwin, M.D. Control of bovine tuberculosis—Mazyck P. Ravenel, M.D. The specific tissue inoculation of vaccines—Gerald B. Webb, M.D., and G. Burton Gilbert, M.D. A study of leukocytes in 100 cases of pulmonary tuberculosis—Henry D. Chadwick, M.D., and Roy Morgan, M.D. Some remarks on the mode of infection and of dissemination of tuberculosis in man based on anatomical investigation— William Ophiils, M.D. CHAPTER XVIII EIGHTH ANNUAL MEETING HE eighth annual meeting of The National Association for the Study and Prevention of Tuberculosis was held at the New Willard Hotel, Washington, D. C., on May 30 and 31, 1912. The president of the Association, Dr. Mazyck P. Ravenel, called the Association to order at 11 o’clock on the morning of May 30. Following the address of the president and he report of the executive secretary, in accordance with the regular pro- cedure of the Association, the following committee was appointed by the chair to present nominations to fill vacancies on the board of directors: Dr. William C. White, Pittsburgh, chairman; Dr. A. M. Forster, Colorado Springs; F. H. Mann, New York; W. S. Ufford, Washington; Dr. Gordon Wilson, Baltimore. The following committee on resolutions was also appointed by the chair: Dr. H. R. M. Landis, Philadelphia, chairman; Dr. W. J. Barlow, Los Angeles; Dr. H. M. Kinghorn, Saranac Lake; Dr. T. B. Sachs, Chicago; J. R. Shillady, Buffalo. At the regular business meeting of the Association, held at noon on May 31, the following were unanimously elected directors of the Association for terms of five years: Dr. W. Jarvis Barlow, Los Angeles; Miss Mabel T. Boardman, Washington; Homer Folks, New York; Dr. Charles J. Hatfield, Philadelphia; John A. Kingsbury, New York; Col. J. L. Ludlow, Winston-Salem ; Dr. Cabot Lull, Birmingham; Dr. C. O. Probst, Columbus, Ohio; Dr. E. C. Schroeder, Washington; Surgeon-General C. F. Stokes, Washington; Dr. E. L. Trudeau, Saranac Lake; Dr. W. H. Welch, Baltimore. Dr. H. E. Dearholt, of Milwaukee, was elected a director to fill the unexpired term of the late Surgeon-General Walter Wyman. The following resolutions were reported favorably by the com- 13 193 194 A HISTORY OF NATIONAL TUBERCULOSIS ASSOCIATION mittee on resolutions and were unanimously adopted by the Association : Resolved, That the Executive Secretary be requested to correspond with the officers of the American Veterinary Medical Association, calling to their atten- tion the following points: 1. The close relationship between the work of The National Association for the Study and Prevention of Tuberculosis and the work of the veterinary medi- cal profession. / 2. The small number of veterinarians who have joined The National Asso- ciation for the Study and Prevention of Tuberculosis. 3. Inviting them individually to take membership in The National Associa- tion for the Study and Prevention of Tuberculosis. 4. Inviting the veterinarians to arrange a part of the program of the Patho- logical Section for the next annual meeting of the National Association. Resolved, That The National Association for the Study and Prevention of Tuberculosis indorse the following terms of a resolution adopted by the South- western Conference on Tuberculosis, held at Waco, Texas, April 16, 1912: “WHEREAS, Southwestern States have climatic and other natural advan- tages which have attracted people from other states for years past, and espe- cially the sick—and as many of these people come into the Southwest with insufficient funds to maintain themselves until well, as a result of which they become public charges or suffer great privation, which counteracts all possible benefit of climate, and “WHEREAS, The number of such indigent persons who are careless in their habits of living and spread their disease, not decreasing, it seems proper for us to issue a warning to the public, and especially to that portion of it afflicted with tuberculosis, and to all physicians, churches, lodges, labor unions, and charitable organizations; therefore be it “‘ Resolved, That the newspapers of the country be asked to give publicity to the following facts: ““(a) There are no free hospitals in the Southwest for other than citizens of Southwestern States. ‘“(b) No assistance can be given strangers by charitable associations because the public does not contribute funds for that purpose. ““(c) Owing to the large immigration of healthy people there is small chance for employment for sick persons. The number of factories is limited, cheap labor is performed by Mexicans and Negroes, ranch and farm work is strenuous, and invalids are not employed by land owners. “‘(d) That invalids cannot hope to secure assistance from private individuals because the demands for aid from strangers have exhausted the patience of the people. “(e) That invalids coming to the Southwest should have funds sufficient to carry them for one year, as they cannot hope for restoration to health and strength under that period of time. EIGHTH ANNUAL MEETING 195 “(f) That each community should provide proper hospitals, dispensaries, visiting nurses, etc., and care for its own people.” WHEREAS, Hospital care of advanced cases of tuberculosis is essential to the gradual reduction of the present incidence of this disease, and Wuereas, Experience has shown that patients will not enter or remain in institutions unless the surroundings are attractive and the care is of a higher standard than now prevails, be it Resolved, That The National Association for the Study and Prevention of Tuberculosis, in its advocacy of sufficient institutional provision for the ad- vanced consumptive, emphasize the importance of proper care of these unfor- tunate patients, including sufficient and efficient medical and nursing service, as well as a proper diet, and, further, Resolved, That the Association indorses the efforts now being made by local communities for the proper care of advanced cases, and approves of the ap- pointment by the Board of Directors of a Committee to investigate the present status of hospitals for advanced cases in this country and to formulate proper standards for their construction and management. WHEREAS, Attention has been directed to the social and industrial causes of tuberculosis, the relation of dusty trades and other occupational factors to the morbidity and mortality from tuberculosis, and , WHEREAS, The prevalence of special tuberculosis clinics affords an oppor- tunity for the recording of valuable information as to these important factors, therefore be it Resolved, That the Board of Directors of The National Association for the Study and Prevention of Tuberculosis be requested to appoint a special com- mittee to consider the possibility of securing the adoption of uniform dis- pensary records prepared with special reference to recording detailed data on industrial and social factors, past and present, in the patient’s history. WHEREAS, The double red cross has been used as the emblem of The Na- tional Association for the Study and Prevention of Tuberculosis for several years, having been adopted officially by said Association in 1906, and Wuereas, No fixed standards as to form or dimensions of the double red cross have ever been adopted by the Association, and Wuereas, There has been considerable variation in the forms and dimen- sions of the crosses used by the numerous anti-tuberculosis organizations in the United States and elsewhere, be it Resolved, That the Board of Directors of The National Association for the Study and Prevention of Tuberculosis be requested to appoint a committee to consider the various questions involved in the history, artistic appearance, form, and proportions of the double red cross as the emblem of the anti-tuber- culosis crusade in the United States, and that this Committee be directed to report to the Board of Directors for such action as the Board may deem advis- able. 196 A HISTORY OF NATIONAL TUBERCULOSIS ASSOCIATION At the suggestion of the president it was voted unanimously that a telegram conveying the greetings and good wishes of the Association be sent to Dr. Edward L. Trudeau, the first president of the Association. At a meeting of the board of directors, held on Friday after- noon, May 31, the following officers were unanimously elected for the ensuing year: Homer Folks, New York, president; Dr. Robert H. Babcock, Chicago, and Dr. Edward R. Baldwin, Saranac Lake, vice-presidents; Dr. Henry Barton Jacobs, Balti- more, secretary. The following directors were elected to serve on the executive committee for the ensuing year: William H. Baldwin, Washing- ton; Dr. Charles J. Hatfield, Philadelphia; Frederick L. Hoff- man, Newark; Dr. S. A. Knopf, New York; Dr. George M. Kober, Washington; Dr. Walter R. Steiner, Hartford; Dr. Wil- liam C. White, Pittsburgh. General George M. Sternberg, having declined to accept.re- election as treasurer of the Association, the responsibility of filling the office of treasurer was referred to the executive committee with power to act, and General Sternberg, upon request, con- sented to serve as acting treasurer until his successor should be elected. The board of directors adopted the following resolution: WueEREAS, General George M. Sternberg, who has been Treasurer of The National Association for the Study and Prevention of Tuberculosis since its organization in 1904, has found it necessary to ask to be relieved from further duty in that capacity, be it Resolved, That the Board of Directors of the National Association, in reluc- tantly yielding to this request, desires to place on record its deep appreciation of the invaluable services of General Sternberg not only to the National Asso- ciation, but to the entire anti-tuberculosis movement and the cause of public health in the United States. Following the meeting of the Advisory Council on the evening of May 30, Dr. Charles J. Hatfield of Philadelphia was unani- mously elected chairman of the Advisory Council for the next annual meeting. The summarized report of the Treasurer, Gen. George M. Sternberg, is as follows: EIGHTH ANNUAL MEETING 197 Balance on hand April 30, 1911............005 $2,543.13 IREGEI DUS Bs sihue sida decays teow Guators acene a mre NS eanenel Oe 36,230.15 Disbursements. .........0.ccce cece seeeeeees 38,479.51 Balance on hand April 30, 1912............4. $293.77 At the meeting of the Association in 1912 there were reported by the secretary a membership of 2,223; 511 associations; 342 dispensaries, and 422 sanatoria and special hospitals with a capacity of 26,360 beds. A list of officers and directors for 1911 to 1912 follows: President, Dr. Mazyck P. Ravenel; honorary vice-presidents, Theodore Roose- velt and Sir William Osler; vice-presidents, John M. Glenn and Dr. G. Walter Holden; treasurer, Gen. George M. Sternberg; secretary, Dr. Henry Barton Jacobs; directors, Joseph S. Ames, Baltimore; Dr. Robert H. Babcock, Chicago; Dr. Edward R. Baldwin, Saranac Lake; William H. Baldwin, Wash- ington; Miss Kate Barnard, Oklahoma City; Ernest P. Bicknell, Washington; Dr. Hermann M. Biggs, New York; Dr. Frank Billings, Chicago; W. K. Bixby, St. Louis; C. B. Boothe, Los Angeles; Dr. Vincent Y. Bowditch, Boston; Jeffrey R. Brackett, Boston; Dr. T. D. Coleman, Augusta, Ga.; Dr. R. W. Corwin, Pueblo, Colo.; Albert B. Cummins, Des Moines; Dr. John L. Dawson, Charleston; Edward T. Devine, New York; Dr. George Dock, St. Louis; Dr. W. F. Drewry, Petersburg, Va.; Dr. Henry B. Favill, Chicago; Dr. Lawrence F. Flick, Philadelphia; David R. Francis, St. Louis; Dr. John S. Fulton, Baltimore; Robert Garrett, Baltimore; John M. Glenn, New York; Samuel Gompers, Washington; Dr. Charles Lyman Greene, St. Paul; Dr. Elmer E. Hegg, Seattle; James J. Hill, St. Paul; Frederick L. Hoffman, Newark; Dr. G. Walter Holden, Denver; Dr. John N. Hufty, Indianapolis; Dr. Henry Barton Jacobs, Baltimore; Dr. S. A. Knopf, New York; Dr. George M. Kober, Washington; Charles M. Lea, Philadelphia; Dr. John H. Lowman, Cleveland; Dr. Rudolf Matas, New Orleans; R. B. Mellon, Pittsburgh; Dr. Alfred Meyer, New York; Dr. James Alexander Miller, New York; Dr. Charles L. Minor, Asheville; W. C. Nones, Louisville; Dr. E. A. Pierce, Portland, Ore.; Dr. Joseph Y. Porter, Key West, Fla.; Redfield Proctor, Jr., Proctor, Vt.; Dr. Mazyck P. Ravenel, Madison, Wis.; Julius Rosenwald, Chicago; Dr. Theodore B. Sachs, Chicago; W. T. Sedgwick, Boston; Gen. George M. Sternberg, Washing- ton; Dr. Walter R. Steiner, Hartford, Conn.; Dr. Thomas D. Tuttle, Helena; Dr. Victor C. Vaughan, Ann Arbor; Dr. Joseph Walsh, Philadelphia; Dr. Gerald B. Webb, Colorado Springs; Dr. F. F. Wesbrook, Minneapolis; Dr. William Charles White, Pittsburgh; Alexander M. Wilson, Philadelphia. Executive secretary, Dr. Livingston Farrand; assistant secretaries, Philip P. Jacobs, Ph.D., and Thomas Spees Carrington, M.D. 198 A HISTORY OF NATIONAL TUBERCULOSIS ASSOCIATION The following is a list of papers read before the respective sec- tions at the meeting of May 30-31, 1912: Should the prevention of tuberculosis be under exclusive official control?— C. O. Probst, M.D. The relation of the health official to the anti-tuberculosis campaign—John H. Landis, M.D. The relation of the physician to the anti-tuberculosis campaign—James Alex- ander Miller, M.D. The relation of the layman to the anti-tuberculosis campaign—J. L. Ludlow, C.E. A brief account of the treatment and care of tuberculous wage-earners in Ger- many—Frederick L. Hoffman, LL.D. A preliminary study of the value of sanatorium treatment—Herbert Maxon King, M.D. Employment of patients after leaving sanatoria—W. J. Vogeler, M.D. A revised estimate of the economic cost of tuberculosis—Irving Fisher, Ph.D. The unjustified prejudice of tuberculous patients against sanatoria and hos- pitals—S. Adolphus Knopf, M.D. Examination of employees for tuberculosis—Theodore B. Sachs, M.D. Misleading mortality statistics on tuberculosis—Philip P. Jacobs, Ph.D. The visiting nurse and tuberculosis control—Miss Lillian Wald. The New Jersey tuberculosis exhibit—Millard Knowlton, M.D. Hygienic and economic features of the East River Homes Foundation—Henry L. Shively, M.D. A home hospital for tuberculosis—John A. Kingsbury. Adequate hospital control—Bertram H. Waters, M.D. Adequate clinic control—F. Elisabeth Crowell. An adequate educational campaign—Hoyt E. Dearholt, M.D. The external use of water for enhancing resistance in tuberculosis—Simon Baruch, M.D. The present status of the therapeutic use of tuberculin—Lawrason Brown, M.D. The value of reactions in tuberculin therapy—William Charles White, M.D., and K. H. Van Norman, M.B. The use of the tuberculin test (subcutaneous)—William L. Dunn, M.D. The diagnostic use of tuberculin—Edward R. Baldwin, M.D. Note on the death rate from tuberculosis in various large municipalities— ; Hermann M. Biggs, M.D. Induced pneumothorax in the treatment of pulmonary disease—Louis Ham- man, M.D., and Martin F. Sloan, M.D. A report of 31 cases of pulmonary tuberculosis treated by compression of the lung—Mary E. Lapham, M.D. Restoration of working efficiency after sanatorium treatment—Herbert Maxon King, M.D. EIGHTH ANNUAL MEETING 199 A study of the ultimate results in the dispensary treatment of tuberculosis— H. R. M. Landis, M.D. Prevention of hemorrhage in pulmonary tuberculosis by the administration of autogenous vaccine—Roswell T. Pettit, M.D. Advanced tuberculosis confined to one lung; a comparative analysis of 150 cases—F. C. Smith, M.D. A further study of the prognostic value of Arneth’s leukocytic blood-picture in pulmonary tuberculosis, based upon 729 counts in 475 patients—Paul H. Ringer, M.D. The polynuclear neutrophile leukocytic count as a guide for the administration of tuberculin—Wallace J. Durel, M.D. The effect of graduated work upon the leukocytes in pulmonary tuberculosis— Myer Solis-Cohen, M.D., and Albert Strickler, M.D. Report of 150 cases of pulmonary tuberculosis treated with tuberculin—Harry Lee Barnes, M.D. Acid agglutination of tubercle bacilli—Charles Krumwiede, Jr., M.D. Some observations on tuberculous cattle—Charles F. Briscoe, A.M., and W. J. MacNeal, M.D. Lime assimilation and tuberculosis—Ira Van Gieson, M.D. The relation of animal fat to tubercle bacillus fat—William Charles White, M.D., and A. Marion Gammon. The variation in the longevity of tubercle bacilli from different individuals— B. L. Arms, M.D., and E. Marion Wade, B.A. The relation of the virulence of the tubercle bacillus to its persistence in the circulation—Alfred F. Hess, M.D. The bacteriology of the blood in pulmonary tuberculosis: a preliminary re- port—Lawrason Brown, M.D., and S. A. Petroff. Report of Committee on Nomenclature of the American Sanatorium Associa- tion—Lawrason Brown, M.D., chairman. CHAPTER XIX NINTH ANNUAL MEETING HE ninth annual meeting of The National Association for the Study and Prevention of Tuberculosis was held at the New Willard Hotel, Washington, D. C., on Thursday and Friday, May 8 and 9, 1913. The president of the Association, Mr. Homer Folks, called the Association to order at 11 o’clock on the morning of May 8. Fol- lowing the address of the president and the report of the execu- tive secretary, in accordance with the regular procedure of the Association, the following committee was appointed by the chair to present nominations to fill vacancies in the board of directors: Frederick L. Hoffman, New Jersey, chairman; Dr. J. W. Coon, Wisconsin; James Minnick, Illinois; Seymour H. Stone, Massa- chusetts; Dr. Linsly R. Williams, New York. The following committee on resolutions was also appointed by the chair: Dr. Henry Barton Jacobs, Maryland, chairman; Wil- liam H. Baldwin, District of Columbia; Dr. George H. Evans, California; Dr. John H. Lowman, Ohio; Dr. W. S. Rankin, North Carolina. At the general meeting of the Association, held at noon on May g, the regular order of business was varied to admit the presenta- tion of a report on the status of the investigation of the Fried- mann Treatment by the United States Public Health Service. The report was presented by Dr. John F. Anderson. Following the report of the United States Public Health Ser- vice, the following resolutions were presented on behalf of the board of directors and after discussion were adopted: WHEREAS, Wide-spread publicity has been given to the claims of an alleged cure for tuberculosis, Resolved, That there is no information before The National Association for the Study and Prevention of Tuberculosis to justify the belief that any 200 NINTH ANNUAL MEETING 201 specific cure for tuberculosis has been discovered which deserves the confidence of the medical profession or of the people, and , Resolved, That it is the duty of the public to continue unabated all the present well-tried agencies for the treatment and prevention of tuberculosis. At the business meeting of the Association the following were unanimously elected directors of the Association for terms of five years: Frederic Almy, Buffalo; Dr. Hermann M. Biggs, New York; Severance Burrage, Indianapolis; Dr. George H. Evans, San Francisco; Dr. Lawrence F. Flick, Philadelphia; Lee K. Frankel, New York; Dr. Herbert Maxon King, Liberty; Miss Julia Lathrop, Washington; Charles P. Neill, New York; Dr. W. S. Rankin, Raleigh; Dr. M. P. Ravenel, Madison, Wis.; Rt. Rev. F. S. Spalding, Salt Lake City. The following resolution was reported favorably by the com- mittee on resolutions and was unanimously adopted by the Asso- ciation: Resolved, That The National Association for the Study and Prevention of Tuberculosis recommend to the United States House of Representatives that it appoint from its body a Committee on Public Health. The special committee on the form of the double-barred red cross through its chairman, Dr. Henry Barton Jacobs, presented a report. The recommendations of the committee were unani- mously adopted. At a meeting of the board of directors, held on Friday after- noon, May 9, the following officers were unanimously elected for the ensuing year: Dr. John H. Lowman, Cleveland, president; Miss Mabel T. Boardman, Washington, and Dr. Theodore B. Sachs, Chicago, vice-presidents; Dr. Henry Barton Jacobs, Baltimore, secretary; William H. Baldwin, Washington, treas- urer. The following directors were elected to serve on the executive committee for the ensuing year: William H. Baldwin, Washing- ton; Dr. Hermann M. Biggs, New York; Homer Folks, New York; Dr. Charles J. Hatfield, Philadelphia; Dr. George M. Kober, Washington; Dr. Walter R. Steiner, Hartford; Dr. Wil- liam Charles White, Pittsburgh. 202 A HISTORY OF NATIONAL TUBERCULOSIS ASSOCIATION In recognition of his long and eminent services Gen. George M. Sternberg was elected an honorary member of the Association. The summarized report of the treasurer, Mr. William H. Bald- win, is as follows: Balance on hand April 30, 1912............4.006 $293.77 ReGei PtSi sc ge isge ees dev ead vis ONT e eee TES 37,191.91 Disbursements. .............20 00 eee eee eee 34.951.31 Balance on hand April 30, 1913. .............00. $2,534.37 At the meeting of the Association in 1913 the secretary reported a membership of 2,132; associations, 660; dispensaries, 373; sanatoria and special hospitals, 466; open-air schools, 95. A list of officers and directors for 1912 to 1913 follows: President, Homer Folks; honorary vice-presidents, Theodore Roosevelt and Sir William Osler; vice-presidents, Dr. Robert H. Babcock and Dr. Edward R, Baldwin; treasurer, William H. Baldwin; secretary, Dr. Henry Barton Jacobs; directors, Joseph S. Ames, Baltimore; Dr. Robert H. Babcock, Chicago; Dr. Edward R. Baldwin, Saranac Lake; William H. Baldwin, Washington; Dr. W. Jarvis Barlow, Los Angeles; Miss Kate Barnard, Oklahoma City; Ernest P. Bicknell, Washington; W. K. Bixby, St. Louis; Miss Mabel T. Boardman, Washington; C. B. Boothe, Los Angeles; Dr. Vincent Y. Bowditch, Boston; Jeffrey R. Brackett, Boston; Dr. T. D. Coleman, Augusta, Ga.; Albert B. Cummins, Des Moines; Dr. Hoyt E. Dearholt, Milwaukee; Dr. George Dock, St. Louis, Mo.; Dr. W. F. Drewry, Petersburg, Va.; Dr. Henry B. Favill, . Chicago; Homer Folks, New York; Dr. John S. Fulton, Baltimore; John M. Glenn, New York; Samuel Gompers, Washington; Dr. Charles Lyman Greene, St. Paul; Dr. Charles J. Hatfield, Philadelphia; Dr. Elmer E. Hegg, Seattle; James J. Hill, St. Paul; Frederick L. Hoffman, Newark; Dr. G- Walter Holden, Denver; Dr. John N. Hurty, Indianapolis; Dr. Henry Barton Jacobs, Baltimore; John A. Kingsbury, New York; Dr. S. A. Knopf, New York; Dr. George M. Kober, Washington; Dr. John H. Lowman, Cleveland; Col. J. L. Ludlow, Winston-Salem; Dr. Cabot Lull, Birmingham, Ala.; Dr. Rudolf Matas, New Orleans; R. B. Mellon, Pittsburgh; Dr. Alfred Meyer, New York; Dr. James Alexander Miller, New York; Dr. Charles L. Minor, Asheville; Dr. E. A. Pierce, Portland, Ore.; Dr. Joseph Y. Porter, Key West, Fla.; Dr. Charles O. Probst, Columbus, O.; Redfield Proctor, Proctor, Vt.; Julius Rosenwald, Chicago; Dr. Theodore B. Sachs, Chicago; Dr. E. C. Schroe- der, Washington; W. T. Sedgwick, Boston; Dr. Walter R. Steiner, Hartford, Conn.; Gen. C. F, Stokes, Washington; Dr. Edward L. Trudeau, Saranac Lake; Dr. Thomas D., Tuttle, Helena; Dr. Victor C. Vaughan, Ann Arbor; Dr. Joseph Walsh, Philadelphia; Dr. Gerald B. Webb, Colorado Springs; Dr. William H. Welch, Baltimore; Dr, F. F. Wesbrook, Minneapolis; Dr. William Charles White, Pittsburgh; Alexander M. Wilson, Philadelphia. NINTH ANNUAL MEETING 203 Executive secretary, Dr. Livingston Farrand; assistant secretaries, Philip P. Jacobs, Ph.D., and Thomas Spees Carrington, M.D. The following is a list of papers read before the respective sec- tions at the meeting of May 8-9, 1913: The tuberculosis campaign—its influence on the methods of public health work generally—Hermann M. Biggs, M.D., and Charles F. Bolduan, M.D. The tuberculosis problem from the sociological and medical points of view— John R. Commons. The medical side of the tuberculosis problem—William Charles White, M.D. Tuberculosis and public health—H. R. M. Landis, M.D. The decline in the tuberculosis death-rate, 1871-1912—Frederick L. Hoffman, LL.D. Is the economic problem of the sanatorium graduate being solved?—John H. Huddleston, M.D. The relation of the industries to tuberculosis—B. S. Warren, M.D. A method of finding early cases of pulmonary tuberculosis—Harry Lee Barnes, M.D. One year’s results at the Home Hospital—Edward C. Brenner, M.D. The tuberculosis preventorium—Alfred F. Hess, M.D. The tuberculosis problem of the country and small towns—Charles S. Prest, M.D. The value of auto-inoculation in pulmonary tuberculosis—Harry Lee Barnes, M.D. The occurrence and importance in treatment of secondary infection in pul- monary tuberculosis—Lawrason Brown, M.D., F. H. Heise, M.D., and S. A. Petroff. The treatment of progressive cases of pulmonary tuberculosis—Mary E. Lap- ham, M.D. Results on January 1, 1913, in Philadelphia patients discharged from Mont Alto in 1909—Albert P. Francine, M.D. What became of one group of cases—E. S. Bullock, M.D., and L. S. Peters, M.D. Clinical observations with the bacilli emulsion administered by the poly- nuclear neutrophile index method—Wallace J. Durel, M.D. Report on a group of infants infected by a tuberculous attendant—Alfred F. Hess, M.D. Further observations on .vital stains in relation to tubercle—Paul A. Lewis, M.D. 7 The relation of the spleen in rats and mice to their resistance to experimental tuberculosis—Paul A. Lewis, M.D., and Arthur Georges Margot. Observations on the products obtained from the tubercle bacillus by the method of Vaughan—Benjamin White, Ph.D. 204 A HISTORY OF NATIONAL TUBERCULOSIS ASSOCIATION Factors in immunity in tuberculosis—W. H. Manwaring, M.D., and J. Bronfen Brenner, Ph.D. Chemo-therapeutic experiments with trypan-red compounds in experimental tuberculosis—Paul A. Lewis, M.D., and Robert B. Krauss. The chemical composition of commercial tuberculins—William Charles White, M.D., and Lester Hollander, M.D. Further observations on experimental tuberculosis of the cornea—Paul A. Lewis, M.D. The comparative study of cultures from type cases of human pulmonary tu- berculosis—Karl F. Meyer, M.D., and Paul A. Lewis, M.D. The relative virulence of type cultures of B. tuberculosis for guinea-pigs— Paul A. Lewis, M.D. Some new biological relations between tubercle bacilli and other acid-fast forms—Allen K. Krause, M.D., and Edward R. Baldwin, M.D. Variations of the tubercle bacillus when cultivated on potato media—S. A. Petroff. The bacteriology of the blood in pulmonary tuberculosis—Lawrason Brown, M.D., Fred H. Heise, M.D., and S. A. Petroff. Study of a case of generalized tuberculous lymphadenitis in an adult—Lever Stewart, M.D., and Arthur Georges Margot. Further observations on tuberculous cervical adenitis—Paul A. Lewis, M.D., and Arthur Georges Margot. Specimen showing cavitation of lung in an infant dying in the seventh month— B. M. Randolph, M.D. Report of the Committee on Hospitals for Advanced Cases of Tuberculosis. Report of the Committee on Clinical Nomenclature. CHAPTER XX TENTH ANNUAL MEETING HE tenth annual meeting of The National Association for the Study and Prevention of Tuberculosis was held at the New Willard Hotel, Washington, D. C., on Thursday and Friday, May 7 and 8, 1914. The president of the Association, Dr. John H. Lowman, called the Association to order at eleven o'clock on the morning of May 7. Following the address of the president and the report of the executive office, in accordance with the regular procedure of the Association, the following com- mittee was appointed by the chair to present nominations to fill vacancies in the board of directors: Dr. Walter R. Steiner, Connecticut, chairman; Dr. R. H. Bishop, Jr., Ohio; Dr. H. M. Bracken, Minnesota; Paul Kennaday, New York; Dr. William Charles White, Pennsylvania. The following committee on resolutions was also appointed by the chair: Dr. George M. Kober, District of Columbia, chair- man; William H. Baldwin, District of Columbia; Frederick L. Hoffman, New Jersey; Dr. Lawrence Litchfield, Pennsylvania; Dr. Theodore B. Sachs, Illinois. At the regular business meeting of the Association, held at noon on May 8, the following were unanimously elected directors of the Association for terms of five years: Dr. Rupert Blue, Washing- ton; Dr. Lawrason Brown, Saranac Lake; Dr. Livingston Farrand, Boulder, Colo.; Frederick L. Hoffman, Newark, N. J.; Dr. S. A. Knopf, New York; Dr. H. R. M. Landis, Philadelphia; Dr. David R. Lyman, Wallingford, Conn.; S. Livingston Mather, Cleveland; Dr. James Alexander Miller, New York; A. L. Mills, Portland, Ore.; Dr. Charles L. Minor, Asheville; John Mitchell, New York. Upon motion made by Dr. Ravenel, and seconded by Mr. Baldwin, the following resolutions, passed by the board of direc- 205 206 A HISTORY OF NATIONAL TUBERCULOSIS ASSOCIATION tors at their meeting on March 7, 1914, were unanimously en- dorsed by the general meeting: Wuereas, Dr. Livingston Farrand, who has served as executive secretary of The National Association for the Study and Prevention of Tuberculosis since January 15, 1905, or practically during the entire existence of the organ- ization, has resigned to accept the presidency of the University of the State of Colorado, and WuerEas, The executive secretary, Dr. Farrand, has been largely re- sponsible both for suggesting the lines of policy and work of The National Association for the Study and Prevention of Tuberculosis and for carrying into effect the policies and lines of activity approved by the board of directors, and Wuereas, During the nine years of Dr. Farrand’s incumbency of the position of executive secretary the number of organizations engaged in the prevention of tuberculosis has increased from a very few to over 1,200; thenum- ber of hospitals and sanatoria has increased to 550, with more than 35,000 beds; the number of dispensaries to 400; the number of visiting nurses to 3,000; the number of open-air schools and fresh-air schools to over 200; and advanced laws dealing with the treatment and prevention of tuberculosis have been enacted in 45 states, and WHEREAS, These results are the most eloquent and conclusive justification possible of the policies suggested to the Association by Dr. Farrand during the early years of his incumbency of the position of executive secretary, therefore be it Resolved, That The National Association for the Study and Prevention of Tuberculosis hereby places on record an expression of its recognition of the far- reaching benefit and value to the people of the country as a whole of the ser- vices which Dr. Farrand has rendered as executive secretary of The National Association for the Study and Prevention of Tuberculosis during the past nine years; of its appreciation of the admirable spirit he has shown in all his dealings with the officers and members of the Association; of his exceptional far-sighted- ness and sagacity in meeting the problems that have arisen from year to year; of his unqualified devotion to the success of the cause; of his sound judgment on the wide variety of medical, scientific, social, political, and practical ques- tions arising in its work; and of the very great regard and affection felt for him by every member of the Association who has had the pleasure of working with him, and Resolved, That we part from him as executive secretary with the greatest regret and extend to him our best wishes and confident assurance of his com- plete success in the new position to which he has been called, and urge him to continue, to the largest extent compatible with his new duties, his active inter- est in the cause of public health and in the work of this Association. At a meeting of the Board of Directors, held on Friday after- TENTH ANNUAL MEETING 207 noon, May 8, the following officers were elected for the ensuing year: Dr. George M. Kober, Washington, president; Lee K. Frankel, Ph.D., New York, and Dr. W. Jarvis Barlow, Los Angeles, vice-presidents; Dr. Henry Barton Jacobs, Baltimore, secretary; William H. Baldwin, Washington, treasurer. The following directors were elected to serve on the executive committee for the ensuing year: William H. Baldwin, Washing- ton; Dr. Hermann M. Biggs, New York; Homer Folks, New York; Dr. Charles J. Hatfield, Philadelphia; Dr. David R. Ly- man, Wallingford; Dr. Theodore B. Sachs, Chicago; Dr. Wil- liam Charles White, Pittsburgh. The summarized report of the treasurer, Mr. William H. Bald- win, is as follows: Balance on hand April 30, 1913................ $2,534.37 Receipts; i cde G.encthamayed Mates Kieiecaen staan Aare 331374-31 Disbursements............. 000 ceeeeceeeeees 34,092.59 Balance on hand April 30, 1914..............45% $1,816.09 At the meeting of the Association in 1914 the secretary reported a membership of 2,134; associations, 1,049; dispensaries, 400; sanatoria and special hospitals, 577; open-air schools, 169. A list of officers and directors for 1913 to 1914 follows: President, Dr. John H. Lowman; honorary vice-presidents, Theodore Roosevelt and Sir William Osler; vice-presidents, Miss Mabel T. Boardman and Dr. Theodore B. Sachs; treasurer, William H. Baldwin; secretary, Dr. Henry Barton Jacobs; directors, Frederic Almy, Buffalo; Joseph S. Ames, Baltimore; Dr. Robert H. Babcock, Chicago; William H. Baldwin, Washing- ton; Dr. W. Jarvis Barlow, Los Angeles; Miss Kate Barnard, Oklahoma City; Ernest P. Bicknell, Washington; Dr. Hermann M. Biggs, New York; W. K. Bixby, St. Louis; Miss Mabel T. Boardman, Washington; Dr. Vincent Y. Bowditch, Boston; Jeffrey R. Brackett, Boston; Severance Burrage, Indiana- polis; Dr. T. D. Coleman, Augusta, Ga.; Dr. Hoyt E. Dearholt, Milwaukee; Dr. George Dock, St. Louis; Dr. W. F. Drewry, Petersburg, Va.; Dr. George H. Evans, San Francisco; Dr. Henry B. Favill, Chicago; Dr. Lawrence F. Flick, Philadelphia; Homer Folks, New York; Lee K. Frankel, New York; Dr. John S. Fulton, Baltimore; John M. Glenn, New York; Dr. Charles Lyman Greene, St. Paul; Dr. Elmer E. Hegg, Seattle; Dr. G. Walter Holden, Denver; Dr. Henry Barton Jacobs, Baltimore; Dr. Herbert M. King, Loomis, N. Y.; John A. Kingsbury, New York; Dr. George M. Kober, Washington; Miss Julia C. Lathrop, Washington; Dr. John H. Lowman, Cleveland; Col. J. L. Ludlow, Winston-Salem; Dr. Cabot Lull, Birmingham, Ala.; R. B. 208 A HISTORY OF NATIONAL TUBERCULOSIS ASSOCIATION Mellon, Pittsburgh; Dr. Alfred Meyer, New York; Dr. James Alexander Miller, New York; Charles P. Neill, New York; Dr. E. A. Pierce, Portland. Ore.; Dr. Joseph Y. Porter, Key West, Fla.; Dr. Charles O. Probst, Columbus, O.; Dr. Watson S. Rankin, Raleigh, N. C.; Dr. Mazick P. Ravenel, Madison, Wis.; Julius Rosenwald, Chicago; Dr. Theodore B. Sachs, Chicago; Dr. E. C. Schroeder, Washington; W. T. Sedgwick, Boston; Rt. Rev. F. S. Spalding, Salt Lake City; Dr. Walter R. Steiner, Hartford, Conn.; Gen. C. F. Stokes, Washington; Dr. Edward L. Trudeau, Saranac Lake; Dr. Thomas D. Tuttle, Warm Springs, Mont.; Dr. Gerald B. Webb, Colorado Springs; Dr. William H. Welch, Baltimore; Dr. F. F. Wesbrook, Vancouver; Dr. William Charles White, Pittsburgh; Alexander M. Wilson, Philadelphia. Executive secretary, Dr. Livingston Farrand; assistant secretaries, Philip P+ Jacobs, Ph.D., and Thomas S. Carrington, M.D.; field secretary, Dixon Van Blarcom. The following is a list of papers read before the respective sec- tions at the meeting of May 7-8, 1914: The campaign in Chicago for medical examinations of employes—Theodore B. Sachs, M.D. An efficient system of medical examination of employes—Harry E. Mock, M.D. The relation of medical examinations of employes to the hygiene of the work- ing-place and the efficiency of the working force—James A. Britton, M.D- Medical examination of employes as a part of industrial insurance—J. W. Schereschewsky, M.D. Action of drugs on the pulmonary circulation—David I. Macht, M.D. The treatment of advanced pulmonary tuberculosis—S. A. Knopf, M.D. The occurrence of the Widal reaction in tuberculous people—Mazyck P. Ravenel, M.D. The prognosis of tuberculous infection among infants—Alfred F. Hess, M.D. A scheme for promoting efficiency in state sanatoria—Walter C. Bailey, M.D. and Carl C. MacCorison, M.D. Artificial pneumothorax, with report of gas analyses and experiments to de- termine the use of air or nitrogen—Gerald B. Webb, M.D., G. Burton Gilbert, M.D., T. L. James, M.D., and Leon C. Havens, M.A. Exercise as a therapeutic measure in pulmonary tuberculosis—Charles W. Mills, M.D., and Herbert Maxon King, M.D. Variation in tuberculin hypersensitiveness during the course of pulmonary tuberculosis—James B. Holmes, M.D. The réle of surgery in the treatment of pulmonary tuberculosis—a résumé— Edward Archibald, M.D. Subsequent report of patients who received injections of Friedmann vaccine over a year ago—George Mannheimer, M.D. A study of intravenous injections of stained organisms—John W. Churchman, M.D. TENTH ANNUAL MEETING 209 Tuberculocidal action of certain chemical disinfectants—Lydia M. DeWitt, M.D., and Hope Sherman. Streptothrix infections and their differentiation from tuberculosis—Edith J. Claypole, M.D. Blood platelets and tuberculosis—Gerald B. Webb, M.D., George Burton Gil- bert, M.D., and Leon C. Havens, M.A. Biological curves obtained during the onset and course of tuberculous infec- tion—Alfred H. Cauldfeild, M.B., and F. S. Minns, M.B. Tuberculin treatment based upon clinical and biological data—Alfred H. Cauldfeild, M.B., and F. S. Minns, M.B. A study of tuberculous lesions in infants and young children, based on post- mortem examinations—Martha Wollstein, M.D., and Frederick H. Bartlett, M.D. Some new features of interest about the pulmonary circulation and the fate therein of intravenously introduced fats—William Charles White, M.D., and A. Marion Gammon. An attempt to immunize calves against tuberculosis by feeding the milk of vaccinated cows—W. L. Moss, M.D. The work of the state livestock sanitary board of Pennsylvania upon the artificial immunization of animals against tuberculosis—S. H. Gilliland, V.M.D., M.D. The effect of ligation of the pulmonary vein on the development of experi- mental tuberculosis—by G. L. Kite, M.D. Studies on the morphology of living miliary tubercles—G. L. Kite, M.D. The diagnosis of tuberculosis of biological methods—J. Bronfenbrenner, Ph.D. The prognostic value of a study of the leukocytes—Henry D. Chadwick, M.D., and Roy Morgan, M.D. The problem of infection in tuberculous families—John B. Hawes, 2d, M.D. Prenatal and early childhood problems—William Charles White, M.D. School child problems—Frank H. Mann. The needs of patients discharged from tuberculosis sanatoria—Charles F. Bolduan, M.D. Employment for post-sanatorium cases—Rabbi Sidney E. Goldstein. The health aspect of the clothing industry—H. R. M. Landis, M.D., and Janice S. Reed. : The state health department and the tuberculosis problem—E. F. McCamp- bell, Ph.D., M.D. The municipal health department and the tuberculosis problem—C. E. Ford, M.D. Report of the Committee on Exhibits. Report of Committee on Literature and Red Cross Seals. 14 CHAPTER XXI ELEVENTH ANNUAL MEETING HE eleventh annual meeting of The National Association for the Study and Prevention of Tuberculosis was held at Plymouth Congregational Church, Seattle, Washington, on Monday, Tuesday, and Wednesday, June 14, 15, and 16, I915. The president of the Association, Dr. George M. Kober, ‘called the meeting to order at nine o’clock on the morning of June 15. The address of the president was presented and filed for publica- tion in the Transactions. The report of the executive office for the year ending April 30, 1915, was read and approved. On motion from the floor, the following committee was ap- pointed by the chair to present names to fill vacancies on the board of directors: Dr. Gerald B. Webb, Colorado, chairman; Dr. W. Jarvis Barlow, California; Dr. George T. Palmer, Illinois; Dr. Wilfred Manwaring, California; George J. Nelbach, New York. The following committee on resolutions was also appointed by the chair: Dr. Edward O. Otis, Massachusetts, chairman; Dr. Christen Quevli, Washington; Dr. Alfred Meyer, New York; Dr. Theodore B. Sachs, Illinois; Dr. Thomas D. Tuttle, Wash- ington. At the business meeting of the Association, held on June 16, the following were elected directors of the Association for terms of five years: Dr. Edward R. Baldwin, New York; William H. Baldwin, District of Columbia; Dr. Hoyt E. Dearholt, Wiscon- sin; John M. Glenn, New York; Sherman C. Kingsley, Illinois; Dr. O. W. McMichael, Illinois; Dr. George T. Palmer, Ilinois; Dr. LeRoy S. Peters, New Mexico; Dr. Christen Quevli, Wash- ington; Seymour H. Stone, Massachusetts; Dr. E. R. Van der Slice, Nebraska; Miss Maude Van Syckle, Michigan. Dr. Edward O. Otis, chairman of the committee on resolutions, 210 ELEVENTH ANNUAL MEETING 211 presented the following resolutions with the endorsement of the committee. They were unanimously adopted by the general meeting: Resolved, That The National Association for the Study and Prevention of Tuberculosis expresses its gratitude and appreciation of the courtesies ex- tended to it by the Washington Association for the Prevention and Relief of Tuberculosis, the Seattle Red Cross Seal Committee, the Chamber of Com- merce, the local Committee of Arrangements, the Tacoma and Pierce County Anti-Tuberculosis Association, the city and state officials, and to Mrs. Bu- chanan, Dr. and Mrs. Quevli, Mr. H. C. Henry, Mrs. W. E. Humphrey, and to all the good citizens of Seattle who have contributed so largely to the success of the meeting and entertainment and comfort of the attending members. WHEREAS, State, city, and county tuberculosis hospitals and sanatoria are an important factor in the gradual attainment of control of tuberculosis in this country, and , WHEREAS, The efficiency of these institutions can be attained only through administration free from politics and by a personnel selected solely upon the consideration of their fitness, it is Resolved by The National Association for the Study and Prevention of Tuberculosis that the boards of management of such institutions should al- ways be chosen on the basis of their knowledge and experience in the different phases of the problem, and it is further Resolved, That it is essential that all the administrative and medical officers of such institutions be selected by means of strict competitive civil service examinations. Resolved, That The National Association for the Study and Prevention of Tuberculosis urge upon all local anti-tuberculosis associations the importance of co-operating with various official and voluntary associations having for their object the prevention of disease, and especially those associations dealing with the problems of housing; and Resolved, That The National Association recommends that in communities where there are no housing associations the local tuberculosis association ap- point an active committee to be known as the housing committee. Resolved, That The National Association for the Study and Prevention of Tuberculosis approves of the plan for municipal regulation and supervision of the milk supply, such regulation and supervision supplementing state and federal control; and that such regulation include—(1) pasteurization of all milk for human consumption, if not of the grade of certified milk; (2) tubercu- lin tests for all dairy herds supplying milk for municipal consumption; and (3) the frequent inspection of dairy herds. At a meeting of the board of directors, held on Wednesday, 212 A HISTORY OF NATIONAL TUBERCULOSIS ASSOCIATION June 16, the following officers were elected for the ensuing year: Dr. Theodore B. Sachs, Illinois, president; Dr. Edward R. Bald- win, New York, first vice-president; Dr. Christen Quevli, Wash- ington, second vice-president; Dr. Henry Barton Jacobs, Balti- more, secretary; William H. Baldwin, Washington, treasurer. The following directors were elected to serve on the executive committee for the ensuing year: William H. Baldwin, District of Columbia; Homer Folks, New York; John M. Glenn, New York; Dr. David R. Lyman, Connecticut; Dr. O. W. McMichael, Illinois; Seymour H. Stone, Massachusetts; Dr. William Charles White, Pennsylvania. A resolution was adopted to the effect that it was the con- sensus of opinion that the next annual meeting shall be held in Cincinnati, but that the final decision shall be left to a later meeting of the executive committee or the board of directors. The summarized report of the treasurer, Mr. William H. Bald- win, is as follows: Balance on hand April 30, 1914............-- $1,816.09 ROCO1DtS /.55- Socks aca dhs Gplnecd ad Glee HARE amebe sad 36,226.92 Disbursements. ........... 2.200: e cere eens 34,999.85 Balance on hand, April 30, 1915............-. $3,043.16 At the meeting of the Association in 1915 the secretary reported a membership of 2,419; number of associations, I,210; dis- pensaries, 418; sanatoria and special hospitals, 468. A list of officers and directors for 1914 to 1915 follows: President, Dr. George M. Kober; honorary vice-presidents, Theodore Roosevelt and Sir William Osler; vice-presidents, Lee K. Frankel and Dr. W. Jarvis Barlow; treasurer, William H. Baldwin; secretary, Dr. Henry Barton Jacobs; directors, Frederic Almy, Buffalo; Joseph S. Ames, Baltimore; Wil- liam H. Baldwin, Washington; Dr. W. Jarvis Barlow, Los Angeles; Miss Kate Barnard, Oklahoma City; Ernest P. Bicknell, Washington; Dr. Her- mann M. Biggs, New York; W. K. Bixby, St. Louis, Mo.; Dr. Rupert Blue, Washington; Miss Mabel T. Boardman, Washington; Dr. Vincent Y. Bow- ditch, Boston; Dr. Lawrason Brown, Saranac Lake; Severance Burrage, Indianapolis; Dr. T. D. Coleman, Augusta, Ga.; Mrs. O. B. Colquitt, Dallas, Tex.; Dr. Hoyt E. Dearholt, Milwaukee; Dr. George Dock, St. Louis; Dr. George H. Evans, San Francisco; Dr. Livingston Farrand, Boulder, Colo.; Dr. Henry B. Favill, Chicago; Dr. Lawrence F. Flick, Philadelphia; Homer Folks, New York; Lee K. Frankel, New York; Dr. John S. Fulton, Baltimore; ELEVENTH ANNUAL MEETING 213 Dr. Ethan A. Gray, Chicago; Dr. Charles Lyman Greene, St. Paul; Dr. Elmer E. Hegg, Seattle; Frederick L. Hoffman, New York; Dr. G. Walter Holden, Denver; Dr. Henry Barton Jacobs, Baltimore; Dr. Herbert M. King, Loomis, N. Y.; John A. Kingsbury, New York; Dr. S. A. Knopf, New York; Dr. H. R. M. Landis, Philadelphia; Miss Julia C. Lathrop, Washington; Col. J. L. Ludlow, Winston-Salem; Dr. Cabot Lull, Birmingham, Ala.; Dr. David R. Lyman, Wallingford, Conn.; S. Livingston Mather, Cleveland; Dr. Alfred Meyer, New York; Dr. James Alexander Miller, New York; A. L. Mills, Portland, Ore.; Dr. Charles L. Minor, Asheville; John Mitchell, New York; , Charles P. Neill, New York; Dr. Charles O. Probst, Columbus, O.; Dr. Wat- son S. Rankin, Raleigh, N. C.; Dr. Mazyck P. Ravenel, Madison, Wis.; Julius Rosenwald, Chicago; Dr. Theodore B. Sachs, Chicago; Dr. E. C. Schroeder, Washington; Gen. C. F. Stokes, Washington; Seymour H. Stone, Boston; Dr. Edward L. Trudeau, Saranac Lake; Dr. Thomas D. Tuttle, Warm Springs, Mont.; Dr. Gerald B. Webb, Colorado Springs; Dr. William H. Welch, Baltimore; Dr. F. F. Wesbrook, Vancouver; Dr. William Charles White, Pittsburgh; Alexander M. Wilson, Philadelphia. Executive secretary, Charles J. Hatfield, M.D.; assistant secretary, Philip P. Jacobs, Ph.D.; field secretaries, Dixon Van Blarcom and Charles M. De Forest. The following is a list of papers read before the respective sec- tions at the meeting of June 14-16, 1915: The child and the home—George M. Kober, M.D. The child and the school—Sherman C. Kingsley. The child and the community—Edward O. Otis, M.D. Trachea position—Gerald B. Webb, M.D., Alexius M. Forster, M.D., and G. Burton Gilbert, M.D. The cutaneous tuberculin vaccination method—John Ritter, M.D. A study of Kroenig’s isthmus in pulmonary tuberculosis—Walter C. Klotz, M.D. The diagnosis of intra-thoracic tuberculosis in children—W. J. Dobbie, M.D. A clinical study of 228 children in relation to tuberculosis exposure controlled by von Pirquet reaction—John B. Manning, M.D., and Howard James Knott, M.D. Does the general practitioner utilize the means at his disposal for the diag- nosis of early pulmonary tuberculosis?—James S, Ford, M.D. The x-ray as an aid in the study of pulmonary tuberculosis—Ray W. Matson, M.D. Prevention and care of laryngeal tuberculosis—Julius Dworetzky, M.D. Pancreatic ferment determination in pulmonary tuberculosis—Ethan A. Gray, M.D., and Olga Pickman, M.D. Essential points in the early determination of tubercle—Frederick Slyfield, M.D. Non-tuberculous lesions of the lung—William Charles White, M.D. 214 A HISTORY OF NATIONAL TUBERCULOSIS ASSOCIATION The treatment of pulmonary hemorrhage by venesection—A. G. Shortle, M.D. Artificial pneumothorax in the treatment of pulmonary tuberculosis—Theo- dore B. Sachs, M.D. Artificial pneumothorax in the treatment of pulmonary tuberculosis—C. H. Vrooman, M.D. A clinical report of sixty-nine cases treated by artificial pneumothorax— Henry Schwatt, M.D. Clinical observations on artificial pneumothorax with report of 73 cases— Ralph C. Matson, M.D. The influence of lung disease through artificial diaphragm paralysis (“‘ phreni- kotomie’’)—Ralph C. Matson, M.D., and Marr Bisaillon, M.D. Exudates in artificial pneumothorax—LeRoy S. Peters, M.D. A case of spontaneous pyopneumothorax complicated by hydro- or pyopneumo- pericardium—Alfred Meyer, M.D. Sanatorium temperature records—David R. Lyman, M.D. The serum diagnosis of tuberculosis in relation to immunization and prophy- laxis—Enrico Castelli, M.D. Immunity in tuberculosis—G. Burton Gilbert, M.D., and Gerald B. Webb, M.D. The function of the spleen in the experimental infection of albino mice with bacillus tuberculosis—Paul A. Lewis, M.D., and Arthur Georges Margot. Further observations on the presence of iodine in tuberculosis tissues—Paul A. Lewis, M.D., and Robert B. Krauss. The bacterzmic nature of tuberculosis and leprosy—D. Rivas, M.D. The value of copper in the treatment of tuberculosis—Lydia M. DeWitt, M.D. On new methods of serum diagnosis of tuberculosis—J. Bronfenbrenner, Ph.D., and M. J. Schlesinger. A study of the cultivation of the tubercle bacillus directly from the sputum— Robert A. Keilty, M.D. The Widal reaction in tuberculous persons—A. J. Chesley, M.D., and E. M. Wade. Some observations on streptothrix infections and their relation to tubercu- losis—David John Davis, M.D. Communicability of the avian tubercle bacterium to mammals—L. R. Him- melberger, M.D. Tuberculosis of the ovary—C. E. Royce, M.D. The official responsibility of the state in the tuberculosis problem—William Charles White, M.D. The official responsibility of the city in the tuberculosis problem—Theodore B. Sachs, M.D. The official responsibility of the county in the tuberculosis problem—George J. Nelbach. The duties and opportunities of the state tuberculosis association—Miss E. L. M. Tate. The duties and opportunities of the local tuberculosis association—James Minnick, ELEVENTH ANNUAL MEETING 215 The relation state and local anti-tuberculosis associations should sustain to each other—Charles J. Hatfield, M.D. House infection: a potent source of tuberculosis—Isaac W. Brewer, M.D. Relative prevalence of tuberculosis under good and bad housing conditions— Charles J. Hastings, M.D. Housing and tuberculosis—a legislative program—Lawrence Veiller. CHAPTER XXII TWELFTH ANNUAL MEETING HE twelfth annual meeting of The National Association for the Study and Prevention of Tuberculosis was held at the New Willard Hotel, Washington, D. C., on Thursday and Friday, May 11 and 12, 1916. The president of the Association, Dr. Edward R. Baldwin, called the meeting to order at two o'clock on the afternoon of May 11. The address of the president was presented and filed for publication in the Transactions. The report of the executive office for the year ending April 30, 1916, was read and approved. On motion from the floor, duly seconded and carried, the fol- lowing committee was appointed by the chair to present names to fill vacancies on the board of directors: Dr. John H. Lowman, Ohio, chairman; Mrs. Bethesda Beals Buchanan, Washington; Dr. Alexius M. Forster, Colorado; Sherman C. Kingsley, IIli- nois; Dr. Walter R. Steiner, Connecticut. Likewise on motion from the floor, seconded and carried, the following committee on resolutions was appointed by the chair: William H. Baldwin, District of Columbia, chairman; Dr. Robert H. Babcock, Illinois; Dr. Vincent Y. Bowditch, Massa- chusetts; Dr. Philip King Brown, California; Dr. Livingston Farrand, Colorado. By unanimous vote of the members present the secretary was instructed to send a telegram to Mrs. Theodore B. Sachs, convey- ing the sympathy of the meeting and expressing appreciation of the great work accomplished by Dr. and Mrs. Sachs. At the business meeting of the Association, held at noon on May 12, the following were elected directors of the Association for terms of five years: Dr. Robert H. Babcock, Illinois; Dr. H. M. Bracken, Minnesota; Dr. Philip King Brown, California; Dr. C. E. Edson, Colorado; Miss Edna L. Foley, Illinois; Dr. Louis 216 TWELFTH ANNUAL MEETING 217 V. Hamman, Maryland; Dr. Henry Barton Jacobs, Maryland; H. McK. Jones, Missouri; Dr. George M. Kober, District of Columbia; R. B. Mellon, Pennsylvania; Dr. A. K. Stone, Massa- chusetts; Dr. Victor C. Vaughan, Michigan. Mr. William H. Baldwin, chairman of the committee on resolu- tions, presented the following resolutions with the endorsement of the committee. They were unanimously adopted by the general meeting: Resolved, That The National Association for the Study and Prevention of Tuberculosis express its hearty appreciation of the generous proposition of the Metropolitan Life Insurance Company to contribute $100,000 for conducting a community experiment in the control of tuberculosis. In undertaking this trust the Association hopes that the results of the experi- ment may be commensurate with the desires which inspired the offer. WueEreas, The Prudential Insurance Company of America has recently issued an elaborate statistical treatise on the mortality from cancer throughout the world, in the furtherance of the cause of cancer control, under the auspices of the American Association for Cancer Research and the American Society for the Control of Cancer; and Wuereas, A corresponding treatise on the mortality from tuberculosis throughout the world, with a due consideration of the various medical and sociological aspects of the tuberculosis problem, would aid materially all those who throughout the country are engaged in the study and prevention of tuber- culosis; and WueEreas, Heretofore no collective study of tuberculosis statistics of this world-wide problem in preventive medicine has been made, either under the direction of government or private enterprise; be it Resolved, by The National Association for the Study and Prevention of Tuberculosis, in annual meeting assembled, that it be respectfully suggested to the president and board of directors of the Prudential Insurance Company of America that the said Company cause to be prepared, and make available for gratuitous distribution to those interested in the subject, a work on the mor- tality from tuberculosis throughout the world corresponding to the recently issued volume on the mortality from cancer; and be it further Resolved, That the Association desires to place on record its appreciation of ‘the active interest on the part of the Prudential in the campaign against tuber- culosis. WueEreas, The death of Dr. Edward Livingston Trudeau, the physician, philanthropist, scientist, and first president of the Association, removes from us the leader in the sanatorium movement in America, one of the founders of this body, and an exponent of humanitarian principles of the highest order, and 218 A HISTORY OF NATIONAL TUBERCULOSIS ASSOCIATION WueEreAs, In the life history of this unique man, Providence has given to us in a gifted and lovable personality an example of rare usefulness in the face of adversity, an inspiration to those whom fate leads to tread the same road of invalidism, and a nobility of character developed as a result of suffering, a sympathy deepened and made invaluable to the world by personal experience of disease throughout a long life, and WHEREAS, In the history of American medicine, there existed no finer example of the ideal physician, whose influence radiated far beyond his home in the forest, whose memory will be cherished by the strong and the weak, by the grief-stricken and disheartened in their struggle for life, whose comfort he was, whose presence brought faith and hope to the bedside, and who made an un- dying impression on the art and science of medicine in the field of tuberculosis, be it Resolved, That this Association records these sentiments with a full con- sciousness of the debt we owe to his memory, and a deep appreciation of the glory shed upon his work as well as upon the history of American medicine, and be it further Resolved, That a copy of these resolutions be sent to the family of the late Dr. Trudeau. WueEREAS, In the death of Dr. Theodore B. Sachs, The National Associa- tion for the Study and Prevention of Tuberculosis has suffered the loss of its honored president, and the entire anti-tuberculosis movement a valued worker; and WueEreas, In a spirit of self-sacrifice and devotion to the cause of humanity he has given the best of his life to the anti-tuberculosis campaign; and WuErEAS, His. signal services in tuberculosis work, both as a clinician and an administrator, have proven of inestimable worth to the people of the United States and the rest of the world; be it Resolved, That The National Association for the Study and Prevention of Tuberculosis deplores its own loss of a member, director and president, and expresses its deep and sincere appreciation of the valuable services Dr. Sachs has rendered; and be it further Resolved, That a copy of these resolutions be read at and spread upon the minutes of the twelfth annual meeting of The National Association for the Study and Prevention of Tuberculosis, and that they be transmitted by the executive secretary to the family of Dr. Sachs. WHEREAS, In the death of General George M. Sternberg this Association has lost one of its most highly valuable members, eminent for his service as an executive officer and for his attainments in medicine, as one of the leaders in the movement against tuberculosis and a co-worker with Dr. Robert Koch, and as one of the founders of this Association, be it Resolved, That the secretary be requested to extend to his family the deep sympathy of the members of this Association, while expressing their apprecia- tion of him, both as a man and a physician. TWELFTH ANNUAL MEETING 219 Wuereas, The Senate Joint Resolution number 120, introduced into the United States Congress on April 11, 1916, makes it unlawful for any officer or employee of the Public Health Service of the Federal Government to be or become a member or officer of, or in any way connected with, any medical or private health association or organization of any kind, and Wuereas, In the opinion of The National Association for the Study and Prevention of Tuberculosis the spirit of said resolution is opposed to the aims and objects for which the Association was formed, and its passage would seri- ously interfere with the progress of the anti-tuberculosis movement in the United States, therefore be it Resolved, That The National Association for the Study and Prevention of Tuberculosis records its absolute disapproval of said resolution and urges its members to take such steps as may be proper to prevent its adoption by the United States Congress. WHEREAS, In the past the tendency of general hospitals has been to exclude cases of tuberculosis, and WHEREAS, It has been demonstrated in a number of such institutions that this class of cases may be admitted into separate wards without detriment to other patients, and WueEreas, Both for humanitarian reasons and for purposes of instruction, there is need for a change of policy in this regard, therefore be it Resolved, That The National Association for the Study and Prevention of Tuberculosis recommends to general hospitals, through both their medical and lay boards, that separate wards, one for each sex, be established for the care of such cases. The report of the Committee on Nursing Education was re- ceived and accepted with thanks to the Committee for their labor upon it. At a special meeting held on the afternoon of May 12 the report of the Committee on Standards of Diagnosis of Pulmonary Tuber- culosis in Children was discussed and referred back to the com- mittee for further consideration. At a meeting of the board of directors, held on Friday, May 12, the following officers were elected for the ensuing year: Dr. Edward R. Baldwin, New York, president; Hon. Theodore Roosevelt, New York, and Sir William Osler, Oxford, honorary vice-presidents; Dr. Watson S. Rankin, North Carolina, and Dr. James Alexander Miller, New York, vice-presidents; Dr. Henry Barton Jacobs, Maryland, secretary; Mr. William H. Baldwin, District of Columbia, treasurer. 220 A HISTORY OF NATIONAL TUBERCULOSIS ASSOCIATION The following directors were elected to serve on the executive committee for the ensuing year: William H. Baldwin, District of Columbia; Dr. Hermann M. Biggs, New York; Homer Folks, New York; John M. Glenn, New York; Sherman C. Kingsley, Illinois; Dr. David R. Lyman, Connecticut; Dr. George T. Palmer, Illinois. The summarized report of the treasurer, Mr. William H. Bald- win, is as follows: Balance on hand April 30, 1915............6.- $3,043.16 IRECEIDtS sco riyincntn Rada Vs nan ea auemasanee ne gee 53,431.59 Disbursements. ..........20000 cece eee eee 45,546.27 Balance on hand April 30, 1916............... $10,928.48 At the meeting of the Association in 1916 the secretary reported a membership of 2,505; number of associations, 1,334; dispen- saries, 459; sanatoria and special hospitals, 491; open-air schools, 300. A list of officers and directors for 1915 to 1916 follows: President, Dr. Theodore B. Sachs; honorary vice-presidents, Theodore Roosevelt and Sir William Osler; vice-presidents, Dr. E. R. Baldwin and Dr. Christen Quevli; treasurer, William H. Baldwin; secretary, Dr. Henry Barton Jacobs; directors, Frederic Almy, Buffalo; Joseph S. Ames, Baltimore; Dr. Edward R. Baldwin, Saranac Lake; William H. Baldwin, Washington; Dr. W. Jarvis Barlow, Los Angeles; Miss Kate Barnard, Oklahoma City; Ernest P. Bicknell, Washington; Dr. Hermann M. Biggs, New York; Dr. Rupert Blue, Washington; Miss Mabel T. Boardman, Washington; , Dr. Vincent Y. Bowditch, Boston; Dr. Lawrason Brown, Saranac Lake; Severance Burrage, Indianapolis; Dr. Hoyt E. Dearholt, Milwaukee; Dr. George H. Evans, San Francisco; Dr. Livingston Farrand, Boulder, Colo.; Dr. Lawrence F. Flick, Philadelphia; Homer Folks, New York; Lee K. Frankel, New York; Dr. John S. Fulton, Baltimore; John M. Glenn, New York; Dr. Charles Lyman Greene, St. Paul; Dr. Elmer E. Hegg, Seattle; Frederick L. Hoffman, Newark, N. J.; Dr. Henry Barton Jacobs, Baltimore; Dr. Herbert M. King, Loomis, N. Y.; John A. Kingsbury, New York; Sherman C. Kingsley, Chi- cago; Dr.’S. A. Knopf, New York; Dr. H. R. M. Landis, Philadelphia; Miss Julia C. Lathrop, Washington; Col. J. L. Ludlow, Winston-Salem; Dr. Cabot Lull, Birmingham, Ala.; Dr. David R. Lyman, Wallingford, Conn.; Dr. O. W. McMichael, Chicago; S. Livingston Mather, Cleveland; Dr. James Alexander Miller, New York; A. L. Mills, Portland, Ore.; Dr. Charles L. Minor, Ashe- ville; John Mitchell, New York; Charles P. Neill, Washington; Dr. George T. Palmer, Springfield, Ill.; Dr. LeRoy S. Peters, Albuquerque; Dr. Charles TWELFTH ANNUAL MEETING 221 O. Probst, Columbus, O.; Dr. Christen Quevli, Tacoma; Dr. Watson S. Rankin, Raleigh, N. C.; Dr. Mazyck P. Ravenel, Columbus, Mo.; Dr. Theo- dore B. Sachs, Chicago; Dr. E. C. Schroeder, Washington; Gen. C. F. Stokes, Washington; Seymour H. Stone, Boston; Dr. Edward L. Trudeau, Saranac Lake; Dr. Thomas D. Tuttle, Seattle; Dr. E. R. Vander Slice, Kearney, Neb.; Miss Maude Van Syckle, Detroit; Dr. Gerald B. Webb, Colorado Springs; Dr. William H. Welch, Baltimore; Dr. William Charles White, Pittsburgh. Executive secretary, Charles J. Hatfield, M.D.; assistant secretary, Philip P. Jacobs, Ph.D.; field secretaries, Charles M. DeForest and Frederick D. Hopkins. The following is a list of papers read before the respective sec- tions at the meeting of May 11-12, 1916: Housing and tuberculosis—Lawrence Veiller. The separation of tuberculosis from general medicine—Thomas McCrae, M.D. The relation of the general hospital to tuberculosis—George Dock, M.D. Observations on the teaching of tuberculosis—William S. Thayer, M.D. Hemoptysis as a symptom—Frederick T. Lord, M.D. Tuberculosis often of secondary importance to other pathological conditions— C. D. Parfitt, M.D. Results obtained by the class method of home treatment in pulmonary tu- berculosis during a period of ten years—Joseph H. Pratt, M.D. D’Espine’s sign: its significance in pulmonary and glandular tuberculosis— H. S. Hatch, M.D. The use of the x-ray in the diagnosis and study of pulmonary tuberculosis— Charles L. Minor, M.D. The early diagnosis of pulmonary tuberculosis by x-rays: the Roentgeno- logical aspect—Frederick H. Baetjer, M.D. The therapeutic value of the U. S. P. tincture of iodine in the treatment of tuberculosis and other infectious diseases when properly administered and given in progressively increasing doses—John Ritter, M.D. Chronic non-tuberculous pulmonary infections—Louis Hamman, M.D., and S. Wolman, M.D. The teeth in tuberculosis—David R. Lyman, M.D. Rest of the individual lung by posture—Gerald B. Webb, M.D., Alexius M. Forster, M.D., and F. M. Houck, M.D. Gastric function in pulmonary tuberculosis—Henry K. Mohler, M.D., and Elmer H. Funk, M.D. The relation of tuberculosis of the bronchial glands to the diagnosis of tubercu- losis of the lungs—Mary E. Lapham, M.D. Complement fixation in the diagnosis of tuberculosis—H. J. Corper, M.D. A clinical and experimental study of complement fixation in tuberculosis— S. A. Petroff. Complement fixation in pulmonary tuberculosis: some clinical observations— Alfred Meyer, M.D. 222 AHISTORY OF NATIONAL TUBERCULOSIS ASSOCIATION Diagnosis of tuberculosis by complement fixation test—J. Bronfenbrenner, Ph.D., and M. J. Schlesinger. Attempts to alter the resistance of guinea-pigs to tuberculous infection and ex- tension by anaphylactic shock—Allen K. Krause, M.D. Experimental studies on cutaneous hyper-sensitiveness to tuberculo-protein— A. K. Krause, M.D. Some unusual consequences of artificial pneumothorax—A. K. Krause, M.D. Fatal hemorrhage in bone tuberculosis: case report and autopsy—Robert C. Paterson, M.D. Cellular or tissue immunity to tuberculosis and its relation to the pathology of tuberculosis—A. K. Krause, M.D. Demonstration of the lungs of rabbits immunized against tuberculous infec- tion—Willard B. Soper, M.D. Leucocytic counts in rabbits immunized against tuberculosis; a preliminary report—Robert C. Paterson, M.D., and E. N. Packard, Jr., M.D. Some derivatives of methylene blue in tuberculosis chemo-therapy—Lydia M. DeWitt, M.D. Influenza bacilli in the sputum of consumptives—Mary L. Hamblet, M.D., and H. L. Barnes, M.D. Streptothricosis of the lungs with report of cases—William M. Stockwell, M.D. Studies in tuberculin hypersensitiveness as determined by intracutaneous tests of different dosages—Myer Solis-Cohen, M.D. The occurrence of living tubercle bacilli in river water contaminated by sewage from a health resort—Lawrason Brown, M.D., S. A. Petroff, M.D., and F. H. Heise, M.D. The Diazo and urochromogen reactions in pulmonary tuberculosis—H. J. Corper, M.D., F. F. Callahan, M.D., and M. I. Marshak, M.D. Interstate factors in the tuberculosis problem—Homer Folks, LL.D. Interstate control of the tuberculosis problem—Hon. William Kent. Interstate control of tuberculosis; Will the Kent Bill help?—Gertrude Vaile. The solution of the interstate tuberculosis problem—Wilbur A. Sawyer, M.D. Dispensary standards—F. Elisabeth Crowell. Pay clinics for tuberculosis—Michael M. Davis, Jr., Ph.D. Colored physicians and colored nurses for colored patients—H. R. M. Landis, M.D. Health insurance—John B. Andrews, Ph.D. Tuberculosis relief associations—Charles J. Hatfield, M.D. Present status of medical examination of employees—Harry E. Mock, M.D. Report of the Committee on Research. Report of the Committee on Standards of Diagnosis of Pulmonary Tubercu- losis in Children. Report of Committee on Education for Student Nurses in Tuberculosis. Eleventh midwinter meeting of the American Sanatorium Association. Eleventh spring meeting of the American Sanatorium Association. CHAPTER XXIII THIRTEENTH ANNUAL MEETING HE thirteenth annual meeting of The National Association for the Study and Prevention of Tuberculosis was held at the Hotel Sinton, Cincinnati, Ohio, on Wednesday, Thurs- day, and Friday, May 9, 10, and 11, 1917. The meeting of the Association was called to order by the president, Dr. Edward R. Baldwin, at 4.30 o'clock on Wednesday. The address of the presi- dent was presented and filed for publication in the Transactions. The report of the executive office for the year ending April 30, 1917, was read and approved. On motion, duly seconded and carried, the following committee was appointed by the chair to nominate candidates for vacancies on the board of directors: William H. Baldwin, District of Columbia, chairman; Dr. Lawrason Brown, New York; Dr. David R. Lyman, Connecticut; Dr. Hoyt E. Dearholt, Wis- consin; Homer Folks, New York. On motion, duly seconded and carried, the following committee on resolutions was appointed by the chair: Dr. John H. Lowman, Ohio, chairman; Dr. Vincent Y. Bowditch, Massachusetts; Dr. Robert H. Babcock, Illinois; Dr. H. M. Bracken, Minnesota; Dr. Philip King Brown, California. The meeting was well attended, the registration being over 800, with a large representation from all parts of the United States. At the business meeting, held on Thursday afternoon, the follow- ing directors were elected for terms of five years each: Ernest P. Bicknell, District of Columbia; Dr. Vincent Y. Bowditch, Massa- chusetts; Dr. C. C. Browning, California; Dr. J. W. Coon, Wis- consin; Dr. H. K. Dunham, Ohio; Rev. George Eaves, Alabama; E. K. Gaylord, Oklahoma; Surgeon General W. C. Gorgas, Dis- trict of Columbia; Dr. Allen K. Krause, Maryland; Dr. John 223 224 A HISTORY OF NATIONAL TUBERCULOSIS ASSOCIATION H. Lowman, Ohio; Dr. Gerald B. Webb, Colorado; Dr. William Charles White, Pennsylvania. Dr. John H. Lowman, chairman of the committee on resolu- tions, presented the following resolutions with the endorsement of the committee. Each of the resolutions was unanimously adopted: InasmucH as Dr. Franklin Martin, of the Advisory Committee of the Gen- eral Medical Board of the Council of National Defense, has written to the president of The National Association for the Study and Prevention of Tuber- culosis, for recommendation to the Medical Board concerning tuberculosis, to be sent to the subcommittee of the Board, namely, Dr. Hermann M. Biggs, Chairman, Mr. Homer Folks, Dr. Lawrason Brown, Dr. George T. Palmer, and Dr. E. R. Baldwin, the following resolutions have been prepared: WHEREAS, It has been the experience of the warring nations of Europe that cases of incipient and even moderately advanced tuberculosis are frequently unrecognized in the routine examination of recruits; and Wuereas, Inactive tuberculosisis frequently rendered active by the physi- cal and mental strain and exposure of modern warfare; and WHEREAS, The appalling prevalence of tuberculosis in the armies both in the field and in the concentration camps with the inevitable and widespread extension of the infection from these to the civilian population is the greatest of all health problems presented by the present war; and WHEREAS, The extreme gravity of the situation demands that the services of all the most highly trained men available be utilized most effectively for protection against the occurrence of conditions now prevailing in France and other countries; and WHEREAS, The continued presence in their several communities of men and women now engaged in tuberculosis and other health work is likewise necessary for the preservation of the health of our people, and to care for returning invalided soldiers; therefore be it Resolved, That The National Association for the Study and Prevention of Tuberculosis in convention assembled pledges its loyal support to the Govern- ment; and further Resolved, That The National Association for the Study and Prevention of Tuberculosis urges upon the Council of National Defense the following meas- ures: I. The registration and organization for the term of the war of the tuber- culosis workers of our country, including clinicians, roentgenologists, laboratory workers, nurses, social workers, and administration officers, and their commis- sion as reserve officers. II. The division of the country into districts in which these new federal forces may be utilized without unduly interfering with the present vital work of conserving the health of their several localities. III. The employment of these forces for the following specific purposes: a. To make under the command of a ranking medical officer of the army THIRTEENTH ANNUAL MEETING 225 corps, repeated routine examination and observation of recruits while in train- ing and mobilization camps for the purpose of detecting any obscure tuber- culous lesions; b. To utilize and enlarge the existing sanatoria and hospitals of our country so that all cases of tuberculosis arising in our forces may be adequately cared for as near as possible to their own homes; c. To work out in codperation with existing health authorities a definite, comprehensive, and constructive program for adequate prevention and control of tuberculosis among the whole population. Wuereas, A large number of public health nurses have already enrolled or are being urged to enroll in the active service of the American Red Cross and other agencies for nursing work during the war; and WHEREAS, The Red Cross and other bedside nursing can be done as well by the regular graduate and undergraduate nurses as by those who have had special training in public health work, while we have no substitutes available for the latter; and WHEREAS, Our national efficiency, depending as it does upon our national health, demands of each of us that we give our services where they will be of the widest benefit rather than follow our personal inclinations therefore, be it Resolved, That The National Association for the Study and Prevention of Tuberculosis urges upon all public health nurses, and particularly upon those who have had special training in tuberculosis work, that they can best serve our country in its present crisis by continuing, for the present at least, to employ their energies with the complicated health problems of our various communities. Wuereas, The National Association for the Study and Prevention of Tuber- culosis has an organization extending throughout every State of the Union which is thoroughly conversant with health conditions and philanthropic activities, and WueEreas, The American Red Cross is confronted with the immense task of codrdinating the health and philanthropic activities throughout the country; be it Resolved, That The National Association for the Study and Prevention of Tuberculosis offers to the president of the American Red Cross the services of its organization for codperation in promoting Red Cross work in any form that may be determined upon. WueEreas, Several of the European countries engaged in the great war have found it desirable to place themselves on a prohibition basis; and Wuerzas, We wish to neglect nothing that will make for the general good of the service; and Wuereas, Our loyalty in such time of stress should lead us to ask nothing of those going to the front which those remaining are not willing to demand of themselves; therefore, be it 15 226 A HISTORY OF NATIONAL TUBERCULOSIS ASSOCIATION Resolved, That this Association place itself on record as favoring National Prohibition, both for soldiers and civilians during the war period and for one year thereafter. WuereEas, The National Association for the Study and Prevention of Tuberculosis is opposed to the vending of patent medicines and the self-ad- ministration of ‘‘cures’’ for various diseases; and WHEREAS, The American Medical Association has also condemned the sale and use of self-administered ‘‘cures’’; and WHEREAS, The patent medicine interests of the United States have been seeking an outlet for their trade in foreign countries; and WHEREAS, The United States Department of Commerce in its special Con- sular Report No. 76, issued in March, 1917, has advocated and urged upon the patent medicine interests of the United States that they exploit China and the Chinese people as a lucrative field for their business; be it Resolved, That The National Association for the Study and Prevention of Tuberculosis condemns such action on the part of the United States Depart- ment of Commerce, and that the executive secretary be instructed to forward a copy of this resolution to the secretary of said department, urging that here- after the influence of the United States Government should not be used in support of the patent medicine business, WHEREAS, Since the year 1907, the Russell Sage Foundation has generously contributed to the work of The National Association for the Study and Pre- vention of Tuberculosis, making it possible for the Association to carry on such activities as publicity, the publication of the Directory and the development of work in the field, the financing of which would have been extremely difficult; and WHEREAS, The trustees of the Russell Sage Foundation feel unable longer to continue their annual grant to the National Association; be it 5 Resolved, That The National Association for the Study and Prevention of Tuberculosis thus publicly expresses and records its appreciation and thanks for this service of the Russell Sage Foundation; and that the executive secre- tary be instructed to forward a copy of this resolution to the directors of the Russell Sage Foundation. Resolved, That the thanks of The National Association for the Study and Prevention of Tuberculosis be extended to the Local Committee of Arrange- ments, to the Cincinnati Anti-Tuberculosis League, to the Cincinnati Chamber of Commerce, and to all of those who have helped to promote the attendance at this thirteenth annual meeting, and to make it a success. The report of the Committee on the Expenditure of Red Cross Seal Funds was presented by the chairman, Homer Folks, and was adopted. The report is as follows: THIRTEENTH ANNUAL MEETING 227 REPORT OF SPECIAL COMMITTEE ON EXPENDITURE OF RED CROSS SEAL FUNDS, SHOWING AN EVALUATION OF THE PUR- POSES TO WHICH THE PROCEEDS OF THE RED CROSS SEAL SALE MAY BE APPLIED (Exact statements as to relative values are, of course, impossible, but the different purposes are stated in the order of their estimated value as preventive measures.) 1. Aiding in the Development of a State Tuberculosis Association which shall formulate a constructive program for the prevention of tuberculosis, and shall organize, codrdinate, and unify measures adopted for the fulfilment of the program. 2. Securing the Establishment, in State or Local Health Departments, of Divi- sions of Tuberculosis, or of definitely organized tuberculosis pent for the promotion of all forms of anti-tuberculosis work. 3. Direct Educational Work as to the nature, treatment, and prevention of tuberculosis, such educational work to be addressed, whenever practicable, to securing the adoption of certain definite community activities in the anti- tuberculosis campaign. This educational work should include the payment of the expenses of representatives of tuberculosis agencies in attending tubercu- losis conferences. 4. Propaganda Efforts, for the establishment and operation by public au- thorities of survey, nursing, clinic, hospital, sanatorium, day or night camp, open-air school or class, or other kindred agencies. 5. Educational and other work for safeguarding infants and others from tuberculosis infection and for increasing their powers of resistance to such in- fection. Note: In all communities having a population of more than, say, 30,000, the promotion of I, 2, 3, 4, and 5 can most effectively be done by the employment of the anti-tuberculosis organization of a paid, full-time, trained executive secretary. 6. Employment of Nurses for Tuberculosis Surveys or temporarily (pending public provision) for assisting and nursing the tuberculous sick, securing ad- mission to hospitals and sanatoria, etc. 7. Organization and Temporary Operation of Clinics, Dispensaries, or Out- Patient Stations, for the diagnosis and treatment of tuberculosis and for the expert medical examination of all persons who have been exposed to tubercu- losis. 8. Establishment and, if Need Be, Temporary Operation (Pending Public Provision) of Open-Air Schools or Fresh Air Classes for Children who are pre- tubercular or have been exposed to tuberculosis. 9. Establishment and, if Need be, Temporary Operation (Pending Public Provision) of Preventoria for pre-tuberculous cases, or children’s divisions of sanatoria or hospitals. 228 A HISTORY OF NATIONAL TUBERCULOSIS ASSOCIATION 10. Payment in Whole or Part for Maintenance of Patients in Hospitals or Sanatoria, when efforts to secure funds therefor from relatives, employers, churches, lodges, or the public or other private relief agencies prove unavailing. 11. After-Care: 1. e., advice, employment, and, if need be, relief of patients leaving sanatoria as arrested or cured. 12. Relief, of whatever medical or material form may be needed (so far as efforts to procure it from other private or public sources, as set forth in No. 10 above, prove unavailing), for families in which there is a case of tubercu- losis which cannot be placed ina hospital, provided that through definite medi- cal nursing and social supervision conditions are maintained which will prevent further infections. 13. Relief (so far as it is not available from private or public sources, as set forth in No. 10 above) which may be needed to enablea patient who is a bread- winner or a caretaker of a family to accept hospital care. We recommend: I. That the report of the committee on a circular of advice as to policy in the use of Red Cross Seal funds, appointed in January last, be adopted. 2. That this Association recommend to the American Red Cross the adop- tion of the Committee’s report as its definition of anti-tuberculosis work, in place of the existing definition. 3. That the National Association recommend to the State Associations and to local associations through State Associations, where such exist, the adoption of the program of work outlined in this Committee’s report, with any modifica- tion called for by local conditions, in the expenditure of Red Cross Seal funds and any further available resources. 4. That the National Association secure annually from State Associations and from local associations through State Associations, where such exist, a financial statement, so far as practicable, for the year ending November 1, of the expenditure of their funds; subdivided so far as may be practicable on the lines indicated by the purposes enumerated in this report. 5. That a circular letter of explanation be framed to be addressed to the State Associations and local associations and through State Associations ampli- fying the Committee’s report and dealing more fully with the relation between agencies and tuberculosis associations. The Red Cross Seal banners awarded in the inter-city and inter- state competition for 1916 were presented to the following states and cities: Wyoming, Minnesota, and New York; and Thorn- burg, Pa.; Hershey, Pa.; River Falls, Wis.; Sewickley, Pa.; Morristown, N. J.; Elmira, N. Y.; Troy, N. Y.; Rochester, N. Y.; Buffalo, N. Y.; and Brooklyn, N. Y. At a meeting of the board of directors held on the afternoon of Thursday, May 10, the following officers were elected for the ensuing year: Dr. Charles L. Minor, North Carolina, president; THIRTEENTH ANNUAL MEETING 229 Theodore Roosevelt, New York, and Sir William Osler, England, honorary vice-presidents; Dr. David R. Lyman, Connecticut, and Frederick L. Hoffman, New Jersey, vice-presidents; Dr. Henry Barton Jacobs, Maryland, secretary; William H. Baldwin, District of Columbia, treasurer. The following directors were elected to serve on the executive committee for the ensuing year: Dr. Edward R. Baldwin, New York; William H. Baldwin, District of Columbia; Dr. Hoyt E. Dearholt, Wisconsin; Dr. Lee K. Frankel, New York; John M. Glenn, New York; Dr. George Thomas Palmer, Illinois; Dr. William Charles White, Pennsylvania. The vice-presidents were authorized by special resolution to serve as members of the executive committee for the ensuing year. The summarized report of the treasurer, Mr. William H. Bald- win, is as follows: Balance on hand April 30, 1916............... $10,928.48 REGe1 PS ines oe adore Red aeahen alone koe eed alan 66,061.48 Disbursements. ........... 000 cece eee ee eens 74,469.55 Balance on hand April 30, 1917. ...........0.% $2,520.79 At the meeting of the Association in 1917 the secretary reported a membership of 2,493; number of associations, 1,100; dispen- saries, 437; sanatoria and special hospitals, 501. A list of officers and directors for 1916 to 1917 follows: President, Dr. Edward R. Baldwin; honorary vice-presidents, Theodore Roosevelt and Sir William Osler; vice-presidents, Dr. W. S. Rankin and Dr. James A. Miller; treasurer, William H. Baldwin; secretary, Dr. Henry Barton Jacobs; directors, Frederic Almy, Buffalo; Dr. Robert H. Babcock, Chicago; Dr. Edward R. Baldwin, Saranac Lake; William H. Baldwin, Washington; Dr. W. Jarvis Barlow, Los Angeles; Dr. Hermann M. Biggs, New York; Dr. Rupert Blue, Washington; Miss Mabel T. Boardman, Washington; Dr. H. M. Bracken, Minneapolis; Dr. Lawrason Brown, Saranac Lake; Dr. Philip King Brown, San Francisco; Severance Burrage, Indianapolis; Mrs. O. B. Colquitt, Dallas, Tex.; Dr. Hoyt E. Dearholt, Milwaukee; Dr. C. E. Edson, Denver; Dr. George H. Evans, San Francisco; Dr. Livingston Farrand, Boulder, Colo.; Dr. Lawrence F. Flick, Philadelphia; Miss Edna L. Foley, Chicago; Homer Folks, New York; Lee K. Frankel, New York; John M. Glenn, New York; Dr. Louis V. Hamman, Baltimore; Frederick L. Hoffman, Newark; Dr. Henry Barton Jacobs, Baltimore; H. McK. Jones, St. Louis; Dr. Herbert M. King, Loomis, N. Y.; John A. Kingsbury, New York; Sher- man G. Kingsley, Chicago; Dr. S. A. Knopf, New York; Dr. George M. 230 A HISTORY OF NATIONAL TUBERCULOSIS ASSOCIATION Kober, Washington; Dr. H. R. M. Landis, Philadelphia; Miss Julia C. Lathrop, Washington; Dr. John H. Lowman, Cleveland; Col. J. L. Ludlow, Winston-Salem; Dr. Cabot Lull, Birmingham, Ala.; Dr. David R. Lyman, Wallingford; Dr. O. W. McMichael, Chicago; S. Livingston Mather, Cleve- land; R. B. Mellon, Pittsburgh; Dr. James Alexander Miller, New York; A. L. Mills, Portland, Ore.; Dr. Charles L. Minor, Asheville; John Mitchell, New York; Charles P. Neill, Washington; Dr. George T. Palmer, Springfield, Ill.; Dr. LeRoy S. Peters, Albuquerque; Dr. Charles O. Probst, Columbus, O.; Dr. Christen Quevli, Tacoma; Dr. Watson S. Rankin, Raleigh, N. C.; Dr. Maziyck P. Ravenel, Columbia, Mo.; Dr. F. C. Schroeder, Washington; Gen. F. C. Stokes, Washington; Dr. A. K. Stone, Boston; Seymour H. Stone, Boston; Dr. E. R. Vander Slice, Mason, Mich.; Miss Maude Van Syckle, Detroit; Dr. Victor C. Vaughan, Ann Arbor; Dr. William H. Welch, Balti- more; Dr. Dunning S. Wilson, Louisville. Executive sécretary, Charles J. Hatfield, M.D.;, assistant secretaries, Philip P. Jacobs, Ph.D., and Donald B. Armstrong, M.D.; field secretaries, Charles M. DeForest and Frederick D. Hopkins. The following is a list of papers read before the respective sec- tions at the meeting of May 9-11, 1917: Lessons from Canada’s war experience with tuberculosis—Jabez M. Elliott, M.B. The relation of the federal government to the anti-tuberculosis movement— F. C. Smith, M.D. A war tuberculosis program for the nation—Hermann M. Biggs, M.D. The nose in the tuberculous—G. W. Wagner, M.D. Tuberculosis and pregnancy: A study of three hundred cases with a review of the literature—S. A. Douglass, M.D., and J. E. J. Harris, M.D. The réle of surgery in the treatment of intestinal tuberculosis—Edward Archi- ‘bald, M.D. A comparison between the skin tests, using various tuberculosis antigens and the complement fixation phenomenon—F. W. Wittich, M.D. The Wassermann reaction and pulmonary tuberculosis—James S. Ford, M.D. A tuberculosis preventorium for infants—Alfred F. Hess, M.D. Medical aspects of the Michigan tuberculosis survey—Victor C. Vaughan, Jr., M.D. Tuberculous abscess of the thoracic wall—Samuel Robinson, F.A.C.S. The primary and secondary lobules of the lung—W. S. Miller, M.D. Clinical observations derived from the examination of over three thousand chests checked by stereoroentgenograms—H. Kennon Dunham, M.D. The interpretation of pathology visualized by the roentgen examination of the chest—Lewis G. Cole, M.D., and Joseph M. Steiner, M.D. Diaphragmatic pleurisy in the tuberculous—Gerald B. Webb, M.D., Alexius M. Forster, M.D., and G. Burton Gilbert, M.D. THIRTEENTH ANNUAL MEETING 231 Are sanatoria worth while? A study of the present condition of 1,056 pa- tients discharged from Massachusetts State Sanatoria from May, 1912, to May, 1914—Bernice W. Billings and John B. Hawes, 2d, M.D. Prognosis in tuberculosis from the standpoint of the occurrence of hemoptysis and tubercle bacilli in the sputum—Fred H. Heise, M.D. Deductions from four and one-half years’ use of artificial pneumothorax in the treatment of pulmonary tuberculosis—Charles L. Minor, M.D. Undergraduate instruction in tuberculosis—Allen K. Krause, M.D. The seasonal variation of the weight-curve—Karl Schaffle, M.D. Gold therapy of tuberculosis—Lydia M. DeWitt, M.D. Experimental tuberculosis of the liver—W. B. Soper, M.D. The correlation of certain sputum findings with the clinical symptoms in pul- monary tuberculosis—Joseph Elbert Pottenger, M.D. The destruction of tubercle bacilli in the sewage of tuberculosis sanatoria— Arthur T. Laird, M.D. | The reaction of the local tubercle: a method for determining the value of in- direct therapeutic agents in tuberculosis—H. J. Corper, M.D. The pleural reaction to inoculation with tubercle bacilli in vaccinated and nor- . mal guinea-pigs—Robert C. Paterson, M.D. The Wassermann and luetin reactions in tuberculosis—H. J. Corper, M.D., W. A. Gekler, M.D., and H. C. Sweany, M.D. The cone and collateral lymphatic circulation in pulmonary tuberculosis— H. Kennon Dunham, M.D. Bilateral spontaneous non-tuberculous pneumothorax, with autopsy—Alfred Meyer, M.D. A state program for the promotion of tuberculosis nursing—Katherine M. Olmsted. Three typical case problems in tuberculosis—Mrs. Henrietta E. Knorr. A state bureau of tuberculosis hospital admissions and discharges—Amy L. Mercer. A health center in a large city—Robert H. Bishop, Jr., M.D. The social unit—Wilbur C. Phillips. The Framingham health and tuberculosis demonstration—D. B. Armstrong, M.D., M.A., M.S. Tuberculosis associations and relief agencies—Homer Folks, LL.D. An adequate relief program for tuberculosis cases—Boris D. Bogen. Rural nursing—Fannie F. Clement. Medical examination of school children in the rural districts—J. N. Hurty, M.D. Some problems of county tuberculosis hospitals—George J. Nelbach. County tuberculosis hospital problems—Otto R. Eichel, M.D. Budget and program—Arthur J. Strawson. Publicity and education—why is a press agent?—E. A. Moree. Report of Committee on Expenditure of Red Cross Seal Funds. Twelfth mid-winter meeting of the American Sanatorium Association. Twelfth spring meeting of the American Sanatorium Association. & CHAPTER XXIV FOURTEENTH ANNUAL MEETING , “HE fourteenth annual meeting of The National Tubercu- losis Association was held at the Copley-Plaza Hotel, Bos- ton, Mass., on Thursday, Friday, and Saturday, June 6, 7, and 8, 1918. The meeting of the Association was called to order by the president, Dr. Charles L. Minor, at 4.30 o’clock on Thursday. The address of the president was presented and filed . for publication in the Transactions. The report of the executive office for the year ending April 30, 1918 was read and ordered filed. On motion, duly. carried, the following committee was ap- pointed by the chair to nominate candidates for vacancies on the board of directors: Dr. Lee K. Frankel, New York, chairman; Dr. Vincent Y. Bowditch, Massachusetts; Dr. Hoyt E. Dearholt, Wisconsin; Dr. W. L. Dunn, North Carolina; Dr. Stephen J. Maher, Connecticut. On motion, duly made and carried, the following committee on resolutions was appointed by the chair: William H. Baldwin, District of Columbia, chairman; Dr. Robert H. Babcock, IIli- nois; Frederick L. Hoffman, New Jersey; Dr. Edward O. Otis, Massaschusetts; Dr. O. W. McMichael, Illinois. The meeting was well attended, the registration totaling 548, representing every state in the union except nine. Three sessions of the Clinical Section, three of the Sociological Section, two of the Pathological Section, and one of the Advisory Council were held. In addition to these there was a mass meeting under the auspices of a local committee. At the business meeting of the Association on Friday afternoon, the following directors were elected for the term of five years each: Mr. Isaac Adler, New York; Dr. W. Jarvis Barlow, Cali- fornia; Col. Frank Billings, Illinois; Col. George E. Bushnell, 232 FOURTEENTH ANNUAL MEETING 233 District of Columbia; George F. Canfield, New York; Lieut.- Col. A. M. Forster, Colorado; Dr. Alfred Henry, Indiana; Mrs. F. G. Hodgson, Georgia; Dr. Thomas McCrae, Pennsylvania; Dr. Alfred Meyer, New York; W. Frank Persons, District of Columbia; Bolton Smith, Tennessee; Miss Agnes D. Randolph, Virginia (for unexpired term of Dr. Bracken). On behalf of the committee on resolutions Mr. William H. Baldwin, chairman, presented the following resolutions with the endorsement of the committee. Each of the resolutions was unanimously adopted: WHEREAS, The board of directors of the National Association at a meeting on March 16 last voted in accordance with Article VIII of the By-Laws of this Association to amend the name of this society from The National Association for the Study and Prevention of Tuberculosis to National Tubercu- losis Association. Resolved, That, in accordance with Article VIII of the By-Laws of the Association, the action of the board of directors is hereby approved and the name of this society shall be known hereafter as National Tuberculosis Association. Resolved, That the Board of Directors of the National Tuberculosis Association be and they are hereby authorized, directed, and empowered to incorporate this Association under the laws of the state of Maine, or such other state as may be selected by them, and to transfer all the property and assets of every name and nature of this Association to such new corporation upon such terms and conditions as to them may seem desirable; and to do any and all other things in connection therewith. Resolved, That the codperation of the National Tuberculosis Association and its affiliated agencies be given to the fullest possible extent to the Inter- national Health Board of the Rockefeller Foundation in the study of the anti-tuberculosis movement being made by that organization. Resolved, That the thanks of the National Tuberculosis Association be ex- tended to the Bureau of Vocational Guidance of Harvard University for the work it is undertaking in a study of open-air schools in the United States, and Resolved, Further, That the coéperation of the National Association and all its affiliated agencies be extended in the fullest possible measure to those who are making this investigation. WHEREAS, It is vital to the progress of the medical profession that the valu- able experience being gained at the present time in war medicine and surgery be gathered together and preserved for future generations; and WHEREAS, The Army Medical Museum at Washington, D. C., is taking nec- 234 A HISTORY OF NATIONAL TUBERCULOSIS ASSOCIATION essary steps to do this with the hope that it will eventually become, as it should be, a center for medical teaching and research; and WHEREAS, Plans for a new building and new equipment and for the expan- sion of the Museum on a scale adequate to meet the growing needs brought about by the war have been made by those in charge, Resolved, That the National Tuberculosis Association pledges its support to the directors of the Army Medical Museum in their efforts to secure appropri- ation from Congress, and in other ways. WHEREAS, It has been found necessary by the American Red Cross and the National Tuberculosis Association to withdraw the rebates allowed from the ten per cent. of the gross sale of Red Cross Christmas Seals payable to the American Red Cross, and WHEREAS, Certain agents have expressed themselves as unfavorable to this change in percentage because of the withdrawal of revenue from their treasuries, Resolved, That in case any state or general agent appointed by the National Tuberculosis Association finds after the 1918 Seal Sale that his net return from the sale of Red Cross Seals has diminished below that of 1917 because of the withdrawal of rebates, the National Tuberculosis Association will recommend to the American Red Cross the adjustment of his returns to the extent of the deficit under the 1917 rate of rebate applied to the 1918 sale. WuaeErEAS, The National Tuberculosis Association and its affiliated agencies fully appreciate the necessity for prompt increase in the number of beds avail- able in tuberculosis hospitals and sanatoria throughout the United States; and WHEREAS, The Federal Reserve Board of the United States Government, through its Capital Issues Committee, has taken the position in some cases brought before it that the issuance of bonds and other securities must be limited to construction of a temporary nature only; and WueErREAS, The National Tuberculosis Association realizes that this action is in danger of decidedly hindering the construction of necessary tuberculosis hospital facilities throughout the country; and WHEREAS, The National Tuberculosis Association and its affiliated agencies desire to work heartily and earnestly with the President and the Government in taking the course which will do the country the most good with the least harm, - Resolved, That the National Tuberculosis Association urges upon all com- munities of the United States the necessity of promptly increasing their hospital provisions, and of planning them in such a way as to minimize the difference between permanent and temporary construction; and Resolved, Further, That the Capital Issues Committee be urged to allow permanent buildings to be constructed in all cases where the difference is not too great, in order that it may not be necessary to repeat the process a few years later, or to waste the money which it is so difficult to obtain for any kind of construction. FOURTEENTH ANNUAL MEETING 235 Resolved, That the National Tuberculosis Association would deplore the re- tirement of Surgeon General Gorgas from the office he now fills so admirably, and that we request that he be continued in active service in his present position, so that neither his work nor his plans may be interrupted. Resolved, That the National Tuberculosis Association expresses its apprecia- tion and thanks to the Massachusetts Anti-Tuberculosis League and the Bos- ton Association for the Relief and Control of Tuberculosis for their assistance in arranging for this meeting; to the management of the Copley-Plaza Hotel for the use of its meeting rooms; to the organizations which have shown the inter- esting and instructive exhibits; and to the nurses and others who have given able assistance in making the conference a success. Announcement of the winners of Red Cross Seal banners in the inter-state and inter-city competition for 1917 was made on be- half of the following states and cities: Wyoming, Minnesota, and Wisconsin; and Broadview, Mont.; Big Timber, Mont.; Kel- logg, Idaho; Dillon, Mont.; Phoenix, Ariz.; Tulsa, Okla.; Okla- homa City, Okla.; Minneapolis, Minn.; Buffalo, N. Y.; and Brooklyn, N.Y. . At a meeting of the board of directors on Friday afternoon, June 7, the following officers were elected for the ensuing year: Dr. David R. Lyman, Connecticut, president; Hon. Theodore Roosevelt, New York, Sir William Osler, England, and Col. George E. Bushnell, District of Columbia, honorary vice-presi- dents; Dr. Lawrason Brown, New York, first vice-president; Lee K. Frankel, Ph.D., New York, second vice-president; Dr. Henry Barton Jacobs, Maryland, secretary; Mr. William H. Baldwin, District of Columbia, treasurer. The following directors were elected to serve on the executive committee for the ensuing year: Dr. E. R. Baldwin, New York; Dr. Hoyt E. Dearholt, Wisconsin; Mr. Frederick L. Hoffman, New Jersey; Dr. O. W. McMichael, Illinois; Mr. William H. Baldwin, District of Columbia; Dr. George T. Palmer, Illinois; Mr. W. Frank Persons, District of Columbia. The vice-presidents and honorary vice-presidents were au- thorized by special resolution to attend the meetings of the execu- tive committee. The executive committee was authorized by the board of directors to consider itself a War Board and to take up actively all matters of concern in relation to tuberculosis and the war. It was also instructed to hold monthly meetings. 236 A HISTORY OF NATIONAL TUBERCULOSIS ASSOCIATION The summarized report of the treasurer, Mr. William H. Bald- win, is as follows: Balance on hand April 30, 1917.........+.-..4. $2,520.79 Recéiptsics: x vav vs uwecewegenegs eae hs nee Dewe 99,203.15 Disbursements i035 cies 04 alert ae ok aa sae es 92,062.96 Balance on hand April 30, 1918. ........-..00. $9,660.98 At the meeting of the Association in 1918 the secretary reported a membership of 4,050; number of associations, 997; dispen- saries, 457; sanatoria and special hospitals, 530. A list of officers and directors for 1917 to 1918 follows: President, Dr. Charles L. Minor; honorary vice-presidents, the Hon. Theo- dore Roosevelt and Sir William Osler; vice-presidents, Dr. David R. Lyman and Frederick L. Hoffman, Ph.D.; treasurer, William H. Baldwin; secretary, Dr. Henry Barton Jacobs; directors, Frederic Almy, Buffalo; Dr. Robert H. Babcock, Chicago; Dr. Edward R. Baldwin, Saranac Lake; Ernest P. Bick- nell, Washington; William H. Baldwin, Washington; Dr. Hermann M. Biggs, New York; Dr. Rupert Blue, Washington; Dr. V. Y. Bowditch, Boston; Dr. H. M. Bracken, Minneapolis; Dr. Lawrason Brown, Saranac Lake; Dr. Philip King Brown, San Francisco; Dr. C. C. Browning, Les Angeles; Severance Burrage, Indianapolis; Mrs. O. B. Colquitt, Austin, Tex.; Dr. J. W. Coon, Stevens Point, Wis.; Dr. Hoyt E. Dearholt, Milwaukee; Dr. H. K. Dunham, Cincinnati; Rev. George Eaves, Birmingham, Ala.; Dr. C. E. Edson, Denver; Dr. Geo. H. Evans, San Francisco; Dr. Livingston Farrand, Boulder, Colo.; Dr. Lawrence F. Flick, Philadelphia; Miss Edna L. Foley, Chicago; Lee K. Frankel, New York; E. K. Gaylord, Oklahoma City; John M. Glenn, New York; Gen. W. C. Gorgas, Washington; Dr. Louis V. Hamman, Baltimore; Frederick L. Hoffman, Newark; Dr. Henry Barton Jacobs, Baltimore; H. McK. Jones, St. Louis; Dr. Herbert M. King, Loomis, N. Y.; Sherman C. Kingsley, Cleveland; Dr. S. A. Knopf, New York; Dr. George M. Kober; Washington; Dr. Allen K. Krause, Baltimore; Dr. H. R. M. Landis, Philadel- phia; Miss Julia C. Lathrop, Washington; Dr. John H. Lowman, Cleveland; Dr. David R. Lyman, Wallingford, Conn.; Dr. O. W. McMichael, Chicago; S. Livingston Mather, Cleveland; R. B. Mellon, Pittsburgh; Dr. James Alex- ander Miller, New York; A. L. Mills, Portland, Ore.; Dr. Charles L. Minor, Asheville; John Mitchell, New York; Charles P. Neill, Washington; Dr. George T. Palmer, Springfield, Ill.; Dr. LeRoy S. Peters, Albuquerque; Dr. Christen Quevli, Tacoma, Wash.; Dr. Watson S. Rankin, Raleigh, N. C.; Dr. Mazyck P. Ravenel, Columbia, Mo.; Dr. A. K. Stone, Boston; Seymour H. Stone, Boston; Dr. E. R. Vander Slice, Mason, Mich.; Miss Maude Van Syckle, Detroit; Dr. Victor C. Vaughan, Ann Arbor; Dr. Gerald B. Webb, Colorado Springs; Dr. William Charles White, Pittsburgh. Managing director, Charles J. Hatfield, M.D.; assistant secretaries, Philip P, Jacobs, Ph.D. and Donald B. Armstrong, M.D.; field secretaries, Charles M. DeForest, Frederick D. Hopkins and H. A. Pattison, M.D. . FOURTEENTH ANNUAL MEETING 237 The following is a list of papers read before the respective sec- tions at the meeting of June 6-7, 1918: The program of the Massachusetts state department of health against tu- berculosis—Eugene R. Kelley, M.D. Massachusetts and tuberculosis—the state sanatoria—Arthur K. Stone, M.D. The municipal hospitals of Massachusetts—John F. O’Brien, M.D. How America is helping France with her tuberculosis problem—James Alex- ander Miller, M.D. How the United States is meeting the tuberculosis war problem—Col. George E. Bushnell, M.D. How Canada is meeting the tuberculosis war problem—Lieut.-Col. Jabez H. Elliott, M.B. The ultimate result in 1,654 cases of tuberculosis treated at the Modern Wood- men of America Sanatorium—J. A. Rutledge, M.D., and John B. Crouch, M.D. An x-ray study of pulmonary tuberculosis with syphilis—Cleaveland Floyd, M.D., H. K. Boutwell, M.D., and R. L. Leonard, M.D. The necessity for caring for the careless consumptive—John J. Lloyd, M.D. A study of pulmonary and pleural annular radiographic shadows—H. L. Samp- son, F. H. Heise, M.D., and Lawrason Brown, M.D. Pain in the chest with special reference to pulmonary tuberculosis—John B. Hawes, 2d, M.D. Pulmonary conditions simulating tuberculosis—Lieut.-Col. Jabez H. Elliott, M.B. Methuselah and life in the open—Vincent Y. Bowditch, M.D. The word tuberculosis—Allen K. Krause, M.D. Rest and exercise in the treatment of pulmonary tuberculosis—Hugh M. King- horn, M.D. A study of the effects of typhoid fever and anti-typhoid immunization on pul- monary tuberculosis: history of a typhoid fever epidemic at the Trudeau Sanatorium—Lawrason Brown, M.D., Fred H. Heise, M.D., S. A. Petroff, and George E. Wilson, M.D. The clinical value of complement fixation in pulmonary tuberculosis based on a study of 540 cases—Lawrason Brown, M.D., and S. A. Petroff. Diabetes complicated with tuberculosis, treated by means of the Allen Fasting Method—H. R. M. Landis, M.D., Elmer H. Funk, M.D., and C. M. Montgomery, M.D. Artificial pneumothorax and pregnancy—S. A. Slater, A.B., M.D. Institutional care of laryngo-pulmonary tuberculosis—Julius Dworetzky, M.D. The treatment of laryngeal tuberculosis by reflected condensed sunlight— Charles W. Mills, M.D., and Lieut.-Col. Alexius M. Forster, M.D. The recording of physical findings in chest examinations—D. MacDougall King, M.B. Anti-tuberculosis organization in France for the period of the war—summarized by P. Armand-DeLille, M.D. 238 A HISTORY OF NATIONAL TUBERCULOSIS ASSOCIATION The struggle against infantile tuberculosis in France and the preservation of childhood against its ravages by the system of the Oeuvre Grancher— P. Armand-DeLille, M.D. Tuberculosis as a war problem—Major Joseph H. Pratt, M.R.C., and Lawra- son Brown, M.D. Attempts to reduce the resistance of the guinea-pig to tuberculosis by means of various agents; Roentgen ray, benzene, thorium X, tuberculin, ether and chloroform—H. J. Corper, M.D. Experiments on the effect of repeated protein injections on tuberculous in- fection—Allen K. Krause, M.D., and H. S. Willis, M.D. Experimental arrested tuberculosis and subsequent infections—Edward R. Baldwin, M.D. Notes on the experimental infection of guinea-pigs with virulent tubercle bacilli—Allen K. Krause, M.D., and Linda B. Lange, M.D. Preliminary report on experiments performed to produce an immune serum for tuberculosis—H. J. Corper, M.D. Mercury in the chemotherapy of experimental tuberculosis in guinea-pigs— Lydia M. DeWitt, M.D. The urochromogen test as an aid in prognosis in far advanced pulmonary tuberculosis—Thomas H. A. Stites, M.D. The complement fixation test for tuberculosis—Linda B. Lange, M.D. A glycerine extract of tubercle bacilli as an antigen—S. A. Petroff. X-ray chest manual—Kennon Dunham, M.D. Tuberculosis of the lungs with especial reference to the importance of adenop- athy—James A. Honeij, M.D. New evidence on the cause of human tuberculosis—Burton R. Rogers, D.V.M. Reclaiming the tuberculous soldier from the military and industrial army— Lieut.-Col. Harry E. Mock. Problems in the vocational re-education of disabled men—C. A. Posser, Ph.D. Ten years’ experience with the Eudowood Farm Colony—Martin F. Sloan, M.D. Eighteen years’ experience with ergotherapy—Philip King Brown, M.D. Occupations in relation to tuberculosis—Bayard T. Crane, M.D. Occupation and industrial training of tuberculous soldiers in sanatoria— J. Roddick Byers, M.D. Employment of post-tuberculous workers—George M. Price, M.D. Three years’ experience in the employment of the discharged tuberculous patients in factory work—Edward Hochhauser. Promoting adult efficiency through child welfare—S. C. Kingsley. The Framingham health program: first year results—D. B. Armstrong, M.D., M.A., M.S. Consultation and medical examination work of the Framingham community health and tuberculosis demonstration—P. Challis Bartlett, M.D. Framingham educational and organization activities—Mary A. Abel. Thirteenth midwinter meeting of the American Sanatorium Association. Thirteenth spring meeting of the American Sanatorium Association. CHAPTER XXV FIFTEENTH ANNUAL MEETING HE fifteenth annual meeting of the National Tuberculosis Association was held at St. Paul’s Methodist Episcopal Church, Atlantic City, N. J., on Saturday, Monday, and Tuesday, June 14, 16, and 17, 1919. The meeting of the Association was called to order by the president, Dr. David R. Lyman, at 4.30 o’clock on Saturday. The address of the president was presented and filed for publica- tion in the Transactions. The report of the executive office for the year ending May 31, 1919, was read and ordered filed. The report of the committee previously appointed, Dr. James Alexander Miller, chairman, to nominate candidates for vacancies on the board of directors, was presented, and it was moved and carried that the report of the committee be accepted and that the names be forwarded for formal election to Portland, Me., where the corporate meeting was held on Monday, June 16, at 10 A. M., and the following directors were duly and legally elected for terms of five years each unless otherwise indicated: Dr. John S. Billings, New York, N. Y.; Dr. Charles V. Chapin, Providence, R. I.; Dr. Gordon K. Dickinson, Jersey City, N. J.; Dr. W. L. Dunn, Asheville, N. C.; Lee K. Frankel, New York, N. Y.; Dr. Paul A. Lewis, Philadelphia, Pa.; Dr. Harry T. Marshall, Uni- versity, Va.; Dr. John H. Peck, Des Moines, Ia.; James H. Pershing, Denver, Colo.; Fred M. Stein, New York, N. Y.; Dr. Walter R. Steiner, Hartford, Conn.; Dr. Josephine Milligan, Jackson, Ill. (four years, in place of Mr. Isaac Adler); Henry B. Platt, New York, N. Y. (one year, in place of Dr. O. W. McMichael); Dr. Z. T. Scott, Austin, Tex. (three years, in place of Dr. John H. Lowman). On motion duly made and carried, the following committee on resolutions was appointed by the chairman: Dr. Vincent Y. 239 240 A HISTORY OF NATIONAL TUBERCULOSIS ASSOCIATION Bowditch, Boston, chairman; Dr. Christen Quevli, Tacoma; Dr. G. W. Holden, Denver; Dr. Horace J. Howk, Mt. McGregor, N. Y.; Seymour H. Stone, Boston. The meeting was well attended, the registration totaling 608, with representatives from every state in the Union and from Canada and England and other foreign countries. Three sessions of the Clinical Section were held, three of the Pathological, three of the Sociological, one of the Nursing Section, and one of the Advisory Council. The announcement was made by the chair that Mr. Henry B. Platt, of New York, one of the newly elected directors, had con- sented to serve as treasurer of the Association, succeeding Mr. William H. Baldwin,-who resigned after seven years of service. On behalf of the committee on resolutions, Dr. Vincent Y. Bow- ditch, chairman, presented the following resolutions with the endorsement of the committee. Each of the resolutions was adopted unanimously: WueErEAs, The National Tuberculosis Association has always advocated a maximum amount of sunlight and fresh air as a means of prevention and cure of tuberculosis, and WHEREAS, The said Association considers the present daylight-saving law an aid in preserving the general health of the country, and in particular, a help in the prevention of tuberculosis, be it Resolved, That the National Tuberculosis Association views with concern the present effort to abrogate the daylight-saving law, and hereby protests against any effort that shall tend to stop the operation of that law. Be it Resolved, That the National Tuberculosis Association through its executive officers take immediate steps to secure the codperation of all other great health organizations, especially the American Medical Association and state and territorial health officers in placing before the American people a united demand for the adoption of universal military service as a public health measure. WHEREAS, The introduction of physical education into the schools, includ- ing instruction in health principles, direction in physical activities, and periodic physical examinations, is of vital importance in the prevention and combating of tuberculosis, and WHEREAS, The National Physical Education Service has been established for the purpose of unifying the efforts of all interested organizations for the promotion of a physical education in the elementary and secondary schools, therefore, be it FIFTEENTH ANNUAL MEETING 241 Resolved, That the National Tuberculosis Association will codperate in every practicable way with the National Physical Education Service in the promotion of physical education in the schools. Wuereas, It has become increasingly apparent that a Division of Tuber- culosis of the United States Public Health Service is necessary and that the creation of such a division will be the greatest step forward in the struggle against this disease which it is possible to take at the present time, be it Resolved, That the National Tuberculosis Association earnestly urges Con- gress to pass as promptly as possible the Ransdell-Esch bill (S. 1660, H. R. 3855) to provide such a Division of Tuberculosis in, and Advisory Council for, the United States Public Health Service. Resolved, That a vote of thanks be given to the members of the St. Paul’s Methodist Episcopal Church and to their pastor, Rev. A. A. Lucas; to the Local Committee of Arrangements, and the Committee on Registration for their splendid codperation and assistance during this conference; and to Mr. Boyer, the Superintendent of Schools, for the use of the High School Audi- torium. On behalf of the Committee on Indigent Migratory Consump- tives, Mr. James H. Pershing, chairman, presented the following report, which was ordered accepted and placed on file: REPORT OF THE COMMITTEE ON INDIGENT MIGRATORY CONSUMPTIVES In certain portions of the country, particularly the Southwest, the people are greatly concerned with the problem of the indigent migratory consump- tives. This region is relatively sparsely populated and undeveloped. There- fore, the burden of indigence is sustained with difficulty. Besides, there has existed the feeling that with life in the arid regions tuberculosis is not a con- comitant, but is the product of less salubrious climates, which is being shifted upon a people who are not responsible for its existence. The results are mani- fest. Not only is the migratory consumptive neglected, but the people of the arid regions fail to promote their own proper well-being by reason of the fear that by so doing they will be unduly burdened with responsibilities which be- long to others. Recognizing this situation, the National Tuberculosis Association, in De- cember last, appointed a committee ‘‘to make a study of the problem of the indigent migratory consumptive in all of its various aspects and to outline and prepare a plan for dealing with the problem.” The present members of the committee are the following: Mr. James H. Pershing, Chairman, Denver, Colo.; Mr. William H. Baldwin, Washington, D. C.; Dr. Philip King Brown, San Francisco, Cal.; Dr. S. J. Crumbine, Topeka, Kas.; Mr. E. K. Gaylord, Oklahoma City, Okla.; Mr. John M. Glenn, 16 242 A HISTORY OF NATIONAL TUBERCULOSIS ASSOCIATION New York City; Dr. B. J. Lloyd, Hygienic Laboratory, U. S. Public Health Service, Washington, D. C.; Dr. Z. T. Scott, Austin, Tex.; Mr. E. C. Shaw, Akron, Ohio; Dr. A. G. Shortle, Albuquerque, N. Mex.; Mrs. E. L. M. Tate- Thompson, Los Angeles, Cal.; Miss Gertrude Vaile, Denver, Colo.; Dr. Allen Hamilton Williams, Phoenix, Ariz. Dr. Severance Burrage, who in 1918 served as special public health investi- gator in Serbia with the Red Cross, and more recently on the staff of the United States Public Health Service, was appointed by the National Association as the executive secretary for the committee, with an office at 519 Chamber of Com- merce Building, Denver, Colorado. The committee met for organization at Santa Fé, New Mexico, on March I, 1919. It appeared to the committee that the subject before it naturally resolved itself into three branches: 1. The prevention of migration; 2. The measures to be taken for the relief of communities into which indi- gent consumptives most generally migrate; and 3. The relief of migrating indigent consumptives. The matter of prevention resolves itself largely into a question of education along three lines: (a) Early diagnosis by the attending physician; (b) Knowledge on the part of physician and patient that successful home treatment is possible; and (c) General diffusion of knowledge with respect to (a) and (8). The Committee has suggested to the National Association the adoption of an education program involving the following: (a) The securing for the control of tuberculosis emphasis and publicity by the Federal Government similar to that given to the control of venereal dis- eases. (b) Assistance from the Federal Government directed to the medical pro- fession by supplying information in aid of early diagnosis and home treatment. (c) The exertion of influence which may lead to the adequate financing of the Public Health Service through the appropriate Federal Department and by means of appeals to such large private endowments as the Rockefeller Founda- tion. The Committee also urges the creation of a special department of tubercu- losis in the Federal Public Health Service. Since March 1st, Dr. Burrage, the committee’s secretary, has been making an intensive study of the problem throughout the Southwest and on the Pacific Coast. Dr. Burrage has not as yet completed his investigation, but in due course will report his findings to the committee which will, in turn, report to the National Association. In view of the unfinished condition of the committee’s investigations, it is impossible at this time to state conclusions. The data at hand, however, indicate, first, that the number of indigent consumptives who seek relief by change of climate is not as great as the committee had been led to believe; and FIFTEENTH ANNUAL MEETING 243 second, that the number has been decreasing, at least during the period of the war. The problem has been complicated somewhat by the tuberculous soldier, a condition which may be expected to improve as the relief agencies provided by the Federal Government become better established. In general it may be said that throughout the Southwest there is great want of public health legislation and no adequate enforcement of such laws as do exist. Aside from the fear of the burden of indigence, public opinion does not seem to be awake to the fact that there is a tuberculosis problem—California is the only resort state which is making community provision for the care of its resident patients. The Colorado legislature, recently adjourned, refused to adopt a measure before it for the reorganization of its State Board of Health; but in this connection it should be said that the New Mexico Legislature created a Board of Health. Denver, at the municipal election of May 20, defeated a proposed bond issue to provide a municipal sanatorium for the tuber- culous. Undoubtedly the fear that such an institution would increase the in- flux of indigent consumptives was an influence against its establishment. The committee hopes to complete its work by September 1. At a meeting of the board of directors the following officers were elected for the ensuing year: Dr. Victor C. Vaughan, Michigan, president; Sir William Osler, England, and Col. G. E. Bushnell, District of Columbia, honorary vice-presidents; Dr. Gerald B. Webb, Colorado, and Mr. John M. Glenn, New York, vice- presidents; Dr. Henry Barton Jacobs, Maryland, secretary; Mr. Henry B. Platt, New York, treasurer. The following directors were elected to serve on the executive committee for the ensuing year: Dr. E. R. Baldwin, New York; Dr. George T. Palmer, Illinois; Dr. William Charles White, Pennsylvania; Dr. Vincent Y. Bowditch, Massachusetts; Dr. George M. Kober, District of Columbia; Dr. Hoyt E. Dearholt, Wisconsin; Mr. William H. Baldwin, District of Columbia. The summarized report of the treasurer is as follows: Balance, May I, 1918.......... 0.0.00 eee eee $9,660.98 Receiptss cise ck ianaw tenet aneesecia tedhan an 76,685.51 $86,346.49 Disbursements. ........... 0000 ee eee cee eee 83,294.43 Balance, December 31, 1918......-.-...-0-0+ $3,052.06 Note: This report covers a period of eight months instead of one year, the fiscal year of the Association having been changed to correspond to the calendar year. 244 A HISTORY OF NATIONAL TUBERCULOSIS ASSOCIATION At the meeting of the Association in 1919 the secretary reported a membership of 4,066; number of associations, 1,024; dispen- saries, 478; sanatoria and special hospitals, 572. A list of officers and directors for 1918 to 1919 follows: President, Dr. David R. Lyman; honorary vice-presidents, the Hon. Theo- dore Roosevelt, Sir William Osler, and Col. George E. Bushnell; vice-presi- dents, Dr. Lawrason Brown and Dr. Alfred Meyer; treasurer, William H. Baldwin; secretary, Dr. Henry Barton Jacobs; directors, Isaac Adler, Roch- ester, N. Y.; Dr. Robert H. Babcock, Chicago; Dr. Edward R. Baldwin, Saranac Lake; William H. Baldwin, Washington; Dr. W. Jarvis Barlow, Los Angeles; Ernest P. Bicknell, Washington; Col. Frank Billings, Chicago; Surg. Gen. Rupert Blue, Washington; Dr. Vincent Y. Bowditch, Boston; Dr, Lawrason Brown, Saranac Lake; Dr. Philip King Brown, San Francisco; Dr. C. C. Browning, Los Angeles; Col. Geo. E. Bushnell, Washington; George F. Canfield, New York; Dr. J. W. Coon, Stevens Point, Wis.; Dr. Hoyt E. Dear- holt, Milwaukee; Dr. H. K. Dunham, Cincinnati; Rev. George Eaves, Bir- mingham, Ala.; Dr. C. E. Edson, Denver; Dr. Livingston Farrand, Boulder, Colo.; Miss Edna L. Foley, Chicago; Lieut. Col. A. M. Forster, New Haven; E. K. Gaylord, Oklahoma City; John M. Glenn, New York; Gen. W. C. Gorgas, Washington; Dr. Louis V. Hamman, Baltimore; Dr. Alfred Henry, Indianapolis; Mrs. F. G. Hodgson, Atlanta; Frederick L. Hoffman, Newark; Dr. Henry Barton Jacobs, Baltimore; H. McK. Jones, St. Louis; Sherman C. Kingsley, Cleveland; Dr. S. A. Knopf, New York; Dr. George M. Kober, Washington; Dr. Allen K. Krause, Baltimore; Dr. H. R. M. Landis, Philadel- phia; Dr. John H. Lowman, Cleveland; Dr. David R. Lyman, Wallingford; Dr. Thomas McCrae, Philadelphia; Dr. O. W. McMichael, Chicago; S. Livingston Mather, Cleveland; Dr. Ralph C. Matson, Portland, Ore.; R. B. Mellon, Pittsburgh; Dr. Alfred Meyer, New York; Dr. James A. Miller, New York; A. L. Mills, Portland, Ore.; Dr. Charles L. Minor, Asheville; John Mitchell, New York; Dr. George T. Palmer, Springfield, Ill.; Dr. LeRoy S. Peters, Albuquerque; Dr. Christen Quevli, Tacoma, Wash.; Miss Agnes D. Randolph, Richmond; Bolton Smith, Memphis; Dr. A. K. Stone, Boston; Seymour H. Stone, Boston; Dr. E. R. Vander Slice, Ann Arbor; Miss Maude Van Syckle, Detroit; Dr. V. C. Vaughan, Ann Arbor; Maj. Gerald B. Webb, Colorado Springs; Dr. William Charles White, Pittsburgh. Managing director, Charles J. Hatfield, M.D.; assistant secretaries, Philip P. Jacobs, Ph.D., Donald B. Armstrong, M.D.; medical field secretary, H. A. Pattison, M.D.; regional secretaries, Murray A. Auerbach, Atlanta; Leet B. Myers, New York; George Everson, Spokane; Severance Burrage, Ph.D., Denver; Modern Health Crusader executive, Charles M. DeForest; field secretary, Frederick D. Hopkins; publicity secretary, B. G. Eaves. FIFTEENTH ANNUAL MEETING 245 The following is a list of papers read before the respective sec- tions at the meeting of June 14-17, 1919: The national welfare—Victor C. Vaughan, M.D. Experience abroad, showing relationship between tuberculosis and a general health program—Homer Folks, LL.D. X-ray study of advanced tuberculosis of the lungs with autopsies—Joseph Walsh, M.D., James W. Wood, M.D., and Capt. James C. Thompson, M.C. A preliminary study of clinical activity—Lawrason Brown, M.D., Fred H. Heise, M.D., S. A. Petroff, and Homer L. Sampson. A study of thirty cases of pneumothorax found in the first 2,000 consecutive cases received at U. S. A. General Hospital No. 1g—Major Kennon Dun- ham, M.C. Spontaneous pneumothorax—Capt. Everett Morris, M.C. Odds and ends in artificial pneumothorax—LeRoy S. Peters, M.D. Physical reconstruction applied in the treatment of pulmonary tuberculosis— Col. Frank Billings, M.C. The epidemiology of tuberculosis in the military service—Col. G. E. Bushnell. Medical, hospital, and special aspects of reconstruction for the tuberculous— Lieut.-Col. Estes Nichols, M.C. Tuberculosis among European nations at war—James Alexander Miller, M.D. Clinical follow-up of influenza cases—P. Challis Bartlett, M.D. The temperature of tuberculosis in its diagnostic and prognostic significance— Charles L. Minor, M.D. Community machinery for the discovery of tuberculosis—D. B. Armstrong, M.D. Employment of rest and exercise after tuberculous patients have returned to Work—Hugh M. Kinghorn, M.D. Treatment in tuberculosis—Capt. C. B. Sylvester, M.C. The classification of laryngeal tuberculosis—Julius Dworetzky, M.D. Lung abscess following operation on the upper respiratory tract—Frederick Slyfield, M.D. Etiological studies in tuberculosis—Lawrason Brown, M.D., S. A. Petroff, and Gilberto Pesquera, M.D. The origin and relationship of the bronchial artery in the guinea-pig— H. S. Willis, M.D. The circulatory relationships of experimental tubercle in the rabbit’s lung— William Snow Miller, M.D. An investigation on the acid fastness of tubercle bacilli—B. Suyenaga, M.D. The mode and growth of the tubercle bacillus on fluid mediums—Paul A. Lewis, M.D. Further observations on the inhibition of growth of the tubercle bacillus by chemical compounds—Paul A. Lewis, M.D. Some observations which may lead to the classification of tubercle bacilli— S. A. Petroff and Gilberto Pesquera, M.D. 246 A HISTORY OF NATIONAL TUBERCULOSIS ASSOCIATION Tuberculosis and evolution—Lieut. John Paul Giver, S.C. Continuous injection method in treatment of experimental tuberculosis— Julian H. Lewis, M.D., and Lydia M. DeWitt, M.D. The influence of anesthesia on experimental tuberculosis in guinea-pigs— Lawrason Brown, M.D., and S. A. Petroff. The microdrganisms, especially pneumococci and streptococci, in the sputum and blood of cases of pulmonary tuberculosis—Major H. J. Corper, M.C., Lieut. W. G. Donald, M.C., and Lieut. J. J. Enright, M.C. Streptococcus hemolyticus in tuberculous lungs—Lieut. John N. Hayes, M.C. A comparison of certain antigens used in complement fixation tests in pul- monary tuberculosis—Lieut. H. C. Young, S.C., and Lieut. J. P. Givler, S.C. Some problems in complement fixation in tuberculosis—S. A. Petroff. The types of tuberculous lesions found at autopsy in a military hospital— Lieut. E. D. Downing, M. C. An interesting case of foreign body in the bronchus recovered at postmortem —James B. Dinnan, M.D. Comparisons of stereoroentgenograms of the chest with autopsy findings at U. S. A. General Hospital No. 19, Oteen, N. C—Major Kennon Dun- ham, M.C., and Lieut. J. N. Hayes, M.C. Centralized control of tuberculosis through the United States Public Health Service—J. B. Lloyd, M.D. Centralized control of tuberculosis by state commissions or divisions of tu- berculosis—Eugene R. Kelley, M.D. Centralized control of tuberculosis by divisions of tuberculosis in county or city boards of health—Gordon K. Dickinson, M.D. Present status of soldiers and draft rejects with tuberculosis—William H. Baldwin, M.D. Occupational therapy and prevocational training for soldiers about to be dis- charged—Capt. Samuel M. North, S. C. The program of the Federal Board for Vocational Education—H. A. Pattison, M.D. Relief in the home, by state, by municipalities, by private agencies—Walter S. Ufford. Social insurance as a means of relieving poverty—John A. Lapp. An intensive educational program—Mary A. Meyers, R.N. A tuberculosis survey—Arthur K. Stone, M.D. Preparation of the public health nurse for tuberculosis nursing—Mary Van Zile, R.N. Report of the Committee on Indigent Migratory Consumptives. Fourteenth midwinter meeting of the American Sanatorium Association. Fourteenth spring meeting of the American Sanatorium Association. CHAPTER XXVI SIXTEENTH ANNUAL MEETING Ths sixteenth annual meeting of the National Tuberculosis Association was held at the Hotel Statler, St. Louis, Mo., April 21 to 24, 1920. The meeting was called to order at 2 o’clock on Thursday after- noon by the president, Dr. Victor C. Vaughan. Following a few brief remarks of welcome by Archbishop Glennon, of St. Louis, the address of the president was presented and filed for publica- tion in the Transactions. The report of the executive office for the year ending April 20, 1920, was read and ordered filed and published. The report of the nominating committee, which had been ap- pointed in March, was presented by the chairman, Dr. Vincent Y. Bowditch. The committee placed in nomination 12 directors to fill five-year terms, and two directors to fill vacancies caused by resignation. The report of the nominating committee was ap- proved and the names were forwarded for formal election to Port- land, Me., where the corporate meeting of the members of the National Tuberculosis Association was held on Friday, April 23, at 10 A.M. The following directors were duly and legally elected for terms of five years each, unless otherwise indicated: Dr. Wil- liam N. Anderson, Omaha, Neb.; Dr. A. C. Bachmeyer, Cincin- nati, O.; H. R. Cunningham, Helena, Mont.; Dr. George Dock, St. Louis, Mo.; Dr. Livingston Farrand, Washington, D. C.; Homer Folks, New York; Dr. David R. Lyman, Wallingford, Conn.; Dr. James A. Miller, New York; Henry B. Platt, New York; J. V. A. Smith, Seattle, Wash.; Prof. Reed Smith, Colum- bia, S. C.; Dr. Allen H. Williams, Phoenix, Ariz.; Miss Mary Beard, Boston, Mass. (three years in place of Mrs. F. G. Hodg- son); Dr. Walter J. Marcley, Minneapolis, Minn. (one year in place of Dr. Henry Barton Jacobs). 247 248 A HISTORY OF NATIONAL TUBERCULOSIS ASSOCIATION On motion duly made and carried, the following committee on resolutions was appointed by the president: Dr. Gerald B. Webb, Colorado Springs, chairman; Dr. S. Adolphus Knopf, New York; Dr. Philip King Brown, San Francisco; Dr. W. L. Dunn, Ashe- ville; Dr. Josephine Milligan, Jacksonville, Ill. Over 800 persons were registered at the meeting, and it is esti- mated that there was a considerable number who were not registered. The Clinical Section held two meetings and the Pathological Section one meeting. Two combined sessions of the Clinical and Pathological Sections were also held. The Advisory Council held one session, the Sociological Section three sessions, and the Nursing Section one session. On Friday evening, under the auspices of the local committee of arrangements and the Missouri Tuberculosis Association, a reception and Modern Health Crusader program was given. On behalf of the committee on resolutions, Dr. Gerald B. Webb, chairman, presented the following resolutions with the endorse- ment of the committee. Each of the resolutions was adopted unanimously: WHEREAS, In the death of Sir William Osler, Bart., the National Tuberculosis Association has suffered the loss of its first Honorary Vice-President and the three English-speaking countries, Canada, America, and England, a most dis- tinguished physician, medical teacher, and anti-tuberculosis worker; and WHEREAS, This Association is indebted to the late Sir William Osler for hav- ing been one of the prime movers in its formation and in no small measure re- sponsible for its success from the beginning until now; and WHEREAS, His interest in our Association was unabated even throughout the years of his sojourn as Regius Professor in Oxford; and WHEREAS, By his wisdom, devotion, high ideal, and love for humanity he not only labored among physicians for a better understanding of the medical problems of tuberculosis but also labored untiringly for the improvements of the social conditions responsible for the spread of tuberculosis, and always took a special interest in the care of the consumptive poor, and during the World War in the medical and sanitary care of the British and Allied armies; and WHEREAS, Sir William Osler, by his lovable personality, his genial spirit, ven- eration for his teachers, friendship for his colleagues, love for his pupils, great diagnostic skill, and devotion to his patients, endeared himself to thousands of American physicians and patients; be it Resolved, That this Association record these attributes with the full con- sciousness of the profound debt it owes to the memory of Sir William Osler and ‘SIXTEENTH ANNUAL MEETING 249 a deep appreciation of the glory he has shed upon his work as well as upon the history of the anti-tuberculosis movement in the three English-speaking coun- tries in which he lived and labored; and Resolved, further, That these resolutions be spread on the minutes of this meeting of the Association and that they be engrossed and sent to Lady Osler with the expression of profound sympathy in the great sorrow which has be- fallen her in the passing away of her distinguished husband and her brave and only son, who made the supreme sacrifice on the field of battle in the recent world war. : Wuereas, During the fifteen years of its existence the National Tuberculo- sis Association has encouraged the elaboration of new methods of handling tuberculosis, has co-ordinated existing methods, and has given its influence to the building up of a complete program for the treatment as well as the pre- vention of the disease; and WHEREAS, There appears to be a sentiment on the part of most of our work- ers that the care of arrested cases demands further elaboration and machinery, and for some years past the farm colony and industrial community have been recommended for handling this side of the question, but have not had an ade- quate trial; and WHEREAS, It is recognized that the trend from rural to urban life is a serious factor in complicating the prevention of tuberculosis, and that it is recognized that the very cases unsuited for the complications of urban life are particularly liable to break down from tuberculosis; and WueEreas, Various public and governmental agencies are asking for advice in regard to this phase of the problem, therefore be it Resolved, That the National Tuberculosis Association recognizes the present necessity for a carefully planned trial of this measure and that the President is empowered to appoint a committee to investigate and to study the situation and to recommend a proper course for the organization of such colonies and communities. WHEREAS, The campaign against tuberculosis is founded directly on medical research and animal experimentation and WueErEAs, It is necessary in the development of new discoveries that lab- oratory experiments be made upon animals, and Wuereas, Existing laws for the prevention of cruelty to animals are ade- quate to prevent improper practices; be it Resolved, That the National Tuberculosis Association approves of animal experimentation conducted under proper supervision and urges the further de- velopment of research in tuberculosis to the end that a greater knowledge of the means of prevention and treatment of the disease may be obtained; and Resolved, That the National Tuberculosis Association considers unwise spe- cial legislative restriction of experimentation on animals. Wuereas, The National Tuberculosis Association, is fully aware of the 250 A HISTORY OF NATIONAL TUBERCULOSIS ASSOCIATION widespread lack of suitable provision for the care, supervision and control of tuberculous patients in the country, either public or private, and Wuereas, The Federal Government has provided liberal pensions and skilled treatment for disabled soldiers, sailors and others entitled to care by rea- son of injuries and other diseases acquired in our country’s service during the World War, but has not thus far done so for those afflicted with tuberculosis, be it Resolved, That this Association urgently recommends immediate legislation to deal with this large problem. Furthermore and by reason of the investiga- tion of a special committee appointed to advise with the U. S. Public Health Service, which is duly charged with responsibility for the care of these disabled soldiers, sailors, etc., after their discharge from the military and naval service, we specifically urge the following: First, Immediate authorization for increased salaries for the personnel of the U.S. Public Health Service, without which it has been found and is clearly im- possible to secure or train competent medical officers. Second, Immediate appropriations for the construction of a sufficient number of sanatoria near the large centers of population and in salubrious surroundings, together with the ample provision for hospital cases in existing U.S. P. H. S. hospitals, or by establishing new units for this purpose. Furthermore, We urge that provision be made for the training and employ- ment of arrested tuberculous beneficiaries in such occupations as may be found suitable and under such conditions as will conduce to their continued health. WHEREAS, In connection with the Open Air School movement—open win- dow rooms—and classes for anemic and other children have demonstrated the value of these classes in ordinary school buildings; Wuereas, The school authorities in a number of the large cities of the United States have already adopted plans to provide open window rooms in all new school structures, be it Resolved, That the National Tuberculosis Association recommends the adop- tion of plans‘by school authorities for the provision of a sufficient number of open window rooms in every new school building hereafter erected in the United States and further resolved that copies of this resolution be circulated among the Federal, State and Local School authorities throughout the United States. WuereAs, Tuberculosis among the Negro race is very prevalent and on the increase and due partly to bad housing, bad sanitation in general and lack of institutions for tuberculous cases in all stages of the disease of the Negro race; be it Resolved, That this Association recommends the passage of better housing laws for the United States as a whole; more institutions for the treatment of tuberculous Negroes and the admission of colored physicians to post graduate courses in the study of tuberculosis. Resolved, That the National Tuberculosis Association expresses its apprecia- SIXTEENTH ANNUAL MEETING 251 tion and thanks to the Local Committee on Arrangements, the St. Louis Soci- ety, and the Missouri Tuberculosis Association for their generous hospitality and their assistance in arranging for this meeting; to the Management of the Hotel Statler for the use of its meeting rooms and to all those who have helped to make the conference a success. On behalf of the Committee on Indigent Migratory Consump- tives, Mr. James H. Pershing, Chairman, presented a report. On motion duly made and carried, it was ordered that the report be accepted and the Committee be continued and enlarged. The report of the Committee follows: FINAL REPORT OF COMMITTEE ON INDIGENT MIGRATORY CONSUMPTIVES Your Committee, through its Secretary, has collected a large amount of data concerning the indigent migratory consumptive, largely from the southwestern states, but including a number of communities in other parts of the country as well. Unfortunately the records available have been so incomplete that au- thentic figures in regard to a number of the points investigated could not be obtained. We have however been able to learn certain definite facts. First: That there is a large indigent migratory problem. The region most seriously affected is the Southwest,—Arizona, California, Colorado, New Mex- ico and Texas receiving by far the greater majority of migrants. Colorado and California have the largest number, but in proportion to the population Ari- zona, New Mexico and certain small communities in Texas are more seriously affected. Certain communities in Kansas, Wyoming, Utah, eastern Texas and several cities in the Middle West may be looked upon as gateways, which receive cases stopping off en route to the so-called«health resort. states. Second: That the problem also prevails more or less extensively in other health resort communities, particularly in Asheville, certain portions of Florida, and Saranac Lake. Also, there is a definite movement of tuberculous indigents toward and from the large industrial centers of the East and Middle West. Third: That the ex-soldier is no longer to be regarded as a factor in the indi- gent migratory consumptive problem, because of Government care. Fourth: That among these cases there is an unusually high death rate within the first year after migration. For example, in Arizona, out of 1,132 deaths from tuberculosis reported in 1918, 440 or 39 24 per cent. had resided in the state less than twelve months. Fifth: That, of the indigent tuberculous persons, a varying but large per: centage are non-residents. Sixth: That the principal causes of the migration of the indigent tubercu- lous are: 252 A HISTORY OF NATIONAL TUBERCULOSIS ASSOCIATION 1. The advice of physicians. Out of 1,786 cases reported from the southwestern States in the last six months 738 were advised to go there by their physicians. 2. By the advice of others. 250 of the 1,786 cases upon such advice. 3. The passing on of indigent cases by charity organizations of local officials. This cause is diminishing, apparently through better codperation between social agencies. 4. The lack of knowledge and lack of facilities for treatment in home states. This applies not only to the lack of sanatoria, but more especially to the ignor- ance on the part of the public concerning the proper treatment of tuberculosis, and to the faulty diagnosis, as well as the indifference and ignorance in regard to the treatment on the part of many physicians. Thus, no other remedy being known to the patient, he is practically forced to seek a change of climate. 5. The alluring advertisements: put out by some health resort communities. For example, an illustrated booklet from the chamber of commerce of a south- western city states, ‘‘ While the climate alone is almost a specific for incipient tuberculosis . . . there is ample provision for sufferers who need hospital treatment.” In view of these ascertained facts, your Committee has come to the following conclusions: A. That the problem is a serious one demanding immediate attention, be- cause 1. It isa menace to the public health. The indigent migratory consumptive is ignorant and careless, and is a danger to those about him both during his mi- gration and after he arrives in a community not prepared to look after him. 2. It is a heavy financial drain on the communities to which the migration goes. 3. It is the cause of much needless suffering and loss of life. Inadequate care, worry, homesickness, lack of proper food and often actual starvation, are the conditions frequently met. A certain number of these cases that die undoubtedly might have recovered had they stayed at home. B. That the remedy for this whole situation lies in the education of the doc- tors and the public, and in increased facilities for the treatment of patients in their home states. Your Committee therefore makes these general recommendations: A. That an extensive campaign of education of physicians and the public be instituted by the following agencies: 1. The United States Public Health Service, through a division of tubercu- losis. 2. The American Medical Association and its Journal, and the component state medical associations and their journals. 3. State Boards of Health and their publications. 4. The National, state, and local tuberculosis associations. 5. Agricultural and labor publications. 6. Chambers of commerce of health resort communities. SIXTEENTH ANNUAL MEETING 253 B, That persistent efforts be made to increase facilities for the early diagno- sis and treatment of patients in their home states. 1. By the establishment of schools for the intensive study of tuberculosis similar to those at Trudeau and Colorado Springs. 2. By the construction of ,additional sanatoria and the establishment of more tuberculosis clinics. C. That health resort communities be urged to make and enforce such rules and regulations as are necessary to protect themselves from the dangers caused by the presence of persons afflicted with tuberculosis. Such regulation and supervision are necessary in all states but especially so in those to which suffer- ers go from other states. Better control along these lines might become an im- portant factor in actually reducing migration. To assist in the practical and early fulfillment of these general recommenda- tions your Committee makes the following specific suggestions: First: That our Association urge the establishment of a division of tuber- culosis in the United States Public Health Service, provided with adequate funds and personnel. Second: That this Indigent Migratory Consumptive Committee be con- tinued, with power to enlarge, for the purpose of furthér study, and particularly for the purpose of inaugurating the proposed educational and publicity work. On behalf of the Committee on History of the National Associa- tion, Dr. S. Adolphus Knopf read a progress report and summary of the history as it was compiled to date. In connection with it he read short tributes to the departed leaders of the Association, 4. €., Grover Cleveland, honorary vice-president from 1905 to 1908; Theodore Roosevelt, honorary vice-president from 1906 to 1919; Edward Livingston Trudeau, the first president; Edward G. Janeway, president I909-1910; Theodore B. Sachs, president 1915-1916; John Henry Lowman, president 1913-1914; Surgeon General George M. Sternberg, treasurer from 1904 to 1912; and lastly, Sir William Osler, honorary vice-president from 1905 to 1919. After the reading of the report, Dr. Knopf made the motion that the president request the audience to rise and remain stand- ing in silence for a few moments in honor of the departed leaders of the Association. At a meeting of the board of directors the following officers were elected for the ensuing year: Dr. Gerald B. Webb, Colorado, president; General William C. Gorgas, District of Columbia, honorary vice-president; Colonel George E. Bushnell, Massa- chusetts, honorary vice-president; Dr. Philip King Brown, Cali- 254 A HISTORY OF NATIONAL TUBERCULOSIS ASSOCIATION fornia, and Dr. James Alexander Miller, New York, vice-presi- dents; Dr. George M. Kober, District of Columbia, secretary; Mr. Henry B. Platt, New York, treasurer; Mr. Wadleigh B. Drummond, Maine, clerk. The following directors were elected to serve on the executive committee for the ensuing year: Dr. H. Kennon Dunham, Ohio; Dr. W. L. Dunn, North Carolina; Miss Edna L. Foley, Illinois; Dr. Alfred Henry, Indiana; Dr. Walter R. Steiner, Connecticut; Dr. Victor C. Vaughan, Michigan; Dr. William Charles White, Pennsylvania. The summarized report of the treasurer, Mr. Henry B. Platt, is as follows: Balance, December 31, 1918...........+4: $3,052.06 IReCelpts 5.7 cis aq siasexcae Div ae aes ep hesy 2,743,819.31 $2,746,871.37 Disbursements...............04- inane 2,728,159.35 Balance, December 31, I919............-- $18,712.02 A list of officers and directors for 1919 to 1920 follows: President, Dr. Victor C. Vaughan; honorary vice-presidents, Sir William Osler and Col. George E. Bushnell; vice-presidents, Dr. Gerald B. Webb and John M. Glenn; treasurer, Henry B. Platt; secretary, Dr. Henry Barton Jacobs; clerk, W. B. Drummond; directors, Dr. Robert H. Babcock, Chicago; Dr. Edward H. Baldwin, Saranac Lake; William H. Baldwin, Washington; Dr. W. Jarvis Barlow, Los Angeles; Ernest P. Bicknell, Washington; Col. Frank Billings, Chicago; Dr. John S. Billings, New York; Dr. Vincent Y. Bowditch, Boston; Dr. Philip King Brown, San Francisco; Dr. C. C. Brown- ing, Los Angeles; Col. George E. Bushnell, Washington; George F. Canfield, New York; Dr. Charles V. Chapin, Providence; Dr. J. W. Coon, Stevens Point, Wis.; Dr. Hoyt E. Dearholt, Milwaukee; Dr. G. K. Dickinson, Jersey City; Maj. H. K. Dunham, Cincinnati; Dr. W. L. Dunn, Asheville; Rev. Geo. Eaves, Birmingham, Ala.; Dr. C. E. Edson, Denver; Miss Edna L. Foley, Chicago; Dr. A. M. Forster, Colorado Springs; Lee K. Frankel, New York; E. K. Gaylord, Oklahoma City; John M. Glenn, New York; Surg. Gen. W. C. Gorgas, Washington; Dr. Louis V. Hammon, Baltimore; Dr. Alfred Henry, Indianapolis; Dr. H. W. Hoagland, Colorado Springs; Mrs. F. G. Hodgson, Atlanta; Dr. Henry Barton Jacobs, Baltimore; H. McK. Jones, St. Louis; Sherman G. Kingsley, Cleveland; Dr. George M. Kober, Washington; Dr. Allen K. Krause, Baltimore; Dr. Paul A. Lewis, Philadelphia; Dr. Thomas McCrae, Philadelphia; Dr. Harry T. Marshall, University, Va.; Dr. Ralph C. Matson, Portland, Ore.; R. B. Mellon, Pittsburgh; Dr. Alfred Meyer, New SIXTEENTH ANNUAL MEETING 255 York; Dr. Josephine Milligan, Jacksonville, Ill.; Dr. George T. Palmer, Spring- field, Ill.; Dr. John H. Peck, Des Moines; James H. Pershing, Denver; Dr. LeRoy S. Peters, Albuquerque; Henry B. Platt, New York; Dr. Christen Quevli, Tacoma, Wash.; Miss Agnes D. Randolph, Richmond; Dr. Z. T. Scott, Austin, Texas; Bolton Smith, Memphis, Tenn.; Fred M. Stein, New York; Dr. Walter R. Steiner, Hartford; Dr. A. K. Stone, Boston; Seymour H. Stone, Boston; Dr. E. R. Vander Slice, Ann Arbor; Miss Maude Van Syckle, Detroit; Dr. Victor C. Vaughan, Ann Arbor; Dr. Gerald B. Webb, Colorado Springs; Dr. William Charles White, Pittsburgh. Executive Staff: Administrative Service, Charles J. Hatfield, M.D., man- aging director; Philip P. Jacobs, Ph.D., assistant secretary; A. J. Leverton, office secretary; Grace Douglass, assistant office secretary; L. B. Whitcomb, purchasing agent; F. W. Coriell, auditor. Medical Service, H. A. Pattison, M.D., medical field secretary; T. B. Kidner, institutional secretary; Benjamin K. Hays, M.D., educational secre- tary; Mary E. Marshall, R.N., secretary for nursing. Modern Health Crusade Service, Charles M. DeForest, crusader executive; Mildred Terry, assistant crusader executive. Framingham Demonstration, Donald B. Armstrong, M.D., executive officer; P. Challis Bartlett, M.D., chief medical examiner. Field Service, Frederick D. Hopkins, supervisor of field service. Regional Secretaries, Murray A. Auerbach, Atlanta; Paul L. Benjamin, Philadelphia; George Everson, Portland, Ore.; Leet B. Myers, New York; Arthur J. Strawson, Indianapolis; John Tombs, Albuquerque, N. M. Research Service, Jessamine S. Whitney, research secretary; Eleanor B. Conklin, research secretary; Josephine McK. Stults, librarian. Publicity Service, Basil G. Eaves, publicity secretary; Helena V. Williams, assistant publicity secretary. National Committee on Indigent Migratory Consumptives, Severance Burrage, D.P.H., secretary, Denver. The following is a list of the papers read before the respective sections of the meeting of April 21-24, 1920: The administrative problem of public health nursing—A. W. Freeman, M.D. The Red Cross program for codperation in public health nursing—Elizabeth G. Fox. : Codperation in public health nursing between the state society and the state health organization—Robert G. Paterson, Ph.D. The need of a unified nursing service—Katherine M. Olmsted. Intrapleural hypertension for evacuating pus through bronchi in spontaneous pyopneumothorax—Alfred Meyer, M.D., and B. Stivelman, M.D. The classification of pulmonary tuberculosis, based upon symptoms, physical and x-ray findings—Lawrason Brown, M.D., Fred H. Heise, M.D., and H. L. Sampson. 256 A HISTORY OF NATIONAL TUBERCULOSIS ASSOCIATION Physical diagnosis vs. the x-ray in disease of the lungs—George William Norris, M.D. First infection with tuberculosis—Eugene L. Opie, M.D. The relation of sound and light to the interpretation of x-ray examinations of the chest—J. J. Singer, M.D. The classification of pulmonary tuberculosis as modified by stereoscopic Roentgenographs—Bertram H. Waters, M.D., and J. Burns Amberson, Jr., M.D. The concurrence of intestinal tuberculosis in patients with pulmonary tubercu- losis at the Trudeau Sanatorium—Lawrason Brown, M.D., Homer L, Sampson, and F. H. Heise, M.D. Studies on pneumothorax and tuberculosis—H. J. Corper, M.D., Saling Simon, M.D., and O. B. Rensch, M.D. How may the tuberculous patient secure an arrestment of his disease without becoming an invalid?—F. M. Pottenger, M.D. Relationship of influenza to clinical pulmonary tuberculosis; deductions from the epidemic of 1918-1919—Martin F. Sloan, M.D. Twenty years’ experience with the subcutaneous tuberculin test—Lawrason Brown, M.D., and Fred H. Heise, M.D. Serological studies in tuberculosis, third contribution, concerning precipitins and complement-fixing antibodies—Yoshio Nishida, M.D., and S. A. Petroff. Masked juvenile tuberculosis—J. V. Cooke, M.D., and T. C. Hempelmann, M.D. Studies on the inhibitory action of sodium cinnamate in tuberculosis—H. J: Corper, M.D., H. Gauss, M.D., and W. A. Gekler, M.D. The influence of creosote, guaiacol, and related substances on the tubercle bacillus and on experimental tuberculosis—Lydia M. DeWitt, M.D., Binzi Suyenaga, M.D., and H. Gideon Wells, M.D. Tb.—the proper abbreviation for the words ‘‘tuberculous” or “‘tuberculosis’— L. B. McBrayer, M.D., F.A.C.P. Some problems in the differential diagnosis of pulmonary tuberculosis—James Alexander Miller, M.D. Pulmonary findings in circulatory changes—J. S. Pritchard, M.D., and M. A. Mortensen, M.D. Influenza as a factor in the activation of latent tuberculosis—Louis C. Bois- liniere, M.D. Tuberculosis among the Negroes—H. G. Carter, M.D. The influence of smallpox and vaccination on pulmonary tuberculosis— Horace John Howk, M.D., and William E. Lawson, M.D. A study of the effect of pulmonary tuberculosis on vital capacity, first report— F. W. Wittich, M.D., J. A. Myers, Ph.D., and F. L. Jennings, M.D. Elimination of tuberculosis from the army—Ralph C. Matson, M.D. Climate—LeRoy S. Peters, M.D. Pregnancy and pneumothorax—Ethan A. Gray, M.D. SIXTEENTH ANNUAL MEETING 257 The importance of physical signs in the prognosis of pulmonary tuberculosis —Francis B. Trudeau, M.D. Artificial heliotherapy in pulmonary tuberculosis—Selig Simon, M.D. Silence in the treatment of pulmonary tuberculosis—S. W. Schaefer, M.D. Extrapleural thoracoplasty and a modification of the operation of apicolysis, utilizing muscle flaps for compression’ of the lung—Edward Archibald, M.D. Pulmonary hemorrhage in Banti’s disease—Herbert M. Rich, M.D. A report of the results by heliotherapy in surgical tuberculosis after six and one-half years’ use at the J. N. Adam Memorial Hospital—Clarence L. Hyde, M.D., and Horace LoGrasso, M.D. An investigation on the acid fastness of tubercle bacilli, II—Binzi Suyenaga, M.D. The utilization of amino acids by tubercle bacilli and other acid fast organisms —Esmond R. Long, Ph.D. Hypernephrectomy and experimental tuberculosis—Gerafd B. Webb, M.D., G. B. Gilbert, M.D., J. B. Hartwell, M.D., and C. T. Ryder, M.D. Possibilities of producing local lung lesions in smaller animals—William Charles White, M.D. Weight curves of tuberculous guinea-pigs—Lydia M. DeWitt, M.D. Studies on the relation of dust to tuberculosis—a preliminary report on the effect of inhaled granite dust on pulmonary tuberculosis—LeRoy U. Gard- ner, M.D. Experimental arrested tuberculosis and subsequent infections—Edward R. Baldwin, M.D. The effect of heat on experimental tuberculosis—H. J. Corper, M.D., and H. Gauss, M.D. The effect of bleeding upon tuberculosis in the guinea-pig—H. J. Corper, M.D. Experimental studies on the leucocytes with particular reference to tubercle bacillus infections—J. B. Rogers, M.D. Possible modifications in tuberculosis programs on the basis of recent Framing- ham experience—D. B. Armstrong, M.D. Some findings in regard to the economic costs of tuberculosis—Jessamine S. Whitney. Sociology and public health—H. W. Hill, M.D. The industrial colony in the campaign against tuberculosis—Alexius M. Forster, M.D. Let the public know—B. L. Taliaferro, M.D. Rehabilitation of discharged tuberculous service men—John W. Turner, M.D. Control of tuberculosis in industrial organizations—John S. Billings, M.D. The program of the American Red Cross with reference to tuberculosis and other diseases—Ervin A. Peterson, M.D. A broader attack on tuberculosis—Joseph Herzstein. Tuberculosis in the Philippines—Carmelo Penaflor, M.D. Nutrition classes for undernourished children—Mrs. Ira Couch Wood. The relations of feeble-mindedness and tuberculosis—K. A. Menninger, M.D. 17 258 A HISTORY OF NATIONAL TUBERCULOSIS ASSOCIATION The crusade in the school and the community—M. Grace Osborne. University leadership in public health—John Sundwall, Ph.D., M.D. Some considerations on tuberculosis—Sir Arthur Newsholme, M.D., K.C.B. Occupational therapy and tuberculous patients—Bertha Thompson. The value of occupational therapy in tuberculosis sanatoria from a medical administrative standpoint—Glenford L. Bellis, M.D. Missouri Association for Occupational Therapy—Idelle Kidder. Final Report of Committee on Indigent Migratory Consumptives. Report of Committee on History. Final Report of the Committee on Standardization of Sanatoria of the Ameri- can Sanatorium Association. Fifteenth midwinter meeting of the American Sanatorium Association. Fifteenth spring meeting of the American Sanatorium Association. CHAPTER XXVII SEVENTEENTH ANNUAL MEETING , NHE seventeenth annual meeting of the National Tubercu- losis Association was held at the Waldorf Astoria Hotel, New York City, on June 14, 15, 16, and 17, 1921. The meeting was called to order at 2 o’clock on Tuesday after- noon by the president, Dr. Gerald B. Webb. Following the address of welcome by Dr. Hermann M. Biggs, chairman of the honorary committee of arrangements, the ad- dress of the president was presented and filed for publication in the Transactions. The report of the executive office for the year ending June I, 1921, was read and ordered filed. The report of the nominating committee, which had been ap- pointed in March, was presented by the chairman, Dr. Lee K. Frankel. In view of the fact that a new constitution and by-laws were ratified by the board of directors at its meeting on March 11, 1921, following the recommendation of the committee on reorganiza- tion, it became necessary for the nominating committee to nomi- nate a new board of directors under the new by-laws. The board is to consist of representative directors, nominated by ‘‘repre- sented affiliated’’ associations and, in addition, 50 directors at large. The report of the nominating committee is as follows: DrrEcTors TO SERVE ONE YEAR TERM Representative Directors: Dr. William N. Anderson, Omaha, Neb.; Mr. George F. Canfield, New York City, N. Y.; Mr. H. M. Cass, Huron, S. D.; Dr. J. W. Coon, Stevens Point, Wis.; Dr. O. C. Gebhart, St. Joseph, Mo.; Dr. Charles R. Grandy, Norfolk, Va.; Major R. J. Guinn, Atlanta, Ga.; Dr. Alfred Henry, Indianapolis, Ind.; Dr. G. Walter Holden, Denver, Colo.; Dr. A. T. Laird, Nopeming, Minn.; Dr. Charles H. Lerrigo, Topeka, Kan.; Dr. Thomas McCrae, Philadelphia, Pa.; Dr. E. D. Merrill, Foxcroft, Me.; Dr. Edward O. Otis, Boston, Mass.; Mr. J. F. Owens, Oklahoma City, Okla.; Mrs. H. E. Pearce, Birmingham, Ala.; Dr. J. W. Pettit, Ottawa, Ill.; Dr. D. 259 260 A HISTORY OF NATIONAL TUBERCULOSIS ASSOCIATION L. Richardson, Providence, R. I.; Dr. Thomas J. Riley, Brooklyn, N. Y.; Dr. E. O. Schroeder, Bethesda, Md.; Dr. Z. T. Scott, Austin, Texas; Mr. J. V. A. Smith, Seattle, Wash.; Col. Kenneth P. Williams, Little Rock, Ark.; Mr. R. B. Wilson, Raleigh, N. C.; Dr. John M. Wise, Glencliff, N.H. Direc- tors at large: Dr. Edward R. Baldwin, Saranac Lake, N. Y.; Mr. William H. Baldwin, Washington, D. C.; Dr. Hermann M. Biggs, New York City, N. Y.; Dr. Vincent Y. Bowditch, Boston, Mass.; Dr. C. C. Browning, Los Angeles, Cal.; Col. George E. Bushnell, Bedford, Mass.; Dr. S. J. Crumbine, Topeka, Kansas; Dr. H. K. Dunham, Cincinnati, Ohio; Dr. W. L. Dunn, Asheville, N.C.; Dr. Livingston Farrand, Washington, D. C.; Dr. Lee K. Frankel, New York City, N. Y.; Mr. E. K. Gaylord, Oklahoma City, Okla.; Mrs. John M. Glenn, New York City, N. Y.; Father Charles Hannigan, Baltimore, Md.; Mr. A. W. Jones, Jr., St. Louis, Mo.; Mr. John A. Kingsbury, New York City, N. Y.; Mrs. R. C. McCredie, Sunnyside, Washington; Dr. O. W. McMichael, Chicago, Ill.; Dr. Josephine Milligan, Jacksonville, Ill.; Dr. Charles L. Minor, Asheville, N. C.; Dr. B. S. Pollak, Secaucus, N. J.; Dr. Theobald Smith, Princeton, N. J.; Dr. Gerald B. Webb, Colorado Springs, Colo.; Dr. William H. Welch, Baltimore, Md.; Dr. William Charles White, Pittsburgh, Pa. DrrEcTors TO SERVE Two YEAR TERM Representative Directors: Dr. G. H. Barksdale, Charleston, W. Va.; Dr. Robert H. Bishop, Jr., Cleveland, Ohio; Dr. Henry Boswell, Sanatorium, Miss.; Dr. T. Z. Cason, Jacksonville, Fla.; Mr. H. R. Cunningham, Helena, Mont.; Dr. S. B. English, Glen Gardner, N. J.; Dr. A. F. Fischer, Hancock, Mich.; Dr. John W. Flinn, Prescott, Ariz.; Mrs. John M. Fulton, Reno, Nev.; Dr. J. Grassick, Grand Forks, N. D.; Dr. Ethan A. Gray, Chicago, IIl.; Dr. A. T. McCormack, Louisville, Ky.; Dr. Stephen J. Maher, New Haven, Conn.; Dr. Ralph C. Matson, Portland, Ore.; Dr. James Alexander Miller, New York City, N. Y.; Dr. Charles R. Mowery, Wallace, Idaho; Dr. John H. Peck; Des Moines, Iowa; Dr. Robert A. Peers, Colfax, Cal.; Dr. Edward J. Rogers, Pittsford, Vt.; Dr. J. D. Shingle, Cheyenne, Wyo.; Dr. Martin F. Sloan, Baltimore, Md.; Mr. Henry Teitlebaum, Nashville, Tenn.; Mr. John P. Thomas, Jr., Columbia, S. C.; Mr. James H. Wallis, Salt Lake City, Utah; Mr. Edward A. Woods, Pittsburgh, Pa. Directors at large: Dr. Wallace S. Allis, Norwich, Conn.; Dr. A. C. Bachmeyer, Cincinnati, Ohio; Dr. W. Jarvis Barlow, Los Angeles, Cal.; Dr. Max Biesenthal, Chicago, IIl.; Dr. Frank Billings, Chicago, Ill.; Dr. James A. Britton, Chicago, Ill.; Dr. Lawrason Brown, Saranac Lake, N. Y.; Dr. Hoyt E. Dearholt, Milwaukee, Wis.; Dr. William DeKleine, Flint, Mich.; Mr. Henry S. Dennison, Framingham, Mass.; Dr. Oscar Dowling, New Orleans, La.; Mr. Homer Folks, New York City, N. Y.; Dr. A. M. Forster, Colorado Springs, Col.; Mr. Hugh Frayne, New York City, N. Y.; Mr. Morton D. Hull, Chicago, Ill.; Mr. Sherman C, Kings- ley, Philadelphia, Pa.; Dr. Roger I. Lee, Cambridge, Mass.; Dr. Paul A. Lewis, Philadelphia, Pa.; Dr. David R. Lyman, Wallingford, Conn.; Dr. Alfred Meyer, New York City, N. Y.; Dr. George M. Price, New York City, SEVENTEENTH ANNUAL MEETING 261 N. Y.; Mr. Julius Rosenwald, Chicago, Tll.; Mr. Fred M. Stein, New York City, N. Y.; Dr. Charles Stover, Amsterdam, N. Y.; Mrs. F. E. Whitley, Webster City, Iowa. The report of the nominating committee was approved and the names were forwarded for formal election to Portland, Me., where the corporate meeting of the members of the National Tuberculosis Association was held on Wednesday, June 15, at 12 o’clock noon, and the directors were duly and legally elected. Over 1,000 persons were registered at the meeting and a con- siderable number who attended were not registered. The Clinical Section held three meetings and the Pathological Section two meetings. A combined session of the Clinical and Pathological Sections was also held. The Advisory Council held one session, the Sociological Section three sessions, the Nursing Section two sessions. There was also a combined session of the Sociological and Nursing Sections. Under the direction of the local committee on arrangements several unique features were provided, among which were an exhibit, a demonstration by the health clown, ‘‘Humpty Dumpty,” and a pageant, ‘‘ The Spirit of the Double-Barred Cross.”’ The following committee on resolutions was appointed by the president: Dr. George M. Kober, Washington, D. C., chairman; Dr. Philip King Brown, San Francisco; Dr. Vincent Y. Bowditch, Boston; Dr. E. R. Baldwin, Saranac Lake; Dr. J. W. Pettit, Ottawa, III. On behalf of the committee on resolutions, Dr. George M. Kober, chairman, presented the following resolutions with the endorsement of the committee. Each of the resolutions was adopted unanimously. Wuereas, The National Tuberculosis Association has always been deeply concerned with the subject of medical education in tuberculosis, and Wuereas, The movement for the inauguration of special departments of tuberculosis has as yet been taken up by very few of our medical schools, and WHEREAS, We regard the spread of this movement as of vital importance to the future development of all tuberculosis work, be it therefore Resolved, First, that the medical schools of our country be urged to take special account in the development of their curricula of the necessity for the -establishment of such departments. Second, that in the question of the location of new sanatoria due considera- 262 A HISTORY OF NATIONAL TUBERCULOSIS ASSOCIATION tion be given to placing them, whenever possible, where their facilities will be available for the development of such special tuberculosis departments in our medical schools. Wuereas, The rehabilitation of our tuberculous ex-service men and women is at once our most imperative duty and the biggest problem in public health before our people, and WuereEas, The National Tuberculosis Association through the codperation with the government services, both of the executive staff and of its individual members, has acquired a close familiarity with the work of these various ser- vices and especially that of the tuberculosis hospitals, and WHEREAS, The best results in these hospitals can only be attained by the maintenance of a close codperation of physicians and patients under strict dis- ciplinary regulations, and WHEREAS, Such conditions do not at present generally exist in government tuberculosis hospitals in spite of the continuous and conscientious effort of gov- ernment departments, and WHEREAS, The chief causes of this fatal defect are: first, the demoralizing influence upon many of the men of the present compensation act and its ad- ministration; second, the failure of the public, of the Congress, of the local posts of the American Legion and of other organizations interested in the wel- fare of ex-service men, to familiarize themselves with the facts of the tuber- culosis situation and to bring to the aid of the government departments that intelligent codperation which they sorely need and without which they cannot do their best work; be it therefore Resolved, That it be urged upon Congress both by the executive office of the National Tuberculosis Association and by each affiliated state association through the members of its state delegation, that the government departments be given the assistance necessary to establish the discipline so essential to the maintenance of this needed morale by: First, such changes in the compensation act as will result in the immediate and material reduction in compensation for those cases who refuse to make proper use of the facilities provided for their benefit, and Second, by making the welfare of the men and of the country at large, and not the desires of the individual constitutents, the basis of action both as re- gards appointments of those charged with the care of these men, and as regards the individual cases of the men themselves. Resolved, That the National Tuberculosis Association hereby expresses its appreciation and commendation of the efforts thus far of the national officials of the American Legion to have corrected the defects in legislation pertaining to rehabilitation of ex-service men, and its administration, and urges the Legion to continue these efforts and to see that its local posts throughout the country give their full codperation to the government departments in their efforts to prevent an uncontrolled minority of the ex-service men from seriously interfering, as they now do, with the chance of the recovery of their fellow patients. SEVENTEENTH ANNUAL MEETING 263 Resolved, That the local tuberculosis associations throughout the country be urged to inaugurate immediately a campaign of publicity, which will give the people of their respective localities the true facts of the situation, and will de- velop in all parts of the country that educated public opinion, the lack of which has been largely responsible for the present unfortunate situation. Resolved, That the National Tuberculosis Association approves the prin- ciples involved in sheltered training and employment for the tuberculous, and the necessity for providing various forms of sheltered employment as a nec- essary and important factor in the management of the tuberculosis problem. In view of the various existing means for providing such sheltered employ- ment and the extension of these ideas into the consideration of various plans for industrial and agricultural settlements by governmental and non-govern- mental agencies, the National Tuberculosis Association invites the attention of these agencies to the large amount of data gathered by its Committee on Farm Colonies and Industrial Communities for the Tuberculous, which the executive office is directed to place at the disposal of all of those interested in the problem. It is the sense of the National Association that the many difficulties, objec- tions and criticisms of proposals for agricultural and industrial settlements demand a most careful and continued study of all the medical, economic and political factors involved, and it desires to express its interest in the elaboration of these proposals; and therefore directs the continuation of this Committee, to prepare and present at the next annual meeting a complete digest of the information that it gathers. Wuereas, The admission of immigrants with tuberculosis has provided our state and municipal institutions with a large number of cases of pulmonary tuberculosis because of the absence of a physical examination on entrance into this country, and WHEREAS, These immigrants with tuberculosis create a social and economic problem which is likely to be greater and more important during the present period of depression in Europe, therefore be it Resolved, That the National Tuberculosis Association in conference assem- bled ask that the United States Public Health Service detail medical examiners especially trained in tuberculosis work to be stationed at ports of debarkation and further that steamship companies be encouraged to protect themselves from the burden of returning such cases by some type of examination or health certificate at port of embarkation. WHEREAS, The National Tuberculosis Association has lost by death Major General William Crawford Gorgas, U.S. A., Honorary Vice-President, there- fore be it Resolved, First, that this Association commemorates the great services of General Gorgas as a sanitarian whose worldwide activities have resulted in the practical elimination of one of the worst scourges of mankind, yellow fever, and in the successful combating of other communicable diseases. Second, That it deplores the loss of this great man, this good friend and 264 A HISTORY OF NATIONAL TUBERCULOSIS ASSOCIATION modest and kindly gentleman, whose memory will always be cherished not only on account of his unparalleled services to humanity but also for his quali- ties of mind and heart. Third, That the National Tuberculosis Association extends the sympathy of its members to the wife and family of its deceased member. Fourth, That a copy of these resolutions be forwarded to Mrs. Gorgas. WHEREAS, There exist between this country and the Republic of Mexico many common health problems the chief of which is tuberculosis, and WHEREAS, The President of Mexico through the Department of Public Health has extended an invitation to the National Association to hold its meet- ing in 1922 in Mexico City, be it Resolved, That this Association express to the President of Mexico its appre- ciation of the invitation and its desire to further the intimate consideration of that special part of our common medical problem for which this Association was organized, and That the Association regrets its inability to accept the invitation for 1922 on account of the triennial meeting of all the national medical societies in Wash- ington that year; and be it Further Resolved, That this Association invite the Department of Public Health and the interested members of the profession in Mexico to meet with it on the occasion of the next annual meeting in Washington, D. C. WHEREAS, The National Tuberculosis Association has always advocated that advanced cases of tuberculosis be cared for in separate wards in the general hospitals of their own towns, and WHEREAS, There is an unfortunate tendency in some quarters to interpret this to mean that the incipient or favorable case can also be treated efficiently in such local hospitals, be it therefore Resolved, That the National Tuberculosis Association, while strongly reaf- firming its previous stand on the local hospitalization of advanced cases, does not approve of the suggestion of caring for the incipient or favorable case in like manner, and for the following reasons: (1) It has been well proven that the favorable case can have his best chances only in institutions situated outside of the cities and with a régime centered on the education of the patient for his after life, along with his physical rehabilita- tion, and (2) It is disadvantageous to arrange for the treatment of the curable case in connection with the advanced cases, because of the depressing mental effect which prevents the incipient case coming for treatment at the only time when it can be prevented from developing into an open case and an active focus for the spread of the disease. The following resolution was presented in connection with the Summary Report of the Committee on Dusty Trades to the Executive Committee and approved, with the understanding that the resolution be published with the resolutions adopted at the Annual Meeting. -SEVENTEENTH ANNUAL MEETING 265 The Directors of the National Tuberculosis Association having completed an investigation of the mortality from tuberculosis in the granite industry under the auspices of a special committee, after which an x-ray and physical examina- tion was made of more than 400 men in the city of Barre, Vermont, hereby make the following resolutions: WHEREAS, It has been demonstrated by the death certificates of men employed for varying periods, ranging from ten to forty years in the trade of granite stone cutting, that an unusually high and increasing death rate from pulmonary tuberculosis prevails, (2) That this occurs in men of good physique and previous good health who usually undergo heavy work with ease. (3) That the repeated inhalation of fine dust resulting from the cutting of granite, especially since the introduction of pneumatic tools, induces in the large majority of men so employed a condition known as silicosis, due to deposits of this dust in the lungs which predisposes them to tuberculosis and aggravates any existing disease of the lungs. (4) That by means of an x-ray and physical examination of the chest these diseases can be recognized in an early stage, be it Resolved, That this Association urges: (1) The adoption of more efficient methods of removing the fine dust, the iso- lation of the most dusty operations so far as may be practicable and of general sanitary measures to prevent infection in the sheds. (2) The introduction of a system of periodic physical examinations by trained physicians selected for this duty; also that obligatory x-ray examina- tions by skilled technicians shall be required at the same time for all men enter- ing the trade and while engaged therein. At a meeting of the board of directors on Wednesday, June 15, the following officers were elected for the ensuing year: Dr. James Alexander Miller, New York, president; Hon. Warren G. Hard- ing, District of Columbia, honorary vice-president; Col. George E. Bushnell, Massachusetts, honorary vice-president; Dr. Lawrason Brown, New York, vice-president; Dr. Ralph Matson, Oregon, vice-president; Dr. George M. Kober, District of Columbia, secretary; Mr. Henry B. Platt, New York, treasurer. The following directors, in addition to the president, the vice- president, the secretary, and the treasurer, ex-officio, were elected to serve on the executive committee for the ensuing year: Dr. William Charles White, Pennsylvania; Dr. Kennon Dunham, Ohio; Dr. Alfred Henry, Indiana; Dr. W. L. Dunn, North Carolina; Homer Folks, New York; Dr. David R. Lyman, Con- necticut, Sherman C. Kingsley, Pennsylvania. a 266 A HISTORY OF NATIONAL TUBERCULOSIS ASSOCIATION The summarized report of the treasurer, Mr. Henry B. Platt, is as follows: Balance, December 31, 1919............-..+ $18,712.02 Receipts). :..s.05 cestode shame seacees oe saned 227,841.49 $246,553.51 Disbursements. ........ 000 css cseeeweeeee ee 174,749.82 Balance, December 31, 1920...........-..-5 $71,803.69* A list of officers and directors for 1920 to 1921 follows: President, Dr. Gerald B. Webb; honorary vice-presidents, Gen. W. C. Gorgas, Col. George E. Bushnell; vice-presidents, Dr. James Alexander Miller, Dr. Philip King Brown; treasurer, Henry B, Platt; secretary, Dr. George M. Kober; clerk, W. B. Drummond. Directors, Dr. William N. Ander- son, Omaha; Dr. Robert H. Babcock, Chicago; Dr. A. C. Bachmeyer, Cin- cinnati; Dr. W. Jarvis Barlow, Los Angeles; Miss Mary Beard, Boston; Ernest P. Bicknell, Washington; Dr. Frank Billings, Chicago; Dr. John S. Billings, New York; Dr. Vincent Y. Bowditch, Boston; Dr. Philip King Brown, San Francisco; Dr. C. C. Browning, Los Angeles, Cal.; Col. George E. Bushnell, Concord, Mass.; George F. Canfield, New York; Dr. Charles V. Chapin, Providence; Dr. J. W. Coon, Stevens Point, Wis.; H. R. Cunning- ham, Helena, Mont.; Dr. Gordon K. Dickinson, Jersey City; Dr. George Dock, St. Louis; Dr. H. K. Dunham, Cincinnati; Dr. W. L. Dunn, Asheville; Rev. George Eaves, Birmingham, Ala.; Dr. C. E. Edson, Denver; Dr. Livings- ton Farrand, Washington; Miss Edna L. Foley, Chicago; Homer Folks, New York; Dr. A. M. Forster, Colorado Springs; Lee K. Frankel, New York; E. K. Gaylord, Oklahoma City; Gen. W. C. Gorgas, Washington; Dr. Louis V. Hamman, Baltimore; Dr. Alfred Henry, Indianapolis; Dr. Henry W. Hoag- land, Colorado Springs; H. McK. Jones, St. Louis; Dr. George M. Kober, Washington; Dr. Allen K. Krause, Baltimore; Dr. Paul A. Lewis, Philadel- phia; Dr. David R. Lyman, Wallingford; Dr. Thomas McCrae, Philadelphia; Dr. Walter J. Marcley, Minneapolis; Dr. Harry T. Marshall, University, Va.; Dr. Ralph C. Matson, Portland, Ore.; R. B. Mellon, Pittsburgh; Dr. Alfred Meyer, New York; Dr. James Alexander Miller, New York; Dr. Josephine Milligan, Jacksonville; Dr. John H. Peck, Des Moines; James H. Pershing, Denver; Henry B. Platt, New York; Miss Agnes D. Randolph, Bisbee, Ariz.; Dr. Z. T. Scott, Austin, Tex.; Bolton Smith, Memphis, Tenn.; J. V. A. Smith, Seattle; Reed Smith, Columbia, S. C.; Fred. M. Stein, New York; Dr. Walter R. Steiner, Hartford; Dr. A. K. Stone, Boston; Dr. V. C. Vaughan, Ann Arbor, Mich.; Dr. Gerald B. Webb, Colorado Springs; Dr. William Charles White, Pittsburgh; Dr. Allen H. Williams, Phoenix, Ariz. Executive staff,t Dr. Charles J. Hatfield, managing director; Frederick D. * Not including expenditures on Campaign. t As of January 1, 1922, SEVENTEENTH ANNUAL MEETING 267 Hopkins, administrative secretary; Amelia T. Dutcher, administrative assis- tant; S. M. Sharpe, business manager; L. B. Whitcomb, purchasing agent; Grace Douglass, office secretary; Dr. Donald B. Armstrong, assistant secretary and executive officer of the Community Health and Tuberculosis Demonstra- tion at Framingham; Dr. H. A. Pattison, supervisor medical service; Dr. Edgar Thomson Shields, medical field secretary; T. B. Kidner, institutional secretary: Mary E. Marshall, R.N., secretary for nursing; Walter I. Hamil- ton, industrial research secretary; George T. Eddy, industrial research libra- rian; Philip P. Jacobs, Ph.D., publicity director; Basil G. Eaves, campaign secretary; Helena V. Williams, assistant publicity secretary; Elizabeth Cole, assistant publicity secretary; Eleanor B. Conklin, editorial assistant; Arthur J. Strawson, supervisor field service; Jessamine S. Whitney, statistician; Charles M. DeForest, Modern Health Crusader executive; M. Grace Osborne and Louise Strachan, assistant Crusader executives. The following is a list of papers read before the respective sec- tions at the Seventeenth Annual Meeting of the National Tuber- culosis Association, June 14th to 17th, 1921: How compensation is provided for ex-service beneficiaries by the Bureau of War Risk insurance—Haven Emerson, M.D. Provision for hospital and dispensary care of tuberculous ex-service patients by the Public Health Service—F. C. Smith, M.D. Vocational training for arrested tuberculous patients by the Federal Board for Vocational Education—Hon. Uel W. Lamkin. The limitations and possibilities in the federal care of tuberculous ex-service patients—David R. Lyman, M.D. Di-chloramine T in tuberculous abscesses—Edward J. Murray, M.D. The management of pleural effusions in the course of therapeutic pneumo- thorax—Barnett P. Stivelman, M.D., and Joseph Rosenblatt, M.D. Theoretical explanation of the formation of Roentgenographic pleural annular shadows—J. Burns Amberson, M.D. Theoretical considerations on the application of ultraviolet radiation to tuberculous laryngitis—Edgar Mayer, M.D. Results in one hundred cases of pulmonary and intestinal tuberculosis with the use of the ultraviolet ray—Sidney F. Blanchet, M.D. A comparison of vital capacity readings and x-ray findings in pulmonary tuberculosis—J. A. Myers, M.D. The curative value of pneumothorax in non-tuberculous lesions of the lung— disappearance of osteo-arthropathy—William Charles White, M.D. Certain manifestations of hypertrophic osteo-arthropathy in pulmonary tuberculosis: a survey of a sanatorium group of patients—H. J. Corper, M.D., and Philip Cosman, M.D., in collaboration with William H. Gil- more, M.D., and Louisa T. Black, M.D. Lymphatism and tuberculosis—Maurice Fishberg, M.D. 268 A HISTORY OF NATIONAL TUBERCULOSIS ASSOCIATION A workshop for the rehabilitation of the tuberculous—Grant Thorburn, M.D., and John S. Billings, M.D. Clinical and therapeutic aspects of the Framingham work—P. Challis Bartlett, M.D. Undergraduate instruction in tuberculosis—Walter C. Klotz, M.D. Post-graduate education in tuberculosis—Edward R. Baldwin, M.D. Some problems of medical education in tuberculosis—Allen K. Krause, M.D. Interim report on cases of extra-pleural thoracoplasty—Edward Archibald, M.D. Dettweiler and his methods—Hugh M. Kinghorn, M.D. Small pneumothorax in tuberculosis—abstract of a monograph—Nathan Bar- low, M.D., and James C. Thompson, M.D. Physical and clinical variations in a study of seven hundred tuberculous young women—Philip King Brown, M.D. The taking of temperature in the diagnosis and treatment of tuberculosis— George Thomas Palmer, M.D. The safe removal of tonsils by the desiccation method with the high frequency current in poor surgical risks, with especial reference to the tuberculous— P. P. McCain, M.D. Further observations on heredity as influencing natural resistance to tubercu- losis—Paul A. Lewis, M.D., and Sewall Wright, Ph.D. Fundamental features of the complement deviation reaction as applied to tuberculosis—Paul A. Lewis, M.D., and Joseph D. Aaronson, M.D. The destruction of tubercle bacilli in sewage by chlorine—John M. Conroy, M.D., Bernice Brasted Conroy, and Arthur T. Laird, M.D. The survival and virulence of tubercle bacilli in excised animal lymph nodes— G. B. Webb, M.D., C. T. Ryder, M.D., and G. B. Gilbert, M.D. The Griffith method for direct isolation of the tubercle bacillus—Harold W. Lyall, Ph.D. Tuberculosis of the heart—with the report of two cases—Edward Weiss, M.D. The course of pulmonary tuberculosis in guinea-pigs produced by the inhala- tion of a low-virulent strain—Leroy U. Gardner, M.D. Studies of the influence of carbon dioxide on the resistance to tuberculosis: the effect of carbon dioxide upon the tubercle bacillus—H. J. Corper, M.D., H. Gauss, M.D., and O. B. Rensch, M.D. Studies with morphine in experimental tuberculosis—H. J. Corper, M.D., H. Gauss, M.D., and O. B. Rensch, M.D. The significance of allergy in tuberculosis—Allen K. Krause, M.D. Chemical problems in the bacteriology of the tubercle bacillus—Esmond R. Long, Ph.D. Arrangement of the musculature of the bronchioli and its relation to certain pathological conditions in the lung—William Snow Miller, M.D. Finer divisions of the air spaces in man and some of the laboratory animals— William Snow Miller, M.D. Normal radiographic appearance of the chests of children—a symposium—(a) Kennon Dunham, M.D., and Kenneth D. Blackfan, M.D.; (b) H. K. SEVENTEENTH ANNUAL MEETING 269 Pancoast, M.D., and H. R. M. Landis, M.D.; (c) Charles R. Austrian, M.D., and F. H. Baetjer, M.D. Progress report on the investigation of the chemotherapeutics of chaulmoogric acids in tuberculosis—Ernest Linwood Walker. The effect of artificial pneumothorax on the collateral lung—Saling Simon, M.D. A clinical study of granite dust inhalation—D. C. Jarvis, M.D. The results of an experimental study of the dietary requirements in tuberculosis —William S. McCann, M.D. The clinic for Negroes at the Henry Phipps Institute—H. R. M. Landis, M.D. Comprehensive codperation in the tuberculosis program—W. McN. Miller, M.D. An experiment in organization of rural tuberculosis work in Albemarle County, Virginia—Walter C. Klotz, M.D. Framingham yardsticks—Donald B. Armstrong, M.D. Post-sanatorium care of Canadian ex-soldiers—Lieut.-Col. W. M. Hart. The sanatorium care of tuberculous soldiers by the federal government— George Thomas Palmer, M.D., and Henry W. Hoagland, M.D. The care of tuberculous ex-service men: a correlation of local and Public Health Service work—C, Howard Marcy, M.D. When is an exhibit?—E. G. Routzahn. Health education through the school—Willard S. Small, Ph.D. Tuberculosis, marriage and maternity—Maurice Fishberg, M.D. The evidence of intensive anti-tuberculosis effort upon the death rate—Lee K. Frankel, Ph.D. Report of a study of the indigent migratory tuberculous in certain cities of the Southwest—Jessamine S. Whitney. Industrial nursing as a means of fighting tuberculosis—Lee K. Frankel, Ph.D. Tuberculosis nursing by specialized staff—Mary E. Edgecomb, R.N. Tuberculosis nursing by a generalized staff—Anne Sutherland, R.N. Detection and control of contact and arrested tuberculous cases—-Edith M. Blades, R.N. Malnutrition and tuberculosis—W. R. P. Emerson, M.D. Practical applications for the tuberculosis program—Lucinda N. Stringer, R.N. Recommendations of the Committee on Indigent Migratory Consumptives. Sixteenth midwinter meeting of the American Sanatorium Association. Sixteenth spring meeting of the American Sanatorium Association. PART III BIOGRAPHIES OF THE OFFICERS OF THE ASSOCIATION INTRODUCTORY NOTE r ] “\HE biographies of the honorary vice-presidents are given first, and are followed in turn by those of the presidents, treasurers, secretaries, vice-presidents, and some of the executives on the staff. A bibliography of the principal contri- butions to tuberculosis literature is appended to each biographical sketch. In the preparation of these biographies no effort has been made to give an exhaustive personal history of each official, but rather to stress particularly those events that have to do with tubercu-: losis history. CHAPTER XXVIII GROVER CLEVELAND HONORARY VICE-PRESIDENT OF THE NATIONAL TUBERCULOSIS ASSOCIATION FROM 1905 TO 1908 , “HE first layman on whom was conferred by unanimous elec- tion the title of honorary vice-president of the National Tuberculosis Association was Grover Cleveland, ex-presi- dent of the United States, and at the time of his election member of the board of trustees of and professor of jurisprudence at Princeton University. Our society honored itself by making Grover Cleveland its honorary vice-president, in 1906. Grover Cleveland was born in Caldwell, N. J., March 18, 1837. His father was the Rev. Richard Falley Cleveland, and his mother, Anne Neal Cleveland. His interest in medicine and in the unfortunate sick and disabled dates back to 1853, when he became a teacher in the Institute for the Blind, located at Ninth Avenue and 34th Street, in the city of New York. He was drawn to the study of law, however, and admitted to the bar in 1859. He became assistant district attorney in January, 1863, was elected sheriff of Erie County, New York, in 1870, mayor of Buffalo in 1881, and governor of the State of New York by a majority of 192,000 on November 1, 1882. Two years later, on November 4, 1884, he was elected to the presidency of the United States and he was elected for the second time November 8, 1892. Mr. Cleveland on repeated occasions showed deep interest in medicine and disease prevention. His address on the occasion of the fiftieth anniversary of the New York Academy of Medicine on January 29, 1897, may be seen in its autographed form on the walls of the Academy by all who care to read it. It shows that he was well informed on the advances in medicine and sanitation, yet at the same time in touching words he paid his tribute to the village doctor of fifty years ago. After saying that those not born 18 273 274 A HISTORY OF NATIONAL TUBERCULOSIS ASSOCIATION yesterday were living monuments to the faithful care of the village doctor, he continued as follows: “He, too, alleviated suffering and saved human life. We know that it was not given to him to see the bright lights that now mark the path of medicine and surgery, but you cannot convince us that he groped entirely in the dark. We remember with abhorrence his ever ready lancet, and the scars of his blood- letting found in every household... We endure with complacency the recollec- tion of his awful medicine case, containing bottles, powders, and pills, which, whatever might be thought of them now, seemed then to be sufficient for all emergencies, to say nothing of the tooth-pulling tools and other shiver-breed- ing instruments sometimes exposed to view. If he was ignorant of many of the remedies and appliances now in use, he in a large measure supplied the de- ficiency by hard-headed judgment, well-observed experience, and careful nursing. Besides, it was in his favor that he did not have to bother his head with many of the newly invented and refined diseases that afflict mankind to-day. He had no allotted hours for his patients, but was always on duty, and we knew the sound of his gig as he rattled past in the night. “Your ways are better than his; but we desire you to regard this admission asall the more valuable because it is carved out of our loyalty to our old village doctor, who brought us through the diseases of childhood without relapse, who saved from death our parents and our brothers and our sisters in many a hard combat with illness, and who, when vanquished and forced to surrender, was present in the last scene to close the eyes of his dying patient and sympathize with those who wept.” The concluding words of this remarkable address, warning us against neglect of civic duties, are as applicable to conditions of to-day as they were twenty-three years ago: “We cannot accuse you of utter neglect of your duty to the country; and yet we cannot keep out of mind the suspicion that if your professional work in exposing evils was more thoroughly supplemented by labor in the field of citizenship, these evils would be more speedily corrected. If laws are needed to abolish abuses which your professional investigations have unearthed, your fraternity should not be strangers to the agencies which make the laws. If enactments already in force are neglected or badly executed, you should not forget that it is your privilege and duty to insist upon their vigorous and honest enforcement. Let me also remind you of the application to your case of the truth embodied in the homely injunction, ‘If you want a job well done, do it yourself.’ If members of your profession were oftener found in our national and State legislative assemblies, ready to advocate the reformatory measure you have demonstrated to be necessary, and to defend your brotherhood against flippant and sneering charges of impracticability, the prospect of your bestowal upon your fellow-men of the ripened results of your professional labor would be brighter and nearer.” ‘D ELA EV. JER CL ° m4 GROVER CLEVELAND 275 Perhaps the solution of our tuberculosis problem would be nearer if Grover Cleveland’s advice had been followed two dec- ades ago. The address delivered by Mr. Cleveland on the occasion of the one hundredth annual meeting of the Medical Society of the State of New York, held at Albany on February 6, 1906, was a veritable gem of oratory, marked by a keen sense of humor, and at the same time a deep penetration into all that is faulty and also all that is true and noble in our profession. Here follows a portion of this memorable oration: “For the purpose of argument, let us divide humanity in two sections—one composed of a few doctors, and the other embracing the many millions of their actual prospective patients. I appeal for myself and those millions, and I claim at the outset that, notwithstanding our large majority, the medical sec- tion of mankind has, in one way or another, curtailed the opportunity of free- dom of thought and considerate hearing, to which we are entitled by ‘the laws of Nature and of Nature’s God.’ We acknowledge that the world owes this minority a living. With a generous delicacy which reaches sublimity we are on their account not over-obedient to the laws of health; and we sometimes pay their bills. When sick, we submit with more or less humility to their orders. If we recover, it is only to take our place on the waiting list, still subject to further service. If we do not recover, it is left to us to do the dying. “In view of these facts, I think I do not mistake the temper of my clients when I represent that there is growing up among them a feeling that there ought to be less mystery and high and mighty aloofness on the part of their medical advisers. We have long been wont to treat with a kind of amused toleration the names in pigeon Latin or Greek given by the doctors to very common things, and to diseases which already had names both simple and significant. But all this seems to have much increased with the discovery of new remedies, and the chase after new diseases; and this increase has appar- ently been accompanied by additional mystery and additional inclination on the part of our doctors to remind us of their stately superiority. “We fully appreciate the tremendous advance that has been made in medi- cal knowledge and practice within the memory of those not yet old. There are but few left who bear the scars of blood-letting which depleted the veins of a former generation. In these days the fever-stricken wretch who begs for a drop of water to cool his tongue is heard with more favor than was the rich man who cried out to Father Abraham from the flaming torments of the bot- tomless pit. We are now told that germs and microbes, more or less deadly, countless in number, of every conceivable size and shape, and given to habits and tastes adjusted to every emergency of their existence, not only inhabit the earth beneath us and the atmosphere about us, but lurk in every corner and cranny of our bodies with murderous intent. Another marked and startling indication of progress in medical knowledge is found in the sentence of removal 276 A HISTORY OF NATIONAL TUBERCULOSIS ASSOCIATION and destruction lately passed by medical science upon a certain annex or attachment of the human body, which has for centuries substantially escaped more serious accusation than that of inactive uselessness. Its detection in conspiracy against life and health has stimulated our doctors in such hot pur- suit that the man who carries his appendix about with other personal belong- ings is probably just as comfortable if he has never heard the story of the way the devil lost his tail. “In all seriousness, therefore, I desire to concede, without the least reserva- tion, on behalf of the great army of patients, that they owe to the medical pro- fession a debt of gratitude which they can never repay, on account of hard, self-sacrificing work done for their benefit, and for beneficent results accom- plished in their interest. But at the same time we are inclined to insist that, while our doctors have wonderfully advanced in all that increases the useful- ness and nobility of their profession, this thing has not happened without some corresponding advance in the intelligent thought and ready information of their patients along the same lines. We have come to think of ourselves as worthy of confidence in the treatment of our ailments; and we believe if this were accorded to us in greater measure it would be better for the treatment and better for us.” This extract from President Cleveland’s address was selected because it applies so markedly to tuberculosis workers. We have perhaps in a measure endeavored to follow this advice. The con- scientious physician treating a tuberculous patient usually takes him into his confidence, realizing that, in this disease at least, the codperation of the patient and his full knowledge of the character of his affliction are essential to the cure, but we cannot say that this practice is universal. A repetition of Grover Cleveland’s wise counsel is not untimely. Of his personal interest in tuberculosis it was the biographer’s privilege to learn from a letter he received a few years before President Cleveland’s death. Expressing his satisfaction at hav- ing become acquainted with some of the author’s writings, which had aroused his interest in the tuberculosis problem some years ago, he closed his letter by saying: ‘‘ Hoping that the movement on foot for the study and prevention of this direful disease may be upon such lines as will make it practical and effective, I am, etc.” Grover Cleveland passed away on June 24, 1908, at his home in Princeton, universally regretted, forever to be remembered as one of the ablest and most conscientious of statesmen, and a most efficient chief executive of our country. CHAPTER XXIX THEODORE ROOSEVELT HONORARY VICE-PRESIDENT OF THE NATIONAL TUBERCULOSIS ASSOCIATION FROM 1905 TO 1919 P [is second layman to receive a unanimous election as honorary vice-president of the National Tuberculosis Association was Colonel Theodore Roosevelt. He honored the Association by his acceptance of the office in 1906, during his first term as President of the United States. Of all the statesmen of this and foreign countries, there has perhaps never been a man whose name has been more familiar to the masses than that of Theodore Roosevelt, nor any man of whom there have been written more eulogies and more biographies. The high and the low, the rich and the poor, men and women in all walks of life, have felt a deep admiration for this wonderful man. No public character in American history has ever combined such - boundless energy and exuberant enthusiasm with such versatility of achievements. In the present sketch we shall consider mostly what Theodore Roosevelt has meant to public sanitation and medicine in general and to the tuberculosis problem in the United States in particular. Theodore Roosevelt, the son of Theodore and Martha Bulloch Roosevelt, was born October 27, 1858. He received his early education partially from private tutors and by attending the Cutler preparatory school. He entered Harvard, graduating in 1880. Then began a career so varied, so interesting, and so full of achievement that each of the various positions he occupied and the distinction he received therein might be a subject for an essay in itself. He was a member of the New York legislature from 1882 to 1884. He then became a rancher, a cowboy, civil service commissioner, New York police commissioner, assistant secre- tary of the navy, soldier, governor, vice-president, and president. He entered upon his presidential duties October 14, 1901, on the 277 278 A HISTORY OF NATIONAL TUBERCULOSIS ASSOCIATION death of William McKinley. In November, 1904, he was elected president for the term 1905 to 1909. After his retirement from the presidency he became traveler, explorer, naturalist, big game hunter, editor, and author. It has been said that Roosevelt himself as a child must have been tuberculous, but this has not been confirmed, although the possibility exists that there had been a tuberculous diathesis. That he suffered from asthma and was very delicate as a child is well known. If he had a tuberculous diathesis or a pronounced predisposition to tuberculosis, he certainly knew how to master it by choosing the life of a rancher and devoting a number of years to building himself up to strong and vigorous manhood. The occasional asthmatic attacks seem to have remained with him. According to Dr. Alexander Lambert, for many years his private physician, whenever Roosevelt was attacked with bronchitis he would have “‘ tremendous asthmatic spasms of his lungs.’””’ Asthma seems to be antagonistic to the development of tuberculosis, and so we may perhaps be grateful that only asthma was his chief malady in youth. Roosevelt as a police commissioner became intensely interested in public sanitation, clean streets, better housing, etc. His friend, Jacob A. Riis, who was at the time engaged in the ‘‘battle with the slums,” had shown him the iniquity of allowing the existence of overcrowded, unclean, and unsanitary tenements, factories, and sweatshops in the city of New York, with their invariable train of tuberculosis and other diseases. Throughout his official life, and even after his retirement from public office, Roosevelt always had a deep interest in the welfare of the laboring class, in their proper housing, and in factory and workshop sanitation. In an address delivered in Chicago on August 6, 1912, he referred to these vital problems of the nation’s welfare in the following words: “In the last twenty years an increasing percentage of our people have come to depend on industry for their livelihood, so that to-day the wage workers in industry rank in importance side by side with the tiller of the soil. Asa people we cannot afford to let any group of citizens, or individual citizens, live or labor under conditions which are injurious to the common welfare. We must protect the crushable elements at the base of our present industrial structure.”’ THEODORE ROOSEVELT THEODORE ROOSEVELT 279 As governor of the state of New York he looked with favor on the then rising tide of anti-tuberculosis propaganda, and as President of the United States he was, of course, interested in the larger problem of public health of the nation. Dr. Lambert had been asked whether by reason of his intimate relation as family physician to Roosevelt he could not write something worth reproducing in this biography, showing Roose- velt’s interest in state hygiene, in public health in general, and in tuberculosis in particular. With Dr. Lambert’s permission part of his letter to the author is here reproduced: “You can say that it was through Roosevelt’s knowledge and appreciation of the problems of sanitation and public health, as shown in the problems in- volved in the Panama Canal, that he raised Gorgas from a petty, hampered, bureau chief to a Commissioner with equal powers to the others, in order that Gorgas might make the place safe and livable for the workmen to build the Canal. . . . The President was greatly interested in the Tuberculosis Congress of 1908, and talked to me a good deal about it when I was in Wash- ington just after it had occurred.” Roosevelt’s great interest in the International Congress on Tuberculosis referred to by Dr. Lambert was manifest by his acceptance of the presidency of that great scientific gathering, to which all the civilized nations of the world sent their representa- tives. In his letter of acceptance of the presidency of the Tuber- culosis Congress he said: ‘‘The modern crusade against tuber- culosis brings hope and bright prospects of recovery to hundreds and thousands of victims of the disease who, under old teachings, were abandoned to despair.” The letter of acceptance speaks volumes for the Colonel’s comprehension of the tuberculosis prob- lem and will be found. printed in full in the chapter on the Con- gress (p. 143). The Congress was held in Washington September 21 to October 12, 1908. At the closing session the President made a short but very brilliant address, which shows perhaps more than anything else, how well versed he was in public sanitation and how appreciative of what medical science had done to prolong the average of life and add to the happiness of the human race. Mr. Roosevelt said: “T could not deny myself the privilege of saying a word of greeting to this noteworthy gathering. It is difficult for us to realize the extraordinary changes, 280 A HISTORY OF NATIONAL TUBERCULOSIS ASSOCIATION the extraordinary progress, in certain lines of social endeavor during the last two or three generations; and in no other manifestation of human activity have the changes been quite so far reaching as in the ability to grapple with disease. It is not so very long, measuring time by history, since the attitude of man toward a disease such as that of consumption was one of helpless acquies- cence in what he considered to be the mandates of a supernatural power. It is but a short time since even the most gifted members of the medical profession knew as little as any layman of the real causes of a disease like this, and there- fore necessarily of the remedies to be invoked to overcome them. It is an affair of decades,—I am almost tempted to say an affair of years,—when we go back to cover the period in which the real progress has been made. Take, for in- stance, the work the United States government is now doing in Panama, When the first railroad was built across Panama, it was said, with some foundation of truth, with but slight exaggeration, that ‘every sleeper laid cost the life of a man.’ Now the work on the canal, in that identical place, is being prosecuted, on an infinitely larger scale of course, than the mere building of a railroad, under conditions which make the locality stand above the ordinary locality in the United States in point of health. The Isthmus of Panama, which was a by- word for fatal disease, has become well-nigh a sanatorium; and it has become so because of the investigations of certain medical men which enabled them to find out the real causes of certain diseases, especially yellow fever and malarial fever, and to take measures to overcome them. The older doctors here, when they were medical students, would have treated the suggestion of regarding mosquitos as the prime source of disease like that as a subject for mirth. Is not that literally true? These utterly unexpected results have followed patient, laborious, dangerous, and extraordinarily skilful work that has enabled the cause of the disease to be found and the diseases themselves to be combated with extraordinary success. I said dangerous work. That success had its martyrs; doctors laid down their lives to secure the results of which I have spoken, showing exactly as much heroism as ever was shown by the soldier on the field of battle. / “ At this moment, in the middle of the great continent of Africa, there is a peculiarly fatal and terrible disease—the sleeping sickness; a disease which, if it had been known to our ancestors in the middle ages, would have been spoken of as the black death was spoken of in the middle ages—as a scourge sent of God, possibly as something connected with a comet, or some similar explanation would have been advanced. We know now that it is due to the carrying of a small and deadly blood parasite by a species of biting fly, there being this very curious genus of biting flies in Africa, one form of which, al- though harmless to wild animals and men, conveys by its bite a fatal infection to all domestic animals, and even to the closest allies of the wild animals, to which its bite is fatal; while the other form, which does not seem to be fatal to domestic or wild animals, is responsible for the spread of this terrible disease, the sleeping sickness, which in one region killed two hundred thousand out of three hundred thousand inhabitants—a rate of slaughter, of course, infinitely surpassing that of any modern war. And the chance to control that disease THEODORE ROOSEVELT 281 lies in the work of just such men as and, indeed, of some of the men who are assembled here. You who have come here, however, have come to combat not a scourge confined to the tropics, but what is, on the whole, the most terrible scourge of the people throughout the world. But a few years ago hardly an intelligent effort was made or could be made to war against this peculiarly deadly enemy of the human race. The chance successfully to conduct that war arose when the greatest experts in the medical world turned their trained intelligence to the task. It remains for them to find out just what can be done. The task then will be for the representatives of the governments to give all possible effect to this conclusion of the scientific men. “The change in the status of the man of science during the last century has been immeasurable. A hundred years ago he was treated as an interesting virtuoso, a man who was capable of giving amusement, but with whom no practical man dealt with any idea of standing on a footing of equality. Now more and more the wisest men of affairs realize that the great chance for the advancement of the human race in material things lies in the close inter- relationship of the man of practical affairs and the man of science, so that the man of practical affairs can give all possible effect to the discoveries of the most unforeseen and unexpected character now made by the man of science. “T feel that no gathering could take place fraught with greater hope for the welfare of the people at large than this. I thank you all, men and women of this country, and you, our guests, for what you have done and are doing. On behalf of the nation I greet you, and hope you will understand how much we have appreciated your coming here.” The interest this great man took not only in the political, economic, and social, but also in the sanitary, welfare of the nation was so varied that he did not even recall in detail the many things he had done for the betterment of the physical con- dition of the masses during his official life. The author of this sketch had occasion to correspond with Mr. Roosevelt a few years after he had gone out of office concerning certain episodes in the tuberculosis movement of the past. In reply he wrote: ‘‘I can- not at the moment recall the details of my action as Governor and as President, but I have always taken a very real and great inter- est in the anti-tuberculosis cause—I should not regard myself a good citizen if I had failed to do so.” His life-long friend, Major-General Wood, wrote the author that Roosevelt always manifested the greatest interest in pre- ventive medicine and tuberculosis. The same assurance of his interest in tuberculosis was given by Mrs. Douglas Robinson, the sister of Mr. Roosevelt. Mrs. Robinson says that in many con- 282 A HISTORY OF NATIONAL TUBERCULOSIS ASSOCIATION versations with her brother he had shown his deep interest in the tuberculosis campaign. In a personal letter to the author she writes: ‘‘His whole life was an endorsement of preventive meas- ures along the line of medicine and sanitation.” It is interesting to note that, at the instance of the National Tuberculosis Association, Mr. Roosevelt, as President of the United States, issued an executive order prohibiting promiscuous spitting and providing for individual drinking cups and other sanitary arrangements in all Federal offices. While believing that the consumptive should be conscientious in the disposal of his sputum and favoring rigid rules concerning this vital point in the prevention of tuberculosis, Roosevelt’s heart was with the consumptive sufferer. A case in point is that of an Irishman who had lived many years in America and raised a family, but who, by some oversight or carelessness, had failed to become an American citizen, although he had taken out his first papers years before. He returned to visit his native country and while there tuberculosis, which had probably been latent for many years, suddenly became active. He hastened to return to his family in the United States, but because of the evident symp- toms which the man showed and the new law prohibiting those who are not American citizens from entering the United States when tuberculous, he was detained at Ellis Island. The invalid sought legal aid, and the author was called in as expert to testify that as long as the man was instructed and careful concerning the disposal of his sputum and had sufficient means to enter a private sanatorium at once he would be neither a burden to the community nor a danger to his fellow-men. The lawyer’s eloquent plea before the court, as well as this testimony, was in vain. Our last resort was to appeal to the magnanimity and generous heart of President Roosevelt. This did not fail, and the man was per- mitted to reénter the United States. Theodore Roosevelt was indeed an ideal citizen. This nec- essarily inadequate biographical sketch has sought to record mainly events of interest to the medical profession, and particu- larly to tuberculosis workers. Of his character and patriotism his successor in the presidential chair, the Hon. William H. Taft, has said: THEODORE ROOSEVELT 283 “Over and above everything Theodore Roosevelt was a deeply patriotic American. He had intensified his passionate love of his country that was natural in him by acquiring an intimate knowledge and a profound apprecia- tion of the great sacrificial struggle needed to make her great. He left no doubt of his willingness himself to render the ultimate sacrifice in her behalf. His spirit of patriotic devotion was web and woof of his character. He sent his four boys forth to war with the pride of a Roman Tribune. Through his father’s tears for Quentin’s death there shone the stern joy that a son of his had been given to die the death he would himself have sought on the field of battle in his country’s cause. Theodore Roosevelt’s example of real sacrifice was of inestimable value to our country in this war. The nation has lost the most com- manding, the most original, the most interesting, and the most brilliant per- sonality in American public life since Lincoln.” Roosevelt passed away peacefully, on the night of January 5, 1919, mourned by untold numbers in this and other countries. His grave on the hillside in the beautiful little cemetery near his home at Sagamore Hill is the object of pilgrimage for thousands, old and young, high and low, rich and poor, all eager to do homage to the man they had admired and loved as the third of that great trinity of American Presidents, Washington, Lincoln, Roosevelt. For the loan of the excellent photograph of Theodore Roosevelt from which the accompanying photogravure is made the author is indebted to his friend, Dr. Ralph Waldron, of Newark. This is the last photograph of Roosevelt taken before his last illness. Whether or not he felt the approaching end intuitively, the pic- ture shows Theodore Roosevelt in serious mood. Perhaps he thought of the world war and all that it meant to the world at large, to the American nation, and to himself. On his lapel we notice the insignia showing how very close the war had come to his own family. There we see the four stars representing Theodore Roosevelt, Jr., Kermit Roosevelt, Archibald Bullock Roosevelt, and Dr. Richard Derby, who all served in the war, but fortunately returned. In the midst of these stars we notice a golden one, the star of the heroic Quentin Roosevelt, who did not return, having made the supreme sacrifice, and whose body rests in the soil of France surrounded by those of his comrades. Well may we reiterate here the words of Warren G. Harding, President of the United States, expressed on October 27, 1921, the sixty-third anniversary of Roosevelt’s birth, “‘He was the greatest American of his time.” CHAPTER XXX SIR WILLIAM OSLER, Barr., M.D., LL.D. HONORARY VICE-PRESIDENT OF THE NATIONAL TUBERCULOSIS ASSOCIATION FROM 1905 TO Ig19* HE first physician to receive the distinction of a unanimous i election as honorary vice-president of the National Tuber- culosis Association was the late Sir William Osler, who, when at Baltimore, as has already been stated in the preceding pages, was one of the prime movers in its formation. His interest in the tuberculosis problem, in its social as well as its medical aspects, was always uppermost. He was closely identified with the anti-tuberculosis movement in America as well as in England, and his counsel was sought as an expert in all that appertains to this most wide-spread of diseases. The accompanying bibliography comprises some 50 of his most important contributions on the subject of tuberculosis. To Dr. Osler is due the formation of the Laennec Society for the Study of Tuberculosis, which is allied with Johns Hopkins Medical School. In 1900 he established the first social service division in connec- tion with the tuberculosis work at the Johns Hopkins Hospital. This universally beloved physician is justly claimed by three countries—Canada, the United States,and England. Hewas born in Bond Head, Ontario, on July 12,1849. Hecame from a family of culture. His father was the Rev. F. L., and his mother, Ellen Frere Pickton Osler. He started out in life with high ambitions and noble aims, graduating from Trinity College, Toronto, in 1868, and taking his medical degree at McGill University, Mon- treal, in 1872. He went abroad for a post-graduate course, study- * The accompanying picture is a reproduction of a photograph Sir William kindly had taken shortly before his last illness to enable the author to illustrate the biographical sketch for this history. It is generally conceded to be the best portrait of him in existence. The picture was sent from England by Lady Osler shortly after the death of Sir William. 284 , A re SIR WILLIAM OSLER SIR WILLIAM OSLER, BART., M.D., LL.D. 285 ing at London, Berlin, and Vienna. On his return in 1874 he was made professor of the Institute of Medicine of McGill University, where he remained until 1884, and then accepted a call as pro- fessor of clinical medicine at the University of Pennsylvania. With the foundation of the medical department of Johns Hopkins University in 1889 Dr. Osler became professor of theory and prac- tice of medicine at that institution, and at the same time physi- cian-in-chief of Johns Hopkins Hospital. He remained in these positions until the spring of 1905. In the fall of 1904 he had received and accepted a call from Oxford, to become Regius Professor of Medicine of that world- renowned university. In reply to the author’s congratulation, he wrote: “Naturally, I am very loath to leave America, where I have been so well treated and where I have so many warm friends, but it really is an act of self- preservation. I could not possibly stand for very long the high pressure of my present life. The position is almost purely academic, and I still have an abundance of time for my literary work.” When Osler left America, a dinner was given to him, the memory of which will be forever cherished by those who were present. He was eulogized as a teacher, clinician, consultant, and author by such men as Tyson, Shepard, Wilson, Welch, Jacobi, and Mitchell. Osler’s reply was full of expressions of gratitude and appreciation. Among other things he said: “Why so much happiness has come to me I know not. But this I know, that I have not deserved more than others, and yet a very rich abundance of it has been vouchsafed to me. I have been singularly happy in my friends, and for that I say, ‘God be praised!’ I have had exceptional happiness in the pro- fession of my choice, and I oweallofthistoyou. . . . Ihave been happy, too, in the public among whom I worked—happy in my own land in Canada, happy here among you in the country of my adoption.” His mother and his wife were seated in one of the boxes, and turning a grateful glance upward, he said: “Of the greatest of all happiness I cannot speak—of my home. Many of you know it, and that isenough. . . . Ihave had three personal ideals. One, to do the day's work well and not to bother about to-morrow. The second ideal has been to act the Golden Rule, as far as in me lay, toward my professional brethren and toward the patients committed to my care. The third has been 286 A HISTORY OF NATIONAL TUBERCULOSIS ASSOCIATION to cultivate such a measure of equanimity as would enable me to bear success with humility, the affection of my friends without pride, and to be ready when the day of sorrow and grief came to meet it with the courage befitting a man.” The honors bestowed upon Osler are almost too numerous to recount. He received the honorary degree of LL.D. from McGill University in 1895, from the universities of Aberdeen and Edin- burgh in 1898, from the University of Toronto in 1899, from Yale University in 1901, from Harvard University in 1904, and from Johns Hopkins in 1905. The degree of Doctor of Civil Law was .conferred by Trinity University, Toronto, in 1902, and the Uni- versity of Durham in 1913; the degree of Doctor of Science from Oxford University in 1904, Liverpool University in 1910, and the University of Dublin in 1912. He was made a fellow of the Royal College of Physicians in 1883, and a fellow of the Royal Society in 1898. In 1911 Osler was created a Baronet of the United Kingdoms by King George V. In 1918 Sir William was made president of the British Classical Association, a rare honor to be bestowed upon one whose training had been that of a physi- cian purely and simply. Osler’s interest in America, in its medical institutions, and in his countless friends and pupils was genuine and lasting until the end. His work in Oxford equaled his achievements in Montreal, Philadelphia, and Baltimore. In answer to an inquiry prior to the publication of an article on ‘‘The Tuberculosis Situation After the World War,” Sir William wrote the author under date of May 26, 1919, ‘‘All goes well here and I hope we will get the tuberculosis problem settled ere long on national lines.” During the war he worked for the health of the English and Allied armies. The death of his only son in the world war was a terrible blow to this great and good man, but he bore up under it bravely. In reply to a letter of condolence from the author, after expressing his thanks with his usual warmheartedness, Sir William merely added: ‘‘It has, of course, been a pretty hard business.’”’ Then, forgetful of his own sorrow, he went on to speak of our duties as physicians in the world war. He kept on working for the sol- diers and with the soldiers. He talked to them on subjects of hygiene, how to preserve their health and to prevent tuberculosis. The July, 1919, number of the Johns Hopkins Hospital Bulletin SIR WILLIAM OSLER, BART., M.D., LL.D. 287 was entirely devoted to tributes to Osler. Thomas, Barker, Councilman, MacCallum, Thayer, Brown, McCrae, Hamman, Futcher, Jacobs, Brush, Woods, Chatard, Noyes, Hurd, Kelly, and Boggs, all of whom had been either Osler’s co-workers or pupils, related their personal experiences, showing the wide spheres of his activities as a teacher, sanitarian, physician, citizen, scholar, and lover of books. The articles which are of particular interest to us as students of tuberculosis were those of Louis V. Hamman, who wrote on ‘‘Osler and the Tuberculosis Work of the Hospital,’ and of Henry Barton Jacobs, on ‘Osler as a Citizen and His Relation to the Tuberculosis Crusade in Maryland.” In November, 1919, Osler contracted pneumonia, but he him- self hoped for an early recovery, and on Christmas day he sent a typically cheerful cablegram to Johns Hopkins Hospital, announc- ing that he was making a good fight. Four days later he died. Perhaps he only sent that message to give Christmas cheer to his many friends on this side of the Atlantic. He must have analyzed the seriousness of his condition, for after his death the following note, dated December 23, 1919, was found among his effects: “Dear friends, the harbor is nearly reached, after a splendid voyage with such companions all the way; and my boy waiting for me.” How the soul of this great man is revealed in these simple words! Cheerfulness and unbounded capacity for work, a devotion to the highest ideals of medicine and humanity, a marvelous scholar- ship, loyalty to his friends, and kindliness to the humblest of the humble, were the outstanding characteristics of Sir William Osler. His life-long friend, Professor William H. Welch, of Balti- more, well said of him: ‘‘To Osler nothing human was foreign. His home, both in Baltimore and Oxford, was a center of hos- pitality.”” Those who had the rare privilege of walking with Pro- fessor Osler through the medical wards or who had the good for- tune of being present at some of his receptions to students will never forget the human side of his character. Osler’s loyalty to his friends was indeed genuine, particularly when they were in need or in distress, as the author has reason to remember with deepest gratitude. Osler was still smarting under the ignominious slander manufactured by a sensational 288 A HISTORY OF NATIONAL TUBERCULOSIS ASSOCIATION news-seeking press which had taken seriously a jocular remark he had made on the subject of euthanasia when, as a result of a statement the author had occasion to make at a meeting of the National Tuberculosis Association, he had to suffer a similar experience. During a discussion on the use of morphin in tu- berculosis the author ventured to say that in his opinion it was an almost indispensable remedy to assuage pain in the hopelessly ill consumptive. The statement was apparently approved by all present, for it is well known that by the judicious administra- tion of morphin we not only make the patient more comfortable, but in reality prolong life. Yet, to the amazement of nearly everybody who heard it, among whom were the leading authori- ties on tuberculosis in this country, the author was denounced the following morning in a Philadelphia paper as having openly favored the administration of enough morphin to hopelessly ill tuberculous patients to end their lives. As is usual with such sensational so-called news items, this statement quickly made the rounds of the American and European press. On learning of this calumnious attack leveled against a younger colleague, Osler’s indignation had no bounds. His own sufferings from a similar experience he had borne with that equanimity of resigna- tion characteristic of his great soul, but when it befell somebody else it was different. He urged the author to start legal pro- ceedings against that newspaper at once, offered his private purse to defray expenses, and assured him the support of the American profession at large. He stood by him to the end of a very hard but finally victorious battle, defending him publicly and comforting him in private by letters of sympathy and friendship, which helped him to bear up under a most trying and painful experience. Osler was devoted to his pupils, but he was also devoted to his teachers, and the veneration and enthusiasm he expressed when he spoke of his own masters and the masters of us all was an inspiration that not only stimulated the interest in historic medi- cine, but aroused gratitude for the inheritance which the teachers of past generations have left us. On October 5, 1905, he took the American delegation, which had attended the Fifth Inter- national Tuberculosis Congress in Paris, to the cemetery of ‘198u9}}0g pue ueuuelg ‘(}U01J) URUIMOT ‘suRAg ‘(}U01]) Jdouy ‘sqooef ‘uIUsePy ‘(1ea1) JOYyePy “(qUO1}) JeISQ ‘UOIONT ‘(QUOIJ) AYJIEDT ‘ueUTZTY AA ‘(JUOIJ) JoAag ‘Sutprashey ‘sqapy 214311 0} qe, wlos1y Surpeay CO6T NI SINOT AO AWOL AHL LV NOILVOATAC NVOIMANV SIR WILLIAM OSLER, BART., M.D., LL.D. 289 Mont Parnasse to deposit a wreath on the tomb of Louis, the French physician, at whose feet so many American physicians of the past generation had sat. It was a touching tribute and gave the younger men a lesson in gratitude to our teachers. The accompanying picture of that occasion shows Osler in a thought- ful attitude after having made a short and impressive address to the American delegation by whom he is surrounded. The delega- tion included Drs. Whitman, Norton, Leonard Pearson, George H. Evans, Arnold C. Klebs, D. J. McCarthy, A. J. Magnin, Henry Barton Jacobs, John W. Brannan, A. Kayserling, Henry Beyer, John H. Lowman, F. M. Pottenger, and S. Adolphus Knopf. / Such a biographical sketch as this must necessarily be incom- plete. Osler was one of the greatest physicians of the Anglo- Saxon race of the present day, but we are considering mainly his activities as a tuberculosis worker. As such he instructed thou- sands of students by word of mouth and by his writings on early diagnosis, practical prophylaxis, and rational treatment. In a lecture he delivered soon after his arrival in England he said: “Probably go per cent. of mankind has latent tuberculosis, and if I had an instrument here with which I could look into the chest and abdomen of each of you I would probably find somewhere a small area of the disease. So wide- spread is the germ that practically all humans, by the time they become adults, harbor the bacillus of the disease. But we do not die, because we are not guinea- pigs and rabbits. We have attained a certain immunity. But the germ is in us, though negative, and with all of us there is the possibility of slipping into the dangerous state. But when workers have living wages, when the house becomes the home, and the nation spends on food what it now spends on drink, then there will be millions instead of thousands with practically continuous immunity. For the enemy has been tracked to its stronghold, which is de- fended by three allies—poverty, bad housing, and drink.” Characteristic of William Osler and his labors are the words which grace the photograph he presented to those who bade him farewell on May 2, 1905, when he was about to leave for Oxford. They were the immortal words of Abou Ben Adhem, ‘Write me as one that loves his fellow-men.” The tributes paid to Osler by some of his pupils, colleagues and friends are most touching. Harvey Cushing, one of his favorite pupils, closes his remarks in the Annals of Medical History with 19 290 A HISTORY OF NATIONAL TUBERCULOSIS ASSOCIATION the following words: ‘In 1910 ‘Man’s Redemption of Man’ was delivered at a service for the students at the University of Edinburgh. Osler unconsciously chose as his text from Isaiah what he himself has been to those who knew him: ‘And a man shall be as an hiding-place from the wind, and a covert from the tempest; as rivers of water in a dry place; as the shadow of a great rock in a weary land.’” Howard S. Anders, one of Osler’s Philadelphia pupils, recalls in his tribute the master’s saying that ‘‘there is no higher mission in this life than nursing God’s poor.”” And Henry Sewall, the first pupil to matriculate and to graduate from Johns Hopkins, wrote: “‘If I tried to characterize Osler, three words would suffice, sweetness and light.” Dr. Field H. Garrison, of Washington, D. C., describes Osler’s lovable personality in his tribute in “Science” of January, 1920, in the following words: “Osler’s warm glance and utter friendliness of manner told how naturally fond he was of people. He had the gift of making almost anyone feel for the moment as if he were set apart as a valued particular friend, and so became, in effect, a kind of universal friend to patients, pupils and colleagues alike.” Prof. Charles L. Dana, Osler’s New York friend, characterized the great physician’s personality in the following terms: “Sir William Osler was altogether the best known and best loved physician that this or any other country has produced. His influence and achievements are not to be measured by the books he wrote, the students he taught, or the scientific observations he made. Through the influence of his ideas, his per- sonality and the mellowing activities of his career, he enriched the medical profession and greatly helped to raise its art to a point which now compels for it the esteem of society in general.” Another beautiful side of Osler was expressed in the tribute paid to him by Prof. F. J. Shepherd in the Journal of the Canadian Medical Association, wherein he said: “As a clinical teacher, Osler was at his best; not only was he an acute diagnostician and a clear expositor, but he treated his hospital patients most kindly, as human beings and not as mere cases. His example was one which made a great impression on his students and the Osler tradition of gentleness and sympathy with patients was handed on.” SIR WILLIAM OSLER, BART., M.D., LL.D. 291 Osler was a sanitarian to the end. As a demonstration of his firm belief that cremation is the most rational, sanitary, and economic disposal of the dead, he had expressed the wish that his body should be thus disposed of. His life-long friend and col- league, Professor J. George Adami, of McGill University, Mon- treal, in the Memorial Number of the Journal of the Canadian Medical Association, describes the funeral service of Sir William, and among other things says: “From one end of the Dominion to the other there will be those deeply attached to Osler—‘Our Osler’—who hunger to possess a fuller and more per- sonal knowledge of the illness that took him from among us, and of the solemnly beautiful last service at Oxford on New Year’s Day. Most touching at Christ Church was the Psalm ‘Lord Thou hast been our refuge.’ Clear and yet sub- dued, the balanced voices of the choir led the congregation that filled the nar- row Norman nave, transepts, and chancel of the Cathedral and poured over into the side aisles. . . . After a most impressive service the congregation was dismissed, and with the benediction dispersed, leaVing all that was mortal of the great physician at rest for the night in the Lady Chapel, by the grave of his old friend, Burton, of ‘the Anatomy of Melancholy.’ The next morning his remains were conveyed to London to the crematorium, where Lady Osler and her sister, Mrs. Chapin, Mr. Frank Osler, Dr. W. Francis, and Dr. Molloch were alone present at the Committal Service. “Doubtless by the time this reaches Canada it will be known that, in accord- ance, with the expressed desire and as a last gift, Sir William’s ashes are to be conveyed to Montreal, there to be deposited in the midst of his books in the Medical College of his student days, in which he held his first Chair, and which, to the end, retained his deep affection. With loving care those books were brought together, the first and the finest editions of the masterpieces of medical literature. How he loved to expatiate over their virtues! With what enjoyment he hunted for and acquired each rare volume! In that collection is concentrated the whole history of medical progress. There is nowhere so choice and well-selected a corpus of medical literature. Noble in itself, the gift is doubly ennobled by having associated with it all that is mortal of the great physician whose remains, after all his wanderings, are to come thus to rest in the country of his birth. McGill is to become his shrine, and for generations to come those who love medicine and its history will find their inspiration in that room where, surrounded by the books he loved so well, repose the ashes of Sir William Osler. Could there be nobler gifts or greater service to Canadian medicine?” This gift will be deeply appreciated in the land of his birth, but the scientific work done by Osler, the influence he exerted as a medical teacher, the friendships he formed wherever he went, 292. A HISTORY OF NATIONAL TUBERCULOSIS ASSOCIATION belong to us all. On one occasion, when making a farewell ad- dress, he said: “‘T have loved no darkness, sophisticated no truth, Nursed no delusion, allowed no fear.” To those wonderful words, expressing his ideals, we who remain behind may add as our farewell: ‘‘You made countless friends among the rich and poor, the humble and the great. Your life , Was an inspiration to old and young. You gave your heart and devoted the powers of your great intellect to the lessening. of suffering that the world should be made better. You put into practice the maxim that service to man is the highest service to God.” The bibliography of Sir William Osler follows: On the pathology of miner’s lung. Can. Med. and Surg. Jour., 1876, p. 145- 168. Phthisical cavities in left lung: gangrene of pulmonary tissue about one of them. Can. Med. and Surg. Jour., 1877-78, p. 114. Pleura. Small fibroid thickenings on visceral layer. Can. Med. and Surg. Jour., 1877-78, p. I15~-116. Diabetes, phthisical cavity in right lung surrounded by hepatized tissue. Montreal Gen. Hosp. Path. Rep., 1878, p. 34-35. Chronic phthisis; almost entire destruction of both lungs. Healthy portion involved ina pneumonia. Montreal Gen. Hosp. Path. Rep., 1878, p. 35. Chronic phthisis; perforation of lungs; pneumothorax; dermoid cyst of right ovary. Montreal Gen. Hosp. Path. Rep., 1878, p. 39-40. Acute tubercular inflammation of the peritoneum. Small caseous mass in left lung. Right-sided pleurisy. General hyperplasia of the bone mar- row. Montreal Gen. Hosp. Path. Rep., 1878, p. 52-56. Tuberculous disease in right kidney, pelvis, ureter, and bladder. Tubercles in left kidney and lungs. Perforation of tuberculous ulcer in bladder. Peritonitis. Montreal Gen. Hosp. Path. Rep., 1878, p. 72-73. Old scrofulous disease of right kidney, which is converted into cyst. Recent affection of the left. Mont. Gen. Hosp. Path. Rep., 1878, p. 73-74. ‘Old disease of the right kidney, which is converted into five or six cysts, filled with a putty-like material. Extensive tuberculous disease of the organ. Miliary tubercles in lungs. Albuminoid spleen. Montreal Gen. Hosp. Path. Rep., 1878, p. 74-75. Miner's phthisis. Can. Med. and Surg. Jour., 1878-79, p. 452-54. ‘Chronic pleurisy; flattening of sides of chest. Can. Med. and Surg. Jour., 1879-80, viii, IOQ—II1. Perforation of pulmonary artery by ulcer of left bronchus; sudden death from SIR WILLIAM OSLER, BART., M.D., LL.D. 293 hemoptysis; chronic bronchitis, emphysema, phthisis. Montreal Gen. Hosp. Path. Rep., 1880, i, 282-283. Pneumonia phthisis. Montreal Gen. Hosp. Rep., 1880, i, 295-297. Clinical lecture on a case of fibroid phthisis. Can. Med. and Surg. Jour., 1880-81, ix, 641-650. Cestode tuberculosis. A successful experiment in producing it in a calf. Am. Vet. Rev., 1882-83, vi, 6-10. Pulsating pleurisy. Tr. Assn. Am. Phys., 1888, iii, 330-338. The anatomical tubercle. Montreal Med. Jour., 1888-89, xvii, 418. Note on endocarditis in phthisis. Johns Hopkins Hosp. Rep., 1890, ii, 62-64. Tubercular peritonitis; general considerations; tubercular abdominal tumors; curability. Johns Hopkins Hosp. Rep., 1890, ii, 67-113. Diagnosis of tuberculous broncho-pneumonia in children. Arch. Pediat., 1891, viii, 825~829. Acute phthisis; erosion of a large branch of the pulmonary artery; sudden fatal hemoptysis. Tr. Path. Soc., Phila., 1891, xiv, 169. Report on the Koch Treatment in Tuberculosis. Bull. Johns Hopkins Hosp., 1891, ii, 7-14. The healing of tuberculosis. Climatologist, Phila., 1892, ii, 149-153. Tuberculous pericarditis. Am. Jour. Med. Sc., Phila., 1893, 20-27. Cases of sub-phrenic abscess. Tr. Assn. Am. Phys., Phila., 1893, 257-267. Profound toxemia with slight tuberculous lesions. Medical News, Phila., 1893, lxiii, 632. Notes on tuberculosis in children. Arch. Pediat., N. Y., 1893, x, 979-986. Toxzmia in tuberculosis. Practitioner, London, 1894, iii, 26-30. The registration of pulmonary tuberculosis. Phila. Polyclin., 1894, p. 65. Pleuro-peritoneal tuberculosis. Bull. Johns Hopkins Hosp., 1896, p. 79. Ephemerides, 1895: xi. Is the coin sound distinctive of pneumothorax? Montreal Med. Jour., 1895-96, xxiv, 518 to 969. The preventive and remedial treatment of tuberculosis (Discussion). Brit. Med. Jour., 1899, ii, 1155. The home treatment of consumption. Maryland Med. Jour., 1900, p. 8-12. On the study of tuberculosis. Phila. Med. Jour., 1900, vi, 1029-30. The home in its relation to the tuberculosis problem. Med. News, N. Y., 1903, p. 1105-10; also in Sanitarian, N. Y., 1904, p. 322-336; Canada Lancet, Toronto, 1904-05, p. 600-612; Revue Internat. de la Tubercu- lose, Paris, 1905, vii, 403-413. The ‘‘phthisiologia” of Richard Morton, M.D. Med. Libr. & Hist. Jour., Brooklyn, 1904, ii, I-7. Address of the vice-president. Tr. Nat. Tuberc. Assn., i, 20, 1905. Acute tuberculous pneumonia. Brooklyn Med. Jour., 1905, xix, 57-61. Address before National Tuberculosis Association, Fifth Annual Meeting. Tr. Nat. Tuberc. Assn., v, 31, 1909. Edward L. Trudeau—An appreciation. Jour. Outdoor Life, 1910, vii, 162. Men and books: VII, Letters of Laennec. Can. Med. Assn. Jour., 1912, ii, 247-248. 294. A HISTORY OF NATIONAL TUBERCULOSIS ASSOCIATION Men and books: XI, George Bodington. Can. Med. Assn. Jour., 1912, p. 526-27. Bacilli and bullets: an address to the officers and men in the camps at Churn. Brit. Med. Jour., 1914, ii, 569-70. A tribute to Dr. Edward L. Trudeau: a medical pioneer. Am. Med., 1915, N.S. X, Pp. 20. An address on the tuberculous soldier. Lancet, 1916, 220-221. Graduated exercise in prognosis. Lancet, 1918, i, 231. Tuberculosis. In Amer. Textbook Dis. Child. (Starr), Phila., 1894, p. 94- 126. Also in his collected reprints, 1892-97, iii, no. 134. * Tuberculosis. In Syst. pract. med. (Loomis), N. Y. & Phila., 1897, i, 731-848. Tuberculosis. In Amer. text book dis. child. (Starr), 2d edition, Phila., 1898, p. 270-302. The principles and practice of medicine; designed for the use of practitioners and students of medicine, a textbook of which eight editions have ap- peared, containing valuable chapters on tuberculosis. Appleton, N. Y., 1917. This book has been translated into French, German, and Chinese. CHAPTER XXxXI COLONEL GEORGE E. BUSHNELL, M.C., U.S.A. HONORARY VICE-PRESIDENT OF THE NATIONAL TUBERCULOSIS ASSOCIATION FROM I918 R. GEORGE E. BUSHNELL, Colonel of the United D States Army, Retired, was unanimously chosen honorary vice-president of the National Tuberculosis Association at the annual meeting in 1918, in special recognition of the great service he had rendered in the prevention of tuberculosis in the army during the world war. George Ensign Bushnell was born in Worcester, Mass., Septem- ber 10, 1853, his parents being George and Mary Elizabeth Bush- nell. He graduated with the degree of A.B. from Yale in 1876, and obtained the degree of M.D. at the same school in 1880. He passed the examination for assistant surgeon in the United States Army, and was appointed in February, 1881. He passed through the various grades, finally reaching that of colonel, and was re- tired as such on account of age limit September I0, 1917. Since 1903 Colonel Bushnell has paid particular attention to the study of tuberculosis. At that time he had been assigned to duty at the army sanatorium for the tuberculous at Fort Bayard, New Mexico. In 1904 he was in command of the hospital, where he remained until June 2, 1917, when he was assigned to duty in the office of the Surgeon General and placed in charge of all matters appertaining to tuberculosis in the army. Although officially re- tired on September 10, 1917, so experienced a physician could not be spared at such a time, and the Colonel remained on active duty throughout the war. His services at the head of the tuber- culosis section of the Army Medical Corps have been invaluable. One of the most effective circulars brought out during the war was S.G.O. Circular No. 20, which was issued upon his recom- mendation from the Surgeon General’s office. This circular was 295 296 A HISTORY OF NATIONAL TUBERCULOSIS ASSOCIATION highly approved by Major General Gorgas, then Surgeon General, and later by his successor, Major General Ireland. Prior to being issued it had been submitted for revision to two of our most eminent internists, Professor William P. Thayer and the late Professor Theodore C. Janeway, both of Johns Hopkins Univer- sity, but these authorities found only some slight changes to rec- ommend and returned it to the Surgeon General’s office with their absolute approval. Its purpose was to standardize the methods of examination in order to secure uniformity in the rejection or acceptance of doubtful cases of. tuberculosis. Bushnell well said: ‘Military examinations must differ from those in civil life in three respects: (1) The statements of the men examined could not be taken at their face value; the examinations must, therefore, be based on objective facts. (2) Besides the interests of the individual, only considered usually in civil practice, there must be borne in mind the interests of the Government. It was im- portant, above all things, to obtain soldiers; men must, therefore, not be re- jected on doubtful indications—the diagnosis upon which rejection was based must be based upon positive, distinctly marked signs and symptoms. (3) The examinations must be rapidly performed in order to clear the army of the unfit at an early date for the army's sake, and examinations must be early to prevent claims that the disabilities found had been incurred in line of duty— this for the sake of the taxpayer.” Because of the scientific, practical, economic, historical, and above all patriotic value of this circular, it will be well worth while to reproduce here the essential parts of it. The circular was issued on June 13, 1917, for the information of the medical officers to be used in connection with examinations for pulmonary tubercu- losis in military service: “The duties of the examiner are: “1. To exclude cases of manifest tuberculosis from the army. “2, To hold to service men who allege tuberculosis as a ground for exemp- tion or discharge on the basis of insufficient or incorrectly interpreted signs and symptoms. “3. To determine in the case of soldiers accepted for the military service the existence of pulmonary tuberculosis, and to decide whether or not the disease has been incurred in the line of duty.” “The following signs will not be regarded as evidence of pulmonary disease in the absence of other signs in the same portion of the lungs: “1, Slightly harsh breathing, slightly prolonged expiration over the right GEORGE E. BUSHNELL COLONEL GEORGE E. BUSHNELL, M.C., U.S.A. 297 apex above the clavicle anteriorly and to the third dorsal vertebra posteriorly, The same signs at the extreme apex left side. ‘2, Same signs second interspace right anteriorly near sternum (proximity of right main bronchus or trachea). “3. Increased vocal resonance, slightly harsh breathing immediately below center of left clavicle. “4, Fine crepitations over sternum heard when stethoscope touches the edge of that bone. “s. Clicks heard during strong respiration or after cough in the vicinity of the sternocostal articulations. “6. The so-called atelectatic rales heard at the apex during the first inspira- tion which follows a deeper breath than usual or cough. “7, Sounds resembling rales at base of lung (marginal sounds), especially marked in right axilla, limited to inspiration. “8. Similar sounds heard at apex of heart on cough (lingula). “‘g, Slightly prolonged expiration at left base posteriorly. “to. Very slight harshness of respiratory sounds with prolonged expiration in, the lower paravertebral regions of both lungs posteriorly, most marked at about angle of scapula, disappearing a short distance above that point, equal on both sides, or slightly more marked at the angle of one side, more frequently the left.” “Incipient tuberculosis of the apex is often erroneously diagnosticated: “‘r, On account of misinterpretation of normal signs. ‘2, Because the importance of minor differences between the two sides is exaggerated. “3. Because signs of a healed lesion are considered to indicate an incipient lesion.” “The only trustworthy sign of activity of apical tuberculosis is the presence of persistent moist rales.” Concerning the diagnosis of acute lesions, the following are striking sentences: “Tf small, this lesion is manifested by rales, with or without changes in breath sounds, percussion note, and voice transmission. The more acute the lesion the greater the probability that its presence will be indicated only by rales. . . . Large acute lesions are rarely found in candidates for enlistment and the small acute lesion is also comparatively rare. Tubercu- losis as it presents itself to the Army examiner is usually of a chronic type.” “An arrested chronic lesion is characterized by harshness of breath sounds and prolongation of expiration, by increased vocal fremitus and resonance and by more or less pronounced dullness on percussion.” “An active chronic localized lesion is denoted by the presence of rAles, together with the other signs described under the arrested lesion. RAles do not necessarily show that the lesion is extending nor that the activity is of much clinical importance, but in military practice the presence of rales ac-' 298 A HISTORY OF NATIONAL TUBERCULOSIS ASSOCIATION companied by breath changes and other signs should be an indication for rejec- tion. The more active and recent the chronic lesion the less marked the breath changes and the more conspicuous the r4les.”’ “True miliary tuberculosis is not likely to come to the attention of the military examiner. The peribronchial type is common and frequently not recognized. In the adolescent the peribronchial tuberculosis may be extending from the deep lung without as yet developing a superficial focus. It may be manifested only by the presence of distant rales with or without slight changes in the breath sounds which are of a slightly bronchovesicular quality. If the case is well marked there will be impairment of expansibility of the affected _ side and increased vocal resonance. Less pronounced cases are distinguished from chronic bronchitis only by the character of the rales (coarser in bron- chitis) and by their typical distribution.” “A definitely demonstrated tuberculous lesion of more than insignificant size below the apex is cause for rejection whether such lesion be active or inactive. . . . No examination for tuberculosis is complete without auscultation following a cough.” “The Method of ‘Expiration and Cough.’—It is best executed as follows: Starting from the state of rest of the lung the subject forcibly expels the air from the lungs, reserving the last portion of the expiration for a short cough, after which inspiration immediately follows, but only enough air is inhaled to return the lung to the state of rest. The idea is to diminish the size of the bronchi as much as may be by expiration, then to cough to stir up forcibly such fluid as may be present in them. The moisture is more likely to be moved by the current of air and so produce rales when the tubes are of their least caliber. This procedure should invariably be employed in examinations in order to determine the activity of lesions found by other signs and also to detect the existence of fresh disseminated tuberculosis.” “The presence of tubercle bacilli in the sputum is cause for rejection.”’ “Tuberculin.—It is well recognized that a positive reaction to tuberculin, especially in the young adult, is not a proof of the presence of active clinically important tuberculosis. Tuberculin only demonstrates activity of the tuber- culous process in the clinical sense when it can be shown to produce a focal reaction. Such reaction is not without danger. Since, therefore, tuberculin rarely leads to a correct diagnosis and may do injury, its general use in the diagnosis of tuberculosis in examinations for enlistment is prohibited.” “Résumé of Indications from X-ray Negatives—The X-ray shows: 1. Tuberculous disease confined to region of hilus in deep lung. 2. Extension upward toward apex or downward and outward toward base, confined to deep lung. 3. A fine line or two extending to apex with or without small focus or foci there—condition not determinable by physical signs. 4. Clouding of apex without marked lines from hilus, probably largely pleuritic. 5. Well- marked lines extending to superficies of apex, usually, but not necessarily, with foci there—lesion accessible to physical examination. 6. Lines extending toward shoulder as well as apex. (a) If confined to deep lung may mean early and now obsolete exacerbation. (b) If extending to superficies denote COLONEL GEORGE E. BUSHNELL, M.C., U.S.A. 299 larger lesion and less immunity than 5. 7. More or less widely diffused spots, lines, and streaks through a considerable portion of the lower lobe approaching periphery of lung, with few or no auscultatory signs—deep peribronchial tuberculosis. 8. More extensive streaked opacities involving greater part of one or both lungs and extending to periphery with few or many physical signs—fibrocaseous tuberculosis, fibrosis preponderating in proportion to scantiness of more or less rounded spots or dots. “Conditions as shown by 1, 2, 3, 4, and 6(a) are not causes for rejection. Cases under 5 are to be determined by physical examination. Cases under 6(d), 7, and 8 are to be rejected.” Concerning the reception of this circular-by the examiners of the army, Colonel Bushnell said in an address, delivered before the National Tuberculosis Association on March 6, 1918: “‘These were novel ideas for our examiners, but they grasped them soon and carried them out loyally. The attempt to standardize indications was per~ haps a bold one. Naturally, the ideas advanced in Circular No. 20, though before its publication it had received the approval of some of the leading in- ternists in the country, did not fail to arouse some opposition, which cannot be said to be overcome even now. Almost any statement concerning a disease with regard to which such divergent views are held, as is the case with tubercu- losis, will meet with some dissenters. Still I think it may be said that, though imperfect, a standard is better than no standard, under the conditions of this examination.” It was the writer’s privilege to see the methods of examination indicated in Circular No. 20 put into. practice at Camp Platts- burg, and it was indeed astonishing to see how much could be accomplished and how reasonably sure one could be of not having made a serious mistake by following the directions given by order of the Surgeon General through Colonel Bushnell. The following figures certainly will give food for thought: During the mobiliza- tion period of the war in 1917-1918 the draft boards rejected 62,000 men because of tuberculosis. The examinations, asa rule, were made by civilian practitioners. All men sent to camps and cantonments as fit for military service and free from tuberculosis were again examined by military surgeons according to the indi- cations in Circular No. 20, and as a result 25,000 more were re- “jected on account of tuberculosis, which had escaped the exami- ners at the draft boards. Colonel Bushnell’s activity while at the head of the tuberculosis 300 A HISTORY OF NATIONAL TUBERCULOSIS ASSOCIATION section of the Army Medical Corps was, of course, not confined to inaugurating effective diagnostic work. It was under his direction that ample provision was made in eight newly erected govern- ment hospitals for those in our army who had contracted or developed tuberculosis during service here or abroad. Below will be found the valuable bibliography of Colonel Bush- nell’s literary activity on behalf of the prevention and cure of tuberculosis in the army. Colonel Bushnell has now retired, enjoying a well-deserved rest. Hecan amply afford to do this with the consciousness of having done his duty and having given not only the best of his years, but even the years of later life, which he had a right to enjoy in peace and quiet, to the service of his country. The Colonel, however, does not seem to believe that retirement from active service should be followed by complete inactivity, and so he surprised and delighted his friends and admirers recently by the publication of a remarkable book, entitled ‘A Study of the Epidemiology of Tuberculosis; With Especial Reference to Tu- berculosis of the Tropics and of the Negro Race.’”’ This should be considered one of the most authoritative books that have ap- peared on the subject, showing, as it does, the wide reading of the author and his vast experience as an army surgeon in various parts of the country and under diverse climatic conditions. The bibliography of Col. George E. Bushnell follows: Marginal sounds in the diagnosis of pulmonary tuberculosis. Med. Rec., Dec. 21, 1912. Immunity through tuberculous infection. Mil. Surgeon, Jan., 1913. The diagnosis of tuberculosis in the military service. Mil. Surgeon, June, 1917; also in Med. Rec. and Am. Rev. Tuberc., i, 325-352, I917. Tuberculosis in the army. Address before South. Med. Assn., Memphis, Tenn., Nov. 13, 1917. South. Med. Jour., Dec., 1917. Tuberculosis and war. Address before Am. Sanatorium Assn., Dec. 14, 1917. Med. Rec., Jan. 5, 1918. Complement fixation in tuberculosis with the “partial antigens” of Deycke and Much (With A. Woods and C. Maddux). Jour. Immunol., April, 1917. Extension of tuberculosis of the lungs as shown by the x-ray. Southwestern Med., May, 1917. Manifest pulmonary tuberculosis. Mil. Surgeon, April, 1918; also in Med. Rec. and Am. Rev. Tuberc. COLONEL GEORGE E. BUSHNELL, M.C., U.S.A. 301 The treatment of tuberculosis. Mil. Surgeon, June, 1918; also in Med. Rec. and Amer. Rev. Tuberc. Sanatorium treatment in the appropriate climate, Tr. Nat. Tuberc. Assn., i, 362, 1905. Lessons from the war as to tuberculosis. Address before Nat. Jewish Hosp. for Cons., Jan. 13,1918. Jour. Am. Med. Assn., March 9, 1918. The army in relation to the tuberculosis problem. The Jerome Cochran Lecture read before the Alabama State Med. Assn., April 17, 1918. Jour. Am. Med. Assn., June 15, 1918. How the United States is meeting the tuberculosis war problem. Am. Rev Tuberc., Sept., 1918; also in Tr. Nat. Tuberc. Assn., xiv, 93, 1918. Experimental evidence as to immunity from tuberculous infection. Med. Rec., Jan. 18, 1919. The epidemiology of tuberculosis in the military service, Tr. Nat. Tuberc. Assn., xiv, 155, I919. A study of the epidemiology of tuberculosis; with especial reference to tu- berculosis of the tropics and of the Negro race. William Wood & Co., New York, 1920. CHAPTER XXXII MAJOR GENERAL WILLIAM C. GORGAS, M.C., U.S.A. HONORARY VICE-PRESIDENT OF THE NATIONAL TUBERCULOSIS ASSOCIATION IN 1920 T ITS meeting in April, 1920, in St. Louis, the National A Tuberculosis Association honored itself by the unanimous election of General William C. Gorgas to the honorary vice- presidency. General Gorgas had belonged to the Association officially as adirector since 1917, but asan honorary vice-president he was ours only a few months, for he died on July 4, 1920. Of the many obituaries which appeared at the time of the great General’s death, in all of which high tributes were paid to his achievements, one of the most touching was that by his successor, Merritt W. Ireland, Surgeon General of the United States Army. William Crawford Gorgas, the son of General Josiah and Amelia Gayle Gorgas, was born in Mobile, Ala., October 3, 1854. General Ireland writes of the parents and their son William as follows: “General Josiah Gorgas was Chief of Ordnance of the Confederate Army during the Civil War, and later president of the University of the South at Sewanee, Tenn. His mother was Amelia Gayle, a famous beauty, daughter of the War Governor of Alabama. In lineage and personality the late Surgeon General was a typical southerner. He had what might be called the Alabama temperament, a pleasant, suave, affable manner, and an attractive disposition, which, wherever he went, made him many friends.” William C. Gorgas received his preliminary and classical educa- tion at the University of the South from which he was graduated in 1875. He then entered Bellevue Hospital Medical College, re- ceiving his degree in 1879. He subsequently served there as intern for two years. Entering the army in 1880, he received a commission as first lieutenant. His first post was Fort Brown, Texas. It was here that we may say he was fortunate enough to 302 WILLIAM C. GORGAS MAJOR GENERAL WILLIAM C. GORGAS, M.C., U.S.A. 303 contract yellow fever, which rendered him immune for the great work he was to do later on. He was promoted to captain in 1885. During the Spanish-American War he served as major and briga- dier surgeon of volunteers. On July 6, 1898, he received his com- mission as major in the regular army. At the close of the Spanish- American War Major Gorgas was made Chief Sanitary Officer of Havana, in which capacity he served from 1898 to 1902. General Gorgas’ achievements in combating yellow fever in Cuba and in the Panama Canal Zone are so well known and have been referred to so often in his obituaries and biographies that we shall merely quote here the following statements from General Ireland’s tribute: ‘‘When de Lesseps started his ill-fated venture at canal building in 1880, the French occupants found the Isthmus a death-trap and during the nine years of occupancy they lost 22,819 laborers from the disease. At this time Panama was called ‘the White Man's Grave.’ When the United States took charge of the Canal in 1904, the death rate was as high as ever and a yellow fever epidemic was actually going on. In less than a year’s time, the disease was completely wiped out and there was not a single case since May, 1906.” For his work in Cuba Gorgas was made a Colonel and Assistant Surgeon General by special act of Congress in March, 1903. In 1907 he was made a member of the Isthmus Canal Commission, and as such he remained in charge of the sanitation of the Isthmus until the winter of 1913. In 1913, at the request of the British government, Gorgas went to South Africa to investigate conditions in the Rand mines, where the natives were dying in large numbers from pneumonia, miners’ consumption, malarial fever, and tuberculosis. It was here that for the first time the General’s interest was centered publicly upon tuberculosis, although it is known that he had al- ways felt a profound interest in the combat of this disease, and he had been a member of our Association for a number of years. General Gorgas had a deep insight into the primary causes of tuberculosis, such as bad housing, underfeeding, overwork, and he did not hesitate to state publicly that our present taxation evils, grants, and immunities represent an unjust social order that is largely responsible for insufficient and unsanitary housing, poverty, and want in general. He was an ardent disciple of Henry George and firmly believed in the single tax system. 304 A HISTORY OF NATIONAL TUBERCULOSIS ASSOCIATION Gorgas was an idealist, but an intensely practical one. In one of his most remarkable addresses, entitled ‘‘Economic Causes of Disease,” delivered in Cincinnati, September 29, 1914, he said: “While dwelling upon thoughts such as these (better housing, better food, and better clothing for the laborers in order to combat disease) I came across ‘Progress and Poverty.’ I was greatly impressed by the theory and was soon convinced that the single tax would be the means of bringing about the sanitary conditions I so much desired, and was striving for. It was impressed upon me in a concrete form everywhere, in the United States, in the tropics and par- ticularly in Panama; the great benefit that some such scheme of taxation would confer upon sanitation.” The entire address which to the men engaged in tuberculosis work has a deep significance, was published by Dr. Walter Mendelson, of New York, and endorsed by many of our lead- ing sanitarians, medical teachers, sociologists, and economists throughout the country. In South Africa, where General Gorgas had complete command of the situation, he at once inaugurated a campaign for the com- bat of pneumonia, tuberculosis, miners’ consumption, etc., based on the principles of rational hygiene and general human welfare, such as we apply in the prevention of tuberculosis—more air space for sleeping and living quarters, a pure water supply, a sewer sys- tem, the destruction of flies and mosquitoes, and a better food supply. On January 16, 1914, Gorgas was appointed Surgeon General of the United States Army with the rank of Brigadier General and in 1915 he was made Major General. During the summer and fall of 1916 he spent several months in South America making a pre- liminary survey for the Rockefeller Foundation, of localities still infested with yellow fever. With the entrance of the United States into the World War in 1917, General Gorgas fulfilled the duties of his high office in a remarkably efficient way. The subject of tuberculosis was, of course, of particular interest, because so much work had to be done in order to safeguard our troops from contracting the dis- ease. General Gorgas selected for this work the best talent among the military and civilian population. In the general his- tory of our Association and in Colonel Bushnell’s biography the MAJOR GENERAL WILLIAM C. GORGAS, M.C., U.S.A. 305 work done by the division of tuberculosis in the Surgeon General’s Office has already been referred to in detail. General Gorgas showed his wisdom and interest in the tubercu- losis problem of the army by appointing Colonel Bushnell to the task of looking after that disease and in seeing to it that no inter- ference was placed in his way. It is characteristic of General Gorgas that, having selected the men that he needed, he left them alone in the confidence that they would do the right thing and without the wish to add to his own renown by taking credit for what was accomplished. In recognition of General Gorgas’ service to medical science and to humanity at large, many honors were conferred upon him. He was awarded the Distinguished Service Medal of the United States and was made Commander of the Legion of Honor of France; he was knighted by King George of England and dec- orated by King Albert of Belgium, as well as by rulers of other foreign countries. Honorary degrees were conferred on him by the University of Pennsylvania, the University of the South, the University of Alabama, and by Harvard, Brown, Tulane, Johns Hopkins, Oxford, Lima, and other universities. His alma mater, now the New York University and Bellevue Hospital Medical College, conferred on him the degree of LL.D. in June, 1918, in the midst of the great war. A brilliant assembly gathered in the amphitheater of the college to pay homage to their distinguished fellow alumnus. The gathering was largely composed of physicians training for or already active in war work. At the conclusion of the ceremonies which conferred the degree of LL.D. upon William Crawford Gorgas, the General responded in felicitous terms thanking the faculty for the honor conferred upon him. He then took occasion to express his appreciation of the willingness of the American medical profession to do its duty in the great war. He congratulated those present on having the privilege of serving their country in an hour of greatest need, bidding them an affectionate God speed. He concluded by saying that he hoped soon to meet many of their number in France, for which country he was about to sail with Secretary of War Baker. In addition to the just mentioned honors conferred on General Gorgas, he was awarded the Mary Kingsley medal from Liverpool School of 20 306 A HISTORY OF NATIONAL TUBERCULOSIS ASSOCIATION Tropical Medicine (1907), a gold medal of the American Museum of Safety (1914), and a special medal from the American Medical Association, 1914. Besides being president of the American Med- ical Association in 1909-1910, he was a member of the American Society of Tropical Medicine, American Public Health Associa- tion, and Association of Military Surgeons; honorary fellow of the New York Academy of Medicine and of the College of Phys- cians of Philadelphia, and associate member of the Société de pathologie exotique de Paris. After his retirement from active duty in the army during the year 1919, General Gorgas was occupied with yellow fever investi- gations at Guayaquil and other South American foci. In 1920 the question of exploring the African foci-came up. General Gorgas reached London on his way to West Africa on May 19, apparently in the best of health, and after a short period of travel on the continent, during which time he was decorated by King Albert of Belgium, he returned to London on May 29. On the following day he had a stroke of apoplexy from which he never recovered. The funeral ceremonies in London and in Washington were conducted with the military and civil honors becoming his rank and his distinction as an officer and scientist. To characterize the man Gorgas, we may be permitted to quote again from General Ireland’s tribute: “Reticent and shy in public address, kindly, modest, and unselfish in authority, patient and open-minded, General Gorgas stands as one of the great figures in the application of science to the conquest of disease.” To have known him intimately was indeed a privilege, and his kindly face will never be forgotten by those who served with him or under him, or came into personal contact with him socially. We are indebted to Mrs. Gorgas for the picture of the General, which she considers the best ever taken of him. It was taken just before his retirement from the army. With the death of General Gorgas the world lost oneof the great- est medical authorities, a true benefactor of mankind, an ideal soldier, and a most lovable man. His achievements in preventive medicine have placed his name among the immortals of the age. The remains of General Gorgas were interred at Arlington Cemetery at Washington with impressive military and civilian MAJOR GENERAL WILLIAM C. GORGAS, M.C., U.S.A. 307 ceremonies. A special memorial service in honor of the late Major General was held in Washington on Sunday evening, January 16, 1921. Besides the diplomats, officers of the army and navy, members of Congress and other officials, there was present a large gathering of the many friends and admirers of General Gorgas. The exercises were under the auspices of the Southern Society of Washington, of which he was the former president. Major General Peter C. Harris, the Adjutant Gen- eral of the United States Army, who presided, paid a glowing tribute to the life and career of General Gorgas. The other speakers who followed in the same vein were: Dr. Clarence J. Owens, Past President of the Southern Society; His Excellency Mr. J. J. Jusserand, Ambassador of the French Republic; His Excellency Sefior Don Frederico Alfonzo Pezet, Ambassador of Peru; The Hon. Dr. Carlos Manuel de Cespedes, Minister of Cuba; Hon. Sefior Dr. Don Rafael H. Elizalde, Minister of Equador; Hon. Newton D. Baker, Secretary of War; Hon. Josephus Daniels, Secretary of the Navy; Hon. Sefior Don J. E. Lefevre, Charge d’Affaires ad interim of Panama; Major General H. K. Bethell, Military Attache to the British Embassy; Dr. L. S. Rowe, Director General, Pan-American Union. Cable- grams of tribute to General Gorgas were read from the residents of Uruguay and Costa Rica and from the government of Columbia. Since Major General Gorgas’ death a number of movements have been started to honor his memory. A Senate joint resolu- tion by Senator Heflin, of Alabama, is before Congress, which would authorize the expenditure of $50,000 in the erection of a monument in the city of Washington. Another movement pur- poses to raise a fund of $2,000,000 to establish a medical school as a memorial to Major General William C. Gorgas. The present plan is to have the entire nation contribute to the fund and to locate the school at Tuscaloosa, Ala., where General Gorgas lived as a boy. Dr. Seale Harris, of Birmingham, Ala., is chairman of the National Committee. Lastly, a Gorgas memorial institute has already been established in Washington, D.C. The purpose of the executive committee is to further a movement to introduce the sanitary methods devised by the late Surgeon General Gorgas into all the civilized countries of the world. CHAPTER XXXII WARREN G. HARDING Honorary Vice-President of the National Tuberculosis Association, 1921 O HAVE the President of the United States as an honorary | vice-president of any association is indeed a great distinc- tion, and to be permitted to incorporate a biographical sketch of the first citizen of the United States in the history of the anti-tuberculosis movement in this country, because he has honored us by accepting the honorary vice-presidency, is a privilege which every member of the Association deeply ap- preciates. Warren G. Harding is the son of a physician, the venerable Dr. George Tryon Harding of Marion, Ohio. Dr. Harding, although he has been nearly fifty years in practice, is still hale and hearty and following his profession. Such an ancestry speaks well for the President. The Hardings are of good, old Colonial stock. They settled first in Connecticut, removing later to the Wyoming Valley, Pennsylvania, where some of them were massacred and others fought in the Revolutionary War. The mother of the President, Phoebe Elizabeth Dickerson, was descended from an old-time Holland Dutch family, the Van Kirks; so that in Warren G. Harding is found the blending of the blood of the hardy Holland Dutch and the fearless, alert, and liberty-loving Scotch. His in- terest in medical science, preventive medicine, and, what con- cerns us particularly, the tuberculosis problem, he has evidently acquired directly from his father. Warren G. Harding was born in Blooming Grove, Morrow County, Ohio, November 2, 1865. Of his boyhood an unknown biographer says: ‘‘He was just a natural, healthy, robust boy, endowed with the supremest gifts of nature—good, hard common sense, a rugged constitution, a sunny disposition, and a heart full of the milk of human kindness.”” He attended the village school until fourteen years of age, when he entered the Ohio Central 308 HARDING WARREN G. WARREN G. HARDING 309 College of Iberia from which he was graduated, standing high in scholarship; and it was there, as editor of the college paper, that he first displayed a talent for journalism. Like most aspiring young men in those days, he was obliged to stop for a time now and then to earn the money with which to pursue his college course. At one time we find him cutting corn; at another paint- ing his neighbor’s barns; at still another driving a team and helping to grade the roadbed of the T. & O. C. Railroad, which was then being built through that community. At the age of seventeen we find him teaching a district school, and “‘tooting a horn” in the ‘‘brass band” of the village. When young Harding was nineteen, having completed his college course, his father, Dr. Harding, removed to Marion, Ohio, the county seat of the adjoining county, where he still resides. Warren G. Harding engaged in the newspaper business at Marion, and in 1884 became president of the Harding Publishing Company which published the Daily Star. In 1900 he was elected to the Ohio Senate and served as State Senator until 1904 when he became Lieutenant-Governor, remaining in that position until 1906. He became United States Senator from Ohio in 1915 and remained a member of the Senate until 1921, having been elected President of the United States on November 2, 1920, by an overwhelming majority. An admirer of the President said of him prior to his election: ‘“Were Warren G. Harding elected President of the United States, the country would have a good listener, a man capable of select- ing a strong cabinet of good advisers, a wholesome man of good . physical proportion, a man loving peace but unyielding in the de- mand for protection of the American ideals of right living.”’ When Mr. Charles M. DeForest wrote to the President that the children of the District of Columbia had won the Silver cup offered in the intercity contest of the Modern Health Crusade, President Harding in a charming way consented to present the cup and afterwards wrote the following letter: “The White House, Washington. “My dear Mr. DeForest: September 27, 1921. “JT was very much interested to-day in presenting, on behalf of the National Tuberculosis Association, the silver cup won by the school children of the Dis- 310 A HISTORY OF NATIONAL TUBERCULOSIS ASSOCIATION trict of Columbia because of their larger enlistment, relatively, in the Modern Health Crusade, particularly in their enlistment to make effective warfare against tuberculosis. I may quite sincerely express the hope that in every American city and country district a like large proportion of boys and girls will make themselves knights by faithful attention to their own habits and their care and concern for the health of the nation. “Very truly yours, (Signed) ‘Warren G. Harding.” Mr. Charles M. DeForest, National Tuberculosis Association, New York City, N. Y. President Harding was indeed a good listener, on this occasion listening even to little children. His letter to Mr. DeForest shows not only his love for little children but also his deep interest in the physical well-being and the health of the nation at large. His special interest in the tuberculosis problem is shown by a splendid letter written to Dr. Charles J. Hatfield, the Managing Director of the National Tuberculosis Association, in answer to a letter referring to the Christmas Seal Campaign. It reads as follows: “The White House, Washington. “My dear Dr. Hatfield: November 10, 1921. “T am glad to note the splendid success of the campaign against tuberculosis, as shown by the decline of the death rate in 1920, to the remarkably low level of 114 per 100,000. The enormous saving of life reflected by these figures clearly indicates the success of the work of the National Tuberculosis Association and its affiliated organizations. “As Honorary Vice-President of the Association, I will be glad to have you convey to all who are interested in the prevention of tuberculosis my earnest hope that the coming Fourteenth Annual Christmas Seal Sale may be com- pletely successful, in order that your splendid work may be further developed. I trust that there may bea generous response to your appeal. “Yours sincerely, (Signed) “‘Warren G. Harding.’ Dr. Charles J. Hatfield, Managing Director, National Tuberculosis Association, 370 Seventh Avenue, New York City. President Harding’s attitude toward the anti-tuberculosis work is further shown by the following letter which accompanied the ex- cellent autographed photograph of the President reproduced in WARREN G. HARDING 311 this History, and which the author will always cherish among his most valuable documents: “The White House, Washington. “My dear Dr. Knopf: March 1, 1922. “Tam glad to receive your communication, with enclosures, and to learn that the National Tuberculosis Association has undertaken the publication of “A History of the Anti-Tuberculosis Movement in the United States. “My attention has recently been directed to the beneficent results achieved by the intensive anti-tuberculosis effort, as evidenced by Dr. Frankel’s paper at the Annual Meeting of the National Association last June. It is certainly gratifying to know that sixty thousand fewer deaths occurred in the United States Registration Area from pulmonary tuberculosis in 1919, than would have occurred if the 1900 death rate had prevailed. The knowledge of such im- pressive facts cannot fail to be an inspiration to all engaged in preventive medi- cine and in the mitigation of human suffering and distress. “With all good wishes for the continuing success of your efforts, I remain “Yours sincerely, (Signed) ‘‘ Warren G. Harding.” Dr. S. Adolphus Knopf, 16 West 95th St., New York City. The interest in the tuberculosis problem taken by the Harding family is not confined to the President alone. In the Bulletin of the National Tuberculosis Association of December, and repro- duced in this volume in chapter VI, entitled ‘‘The Tuberculosis Christmas Seal,” a charming picture is shown of Mrs. Harding purchasing her first sheet of Christmas Seals from a small Modern Health Crusader. In his letter to Dr. Hatfield and in the one addressed to the author, President Harding referred to the remarkably low level of the tuberculosis death rate in 1919 and in 1920. With the Presi- dent’s deep interest in the problem, with his ever present anxiety for the care of the tuberculous ex-soldiers and the war veterans afflicted with other diseases or still suffering from wounds re- ceived in battle, and with his ardent advocacy of all measures tending to improve the health of the nation, may we not be cer- tain that during the years while he is President the morbidity and mortality not only of tuberculosis but also of other preventable and curable diseases will continue to decrease? 312 A HISTORY OF NATIONAL TUBERCULOSIS ASSOCIATION The great French scientist, Louis Pasteur, the father of modern bacteriology, to whom preventive medicine is perhaps more in- debted than to any other man, set before his pupils and disciples an ideal to strive for when he pronounced the immortal phrase which has now become classic: ‘‘Il est dans le pouvoir de 1’homme de faire disparaitre toutes les maladies parasitaires du monde. ’’* May our country be privileged under the presidency of Warren G. Harding to show to the rest of mankind that we are in earnest in our efforts to realize this goal, as far as it is humanly possible, ’ by combating all infectious and contagious diseases and their ac- companying or causative abnormal social and economic condi- tions. Thus, we shall make our country a beacon of light in the onward march of civilization, by ourselves becoming spiritually, morally, and physically a strong and happy nation. *It is in the power of man to cause all parasitic (germ) diseases to disappear from the world. CHAPTER XXXIV EDWARD LIVINGSTON TRUDEAU, M.D. PRESIDENT, NATIONAL TUBERCULOSIS ASSOCIATION, FROM 1904 TO 1905 DWARD LIVINGSTON TRUDEAU was the first presi- kK dent of the National Tuberculosis Association. He was unanimously elected on June 6, 1904, and on retiring a year later from the office he was made the first honorary member. The outstanding qualities of this great man as a pioneer in sana- torium treatment in the United States, his many contributions to tuberculosis science, and his philanthropic work on behalf of the tuberculous poor and those of moderate means, give him a unique position in the history of the tuberculosis movement in this country. Many biographies have been written of Trudeau, the best perhaps being that of Stephen Chalmers, entitled, ‘‘The Beloved Physician—Edward Livingston Trudeau.”’ Of greatest interest and value, however, is his autobiography. We shall con- tent ourselves here with a relatively short sketch of the life of this pioneer in the American tuberculosis movement. Dr. Edward Livingston Trudeau, son of a prominent practi- tioner in New York, was born in that city October 5, 1848. The father, being of French descent, decided to give his son a thor- ough knowledge of that language, and sent him to Paris to get his preliminary education. There he attended the celebrated Lycée Bonaparte. After the completion of his studies in the French capital young Trudeau came back to the United States in 1867, undecided what career to choose. He finally secured an appointment as mid- shipman in the Naval Academy, but remained there a very short time. His brother had become ill, and the disease proved to be tuberculosis. Trudeau’s career as a tuberculosis fighter began by his nursing the hopelessly ill brother with that self-sacrifice and devotion characteristic of all the things he did throughout his 313 314 A HISTORY OF NATIONAL TUBERCULOSIS ASSOCIATION long, eventful life. He cared for his brother until the latter’s death, hardly ever leaving his bedside. Precautions to avoid in- fection were then unknown, and open windows and fresh air were considered contraindications. There is no doubt that Edward contracted tuberculosis from his brother, yet one cannot help feeling that a Divine Providence ordained it to be thus, for his brother’s illness led young Trudeau to choose medicine as a career, and his own illness made him a pioneer in the life-saving open-air treatment. A brilliant student ’ of tuberculotherapeutics, a beloved physician, a savior of count- less lives, and last, but not least, the teacher of a great many men who are now carrying on the work in all parts of the United States. After graduating from the College of Physicians and Surgeons in 1871, Trudeau started in general practice, becoming an asso- ciate of Dr. Fessenden Otis. He worked hard to gain a foothold in practice, but the disease he had contracted from his brother became seriously active and he was obliged to give up. He con- sulted Professors Loomis and Janeway, who advised a climatic change. He went South, but returned to New York with very little, if any, improvement. Recalling the delightful times he had had during vacations when hunting and fishing in the Adirondacks, and having always been an ardent lover of nature, he decided to spend his last days in the midst of what was to him the most congenial of environ- ments. He had given up all thought of practising medicine. The Adirondack climate and the outdoor life, coupled with his good, sound judgment, which led him not to overdo, with plenty of com- plete rest whenever possible, restored the young physician to almost perfect health within a few years, to the surprise of him- self as well as his friends. The cold season, which was feared by all other invalids who came to the Adirondack Mountains, did even more for him than the summer, and to the astonishment of the inhabitants of Paul Smith’s, where the doctor had made his home, he remained with them through the most rigorous winters. Trudeau proved that tuberculosis is curable in pure air inde- pendent of the seasons of the year, by means of a careful, regu- lated outdoor life. EDWARD LIV TRUDEAU EDWARD LIVINGSTON TRUDEAU, M.D. 315 A mind like that of Trudeau’s could not be idle, and a heart like his could not see a suffering patient without offering help; but he had his own notions of how to prescribe for the poor. It is told of him that once, in the early days, Fitz Hallock, his guide, friend, and neighbor, came in to tell the doctor that a poor family who lived back in the woods were in trouble and had sent him to get them medicine. The doctor took a prescription pad and wrote on it ‘A sack of flour and a strip of bacon,” and said: ‘‘Here is some money; get that prescription filled at the store and take it to them.” The writings of Hermann Brehmer, of Germany, on the open- air, hygienic and dietetic treatment of tuberculosis in closed insti- tutions (sanatoria) and the discovery of the tubercle bacillus by Koch awoke in Trudeau an ardent desire to devote his entire life to the study and cure of tuberculosis. The story of how he estab- lished his first laboratory to confirm Koch’s experiments of iso- lating the tubercle bacillus in sputum, and of his later original experiments in the hope of producing artificial immunity, is full of romance. He selected a little room in his own house which he called a laboratory, and made his own thermostat, which was heated by a kerosene lamp. The laboratory was heated by a wood stove, which on many a cold night the doctoi had to get up to replenish. Yet in spite of all these difficulties he succeeded in isolating the tubercle bacillus. In 1893, while Trudeau was on a visit to New York, word reached him that the lamp which was connected with the thermostat had exploded and his home and laboratory had burned to the ground. When Osler heard of the misfortune, he wrote the following characteristic lines: ‘‘Dear Trudeau: Sorry to hear of your misfortune, but take my word for it there is nothing like a fire to make a man do the Phoenix trick.” In reality it was not very long before a magnificent building of stone and tile was erected at Saranac Lake which compares well with any of the best equipped laboratories of the country, and which has been a Mecca for students from all over the world. There has, perhaps, never been a physician who had so many kind-hearted and wealthy friendsand grateful patientsas Trudeau. Mr. George C. Cooper built the laboratory, Mr. A. A. Anderson endowed it, and Mr. Horatio W. Garrett, of Baltimore, presented 316 A HISTORY OF NATIONAL TUBERCULOSIS ASSOCIATION the institution with a splendid library. From the laboratory many valuable contributions have gone out into the world and have done honor to American tuberculosis research. In 1908, on the occasion of Trudeau’s sixtieth birthday, his former pupils and assistants presented to him a Festschrift containing the re- sults of work done in the laboratory. Trudeau’s own careful studies on the use of tuberculin as a therapeutic agent have done much to show that its indiscriminate use in the hands of inexperi- enced practitioners is dangerous. His conservatism and pains- “taking care in all his investigations made him the ideal phthisio- therapist. But if the history of the laboratory, of which Trudeau remained director until his death, is interesting and far-reaching, the story of the sanatorium itself is of as great if not greater importance. It was in 1884 that the guides and residents of Saranac Lake donated money enough to buy five acres of land near the village in a spot selected by Trudeau because, as he used to say, he could always light his pipe there, showing that it was sheltered from the strong winds by the conformation of the hills and woods. Two little shacks were erected. They constituted the nucleus of what is to-day one of the greatest and most splendidly equipped insti- tutions for the treatment of the tuberculous poor and those in moderate circumstances in the United States, if not in the world, the Trudeau Sanatorium. Although a great admirer of the teachings of Brehmer as to out- door life, and of Dettweiler’s theory of the rest cure, Trudeau never favored the one-house system characteristic of the German sanatorium. It is to him that we are indebted for what is known as the cottage plan sanatorium for the treatment of tuberculous patients. Over 40 cottages accommodating from four to six patients each, an administration building, a library, a nurses’ home, and a church, called ‘‘St. Luke the Beloved Physician,” besides the laboratory already mentioned, to-day comprise the institution. It has served as a model for many of the existing sanatoria now in operation in the United States. The patients who, passing through the institution, have gained their health and been restored to their earning capacity, thanks to the genius of Trudeau, can be numbered by the thousands. How Trudeau, EDWARD LIVINGSTON TRUDEAU, M.D. 317 with virtually no means of his own, was nevertheless able to build this vast institution and maintain its workings has been a wonder to the world. The explanation is to be found in his optimism and in the generosity of his countless wealthy friends who were always willing to give when he asked for money for the building of a cottage or for this or for that. Those who came into close contact with Trudeau will recall his personal charm. Tall, slender but wiry, with a wonderful head and pleasing smile, he was the ideal physician and friend. His humor never left him no matter how trying the hour. A few years ago, when he had had one of his unpleasant relapses, the author of this sketch had occasion to write him and closed the letter wishing him a speedy recovery, to which Dr. Trudeau re- plied as follows: ‘‘I am still on my chair on my porch, to which I am glued like the fly on the fly-paper, and still have a nurse. I am afraid I don’t ‘enjoy’ poor health as some people seem to, and it is much preferable to play the part of doctor to that of patient.” Few men of the medical profession were so greatly beloved and honored as he. His alma mater, the College of Physicians and Surgeons, now the medical department of Columbia University, conferred on him the honorary degree of M.Sc. in 1899, and McGill University of Montreal gave him the degree of LL.D. in 1905. In 1910 he was tendered the presidency of the Congress of American Physicians and Surgeons, one of the highest honors within the gift of the medical profession. In May, 1913, he re- ceived the degree of LL.D. from the University of Pennsylvania. Custom requires the presence of those about to receive the degree, but in this case, owing to his illness at the time, precedent was waived and the degree conferred ‘‘in absentia,’’ an added honor. We have already referred to the enthusiastic reception (see p. 31) which was given him in Atlantic City at June, 1904, when he was elected president of the National Tuberculosis Association, and have quoted the remarks he made in his address of accept- ance. The scene which preceded his acceptance, however, is of sufficient historical interest to be related here. Trudeau’s name was proposed as president and his election was proclaimed by a unanimous vote, but Dr. Trudeau declined. Dr. Osler and Dr. 318 A HISTORY OF NATIONAL TUBERCULOSIS ASSOCIATION Henry Barton Jacobs then took hold of his arms and marched him up to the platform. The audience stood and would not listen to his declination, but on the contrary a loud and continued ‘‘No” arose from the vast assembly. At the International Congress on Tuberculosis in September, 1908, in Washington, Trudeau received an ovation whenever he appeared on the platform, and what he said as greeting to the delegates illustrates the man’s labors and great modesty. Speaking of the achievements in tuberculosis work from the time when he started his professional ‘career up to that date, he said: “For thirty-five years I have lived in the midst of a perpetual epidemic, struggling with tuberculosis both within and without the walls, and no one can appreciate better than I do the great meaning of such a meeting. I have lived through many of the long and dark years of ignorance, hopelessness, and apathy, when tuberculosis levied its pitiless toll on human life unheeded and unhindered; when, as Jaccoud has tersely put it, ‘The treatment of tubercu- losis was but a meditation on death.’ But I have lived also to see the dawn of the new knowledge, to see the fall of the death-rate of tuberculosis, to see hundreds who have been rescued, to see whole communities growing up of men and women whose lives have been saved, and who are engaged in saving the lives of others. I have lived to see the spread of the new light from nation to nation until it has encircled the globe and finds expression to-day in the gather- ing of the International Congress of Tuberculosis, with all that it means to science, philanthropy, and the brotherhood of men.” During the last years of his life Trudeau suffered a great deal from his old tuberculous lesion. When artificial pneumothorax came into vogue a few years ago, he submitted himself to this treatment, and for a time it gave very gratifying results. Later he gave it up, feeling that it did not help him. Though illness and the loss of two beloved grown-up children—a son and a daughter —had left an impress of sadness on Trudeau, he kept up admir- ably, was optimistic and cheerful most of the time, and until the very last took the keenest interest in the institutional and lab- oratory work of the sanatorium. i We are indebted to him for a most remarkable address on ‘‘The Value of Optimism in Medicine,’’ which should be read and reread by every physician. This wonderful address was delivered before the Congress of American Physicians and Surgeons in 1910. To give the full weight and meaning to the address on EDWARD LIVINGSTON TRUDEAU, M.D. 319 optimism we will quote Mr. Alfred L. Donaldson’s description of the circumstances under which it was written. “He had been suffering from one of his most serious relapses—high fever, acute coughing spells, and broken sleep. He woke in the small hours of each morning, and lay tossing uncomfortably on his bed. Then it occurred to him that instead of lying there idly between coughs, thinking of himself and his troubles, he might better concentrate his mind on some preparation for the great meeting over which he had been asked to preside. So he turned on the light near his bed, reached for pad and pencil, and began the rough draft of this notable address on optimism. Not long after he was able to leave his bed and deliver it in person. What it means to turn out optimistic literature under such conditions only those who have tasted them can realize; but the unusual feat is essentially typical of Dr. Trudeau’s whole career.” The same all-pervading optimism, faith in God, and faith in his friends and colleagues, faith in the present and the future, per- meated the life of this beloved physician from the beginning to the end of his earthly career. He died November 15, 1915, at the age of sixty-seven. By his own life, with its sufferings and trials, he showed us how to forget self, and taught us that by consecrat- ing our lives to high ideals and true service to our fellow-men we are rendering the highest service to God. A few weeks before his death there occurred an event that must have tended to make the last hours of the great Trudeau su- premely happy. An ardent admirer of his, Mr. Samuel Mather, of Cleveland, made it possible, through a magnificent gift, for a post-graduate medical institution, to be known as the Trudeau School for Instruction in Tuberculosis Science, to be established at Saranac Lake. Thus Trudeau’s noble wish to spread the best scientific knowledge of the prevention and cure of tuberculosis became realized. Several societies whose object is the scientific study of tuberculosis have also been named in his honor. On August I0, 1918, a distinguished company of physicians, friends, and former patients of Dr. Edward L. Trudeau gathered in the grounds of the Sanatorium at Saranac Lake, N. Y., to witness the unveiling of a memorial statue of the noted physician. In this life-size bronze the sculptor, Gutzon Borglum, has suc- ceeded in reproducing in a marvelous manner the spiritual ex- pression so characteristic of the great teacher. The statue is the 320 A HISTORY OF NATIONAL TUBERCULOSIS ASSOCIATION gift of 1,200 of Doctor Trudeau's former patients, and the formal presentation to the institution was made by one of these patients, Miss Louise E. Bonney, now a high-school teacher in New York. The statue is mounted on a marble pedestal and placed on the terrace in front of the main building, in which are located the administration offices. From this point one has a wonderful view of the mountains in all their grandeur. The front of the pedestal bears the following inscription: Epwarp L. TRUDEAU THOSE WHO HAVE BEEN HEALED IN THIS PLACE HAVE PUT THIS MONUMENT HERE A TOKEN OF THEIR GRATITUDE AUGUST I0, 1918. On the reverse of the pedestal, in the original French, are the words: GUERIR QUELQUEFOIS SOULAGER SOUVENT, CONSOLER TOUJOURS. (To cure sometimes, to relieve often, to comfort always.) Some day, when the Great White Plague shall be no more, the name of Edward Livingston Trudeau will be gratefully remem- bered as one who taught us how to fight and conquer this great enemy of mankind. The bibliography of Dr. Edward Livingston Trudeau follows: Infectiousness of non-bacillary phthisis. Am. Jour. Med. Sc., Oct., 1885. Environment experiment in relation to bacterial invasion. Am. Jour. Med. Sc., July, 1887; also in Tr. Am. Clim. and Clin. Assn., iv, 131, 1887. Sulphuretted hydrogen vs. the tubercle bacillus. Med. News, li, 570, 1887. Environment experiments repeated. Tr. Am. Clim. and Clin. Assn., v, 91, 1888. Hydrofluoric acid as a destructive agent to tubercle bacilli. Med. News, lii, 486, May 5, 1888. Hot-air inhalations in pulmonary tuberculosis. Med. News, Sept. 28, 1889; also in Tr. Assn. of Am. Physicians, iv, 287, 1889. Some cultures of the tubercle bacillus illustrating variations, growth and pathogenic properties. Tr. Assn. Am. Physicians, v, 183, 1890. Limitation of prevalence of tuberculosis. (Discussion.) Tr. Assn. Am. Phy- sicians, v, p. 207, 1890. NVAGNUAL NOLSONIAIT GUYVMGH OL LNAHWONON EDWARD LIVINGSTON TRUDEAU, M.D. 321 Study of preventive inoculations in tuberculosis. Med. Rec., Nov. 22, 1890. Treatment by Koch's tuberculin, Hunter’s modification and other products of the tubercle bacillus. Med. News, Sept. 3, 1892; also in Tr. Assn. Am. Physicians, 1892, p. 87. Results of employment of tuberculin and modifications at the Adirondack Cottage Sanitarium. Med. News, Sept. 10, 1892; also in Tr. Am. Clim. and Clin. Assn., ix, 18, 1892. Eye-tuberculosis and anti-tubercular inoculization in the rabbit. N.Y. Med. Jour., July 22, 1893; also in Tr. Assn. Am. Physicians, 1893, p. 108. Creosote in pulmonary tuberculosis. (Discussion.) Tr. Assn. Am. Physicians, vili, 194, 1893. Sarcoma of the lung, Diagnosis of. (Discussion.) Tr. Assn. Am. Physicians, vili, 194, 1893. Ultimate results of eye-tuberculosis and anti-tuberculosis inoculation in the rabbit. Med. News, Sept., 1894; also in Tr. Assn. Am. Physicians, 1894, p. 168. Letter on Klebs’ ‘‘Anti-Phthisin.” Feb. 8, 1896. Sanitaria for the treatment of incipient tuberculosis. N. Y. Med. Jour., Feb. 27, 1897. The tuberculin test in incipient and suspended tuberculosis. Med. News, May 29, 1897. The need of improved technique in the manufacture of ““T. R.”. Med. News, Aug. 28, 1897. Remarks on artificial immunity in tuberculosis. Brit. Med. Jour., Dec. 25, 1897. Résumé of experimental studies on the preparation and effects of antitoxins for tuberculosis. Tr. Assn. Am. Physicians, xiii, 1898. The Adirondack Cottage Sanitarium for the Treatment of Tuberculosis. Practitioner, Feb., 1899. The present aspect of some vexed questions in tuberculosis. Bull. Johns Hop- kins Hosp., July, 1899. ; The sanitarium treatment of tuberculosis and its results. Med. News, June 2, 1900. The first people’s sanitarium in America for the treatment of tuberculosis. Zeitschr. f. Tuberk. u. Heilstwn., i, no. 3, 1900. Recent research work on the chemistry of the tubercle bacillus. Tr. Assn. Am. Physicians, 1900. The importance of the recognition of the significance of early tuberculosis in relation to its treatment. Tr. Assn. Am. Physicians, 1901. The history of the work of the Saranac Laboratory for the Study of Tubercu- losis. Bull. Johns Hopkins Hosp., Sept., 1901. Artificial immunity in experimental tuberculosis. N.Y. Med. Jour., July 18, 1903; also in Tr. Assn. Am. Physicians, 1903. Bovine, avian and human tuberculosis. (Discussion.) Tr. Assn. Am. Phy- sicians, 1903. ‘ 21 322, A HISTORY OF NATIONAL TUBERCULOSIS ASSOCIATION The history of the tuberculosis work at Saranac Lake. Med. News, Oct. 24, 1903. Address of the president. Tr. Nat. Tuberc. Assn., i, 13, 1905. Two experiments in artificial immunity against tuberculosis. Tr. Nat. Tuberc. Assn., i, 157, 1905; also in Med. News, Sept. 30, 1905. The therapeutic use of tuberculin combined with sanitarium treatment of tuberculosis. Tr. Nat. Tuberc. Assn., ii, 297, 1906; also in Am. Jour. Med. Sc., August, 1906. Tuberculin immunization in the treatment of pulmonary tuberculosis. Am. Jour. Med. Sc., June, 1907. Antibacterial and antitoxic immunization in tuberculin treatment. Jour. Am. Med. Assn., Jan. 23, 1909. Animal experimentation and tuberculosis. Pamphlet II, Defense of Re- search, Am. Med. Assn., 1909. y The value of optimism in medicine. President’s address to the Congress of American Physicians and Surgeons, 1910. Am. Jour. Med. Sc., cxl, 1, 1910. Letter in answer to E. G. Bullock. Brit. Jour. Tuberc., Aug. 25, 1915. Relative immunity in tuberculosis and the use of tuberculin. Brit. Jour. Tuberc., January, 1916. An autobiography. Lea & Febiger, Philadelphia, 1915. CHAPTER XXXV HERMANN M. BIGGS, M.D., Sc.D., LL.D. PRESIDENT OF THE NATIONAL TUBERCULOSIS ASSOCIATION FROM 1905 TO 1907 R. HERMANN M. BIGGS was president of the National D Tuberculosis Association for two years—from 1905 to 1907. The son of Melissa T. Pratt and Joseph Hunt Biggs, he was born in Trumansburg, N. Y., September 29, 1859. He attended Cornell University and was graduated in 1882. He received his degree of M.D. from Bellevue Hospital Medical College, New York, in 1883. He served as intern in Bellevue Hospital from 1883 to 1884. With the formation of the Bellevue Hospital Alumni Association he became its first president. In 1910 New York University conferred the degree of LL.D. upon Dr. Biggs, and in 1917 he received the same degree from the University of Rochester. In 1920 Harvard University conferred upon him the degree of Doctor of Sciences. From the time of his graduation from Bellevue Hospital Dr. Biggs has served as pathologist and visiting or consulting physi- cian to many of our leading New York hospitals and tuberculosis sanatoria. Dr. Biggs was also professor of pathological anatomy at Bellevue Hospital Medical College from 1885 to 1894, professor of therapeutics and clinical medicine from 1897 to 1907, associate professor of medicine from 1907 to 1914. He now occupies the position of professor of medicine of the University and Bellevue Hospital Medical College. He is a member of the International Health Board of the Rockefeller Foundation, and has been a mem- ber of the Board of Scientific Donation of the Rockefeller Insti- tute for Medical Research since its foundation. Dr. Biggs is an honorary fellow of the Royal College of Physicians of Edinburgh and of the Royal Sanitary Institute of Great Britain. He is now president of the Association of American Physicians and of the 323 324 A HISTORY OF NATIONAL TUBERCULOSIS ASSOCIATION American Social Hygiene Association. Dr. Biggs was decorated by the King of Spain for the valuable services he has rendered the world as a hygienist and sanitarian. Besides having made many valuable contributions to nearly all the clinical, pathological, and bacteriological branches of internal medicine, Dr. Biggs has rendered the most conspicuous services to sanitary science, and particularly in the prevention of tuber- culosis. He occupied the position of General Medical Officer of _ the Department of Health of the city of New York from 1901 to 1914. Since that date he has been the Health Commissioner of the State of New York. As General Medical Officer of New York city, Dr. Biggs was responsible more than any other medical man in this or any other country for obtaining the official rec- ognition of tuberculosis as a communicable and reportable dis- ease in order to combat it successfully. As already mentioned in our general history, it was due to the efforts of Dr. Biggs and his co-workers, Dr. T. Mitchell Prudden and Dr. Joseph D. Bryant, that a voluntary notification of private cases of tuber- culosis and a compulsory notification of all cases treated in insti- tutions was inaugurated by the New York Health Department in 1893, and that in 1897 the Department adopted regulations re- quiring the notification of all cases. But Dr. Biggs was not satisfied with a mere statistical control of tuberculosis. He inaugurated at the same time a system whereby an early and definite diagnosis of all cases of tuberculosis could be obtained. This consisted in the gratuitous examination of any specimen of sputum sent to the Health Department’s lab- oratory for that purpose. To this Dr. Biggs added educational measures. Circulars teaching the simple rules of the prevention of tuberculosis, designed to reach the different classes of the com- munity, were widely distributed. For the foreign population these were translated into their respective languages. In 1902, when the author presented an appeal for the formation of a committee or society for the prevention of tuberculosis in New York, Dr. Biggs was the first to sign, and from the day of its first meeting he has been a most active member of the Com- mittee for the Prevention of Tuberculosis of the Charity Organ- ization Society, now the New York Tuberculosis Association. HERMANN M. BIGGS HERMANN M. BIGGS, M.D., Sc.D., LL.D. 325 Under the inspiration of Dr. Biggs this committee worked hand in hand with the Health Department in the educational propa- ganda. Again it was through the initiative of Dr. Biggs that the first municipal dispensary (clinic) for the treatment of the con- sumptive poor was established in the city of New York. In the course of years these dispensaries have been multiplied so that to-day there are no less than twenty dispensaries distributed throughout the city under the Health Department's direction. Following the example of the Health Department, 10 tuberculosis clinics connected with the larger hospitals have been established in a comparatively short time. To codrdinate their activities, the Association of Tuberculosis Clinics of the city of New York was founded, and under Dr. Biggs’ direction and with the codpera- tion of Dr. James Alexander Miller, the Health Department issued a pamphlet outlining the purposes of the association, which are in brief as follows: First.—To organize dispensary control of pulmonary tuberculosis in New York city. Second.— To develop a uniform system of operation of such dispensaries as are organized for this purpose. Third. To retain patients under observation until they are satisfactorily disposed of, and to prevent them from drifting from one dispensary to another. Fourth.—To establish and maintain a district system of dispensary treat- ment. Fifth.—To facilitate the attendance of patients at the dispensary most con- venient to their homes. Stxth.—To facilitate the work of visiting nurses in the homes of patients. Seventh.—To provide for each patient requiring it assistance by special funds or benevolent organizations, and proper hospital or sanatorium care. Eighth.—To coéperate with, and assist as far as possible, the Department of Health in the supervision of pulmonary tuberculosis. In 1904 Dr. Biggs established the Riverside Hospital-Sana- torium for advanced cases on North Brother Island as one of the Health Department’s activities, particularly designed to remove cases of tuberculosis constituting centers of infection in their homes. When the first New York municipal sanatorium was opened at Otisville, N. Y., in 1906, Dr. Biggs was made the medical director 326 A HISTORY OF NATIONAL TUBERCULOSIS ASSOCIATION and physician-in-chief. He occupied the position until 1914, and from its inception took the keenest interest in this institution. To-day it is one of the largest sanatoria of its kind, having three units (males, females, children) with 600 beds. To Dr. Biggs’ initiative is due the employment of that invaluable adjuvant in the modern treatment of pulmonary tuberculosis known as work therapy, which is successfully employed at the Otisville Sana- torium. Dr. Biggs has also the distinction of having been presi- dent of the first tuberculosis preventorium for children, which was founded some years ago in Farmingdale, N. J., largely through the munificence of Mr. Nathan Straus. The tuberculosis work, inaugurated by Dr. Biggs and being carried on by the Health Department of the city of New York, has served as a model to many cities in this and other countries. It may be summarized as follows: (1) Notification and registration of all cases of tuberculosis. (2) Free bacteriological examination of sputum, to aid notification and to facilitate the early and definite diagnosis. (3) Educational measures of various kinds—circulars, lectures, exhibits, newspaper articles. (4) Visitation of consumptives in their homes. Continuous supervision of cases in tenement houses by corps of trained nurses. (5) Free disinfection by the Department of Health, and issuance of orders for the renovation of rooms vacated by consumptives. (6) Referring needy cases to the proper charitable organizations. (7) Three classes of institutions are provided: (a) Free clinics (dispensaries) for ambulant cases unable to go to sanatoria. (b) Free sanatoria for incipient and early cases. (c) Free hospitals for advanced cases. (8) Forcing certain classes of patients into a hospital and retaining them there. (9) Enforcing regulations concerning spitting in public places. (10) Research studies concerning the mode of infection, the réle of bovine tuberculosis, characteristics of the tubercle bacillus, etc. What was the result of all these activities inaugurated under the leadership of Dr. Biggs? In 1887 he was one of the consulting pathologists of the Department of Health of the city of New York. He had felt for several years the primary importance and necessity for administrative action in relation to tuberculosis, and HERMANN M. BIGGS, M.D., Sc.D., LL.D. 327 he urged upon the Board of Health of New York city the imme- diate enactment of suitable regulations for the sanitary sur- veillance of this disease. The year previous—in 1886—the mortality from pulmonary tuberculosis was 355 per 100,000 popu- lation; in 1910 the mortality was 185. This means virtually a re- duction of the mortality from tuberculosis by one-half during a quarter of acentury’s labors and tuberculosis activities, such as were directed by Dr. Biggs. In 1920 the death-rate in New York city for pulmonary tuberculosis had been reduced to 110.7 per 100,000 population. Since Dr. Biggs has been at the helm of the New York State Department of Health he has transferred his enthusiasm and in- terest in the tuberculosis problem to the state at large. He inau- gurated a special tuberculosis division of the State Department of Health for educational propaganda, and a few years ago was instrumental in working out a plan for traveling clinics. These clinics are of invaluable help in the discovery of early cases of tuberculosis, in the supervision of former sanatorium cases, and in education in the prevention of tuberculosis through visiting nurses. The local physicians are invited to codperate and to visit these clinics. Dr. Biggs came to the New York State Health Department immediately upon its reorganization in 1914. His administrative skill and far-seeing vision are best shown in the decline of the death-rate from tuberculosis. In 1914 for ‘“‘upstate’’ New York, the pulmonary tuberculosis rate was 118.8 per 100,000 popula- tion. In 1920 it had dropped to 98.0 per 100,000 a decline of 17.5 per cent. Dr. Biggs’ activities in anti-tuberculosis work and his vast knowledge and experience were, of course, utilized during the recent World War. He became a member of the Council of Na- tional Defence, of the Advisory Committee of the United States Food Administration, and of the American Red Cross. The Rockefeller Foundation sent him to France to investigate the unfortunate tuberculosis situation which was reported to exist throughout that country, particularly in the war zone. Dr. Biggs’ report on his return from France resulted in the appoint- ment of a tuberculosis commission under the leadership of Dr. 328 A HISTORY OF NATIONAL TUBERCULOSIS ASSOCIATION Livingston Farrand, which has done incalculable good not only in taking care of the immediate needs, but in stimulating an active anti-tuberculosis propaganda and in establishing clinics and sanatoria throughout France. In the fall of 1920 Dr. Biggs took over temporarily the direction of the General Medical Department of the League of Red Cross Societies, with headquar- ters at Geneva, Switzerland. Well may it be said of Dr. Biggs that his lifelong enthusiasm and devotion to the tuberculosis cause and to preventive medicine in general have had the widest and most beneficent influence, not only throughout the United States, but throughout the entire civilized world. The bibliography of Dr. Hermann M. Biggs follows: The accidents incidental to the use of the exploring needle for diagnosis. 1888. The sanitary supervision of tuberculosis as practiced by the New York City Board of Health. (With John H. Huddleston, M.D.) Jour. Am. Med. Assn., Jan., 1895. , The health of the city of New York. Wesley M. Carpenter Lecture, Nov. 7, 1895. The conduct of an isolation period for communicable disease in a home. Provision for the care of advanced cases of tuberculosis. Preventive medicine in the city of New York. 1897. Sanitary science, the medical profession and the public. 1897. The registration of tuberculosis. 1900. An ideal health department. (With C. F. H. Winslow, M.D.) Minneapolis. Tuberculosis—its causation and prevention. New York, Ig0l. ~ Brief history of the campaign against tuberculosis in New York. (With Charles F. Bolduan, M.D.) Preventive medicine, its achievements, scope, and possibilities. 1904. The reduction in the tubercular death rate in children in New York City. 1904. Address of the vice-president. Tr. Nat. Tuberc. Assn., i, 23, 1905. Address of the president. Tr. Nat. Tuberc. Assn., iii, 16, 1907. Compulsory notification and registration of tuberculosis. Tr. Nat. Tuberc. Assn., iii, 39, 1907. The health of the city. 1868-1910. Administrative control of tuberculosis. 1912. Comments on some plans of hospital construction. (Monograph) 1912. The municipal sanatorium at Otisville. (Reprint) 1913. Note on the death rate from tuberculosis in various large mania Tr. Nat. Tuberc. Assn., viii, 357, 1912. Facts every emigrant dhauld know. How to enjoy health and how to avoid sickness. 1913. HERMANN M. BIGGS, M.D., Sc.D., LL.D. 329 The tuberculosis campaign, its influence on the methods of public health work generally. (With C. F. Bolduan.) Tr. Nat. Tuberc. Assn., ix, 39, 1913. The infectiousness of tuberculosis. 1915. What has been learned about tuberculosis since the International Congress of 1908? 1916. Tuberculosis in France. Am. Jour. Pub. Health, July, 1917. A war tuberculosis program for the nation. Tr. Nat. Tuberc. Assn., ‘xiii, 73, 1917; also in Am. Rev. Tuberc., July, 1917. CHAPTER XXXVI FRANK BILLINGS, M.D., Sc.D. PRESIDENT OF THE NATIONAL TUBERCULOSIS ASSOCIATION FROM 1907 TO 1908 R. FRANK BILLINGS succeeded Dr. Hermann M. Biggs D as the third president of the National Tuberculosis Asso- ciation (1907-1908). He was born April 2, 1854, at Highland, Iowa County, Wiscon- sin, the son of Henry M. and Anne Bray Billings. He graduated from the medical department of the Northwestern University in 1881, and obtained the degree of M.S. in 1890. He served as intern in the Cook County Hospital from 1881 to 1882, and studied in Vienna, London, and Paris from 1885 to 1886. Dr. Billings obtained the title of Doctor of Science from Harvard in 1915. Beginning as a humble demonstrator of anatomy, by his un- tiring energy, intense application, and hard study, Dr. Billings rose in a relatively short time to be professor of medicine and dean of Rush Medical College in Chicago. He served as attending and consulting physician to many of the most important hospitals of that city. He was Shattuck lecturer in Boston in 1902, and Lane medical lecturer at the Leland Stanford University in 1915. Al- though a general medical consultant, his interest in tuberculosis, in its social as well as its medical aspects, has always been intense. From 1906 to 1912 Dr. Billings was president of the Illinois State Board of Charities. He is a member of the medical societies of his State and city, and was president of the Chicago Medical Society in 1891. The American medical profession at large made him president of the Association of American Physicians and of the American Medical Association. In codperation with Drs. Henry B. Favill, Arnold C. Klebs, Theodore B. Sachs, and others, he was instrumental in calling into life the Chicago Tuberculosis Institute. As one of the most active members of the National 330 FRANK BILLINGS FRANK BILLINGS, M.D., Sc.D. 331 Tuberculosis Association, his discussions‘in the clinical, patho- logical, and sociological sections have always been inspiring and helpful. His presidential address at the meeting of the Associa- tion in 1908 was full of sound advice and prophetic vision. It goes without saying that a personality such as Dr. Billings, with his vast medical experience and his splendid executive ability, had to be called upon by our War Department during the recent war. Thus he was made chairman of the American Red Cross Mission to Russia, where he rendered valuable service. On his return he entered active service, and attained the rank of colonel on April 30, 1918, being attached to the Surgeon General’s office in Washington and devoting his vast knowledge and energy to the rehabilitation of wounded, sick, and disabled soldiers. For his admirable work at the head of the Rehabilitation Department of the Surgeon General's office he was awarded the Distinguished Service Medal. He published a number of lectures on rehabili- tation of the disabled which, because of their clearness and preci- sion, attracted a great deal of attention. Although Dr. Billings modestly claims not to have done or written anything of note on tuberculosis, those who have had the privilege of working with him know what an invaluable factor he has been in the combat of tuberculosis in general among the civil- ian population, and of his recent work on behalf of the tuberculous soldiers. Colonel Billings is an enthusiast regarding the value of curative work in wards, schools, shops, garden, and field for the recovery of tuberculous soldiers, and justly considers it of the greatest psycho- logical and material value in the treatment of pulmonary tuber- culosis generally. The bibliography of Dr. Frank Billings follows: Address of the president. Tr. Nat. Tuberc. Assn., iv, 15, 1908. The standards of physical examinations and the selective service. Jour. Am, Med. Assn., July 6, 1918. Rehabilitation of the disabled. Jour. Am. Med. Assn., May 24, 1919. The physical and mental rehabilitation of disabled soldiers of the United States Army. Congress Amer. Phys. and Surg., June 16, 1919. Physical reconstruction applied in the treatment of pulmonary tuberculosis. Jour. Am. Med. Assn., Oct. 4, 1919; alsoin Tr. Nat. Tuberc. Assn., xv, ' 146, 1919. CHAPTER XXXVII VINCENT Y. BOWDITCH, M.D. PRESIDENT OF THE NATIONAL TUBERCULOSIS ASSOCIATION FROM 1908 TO 1909 UR fourth president, unanimously elected to serve for the O year 1908-1909, was Dr. Vincent Y. Bowditch. He had already served the Association as vice-president from 1906 to 1908. The son of Dr. Henry I. and Olivia Yardley Bowditch, he was born July 7, 1852, at Weston, Mass. He was graduated from Harvard in 1875, and received his M.D. in 1879 from the Harvard Medical School. He was house officer in the Massachusetts Gen- eral Hospital from 1878 to 1879, instructor in clinical medicine at Harvard Medical School from 1892 to 1899, and attending physi- cian to the Carney and Boston City Hospitals. His father, the elder Bowditch, as has been mentioned on p. 4, was a great physician, and particularly interested in diseases of the lungs. To him we are indebted for the introduction of the operation known as paracentesis thoracis (tapping of the chest to remove accumulations of fluid). One of the most inspiring and instructive works it has ever been the author’s privilege to read, not only on medicine, but also on philosophy, religion, and politics, are the two volumes entitled ‘‘ Life and Correspondence of Henry Ingersoll Bowditch,’’ by his son, Vincent Y. Bowditch, who dedicated this wonderful biography to the memory of his mother, the thought of whom was his constant inspiration while writing the book.! The mantle of the older Bowditch could not have fallen upon worthier shoulders than those of young Vincent. With the example of so much wisdom, patriotism, gentleness, and devotion to high ideals, it is no wonder that Dr. Vincent Y. Bowditch has become one of the most beloved and distinguished physicians of New England and one of the most ardent tuberculosis workers. 1 Houghton, Mifflin & Co., Boston and New York, 1902. 332 RY DITCH BOW VINCENT Y. VINCENT Y. BOWDITCH, M.D. 333 We have referred to the Sharon Sanatorium in Massachusetts as the first to be established near a large center of population and independent of any climatic advantages. (See p. 10.) This unique institution owes its inception to Dr. Bowditch’s enthu- siasm and devotion. It was opened in March, 1891, and has demonstrated that more could be done for the tuberculous at low altitude, near the sea, in an inclement climate, than had been thought possible before. The object of the Sharon Sanatorium was to supply a suitable institution for the treatment of incipient pulmonary disease arising in women who are unable, for pecuniary and other reasons, to seek distant health resorts. The institution has now been in existence for almost thirty years, and its constant growth and the splendid results obtained show the wisdom of the enterprise. Dr. Bowditch’s demonstration of the possibility of treating the tuberculous of the state of Massachusetts in their home climates, resulted in the establishment of the Rutland State Sanatorium, the first institution of its kind. It is but natural that Dr. Bowditch should be one of its visiting physicians, a posi- tion which he held for many years. The universal esteem in which Dr. Bowditch has been held by sanatorium workers re- sulted in his election as the first president of the American Sana- torium Association in 1905. When the Massachusetts Tuber- culosis League was formed in 1914 he was also chosen president of that organization. As the accompanying bibliography shows, Dr. Bowditch’s pub- lications on the subject of tuberculosis have been numerous and his labors on behalf of the consumptive poor worthy of the dis- tinguished name he bears. Because of the historic and classic interest of the elder Bowditch’s introduction of paracentesis into the treatment of pleuritic effusions, we may note with special interest the fact that one of the first papers Dr. Vincent Y. Bowditch published was in regard to 96 cases of pleuritic effusion occurring in the private practice of his father, covering a period of thirty years, in which he followed up the cases and gave the after-results as evidence of the possibility of active pulmonary disease showing itself in later life after an attack of pleurisy. The result showed a more favorable aspect than that which had been given previously by Dr. Landouzy, of Paris. 334 A HISTORY OF NATIONAL TUBERCULOSIS ASSOCIATION Unfortunately, owing to serious illness, Dr. Bowditch was pre- vented from delivering the usual presidential address, and the vice-president, Mr. Homer Folks, had to take his place on that occasion. We rejoice in Dr. Bowditch’s complete recovery, which has enabled him since to accomplish so much good work on be- half of the tuberculosis cause. The bibliography of Dr. Vincent Y. Bowditch follows: A case of traumatic linear atrophy. Boston Med. and Surg. Jour., June 25, 1885. The treatment of pulmonary disease by means of ‘‘ pneumatic differentiation.” Boston Med. and Surg. Jour., July 16, 1885. A case of phthisis with numerous bacilli. Complete arrest of the disease. Boston Med. and Surg. Jour., Dec. 10, 1885. The use of strophanthus hispidus in heart disease. Boston Med. and Surg. Jour., March 17, 1887. Homeopathy as viewed by a member of the Massachusetts Medical Society. Address before the Hahnemann Society of the Boston University School of Medicine. Boston Med. and Surg. Jour., June 24 and 30, 1886. Comparative importance of different climatic attributes in the treatment of pulmonary consumption. Med. News, Oct. 13, 1888. Two cases of phthisis treated by intra-pulmonary injections. Read before Mass. Med. Socy., March 13, 1889. Comparative results in ninety cases of phthisis pulmonalis. Delivered before Am. Clim. and Clin. Assn., June, 1889. The establishment of sanatoria for pulmonary diseases in the vicinity of our great cities. Boston Med. and Surg. Jour., Feb. 25, 1892. The effect of change of posture upon heart murmurs. Internat. Med. Maga- zine, Nov., 1892. Three years’ experience with sanitarium treatment of pulmonary diseases near Boston. Tr. Am. Clim. and Clin. Assn., 1894. Suggestions: The result of recent experiences with phthisical patients. Tr. Am. Clim. and Clin. Assn., 1898. State sanatoria for tuberculosis. Read at meeting of the Providence Med. Assn., December 3, 1900. The home (sanitarium) treatment versus the climatic treatment of consump- tion. Boston Med. and Surg. Jour., Sept. 19, 1901. The care of consumptives in state and private sanatoria in Massachusetts. Address before Maryland Public Health Assn., Jan. 28, 1902. Subsequent histories of seventy-nine arrested cases treated at the Sharon Sanatorium, 1891-1902. Tr. Am. Clim. and Clin. Assn., 1903. Origin and growth of sanatoria for.tuberculosis in Massachusetts. Jour. Tuberc., April, 1903. Arrested tuberculosis; subsequent histories of cases treated at the Sharon Sanatorium. Boston Med. and Surg. Jour., March 17, 1904. VINCENT Y. BOWDITCH, M.D. 335 Pulmonary tuberculosis and sanatorium treatment. Boston Med. and Surg, Jour., Dec. 1, 1904. Six years’ experience at the Massachusetts State Sanatorium for Tuberculosis. (With H. B. Dunham.) Tr. Nat. Tuberc. Assn., i, 349, 1905; alsoin Jour. Am. Med. Assn., June 24, 1905. The scope and aim of state sanatoria for tuberculosis. Tr. Nat. Tuberc. Assn., ii, 287, 1906. Subsequent histories of one hundred and sixty ‘‘arrested cases’ of pulmonary tuberculosis treated at the Sharon Sanatorium. Tr. Am. Clim. and Clin. Assn., 1907. The English sanatorium. Jour. Outdoor life, iii, 461, 1907. Tuberculosis in Massachusetts. Prepared by Mass. State Committee for Tuberc. Congress, 1908. Edited by Edwin A. Locke, M.D. The movement for the control and eradication of tuberculosis in Massachusetts. In “Festschrift” in honor of R. W. Philip, M.D., Edinburgh, 1911. A retrospect. A few thoughts and suggestions based upon twenty-five years’ experience with tuberculosis. Boston Med. and Surg. Jour., July 20, 1911. Memorabilia. Extracts from notes made by the late Henry Ingersoll Bow- ditch, M.D., of Boston. Tr. Am. Clim. and Clin. Assn., 1912; also in Boston Med. and Surg. Jour., Oct. 31, 1912. After results in tuberculous patients treated during the years 1891-1911 at the Sharon Sanatorium. (With Dr. W. A. Griffin.) Jour. Am. Med. Assn., Dec. 14, 1912. The origin and aims of the Massachusetts Anti-Tuberculosis League. Boston Med. and Surg. Jour., Aug. 12, 1915. What the general practitioner should know about incipient pulmonary tubercu- losis. Boston Med. and Surg. Jour., Nov. 25, 1915. The history of the growth of the anti-tuberculosis movement in Massachusetts, and the lesson to be learned therefrom. Address delivered at the Tru- deau School of Tuberc., Saranac Lake. Boston Med. and Surg. Jour., Dec. 14, 1916. Methuselah and life in the open. Tr. Nat. Tuberc. Assn., xiv, 197, 1918; also Am. Rev. Tuberc., July, 1918. Medical reminiscences: I. Visits to Brehmer’s and Dettweiler’s sanatoria. Jour. Outdoor Life, March, 1919. II. Memorial service to Florence Nightingale. April, 1919. III. Personal reminiscences of episodes in the medical career of Henry Ingersoll Bowditch, M.D., June, 1919. Life and correspondence of Henry Ingersoll Bowditch, 2 volumes, Houghton, Mifflin & Co., 1902. CHAPTER XXXVIII EDWARD G. JANEWAY, M_.D., LL.D. PRESIDENT OF THE NATIONAL TUBERCULOSIS ASSOCIATION FROM 1909 TO I9IO R. EDWARD G. JANEWAY, the fifth president of the D National Tuberculosis Association, served in that ca- pacity from 1909 to 1910. He was born in Middlesex County, New Jersey, August 31, 1841, received his preliminary education at Rutgers College, and was graduated with the degree of A.B. in 1860. He took his medical course at the College of Physicians of Columbia Univer- sity, from which he was graduated with the degree of M.D. in 1864. The honorary degree of LL.D. was conferred upon him by the Princeton University in 1904. Dr. Janeway’s medical career began as intern in Bellevue Hospital. From 1868 to 1873 he was curator and instructor of pathological anatomy in the Bellevue Hospital Medical College; from 1873 to 1886 professor of pathological anatomy and clinical medicine; in 1886 he succeeded the late Dr. Austin Flint to the chair of principle and practice of medicine and clinical medicine, and later on, with the amalgamation of the University and Bellevue Medical Colleges, he became dean of that institution. Dr. Janeway’s interest in public sanitation, and particularly in tuberculosis, was characteristic throughout his medical career. Although perhaps the greatest fame he attained was because of his unusual diagnostic skill as a general consultant, his activity in the tuberculosis field was greater than the seeming scarcity of his publications on tuberculosis would indicate. Serving as health commissioner of the city of New York from 1875 to 1882, he showed a deep interest in the housing conditions predisposing to tuberculosis, and maintained the then unpopular theory that tu- berculosis was a transmissible disease. Among his first publications on the subject there are some of a 336 EDWARD G. JANEWAY EDWARD G. JANEWAY, M.D., LL.D. 337 very remarkable character, as, for example, one on the con- tagiousness of tuberculosis, published as far back as 1882, prior to Koch’s discovery of the tubercle bacillus as the factor of con- tagion; and a second article, entitled ‘“‘Danger of Errors in Diagnosis between Chronic Syphilitic Fever and Tuberculosis.” Dr. Janeway was among the first American teachers who, after Koch’s discovery, taught the value of the bacteriological examina- tion of sputum as an important diagnostic means. The inval- uable help he gave to the New York Health Department, par- ticularly to Dr. Biggs, in the latter’s early struggles for municipal control of tuberculosis, is a matter of record, and cannot be better illustrated than by quoting what Dr. Biggs said in a letter to the author of this biographical sketch in reference to it: “Dr. Janeway was always one of our strongest and most unswerving sup- porters. Dr. Janeway and Dr. Prudden and Dr. Frank Foster were almost the only men prominent in medicine twenty-five years ago in New York city who actively supported the measures proposed and later adopted by the De- partment of Health for the restriction and prevention of tuberculosis. The first assurance of this effect came, I think, in 1887, when Dr. Bryant sent a letter to a number of prominent physicians in New York asking for advice as to the adoption of the recommendations which had been made to the board by Dr. Prudden, Dr. Loomis, and myself. From that date onward Dr. Jane- way’s attitude never changed, and it was to him that I went more frequently, in the early days of my connection with the Department of Health, for advice and assistance, than to any other man in New York. Dr. Janeway, Dr. Bryant, and Dr. Prudden were the three men who have never been found wanting in support of any measures to improve the public health in New York city.” Dr. Janeway was an examining physician of the Adirondack Cottage Sanatorium from 1895 to the time of his death, and he had likewise been connected with the Loomis Sanatorium since 1900 as a member of the medical board. He was on the consult- ing staff of the Sea Breeze Sanatorium for tuberculous joint dis- eases (now the Neponsit Beach Hospital for Children) from the very foundation of the institution, and he was also a member of the advisory board of the Stony Wold Sanatorium for tubercu- lous working girls and children. In 1901 Dr. Janeway was honorary vice-president of the British Congress on Tuberculosis, and one of the official delegates for the 22 338 A HISTORY OF NATIONAL TUBERCULOSIS ASSOCIATION United States. In an interesting paper read before the Academy of Medicine on December I9 of that year he gave a very complete review of the work of that congress, and made some valuable sug- gestions concerning prophylactic measures. At the International Tuberculosis Congress in Washington in 1908 he was a vice- president of the clinical section. In 1902 Dr. Janeway was one of the first to sign a call for the formation of a local tuberculosis committee, which developed into the permanent Committee on the Prevention of Tuberculosis of the Charity Organization Society of New York city, on which he served as one of the most faithful and active members during the remainder of his life. He was one of the first to join The National Association for the Study and Prevention of Tubercu- losis, of which he became a director and member of the executive committee in 1906 and president in 1909. He was also a member of the Committee.on the Prevention of Tuberculosis of the State Charities Aid Association from the time of its formation in 1907. Dr. Janeway always had the greatest sympathy for the con- sumptive sufferer, and expressed on many occasions his belief in the unwisdom of individual, state, or governmental phthisiopho- bia. On one occasion, when he had heard that a refined and cul- tured tuberculous invalid of English nationality, who had come to visit the United States on some important family affair, was held at Ellis Island because of the new regulation not permitting tuberculous immigrants to land, he called the author’s attention to the injustice being done and asked his codperation to obtain the gentleman’s admittance to the United States. He added his humble efforts to Dr. Janeway’s strong appeal to the authorities in Washington, and the Englishman was finally permitted to enter this country. Dr. Janeway was opposed to the unfortunate Goodsell-Bedell law, which made the establishment of sanatoria in the state of New York virtually impossible for a number of years, and, as a member of the various tuberculosis committees, helped in its ulti- mate repeal. He combated phthisiophobia, whether it originated in the minds of statesmen, laymen, or physicians. He strongly opposed the action of the State Board of Medical Examiners of Oklahoma, whereby tuberculous but otherwise well-qualified EDWARD G. JANEWAY, M.D., LL.D. 339 practitioners were to be excluded from practising in that state, and physicians were forced to sign a sworn statement that they had not in the last three years lived in the house with or nursed any one suffering from said disease (tuberculosis). The following is what Dr. Janeway wrote on this subject: “T think that it is a very oppressive measure, and one not either humane or just. As regards the affidavit, I think that is an additional oppression, espe- cially the part which requires the practitioner to say ‘he has not lived in the house with a consumptive or nursed any one suffering from the disease.’ These measures, it seems to me, are ill calculated to advance the best interests of the struggle against tuberculosis.” This was one of the last messages on tuberculosis he gave to the world. In his presidential address of 1910, reviewing the medical and sanitary progress which had been made during the previous decade, this far-seeing physician, teacher, and lover of his kind again warned us not to slacken our efforts on behalf of the better- ment of the social and living conditions of the poor, and he wisely said, in the conclusion of his address: ‘‘The contest will not be considered carried to the highest point unless at the same time measures are taken to secure the avoidance of overcrowding by the obtaining of suitable dwelling places for the masses.”’ Dr. Janeway’s tact, diagnostic skill, and wisdom in dealing with the consumptive individual, the many physicians who were, or thought themselves to be, afflicted with tuberculosis who went to him for an opinion, and the great number of general practitioners who sought his counsel, will never be forgotten by those who were fortunate enough to come in contact with him. Edward G. Jane- way never claimed to be a tuberculosis specialist, but there is hardly any one who may aspire to this title who has done more for the tuberculosis cause in general and for the individual patient or pupil, as a teacher, physician, or friend. Evidence of the deep interest Dr. Janeway showed throughout his life in the tuberculosis problem is shown by a letter the author received from Mrs. Janeway after the death of her husband in acknowledgement of a tribute to him as teacher and physician. After warmly expressing her thanks, she added: ‘‘My husband gave a great deal of his time and his wisdom to the prevention and 340 A HISTORY OF NATIONAL TUBERCULOSIS ASSOCIATION cure of tuberculosis, long before it became such a world-wide ques- tion, and it is especially gratifying to me and my children that you have recognized the fact in your tribute. He certainly had the respect and confidence of the best men in his profession and that was the thing he cared the most about.” The bibliography of Dr. Edward G. Janeway follows: Possible contagion of phthisis. Arch. of Medicine, viii, 219, 1882. Danger in error in diagnosis between chronic syphilis and tuberculosis. Tr. Am. Physicians, 1898. Some notes on the British Congress on Tuberculosis. Med. News, Feb. 22, 1902, eltaes of the president. Nat. Tuberc. Assn., vi, 19, 1910. CHAPTER XXXIX WILLIAM H. WELCH, M.D., LL.D. PRESIDENT OF THE NATIONAL TUBERCULOSIS ASSOCIATION FROM I910 TO IQII \ , 7 ILLIAM H. WELCH, who was president of the National Tuberculosis Association from 1910 to I9II, was born in Norfolk, Conn., April 8, 1850. His father was Dr. Wil- liam Wickham Welch, his mother Emeline Collins Welch. He graduated from Yale with the degree of A.B. at the age of twenty, and five years later, in 1875, took his degree of M.D. at Columbia University. He served as intern in Bellevue Hospital until 1876, when he went abroad to take post-graduate courses at the uni- versities of Strassburg, Leipzig, Breslau, and Vienna, from 1876 to 1878. On his return he was made professor of pathological anatomy and general pathology at the Bellevue Hospital Medical College, where he established a pathological laboratory and re- mained until 1884. He then went abroad again to study a year at the universities of Berlin, Munich, and Géttingen, working with Koch and Fliigge in bacteriology. With the formation of a nucleus for medical treaching in Johns Hopkins University Dr. Welch became Baxley Professor of Pathology of that institu- tion and pathologist to the Johns Hopkins Hospital, which posi- tion he occupied from 1884 to 1916. From 1893 to 1898 he was dean of the medical faculty of Johns Hopkins Medical School. On the creation of the new School of Hygiene and Public Health of the same university in 1916 he was made its director. The story of how Dr. Welch was called to Baltimore is one which cannot fail to awaken a thrill of pride and patriotism in every American. When Dr. Gilman, who had been placed at the head of Johns Hopkins University, began to look for the right kind of man to fill the chair of pathology he communicated with leading German pathologists, among others with Professor Cohnheim, then at Breslau, and later at Leipzig. ‘‘Why do you 341 342 A HISTORY OF NATIONAL TUBERCULOSIS ASSOCIATION come to us Germans?” asked Professor Cohnheim. ‘‘There is a young American perfectly competent to take that professorship. He is going to be one of the world’s greatest authorities in the science of pathology. Why don’t you ask him to become the professor at Johns Hopkins?” ‘‘Who is he? What is his name?” asked Dr. Gilman’s emissary. ‘‘His name is William H. Welch, and the world is going to hear of him.’’ President Gilman began negotiations which resulted in securing the services of Dr.Welch for Johns Hopkins, where he has ever since remained. Professor Welch’s brilliant caree: may well be illustrated by the honors which have been conferred upon him in this and other countries. He received the honorary degree of M.D. from the University of Pennsylvania; of LL.D. from the Western Reserve University, from Yale, from Harvard, from Toronto, from Colum- bia, from Jefferson Medical College, from Princeton, from Wash- ington University, and from the University of Chicago. He has been president of the Maryland State Board of Health since 1898; president of the Board of Directors of the Rockefeller Institute for Medical Research since 1901; and trustee of the Carnegie Institution of Washington since 1906. He was Huxley lecturer at the Charing Cross Hospital Medical School in London in 1902, president of the Medical and Chirurgical Faculty of Maryland from 1891 to 1892, president of the Congress of American Physi- cians and Surgeons in 1897, president of the Association of American Physicians in 1901, of the American Association for the Advancement of Science from 1906 to 1907, of the American Medical Association from 1910 to 1911, of the National Academy of Science from 1913 to 1916, and of the American Social Hygiene Association in 1916. Dr. Welch is a fellow of the Academy of Arts and Sciences and of the College of Physicians of Philadelphia, an Honorary Fellow of the Royal Society of Medicine, and of the Royal Sanitary Institute, London, and honorary member of the Pathological Society of Great Britain and Ireland, foreign associate of the Academy of Medicine, Paris, and of the Royal Academy of Medicine of Belgium, and an honorary member of the medical societies of Berlin and Vienna. He was chairman of the Section on Pathology and Bacteriology of the Sixth Inter- national Congress on Tuberculosis. He has been decorated by WELCH WILLIAM H. WILLIAM H. WELCH, M.D., LL.D. 343 the Emperor of Japan with the Order of the Rising Sun, and was awarded the gold medal of the National Institute of Social Sciences. Dr. Welch’s renown as a hygienist is as great as his fame as a pathologist. He was one of the prime movers in the creation of the National Tuberculosis Association. As already stated in the historical section, he presided over the first meeting, which re- sulted in the establishment of The National Association for the Study and Prevention of Tuberculosis. It was he, in codéperation with Drs. Osler, Fulton, and others, who was responsible for the first tuberculosis exhibit in this country. Those of us who were privileged to visit that remarkable exposition will recall the inspiring and instructive talks that were given on that occasion by Professor Welch. His interest in the tuberculosis problem has been unabated. He has served not only as president, but has been active as a director and member of the executive committee of the National Tuberculosis Association. His advice is fre- quently sought by the officers of the Association, whether he happens to be on the board of directors or not. It is Dr. Welch’s unique and marvelous ability to judge the merit of educational enterprises and his keen appreciation of worthy scientific endeavors which have caused his counsel to be sought by philanthropic men and philanthropic organizations prior to making donations to an institution of learning or societies or individuals engaged in scientific research. Professor Welch has always taken the greatest interest in all that appertains to public health and public welfare. On more than one occasion his powerful pen has combated the nefarious efforts of well-meaning but ill-advised men and women to curb vivisection for purposes of medical research. He has appeared before legislative bodies and by cogent reasoning has shown that, thanks to the results obtained by scientific vivisection, we have obtained the mastery over some of the most fatal and prevalent infectious diseases. Dr. Welch isan ideal teacher whom those who have been privileged to listen to his lectures on pathology will be able best to appreciate, and is possessed of a charming personal- ity. It is, therefore, no wonder that he is so universally beloved by his colleagues and pupils. 344. A HISTORY OF NATIONAL TUBERCULOSIS ASSOCIATION On April 2, 1910, 500 men of reputation in the world of science, literature, and finance, gathered in Baltimore at a banquet in honor of Dr. Welch’s twenty-fifth anniversary as professor of pathology at Johns Hopkins. On this most interesting occasion appropriate addresses were made by distinguished men. A gold medallion was presented to Professor Welch as an enduring memorial of the event. On one side is Dr. Welch’s portrait in relief, with the words, ‘‘ William H. Welch,” and on the reverse side is a sprig of laurel, intertwined with a spray of roses, em- blematic of success and friendship, with the inscription, “‘From his friends.” Dr. Welch is also well known as a public speaker. Seldom does any great event occur in the medical world of the United States without his voice being heard and eagerly listened to. His interest in medical education, medical research, sanitation, hy- giene, and tuberculosis, besides his vast knowledge of pathological science, is shown by his writings, which have been collected and reprinted in three large volumes under the editorship of Dr. Walter C. Burket, who has recently compiled a bibliography dating from 1875 to 1917, comprising no less than 335 contribu- tions. Of these, 32 deal with the subject of tuberculosis. In the great war a man like Dr. Welch, with vast experience and sound judgment in all things medical, sanitary, and educational, was sure to be called upon to serve his country. He became a member of the Medical Advisory Committee of the American Red Cross, entered the Medical Reserve Corps as Major in 1917, was transferred to active service with the rank of lieutenant colonel, and served as such to the end of the war. He is now commissioned Brigadier General in the Officers’ Reserve Corps. When the great prevalence of tuberculosis among the French civilian and military population was made known by Dr. Her- mann M. Biggs on his return from France, the author of this sketch wrote a little pamphlet, entitled ‘‘What the American Soldier Now Fighting in France Should Know About Tubercu- losis,” which was translated into French and widely circulated in this country, in Canada, and in France. For this pamphlet Professor Welch contributed a preface, from which the following is quoted: WILLIAM H. WELCH, M.D., LL.D. 345 “Particularly interesting is the suggestion that our soldiers possessed of such knowledge as the pamphlet imparts and trained in habits of cleanly, healthy living may be missionaries of health as well as comrades in arms to their French colleagues. “Everything possible must be done to protect our soldiers from the risks of tuberculosis, and I believe that the public may be assured that this will be done. Undoubtedly the education of the individual soldier is an important part of these efforts. There is every reason to anticipate that our army will be spared the pitiful experience of the French in this matter of tuberculosis.” Professor Welch’s activities as a colonel in the United States Medical Corps, and the fact that a number of our best medical men were joined with him as advisers to the Surgeon General, are doubtless in part responsible for the relatively small morbidity and mortality from general diseases, including tuberculosis, in our own army as compared with those of our allies and the armies of the Central Powers. The bibliography of Dr. William H. Welch follows: Zur pathologie des lungenédems. Arch. f. path. Anat., Berlin, Ixxii, 375-412, 1878. Annual address—Modes of infection. Tr. Med. and Chir. Fac., Maryland, 1887, pp. 67-87. How far may a cow be tuberculous before her milk becomes dangerous as an article of food? Tr. Assn. Am. Phys., iv, 285-286, 1889. Tuberculosis of the lip. (Discussion.) Bull. Johns Hopkins Hosp., i, 114, 1889-90. The frequency of the localization of phthisis pulmonalis in the upper lobes. (Discussion.) Tr. Assn. Am. Phys., vi, 52, 1891. Sanitation in relation to the poor. Address before Charity Organization So- ciety of Baltimore, Nov. 14, 1892. The treatment of experimental tuberculosis by Koch’s tuberculin, Hunter’s modifications, and other products of the tubercle bacillus. (Discussion.) Tr. Assn..Am., Phys., vii, 101, 1892. Eye tuberculosis and anti-tubercular inoculation in the rabbit. (Discussion.) Tr. Assn. Am. Phys., viii, 113-114, 1893. Pseudo-tuberculosis in animals. Johns Hopkins Hosp. Med. Society, Feb. 4, 1895. Relations of laboratories to public health. Address before Am. Public Health Assn., Minneapolis, Oct. 31, 1899. Am. Pub. Health Assn. Rep., xxv, 460-465, 1899. The present system of sanitary reporting with some suggestions for its simpli- fication and improvement. Jour. San. Inst., Lond., p. 722-30, 1902-03. 346 A HISTORY OF NATIONAL TUBERCULOSIS ASSOCIATION Theory of pulmonary edema. In Edema, a Consideration of the Physiologic and Pathologic Factors Concerned in its Formation (Meltzer). Am. Med., Philad., viii, 195-196, 1904. Acute miliary tuberculosis, historical note. Address before meeting of the Laennec Society, Feb. 24, 1904. The healing of pulmonary tuberculosis, anatomical condition. Address before meeting of the Laennec Society, Nov. 18, 1904. Tuberculosis of the kidney. Pathology. Address before meeting of the Laennec Society, Dec. 15, 1904. Report of a commission on certain features of the federal meat-inspection regulations (William H. Welch, chairman). Rep. Bureau Animal Indust., 1907; Washington, 1909, 361-373. Address at the fifth annual meeting of the National Association for the Study ‘and Prevention of Tuberculosis, Washington, D. C., May 13, 1909. Tr. Nat. Tuberc. Assn., v, 34-36, 1909. Introductory remarks, the Laennec Society, its history and its aims. Address before meeting of the Laennec Society, Jan. 21, 1909. The influence of the ingestion of dead tubercle bacilli upon infection. (Dis- cussion.) Tr. Assn. Am. Phys., xxiv, 144, 1909. Tuberculosis of the liver. (Discussion.) Bull. Johns Hopkins Hosp., xx, 294, 1909. Marmorek’s serum in the treatment of pulmonary tuberculosis. (Discus- sion.) Bull. Johns Hopkins Hosp., xx, 295, 1909. The significance of the great frequency of tuberculous infection in early life for prevention of the disease. Address of the president at the Seventh Annual Meeting of the National Association for the Study and Preven- tion of Tuberculosis, June 20-21, 1911. Tr. Nat. Tuberc. Assn., vii, 17- 28, 1911. , The influence of Koch and his students. Address before meeting of the Laennec Society, commemorative of Robert Koch, March 27, I911. The duties of a hospital to the public health. Proc. Nat. Conf. Char., 1915, p. 209-218. The School of Hygiene and Public Health at the Johns Hopkins University. Science, New York and Lancaster, Pa., 1916, xliv, 302. Medical problems of the war. (Abstr.) Proc. Johns Hopkins Hosp. Med. Society, Nov. 20, 1916. Med. Bull. Johns Hopk. Hosp., 1917,154—-157. A treatise on the principles and practice of medicine; designed for the use of practitioners and students of medicine. (The pathological sections.) Sixth ed. revised and largely rewritten by the author, assisted by A. Flint and A. Flint, Jr., Lea Bros. & Co., Philadelphia, 1886. CHAPTER XL MAZYCK P. RAVENEL, M.D. PRESIDENT OF THE NATIONAL TUBERCULOSIS ASSOCIATION FROM IQII TO I9I2 AZYCK P. RAVENEL, son of Henry Edmund and M Salina E. R. Ravenel, was our seventh president, officiat- ing from 1911 to 1912. He had already served the Asso- ciation as vice-president from 1907 to 1908. - Dr. Ravenel was born at Pendleton, S.C. His classical educa- tion was obtained at the University of South Carolina, from which he was graduated in 1881. He obtained his medical degree from the Medical College of the state of South Carolina in 1884, and then went to the University of Pennsylvania for post-graduate work, obtaining the Scott fellowship in 1903. He became lecturer on diseases of children to the Charleston Medical School, and later assistant bacteriologist at the University of Pennsyl- vania. Dr. Ravenel went abroad for further post-graduate work, devoting special attention to the study of bacteriology at the Pasteur Institute of Paris and at the Institute of Hygiene at Halle on the Saale. On his return he became director of the Laboratory of Hygiene at Princeton, and bacteriologist of the Live Stock Sanitary Board of Pennsylvania, which position he held from 1897 to 1907. From 1898 to 1903 he was also lecturer on bacteriology of the Veterinary Department of Pennsylvania. With the founding of the Phipps Institute in 1903 he became assistant medical director and chief of its laboratory. In 1907 Dr. Ravenel was called to the chair of bacteriology of the Uni- versity of Wisconsin, and a year later became director of the State Hygienic Laboratory. In 1914 he accepted the chair of preventive medicine and of medical bacteriology at the University of Missouri, and was also made director of the Public Health Laboratories. Dr. Ravenel has enriched our knowledge of bacteriological 347 348 A HISTORY OF NATIONAL TUBERCULOSIS ASSOCIATION science in no small degree. The accompanying bibliography gives evidence of his untiring energy and enthusiasm in his chosen specialty. To him belongs the credit of having first called attention to the importance of tuberculous infection of the digestive tract. He was one of the first to demonstrate beyond any doubt the infection of human beings with the bovine type of the tubercle bacillus. His experiments concerning this impor- tant bacteriological discovery were published in 1902 in the Transactions of the Annual Meeting of the Philadelphia Patho- logical Society. Many honors were conferred upon Dr. Ravenel by the United States Government, which appointed him as delegate to the various international congresses, such as the one on hygiene, which convened in Berlin in 1908; the International Congress on Alimentary Hygiene in Brussels in 1910; and the Interna- tional American Congress at Buenos Aires in 1910. Not only the government, but also many scientific societies, honored Dr. Ravenel. Honorary membership was conferred upon him by the Cleveland Academy of Medicine, the Philadelphia Patho- logical Society, the College of Physicians of Philadelphia, and the Philadelphia Pediatric Society. Besides being a fellow of these associations, Dr. Ravenel was made President of the American Public Health Association in 1920. He is also a mem- - ber of the American School Hygiene Association, the American Philosophic Society, and the Wisconsin Anti-Tuberculosis Asso- ciation, of which he is also an ex-president. It is only natural that a man of Dr. Ravenel’s attainments should have offered his services to his country during the world war. Having joined the Medical Reserve Corps in 1910 as a First Lieutenant, he was commissioned Major July 19, 1917, and ordered for training to Fort Riley, where he remained until November, 1917, doing sanitary and some epidemiological work at Camp Funston, assisting the Division Sanitary Inspector of the Eighty-ninth Division. In November, 1917, he was ordered to Roumania, and sailed from San Francisco on December 5. The transport, however, was called back by wireless owing to the Bolshevists’ riots and the impossibility of getting through Russia. In June, 1918, he was ordered to Camp Kearney, Cal., MAZ\CK P. RAVENEL MAZYCK P. RAVENEL, M.D. 349 where he served as Epidemiologist, Division Sanitary Inspector of the Fortieth Division, and finally as Camp Surgeon, which position he held when the armistice was signed. He was dis- charged after nineteen months’ of service on June 25, 1919, with the rank of Lieutenant Colonel. The bibliography of Dr. Mazyck P. Ravenel follows: Tuberculosis and milk supply. 1897. Three cases of tuberculosis of the skin following accidental inoculation with bovine tubercle bacillus. 1900. Dissemination of tubercle bacilli by cows in coughing a source of contagion. 1900, | Case of pneumonomycosis due to aspergillus fumigatus. 1900. Comparative virulence of tubercle bacilli from human and bovine sources. 1901. A case of tuberculosis of skin from accidental inoculation with bovine tubercle bacilli. 1902. Intercommunicability of human and boviné tuberculosis. 1902. The warfare against tuberculosis. 1903. The passage of tubercle bacilli through normal intestinal wall. 1903. Occurrence of tubercle bacilli of exalted virulence in man. 1903. The influence of bovine tuberculosis on human health. 1904. The animal tuberculoses and their relation to human health. 1904. Report on bacillus of tuberculosis in man and in animals. 1905. Tabes mesenterica due to bovine tuberculosis. 1905. Studies on agglutination. (With H. R. M. Landis.) Tr. Nat. Tuberc. Assn., i, 140, 1905. Report on comparative study of various forms of tuberculosis. 1905. Studies on mixed infection in tuberculosis. (With J. W. Irvin.) Tr. Nat. Tuberc. Assn., i, 231, 1905. The etiology of tuberculosis. 1907. Maragliano’s method of preparing serum for tuberculosis—also Marmorek'’s serum. 1907. Transmission of tuberculosis through milk. 1908. Aetiologie der tuberkulose. 1908. Tuberculous infection through the alimentary canal. 1908. Routes of infection in tuberculosis. 1908. Mixed infection in tuberculosis. 1908. Modes and sources of infection in tuberculosis. 1909. Detection of tubercle bacilli in blood by Rosenberger’s method. 1909. Presence of tubercle bacilli in circulating blood. 1909. Prevention of tuberculosis in children by guarding milk supply. 1910. Passage of tubercle bacilli through intestinal wall. 1911. Control of bovine tuberculosis. Tr. Nat. Tuberc. Assn., vii, 358, IQII. Address of the president. Tr. Nat. Tuberc. Assn., viii, 19, 1912. 350 A HISTORY OF NATIONAL TUBERCULOSIS ASSOCIATION Occurrence of the Widal reaction in tuberculous people. Tr. Nat. Tuberc. Assn., x, 89, 1914. Control of bovine tuberculosis. 1911. Bovine tuberculosis. 1914. Present views in respect to modes and periods of infection in tuberculosis. 1916. Modes and periods of infection in tuberculosis. 1917. CHAPTER XLI HON. HOMER FOLKS, LL.D. PRESIDENT OF THE NATIONAL TUBERCULOSIS ASSOCIATION FROM I9gI2 TO 1913 r | “RUE to its intention not to be exclusively a medical so- ciety, the National Tuberculosis Association, at the meet- ing in 1912, elected for its eighth president a layman, Mr. Homer Folks, and the choice was indeed a happy one. He had already served the Association as vice-president from 1908 to 1909. Among the lay members of the society perhaps no one has done more constructive work in the tuberculosis campaign in the United States than Mr. Homer Folks. He was born Febru- ary 18, 1867, in Hanover, Mich., graduated with the degree of A.B. from Albion College in 1889, and from Harvard with the same degree in 1890. The degree of LL.D. was conferred upon him by Albion College and also by Ohio Wesleyan University in IQII. Mr. Folks was one of the first of what is now a large group of university men who have chosen the field of social work as a career. In August of 1890 he became General Superintendent of the Children’s Aid Society of Pennsylvania, with headquarters in Philadelphia. In February, 1893, he accepted the secretary- ship of the New York State Charities Aid Association, an unoffi- cial organization working for the improvement of public charities and public health in New York State. This position he has since held, except during his term of office as Commissioner of Public Charities of New York city, and during his service abroad with the American Red Cross. As secretary and chief executive officer of this Association, Mr. Folks has taken an active part in organized movements for the improvement of public institutions and the promotion of public health in the city and state of New York since 1893. Among these were the establishment of the Craig Colony for Epileptics, 351 352. A HISTORY OF NATIONAL TUBERCULOSIS ASSOCIATION the securing of a constitutional amendment reorganizing the State Board of Charities and giving it power to control the granting of public aid to private charities, the division of the Department of Charities and Correction of New York city into two separate departments, the establishment of a State Hospital for consumptives, the revision of the Charities Chapter of the Greater New York Charter in 1897, the creation of a Children’s Court in New York city in 1901, and the reorganiza- tion of the State Department of Health in 1914. He was elected in 1897 a member of the first Municipal Assem- bly of Greater New York from the twenty-ninth assembly district, on the Citizen’s Union ticket, for a term of two years. In the winter of 1899-1900 he was a special agent of the United States Commission to the Paris Exposition, and assisted in securing a comprehensive exhibit on the subject of American Charities. In April, 1900, at the request of General Leonard Wood, Mili- tary Governor of Cuba, Mr. Folks spent six weeks in Cuba studying the public relief of that island. He prepared a Chari- * ties Law which was enacted in July, 1900, creating a Cuban Department of Charities, establishing State institutions for destitute and delinquent children and the insane, and a Bureau for Placing Children in Families. As Commissioner of Public Charities in New York city during the years 1902-1903, in the administration of Major Low, Mr. Folks was in control of hospitals, almshouses, and other institu- tions containing an average of over 9,000 inmates, having more than 2,000 employees and with an annual expenditure of $2,000,- ooo. Early in 1902 he organized the first municipal hospital for consumptives in the United States, which developed within two years to a hospital with nearly 500 patients. During these two years the Department was practically reorganized, and was carried on in such a manner as to receive the unanimous com- mendation of the press and of the public generally. The State Charities Aid Association, through a special com- mittee, in 1907 began a systematic movement for the prevention of tuberculosis in the state of New York outside of New York city. As Secretary of the Association, Mr. Folks had direct charge and control of what rapidly became the most compre- HOMER FOLKS HON. HOMER FOLKS, LL.D. 353 hensive and successful of the state campaigns for the prevention of tuberculosis, resulting in the enactment of a number of impor- tant statutes and the establishment, throughout the state, of a series of tuberculosis hospitals and tuberculosis dispensaries, and the employment of a large number of tuberculosis visiting nurses. Mr. Folks was president of the National Conference of Chari- ties and Correction at the time it met in Boston, in 1911, and was president of the American Association for the Study and Prevention of Infant Mortality in 1915. One of the by-products of the tuberculosis campaign in the state of New York was the establishment of a special Public Health Commission in 1913, to recommend an entire revision of the public health law. Mr. Folks was secretary of this com- mission which secured the enactment by the legislature of an entirely new public health law for the state, which has since been copied in substance by a number of other states, including Massachusetts. One of the provisions of the law was for the establishment of a State Public Health Council, with power to enact sanitary regulations having the force of law throughout the state. Mr. Folks was appointed a member of this Council, and has served as such since its establishment. In July, 1917, Mr. Folks went to France for the American Red Cross and organized and directed its Department of Civil Affairs. In this department were developed bureaus dealing with tubercu- losis, child welfare, cripples, relief in the war zone, and relief of refugees through France. Large numbers of physicians, nurses, and trained social workers were secured from America. In less than a year the department had a well-organized staff of 1,400 workers and its expenditures for the relief of French war victims amounted to $4,000,000 per month. At the end of the war Mr. Folks, then a Lieutenant Colonel of the American Red Cross, was asked to make a survey of the condition and needs of the civilian populations of Italy, Greece, Serbia, and Belgium, as well as of France, for the use of the American Red Cross in out- lining its further plans for war relief in Europe. He acquitted himself of this difficult task in his usual thorough manner. The tuberculosis and, in fact, the entire public health move- ment in New York state has had no more valiant and worthy 23 354 A HISTORY OF NATIONAL TUBERCULOSIS ASSOCIATION champion than Homer Folks. His creative imagination, his diplomatic perseverance, and his unswerving integrity make him one of the foremost leaders in all affairs—civic, social, and politi- cal—in the Empire State. The bibliography of Mr. Homer Folks follows: Health as an investment. Tr. Nat. Tuberc. Assn., i, 37, 1905. With a state sanatorium secured, what next? Tr. Nat. Tuberc. Assn., iv, 45, 1908. A state aroused: Effective control of tuberculosis in small cities and rural com- munities. Proc. Internat. Cong. on Tuberc., Washington, D. C., Sept. 21 to Oct. 12, 1908. Conditions in Albany and vicinity in relation to tuberculosis. Proc. of the public meeting on prevention of tuberculosis, Albany, N. Y., January 27, 1908. Hope. A tract on tuberculosis (consumption). Its nature, cure, and prevention. (With John A. Kingsbury.) Published by State Charities Aid Assn., 1909. After care of local committees. A discussion of the functions and problems of local committees on the prevention of tuberculosis. Tr. Nat. Tuberc. Assn., v, 100, 1904; also Jour. Outdoor Life, July, 1909. County hospitals for tuberculosis. State Charities Aid Assn., 1909. Address of the vice-president. Tr. Nat. Tuberc. Assn., v, 21, 1909. A conference with a purpose and the forecast and prophecy. Addresses at conference of local comfnittees on the prevention of tuberculosis of the State Charities Aid Assn., Albany, March 18-19, 1910. Responsibility of the state in the tuberculosis problem. Tr. Nat. Tuberc. Assn., vii., 44, IQII. Points of contact between the health officer and the social worker. Am. Jour. Pub. Health, ii, 776-781, 1912. The present status of the movement for the prevention of tuberculosis in New York State. Jour. Outdoor Life, Sept., 1912. Some adverse factors of the present year. Tr. Nat. Tuberc. Assn., ix, 17, 1913. Address of the president. Tr. Nat. Tuberc. Assn., ix, 17, 1913. A seven years’ campaign. Review of measures and statement of results of the tuberculosis movement in New York State outside of New York City. Address delivered at opening session, State Conference of Tuberculosis Workers, Syracuse, N. Y., Nov. 11, 1914. The next eight years. Address before N. Y. State Tuberc. Conference and North Atlantic States Tuberc. Conference, Albany, N. Y., Nov. 4, 1915. Interstate factors in the tuberculosis problem. Tr. Nat. Tuberc. Assn., xii, 305, 1916. Tuberculosis associations and relief agencies. Tr. Nat. Tuberc. Assn., xiii, 414, 1917. Experience abroad, showing relationship between tuberculosis and a general health program. Tr. Nat. Tuberc. Assn., xv, 6, 1919. CHAPTER XLII JOHN H. LOWMAN, M.D. PRESIDENT OF THE NATIONAL TUBERCULOSIS ASSOCIATION FROM I9QI3 TO I9QI4 r “NHE ninth president of the National Tuberculosis Associa- tion, who was unanimously chosen at the meeting of 1913, was Dr. John H. Lowman, of Cleveland, O. John Henry Lowman was born in Cleveland on October 6, 1849, where his ancestors had lived for two generations. His preliminary education was obtained in the public schools of his native city. In 1871 he took the degree of A.B. at Wesleyan University, and in 1874 his Alma Mater conferred upon him the degree of A.M. In 1873 he graduated in medicine at Wooster. The year following Dr. Lowman served as intern in the Cleveland Charity Hospital. In 1875 he obtained the post of house surgeon to the New York Hospital on Blackwell’s Island. In 1876 he received a degree of M.D. at Columbia. While there he was instrumental in starting the first nose and throat dispensary in New York. In 1877 he became Professor of Materia Medica and Therapeutics at Western Reserve University, and in 1889 Professor of Medicine, being, during this time, the head of the department. In 1919 he relinquished the professorship of medi- cine in favor of a full-time professor, and from then until his death he occupied the chair of clinical medicine at the Western Reserve University. Thus Dr. Lowman was a professor at the Medical School of Western Reserve University for forty-two years. Until 1902 Dr. Lowman’s labors were largely confined to the institutional side of medical education, and to the care of his own enormous private practice. In that year he visited the most prominent tuberculosis sanatoria and institutions in Germany and France, and in 1905 attended the International Congress on Tuberculosis held in Paris. Upon his return he conceived the 355 356 A HISTORY OF NATIONAL TUBERCULOSIS ASSOCIATION idea of and founded the Anti-tuberculosis League of Cleveland, an association that later became responsible for the development of the municipal department of tuberculosis and the Warrensville Sanatorium. He was most active in the International Tubercu- losis Congress held in Washington in 1908. In ‘‘an appreciation” of Dr. Lowman, Dr. Henry J. Gersten- berger writes: “In the building of the Cleveland Anti-tuberculosis League he again showed his clear conception of the problem and his good judgment of the methods for the solution by drawing together, as members of its board of trustees, repre- sentatives of the various groups of society who were already working through well-equipped organizations for the improvement of Cleveland’s educational and social conditions, thus accomplishing the very important work of estab- lishing an enduring relationship between these representatives themselves, and of making the local tuberculosis movement from the start a powerful codpera- tive alliance. The Anti-tuberculosis League of Ohio counted him as one of its founders and he became its first president. . . . Owing to his gracious modesty very few people realized how quick he was to seize an opportunity to improve any work in which he was interested and to secure its benefits for his community, nor how willing he was to give liberally of his valuable time and counsel.” The following incident well illustrates what Dr. Gerstenberger says: Toward the end of 1905, on a certain Tuesday, Dr. Low- man learned of the development in Germany of prophylactic tuberculosis clinics for the members of the families, especially for children, of all patients attending the regular tuberculosis clinics. On the following Saturday he caused the first prophylactic family clinic in this country to be opened. It was the same with the further enlargement of the infant welfare activities in Cleveland. In the narrow margin of time left to him after the performance of his regular professional duties Dr. Lowman lectured before labor unions, schools, church societies, settlements, and wherever he could stir up or create a sound public opinion concerning the combat against tuberculosis. Dr. Gerstenberger recounts that Italy was for Dr. Lowman always a land of enchantment and delight. It was mainly during a stay in that country as a young man that his inborn interest and appreciation of the esthetic values in life blossomed out in pure adoration and enjoyment of things beautiful and great. JOHN H. LOWMAN JOHN H. LOWMAN, M.D. 357 In 1893 he was destined to be in Rome again as one of the vice- presidents of the International Congress of Medicine there assem- bled. He went to Italy in September, 1918, to act as Medical Director of the American Red Cross Tuberculosis Unit, and to establish not only a cordial relationship with the Italian physi- cians, but also an understanding of the purpose of the Commis- sion which would make secure and unhampered the codperation that is so essential to success in such undertakings. His physical condition, however, undermined by the vicissitudes of the ocean voyage and war-time continental travel, and seriously affected by an attack of influenza contracted soon after reaching Rome, largely prevented him from carrying out his mission. He died in New York city on January 23, 1919. To quote again from the ‘‘ Appreciation”: “Dr. Lowman was a man of rare ability and in every sense a gentleman. He was a generous friend, a kindly and sound advisor, and a source of comfort and support to countless others besides the members of his immediate family. When his Samaritan efforts bore fruits he was pleased and grateful, and when they did not, his philosophical mind saw and understood the reasons and his big heart forgave and forgot. “His modesty hid from view many of his accomplishments. Some 70 sonnets were written by him in work and play. Asan essayist he had no equal in the medical profession of Cleveland. His memorial addresses on Gustav C. E. Weber, Edward Fitch Cushing, Dudley P. Allen, and Henry Swift Upson are classics. He was the cultured physician of Cleveland, beloved by many in all walks of life, both rich and poor. The variety of his interests and ac- complishments served but to make him more completely and entirely the physician and to develop in him that broader view and deeper understanding of life which made of him so wise a counselor and so sound a diagnostician. In every sense he was a physician of the highest type.” Dr. Lowman was a speaker of no small ability. By the clear way in which he set forth the essentials in popular tuberculosis work, he knew how to hold his audience spell-bound and to show them their duties in the fight against the Great White Plague. In Cleveland he was probably best known among the general lay public as an expert on tuberculosis. He realized that he had done more than all the rest of the profession in that city to stimu- late interest in the fight against this disease, but at the same time he knew that his other activities and the duties of a heavy prac- 358 A HISTORY OF NATIONAL TUBERCULOSIS ASSOCIATION tice did not give him time for the minute and intensive research work upon this subject which men who are devoting their whole lives exclusively to the study and prevention of tuberculosis are able to do. The accompanying relatively short list of contributions to the tuberculosis literature does not by any means represent all he has written on the subject nor does it include the many lectures he had carefully prepared and delivered on behalf of the cause. Characteristic of the man’s modesty is what Mrs. Lowman wrote when the author asked her kind assistance to complete the biography: ‘‘Dr. Lowman did not feel that he had written any- thing in the real sense of the word, and he always looked forward with the keenest anticipation to the time when he could with- draw from his overbusy life and spend a few years in contempla- tion and study.”’ In sending this short list of contributions and apologizing for the delay, Mrs. Lowman added: “However, I do think also that half unconsciously I have been influenced by a feeling that Dr. Lowman would not have called these fragmentary bits of work writing, in any real sense, nor a true indication of his feeling in the matter. About seventeen or eighteen years ago, when he was trying to stir up a more effective and general interest in Ohio in the combat against tubercu- losis, he gave a great many talks and lectures before colleges, schools, church societies, settlements, labor unions, and factory operatives. I have some of these addresses in type-written form. He put a vast amount of energy and earnestness into informing the general public concerning their duties and responsibilities in regard to this common enemy, and he succeeded in arousing the kind of interest which caused people to go to work at the problem and to persist in their endeavors.” All the charming qualities and fine traits of mind and heart, so well described by Dr. Gerstenberger, will long be remembered by all his co-workers of the National Tuberculosis Association who had the privilege of knowing Dr. Lowman intimately, and his memory will be cherished by all his friends and countless patients. Dr. Livingston Farrand, who was the executive secre- tary of the National Tuberculosis Association for nine years, and who is now president of Cornell University, speaks of Dr. Lowman as ‘‘one of the best and finest men that the medical profession of America has known,” and goes on to say of him, “‘ Of JOHN H. LOWMAN, M.D. 359 all the many physicians with whom I have been associated in the last fifteen years, I know of no one toward whom I felt the same sense of personal attachment, as well as of high admiration.” Dr. Lowman’s death was typical of his life. He made the supreme sacrifice as surely as any American soldier on the battle- fields of Flanders or in France. When he was called to direct the anti-tuberculosis work in Italy under the auspices of the American Red Cross, he knew the risk he was taking, but he answered the call. He returned in broken health and lived but a short time thereafter. Former Secretary of War, the Hon. Newton D. Baker, speaks of Dr. Lowman’s passing away in the following impressive words: ““When the world’s great test came, he could not help sacrificing himself to minister to the stricken and suffering. Surely he died a soldier’s death after living, in the best sense of the words, a physician’s life.” The bibliography of Dr. John H. Lowman follows: Account of the general sanitary condition of Cleveland, Ohio. Nat. Board Health Bull., 1879-80, i, 258. A study of fever. Ohio Med. Jour., 1881-2, {, 159-166. The conflict with tuberculosis. Cleveland Med. Jour., 1902, 485-096. The anti-tuberculosis dispensary. Cleveland Med. Jour., 1903, 404-14. Tuberculosis and the sanatorium. Columbus Med. Jour., 1903, 145-167. An ideal sanatorium with notes on the black forest. Cleveland Med. Jour., 1903, ii, 18-27. The opening of the tuberculosis dispensary in Cleveland. Cleveland Med. Jour., 1904, iii, 488-93. The anti-tuberculosis movement in Cleveland. Cleveland Med. Jour., 1905 iv, 205-212. Schools and tuberculosis. Tr. Nat. Tuberc. Assn., iii, 107, 1907. The care of healthy children in tuberculous families. Tr. Int. Cong. on Tuberc., 1905, ii, 200. The Paris Congress of Tuberculosis, 1905. Cleveland Med. Jour., 1906, v, 1-20. Tuberculosis and the Schools, Charities, New York, 1907, 657-662. Address of the President. Tr. Nat. Tuberc. Assn., x, 17, 1914. CHAPTER XLIII GEORGE M. KOBER, M.D., LL.D. PRESIDENT OF THE NATIONAL TUBERCULOSIS ASSOCIATION FROM I9I14 TO IQI5 R. GEORGE M. KOBER served as president of the D National Tuberculosis Association during the year 1914— 1915 and presided over the very interesting meeting of that year in Seattle. George Martin Kober, son of Jacob and Dorothea Behr Kober, was born at Alsfeld, Hessen-Darmstadt, Germany, March 28, 1850. He was educated at the public and grand-ducal ‘ Real- schule” of hisnative town. His father wasa revolutionist in 1848, and had made a vow that none of his sons should serve under a German king or any prince or potentate. His oldest son emi- grated in 1854 and served’ in the United States Cavalry on the frontiers of Kansas, New Mexico, and Utah, and subsequently throughout the Civil War. In April, 1867, the younger brother George came to the United States, securing an assignment to the Hospital Corps at Carlisle Barracks, Pa., and commencing his medical studies under Surgeon Joseph J. B. Wright, of the United States Army. In January, 1870, he was appointed hos- pital steward and was ordered to Frankford arsenal near Phila- delphia, where he continued his studies under Dr. Robert B. Burns until October, 1871, when he was ordered to duty in the Surgeon General’s office, Washington, D. C. He entered the medical department of Georgetown University the same year, following up his studies in addition to the regular courses under the instruction of his preceptors, Drs. Johnson Eliot and Robert Reyburn, and was graduated in March, 1873. In the following winter he was the first graduate of a post-graduate course inaugurated by Drs. Thompson, Busey, Ashford, and others, at the Columbia Hospital, Washington, D. C. In July, 1874, Dr. Kober was appointed acting assistant sur- 360 GEORGE M. KOBER GEORGE M. KOBER, M.D., LL.D. 361 geon, United States Army, and was post surgeon at Alcatraz Island, Cal., from July to November, 1874; post surgeon at Fort McDermit, Nev., from November, 1874, to July, 1877. In the fall of 1875 he served with the First United States Cavalry in the Southeastern Nevada expedition against hostile Indians, and in 1877 he served in the Nez-Perces War, and was in charge of the field hospital at Kamiah on the Clearwater, Idaho, from July to October, 1877. He was post surgeon at a camp near Spokane Falls, Wash., and at Fort Coeur d’Alene, Idaho, to November, 1879; Fort Klamath, Oregon, to June, 1880; and post surgeon at Fort Bidwell, Cal., to November, 1886. While in this station he was engaged in a large practice among the civilians, and continued there, after severing his connection with the army until June, 1887, when he traveled extensively in America and Europe, returning to Fort Bidwell the following year. In the fall of 1888 Dr. Kober returned to Washington, D. C., with a view to devoting his time to college, hospital, and literary work. In 1889 he was appointed professor of hygiene and state medicine in Georgetown Medical School. During the winter of 1889-90 he directed attention to the sewage pollution of the Potomac River water, as an important factor in the undue preva- lence of typhoid fever in Washington. In August, 1890, he was a member of the Tenth International Medical Congress, held in Berlin, and there read a paper on the Etiology of Typhoid Fever, with special reference to water-borne epidemics, and was ap- pointed honorary secretary of the section of medical geography, history, etc. In December, 1890, his California investments necessitated his return to Bidwell, where he engaged in the practice of his profession, and for a ae or more was again attending surgeon at the post. In the fall of 1893 Dr. Kober returned to Washington, resumed his professional work at the Georgetown Medical School, and be- came deeply engaged in the health and housing problems of the city and its social and industrial betterment.. In 1895, at the request of the Health Officer, he investigated the causes of typhoid fever in Washington, and in his report pointed out for the first time the agency of flies in the transmission of the disease. His public addresses on the relation of water-supply and sewers 362 A HISTORY OF NATIONAL TUBERCULOSIS ASSOCIATION to the health of the city, as well as his researches into the relative merits of slow sand and mechanical filtration, aided materially toward securing the necessary sanitary legislation and requisite ‘appropriations by Congress. Dr. Kobér is an honorary member of the Association af Mili- tary Surgeons of the United States and of the Association of American Physicians. He is a fellow of the American Medical Association, the American Public Health Association, and the Anthropological Society; also a member of the board of directors of the Associated Charities of Washington, D. C., and of the local tuberculosis society. He designed the Tuberculosis Hos- pital of the District of Columbia in Washington, which was formally opened in June, 1908. Dr. Kober’s affiliations with scientific and philanthropic societies are too numerous to men- tion here, as are also his achievements in experimental medicine, industrial and general hygiene, medical education, and anthropo- logical investigations. He is the author of no less than 110 monographs, chapters, and text-books, journal articles and reviews on medical, surgical, and sociological subjects. Dr. Kober’s tabulation of 330 milk-borne epidemics, his monograph on “Milk in Relation to Public Health,’’ and his first book on “Industrial Hygiene,”’ published as Senate Documents, are re- garded as pioneer contributions to American medical literature. In 1916, in collaboration with Dr. Hansen, he published a volume of nearly 1,000 pages, entitled, ‘‘Diseases of Occupation and Vocational Hygiene,” which is recognized as one of the foremost works on this subject. , At the annual meeting of the National Tuberculosis Associa- tion at St. Louis in 1920, a new honor was conferred upon Dr. Kober by his unanimous election to the office of secretary of the Association, succeeding Dr. Henry Barton Jacobs, who had served the Association in this capacity since its formation in 1904. On March 28, 1920, Dr. Kober attained his seventieth birth- day. This was made the occasion of a complimentary dinner to him by his countless friends all over the United States. The dinner was held under the auspices of the Medical Society of the District of Columbia and allied scientific and civic organizations. It was the privilege of the author of this sketch to present for GEORGE M. KOBER, M.D., LL.D. 363 that occasion the following tribute, which sets forth in a concise way the great achievements of Dr. Kober: To GEORGE M. KOBER, M.D., LL.D., Soldier, Scientist, Physician, and Philanthropist, On His Seventieth Birthday, March 28, 1920. Your cradle stood on foreign soil, But love of liberty was your inheritance; Your father was of those who suffered long From persecution and from tyranny. He vowed that you should never be The simple minion of a lord of war, Bowing to king and potentate; But if a soldier you should wish to be, ‘You then should serve in freedom’s holy cause. So you came here and cordial greeting found, For men like you Columbia gladly welcomes; And you repaid her well. You served her first as humble helper To sick and wounded heroes of the war. A faithful student of our noble art you next becarhe, And soon attained a magister’s degree. As soldier and physician you combined True bravery with sympathy of heart, and thus Became the friend of many a suffering soul; And when to former comrades in the field you bade adieu, All said, ‘‘Well done, God speed you on your way.” A life of great devotion then began, To civic welfare, art, and science given; Your earnest studies fitted you to teach To show the younger men what hygiene means, And prove prevention of disease surpasses cure. By your endeavors, plagues and water-borne disease Were banished from within your city fair; You found the reason why so many died Of that disease of all diseases; And better housing of the poor became your passion: Now sanitary homes for black and white Arose where once was wilderness. _ Next to housing of the laboring men You studied how to make his occupation safe And thus prevent disease among the workers. So manifold your triumphs were In battling with disease and death, 364 A HISTORY OF NATIONAL TUBERCULOSIS ASSOCIATION In this small space I cannot count them all, And in your modesty you will not tell What greater things you did for God and man. Throughout your long and earnest life Your greatest joy has been to work, But never for yourself. To serve, To help wherever there was greatest need Was your ideal, the motive of your life. So then be thanked on this your honor day, For inspiration and example you have given To pupils and to friends, For countless deeds of mercy and of good You gave to others. Now may reward of peace and happiness Be yours for many years to come, And may no cloud of sorrow cast a shadow On the evening of your life. The bibliography of Dr. George M. Kober follows: The etiology and prevention of tuberculosis. Report of Board of Health of Calif., xi, Sacramento, 1890. A plea for the prevention of tuberculosis. Proc. State Sanitary Convention, Sacramento, 1894. Morbific and infectious milk. Pub. Health Rep., Feb. 14, 1896. Milk in relation to health and disease. Biannual Health Report of California, Sacramento, 1896. Milk in relation to public health. Senate Document No. 441, 59th Congress, Govt. Printing Office, 1902. The transmission of bovine tuberculosis by milk. Tr. Assn. of Am. Phys., 1903. The prevention and treatment of tuberculosis by state methods. Pan-Am. Med. Congress, Panama, 1906, ii, 249-258. The tuberculosis hospital in Washington, D. C., designed by George M. Kober, 8 plates. Published by Board of Charities, D. C., 1908. Unterbringung von schwerkranken Schwindsiichtigen und der luftkur bediirf- tigen leichtkranken Tuberkulosen in,einem und demselben Krankenhaus. XIV. Intern. Kongr. f. Hygiene u. Demographie, Berlin, 1907, bd. iv, 432. The fight against tuberculosis in various countries. Opening discussion, 6th Internat. Congr. on Tuberc., Washington, D. C., 1908, vol. iv, part 1, p. 105-110. Tuberculosis; report of committee on social betterment of the President’s Homes Commission. Senate Document No. 644. 60th Congress, 2nd Session, Jan. 8, 1909. The influence of sewers and general sanitation upon the prevalence of tubercu- losis. Bull. Johns Hopkins Hosp., vol. xx, March, 1909. GEORGE M. KOBER, M.D., LL.D. 365 The general movement of typhoid fever and tuberculosis in the last thirty years. Jour. Med. Sciences, Nov., 1909. Discussion of dispensary tuberculosis work. Washington Med. Annals. Pp. 370-371, Jan., 1910. Tuberculosis as a disease of the masses. Lecture before the School of Health Officers. Bull. Vermont State Board of Health, 1912, no. 1. Tuberculosis with special reference to its prevention. Address of the presi- dent. Tr. Nat. Tuberc. Assn., xi, 17-26, 1915. The child and the home. Nat. Tuberc. Assn., xi, 41-45, 1915. Tuberculosis with special reference to its epidemiology, transmissibility and prevention. Pub. Health Rep., Oct. 29, 1915. Avoid house dust. Washington Health Rules, 1915. Occupation in relation to tuberculosis. Tr. College of Phys., Philadelphia, 1919; Pub. Health Rep., March 26, 1920. Diseases of occupation and vocational hygiene (Kober and Hanson), 918 pp. Blakiston’s Son & Co. 1916. CHAPTER XLIV THEODORE B. SACHS, M.D. PRESIDENT OF THE NATIONAL TUBERCULOSIS ASSOCIATION FROM 1915 TO APRIL, 1916 HEODORE B. SACHS was elected president of the Na- | tional Tuberculosis Association at the Eleventh Annual Meeting held in Seattle, Washington, in June, 1915. But his tragic death on April 2, 1916 prevented his serving his full term. He had already served the Association as vice-president from 1913 to 1914. Born in Dinaberg, Russia, May 2, 1868, the son of Bernard and Sophie Sachs, he was graduated from the Kherson high school and later, in 1891, received his degree in law from the Imperial New Russian University of Odessa. While at the University, he reported for military duty and was placed on the reserve list in 1887. His removal to America in 1891 was doubt- less prompted by a winter’s exile, imposed upon him and several fellow-students because of their participation in a debate which did not meet with the approval of the local authorities. After his arrival in this country Dr. Sachs determined to study medicine, and gave up his legal career to enter the Medical De- partment of the University of Illinois, from which he graduated in 1895. After two years of work as an intern in the Michael Reese Hospital, he entered general practice, devoting himself particularly to diseases of the lungs. In 1901 Dr. Sachs was appointed instructor in internal medicine at his alma mater, and in 1903 he was appointed attending physician to Cook County Hospital. Even in the earlier days of his medical career, as a strug- gling young practitioner endeavoring to gain a foothold, he saw how conditions were with reference to tuberculosis in Chicago at that time, and he could not refrain from doing something to help. At no little sacrifice and expense, he personally made an 366 SACHS B THEODORE THEODORE B. SACHS, M.D. 367 investigation of the prevalence of tuberculosis in some of the crowded quarters of the city, particularly in the districts where the Jewish population was in evidence. These studies, among the first of their kind, gave Dr. Sachs considerable prominence at the International Congress on Tuberculosis in 1908, and won for him special honorable mention from the jury of awards. Dr. Sachs was greatly interested in the Chicago Tuberculosis Institute, which he helped to call into life, and of which he re- mained one of the most active and representative workers. He served as president of the Institute from January, 1913, until his death. He was one of the most ardent advocates of the routine examinations of employees of large establishments. His advice and example in this respect have since been followed by many corporations and large business concerns throughout the country. It was largely due to Dr. Sachs’ influence that Mrs. Keith Spald- ing donated the funds for the Edward Sanatorium at Naperville, of which institution he became the director and physician in chief. Besides his activities in the Edward Sanatorium he was attached to the Chicago Winfield Sanatorium, the West Side Dis- pensary, and the Chicago Municipal Sanitarium. Concerning his interest in the latter, Dr. Philip P. Jacobs says: “Of all the many activities in which he engaged, however, none claimed so large a share of Dr. Sachs’ personality and skill as the Chicago Municipal Tuberculosis Sanitarium. In a very real sense the Sanitarium was and is Dr. Sachs. It breathes his personality and his genius from almost every ward and brick. Into it he put his very body and soul. He was active in the pas- sage of the Glackin Law, which made the sanatorium possible. He was a prime mover in the monstrous referendum campaign when hundreds of thou- sands of people voted ‘yes’ for the municipal sanatorium. He was the chair- man of the Building Committee which secured the site and conceived the sanatorium long before a brick or a stone had been laid, putting into this effort thousands of dollars’ worth of time and sacrifice, and countless miles of travel to visit the best institutions that the world provided. Later he became presi- dent of the board and its chief administrative director. While the sanatorium was in construction he spent hours daily at no little sacrifice to his practice, and gave of himself unstintedly to see that the people of Chicago should have an institution which would be both of service for the purpose for which it was constructed and which would not squander one dollar of the people’s money.” In the spring of 1915 a new administration came into office in 368 A HISTORY OF NATIONAL TUBERCULOSIS ASSOCIATION the city of Chicago, which, it was universally admitted at the time, was responsible for Dr. Sachs’ untimely death. He had made the Chicago Municipal Sanitarium an ideal institution, but the Thompson administration refused to reappoint him until practically forced to do so by the people of Chicago. Politics finally gained the upper hand, however, and Dr. Sachs was forced to resign; but even after his resignation nefarious politics made life a burden for this brave pioneer who had unselfishly devoted the best years of his life to the welfare of the consumptive poor of the great city of Chicago. In an article entitled ‘‘The Civic Martyrdom of Dr. Sachs,’ Dr. Graham Taylor, the distinguished social worker, says: “No altar of civic patriotism ever held a more loyal offering than that on which Dr. Theodore B. Sachs sacrificed himself in life and death to save Chicago’s Municipal Tuberculosis Sanitarium from ruthless partisan spoils- men. In truth, many altars and offerings seemed to unite in that one costly sacrifice. Such supreme devotion to a cause as the Jewish religious spirit can beget, such self-sacrifice as the Russian oppression of the Jew incites, such idealism as only the Orient inspires, such sensitivity as the heritage of suffering weaves into the very texture of the soul, such humanitarian achievements as are possible only in America—all combined to make the achieving life and the tragic death of Dr. Sachs profoundly impressive.”’ As the accompanying bibliography of Dr. Sachs indicates, his achievements as a clinician and specialist in tuberculosis are equal to his attainments as a propagandist and administrator. He founded the Robert Koch Society for the Study of Tubercu- losis, and read before that body a number of interesting and valuable papers on the various phases of tuberculosis science. A few months before his death (February, 1916) he was elected a fellow of the Institute of Medicine in Chicago. His devotion to high ideals, his passionate love for humanity, his integrity and faithfulness to all things which he undertook, are best shown in a passage from his letter of resignation from the Municipal Sani- tarium Board, wherein he said: “My service to the Sanitarium during the last six years has been prompted by the earnest desire to give the best in me to this community in which I have resided during the last twenty-seven years. . . . I have refused to betray the community that has given me confidence. I have great faith in the city SHOVS “i ANOGOAHL OL LINAWOANON THEODORE B. SACHS, M.D. 369 of Chicago and its citizens. I have passed through ten months of continuous nightmare in trying to avert the politicalization of a great institution. But I find it impossible to continue. Single-handed at present I cannot fight a big political machine.” In this connection the following copy of a letter which Dr. Sachs received from his patients at the Edward Sanatorium a few months before his death is significant: “We the undersigned patients of the Edward Sanatorium wish to take this privilege of expressing our admiration for the stand you have taken in regard to politics in connection with the Municipal Sanitarium of Chicago—your untiring and unselfish interest in humanity. None of the grossly unjust criticisms of you by anyone who does not know you or your methods will have the slightest influence on us who have implicit confidence in your ability as a practitioner and as a man. The past records of a man who possesses your international reputation cannot be easily tossed aside.” The end came at the sanatorium of the Chicago Tuberculosis Institute in the quiet little town of Naperville. There, after his day’s work in town, he sought rest all alone in the quiet of the library. And there they found him the next morning, at peace in his last sleep, which he had himself induced. The National Tuberculosis Association, at its meeting in May, 1916, at which Dr. Sachs should have presided, passed appropriate resolutions which are incorporated in the minutes of the meeting of 1916. (See p. 218.) The body of Dr. Sachs was interred on the grounds of the Naperville Sanatorium, and on the memorial tablet indicating the site, of which we give herewith an illustration, we read the following impressive words by the great blind physician, Dr. Robert H. Babcock, who had never seen Theodore B. Sachs, but whose spiritual insight must have been more keen than many a seeing physical eye: “In Memory of DR. THEODORE B. SACHS, whose life was spent in dis- interested efforts to relieve the condition of the unfortunate, never indifferent to the distress of others, he labored unselfishly and untiringly in their behalf, and this Sanatorium in which ground he sleeps is a monument to his unusual greatness of heart and singleness of purpose. He loved his neighbor as him- self and was in truth a good Samaritan.” 24 370 A HISTORY OF NATIONAL TUBERCULOSIS ASSOCIATION Over the portals of that other monument to Sachs’ genius, the Municipal Sanitarium, which had become a part of his very life, are to be placed the following words: ‘Conceived in boundless love of humanity and made possible by years of toil.”’ The bibliography of Dr. Theodore B. Sachs follows: Tuberculosis in the Jewish district of Chicago. Jour. Am. Med. Assn., Aug. 6, 1904. A plea for the poor consumptives. Reform Advocate, Oct. 29, 1904. The mission of local sanatoria in the crusade against tuberculosis. Jewish Exponent, May 25, 1906. Local sanatoriums and tuberculosis. Charities and the Commons, May 26, 1906. The tuberculosis nurse. Am. Jour. Nursing, May, 1908. Some observations on the ophthalmo-tuberculin reaction. Med. Rec., May 30, 1908. Children of the tuberculous. Tr. Nat. Tuberc. Assn., iv, 283, 1908; also in Jour. Am. Med. Assn., Oct. 24, 1908. A ten year fight against tuberculosis in the Jewish districts of Chicago. Re- form Advocate, Jan. 30, 1909. The diagnostic value of local tuberculin reactions. Tr. Nat. Tuberc. Assn., vi, 203, 1910; also Jour. Am. Med. Assn., Jan. 21, IQII. Care of advanced consumptives. Survey, June 17, 1911. Examination of employees for tuberculosis. Survey, Oct. 21, 1911. When is a case of tuberculosis curable? Time required for cure and subse- quent precautions to be observed. [Illinois Med. Jour., Dec., 1911. Examination of employes for tuberculosis. Tr. Nat. Tuberc. Assn., viii, 157, 1912. Superintending health of employes. The Survey, Oct. 11, 1913. Campaign in Chicago for medical examination of employes. Tr. Nat. Tuberc. Assn., x, 35, 1914. Official responsibility of the city in the tuberculosis problem. Tr. Nat. Tuberc. Assn., xi, 278, 1915. : Artificial pneumothorax in the treatment of pulmonary tuberculosis. Tr. Nat. Tuberc. Assn., xi, 150, 1915; also Jour. Am. Med. Assn., Nov. 27, 1915. CHAPTER XLV EDWARD R. BALDWIN, M.D. PRESIDENT OF THE NATIONAL TUBERCULOSIS ASSOCIATION FROM I9I6 TO 1917 FTER the sudden death of Theodore B. Sachs, Edward R. A Baldwin, the vice-president for the year 1915-1916, as- sumed the function of president until the next election, which was held at the regular meeting at Washington, D. C., May II and 12, 1916, at which time he was elected president of the National Tuberculosis Association for the ensuing year. He had already served the Association as vice-president from 1912 to 1913 and 1915 to 1916. Dr. Baldwin comes from an old New England stock, being the son of the Rev. Elijah C. and Frances M. Hutchinson Baldwin. He was born in Bethel, Conn., September 8, 1864, and attended the New Haven high school from 1878 to 1882. His parents destined their son for the clerical profession, wishing him to be -some day a congregational minister like his father. Edward, however, did not take kindly to the career of a clergyman. In spite of his father’s illness and early breakdown, and consequently impaired finances, young Baldwin started out early in life to work his way through Yale Medical school, from which he graduated in 1890. This struggle and hard work had, however, impaired the young man’s constitution, which was at best not any too strong. While serving in the Hartford City Hospital as intern he de- veloped symptoms of tuberculosis, which were not fully recog- nized. After leaving the hospital he entered general practice in the office of his maternal grandfather, who had been deceased for some years, but who had been a well-known physician in the Connecticut Valley. Dr. Edward R. Baldwin remained one year in the town of Cromwell in general practice, which was a very valuable experience and an excellent preparation for the future specialist. But after six months of practice symptoms of 371 372, A HISTORY OF NATIONAL TUBERCULOSIS ASSOCIATION tuberculosis again made their appearance, and at the completion of a year Dr. Baldwin decided to go to Saranac Lake and place himself under the care of Dr. Trudeau, where he became his assistant and his close associate. The entrance of Dr. Baldwin into the Trudeau Sanatorium meant so much both to Dr. Trudeau and Dr. Baldwin, to medical science and the tuberculosis movement in this country and throughout the civilized world, that it is of historic interest to quote here what Edward L. Trudeau has to say in his auto- biography concerning this episode: “In December, 1892, a slender and pale young man rang my door-bell one morning and told me he was a doctor, had contracted tuberculosis, and wanted to go tothe Sanitarium. Little did I know then how much the coming of this strange young man would mean to me personally, to my work, to Sara- nac Lake, and to the world at large! He told me his name was Edward R. Baldwin, that he was from New Haven; and when I asked what made him think he had tuberculosis, he quite floored me by his answer: that he had used his microscope and knew he had it. Truly Koch’s teaching was beginning to bring practical results. I admitted him to the Sanitarium. “Through many long years of friendly fellowship, through many long years of work side by side, through many long years of physical misery and suffering, my debt to Dr. Baldwin has steadily grown, until it has become a debt which I can never hope to repay but by affection and gratitude; a coin in which many debts, I find, are paid to him, because it is a coin he cannot possibly refuse to accept. Riches, fame, and praise he scorns, but he cannot escape the heritage of affection and gratitude he so unconsciously and abundantly calls forth.” Dr. Baldwin took a deep interest in the laboratory work and Dr. Trudeau affectionately writes of this: “Dr. Baldwin in those days, of course, knew even less than I did about the new science of bacteriology, and I gladly taught him all I knew; and as gladly does he teach me now the latest advances in a branch of medical science in which he is an expert and an acknowledged authority. Many happy hours did we spend working in the laboratory together; and now that I cannot work with him any more, he brings to my bedside the latest literature, and tells me of the work he and the others are doing. . . . Until Dr. Baldwin’s arrival in Saranac Lake I had had no one to discuss my work with, and I had no help of any kind but the manual assistance of a poor Irish patient of mine.” With Dr. Trudeau's illness and ultimate death Dr. Baldwin proved himself a worthy successor to the great physician. Al- EDWARD R. BALDWIN EDWARD R. BALDWIN, M.D. 373 though apparently a laboratory man, as the many invaluable contributions in the accompanying bibliography would indicate, as a patient in the sanatorium and as assistant physician under Dr. Irving H. Hance, and also as examining physician in the sanatorium, he had acquired the knowledge of an expert clinician, and his fame as such rose rapidly. He is now vice-president of the Trudeau Sanatorium, and director of the Edward L. Trudeau Foundation and Trudeau School of Tuberculosis. The Saranac Lake Reception Hospital, which was established through the efforts of Dr. Trudeau, has been under the management and the direction of Dr. Baldwin from its beginning. The Vermont State Sanatorium, which was built by the Proctor family, as well as the Gaylord Farm Sanatorium at Wallingford, Conn., are both indebted to Dr. Baldwin for his great interest in helping to call these institutions into life. The General Hospital in Saranac Lake was also promoted largely through Dr. Baldwin’s efforts. Dr. Baldwin has an enviable war record. On May 5, I917, he was appointed a member of the subcommittee on tuberculosis of the General Medical Board of the Council of National Defense. He was Chairman of the Medical Advisory Board No. 32 of his district during the selective service examination, and served as a Four-Minute Man in the speech-making campaigns for all the different purposes for which this form of publicity was used. During the month of January, 1918, he served as contract surgeon on the tuberculosis examining board, as referee at Camp Devens, and as a member of the executive committee of the National Tuberculosis Association he was most active in the work of that organization. In 1919 he was invited to join the Inter-Allied Red Cross Medical Conference at Cannes. ; The two presidential addresses of Dr. Baldwin are to be found on page 19 of the Association’s Transactions of 1916, and on page 23 of the Transactions for 1917. The bibliography of Dr. Edward R. Baldwin follows: The effects of peppermint inhalation on experimental tuberculosis. N. Y. Med. Jour., Ixi, 623, 1895. A chemical and experimental research on ‘‘antiphthisin’’ (Klebs), (with E. L. Trudeau). Med. Rec., xlviii, 871, 1895. 374 A HISTORY OF NATIONAL TUBERCULOSIS ASSOCIATION The need of an improved technique in the manufacture of Koch's T. R. (with E. L. Trudeau). Med. News, Ixxi, 257, 1897. Infection from the hands in pulmonary phthisis. Phila. Med. Jour., Dec. 3, 1898. Experimental studies on the preparation and effects of antitoxins for tubercu- losis (with E. L. Trudeau). Am. Jour. Med. Sc., Dec., 1898, and Jan., 1899. A case of lymphatic leuceemia combined with pulmonary tuberculosis (with J. A. Wilder). Am. Jour. Med. Sc., June, 1899. The conditions of tuberculosis infection and their control. Yale Med. Jour., March, 1900. Some results of the climatic and sanatorium treatment of tuberculosis in the Adirondacks. Albany Med. Ann., xxi, 213, 1900. Recent work on tuberculosis. Proc. 28th Annual Meeting Am. Pub. Health Assn., Oct. 22-26, 1900. Bacteriology in health and disease. Bacterio-therapeutics with especial reference to tuberculosis. Tr. Cong. Am. Phys. and Surg., v, 1900. The action of proteolytic enzymes on bacterial toxines (with P. A. Levene). Jour. Med. Research, vi, 120, 1901. The selection of favorable cases of pulmonary tuberculosis for sanatorium treatment. Internat. Clin., iii, 11th series, 1901. The tuberculous patient—when and to what extent shall his liberty be limited? Med. Rev. of Rev., Jan., 1903. The rational application and value of specific treatment for tuberculosis. Jour. Am. Med. Assn., Nov. 26, 1904. Studies on the tuberculin reaction (with E. L. Trudeau and H. M. Kinghorn). Studies from the Saranac Laboratory, 1900-1904. On the anti-hemolytic action of some cell and tissue constituents (with P. A. Levene). Studies from the Saranac Laboratory, 1900-1904. Studies on tuberculosis serum and bacteriolysis of bacillus tuberculosis. Studies from the Saranac Laboratory, 1900-1904. Anti-tuberculin or tuberculin precipitin serums. Studies from the Saranac Laboratory, 1900-1904. Differences in precipitins produced by tubercle bacilli. Studies from the Saranac Laboratory, 1900-1904. Studies on immunity in tuberculosis: the properties of the serum of immunized rabbits (with H. M. Kinghorn and A. H. Allen). Tr. Nat. Tuberc. Assn., i, 143, 1905; also Med. News, Sept. 30, 1905. Studies on immunity in tuberculosis, III: Experiments with leucocytes, lymph glands and bone marrow extracts of immunized animals (with J. Woods Price). Tr. Nat. Tuberc. Assn., ii, 281, 1906. Die “ Aggressine” der Tuberkelbazillen (with J. Woods Price). Centralbl. f, Bak., Parasit. u. Infekt. Krankhtn., I. Anteil, 1906, Nr. 24-25. The mechanism of resistance to tuberculosis. Proc. Pathol. Soc., Phila., 1907. new series, ix, 7. Opsonins in tuberculosis. Tr. Assn. Am. Phys., 1907. EDWARD R. BALDWIN, M.D. 375 Review of theoretical considerations and experimental works relative to opsonins with observations at the Saranac Laboratory. N. Y. Med. Jour., June 27, 1908. Conclusions from 1097 conjunctival tuberculin tests by a uniform method. Tr. Internat. Cong. on Tuberc., 1908. The problem of immunity in tuberculosis. Tr. Internat. Cong. on Tuberc., 1908, Hypersusceptibility to tuberculin in tuberculosis; its physiological and clinical importance. 1908. General principles of tuberculin diagnosis and treatment. 1908. Ophthalmo-tuberculin diagnostic test. Jour. Am. Med. Assn., xlix, 1969, 1909. Progress and changes in the treatment of tuberculosis during the past twenty years. Investigations into the nature of tuberculin sensitiveness. Tr. Nat. Tuberc. Assn., vii, 351, 1911. Diagnostic use of tuberculin. Tr. Nat. Tuberc. Assn., viii, 345, 1912. Allergy and reinfection in tuberculosis. Bull. Johns Hopkins Hosp., July, 1913. Tuberculin treatment, address before N. Y. State Med. Soc., Rochester, 1913. Some new biological relations between tubercle bacilli and other acid-fast forms (with Allen K. Krause). Tr. Nat. Tuberc. Assn., ix, 334, 1913 Experimental studies on the blood-serum of cows immunized against tubercu- losis: ‘‘sensitization’’ of living tubercle bacilli. Arch. Int. Med., May, 1914. : Immunity in tuberculosis: with special reference to racial and clinical mani- festations. Harvey Lecture. Am. Jour. Med. Sc., June, 1915. An address: delivered on the occasion of the second commencement of the D. Ogden Mills Training School for Nurses, Trudeau, N.Y. 1915. The consumptive and his neighbor. Survey, July 22, 1916. Address of the president. Tr. Nat. Tuberc. Assn., xii, 19, 1916. The advantages of special training in tuberculosis in sanatorium surroundings. Tr. Am. Clim. and Clin. Assn., 1916. Therapy as related to the immunology of tuberculosis. N. Y. Med. Jour., March 18, 1916. Address of the president. Tr. Nat. Tuberc. Assn., xii, 19, 1916. Address of the president. Tr. Nat. Tuberc. Assn., xiii, 25, 1917. Latent tuberculosis: its importance in military preparation. Cleveland Med. Jour., June, 1917. Address of the president. Tr. Nat. Tuberc. Assn., xiii, 25, 1917. Research problems in tuberculosis. Boston Med. and Surg. Jour., Jan., 1918. Tuberculin in 1917. Therap. Gaz., March 15, 1918. Experimental arrested tuberculosis and subsequent infections (abstract). Tr. Nat. Tuberc. Assn., xiv, 364, 1918. Experimental arrested tuberculosis and subsequent infections. Second report. Tr. Nat. Tuberc. Assn., xvi, 350, 1920. CHAPTER XLVI CHARLES L. MINOR, M.D. PRESIDENT OF THE NATIONAL TUBERCULOSIS ASSOCIATION FROM I917 TO I918 HARLES L. MINOR, our thirteenth president, was elected ( for the term 1917-1918. He had already served the Association as vice-president from 1908 to 1909. He was born in Brooklyn, N. Y., on May I0, 1865, the son of James Monroe and Ellen Josephine Pierpont Minor. He received his early education in private schools in Europe and in the United States. He graduated from the University of Virginia School of Medicine in 1888. Dr. Minor served as intern in the St. Luke’s Hospital, New York, from 1888 to 1890, then went abroad for post-graduate study, chiefly in Vienna, but also in Munich, Ber- lin, London, and Dublin. In 1892 he settled in Washington. His interest in tuberculosis arose from being personally slightly afflicted with the disease. In 1884 he moved to Asheville, N. C. He soon recovered his health and became an enthusiastic phthisio- therapeutist, and one of the leading physicians of his city and state, where he is widely known. His medical skill, his high ideals, and his attractive personality have endeared Dr. Minor to his count- less patients and friends in the profession. His practice is con- fined exclusively to the treatment of tuberculous diseases. Dr. Minor is a member of the Delta Psi Fraternity, of the Phi Beta Kappa honorary fraternity, of the American Medical Asso- ciation, of the North Carolina Medical Society, of the Buncombe County Medical Society, a member and one of the founders of the National Tuberculosis Association, a member of the American Climatological and Clinical Association and its president in 1916, a member of the Southern Medical Association, and a member of the staff of the Asheville Mission Hospital. As the accompanying bibliography shows, Dr. Minor has been a prolific writer on the subject of tuberculosis. His most im- 376 MINOR CHARLES L. CHARLES L. MINOR, M.D. 377 portant contribution is perhaps the one on ‘‘Symptomatology of Pulmonary Tuberculosis” in Klebs’ ‘‘ Treatise of Tuberculosis by American Authors.” Dr. Minor’s elaborate article on the sub- ject, covering 240 pages of Klebs’ system, is recognized as one of the best expositions of the subject and is as up to date to-day as it was teri years ago when it was written. His presidential address is to be found on page 23 of the Transactions of the Fourteenth Annual Meeting, 1918, of the National Tuberculosis Association. Among the most widely used and quoted of Dr. Minor’s writings is his little pamphlet, entitled ‘‘Hints and Help for Tuberculous Patients.” The bibliography of Dr. Charles L. Minor follows: On the feasibility and management of a hygienic cure of pulmonary tubercu- losis outside of closed sanatoria. N.Y. Med. Jour., Dec. and Jan., 1902. Hygiene vs. drugs in the treatment of pulmonary tuberculosis. N. Y. Med. Jour., Jan., 1899. On the use and abuse of pulmonary gymnastics in the treatment of pulmonary tuberculosis. Tr. Nat. Tuberc. Assn., ii, 368, 1906; also in Therap. Gaz., Oct., 1906. Notes on some common errors in the technique of sputum staining for tubercle bacilli (with Paul Ringer). Tr. Nat. Tuberc. Assn., ii, 246, 1906. Treatment of tuberculous patients in their homes and in places other than sanatoria. Jour. Am. Med. Assn., March, 1909. Hints and helps for tuberculous patients. Printed several times in Jour. Out- door Life. What you should know about tuberculosis (with David R. Lyman). Prepared for Nat. Tuberc. Assn. Pamphlet 106. Use of the x-ray in the diagnosis of pulmonary tuberculosis. N.Y. Med. Jour., March, 1910. Early changes in the larynx in pulmonary tuberculosis. Tr. Nat. Tuberc. Assn., vi, 186, 1910. The psychological handling of the tuberculosis patient. Internat. Clin., ii, series 28. Problem of rest or exercise in the treatment of pulmonary tuberculosis. Med. Rec., Oct. 7, 1916. The réle of the x-ray in the physical examination of the lungs. Tr. Am. Clim. and Clin. Assn., 33, 1917. Importance of the control of childhood infection in the crusade for the eradica- tion of tuberculosis. South. Med. Jour., Feb., 1917. Address at thirteenth annual meeting. Tr. Nat. Tuberc. Assn., xiii, 41, 1917. Deductions from four and one-half years’ use of artificial pneumothorax in the treatment of pulmonary tuberculosis. Tr. Nat. Tuberc. Assn., xiii, 218, 1917; also Am. Rev. Tuberc., Nov., 1917. 378 A HISTORY OF NATIONAL TUBERCULOSIS ASSOCIATION Artificial pneumothorax. Its application to the arrest or cure of pulmonary tuberculosis. North Amer. Clinics, 1918. War in its effects upon the development of tuberculosis. South. Med. Jour., Jan., 1918. On the present tendency to nihilism in drug therapeutics. Therap. Gaz., May 15, 1918. Temperature of tuberculosis in its diagnostic and prognostic significance. Tr. Nat. Tuberc. Assn., xv, 207, I919. Pulmonary tuberculosis. Internat. Clin., iii, series 26. Symptomatology of pulmonary tuberculosis. Article in Klebs’ Treatise of Tuberculosis by American Authors, pp. 149 to 296, 1909. Physical examination, ibid., 197-324. Diagnosis, ibid., 325-387. CHAPTER XLVII DAVID R. LYMAN, M.D. PRESIDENT OF THE NATIONAL TUBERCULOSIS ASSOCIATION FROM 1918 TO I9I9 AVID RUSSELL LYMAN was born in Buffalo, N. Y., March 8, 1876, the son of Henry Leslie and Jane Ellen Newman Lyman. He was the youngest man who ever served as president of the National Tuberculosis Association. He was elected to this honor in 1918, on his return from France, where he had served with distinction as associate director of the Rocke- feller Tuberculosis Commission. He had already served the Asso- ciation as vice-president from 1917 to 1918. Dr. Lyman received his collegiate and medical education at the University of Virginia, with the degree of M.D. in 1899. He be- came instructor in histology and in anatomy at his alma mater, and after serving in this capacity for one year he became assistant resident physician at Johns Hopkins Hospital. In 1901 a slight tuberculous trouble caused him to seek the Adirondack Cottage Sanitarium, where he soon became assistant resident physician and pupil of Trudeau. When the Gaylord Farm Sanatorium was established and the directors looked longingly to Saranac Lake for a competent physician-in-chief for their institution, they found such a person in David R. Lyman, who took charge of the insti- tution at Wallingford, Conn. It is the privilege of the author of this biographical sketch to have been associated in the capacity of honorary director of the Gaylord Farm Sanatorium from its very beginning, and thus he has been able to watch the progress of this wonderful institution under the able directorship of Dr. Lyman. : This is not the place to trace the development of any individual institution, but since the success of the Gaylord Farm Sanatorium as an institution for the treatment of tuberculosis has been almost exclusively due to Dr. Lyman’s genius as a physician, organizer, 379 380 A HISTORY OF NATIONAL TUBERCULOSIS ASSOCIATION and executive officer, it may be permissible to repeat here some- thing from an address delivered by the author at the fifteenth anniversary of Gaylord Farm Sanatorium on September 13, 1919: “Up to the tenth anniversary of the Gaylord Farm Sanatorium, at which it was also my privilege to be present, this institution had expended $800,000. Now, what have the patients given back to the state in return for these ex- penditures which made them breadwinners again and supporters of their families? Dr. Lyman, who has kept a careful record of the earning capacity of those who have left the sanatorium as cured or practically cured, finds that they have added something like $2,000,000 to the wealth of the country since they left the institution. That pays surely even if the elimination of a certain number of state liabilities and the decrease of the total sum of unhappiness are not taken into account. Ninety per cent. of the graduates who went to Gaylord Farm in the early stages of tuberculosis are in good health after ten years of work. That percentage cannot be exceeded outside of sanatorium ranks. If the first thousand men passing a given corner were caught and ear- marked to-day, it is not likely that 900 of them would be alive and vigorous ten years later. In the moderately advanced cases 60 per cent. of the pa- tients were restored to health at the sanatorium, and 10 per cent. even of the apparently hopeless cases were turned out well men.” Dr. Lyman’s invaluable services to the commonwealth of the state of Connecticut have been recognized by the state author- ities. He was elected a member of the Connecticut State Tuber- culosis Commission, and served in this capacity for four years. In the year 1908 the medical faculty of Yale University appointed Dr. Lyman a clinical lecturer on tuberculosis, and Yale Univeisity conferred upon him the honorary degree of Master of Arts in 1916. Besides being a member of the National Tuberculosis Association, Dr. Lyman is also a member of the American Climatological and Clinical Association, the American Public Health Association, the New Haven County Medical, Connecti- cut State Medical, and American Medical Associations. In 1919 he had the honor of being president of the New Haven County Medical Association. Dr. Lyman’s service on behalf of the tuberculosis movement has been universally recognized. He was most active in organiz- ing tuberculosis dispensaries in France, particularly in the Depart- ment of Eure et Loir. As already stated, on his return he was unanimously elected as the fourteenth president of the National LYMAN DAVID R DAVID R. LYMAN, M.D. 381 Tuberculosis Association. In the fall of 1919 he was again chosen to represent the National Tuberculosis Association at the British Tuberculosis Conference in London. His value to the National Association was again recognized when he was made chairman of a committee of seven appointed to recommend changes in the organization of the Association. The report of this committee was presented to the board of directors at its meeting on Decem- ber 8, 1920, and resulted in the adoption of the new by-laws of the Association. The bibliography of Dr. David R. Lyman follows: The cutaneous reaction of Lautier and some studies in controls. Tr. Am. Clim. and Clin. Assn., 1909. The employment of arrested cases. Jour. Outdoor Life, Jan., 1911. Diet in tuberculosis. Jour. Outdoor Life, Oct., 1911. The use of artificial pneumothorax in the treatment of pulmonary tubercu- losis. Tr. Conn. State Med. Soc., 1913. After the sanatorium—what? (Symposium). Jour. Outdoor Life, xi, Sept., 1914. The problem of the discharged sanatorium patient. St. Paul Med. Jour., xvii, p. 270-80, April 1, 1915. The tuberculosis work in Connecticut, its development in the last decade, and its future needs. Boston Med. and Surg. Jour., clxxii, 657-60, May 6, 1915. : The work of the State Tuberculosis Commission, its development and present outlook. Proc. Conn. State Med. Socy., 1915. Visiting nurses in the fight against tuberculosis. Virginia Med. Semi-Month., xx, 376-80, Nov. 12, 1915. Sanatorium temperature records. Tr. Nat. Tuberc. Assn., xi, 205-208, 1919. Some of the present needs of the tuberculosis work in Connecticut. Address before the Litchfield County Pub. Health Assn., May 25, 1916. Printed in pamphlet form. The development of the tuberculosis crusade and its needs. Lancet-Clinic, cxvi, 193-199, Aug., 26, 1916. The teeth in tuberculosis. Tr. Nat. Tuberc. Assn., xii, 178, 1916. A case of unsuspected spontaneous pneumothorax. Tr. Amer. Climat. and Clin. Assn., 1916. When is the diagnosis of tuberculosis without positive sputum justified? Boston Med. and Surg. Jour., clxxvii, no. 5, Aug. 2, 1917. The control of the careless consumptive. Am. Rev. Tuberc., ii, no. 1, 36-42, March, 1918. Following up the discharged sanatorium patient. Am. Rev. Tuberc., ii, no. 10, Dec., 1918. Address of the president. Tr. Nat. Tuberc. Assn., xv, 17, 1919. CHAPTER XLVIII VICTOR C. VAUGHAN, M.D. PRESIDENT OF THE NATIONAL TUBERCULOSIS ASSOCIATION FROM IQIQ TO 1920 ‘ YICTOR C. VAUGHAN occupied the presidential chair of our Association from 1919 to 1920. He had already served the Association as vice-president from 1910 to IQII. Dr. Vaughan was born October 27, 1851, at Mount Airy, Randolph County, Mo., the son of John and Adelina Demeron Vaughan. Concerning his early boyhood, he has given us some very interesting information which explains in no small degree his practical sense, his thoroughness in his studies, his patriotism, and his later great achievements as a physician, educator, and military surgeon. On his father’s farm in Missouri everything he wore except his Sunday clothes was made from fibers grown on the farm—wool, flax, hemp, and, during the Civil War, cotton. These fibers were carried through every process necessary to convert them into clothing on the farm. The hides of cattle were tanned and made into shoes. Even the buttons were made on the farm. Spinning- wheels and looms were busy the year around. The cradles in which the children were rocked and the coffins in which the aged were buried were made on the farm. Concerning these early experiences he writes: “T have visited and studied in divers universities in this country and in Europe, but the biggest university I ever went to was my father’sfarm. There I learned more than I could have learned at any university or polytechnic school in the world. I lived in Missouri during the Civil War. My father had both legs broken before the.Civil War and did not serve in either army. My uncle, Moses Vaughan, commanded a Mississippi brigade in the Con- federate Army. We were known as southern sympathizers, and the family received rather rude treatment from Missouri and Iowa home guards, or- ganizations of which occupied Missouri during the Civil War. In February, 1865, with my mother, younger brother, and sister, I fled by night from Mis- 382 VICTOR C. VAUGHAN VICTOR C. VAUGHAN, M.D. 383 souri to southern Illinois, where at that time there were many southern sympa- thizers. We remained in Illinois until the close of the war, when we returned to our farmin Missouri. Before and during the first part of the war my father and some of his neighbors maintained a private school. The school building was a single-roomed house a short distance from my father’s home in the woodland pasture. My most impressive teacher at this time was a Scotch- man who taught me to speak Latin, although I never really knew anything of Latin grammar until I went to college.” In 1867 young Vaughan went to Central College, Fayette, Missouri, where he remained one year. From there he went to Mt. Pleasant College, Huntsville, Mo., and completed his under- graduate course, tutoring and giving instruction in Latin in order to pay his way. In fact, when he graduated he was professor of Latin in this college. He spent one semester teaching Latin in Hardin College, Mexico, Mo., a college for girls, and in 1874 came to the University of Michigan, taking an M.S. degree in 1875, a Ph.D. degree in 1876, and an M.D. degree in 1878. Dr. Vaughan has received the following honorary degrees: Sc.D. , University of Pittsburgh; M.D., University of Illinois; LL.D., University of Michigan, Central College, Jefferson Medical School. In 1888 he took a course in bacteriology in the University of Berlin in Koch’s laboratory. At that time Karl Frankel gave the laboratory course and Professor Koch gave the lectures. Dr. Vaughan’s professional career has indeed been a remark- able one, full of attainments in the field of physical and medical chemistry, therapeutics, hygiene, and medico-military science. He occupied the position of assistant in the chemical laboratory of the Michigan University from 1875 to 1883; he was lecturer on medical chemistry from 1879 to 1880; assistant professor in med- ical chemistry from 1880 to 1883; professor of physiological and pathological chemistry and associate professor in therapeutics and materia medica from 1883 to 1887; professor of hygiene and physiological chemistry and director of the hygienic laboratory from 1887 to 1909. Besides these many teaching positions, Pro- fessor Vaughan has been dean of the department of medicine and surgery of the University of Michigan since 1890; member of the Michigan State Board of Health from 1883 to 1895, and since 1901 president of the Board. 384 A HISTORY OF NATIONAL TUBERCULOSIS ASSOCIATION Dr. Vaughan is a member of many learned societies, such as the American Philosophical Society, the American National Associa- tion of Sciences, the French and Hungarian Societies of Hygiene. In 1909 he was the president of the Association of American Physicians, and in 1915 the president of the American Medical Association. Dr. Vaughan served in the Santiago campaign in 1898 as Major and surgeon of the Thirty-third Michigan Volunteer Infantry. He was soon appointed a Division Surgeon and gradually rose to the rank of Surgeon General. Because of his distinction as a hygienist and as one of our greatest authorities on physiological chemistry, Dr. Vaughan has been made a member of many na- tional and foreign societies, and during the recent World War he served with distinction as Colonel and as Assistant Surgeon General. He isa member of the American Advisory Board of the Red Cross. All of Dr. Vaughan’s five sons served in the World War and distinguished themselves by bravery and devotion. Unfor- tunately, the oldest son, Major Victor C. Vaughan, Jr., was acci- dentally drowned in France. Dr. Vaughan’s text-book on Physiological and Pathological Chemistry is perhaps the most important work existing on the subject. Among some two hundred papers on medical and scien- tific subjects published by him in this country and in Europe, there are a number of highly interesting contributions relating to the subject of tuberculosis, of which a partial list is attached to this sketch. In the tuberculosis movement of his own state, Dr. Vaughan has been most active and is largely responsible for the formation of the state tuberculosis association and the foundation of the admirable Michigan State Sanatorium for the tuberculous. The appended bibliography does not by any means comprise all of the numerous and instructive addresses on behalf of the tuberculosis cause which Dr. Vaughan delivered during his long and interest- ing career. He has been a faithful attendant at nearly all the meetings of the National Tuberculosis Association, and his ad- dresses and discussions have always been most enlightening and instructive. We will make especial mention only of the wonderful VICTOR C. VAUGHAN, M.D. 385 address on ‘‘ The National Welfare,’’ which appears in the Trans- actions of the meeting at Atlantic City in the year 1919. The bibliography of Dr. Victor C. Vaughan follows: Healthy homes and healthy foods for the working classes. The Lomb prize essays. First published in 1886. The infection of meat and milk. Tr. 7th Internat. Congr. on Hygiene and Demography, London, iii, 118-129, 1891. The treatment of tuberculosis with yeast nuclein. Med. News, Ixv, 157-175, 1894. The restriction of tuberculosis. Med. News, Ixviii, 255, 1896. The crusade against tuberculosis. Mich. Publ. Health Jour., iii, 49-54, 1908. The problem of tuberculosis. Wisc. Med. Jour., iv, 59-71. The split products of the tubercle bacillus and their effects on animals (with Sybil May Wheeler). Tr. Nat. Tuberc. Assn., iii, 237~243, 1907. The fight against tuberculosis. Jour. Lab. and Clin. Med., ii, 134. Tuberculosis Legislation. Tr. Nat. Tuberc. Assn., 239, 1909. National Welfare. Tr. Nat. Tuberc. Assn., xv, 55, 1919. Address of the president. Tr. Nat. Tuberc. Assn., xvi, 24, 1920. The service of medicine to civilization. Jour. Am. Med. Assn., lxii, 2003-2012, 1914. Die Phanomene der Infektion. Berlin, 1914, J. Springer. Infection and immunity. In Commemoration volume. Am. Med. Assn., 1915. 25 CHAPTER XLIX GERALD B. WEBB, M.D. PRESIDENT OF THE NATIONAL TUBERCULOSIS ASSOCIATION FROM 1920 TO 1921 ERALD BERTRAM WEBB was one of the youngest men G to serve as president of the Association. Born in England in 1871, he received his preliminary education at Dean Close Memorial School, Cheltenham. As a child he had the privilege of playing in the home of the celebrated Jenner at Berkeley. He began his medical studies at Guy’s Hospital, Lon- don, in 1891, and remained there until 1895. He came to the United States and was graduated from the University of Denver in 1896. He went to Europe in 1905 and pursued special studies on immunity and tuberculosis with Sir A. E. Wright, and did clinical work, particularly in tuberculosis, with Lorenz, Covacs, Ghon, and others at the Allgemeine Krankenhaus in Vienna, and also at some of the other European tuberculosis sanatoria. On his return to America in 1906 he established himself at Colorado Springs, paying particular attention to tuberculosis practice. In 1910 he took over the Cragmor Sanatorium, which was founded by Dr. S. E. Solly in 1905. He has completely rebuilt this sana- torium and enlarged its capacity from 20 to 100 beds. In 1912 Dr. Webb represented the National Tuberculosis Asso- ciation at the International Congress on Tuberculosis in Rome. During the World War Dr. Webb served as Lieutenant Colonel of the Medical Corps of the United States Army. He had active charge of the tuberculosis work of the American Expeditionary Force in France. After his honorable discharge he resumed his work in Colorado Springs and founded the Colorado School of Tuberculosis, of which he became the president. He is now con- sulting physician to the Cragmor and Sunny Rest sanatoria at Colorado Springs. He is a member of the American Medical Association, the American Association of Physicians, the Amer- 386 GERALD B. WEBB GERALD B. WEBB, M.D. 387 ican Climatological and Clinical Association, and the American Association of Immunologists. Dr. Webb was unanimously elected President of the National Tuberculosis Association in 1920. In the same year he was chosen to represent the United States at the International Union against Tuberculosis in Paris, and in 1921 he again represented our country before the same body in London. Dr. Webb has been from the very beginning of his medical career an ardent student of experimental and clinical tuberculosis, and in later years has done valuable and original research work in immunization. The bibliography of Dr. Gerald Bertram Webb follows: Experimental Immunity production by inoculation of increasing numbers of bacteria, be- ginning with one organism (with Williams). Preliminary report, Tr. Nat. Tuberc. Assn., iv, 113, 1908; Tr. 6th Internat. Congress on Tub., 1908. Immunity production by inoculation of increasing numbers of bacteria, be- ginning with one living organism (with Williams and Barber). Jour. Med. Res., Jan., 1909. The integumental tuberculin reactions, with report of 155 more inunction re- actions (with Williams). Colo. Medicine, Jan., 1909. Some immunity problems in tuberculosis (with Williams). Colo. Medicine, April, 1909. Some hematological studies in tuberculosis (with Williams). Tr. Nat. Tuberc. Assn., v, 231, 1909. Artificial lymphocytosis as a possible aid in the treatment of tuberculosis; preliminary report (with Williams and Basinger). Colo. Medicine, Jan., 1910. Artificial lymphocytosis in tuberculosis (with Williams and Basinger). Tr. Nat. Tuberc. Assn., vi, 279, 1910. (These papers include first observa- tions on lymphocyte increase in high altitudes.) Immunity in tuberculosis; a further report on its production by the inocula- tion of increasing numbers of bacilli (with Williams). Jour. Med. Res., Jan., 1911. Immunity in tuberculosis; its production in monkeys and children (with Williams). Jour. Am. Med. Assn., Oct. 28, I91I. Immunity in tuberculosis by inoculation of living tubercle bacilli. New Mexico Med. Jour., Dec., 1911. Immunity in tuberculosis (with Gilbert). Tr. Nat. Tuberc. Assn., xi, 227, 1915. 388 A HISTORY OF NATIONAL TUBERCULOSIS ASSOCIATION Studies in tuberculosis. Bull. Johns Hopkins Hosp., Aug., 1912. Blood platelets—some studies in connection with altitude and tuberculosis; preliminary report (with Gilbert and Havens). Colo. Medicine, Jan., 1914. Immunity in tuberculosis; further experiments (with Gilbert). Jour. Am, Med. Assn., Sept. 26, 1914. Blood platelets and tuberculosis (with Gilbert and Havens). Tr. Nat. Tuberc. Assn., x, 180, 1914; also Arch. Int. Med., Nov., 1914 Immunity in tuberculosis; inoculation with tubercle bacilli mixed with lymphocytes (with Gilbert). Tr. Nat. Tuberc. Assn., xi, 227, 1915. Immunity in tuberculosis. Jour. Lab. and Clin. Med., March, 1916. An attempt to produce immunity by transplanting tuberculous lymph nodes into normal animals (with Ryder and Gilbert). Am. Rev. Tuberc., Feb., 1918, Transplantation of tuberculous lymph nodes (with Ryder and Gilbert). Tr. Assn. Amer. Phys., 1918. Hypernephrectomy and experimental tuberculosis (with Gilbert, Hartwell, and Ryder). Tr. Nat. Tuberc. Assn., xvi, 336, 1920; also Am. Rev. Tuberc., Oct., 1920. The survival of virulence of tubercle bacilli in excised animal lymph nodes; further studies (with Ryder and Gilbert). Am. Rev. Tuberc., July, 1921. Tr. Nat. Tuberc. Assn., 1921. The adrenals and thyroid in experimental tuberculosis (with Gilbert and Ry- der). Am. Rev. Tuberc., May, 1921. Address of the president. Tuberculosis: the rationale of research. Tr. Nat. Tuberc. Assn., xvii, 26, 1921; also Am. Rev. Tuberc., June, 1921. Clinical Some opsonic and bacterial vaccine experiences. Colo. Medicine, March, 1908. Vaccine therapy—theories regarding certain failures; preliminary report (with Gilbert). Colo. Medicine, Feb., 1911. Second Note, Colo. Medicine, April, 1911. The specific tissue inoculation of vaccines (with Gilbert), Tr. Nat. Tuberc. Assn., vii, 375, I9I1. Tuberculosis carriers. Jour. Outdoor Life, Oct., 1912. Artificial pneumothorax; with report of gas analyses and experiments to determine the use of air or nitrogen (with Gilbert, James, and Havens). Tr. Nat. Tuberc. Assn., x, 101, 1914; also Arch. Int. Med., Dec., 1914. Recent progress in the diagnosis and treatment of pulmonary tuberculosis; Pan-American Surg. and Med. Jour., June, 1915. Sunlight treatment of tuberculosis. Jour. Outdoor Life, Sept., 1915. Trachea position (with Forster and Gilbert). Tr. Nat. Tuberc. Assn., xi, 69, 1915; also Jour. Am. Med. Assn., Sept. 18, 1915. GERALD B. WEBB, M.D. 389 Rest of the individual lung by posture (with Forster and Houck). Pre- liminary report. Colo. Medicine, May, 1916; also Tr. Nat. Tuberc. Assn., xii, 182, 1916; Jour. Am. Med. Assn., Nov. 11, 1916. Diaphragmatic pleurisy in the tuberculous (with Forster and Gilbert). Tr. Nat. Tuberc. Assn., xiii, 193, 1917. The effect of inhalation of cigarette smoke on the lungs. Am. Review Tuberc., March, 1918. Bronchiectasis and bronchitis associated with accessory sinus disease (with Gilbert). Jour. Am. Med. Assn., March 12, 1921. Postural rest for pulmonary tuberculosis (with Forster and Gilbert). Jour. Am. Med. Assn., March 26, 1921. CHAPTER L JAMES ALEXANDER MILLER, M.D. PRESIDENT OF THE NATIONAL TUBERCULOSIS ASSOCIATION FROM I92I-I922 AMES ALEXANDER MILLER, who has already served J the Association as vice-president from 1916-1917 and from 1920-1921, was born in Roselle, N. J., March 27, 1874, being the son of Charles Dexter and Julia Hope Miller. Young Miller became a Bachelor of Arts of Princeton in 1893, an A.M. of the same university in 1894, and an M.D. of Columbia University, 1899. He served as intern in the Presbyterian Hos- pital, New York, from 1899 to 1901. Dr. Miller’s interest in tuberculosis was aroused by no less a teacher and pioneer in tuberculosis science than the famous Trudeau. The summer after leaving the Presbyterian Hospital Dr. Miller went up to Paul Smith’s to assist Dr. Trudeau who then did general practice during the summer months at that resort. It was but natural that the young physician, being inspired by Dr. Trudeau's per- sonality, enthusiasm, and achievements in tuberculosis, should himself become so deeply interested as to make tuberculosis his life’s work. On his return to New York and to the Vanderbilt Dispensary, to which he was attached, he urged ‘the establish- ment of special tuberculosis classes. He was supported in this work by his teacher and friend, Dr. Walter B. James, then pro- fessor of medicine at the College of Physicians and Surgeons, the medical department of Columbia University. Dr. Miller is now himself professor of clinical medicine in that school. From the time he inaugurated the tuberculosis classes connected with the Vanderbilt Hospital he has been an untiring worker in his chosen specialty, so that to-day he occupies the enviable position of leader in the anti-tuberculosis work in New York city. He is visiting physician at Bellevue Hospital; physician in charge of the tuberculosis division of Bellevue Hospital; special consultant 390 JAMES ALEXANDER MILLER . JAMES ALEXANDER MILLER, M.D. 391 in tuberculosis at the Presbyterian Hospital, New York. He is consulting physician to the Sea View Hospital, Staten Island, Sprain Ridge Sanatorium, Yonkers, and the Trudeau Sanatorium, Saranac Lake. He is also secretary of the Board of Trustees of the Trudeau Sanatorium. But Dr. Miller is not contented with clinical work in tubercu- losis. From the very beginning of his career as a tuberculosis worker he has realized the importance of the social aspect of this disease and was instrumental in reorganizing the former Tubercu- losis Committee of the New York City Charity Organization Society into the flourishing New York City Tuberculosis Asso- ciation, of which he is now the president. To Dr. Miller we are also indebted for the formation of the Association of Tuberculosis Clinics, which is doing such admirable work under his presidency. As secretary of the Public Health Committee of the Academy of Medicine, member of the Advisory Council of the Phipps Insti- tute, Philadelphia, of the Central Council of the Charity Organiz- ation Society, of the Board of Directors of the Association for Improving the Condition of the Poor, of the Board of Directors of the State Charities Aid Association, and as chairman of the Health Service Committee of the New York County Chapter, American Red Cross, he has been instrumental in furthering the anti-tuberculosis cause perhaps more than any other individual tuberculosis worker. Not the least among the many important positions he occupies at the head of the various anti-tuberculosis movements, is that of editor-in-chief of the Journal of the Out- door Life. During the world war Dr. Miller did admirable service in France from 1917 to 1918, as associate director of the Rockefeller Commission for the Prevention of Tuberculosis in France and as Major in the American Red Cross in France. The French Government honored Dr. Miller by the bestowal of the decoration of Chevalier de Légion d'honneur. Dr. Miller is a fellow of the Association of American Physicians, of the New York County and State Medical Societies and of the American Medical Association. He served from 1915 to 1916 as president of the American Climatological and Clinical Society. At its meeting in June, 1921, the National Tuberculosis Asso- ciation honored itself by electing Dr. Miller president in recogni- 392. A HISTORY OF NATIONAL TUBERCULOSIS ASSOCIATION tion of the valuable clinical and social work which he has carried on in the field of tuberculosis. The bibliography of Dr. James Alexander Miller follows: A clinical study of the children of tuberculous parents (with I. Ogden Wood- ruff, M.D.). Jour. Am. Med. Assn., lii, 1016, 1909. Clinical diagnosis of pulmonary tuberculosis. Tr. Nat. Tuberc. Assn., v, 195, 1909. Relation of the physician to the anti-tuberculosis campaign. Tr. Nat. Tuberc. Assn., viii, 52, 1912. Studies of the leukocytes in pulmonary tuberculosis and pneumonia (with Margaret A. Reed). Arch. Int. Med., ix, 609,-1912. Hospital ventilation from the point of view of the clinician. Jour. Am. Med. Assn., Ixiii, 1623, 1914., The effect of changes in atmospheric conditions upon the upper respiratory tract (with Gerhard H. Cocks, M.D.). Tr. Am. Clim. and Clin. Assn., xxxi, 31, I915. The effects of exposure to cold upon experimental infection of the respiratory tract (with Willis C. Noble). Jour. Exper. Med., xxiv, 223, 1916. Some physiological effects of various atmospheric conditions. Am. Jour. Med. Sci., cliii, 412, 1917. Some problems of differential diagnosis in chronic pulmonary disease. New York Med. Jour., April 28, 1917. Subacute and chronic non-tuberculous pulmonary infections. Tr. Nat. Tuberc. Assn., xiv, 78, 1918; also Am. Jour. Med. Sci., xliv, 805, 1917. How America is helping France with her tuberculosis problem. Am. Rev. Tuberc., ii, 409, 1918. Tuberculosis among European nations at war. Am. Rev. Tuberc., iii, 337, 1919. Some problems in the differential diagnosis of pulmonary tuberculosis. Tr. Nat. Tuberc. Assn., xvi, 197, 1920; also Am. Rev. Tuberc., iv, 502, 1920. Pulmonary tuberculosis. In Nelson’s Loose Leaf System of Medicine, 1921. CHAPTER LI GENERAL GEORGE M. STERNBERG, M.C., U.S.A. TREASURER OF THE NATIONAL TUBERCULOSIS ASSOCIATION FROM 1904 TO I9QI2 URGEON GENERAL GEORGE M.STERNBERG served S the National Tuberculosis Association as its faithful treas- urer from the time of the formation of the society in 1904 to the year 1912. He was born June 8, 1838, in the city of New York and was the son of the Rev. Levi and Margaret Levering Miller Sternberg. He received his preliminary education at the Hartwick Seminary of Otsego County, N. Y., and graduated in medicine from the College of Physicians and Surgeons, New York, in 1860. General Sternberg was an honorary fellow of Johns Hopkins University from 1880 to 1881 and from 1885 to 1887; he was president of the American Public Health Association in 1887, of the Washington Biological Society in 1896, the American Medical Association in 1897, the Washington Philosophical Society in 1897, and the Association of Military Surgeons in 1899. He was also a member of the American Bacteriological Society, the Asso- ciation of American Physicians and of the American Association for the Advancement of Science. General Sternberg’s career as a scientist, physician, medical officer in the United States Army, and worker for the civic wel- fare of Washington was indeed a brilliant one. Entering as an assistant surgeon in 1861, he was made a captain and then major in the United States Army ‘‘for faithful and meritorious services”’ during the Civil War, and a lieutenant colonel “for gallant service in performance of his professional duty under fire in action against the Indians at Clearwater, Idaho, July 12, 1877." Gen- eral Sternberg participated in many engagements, including the first battle of Bull Run, on which occasion he was wounded and 393 394 A HISTORY OF NATIONAL TUBERCULOSIS ASSOCIATION taken prisoner. He escaped from Fairfax Court House shortly afterward, and at once rejoined his regiment. He was under heavy fire while caring for the wounded at the battles of Gaines Mill and Malvern Hill, and afterward suffered a severe attack of typhoid fever. He was executive officer of the United States general hospital at Portsmouth Grove, R. I.; was with General Banks’ expedition to the Gulf of Mexico, and, at the close of the war, was serving as officer in charge of the United States general hospital at Cleveland, Ohio. Dr. Sternberg was in the field in various Indian campaigns from 1868 to 1870. Among his many details was one at Fort Columbus, in New York harbor, during the yellow fever epidemic in 1871, and jin Florida during similar epidemics in 1873 and 1875. He participated in the expedition against the Nez Perce Indians in 1877, and was a member of the Havana yellow fever commission in 1879. He was a delegate from the United States to the inter- national sanitary conference held in Rome, Italy, in 1885, and in 1887 was detailed to make investigations in Brazil, Mexico, and in Cuba relating to the etiology and prevention of yellow fever. . On May 28, 1893, Colonel Sternberg was made Surgeon General on account of his scientific work and his gallantry and bravery on various battlefields. Within a month after his ap- pointment he recommended the establishment of the Army Medical School. This institution marks an epoch in American medicine, and it would seem but just and fitting that it should be made a lasting monument to the great soldier physician. He also recommended the establishment of the sanatorium at Fort Bay- ard in New Mexico for the treatment of pulmonary tuberculosis, with Dr. George E. Bushnell in charge. This institution has accomplished great good not merely by restoring many men to active duty again, but also by the humane care extended to the hopeless cases and the protection afforded to the families of the: afflicted and thus to the community at large. Since the time of its establishment in 1899 to March 31, 1920, it has cared for 12,984 patients. As Surgeon General of the Army, Sternberg’s work in the estab- lishment and improvement of army hospitals and laboratories is acknowledged to be of the greatest importance. During the M. STERNBERG GEORGE GENERAL GEORGE M. STERNBERG, M.C., U.S.A. 395 Spanish-American War he established general hospitals at Key West, Savannah, Fort Thomas, Ky., Fort McPherson, Ga., Fort Monroe, Va., Fort Myer, Washington Barracks, and San Fran- cisco, and upon his recommendation two hospital ships were purchased and equipped. All volunteer surgeons and contract surgeons were appointed on his recommendation. He organized the female nurse corps and the corps of dental surgeons in com- pliance with acts of Congress passed on his recommendations At the outbreak of the conflict he issued a circular calling attention to the danger of typhoid in camps and organized the ‘typhoid fever board,” with Major Walter Reed as chairman. He or- ganized the yellow fever commission of 1900, with the now famous Major Reed and Drs. Carroll, Lazear, and Aramonte as members. In 1901 he recommended that the medical department _be increased to correspond with the increase in the army made at that time. Surgeon General Sternberg was retired from the army on account of age in 1902. Up to his passing away he devoted his energy, knowledge, and experience to the betterment of health in the capital of our country. Hedied on November 3, 1915, at the age of seventy-eight, and was buried with military honors becom- ing his rank. On November 5, 1919, a simple but imposing monu- ment in granite was unveiled at the Arlington National Cemetery, to mark the place where Surgeon General Sternberg had been laid at rest. Tributes were paid on this occasion by Major General Merritt W. Ireland, Surgeon General of the United States Army, Brigadier General Walter D. McCaw, Colonel Edward L. Mon- son, and Colonel Frederick R. Russell. Dr. George M. Kober, his life-long friend, pronounced the following eulogy on his life’s work: “Dr. Sternberg was not only a great scientist, he was also a philanthropist in the fullest and most beautiful meaning of the word. A review of his scien- tific work shows that he always sought the application of science to the ameli- oration of human ills. His first important work in bacteriology was on disin- fectants and disinfection as a means of preventing the so-called germ diseases; a work of incalculable value to mankind. He never lost an opportunity to impress on the profession and the public that the eradication of preventable diseases is the highest aim of scientific medicine. “It was not possible for a man of Dr. Sternberg’s humanitarian attributes 396 A HISTORY OF NATIONAL TUBERCULOSIS ASSOCIATION to rest content with the scientific knowledge that polluted water and infected milk are potent factors in the spread of typhoid fever, bovine tuberculosis, etc., and that unsanitary houses and low standards of living are largely re- sponsible for the prevalence of tuberculosis, but he must make practical appli- cation of this knowledge. We therefore found him in the front rank and as a leader in the campaign for pure water and milk, removal of slums, and the creation of sanitary houses in the National Capital. As a result of his efforts the Washington Sanitary Housing Companies were organized, which have erected healthful houses at reasonable rentals for over 800 families. “Having been the first in America to demonstrate the tubercle bacillus dis- covered by Koch in 1881, and familiar with the cause and prevention of tu- berculosis, it was natural that he should labor long and faithfully in the cam- paign against this disease. He was a charter member of the National Associa- tion and took a deep interest and participated in many discussions at the annual meetings, and at the International Congress on Tuberculosis. As. president of the local Association from its organization until his death in 1915, he was the leader of a great educational campaign. He established several dispensaries, urged the erection of the municipal hospital for indigent tubercu- lous patients, and also established a sanatorium for the middle class victims of this disease. He was instrumental in securing the enactment of a law pro- viding for the condemnation of houses unfit for human habitation and the com- pulsory registration of tuberculous patients." Thus was the monument dedicated as General Ireland said: “‘To the memory of a remarkable man, whose name is writ large in the military and scientific annals of this country.” Professor William H. Welch and his associates on the commit- tee had selected the following sentences to be inscribed on the stone as expressive of the achievements of this remarkable man: “Pioneer American Bacteriologist. Distinguished by his studies of the causation and prevention of infectious diseases, by his discovery of the micro- organism causing pneumonia, and scientific investigation of yellow fever, which paved the way for the experimental demonstration of the mode of transmission of this pestilence.’’ “Veteran of three wars. Brevetted for bravery in action in the Civil War and Nez Perces War. Served as Surgeon General of the U. S. Army for the period of nine years, including the Spanish-American War. Founder of the Army Medical School. Scientist, author, and philanthropist. M.D., LL.D.’" Surgeon General Sternberg’s biography, written by Mrs. Sternberg and published by the American Medical Association,* contains a complete bibliography of the General’s writings on * George M. Sternberg, a biography, by his wife. American Medical Asso- ciation, Chicago, 1920. : GENERAL GEORGE M. STERNBERG, M.C., U.S.A. 397 yellow fever, malarial fever, tuberculosis, and other infectious diseases. The bibliography of Gen. George M. Sternberg follows: Report of microscopical examination of suspended particles found in the atmosphere. Nat. Bd. Health Report 2, p. 387-396, 1880. A fatal form of septicemia in the rabbit, produced by the subcutaneous in- jection of human saliva. (The discovery of the organism causing croupous pneumonia.) Nat. Bd. Health Bull., 2, p. 781-783, 1881; also 3, p. 87-92, 1881. Experiments with disinfectants. Nat. Bd. Health Bull., 3, p. 21, 68, 181. Bacteria and the germ theory of disease. Tr. Med. Society, California, 12, P. 193-198, 1882. Bacterial organisms. Western Lancet 11, p. 198-203, 1882. Is tuberculosis a parasitic disease? Medical News, 1892, p. 730. Sanatorium treatment for the tuberculous. Washington Med. Annals, 1905. First fifty cases of tuberculosis treated at Star Mount Sanatorium. Wash- ington Med. Annals, 1907. . Building of model homes. Report of the President’s Home Commission, 1908. Housing the working classes a factor in the prevention of tuberculosis. Jour. Outdoor Life, 1910. Results of treatment at the Star Mount Tuberculosis Sanatorium. Wash- ington Medical Annals, 1911. Small homes within the city limits for unskilled wage earners. 2nd edition, Nat. Housing Assn. Public no. 27, 1915. Manual of bacteriology. 1893. Textbook on bacteriology. 1901. CHAPTER LII WILLIAM HENRY BALDWIN TREASURER OF THE NATIONAL TUBERCULOSIS ASSOCIATION FROM I9QI2 TO IQI9 ILLIAM HENRY BALDWIN, who served our National W Tuberculosis Association so faithfully as treasurer from 1912 to 1919, was born in Youngstown, Ohio, July 16, 1851. He was the son of Timothy D. and Lucretia K. Manning Baldwin. He obtained his degree of A.B. from the Western Reserve University in 1871. He became cashier of the First National Bank of Youngstown in 1877, its vice-president in 1889; manager of the Arms-Bell Company in 1887, secretary of the Youngstown Iron and Steel Company in 1890, and of the'Union Iron and Steel Company in 1892; secretary and treasurer of the Ohio Steel Company in 1894, and of the National Steel Company in 1899. In r901 Mr. Baldwin retired and devoted himself to social work. We owe it to Dr. Charles O. Probst, of Columbus, Ohio, one of the pioneers and an enthusiastic worker for the tuber- culosis cause in this country and particularly in the state of Ohio, that Mr. Baldwin, a layman, entered with heart and soul into the tuberculosis movement and brought with him a keen sense of the responsibility which all good citizens have in the social and hy- gienic welfare of the nation. Mr. Baldwin’s business training fitted him eminently for the many positions of trust which he has occupied since he settled in Washington, D. C. Aside from being treasurer of the National Tuberculosis Association he has served as a director and member of its executive committee for many years. He was a member of the President’s Home Commission; official delegate of the National Tuberculosis Association to the International Conference on Tuberculosis in Brussels in 1910, and an official delegate of the United States to the International Congress on Tuberculosis 398 WILLIAM H. BALDWIN WILLIAM HENRY BALDWIN 399 in Rome in 1912; a member of the Conference of Commissioners on Uniform State Laws from the District of Columbia; Vice- Chairman of the American Association of Societies for Organizing Charity; and member of the Advisory Council of the Henry Phipps Institute. With the entrance of the United States into the World War it was, of course, evident that Mr. Baldwin would do his share, and in 1917 he became chairman of the District Council of Defense for the District of Columbia. We append here only a very short list of valuable papers Mr. Baldwin has written on the social aspect of tuberculosis. Coming from a layman so intimately associated with the tuberculosis movement in the United States, they are of incalculable value and will serve as classical treatises for many years to come. Mr. Baldwin's social activities, however, were not confined specifically to tuberculosis subjects. Poverty, want, and social unhappiness, all of which contribute toward the propagation of tuberculosis, received his attention and devotion. Mr. Baldwin’s book on ‘‘Family Desertion and Non-Support Laws,” published in 1904, and various papers and reprints on the same subject, are monuments to his philanthropy and eagerness to serve. In con- nection with the Associated Charities in Washington since 1909 he has been chairman of the Citizen’s Committee on the Loan Shark Law, which has stopped the payment of more than $500,000 illegal interest in our capital each year. Although he has retired as our treasurer, we still rejoice in hav- ing Mr. Baldwin as a member of our Association, feeling sure that he will never fail to help us with his valued advice in all matters appertaining to the social and economic side of the tuberculosis problem. The bibliography of Mr. William H. Baldwin follows: The progress of the sanatorium movement in America. Tr. Nat. Tuberc. Assn., i, 70, 1905; also Am. Med., ix, no. 24, 995-1000, June 17, 1905. Influence of a tuberculosis sanatorium on the value of surrounding property. Tr. Nat. Tuberc. Assn., ii, 51, 1906; also in Jour. Am. Med. Assn., Dec. 22, 1906, 2054-58. Reports and registration of cases of tuberculosis. Printed for the Committee on the prevention of consumption, Washington, Nov. 14, 1906. Compulsory reports and registration of tuberculosis in the United States. New York Med. Jour., Dec. 8, 1906. 400 A HISTORY OF NATIONAL TUBERCULOSIS ASSOCIATION ‘ The movement against tuberculosis in Washington, D. C. Jour. Outdoor Life, Sept., 1907. The army and tuberculosis. Printed in the Washington Star, March 30, 1919, under the title Tuberculosis war is army problem. Present status of soldiers and draft rejects with tuberculosis. Tr. Nat. Tuberc. Assn., xv, 366, 1919; also in Am. Rev. Tuberc., iii, no. 6, Aug., 1919. HENRY B. PLATT CHAPTER LUI HENRY BARSTON PLATT TREASURER OF THE NATIONAL TUBERCULOSIS ASSOCIATION, FROM IQI9Q R. PLATT, the present treasurer of the National Tuber- M culosis Association, is modesty personified. It was with great difficulty that a few data were obtained to enable the author to make this short biographical sketch. Henry Barston Platt was born in New York City, February 2, 1860. He is the son of the late Senator Thomas C. and Ellen Barston Platt. After his preliminary education in the public schools, young Platt went to Yale, where he finished his classical education in 1882. After graduating from college he went into the manufacturing business for about three years and became superintendent of coal properties in Pennsylvania. Later on he was made general superintendent of the United States Express Company. He is now vice-president of the Fidelity and Deposit Company of Maryland. During the world war Mr. Platt nat- urally wished to do his duty, and in the year 1918 served as director of the Bureau of Personnel of the Atlantic Division of the American Red Cross. The National Tuberculosis Association is to be congratulated on Mr. Platt’s acceptance of this most im- portant position in our Association. 26 401 CHAPTER LIV HENRY BARTON JACOBS, M.D. SECRETARY OF THE NATIONAL TUBERCULOSIS ASSOCIATION, FROM 1904 TO 1920 T THAT historic meeting in Baltimore on January 28, 1904, A when the National Tuberculosis Association was sug- gested, the choice of a secretary fell tentatively upon Dr. Henry Barton Jacobs. With the establishment of the society this office was definitely conferred upon him and this position he filled until his resignation in 1920. While the duties of secretary were largely performed by the executive secretary, yet. Dr. Jacobs’ interest in the tuberculosis cause has never flagged, and his voice in the development of the organization has always been raised with enthusiasm for all that marked progress and efficiency in the work of the Association. Dr. Jacobs was born in South Scituate, Plymouth County, Mass., June 2, 1858. His parents were Barton Richmond and Frances Almira Ford Jacobs. We are informed of the remarkable fact that through these parents he is a direct descendant of seven of the passengers on the ‘“‘ Mayflower,” which arrived in Plymouth December 29, 1620. Dr. Jacobs received his preliminary educa- tion at the High School in Hingham, Mass., and at the Phillips Exeter Academy, Exeter, N. H. He took his bachelor’s degree at Harvard in 1883, and was graduated with the degree of M.D. from the Harvard Medical School in 1887. He then became a medical intern for one and a half years in the Massachusetts Gen- eral Hospital on the East Side Service under Dr. Reginald H. Fitz and his colleagues. Dr. Jacobs left the hospital in the spring of 1888 and was appointed physician to the Boston Dispensary, opening an office for general practice at 8 Hancock Street, Boston. In August, 1888, he became the private physician of Robert Garrett, president of the Baltimore and Ohio Railroad, and after spending the winter of 1888-89 in Ringwood, N. J., moved to 402 JACOBS ARTON HENRY B ear ee nny ern ieee HENRY BARTON JACOBS, M.D. 403 Baltimore, where he has since resided. He was present at the opening of the Johns Hopkins Hospital in May, 1889, and soon became attached to the dispensary service of that hospital under Dr. William Osler, the physician-in-chief. In 1896 he was made associate in medicine in the Johns Hopkins University, and was engaged in teaching the early classes in the medical school in physical diagnosis and in therapeutics. With the departure of Professor Osler to Oxford in 1905, Dr. Jacobs resigned his position in the medical school and soon after- ward was made a trustee of the Johns Hopkins Hospital. Since then he has devoted his time largely to public health and educa- tional matters. He is a trustee of the Peabody Institute, of the Maryland Institute, of the Church Home and Infirmary, and of the Hospital School for Children; president of The Hospital for Consumptives of Maryland, and president of the Maryland Tu- berculosis Association. He was one of the original directors of the Maryland State Tuberculosis Sanatorium, and with Dr. H. Warren Buckler chose the site and matured the plans of this institution. Dr. Jacobs is also a director of the Baltimore Museum of Art, a member of the executive committee of the Baltimore Society of the Friends of Art, and of the Newport Art Society. He has collected extensively prints illustrating medical portraiture, and also medals illustrating the same subject. Books too have interested him and he serves on the library committee of the Peabody Institute, and Medical and Chirurgical Faculty, and the Redwood Library, Newport. Since he gave up his teaching at the Johns Hopkins Medical Schoo! Dr. Jacobs has not engaged in practice, but he has retained his membership in various medical societies, and together with the crusade for the suppression of tuberculosis, medical history has held his special attention. For a number of years he was president of the Johns Hopkins Medical Historical Society, as well as the Laennec Society, also the Book and Journal Club of the State Medical Society, which was a medical historical club. He is still a member of the Medical Historical Society of Paris, and one of the associate editors of the Annals of Medical History. Dr. Jacobs until his resignation was a faithful attendant at the executive committee and board meetings. He rarely failed to 404 A HISTORY OF NATIONAL TUBERCULOSIS ASSOCIATION attend the national meetings, and at the various international tuberculosis congresses and conferences abroad he has always ably represented the Association. At the final session of the Paris Congress in 1905, when Dr. Flick moved to invite the interna- tional gathering to be the guest of the American nation in 1908, Dr. Jacobs seconded the motion and arranged, by means of the cable, through the assistance of Dr. Welch, to have President Roosevelt confirm the invitation which then was accepted. Aside from Dr. Jacobs’ valuable service as secretary of the Association for the first sixteen years of its existence, he has con- tributed a number of notable papers on the treatment, prevention, and history of tuberculosis. His most important article is perhaps the one entitled ‘‘A Farm Colony Experiment,”’ which he pre- sented at the Sixth International Tuberculosis Congress. Since then a number of institutions have imitated with gratifying suc- cess this farm colony system. The plan was first inaugurated at the Eudowood Sanatorium near Baltimore during the superin- tendency of Dr. Alexius M. Forster, who originated the idea, and who with the codperation of Dr. Jacobs, the president, made every effort to demonstrate its usefulness in caring for conva- lescent and arrested cases. On November 19, 1901, before the semi-annual meeting of the Maryland State Medical Society, Dr. Jacobs read a paper on ‘“The Treatment of Consumption in Local Sanatoria,” in which he demonstrated from the results in Massachusetts that consump- tion could be as successfully treated in eastern local sanatoria as in western mountain resorts, and he made an earnest plea to the members of the society to urge upon the Legislature of Maryland the necessity of establishing a state sanatorium on the slopes of the Blue Mountain chain. In this paper in 1901 Dr. Jacobs was the first to advocate the Maryland State Sanatorium. He followed up the plea at the annual meeting of the State Medical Society April, 1903, by a paper ‘‘Maryland’s Need of a Mountain Sanatorium for Indigent Consumptives.”” Thus it was that the voice of Dr. Jacobs was the first to be raised in Maryland for the State Sanatorium, in the building of which later on he took so much interest. He was influential in choosing its site and in determining its type of buildings and its policy. Perhaps the HENRY BARTON JACOBS, M.D. 405 article of Dr. Jacobs which has attracted most notice is his essay on “Some Distinguished American Students of Tuberculosis,” in which he was the first to bring together data in regard to the eminent early students of the disease in this country. The paper was published in the Johns Hopkins Hospital Bulletin.* In later years Dr. Jacobs has been making efforts to compile the early history of vaccination with special reference to Dr. Jenner him- self. His collection of autograph letters of Jenner is probably by far the largest and most important in this country. The bibliography of Dr. Henry Barton Jacobs follows: The treatment of consumptives in local sanatoria. Maryland Med. Jour., Dec., 1901. International medical congress in Paris. Boston Med. and Surg. Jour., Jan., 1901. Some distinguished American students of tuberculosis. Bull. Johns Hopkins Hosp., xiii, 199-208, Aug.—Sept., 1902. Maryland’s need of a mountain sanatorium for indigent consumptives. Mary- land Med. Jour., Oct., 1903. Remarks upon the International Congress on Tuberculosis, Paris, 1905. Bull. Johns Hopkins Hosp., Nov., 1906. The onward march in Maryland. Jour. Outdoor Life, April, 1907. The tuberculosis situation in Maryland. Proc. Maryland Tuberc. Assn., April, 1907. The prevention of tuberculosis among school children. Maryland Med. Jour., March, 1908. Hygienic instruction in schools. Proc. Sixth Internat. Congr. on Tuberc., Washington, 1908. A farm colony experiment. Proc. Sixth Internat. Congr. on Tuberc., Wash- ington, 1908. The sanatorium school. Proc. 5th Cong. Amer. School Hygiene Assn., New York, Feb., 1911. Osler as a citizen and his relation to the tuberculosis crusade in Maryland. Bull. Johns Hopkins Hosp., July, 1919. President’s reports on the work of the Hospital for Consumptives of Mary- land (The Eudowood Sanatorium). In the annual reports of the Hos- pital for Consumptives of Maryland, 1906-1919. * Johns Hopkins Hosp. Bull., xiii, 199-208, Aug.-Sept., 1902. CHAPTER LV LIVINGSTON FARRAND, M.D. EXECUTIVE SECRETARY OF THE NATIONAL TUBERCULOSIS ASSOCIATION FROM 1905 TO I914 R. LIVINGSTON FARRAND, who was the first execu- D tive secretary of the National Tuberculosis Association, was born in Newark, N. J., June 14, 1867. His father was Samuel A. and his mother Louise Wilson Farrand. Dr. Farrand obtained his degree of A.B. at Princeton University in 1888, and in the year 1891 he received simultaneously the degree of A.M. from Princeton and of M.D. from the College of Physicians and Surgeons of New York city. He studied in Cambridge, England, and in Berlin, devoting a great deal of time to psychology and anthropology. He was instructor in psychology at Columbia Uni- versity from 1893 to 1901, adjunct professor from I90I to 1903, and professor of anthropology from 1903 to 1914. Dr. Farrand served as executive secretary of the National Tuberculosis Association from 1905 to 1914. He left the Na- tional Association, much to the regret of the board of directors and his associates, to accept the presidency of the University of Colorado, over which institution he presided until the year 1917. His work as college president was marked by the same great executive ability and tact which characterized his invalu- able work as executive secretary of the Association. The Uni- versity of Colorado conferred upon him the degree of LL.D. during the first year of his presidency. Besides being intensely interested in his specialties of anthropology and tuberculosis, Dr. Farrand was also most active in the American Psychological Association and the American Public.Health Association, and served the latter association as treasurer and as editor of the American Journal of Public Health from 1912 to 1914. The growth of the National Tuberculosis Association during 406 LIVINGSTON FARRAND LIVINGSTON FARRAND, M.D. 407 the nine years from 1905 to 1914, during which time Dr. Farrand devoted his best energies to the tuberculosis movement in the United States, bears eloquent testimony to his devotion to our cause. When Dr. Farrand began his activities as executive secre- tary of the Association the latter had a membership of less than 500. In 1905 there were in the United States 32 tuberculosis associations, societies, and committees, 24 tuberculosis dispen- saries, and 96 sanatoria and special hospitals. In the year 1914 the membership of the Association had grown to 2,256; there were 1,200 associations, 400 dispensaries, 550 sanatoria and spe- cial hospitals, and 250 open-air schools. Such executive ability and such knowledge of the methods of combating tuberculosis as Dr. Farrand possessed could not have remained unutilized during the great World War, and it was but natural that when the Rockefeller Foundation decided to help tuberculosis-stricken France, Dr. Farrand should be chosen to head the Commission sent to that country to help in an effective anti-tuberculosis campaign. Dr. Farrand speaks in a modest way about the work in a letter to the author, saying: ‘The most definitely constructive piece of work I have ever been engaged in, aside from the development of the general tuberculosis work in this country, was the campaign in France in 1917-18-19. The essential point in that cam- paign was that we were able to gather the results of the work done in different places in America during the last fifteen or twenty years and apply them in concentrated form in a country aroused by the war to a realization of its peril from the point of view of tuberculosis. In other words, we were able to start model equipments in certain selected places in France which were in many ways more completely worked out than anything we have in operation in this country. It is too soon yet to predict results, but I believe the campaign was soundly laid and that the ultimate results will be not only great but obvious.” The French medical profession and the French government appreciated fully Dr. Farrand’s invaluable work and the French government bestowed upon him the decoration of an officer of the Legion of Honor. Another great honor was in store for him on his return to this country when he was made chairman of the Central Committee of the American Red Cross. Dr. Farrand had a very high and patriotic conception of the organization over — whose destinies he was called to preside. In the Red Cross 408 A HISTORY OF NATIONAL TUBERCULOSIS ASSOCIATION Magazine of March, 1920, he expressed himself concerning the destinies of the American Red Cross as follows: “T don’t want to see our Red Cross stand for anything but organized Ameri- _canism. It represents us all. Because of that fact it can be made America’s most powerful agent in community effort. It represents no single class or creed. It stands for the great essential in any community—service. In its every activity it is building up a sound citizenship through community effort.”’ Through his position as chief executive of the American Red Cross he was able to exert a powerful influence in the formation of the National Health Council, of which he was made the first president. Thus was realized a goal in public health codrdination for which he had striven for many years. What Dr. Farrand hoped to do in the responsible position of chairman of the Central Committee of the Red Cross, how keenly he felt the immensity of the task before him, he expressed to the author in the following words: “T feel that there is a tremendous opportunity in working out a program which will place the energy of this great organization behind the general move- ment in this country and the world for the improvement of the public health and for building up the vitality of Europe which has been shattered by the war. Certainly it is a task big enough and inspiring enough to challenge the interest of any one, and I am giving whatever I have to that work.” He succeeded well in his task for which he was so eminently fitted; but a greater honor was still in store for him. Several months ago, when the position of president of Cornell University became vacant by the resignation of Dr. Jacob Gould Schurman, the choice of the board of trustees fell upon Dr. Farrand. A better choice could hardly have been made in view of his vast experience as an educator and an executive officer. On Thursday, October 20, 1921, with most impressive ceremonies, Dr. Farrand was duly installed at Ithaca, N. Y., as president of Cornell University. He has the very best wishes of his former associates of the National Tuberculosis Association for a brilliant career in his new field. 4 LIVINGSTON FARRAND, M.D. 409 The bibliography of Dr. Livingston W. Farrand follows: First annual meeting of the National Association for the Study and Prevention of Tuberculosis. Charities, xiv, 801-6, June 3, 1905. Tuberculosis nomenclature. Am. Med., x, 893, 1905. War against disease. In Proc. New York State Conference of Charities and Correction. 1906, 271-76. Year’s fight against tuberculosis. Charities, xvii, 9-11, Oct. 6, 1906. Looking ahead in the tuberculosis campaign. Charities, xix, 875-6, Oct. 12, 1907. The campaign against tuberculosis in the United States. Tr. Nat. Tuberc. Assn., iii, 28-34, 1907. The campaign in the United States. Jbid., iv, 24-26, 1908. Educational methods in the campaign against tuberculosis. Jour. Am. Med. Assn., xlix, 815-18, 1907. A comprehensive program for the prevention of tuberculosis. Tr. Sixth Internat. Cong. on Tuberc., iii, 236-44, 1908. The National Association. Jour. Outdoor Life, v, 140, 180, 218, 263, May— Aug., 1908; vi, 20, 47, 78, III, 142, 178, 211, 242, 275, 306, 337, 368, Jan.— Dec., 1909. Department edited by Dr. Farrand. Advantages of institutional care. In New York State Charities Aid Associa- tion publication No. 116, 95-99, I910. The National Association for the Study and Prevention of Tuberculosis. Am. Pub. Health Assn., i, 334-37, I9I1. Report of the executive secretary. Tr. Nat. Tuberc. Assn., v, 17-20, 1909; vi, 27-32, 1910; vii, 29-33, I911; viii, 30-37, 1912; ix, 23-28, 1913. Strategy in tuberculosis. Survey, xxvi, 693-4, Aug. 12, I9II. The development of the educational efforts in public and personal hygiene in America. Fifteenth Internat. Congr. on Hygiene and Demography. Tr. Wash. (1912), iv, 17-28, 1913. Introductory remarks to Advisory Council. Tr. Nat. Tuberc. Assn., xii, 59- 60, 1916. Medical education and public health. Colo. Medicine, xiv, 15-17, Jan., 1917. Future codéperation between the American Red Cross and the public health agencies. Am. Jour. Pub. Health, ix, 583-85, Aug., 1919. CHAPTER LVI CHARLES J. HATFIELD, M.D. EXECUTIVE SECRETARY AND MANAGING DIRECTOR OF THE NATIONAL TUBERCU- LOSIS ASSOCIATION FROM I914 HARLES JAMES HATFIELD, son of Daniel Keyser and é Margaret Alexander Hatfield, was born January 23, 1867, in Philadelphia. He received his preliminary education at the Hill School at Pottstown, Pa. He was graduated with the degree of A.B. from Princeton in 1888, with the degree of A.M. from the same university in 1891, and took the degree of Doctor of Medicine at the University of Pennsylvania in 1900. He took post-graduate courses in medicine at the universities of Géttingen in I901 and of Vienna in 1902. On his return to the United States in 1903 he established him- self in general practice in Philadelphia. Intensely interested in tuberculosis work, and identified with the tuberculosis movement in his own state and city, he became a member of the medical staff and later (in 1912) was chosen executive director of the Henry Phipps Institute for the Study and Prevention of Tuber- culosis. He is a visiting physician to the White Haven Sanatorium for the tuberculous, a Fellow of the College of Physicians of Philadelphia, member of the American Medical Association and of the Clinical and Climatological Society, and a director of the American Public Health Association. During the organization of the Sixth International Congress Dr. Hatfield had the difficult position of chairman of the Committee of Awards. The work of this committee extended over several years and was completed to the general satisfaction of the exhibitors. Dr. Hatfield has been a member of the board and of the execu- tive committee of the National Tuberculosis Association for many years, and with the retirement of Dr. Farrand as executive secre- tary he was unanimously elected to this office. His title as execu- 410 CHARLES J. HATFIELD CHARLES J. HATFIELD, M.D. 411 tive secretary was changed December 5, 1918, to that of managing director. Dr. Hatfield has indeed most ably succeeded Dr. Farrand. Under his directorship the Association has been grow- ing rapidly and its activities have extended, particularly during the World War when so much and such useful work was done by the officers of the Association. Dr. Hatfield devoted himself energetically to the development of the field policy, with the result that the National Association’s field service has been one of the most distinctive forces in contributing to the development of tuberculosis work in this country. In his efforts toward coépera- tion and coédrdination of our work with that of various public health agencies and with local and state agencies affiliated directly with the National Association, Dr. Hatfield has shown consum- mate skill. In these fields, requiring careful and diplomatic hand- ling, he has always upheld the traditions of the National Tuber- culosis Association, but at the same time has never hesitated to sacrifice tradition to take a new step forward. Dr. Hatfield ably represented our Association at the recent Conference on Tuberculosis in London and on that occasion visited and conferred with the French tuberculosis authorities as to the best means of furthering the international relations in anti- tuberculosis work. He was instrumental in helping to promote a French National Tuberculosis Committee modeled after our Asso- ciation. One of the most important features of the many increased activities since Dr. Hatfield has been at the helm of the executive office, is his work in coérdinating the fight against tuberculosis with the other public health activities, especially the American Red Cross and the American Public Health Association through the National Health Council. The creation and rapid development of the Modern Health Crusade movement during Dr. Hatfield’s administration reflects not only his judgment in the guidance of this new movement, but also his encouragement of those who have directly contributed to making it a success. Dr. Hatfield is chairman of the S. E. Pennsylvania (Philadel- phia) Chapter of the American Red Cross, president of the Whittier Center Housing Company for Negroes, and a member of 412 A HISTORY OF NATIONAL TUBERCULOSIS ASSOCIATION the executive committee of the Philadelphia Health Council and Tuberculosis Committee and of the Pennsylvania Tuberculosis Society. He is the author of numerous papers on various phases of tuberculosis and Red Cross work. The gradual development of the Red Cross Seal Sale, the ap- propriation of $2,500,000 for the budget in 1919, and the subse- quent development of the Christmas Seal independently of the Red Cross reflect the diplomacy and tact of Dr. Hatfield in dealing with situations that at various times threatened to disrupt the entire tuberculosis movement. The wise guidance of the Christ- mas seal campaign under his leadership has no doubt been the most significant factor in placing the tuberculosis movement where it is to-day. The bibliography of Dr. Charles J. Hatfield follows: History-taking in cases of pulmonary tuberculosis. Med. News, Sept. 17, 1904. Modes of infection in tuberculosis. Sanitation, i, 253-55, 1904-1905. Tuberculosis exhibit at the Louisiana Purchase Exposition. Second annual report Henry Phipps Institute, 1904-05, 405-409. Report on serum treatment. Third annual report Henry Phipps Institute, 1905-1906, 90, 94. Report of the Henry Phipps Institute Training School for Nurses. Third annual report Henry Phipps Institute, 1905-1906; 388; Fifth annual report, 1907-1908, 444. Training for professional nursing in institutions for tuberculous patients. Tr. Sixth Internat. Congr. on Tuberc., iii, 407, 1908. Employment for arrested cases of tuberculosis. Tr. Nat. Tuberc. Assn., iv, 82, 1908. The relation state and local anti-tuberculosis associations should sustain to each other. Tr. Nat. Tuberc. Assn., xi, 321, I9QII. Introductory remarks to Advisory council. Tr. Nat. Tuberc. Assn., ix, 37, 1913. Tuberculosis relief associations. Tr. Nat. Tuberc. Assn., xii, 406, 1916. War and tuberculosis. Boston Med. and Surg. Jour., clxxviii, 863, 1918. Economic aspect of tuberculosis. Proc. Nat. Conference of Social Work, 1919. Henry Phipps Institute. Special report and prospectus, 1919. (Type- written.) Report of the executive secretary. Tr. Nat. Tuberc. Assn., x, 23-29, 1914; xi, 27-36, 1915; xii, 24-36, 1916; xiii, 29-40, 1917; xiv, 32-46, 1918; xv, 26-42, 1919; xvi, 33-48, 1920; xvii, 32-53, I92I. CHAPTER LVII PHILIP P. JACOBS, Pu.D. PUBLICITY DIRECTOR OF THE NATIONAL TUBERCULOSIS ASSOCIATION HILIP PETER JACOBS, for many years our able assistant Pera and now publicity director of the Association, was born in Syracuse, N. Y., March 28, 1879, the son of Theo- dore B. and Dorothy Jacobs. He received his preliminary educa- tion at the Binghamton High School. From Syracuse University he graduated with the degree of A.B. in 1903, from the Drew Theological Seminary with the degree of B.D. in 1908, and from Columbia University with the degree of Ph.D. in 1910. Dr. Jacobs entered the service of the National Tuberculosis Association on March 1, 1908. His first work was the preparation of the tuberculosis directory, entitled, ‘‘The Campaign Against Tuberculosis in the United States,”’ published as a special volume for the International Congress under the auspices of the Russell Sage Foundation. Subsequent directories of a similar character were published by the National Tuberculosis Association in 1911 and 1916, and a new edition in three parts appeared in 1919. From the fall of 1908 until the resignation of Dr. Farrand in the spring of 1915 Dr. Jacobs served as assistant secretary, giving special attention to publicity and organization. Since the resigna- tion of Dr. Farrand he has still served under the title of assistant secretary, but has been more directly in charge of the executive work of the office, under the direction of Dr. Charles J. Hatfield. He has conducted eight institutes for the training of tuberculosis workers in coéperation with the New York School of Social Work. To Dr. Jacobs’ genius and executive ability we are greatly in- debted for the solution of the problems connected with the organ- ization of state and local societies and the general progress of the tuberculosis work. Besides some 30 odd publications under his name, Dr. Jacobs has written many valuable editorials in the 413 414 A HISTORY OF NATIONAL TUBERCULOSIS ASSOCIATION Journal of the Outdoor Life, of which periodical he is the treasurer and managing editor. The growth of this journal in importance and circulation has been already referred to in the general history, but the fact that under the guidance of the managing editor the circulation has been increased from about 2,000 in 1910 to uta 6,500 in 1921, deserves special mention here. Both Dr. Farrand and Dr. Hatfield have frankly stated on many occasions their belief that Dr. Jacobs, by his long associa- tion with the work of the National Tuberculosis Association, has accumulated a greater store of knowledge of the details of tuber- culosis work in the United States than has any other Single in- dividual in this country. It would indeed be ungrateful did the author of this biograph- ical sketch fail to embrace this opportunity to express again to Dr. Jacobs his profound gratitude for the invaluable help he has given in the preparation of the History of the National Tuber- culosis Association. The bibliography of Philip P. Jacobs follows: Ambulance service in Greater New York. Published by N. Y. State Charities Aid Assn., 1907. New hospitals needed? in Greater New York. Published by N, Y. State Chari- ties Aid Assn., 1908. Tuberculosis directory. Published by Nat. Tuberc. Assn., 1908, 1911, 1916 and 1919. German sociology. Columbia doctor's thesis. Published privately 1909. Tuberculosis. Charities, xxi, 686-90, Jan. 16, 1909. Eight million dollars to prevent tuberculosis. Survey, xxii, 821-822, Sept. 18, 1909. National Tuberculosis Association. Survey, xxii, 327-329, May 29, 1909. Trend of anti-tuberculosis crusade. Survey, xxii, 710-713, Aug. 21, 1909. Bird’s-eye view of the anti-tuberculosis campaign. Survey, xxiii, 579-82, Jan. 29, 1910. National Tuberculosis Association meeting. Survey, xxiv, 290-293, May 14, I9IO. New York Tuberculosis Conference. Survey, xxiv, 49-51, April, 1910. Campaign of 1910. Jour. Outdoor Life, viii, 17, 1911. Welfare work of the Metropolitan Life Insurance Company. Survey, xxiv, 705-707, Aug. .13, 1910. Christmas seals. Survey, xxix, 307-308, Dec. 7, 1912. Tuberculosis prevention costs in 1911. Survey, xxvii, 1612-13, Jan. 20, 1912. PHILIP P. JACOBS PHILIP P. JACOBS, Pa.D. 415 Year’s trend in the prevention of tuberculosis. Survey, xxviii, 443-444, June 15, 1912. Expenditures in 1911. A review of what tuberculosis prevention costs. Jour. Outdoor Life, ix, 35, 1912. The part of the Red Cross Seal in the anti-tuberculosis campaign. Jour. Outdoor Life, ix, 181, 1912. Tuberculosis in motion pictures. Jour. Outdoor Life, ix, 302, 1912. Tuberculosis in the state legislatures. Jour. Outdoor Life, x, 138, 1913. Theodore B. Sachs. An appreciation. Jour. Outdoor Life, xiii, 129, 1916. Our equipment for success against tuberculosis. Survey, xxx, 288-289, May 24, 1913. Misleading mortality statistics on tuberculosis. Am. Jour. Public Health, ili, 431-447, 1913. Fake consumption ‘“‘cures.’’ Metropolitan Life Insurance Company pub- lication, 1913. What a western woman did with Red Cross Seals. Ladies’ Home Journal, xxxi, 56, Dec., 1914. Red Cross Seals and the anti-tuberculosis campaign. Jour. Outdoor Life, xii, 17, 1915. The consumptive. Survey, xxxvii, 359, Dec. 30, 1916. Tuberculosis. A bibliography. Bull. Russell Sage Foundation Library, Aug., 1916. Survey nurse and nurse’s survey for a small community. National Tuberc. Assn. publication, 1917. Trend of the tuberculosis campaign. Jour. Outdoor Life, xvi, 213, July, 1919. Programs and policies for 1920. Bull. Nat. Tuberc. Assn., Dec., 1919. On to St. Louis. Bull. Nat. Tuberc. Assn., April, 1920. CHAPTER LVIII DONALD B. ARMSTRONG, M.D. SECOND ASSISTANT SECRETARY OF THE NATIONAL TUBERCULOSIS ASSOCIATION SINCE 1916 R. DONALD B. ARMSTRONG, our second assistant D secretary, was born on December 19, 1886, at Bangor, Pa., and is the son of Elmer R. and Sadie Budd Arm- strong. He received his preliminary education at the public school of Easton, Pa., and Lerch’s preparatory school of the same place, and graduated from Lafayette College as Ph.B. in 1908. Four years later he graduated from Columbia University as A.M..and M.D., and in 1913 as M.S. from the Massachusetts Institute of Technology. The positions which Dr. Armstrong has occupied since he left the Massachusetts Institute of Technology show a wide range of activity. He was superintendent of the Bureau of Public Health and Hygiene of the New York Association for Improving the Condition of the Poor from 1913 to 1914; director of the Depart- ment of Social Welfare of the New York A.I.C.P. from 1914 to 1916; chairman of the Advisory Council, Department of Street Cleaning, New York City, from 1913 to 1916; chairman of the Committee on Sanitation, Advisory Council, Department of Health, New York City, from 1913 to 1916; chairman of the Committee on Food Supply, Borough President’s Office, New York City, from 1914 to 1915; lecturer at Teachers College, New York, from 1915 to 1916; at the New York University Medical School from 1914 to 1916, and at the College of the city of New York from 1914 to 1915. At the meeting of the American Public Health Association in 1916 Dr. Armstrong was chairman of the Sociological Section. In 1916 he became Suctane secretary of the National Tuber- culosis Association and executive officer of the Framingham 416 DONALD B. ARMSTRONG DONALD B. ARMSTRONG, M.D. 417 Community Health and Tuberculosis Demonstration. (See p. 70.) To Dr. Armstrong’s activities and achievements. in this capacity we have already referred in the general history when recording the results of this unique experiment. Since the creation of the National Health Council, Dr. Armstrong has served as acting executive officer of that organization. He has recently resigned as executive officer of the Framingham Com- munity Health and Tuberculosis Demonstration and is now executive officer of the National Health Council. We are indebted to Dr. Armstrong for a number of valuable publications which show his ability as a physician and administrator, emi- nently fitted for that important task to which he has been assigned. The bibliography of Dr. Donald B. Armstrong follows: List OF FRAMINOHAM PUBLICATIONS AND Reports IssuED IN CONNECTION WITH THE COMMUNITY HEALTH AND TUBERCULOSIS DEMONSTRATION Monographs and General Publications Framingham Monographs: No. 1—General series, i, The program. ee te No. 2—Medical series, i, The sickness census. a aE No. 3—Sanitary series, i, Vital statistics. - * No. 4—Medical series, ii, Medical examination campaigns. 4 a No. 5—Medical series, iii, Tuberculosis findings. a H No. 6—Sanitary series, ii, Schools and factories. ae = No. 7—General series, ii, The children’s summer camp. No. 8—General series, iii, Health letters. Diagnostic standards (4 editions). Report of the Committee on Appraisal. Framingham—keep fit. Healthy homes make happiness. Advice to persons having consumption. What has the health demonstration done thus far for Framingham? Framingham’s opportunity. Your annual medical examination. Framingham Yardsticks. Four Years of the Demonstration. Reprints The Framingham Health and Tuberculosis Demonstration. Tr. Nat. Tuberc. Assn., xiii, 398, 1917; also in Am. Jour. Pub. Health, vii, no. 3, March, 1917. 27 418 A HISTORY OF NATIONAL TUBERCULOSIS ASSOCIATION Health administration in cities of less than 20,000 population. Jour. Am. Med. Assn., Nov. 2, 1918. Civilian tuberculosis control following war conditions. Am. Jour. Pub. Health, viii, 12, Dec., 1918. The Framingham health program: the first year results. Tr. Nat. Tuberc. Assn., xiv, 478, 1918. Community machinery for the discovery of tuberculosis. Tr. Nat. Tuberc. Assn., xv, 214, 1919; also Boston Med. and Surg. Jour., Aug. 28, 1919. The consultation service in tuberculosis work. Mod. Med., Nov., 1919. The sanitarian’s definition of a living wage. Mod. Med., Feb., 1920. The state, the municipality, and the private tuberculosis associations in the control of tuberculosis. Jour. Outdoor Life, xvii, 9, Jan., 1920. Possible modifications in tuberculosis programs on the basis of recent Fram- ingham experience. Tr. Nat. Tuberc. Assn., xvi, 381, 1920. CHAPTER LIX JOHN S. FULTON, M.D.* SECRETARY GENERAL OF THE SIXTH INTERNATIONAL CONGRESS ON TUBERCU- LosIS ARYLAND has been fortunate in the development of its M public health and tuberculosis work, both because of the fact that it has had an institution of such international importance as the Johns Hopkins Medical School and also because of the fact that it has had, for over twenty years, state health offi- cers of strong and vigorous personalities. Such a man has been Dr. John Samuel Fulton. Without Dr. Fulton much of the pro- gressive leadership that Maryland has enjoyed in the tuberculosis movement might have been retarded or indefinitely postponed. Dr. Fulton was born in a rectory at Freemont, Ohio, in 1859, his parents being Rev. William Fulton, D.D., a native of Glasgow, Scotland, and Nancy Organ Fulton, of Cable, Ohio. In 1861 the family moved to Snow Hill, Maryland. Dr. Fulton’s educa- tion, therefore, began in the rectory of All Hallows Parish, on the eastern shore of Maryland, with his parents for teachers. The lot of a clergyman in the South during the Civil War was hard enough. There were not fewer than five Scottish born clergy- men on the eastern shore in those days, two of them Fultons, and all of them had to teach for a living. Any boy in a rectory or a manse had, therefore, quite superior educational advantages. Dr. Fulton received his A.B. degree from St. John’s College, Annapolis, in 1876, and began the study of medicine immediately thereafter as student assistant to Dr. Stephen Purnell Dennis, of Salisbury. He taught two years in the public schools, and grad- uated in medicine at the University of Maryland in 1881. In 1897 Dr. Fulton became secretary of the State Board of Health, * As Secretary-General of the International Congress Dr. Fulton was a recognized officer of the National Tuberculosis Association. 419 420 A HISTORY OF NATIONAL TUBERCULOSIS ASSOCIATION expecting to continue in private practice, as did the health officers in most of the states at that time. After he had forgotten a few important appointments in private practice he concluded that state medicine had his real affection, and should become his sole pursuit. In 1898 Dr. Fulton sought and secured the appointment of Dr. William H. Welch as a member of the State Board of Health. Dr. Welch became president of the Board of Health, and still retains that office. It is, therefore, not surprising that the Maryland State Board of Health should have led a campaign for the enact- ment of the first registration law requiring reporting of living cases of tuberculosis, a law which has been a model for practically every state in the Union; or that with such backing Dr. Fulton, and his assistant, Dr. Marshall L. Price, should have planned and realized the first tuberculosis exposition, held in Baltimore in February, 1904, where the first action in regard to the formation of the National Tuberculosis Association was taken. When it was definitely decided to hold the Sixth International Congress on Tuberculosis in this country, the general committee having the arrangements for the Congress in charge in casting about for a man who could serve as secretary-general, selected Dr. Fulton. This arduous task he held from 1906 until about a year after the close of the Congress in 1909. The success of the Con- gress itself, mention of which is made in other pages of the vol- ume, is sufficient testimony to the ability of Dr. Fulton. The reputation that he gained in this connection brought him into such world-wide prominence that he was selected as secretary- general of the Fifteenth International Congress on Hygiene and Demography held in Washington in 1913. During the war Dr. Fulton served in the Medical Reserve Corps with a commission of Lieutenant Colonel. At the present time he is again serving as secretary of the State Department of Health of Maryland. JOHN S. FULTON CHAPTER LX LAWRENCE F. FLICK, M.D.* VICE-PRESIDENT OF THE NATIONAL TUBERCULOSIS ASSOCIATION FROM 1905 TO 1908 , NO THE pioneer in any field of human endeavor there must always come many hours of discouragement. If, however, he has the perseverance to continue, he will sooner or later be heartened by the continuing development of the movement that he has started. Dr. Lawrence F. Flick was a pioneer in every sense of the word. He had the vision, the conviction, and the perseverance of the true pioneer. The nation-wide cam- paign against tuberculosis, to which he as an individual contri- buted so much, must today bring him great encouragement in contrast with the numerous discouragements to which he was subjected in the earlier days of his work. Dr. Flick was born at Carrolltown, Cambria County, Pa., on August 10, 1856. He was the son of an Alsatian farmer and one of a numerous family of children. As a boy he attended the township schools, and when. thirteen entered the Benedictine School, Latrobe, Pa. During his first year in college his health broke down and he returned home with a mild attack of tubercu- losis. He made a fair recovery by living largely out-of-doors at home, but he did not become very strong and robust. The result was that after a few months of teaching in Newark, N. J., he again broke down, and after a second recovery, taught school for two winters in the mountains near his home. Because of the unsatisfactory condition of his health he de- cided to study medicine, hoping thus to find the way to his own cure. After a year’s preliminary work in a country doctor’s office, he matriculated in 1877 at the Jefferson Medical College in Philadelphia and graduated from that school in 1879. After a * Written by Philip P. Jacobs. 421 422, A HISTORY OF NATIONAL TUBERCULOSIS ASSOCIATION year of internship he took up the general practice of medicine. At the same time he began the study of law to gratify an old ambi- tion, registering as a student in the office of Benjamin Harris Brewster, of Philadelphia. The strain of practising medicine and studying law, however, was too much for him, and he again broke down. Hoping to improve his health by life at sea, he applied for assignment in the United States Navy, but was rejected on phys- ical grounds. The naval physicians advised him to go west. With a few dollars in his pocket he started for Colorado, and after countless hardships and calling upon several of his friends for assistance he reached Los Angeles by way of Texas and Arizona in December, 1881, with $25 in borrowed money as his total assets. He was thrown from a horse while looking for work the day after he reached Los Angeles, and was taken back to his boarding-house in a grocery wagon. For somewhat over six months he struggled for existence, all the time, however, improv- ing his health. He says that his poverty was the principal reason for his cure because he was compelled to live largely on milk, drinking as much as six quarts a day. From this personal experi- ence he gathered many interesting suggestions in regard to diet in tuberculosis that he put into practice in later life. In September, 1882, he resumed his practice in Philadelphia and rapidly began to develop a reputation as a specialist in tuber- culosis. From that time on he did not suffer seriously on account of tuberculosis. He married and reared a family of seven chil- dren, all of whom are living at this time. Dr. Flick’s early contributions to tuberculosis excited a con- siderable amount of opposition, not only because of the fact that his general views regarding the communicability and curability of the disease were counter to the notions of most of his professional brothers, but also because he had developed from his own personal experience very positive convictions regarding the climatic treat- ment of tuberculosis. As early as 1888 he developed and presented a paper on the con- tagiousness of phthisis, and began to advocate the registering and reporting of living cases of tuberculosis in Philadelphia. His daily practice in one of the most congested districts of Philadelphia convinced him of the necessity of free treatment and LAWRENCE F. FLICK 2 LAWRENCE F. FLICK, M.D. 423 diagnosis. He saw all about him the evidences of tuberculosis and the inability of the average tenement-house dweller to secure adequate diagnosis or proper treatment. He was perplexed as to the cause of tuberculosis, and for years struggled singlehanded in research on tuberculosis. The Rush Hospital for Consumption and Allied Diseases, incor- porated in September, 1890, realized only in part his ambitions and ideals. It was not until the White Haven Sanatorium, for which he had worked for several years, became an actual fact in 1900 that Dr. Flick began to see the consummation of his dream. Here was an institution where the poor could receive treatment free of charge or at reasonable rates. In 1901, through the influence of a member of the State Board of Charities, Dr. Flick met Mr. Henry Phipps, and out of the meeting grew and developed a friendship which bore fruit in a great many different ways. Commenting on Mr. Phipps’ first visit to the White Haven Sanatorium in 1901, Dr. Flick says: “Tt was a rainy day and the grounds were muddy. Overhead everything was gloomy. Mr. Phipps found the patients lodged in an old barn, their beds ranged on the threshing floor and in the hay-mows. The administration building was a small and dilapidated farm-house. There were about forty patients in the institution. As Mr. Phipps left me on Saturday afternoon at Bethlehem he said, ‘You may hear from me again,’ but I was very much down- cast and feared that the sanatorium had made a bad showing indeed. Imagine my surprise when at four o’clock the next morning I was routed out of bed by a special delivery letter from Mr. Phipps which read, ‘It really surprises me how much good you are doing with so little money at your command. It is very creditable to your management. If you had been a business man in any line you would have been a serious competitor, but you wisely selected a better line than that of business, that of conferring benefits on your fellow-men. Please accept my check enclosed for $2,500, which please use in any way you may prefer for the benefit of the Free Hospital for Poor Consumptives.’”’ In October, 1901, Dr. Flick had occasion to tell Mr. Phipps about his ideas regarding a dispensary in one of the congested districts of Philadelphia. Imagine his surprise when Mr. Phipps, on learning of the plan, offered to buy a whole block and equip a hospital for him. Out of this conversation grew the Henry Phipps Institute for the Study and Prevention of Tuberculosis, and later the Phipps Tuberculosis Dispensary in Baltimore and the Phipps 424 A HISTORY OF NATIONAL TUBERCULOSIS ASSOCIATION Model Tenement Houses in New York. In 1903 the Phipps Institute was opened with 52 beds and with laboratories, dispen- saries, and full facilities for research and clinical observation. For several years Dr. Flick remained Director of the Institute until, in 1910, it was turned over to the University of Pennsylvania. Shortly after the formation of the Henry Phipps Institute the discussion regarding a national association in the United States began to grow intense. As early as 1898 Dr. Flick, in corre- spondence with Dr. Otis, Dr. Bowditch, Dr. Knopf, and others, had discussed with them the possibilities of a national association in this country. In 1892 he had formed the Pennsylvania Society for the Prevention of Tuberculosis, the first organized society of its type in the world. In coédperation with Dr. Edward L. Trudeau, Dr. William Osler, Dr. William H. Welch, General Sternberg, Dr. Henry Barton Jacobs, Dr. Charles L. Minor, Dr. M. P. Ravenel, Dr. Hermann M. Biggs, Dr. S. A. Knopf, and others, he helped to organize The National Association for the Study and Prevention of Tuberculosis which was formed in 1904. In 1905 he took a leading part in arranging for bringing to this country the International Congress on Tuberculosis and was made the chairman of the Central Committee of the Congress. He devised the plan for financing the Congress and was most active in raising the funds which made the gathering possible. The success of this gathering in 1908 is due largely to his hard and painstaking endeavor, as well as to his far-seeing vision, a fact which has been suitably acknowledged by the members of the Central Committee and the Board of Directors of the National Association. In his own community and state Dr. Flick has been the origina- tor of almost every line of work against tuberculosis that is now in operation; in the national organization he has been a leader and potent factor; internationally he is recognized as one of the pioneers in the world-wide anti-tuberculosis campaign. Dr. Flick published a popular book on tuberculosis in the sum- mer of 1903. It was called ‘‘Consumption, a Curable and Pre- ventable Disease—What the Layman Should Know About It.” An abbreviated edition of this book was also published later. Both have had a very wide and continuous sale since that date. 1 LAWRENCE F. FLICK, M.D. 425 During the many years of his active life Dr. Flick has contrib- uted numerous articles on various phases of tuberculosis treat- ment and prevention to the leading medical journals of the United States and foreign countries. After the International Congress on Tuberculosis Dr. Flick retired from active participation in the national campaign against tuberculosis. He is now devoting himself to the preparation of a magnum opus, a comprehensive treatise on the subject of tuber- culosis, to which he has devoted his life. It is sincerely hoped that he will be spared. to complete this work. The bibliography of Dr. Lawrence F. Flick follows: The hygiene of phthisis. Tr. Phila. Co. Med. Soc., 1888. The contagiousness of phthisis. Tr. Med. Soc. State of Pennsylvania, 1888. How to take care of the lungs. Tr. Alumni Association of the Phila. College of Pharmacy, 1889. A review of the cases of tuberculosis which terminated in death in the fifth ward of the city of Philadelphia during the year 1888. Tr. of the Phila. Co. Med. Soc., 1889. The mode of entrance of the tubercle bacillus into the system. Times and Register, Oct. 19, 1889. Special hospitals for the treatment of tuberculosis. Tr. of the College of Physicians of Phila., 1890; also Times and Register, March, 1890. The treatment of tuberculosis. Med. News, Nov. 15, 1890. The prevention of tuberculosis. Tr. Am. Pub. Health Assn., 1890; also Sani- tarian, 1891. . Some points in the treatment of tuberculosis. Tr. Phila. Co. Med. Soc., 1891. A further report on the treatment of tuberculosis by iodoform inunctions. Med. News, March, 1892. The influence of the doctrine of contagion upon the death rate from tubercu- losis in the city of Philadelphia. Med. News, May, 1892. The early recognition of tuberculosis. Penn. University Med. Magazine, Nov., 1893. Practical measures for the prevention of tuberculosis. Med. News, Oct. 21, 1893. The registration of tuberculosis. . Phila. Polyclinic, Feb. 17, 1894. Prophylaxis in the treatment of tuberculosis. Penn. University Med. Maga- zine, Oct., 1894. , The control of tuberculosis. Twelfth annual report of the State Board of Health of Pennsylvania. Contagiousness of tuberculosis. Annual report of the Woman’s Health Pro- tective Assn. of the U. S., 1897. Immunity as against heredity in tuberculosis. Jour. of Tuberc., Oct., 1899. 426 A HISTORY OF NATIONAL TUBERCULOSIS ASSOCIATION Consumption: its nature, history, curability, and prevention. Annual report, Phila. Col. of Pharmacy, 1897. Nitroglycerine as a hemostatic in hemoptysis. Phila. Med. Jour., Feb., 1898. Immunity the fundamental principle underlying all treatment of tuberculosis. Jour. Am. Med. Assn., Oct., 1898. Contagion: its meaning and limitations. Phila. Med. Jour., Jan., 1899. The treatment of tuberculosis. Med. News, Sept., 1899. The therapeutics of tuberculosis. Therap. Gaz., Jan., 1900. The registration of tuberculosis. Phila. Med. Jour., June, 1900. The treatment of tuberculosis. Hare’s System of Therapeutics, 1901. Home treatment of tuberculosis. Proc. Phila. Co. Med. Soc., Feb., 1901. Primary abdominal tuberculosis. Courier of Med., Dec., 1901. The implantation of tuberculosis. Courier of Med., July, 1902. Are meat and milk a source of seed supply for human tuberculosis? Jour. of Tuberc., Oct., 1902. A year’s work at the White Haven Sanatorium of the Free Hospital for Poor Consumptives. Phila. Med. Jour., Nov., 1902. Differential diagnosis between tuberculosis of the lungs and diseases which resemble it. Internat. Clin., iv, 12th series. The Henry Phipps Institute for the Study, Treatment, and Prevention of Tuberculosis. Phila. Med. Jour., Jan., 1903. House infection of tuberculosis. Am. Med. Jour., Feb., 1904; also in Med. News, Feb., 1904. Communities without health departments in the crusade against tuberculosis. Tr. of the Scranton Society for Prevention and Cure of Tuberc.; also in New York Med. Jour. and Phila. Med. Jour., 1904. Municipalities in the crusade against tuberculosis. Med., April, 1904. The treatment and control of the tuberculous patient in his home. Am. Med., July, 1904. Report of the committee on tuberculosis. Am. Pub. Health Assn., Havana, Jan., 1905. Published in Transactions. The hospital and the dispensary in the warfare against tuberculosis. Am. Med., May, 1905. The pneumococcus as a factor in hemoptysis (with Ravenel and Irwin). From the Laboratory of the Henry Phipps Institute. Med. News, Sept., 1905. Prognosis in tuberculosis. Am. Med., Jan., 1906. Vicarious action of the bowels for the kidneys in tuberculosis (with Joseph Walsh). From the Laboratory of the Henry Phipps Institute. Tr. Nat. Tuberc. Assn., i, 198, 1905; also in Am. Med., July, 1905. America and the International Congress on Tuberculosis. One hundred thousand dollar fund proposed for the great Washington gathering of 1908. Charities, Dec., 1905; also in Jour. Outdoor Life, March, 1907. The relative value of home treatment of tuberculosis. Tr. Nat. Tuberc. Assn., ii, 442, 1906. LAWRENCE F. FLICK, M.D. 427 Address of the vice-president. The duties, responsibilities and opportunities of the National Association for the Study and Prevention of Tuberculosis. Tr. Nat. Tuberc. Assn., ii, 14, 1906. The way of infection in tuberculosis. Med., Dec., 1906. The essentials in the crusade against tuberculosis. N. Y. Med. Jour., March, 1907. The crusade against tuberculosis, Bull. Johns Hopkins Hosp., Aug., 1907. Report on the International Congress on Tuberculosis. Tr. Nat. Tuberc. Assn., iii, 20, 1907; also Tr. Nat. Tuberc. Assn., iv, 18, 1908. The hospital for advanced cases of tuberculosis. Internat. Clin., i, 19th series. The influence of the International Congress on Tuberculosis in Washington, 1908. Read at the opening of the International Tuberculosis Exhibit of New York, Dec., 1908. Our consumptive brethren. Sunday School Times, Dec., 1908. The crusade against tuberculosis in Pennsylvania. Annual report of the Free Hospital for Poor Consumptives, 1908. Work for patients as an economic factor. Tr. Nat. Tuberc. Assn., v, 181, 1909. State appropriations to hospitals not under state control. Objections to the Pennsylvania method. Penn. Med. Jour., Jan., 1910. Present status of the tuberculosis campaign and the essentials for thorough and prompt success. New York Med. Jour., Feb. 5, 1910. The tuberculosis situation in Pennsylvania in the year 1909. Privately printed 1910. The medical profession in relationship to preventive medicine. Interstate Med. Jour., xvii, no. 6, 1910. Skin inunction as a therapeutic measure. Monthly Cyclopedia and Med. Bull., Aug., 1910. The crux of the tuberculosis problem. Med. Rec., May, 1910. Tuberculosis among the poor. Tr. Conference of Catholic Charities, Wash- ington, D. C., 1910. Advantages of local care and treatment of tuberculosis. Interstate: Med. Jour., xvii, no. 12, 1910. The progress in the tuberculosis campaign in Pennsylvania up to 1911. Tr. College of Physicians of Phila., 1911; also Interstate Clinics, ii, 21st series. Tuberculosis as it concerns the physician. Interstate Med. Jour., xviii, no. 2, IQII. Crusade against tuberculosis. - Consumption a curable and preventable disease. P. Reilly, Phila., 1903. Several editions. CHAPTER LXI JOHN P. C. FOSTER, M.D. VICE-PRESIDENT OF THE NATIONAL TUBERCULOSIS ASSOCIATION FROM 1907 TO 1908 R. JOHN PIERPONT CODDINGTON FOSTER, who D was one of our early vice-presidents, is no longer with us, but to convey an idea of the life of this fine and interesting man, scholar, and physician, we cannot do better than to quote from the admirable tribute paid to Dr. Foster by his pupil and friend, Dr. David R. Lyman, which appeared in the Transactions of the American Climatological and Clinical Association of 1910. “Dr. Foster was born in New Haven, Connecticut, on March 2, 1847. He prepared for college at Russell’s Collegiate Institute in New Haven. He graduated from Yale Medical School in 1875, and settled in New Haven, where his family had borne a prominent part in the town’s history since its foundation. In 1878 he was appointed instructor in anatomy in the Yale Art School, which position he held up to his death. He was for many years port surgeon of the United States Marine Hospital Service and consulting physician to the Yale Infirmary. Deeply enthusiastic, untiring, and unselfish in his devotion to his profession, he has left behind him a lasting impression of his life work such as is equaled by few men. _ “He was best known to the general public through his work in tuberculosis, in recognition of which Yale conferred upon him the honorary degree of M.A. in June, 1909. He knew from personal experience what it meant to fight through life handicapped by the disease. He combined a deep insight into the mental unrest of those first facing the fight against it with an ever-ready sympathy for them and a thorough knowledge of their needs. He spared him- self nothing if he could lighten the burden of a tuberculous patient. This unselfishness, which characterized his private practice, he carried into his public work, and to his untiring devotion Connecticut is indebted to-day for four of its existing sanatoria. “To Dr. Foster belongs the distinction of having been the first physician in America to apply Koch’s tuberculin for therapeutic purposes. “He was on the original board of directors of The National Association for the Study and Prevention of Tuberculosis, and was vice-president of the Association in 1908. He was one of the incorporators of the New Haven County Anti-Tuberculosis Association, and as chairman of its executive com- mittee was more than any one man personally responsible for the character 428 JOHN P. C. FOSTER JOHN P. C. FOSTER, M.D. 429 and success of the Gaylord Farm Sanatorium. When Governor Woodruff appointed a commission to study the tuberculosis problem in Connecticut he chose Dr. Foster as its chairman. His report to the Governor is one of the most exhaustive and practical of the many that have been submitted by like commissions. Recognizing the fact that the greatest need in the work was a proper provision for the care of the advanced cases, he insisted that the state’s duty was primarily to these, leaving the sanatoria for curable cases to the care of private philanthropy. When his report was brought before the legislature it was largely through his energy that a bill was passed carrying two all- important provisions—the compulsory notification of tuberculosis and the establishment of county homes under the control of the State Commission, where all classes of cases could be received. He was appointed chairman of the permanent commission and given an appropriation of $175,000 to open three such institutions of 100 beds each. Few believed that the appropria- tion could be made to accomplish so much. These institutions are now in operation and accommodate 330 patients. “But the accomplishment cost the state dear, as the great labor entailed was largely responsible for Dr. Foster’s death. He had hoped to hold out until their completion before taking a sorely needed rest. While on a business trip to one of them he contracted pneumonia, and died six days later. Realiz- ing that his end was near, he concentrated his energies for these six days in planning the completion of his work with the least possible disorganization after his death. “He was best known in Yale through his work among the students. Many a young man has had cause to be thankful for having come under his influence. As Professor Phelps said in introducing him for his degree: ‘But perhaps greater than all his honors is the daily quiet work that Dr. Foster has done for many years among the undergraduates of Yale. Trusted by the faculty and students, he has been of material assistance to both, and many a man to-day owes his health and character largely to the kindly counsel he re- ceived at the critical period of adolescence.’ “By those of us privileged to be counted among his friends, he was, as Presi- dent Hadley says, ‘If possible, loved even more than he was respected,’ and has left to us an inspiring memory of one who lived and died ‘a gentleman unafraid.’”” There is little to be added to this fine and well-deserved eulogy. The author had the privilege of knowing Dr. Foster intimately and will never forget a lengthy and interesting visit he had with him a few weeks prior to his passing away. Dr. Foster main- tained to the end his enthusiasm and desire to be helpful in all that concerned the solution of the tuberculosis problem. His name will be cherished by all workers in tuberculosis and all patients who had the privilege of coming in contact with him. CHAPTER LXII EDWARD THOMAS DEVINE, Pu.D., LL.D. VICE-PRESIDENT OF THE NATIONAL TUBERCULOSIS ASSOCIATION FROM 1909 TO 1910 DWARD THOMAS DEVINE was born in Union, Hardin Ek County, Iowa, May 6, 1867, the son of John and Laura Hall Devine. He obtained his degree of A.B. from Cornell College, Iowa, in 1887, of A.M. in 1890, and of Ph.D. from the University of Pennsylvania in 1893. The degree of LL.D. was conferred upon him by Cornell College in 1904. He studied also at the University of Halle, Germany, and was a fellow of the Uni- versity of Pennsylvania from 1891 to 1895. Dr. Devine was principal of the schools at Albion, Marshall- town, and Mt. Vernon in Jowa from 1886 to 1890. From 1891 to 1896 he was staff lecturer on economics and the secretary of the American Society for the Extension of University Teaching. In 1896 he became general secretary of the New York Charity Organization Society, which position he occupied until 1917. He was professor of social economy at Columbia from 1905 to 1919, director of the School of Philanthropy from 1904 to 1907, and from 1912 to 1917. Dr. Devine was editor of the Survey from 1897 to 1912, and has been serving in the capacity of asso- ciate editor ever since. He was chief of the Bureau of Refugees and Home Relief under the American Red Cross Commission to France from 1917 to 1918. Prior to these important positions Dr. Devine had been active as special representative of the American Red Cross in charge of relief work in San Francisco in 1906 after the earthquake and fire, and he served again as special representative for the American Red Cross in charge of Storm and Flood Relief in Dayton, Ohio, in 1913, and as special agent to the American Embassy in Petrograd in 1916. Because of this great executive ability Dr. Devine was chosen president of the 430- EDWARD T. DEVINE EDWARD THOMAS DEVINE, Pu.D., LL.D. 431 National Conference of Charities and Correction in 1906, chair- man of the Section of Hygienic, Social, Industrial, and Economic Aspects of Tuberculosis of the International Congress on Tuber- culosis in Washington in 1908. In 1909 he was elected vice- president of the National Tuberculosis Association. He has served on many commissions for the improvement of prison conditions, industrial relations, etc., and has been especially interested in the social aspect of the tuberculosis problem. The author of this history is greatly indebted to him for the help extended in 1902 in the formation of a local tuberculosis com- mittee. When the appeal for such a committee was shown him bearing the signatures of eleven leading physicians, Dr. Devine at once offered his services and became its first lay member and secretary. The valuable work which that committee did is re- ferred to in the historical part of this book. Dr. Devine was equally helpful in the formation of the National Tuberculosis Association in 1904. He was a member of the Association’s first executive committee and was largely responsible for raising the initial funds that made possible the selection of Dr. Livingston Farrand as executive secretary in January, 1905. As secretary of the New York Committee on the Prevention of Tuberculosis, and as editor of the Survey, Dr. Devine has written many interesting articles and circulars, which, unfortunately, never bore his signature, and for this reason we are deprived of a tuberculosis bibliography of this distinguished leader in the anti- tuberculosis crusade. Dr. Devine has become world famous as a leader and organizer in social relief work. The National Tuberculosis Association may congratulate itself that he has been and still is one of its most enthusiastic workers in the combat of the social causes of tuberculosis. Among his published works which bear on the tuberculosis problem we must not fail to mention here his valuable contri- butions, entitled ‘‘Misery and Its Causes,” 1909; ‘‘The Family and Social Work,” 1912; ‘‘Disabled Soldiers and Sailors,” 1919. CHAPTER LXIII HENRY SEWALL, M.D., Pu.D., Sc.D. VICE-PRESIDENT OF THE NATIONAL TUBERCULOSIS ASSOCIATION FROM 1909 TO 1910 ENRY SEWALL, the son of Thomas and Elizabeth Waters Sewall, was born at Winchester, Va., May 25, 1855. He received the degree of B.S. from the Wesleyan University of Connecticut in 1876, of Ph.D. from Johns Hopkins University in 1879, Hon. M.D. from the University of Michigan in 1888, M.D. from the University of Denver in 1889, and Sc.D. from the University of Michigan in 1912. Dr. Sewall was assist- ant fellow and associate in biology at Johns Hopkins University from 1876 to 1881, professor of physiology at the University of Michigan from 1882 to 1889, professor of physiology at the Den- ver and Gross College of Medicine from 1890 to 1908, professor of medicine at the same school from 1911 to 1917, and lecturer in medicine at the University of Colorado from 1917 to 1919. Dr. Sewall was a member of the National Board of Medical Examiners until 1919 and secretary of the Colorado State Board of Health from 1893 to 1899. He is a member of the American Physiological Society and of the Association of Physicians, whose president he was from 1915 to 1916. He is also a member of the American Climatological Association and was its president from 1914 to 1915. He isa member of the Colorado State Medi- cal Society and of the American Medical Association. The numerous degrees, medical and purely scientific, which Dr. Sewall is entitled to add to his name are evidence of the great achievements in scientific medicine for which we are indebted to him. The bibliography of Dr. Sewall, shows how much we owe him for the many valuable contributions on the subject of tuber- culosis. In Colorado he is justly considered as one of the State’s pioneers in tuberculosis work. 432 WALL SE HENRY HENRY SEWALL, M.D., Pu.D., Sc.D. 433 The bibliography of Dr. Henry Sewall follows: On the relations of diaphragmatic and costal respiration (with M. E. Pollard). Jour. Physiol., xi, 159, 1890. On tuberculosis contracted in Colorado. Tr. Colo. State Med. Soc., 1895, 385: Clinical uses of stethoscopic pressure. N. Y. Med. Jour., Ixvi, 758, 1897. Comparison of physical signs and x-ray pictures of the chest in early stages of tuberculosis (with S. B. Childs). Arch. Int. Med., 1912, x, 45. Bimanual palpatory percussion. Arch. of Diagnosis, v, 13, 1912. On what do the hygienic and therapeutic properties of the open air depend? Jour. Am. Med. Assn., lviii, 174, 1912. Réle of the stethoscope in physical diagnosis. Am. Jour. Med. Sc., cxlv, 234, 1913. The auscultatory determination of early pathologic changes in the lungs. Jour. Am. Med. Assn., Ix, 2027, 1913. Another view on ventilation. Interstate Med. Jour., xxiii, 23, 1916. Experimental tuberculosis in guinea pigs following preliminary treatment with tuberculin by the nose (with C. F. Hegner and C. Powell). Am. Rev. Tuberc., i, 220, 1917. Experimental asthma in guinea pigs. Jour. Lab. and Clin. Med., ii, 874, 1917. Diagnosis of tuberculosis. Colo. Med., xiv, 286, 1917. On occult tuberculosis. Am. Rev. Tuberc., iii, 665, 1920. Importance of subliminal symptoms and period of alternation of rest and exercise in the treatment of tuberculosis. Am. Rev. Tuberc., v, 236, 1921. The effects of limiting the respiratory excursions of the upper thorax in re- fractory cases of pulmonary tuberculosis (with S. Swezey). Am. Rev. Tuberc., v, 547, 1921. 28 CHAPTER LXIV GEORGE DOCK, M.D., Sc.D. VICE-PRESIDENT OF THE NATIONAL TUBERCULOSIS ASSOCIATION FROM I9I0 TO I9II EORGE DOCK was born at Hopewell, Pa., April 1, 1860. G He was the:son of Gilliard and Lavinia Lloyd Bombaugh Dock. He received his preliminary education at the com- mon school of Lancaster, Pa., and at the Harrisburg, Pa., Acad- emy. He was graduated in 1884 with the degree of M.D. from the University of Pennsylvania; in 1895 he received the honorary degree of A.M. from Harvard, and in 1904 the degree of Sc.D. from the University of Pennsylvania. Dr. Dock was assistant to the chair of Clinical Pathology at the University of Pennsylvania from 1887 to 1888, professor of pathology of the Texas Medical College and Hospital from 1888 to 1891, professor of theory and practice of medicine and clinical medicine at the University of Michigan from 1891 to 1908, and professor of theory and practice of medicine at Tulane University from 1908 to 1910. He now occupies the chair of professor of medicine at the Washington University Medical School, St. Louis, where he has been since 1910, and also the position of physician-in-chief of the Barnes Hospital, connected with the school of medicine. Dr. Dock is a member of the Association of American Physi- cians (president, 1916-1917), also of the American Medical Asso- ciation, and of numerous other medical bodies. His contributions on various subjects in medicine and his practical clinics have given him an enviable reputation. He has always been deeply inter- ested in the tuberculosis problem and was most helpful in the work of the local tuberculosis associations as well as the National. Some of his most important contributions on the subject of tuber- culosis may be found in the following bibliography. 434 GEORGE DOCK GEORGE DOCK, M.D., Sc.D. 435 The bibliography of Dr. George Dock follows: Sputum examination for the diagnosis of tuberculosis. Texas Cour.-Rec. Med., Dallas, March, 1890. An etiologic study of tuberculosis in country people (with. T. L. Chadbourne). Phila. Med. Jour., Nov. 5, 1898. Tuberculosis. Physician and Surg., Sept., 1900. Tuberculosis hospital at Ann Arbor. Physician and Surg., May, 1902. Address of the chairman of clinical section. Tr. Nat. Tuberc. Assn., iii, 341, 1907. Clinical and pathological possibility of spontaneous healing in renal tubercu- losis without destruction of kidney. Tr. Am. Urolog. Assn., 1916. The relation of the general hospital to tuberculosis. Tr. Nat. Tuberc. Assn., xii, 89, 1916. CHAPTER LV JOHN M. GLENN, A.M., LL.D. VICE-PRESIDENT OF THE NATIONAL TUBERCULOSIS ASSOCIATION FROM IQII-I912 AND 1919-1920 OHN MARK GLENN, the son of William Wilkins and Ellen J Mark Smith Glenn, was born in Baltimore, Md., October 28, 1858. He received the degree of A.M. at the Washington and Lee University in 1879, took up special studies at Johns Hopkins University from 1879 to 1880, became LL.B. of the Uni- versity of Maryland in 1882, and an honorary A.M. of Johns Hopkins Hospital in 1902. He was admitted to the bar in 1882. Washington and Lee University conferred upon him the degree of LL.D. in 1897. Mr. Glenn’s activities have been preéminently philanthropic, and in the interest of social work and public welfare. He was one of the supervisors of the City Charities of Baltimore from 1898 to 1907, and from 1904 to 1907 was president of the board. In 1907 he was selected director of the Russell Sage Foundation, a fund of $10,000,000 set aside by the late Mrs. Russell Sage for the betterment of the social and living conditions. It was fortunate, indeed, that Mr. Glenn was chosen to administer that fund. Being deeply interested in the tuberculosis problem, he has been not only sympathetic, but most helpful to the work which the Na- tional Tuberculosis Association is doing. Through his interest grants of considerable sums were made to the National Tubercu- losis Association beginning with 1907, and extending over a period of several years. These funds did much to start the struggling National Association on its career of usefulness. Mr. Glenn was chosen president of the National Conference of Charities and Correction in 1901. He is a member of the Administration Com- mission of the Federal Council of Churches, of the Joint Commis- sion of Social Service of the Protestant Episcopal Church, and of the Central Commission of the American Red Cross, and a trustee of the Johns Hopkins: Hospital. 436 JOHN M. GLENN CHAPTER LXVI G. WALTER HOLDEN, M.D. VICE-PRESIDENT OF THE NATIONAL TUBERCULOSIS ASSOCIATION FROM IQII TO 1912 R. G. WALTER HOLDEN was born at Barre, Mass., D September 17, 1866. His parents were James E. and Harriet A. Wheelock Holden. He received his pre- liminary education at the Mount Hermon Academy, Northfield, Mass., and graduated as Doctor of Medicine of the University of Vermont in 1895. Dr. Holden was in general practice in North Brookfield, Mass., from 1896 to 1898, and at Denver, Colo., -from 1898 to 1904, when he became director of the Agnes Memo- rial Sanatorium. As such he has been identified nationally and internationally with anti-tuberculosis work since 1907, when he was elected a member of the International Tuberculosis Con- ference. In April, 1908, he formed the Colorado State Organiza- tion of the International Congress on Tuberculosis, which was held from September 21 to October 12 of that year in Washington, D.C. Among the exhibits sent by the Colorado State Organiza- tion to this International Congress was one submitted by Dr. Holden of new architectural plans for a sanatorium for the treat- ment of curable cases of tuberculosis among the working classes. This exhibit was awarded a silver medal. TheColorado State Organization became a permanent organiza- tion in 1908, with Dr. Holden as its first president. On retiring from this office in 1912 he was made an honorary life member and is still the only member of the Colorado Association to hold this title. He has continued his interest and constant assistance in the anti-tuberculosis work in Colorado, as a member of the executive committee both of the Colorado Tuberculosis Association and of the Denver Anti-Tuberculosis Society, which latter was organized in October, 1917. Dr. Holden has also been closely connected with the work of the 437 438 A HISTORY OF NATIONAL TUBERCULOSIS ASSOCIATION National Tuberculosis Association. He was a director from 1910 to 1915, holding the office of vice-president from 1911 to 1912. In 1912 he also represented the National Association at the Fifteenth International Congress on Hygiene and Demography, held at Washington, D. C., in September. In this same year he was appointed United States official delegate to the Seventh Inter- national Congress on Tuberculosis held at Rome in April, 1912. He was again elected a director of the National Tuberculosis Association in June of 1921 to represent the State of Colorado. During the war Dr. Holden was a member both of the executive committee and the ways and means committee of the Denver Chapter of the Red Cross and has served constantly on these com- mittees ever since. He gave much time in 1918 to the organiza- tion of first aid and home nursing classes. For several months of this same year he served as chairman of the Medical Advisory Board, examining chests of drafted men several mornings a week. During the World War he was appointed a captain of the Medical Corps, United States Army, and stationed at General Hospital 21, near Denver. Notwithstanding these many services so generously given, Dr. Holden still supervised the work at the Agnes Memorial Sana- torium, an institution of 150 beds, and held it unswervingly to the same high standards which he has always maintained. He has been superintendent and medical director of this institution since it was planned. In preparation for the building of the Agnes Memorial, Dr. Holden visited all the important tuberculosis sana- toria of Europe and, on his return in 1903, superintended the building and equipping of this now justly famous sanatorium. From the very beginning of his work as a sanatorium director, Dr. Holden doubted the wisdom of excessive feeding of patients which was in vogue in the early days in many European and also in some American sanatoria. Six meals a day was the accepted custom. While he continued this method of “stuffing” with half of his patients he allowed the other half only three meals a day. At the end of three months the latter group had made better gains in weight, had better appetites, and slept. better. Dr. Holden was also one of the early advocates of rest before and after each meal. G. WALTER HOLDEN G. WALTER HOLDEN, M.D. 439 Dr. Holden is a member of the International Anti-tuberculosis Association, the American Climatological Association, the Ameri- can Public Health Association, and the National Association of Hospital Superintendents, of which he is a vice-president. The bibliography of Dr. G. W. Holden follows: The advantages of sanatorium over home treatment of pulmonary tubercu- losis. Denver Med. Times, xxv, 707-17, June, 1906. Agnes Memorial Sanatorium. The Hospital, 1906. A case of pulmonary and glandular aspergilosis. Am. Clim. and Clin. Assn., xxxi, 97-105, 1 pl., 1915. Digested in New York Med. Jour., cii, 479, Aug. 28, 1915. Does Colorado climate influence tuberculosis? Read before Colorado Springs Society. Duties of municipality and state in control of tuberculosis. Jour. Am. Med. Assn., ccvii, 10, 1907. The mother’s responsibility in the prevention of tuberculosis. Read before Mothers’ Congress, Denver, 1910. Open-air pavilions for the tuberculous. Brochure, Internat. Congr. on Tuberc., 1908. Prevention of tuberculosis. Lecture at Cesa Virinda, Pueblo, 1908. Report of committee on model health ordinances for a city which is a resort of consumptives. [American Medical Association. Section on preventive medicine.] Chicago, i911. 10 p. Reprint Jour. Am. Med. Assn., Dec. 9, I9II. Sanatorium treatment of tuberculosis in Colorado. III. Med. Jour., ix, 14-24, 1906; also Medical Age, Detroit, xxiv, 41-84, 1906. Suggestions to physicians in the care of the consumptive. Tr. Med. Assn. of Alabama, 404-15, 1906. CHAPTER LXVII ROBERT H. BABCOCK, M.D., LL.D. VICE-PRESIDENT OF THE NATIONAL TUBERCULOSIS ASSOCIATION FROM I9I2 TO 1913 OBERT HALL BABCOCK was born at Watertown, N. Y., July 26, 1851. He was the son of Robert Stanton and Emily M. Hall Babcock. His father was of old New England stock, having been born at Stonington, Conn., but he was for many years a merchant and banker in Kalamazoo, Mich., where he died in 1885. Dr. Babcock’s mother was also of old New England stock. She died in her eighty-sixth year at Washington, D.C. When one considers that Dr. Babcock lost his eyesight at the age of thirteen, one cannot help being moved to admiration at his achievements. Educated in the Institute for the Blind from 1864 to 1867, he entered the preparatory department of Olivet College of Michigan in 1867. After remaining there for two ‘years he went to the Western Reserve College (1869 to 1873), from which he was graduated with the degree of A.B. He entered the literary department of the University of Michigan in 1873, and remained there for one year. Dr. Babcock began his illus- trious medical career by entering the medical department of the same university in 1874 and received the degree of M.D. in 1876. He studied at the Chicago Medical College in 1878, the College of Physicians and Surgeons in New York in 1879, and continued his medical studies in Berlin, Munich, and Wiirzburg up to 1883, when he established himself in practice in Chicago. His alma mater, the University of Michigan, conferred upon him the degree of A.M. in 1897, and the degree of LL.D. in 1910. In spite of his blindness, his indomitable energy and his fine training have made him one of the most distinguished citizens of Chicago. He was chosen professor of clinical medicine and physi- 440 . BABCOCK ROBERT H ROBERT H. BABCOCK, M.D., LL.D. 441 cal diagnosis of the Chicago Post-Graduate Medical School, and remained there from 1887 to 1892. He was professor of clinical medicine and diseases of the chest at the College of Physicians and Surgeons of Chicago from 1901 to 1905, and attending physician to the Cook County Hospital from 1891 to 1897, when he became one of its consultants. He is a consulting physician to a number of other Chicago institutions, a member of the Asso- ciation of American Physicians, the Climatological Association, and many other medical associations, among them the Medico- Chirurgical Society of Edinburgh and the International Anti- tuberculosis Association. From the day of the untimely death of the late Theodore B. Sachs until January first of the year 1921 Dr. Babcock served faithfully as director of the Chicago Tuber- culosis Institute. Dr. Babcock’s interest in the tuberculosis problem has been unusual. When asked to send a list of his contributions on the subject of tuberculosis, he modestly wrote: ‘I have contributed a few articles to current medical literature on subjects pertaining to pulmonary tuberculosis, but cannot now give their titles or dates.’’ This is much to be regretted because he has written much more than his bibliography would indicate. His out- standing work is his book, entitled, ‘‘Diseases of the Lungs,” which, although published more than a decade ago, is still con- sidered and will for a long time to come be considered as a classic. The author now desires to digress from the usual order of these biographies to relate the circumstances of his first meeting with this great blind master of medicine. During the author’s student days in the late eighties at the Bellevue Hospital Medical College, Dr. Babcock, while attending one of the clinics held at the old amphitheater, was introduced to the class. All were deeply moved and impressed when Professor Edward G. Janeway introduced the blind physician from Chicago. A patient was brought in, and Dr. Janeway courteously asked whether our honored guest would care to examine the case. He consented. Gently palpating over the posterior and anterior portions of the chest, he turned to the class and said: ‘‘ This is an aneurism of the aorta.” He made the diagnosis even without placing the ear or stethoscope to the chest. Dr. Janeway then examined the case, 442 A HISTORY OF NATIONAL TUBERCULOSIS ASSOCIATION confirming the diagnosis, and an ovation was given to Dr. Bab- cock such as is seldom seen in a medical amphitheater. It was a scene which will never be forgotten by those who were privileged to be present. The bibliography of Dr. Robert H. Babcock follows: The treatment of consumption, 1895. The open air treatment of consumptives who cannot seek change of climate. Jour. Am. Med. Assn., April 6, 1895. The treatment of hemoptysis. Medicine, Sept., 1896. Antitoxin or serum therapy. North Am. Practitioner, Oct., 1896. The diagnosis of pulmonary tuberculosis. Jour. Am. Med. Assn., Oct. 20, 1900. The home treatment of pulmonary tuberculosis. N.Y. Med. Jour., July 13, IgOI. Cases of pleurisy with more or less permanent pneumonic induration—are they tuberculosis? Internat. Clin., i, series 12. Pulmonary tuberculosis and syphilis, with reports of three cases. Lancet- Clinic, April 15, 1911. . The early diagnosis of pulmonary tuberculosis. Ill. Med. Jour., June, 1915. Diseases of the lungs—a practical presentation of the subject for the use of students and practitioners of medicine. D. Appleton & Co., 1907. 809 pages. CHAPTER LXVIII MABEL T. BOARDMAN, A.M., LL.D. VICE-PRESIDENT OF THE NATIONAL TUBERCULOSIS ASSOCIATION FROM 1913 TO 1914 ABEL THORPE BOARDMAN was born in Cleveland, M Ohio, and was the daughter of William Jarvis and Florence Sheffield Boardman. Miss Boardman received her preliminary education in private schools in Cleveland and New York and also studied in Europe. She received the honorary degree of A.M. from Yale University in 1911, and of LL.D. from Western Reserve University, Smith College, and the Georgetown University. She also holds the degree of D.H.L. from Converse College. Miss Boardman is a member of the Central Committee of the American Red Cross, and was delegated to the Eighth and Ninth International Red Cross Conferences in London in 1907, and in Washington in 1912. She is now the secretary and a mem- ber of the executive committee of the American Red Cross. The remarkable preparedness of the American Red Cross in the recent world war was largely due to the broad vision and leadership of Miss Boardman, who was instrumental in stimulating the organi- zation of Red Cross medical units long before our country entered the war. For her activities she has been decorated by the King of Sweden and the Emperor of Japan. Miss Boardman served as Commissioner of the District of Columbia, 1920 to 1921, for which position she was so eminently qualified because of her executive and business ability. It was a source of great disappointment to the citizens of the national capital that she was not reappointed, so that she might have con- tinued her splendid efforts for the welfare of 165,455 women and 132,316 children out of a total population of 437,571. Miss Boardman is the author of a valuable work entitled 443 444 A HISTORY OF NATIONAL TUBERCULOSIS ASSOCIATION “Under the Red Cross Flag.’’ Because of her Red Cross work she has, as a matter of course, always been intensely interested in the tuberculosis problem and has rendered important financial aid by promoting the Red Cross Christmas Seal Sale and numerous other health activities. It was due largely to Miss Boardman that the Red Cross Seal became a part of the program of the American Red Cross in 1908. MABEL T. BOARDMAN CHAPTER LXIX LEE K. FRANKEL, Pu.D. VICE-PRESIDENT OF THE NATIONAL TUBERCULOSIS ASSOCIATION FROM IQ14 TO 1915, EE KAUFMAN FRANKEL, the son of Louis and Aurelia [tetas Frankel, was born in Philadelphia August 13, 1867. He received the degree of B.S. from the University of Pennsylvania in 1887, and of Ph.D. in 1891. He was an instructor in chemistry at the University of Pennsylvania from 1888 to 1893, practised as consulting chemist in Philadelphia from 1893 to 1899, served as Manager of the United Hebrew Charities of New York fiom 1899 to 1908, and subsequently for one year was a special investigator for the Russell Sage Foundation. In 1909 Dr. Frankel entered the Metropolitan Life Insurance Company as head of the welfare work for its many employees. It was this position which caused him to become intensely interested in the social problem of tuberculosis. He not only inaugurated an edu- cational campaign among the policy-holders of the company, but was also largely instrumental in the establishment of the Mount McGregor Sanatorium for tuberculous employees of the Metro- politan Life Insurance Company. This institution may well be _considered as one of the finest in this country, and is doing incal- culable good by furthering the health and physical welfare of the Company’s numerous employees. To Dr. Frankel we are also indebted for the conception of the Framingham Health and Tuberculosis Demonstration, which has been one of the most important features of the anti-tuberculosis campaign of our coun- try. He has served as a member of the National Committee of the Framingham Demonstration from its very beginning, and besides, has shown his deep interest in the tuberculosis problem as a member of the executive committees of our national, state, and local tuberculosis associations. 445 446 A HISTORY OF NATIONAL TUBERCULOSIS ASSOCIATION Dr. Frankel, however, has not limited his activities to the pre- vention of tuberculosis alone. He is an honorary member of the American Social Hygiene Association, a member of the General Committee of the Child Health Organization, and a director of the American Public Health Association, which body has honored him with the position of treasurer and president. He is the dele- gate from the American Public Health Association to the Na- tional Health Council, of which he is chairman, and in 1917 he was president of the New York Conference of Charities and Correction. He is also intensely interested in public health nurs- ing, and originated and organized the visiting nurse service of the Metropolitan Life Insurance Company. Dr. Frankel’s reputation as a welfare worker is indeed national, if not international, and the United States Government has rec- ognized his experience and authority. In spite of his multiple duties as the head of the Welfare Department of the Metro- politan Life Insurance Company, of which he is now the third vice-president, he accepted without pay the big contract of organizing a welfare department of the United States Post-Office. His official title is Welfare Director of the United States Post- Office Department, and the Government and former Postmaster General Hays may well be congratulated on having secured the services of so able a man. The bibliography of Lee K. Frankel follows: Tuberculosis as affecting charity organization. Address before National Conference of Jewish Charities, June 12, 1900. Coéperation and health insurance for consumptives. Proc. N. Y. State Con- ference of Charities and Correction, Nov., 1901, 253-274. Insurance against tuberculosis. Tr. Nat. Tuberc. Assn., vi, 35, 1910. Statement showing that German sickness insurance will eventually reduce percentage of tuberculosis. Tr. Nat. Tuberc. Assn., viii, 175-76, 1912. Influence of private life insurance companies on tuberculosis. Internat. Tuberc. Conference, Berlin, 1913. Discussion on the needs of patients discharged from tuberculosis sanatoria. Tr. Nat. Tuberc. Assn., x, 306-308, 1914. Fighting the white plague. Nat. Safety Council, round table discussion, Oct. 15, 1914, 216-218. Plea for a Federal commission on tuberculosis. Address before Mississippi Valley Conference on Tuberculosis, Sept. 30, 1915. LEE K. FRANKEL LEE K. FRANKEL, Pa.D. 447 Tuberculosis from the industrial point of view. Boston Assn. for the Relief and Control of Tuberculosis. Report, 1916, 25-27. Study of mortality statistics of southern communities from typhoid fever, malaria, pellagra, tuberculosis, and all causes. Address before Southern Sociological Congress, New Orleans, April 12, 1916. Framingham Health and Tuberculosis Demonstration. Tr. Nat. Tuberc. Assn., xiii, 407-409, I917. Community Health and Tuberculosis Conference Demonstration. Safety Engineering, July, 1917, 380-381. The evidence of intensive anti-tuberculosis effort upon the death rate. Tr. Nat. Tuberc. Assn., xvii, 505-514, 1921. Industrial nursing as a means of fighting tuberculosis. Tr. Nat. Tuberc. Assn., xvii, 525-531, 1921. CHAPTER LXX W. JARVIS BARLOW, M.D. VICE-PRESIDENT OF THE NATIONAL TUBERCULOSIS ASSOCIATION FROM IQI4 TO T9I5 ALTER JARVIS BARLOW was born in Ossining, N. Y., January 22, 1868. He was the son of William Henry and Catherine Lent Barlow, and received his preliminary edu- cation at the Mount Pleasant Military Academy at Ossining, N. Y., and his classical education at the Columbia University School of Arts, from which he was graduated with the degree of A.B. in 1889. He entered the medical department of Columbia Uni- versity, and was graduated with the degree of M.D. in 1892. The same university conferred upon him the honorary degree of A.M. in 1919 for his valuable professional work on the Pacific Coast. Dr. Barlow served for two and a half years as intern in the Mount Sinai Hospital, also one year in the Sloan Maternity Hos- pital. Breaking down in health, he was sent by his teacher and friend, Dr. Janeway, to Los Angeles, where he completely recov- ered and established himself in practice in 1897. He soon became one of the prominent practitioners of that city, and was honored by the presidency of the Los Angeles County Medical Associa- tion. Subsequently he was made professor of medicine and dean of the Los Angeles Medical Department of the University of California. From the very beginning of his career in Los Angeles Dr. Bar- low took the deepest interest in the tuberculosis problem. He became president of the California Tuberculosis Association, and on his retirement from the presidency became secretary-treasurer of the Association, which position he still holds. Besides being a member of the Los Angeles County Medical Society, he is a mem- ber of the American Medical Association and the American Climatological and Clinical Association. 448 W. JARVIS BARLOW W. JARVIS BARLOW, M.D. 449 As one of the greatest achievements in Dr. Barlow’s life work we must mention the Barlow Sanatorium, which was founded in 1903 and which is one of the most flourishing philanthropic insti- tutions of its kind in the West. It is located in the Chavez Ravine, within the city of Los Angeles. Dr. Barlow was its founder and is its physician in chief. A further evidence of Dr. - Barlow’s scientific and philanthropic interest is the Barlow Medi- cal Library which he has established and which is one of the most important medical libraries on the Pacific Coast. The bibliography of Dr..W. Jarvis Barlow follows: | Climatic therapeutics. Article in Klebs’ Tuberculosis. A Treatise by Amer- ican Authors, Appleton, 1909. Practical climatic therapy. Article in Hare’s Therapeutics. Sanatorium treatment. Tr. Los Angeles County Med. Assn., 1909. Medical organization—conservation of public health. Tr. Los Angeles County Med. Assn., 1911. Chronic nephritis. Am. Med. Assn., Ixv, 1915. 1 29 CHAPTER LXXI CHRISTEN QUEVLI, M.D VICE-PRESIDENT OF THE NATIONAL TUBERCULOSIS ASSOCIATION FROM IQI5 TO 1916 HRISTEN QUEVLI was born in Norway, June 26, 1864, C and was the son of Anders and Gorrina Quevli. He came to the United States at the age of five, when his father settled at Windom, Minnesota, and engaged in mercantile busi- ness. Young Quevli attended the public schools, and later on the St. Olaf’s College at Northfield, Minn. He graduated in medicine from the Minnesota College Hospital in 1886, and after that he went to Christiania, Norway, where he took a post-grad- uate course. In 1888 he returned to the United States and established himself in practice at Tacoma, Washington, where he remained until 1892, when he again began to do post-graduate work, visiting New York, Berlin, and the medical centers of Nor- way, Denmark, England, and France. Returning to Tacoma he became health officer of the city, in which capacity he served for two years. In 1901 he went abroad again, studying mainly at the University of Vienna. On his re- turn to Tacoma he took deep interest in tuberculosis work, and in I9II was made president of the Washington Tuberculosis Asso- ciation, which flourished remarkably under his administration. When he entered upon this office there was no tuberculosis legisla- tion in the state of Washington, there were no leagues, no visiting nurses, no sanatoria, and the treasury of the association was empty. To-day there are 4 county sanatoria, 25 visiting nurses, 30 leagues, and a number of clinics in operation, and the treasury is far from being empty. All these achievements are due to Dr. Quevli’s indomitable energy and enthusiasm. 450 CHRISTEN QUEVLI CHAPTER LXXII WATSON S. RANKIN, M.D. VICE-PRESIDENT OF THE NATIONAL TUBERCULOSIS ASSOCIATION FROM 1916 TO 1917 ATSON S. RANKIN was born in Mooresville, N. C., on January 18, 1879. He was the son of John Alexander and Minnie Isabella McCorkle Rankin. His preliminary edu- cation was received in the high schools of Mooresville and States- ville, N. C., and he began his medical studies at the North Caro- lina Medical College, continuing at Davidson Medical College. He was graduated from the University of Maryland with the degree of M.D. in 1901. Dr. Rankin served as intern in the Uni- versity of Maryland Hospital for eighteen months, and did post- graduate work in Johns Hopkins Medical School for one year. He was also a resident in the obstetrical department of the University of Maryland for six months, and resident pathologist at the University of Maryland Hospital for thirteen months. Dr. Rankin was called to the chair of pathology of the Medical Department of Wake Forest College, which position he occupied until 1905. He then became dean of the School of Medicine; this position he occupied until 1909. From that date on he has served the state of North Carolina as one of its most efficient state health officers. Between 1904 and 1905 he distinguished himself by making important investigations regarding the fre- quency of hookworm disease in North Carolina. At the present time he is a trustee of the Wake Forest College and of the North Carolina Sanatorium for the Treatment of Tuberculosis, a mem- ber of the American Medical Association, and of the American Public Health Association, having been president of the latter from 1919 to 1920, and a member of the executive committee. He also was secretary and later president of the Conference of State and Provincial Health Authorities, a vice-president of the 451 452 A HISTORY OF NATIONAL TUBERCULOSIS ASSOCIATION National Association for the Prevention of Infant Mortality, and a member of the National Health Council. In nearly all his contributions on public health and sanitation, of which there are many, Dr. Rankin has never failed to advocate the prophy- laxis of tuberculosis and also sanatorium provision. Unfor- tunately, no separate works on the subject of tuberculosis have been written by him, and so the author is unable to attach any distinct tuberculosis bibliography of this distinguished vice- president. W: S. RANKIN CHAPTER LXXIII FREDERICK L. HOFFMAN, LL.D. VICE-PRESIDENT OF THE NATIONAL TUBERCULOSIS ASSOCIATION FROM 1917 TO 1918 REDERICK L. HOFFMAN, the son of Augustus F. and Pariser von Laar Hoffman, was born May 2, 1865, at Varel, Germany. He received his education in private and public schools, equivalent to what might be considered here a grammar school grade. This brilliant statistician very frankly admitted to the author that he never graduated from any school, and was almost always the last in his class and a grade or two behind. He came to the United States in 1884, and, after a varied commercial career, entered the business of life insurance with the Metropolitan Company at Somerville and Waltham, Mass., in 1888. He remained with that company for some years, then changed to the Life Insurance Company of Virginia, and in 1895 accepted a position with the Prudential Insurance Company. In 1900 Mr. Hoffman had charge of the Prudential’s Exhibit in Paris and in 1904 received the Grand Prix on life insurance meth- ods and results contributed to the Louisiana Purchase Exposition. In 1906 he represented the United States Government at the International Actuarial Congress held in Vienna and the Inter- national Statistical Institute held in Paris that year. Ever since Mr. Hoffman has been active in various international statistical and also tuberculosis congresses. He is a member of the American Association for the Advancement of Science, a fellow of the Royal Anthropological Institute, the Society of Arts, the Royal Sani- tary Institute, etc. He is an honorary member of the Swiss Actuarial Society and an associate fellow of the American Medical Association. In 1911 Tulane University conferred upon Mr. Hoffman together with the late Major General Gorgas the honor- ary degree of LL.D. in recognition of the services rendered to the cause of southern sanitation and mortality research. 453 454 A HISTORY OF NATIONAL TUBERCULOSIS ASSOCIATION Dr. Hoffman’s contributions to statistical science are numerous. His first article was on the Vital Statistics of the Negro, published in the Arena of Boston, and his first book was ‘‘The Race Traits and Tendencies of the American Negro.’’ Dr. Hoffman is an ardent American patriot, and during the recent world war was one of the most active members of the American Friends of Ger- man Democracy, a fact which was recorded in Mr. Creel’s book, prefaced by Mr. Baker, Secretary of War. In his busy life Dr. Hoffman has found time and opportunity to devote much of his energy to the anti-tuberculosis cause in the United States. Twenty-four most important contributions on the various phases of tuberculosis are the product of his fertile pen. The bibliography of Frederick L. Hoffman follows: Industrial insurance and prevention of tuberculosis. Address before British Congress on Tuberc., July 23, 1901. Coédperation and health insurance for consumptives. Second N. Y. State Conference of Charities and Corrections, Albany, Nov. 19, 1901. The statistical laws of tuberculosis. Maryland Tuberc. Conference, 1904. The detection and prevention of tuberculosis in factories. Tr. Nat. Tuberc. Assn., May 6, 1907. Logical position of the government and insurance companies in the crusade against tuberculosis. Address before Am. Assn. of Med. Examiners, June 3, 1907. The relation of occupation to tuberculosis. Address before Assn. of Med. Examiners, Atlantic City, June 3, 1907. Tuberculosis as an industrial disease. Internat. Congress on Tuberc., Wash- ington, Sept. 21, 1908. Mortality from consumption in dusty trades. U.S. Bureau of Labor, Bulletin 79, 1908. Relation of life insurance institutions to the problem of tuberculosis preven- tion. Internat. Tuberc. Exhibition, Philadelphia, March 10, 1909. Mortality from consumption in certain occupations—exposing to municipal and general organic dust. Bureau of Labor Stat., Bull. 82, May, 1909. Insurance against tuberculosis. Discussion of paper by Dr. Lee K. Frankel. Tr. Nat. Tuberc. Assn., vi, 50-56, 1910. Pulmonary disease among miners. Engineer. and Mining Journal, March 11, Igtt. A brief account of the treatment and care of tuberculous wage-earners in Germany. Tr. Nat. Tuberc. Assn., viii, 75,1912; Bull. ror, U.S. Bureau of Labor, July, 1912. The decline in the tuberculosis death-rate, 1871-1912. Tr. Nat. Tuberc. Assn., ix, IOI, 1913. FREDERICK L. HOFFMAN FREDERICK L. HOFFMAN, LL.D. 455 Letter on the tuberculosis death rate. N.Y. Evening Sun, Nov. 18, 1914. Tuberculosis as an occupational disease. Address before Second North At- lantic Conference and Second N. Y. State Conference of Tuberc. Workers, Albany, Nov. 4, 1915. Mortality from tuberculosis in dusty trades. In Kober & Hanson’s Diseases of Occupation and Vocational Hygiene, Nov., 1915. The tuberculosis death rate for 1917. Spectator, N. Y. City, June 6, 1918. Mortality from respiratory. diseases in dusty trades (inorganic dusts). U.S. Bureau of Labor Bulletin 231, June, 1918. Mortality from tuberculosis in dusty trades. First preliminary report, Dec. 5, 1918; second report, Sept., 1919. The tuberculosis problem. Spectator, N. Y. City, June 19, 1919. Mortality from tuberculosis, 1900-1919. Spectator, N. Y. City, Sept. 23 and 30, 1920. Sanatorium benefit under British national health insurance. Address before Mississippi Valley Conference on Tuberc., Duluth, Minn., Sept., 1920. The mortality from dust phthisis in the granite stone industry of Vermont (in press). CHAPTER LXXIV LAWRASON BROWN, M.D. VICE-PRESIDENT OF THE NATIONAL TUBERCULOSIS ASSOCIATION FROM 1918 TO 1919 AWRASON BROWN, the son of William Judson and Mary [ounce Lawrason Brown, was born in Baltimore, Maryland, September 29, 1871. He was educated in the private and public schools of Baltimore and received his degree of A.B. from Johns Hopkins University in 1895, and of M.D. from Johns Hopkins Medical School in 1900. Dr. Brown went to the Adirondacks for his health first in 1898. In 1900 and 1901 he was assistant resident physician at the Adirondack Cottage Sanitarium, now the Trudeau Sanatorium; resident physician IQ90I-1912; visiting physician 1912-1914, and since 1914, chair- man of the medical board, consulting physician and trustee. He served on the village board of Saranac Lake Village; was the first president of the Stevenson Society of America. He started the Journal of the Outdoor Life in 1904 and conducted it until 1909, when it was turned over to the committee at present in charge of it. He was the first president of the Adirondack Good Roads Association which helped to bring about the system of good roads now in existence throughout the mountains. He isa Trustee of the Ray Brook State Sanatorium for Incipient Tu- berculosis. During the war he was a member of the Medical Advisory Board of Saranac Lake; member of the Tuberculosis Committee of the Medical Section of the National Council of Defence; served as contract surgeon at Camp Devens for a short time, and was a ‘‘four minute man.” Dr. Brown’s contribution to tuberculosis literature is an ex- tensive one. He is the author of ‘Rules for Recovery from Tu- berculosis,” a handbook for patients which has gone through several editions, of ‘‘Diagnostic Theses,” later enlarged to “Theses, Diagnostic, Prognostic, and Therapeutic,” which has 456 LAWRASON BROWN LAWRASON BROWN, M.D. 457 been reprinted for distribution by several societies. He is a lover of books, member of the Grolier Club of New York, possesses an exten- sive library on tuberculosis, including some rare first editions, which he intends to donate to the Trudeau Sanatorium as soon as the library building is completed. Dr. Brown has been president of the American Clinical and Climatological Association. Heisa member of the Association of American Physicians, American Medical Asso- ciation, American Public Health Association, American Associa- tion for Thoracic Surgery, Ecological Society, Association for the Advancement of Science, Medical Library Association. He has made a number of contributions to medical literature. We are indebted to Dr. Lawrason Brown, perhaps more than to any one else, for the formation of the American Sanatorium Asso- ciation, which has done and is doing so much toward improving our knowledge of sanatorium construction, sanatorium manage- ment, sanatorium treatment, and classification of cases according to the extent of invasion and symptoms. He is now president of this important organization. Besides being a fertile writer, Dr. Brown is one of the principal teachers at the celebrated Trudeau School, to which he has been attached from its very beginning. The bibliography of Dr. Lawrason Brown follows: Sputum examination in pulmonary tuberculosis and its prognostic’ value. Montreal Med. Jour., Oct., 1901. The prognostic value of tubercle bacilli in sputum. Jour. Am. Med. Assn., Feb. 21, 1903. A study of weights in pulmonary tuberculosis. Am. Med., April 25, 1903. Zomotherapy in tuberculosis. Am. Jour. Med. Sci., June., 1903, cxxv, 1071— 1078. An analysis of fifteen hundred cases of tuberculosis. Jour. Am. Med. Assn., Nov. 21, 1903. Some weather observations in the Adirondacks. Med. News, Aug. 20, 1904. The shape of the chest in health and in tuberculosis (E.G. Pope). Am. Jour. Med. Sci., Oct., 1904, 619-636. Treatment of the digestive disturbances occurring in pulmonary tuberculosis. Internat. Clin., iii, 14th series, 1904, 124-139. The early physical signs of pulmonary tuberculosis. Med. News, Oct. 15, 1904. The post-discharge mortality among the patients of the Adirondack Cottage Sanitarium (E. G. Pope). Am. Med., Nov. 19, 1904, 879-882. A study of the cases of pulmonary tuberculosis treated with tuberculin at the Adirondack Cottage Sanitarium. Zeitschr. f. Tuberk. u. Heilstattenw., Band vi, Heft 4, 235-254, 1904. 458 A HISTORY OF NATIONAL TUBERCULOSIS ASSOCIATION Some points in the diagnosis and treatment of tuberculosis. Albany Med. Annals, April, 1906. . Suggestion in the treatment of hemoptysis. Tr. Nat. Tuberc. Assn., ii, 459, 1906. The prevention of tuberculosis. Brehmer Rest, Third Annual Report, 1907. A brief study of a diphtheria epidemic at the Adirondack Cottage Sanitarium (A. H. Allen and E. J. S. Lupton). Am. Jour. Med. Sci., Feb., 1907. The ultimate test of sanatorium treatment of pulmonary tuberculosis and its application to the results obtained in the Adirondack Cottage Sanitarium (E. G. Pope). Zeitschr. f. Tuberk., bd. xii, ht. 3, 1908, 206-15. The sanatorium. Internat. Clin., i, 18th series, 1-21. The early diagnosis of pulmonary tuberculosis. Albany Med. Annals, April, 1908. New York State Jour. of Med., May, 1908. Dissecting aneurism of the aorta and pulmonary artery following rupture of the arch of the aorta. N.Y. Med. Jour., July 4, 1908. The diagnostic and therapeutic use of tuberculin. Boston Med. and Surg. Jour., July 23, 1908, 97-106. The hygienic requirements for the construction and equipment of sanatoriums. Internat. Tuberc. Conference, Phila., Sept., 24-26, 1908. The ultimate results of sanatorium treatment. Tr. Sixth Internat. Congr. on Tuberc., i, part 2, 927-949, 1908. The heart in pulmonary tuberculosis. Tr. Nat. Tuberc. Assn., iv, 116, 1908; also Am. Jour. Med. Sci., Dec., 1908, and Feb., 1909. The clasisfication of pulmonary tuberculosis and statistical reports of sana- toria. Jour. Am. Med. Assn., Jan. 30, 1909, 341-348. An outline for a co-ordinated attack upon tuberculosis. N. Y. Med. Jour. Nov. 20, 1909. Some studies with the cutaneous tuberculin test. A preliminary report. Tr. Assn. Am. Phys., 1909, 104-144. The cultivation of tubercle bacilli directly from sputum by the use of anti- formin (Daniel Smith). Jour. Med. Research, June, 1910. Properly regulated rest and exercise in pulmonary tuberculosis. Jour. Out- door Life, June, 1911, 149-152. The specificity, danger and accuracy of the tuberculin test. Am. Jour. Med. Sci., Oct., 1911, 469-475. The causes of death in pulmonary tuberculosis. Tr. Am. Clim. and Clin. Assn., 1911, 65-86; also Zeitschr. f. Tuberk., bd. xviii, h. 1, 1911, 43-52. The albumin reaction in the sputum in pulmonary tuberculosis (with W. H. Ross). Tr. Nat. Tuberc. Assn., vii, 260-289, I9II. The present status of the tuberculin test. Tr. Assn. Am. Phys., 1911, 22-32. A study of the blood of patients with pulmonary tuberculosis undergoing sanatorium and tuberculin treatment (A. F. Miller and E. J. S. Lupton). Am. Jour. Med. Sci., May, 1912, 683-693. , Tuberculin, its history, preparation and value (A. F. Miller). Jour. Outdoor Life, Jan., 1912, 12-13. Routine medical work in a sanatorium (H. L. Barnes and V. F. Cullen). Bos- ton Med. and Surg. Jour., Oct. 31, 1912, 613-614. LAWRASON BROWN, M.D. 459 Recent advances in the treatment of pulmonary tuberculosis by air, food and rest. Jour. Am. Med. Assn., June 1, 1912, 1678-1681. The therapeutic use of tuberculin, a working hypothesis and some personal observations. Tr. Nat. Tuberc. Assn., viii, 23, 1912; also Am. Jour. Med. Sci., Oct., 1912, 524-535. The bacteriology of the blood in pulmonary tuberculosis, a preliminary report (S. A. Petroff). Tr. Nat. Tuberc. Assn., viii, 505-511, 1912. Preliminary talk to patients undergoing treatment for pulmonary tubercu- losis. Jour. Outdoor Life, Dec., 1912, 289-292. The bacteriology of the blood in pulmonary tuberculosis (F. H. Heise and S. A. Petroff). Tr. Nat. Tuberc. Assn., ix, 344-361, 1913. The occurrence and importance in treatment of secondary infection in pul- monary tuberculosis (F. H. Heise and S. A. Petroff). Tr. Tuberc. Assn., ix, 254-269, 1913. The uncertainties of the treatment of pulmonary tuberculosis by artificial pneumothorax (A. K. Krause). Tr. Assn. Am. Phys., 1913, 441-448. When is a tuberculous patient cured? Tr. Clim. and Clin. Assn., 1914, 315- 321. How and when do we contract tuberculosis? Jour. Outdoor Life, April, 1914. Some errors in the diagnosis and treatment of pulmonary tuberculosis. Bull. Johns Hopkins Hosp., April, 1914, 117-127. Tuberculin therapy (E. N. Packard). Medical Annual, 1914. An attempt to immunize guinea pigs against tuberculosis by the use of gradu- ated, repeated doses of living tubercle bacilli (F. H. Heise and S. A. Pet- roff). Jour. Med. Research, July, 1914, 475-485. Honesty, sympathy and humbleness in nursing. Address at the first commence- ment of the Adirondack Cottage Sanitarium Training School for Nurses, Oct. I, 1914. The significance of tubercle bacilli in the urine. Jour. Am. Med. Assn., March 13, 1915, 886-890. Diagnostic theses in pulmonary tuberculosis. Jour. Am. Med. Assn., June 12, 1915, 1977-1978. Ueber das vorkommen von tuberkel-bazillen im blute von patienten mit lun- gentuberkulose (F. H. Heise and S. A. Petroff). Zeitschr. f. Tuberk., band 24, heft 2, 1915. Sanatoria in the fight against tuberculosis. Virginia Med. Semi-Monthly, Nov.:‘12, 1915, 369-372. The occurrence of living tubercle bacilli in river water contaminated by sewage from a health resort (F. H. Heise and S. A. Petroff). Tr. Nat. Tuberc. Assn., xii, 287, 1916, Am. Jour. Pub. Health, Nov., 1916, 1148-1152. Tuberculosis theses: diagnostic, prognostic, therapeutic. Am. Rev. Tuberc., June, 1917, 193-205. A preliminary study of the clinical value of complement fixation in tubercu- losis (S. A. Petroff). Tr. Nat. Tuberc. Assn., xiii, 528-534, 1917. Herbert Maxon King: 1864-1917 (Tribute). Am. Rev. Tuberc., Aug., 1917, 321-324. 460 A HISTORY OF NATIONAL TUBERCULOSIS ASSOCIATION Value of Roentgen ray in diagnosis of pulmonary tuberculosis in war time. Jour. Am. Med. Assn., Feb. 23, 1918, 516-519. Tuberculosis as an army problem. Tr. Nat. Tuberc. Assn., xiv, 318, 1918; also Am. Rev. Tuberc., Aug., 1918, 335. The clinical value of complement fixation in pulmonary tuberculosis based on a study of 540 cases (S. A. Petroff), Tr. Nat. Tuberc. Assn., xiv, 250, 1918; also Am. Rev. Tuberc., Nov., 1918. A study of pulmonary and pleural annular radiographic shadows. Tr. Nat. Tuberc. Assn., xiv, 171, 1918; also Am. Rev. Tuberc., Jan., 1919. A study of the effects of typhoid fever and antityphoid immunization on pul-: monary tuberculosis. (History of a typhoid fever epidemic at the Tru- deau Sanatorium) (Heise, Petroff and Wilson). Tr. Nat. Tuberc. Assn., xiv, 230, 1918; also Am. Rev. Tuberc., Feb., 1919. The early Roentgen diagnosis of ulcerative tuberculous colitis (H. L. Sampson). Jour. Am. Med. Assn., July 12, 1919, 77-85. Etiological studies in tuberculosis (Petroff and Pesquera). Tr. Nat. Tuberc. Assn., xv, 259, 1919; also Jour. Am. Med. Assn., Nov. 22, 1919, 1576-1578. A preliminary study of clinical activity (Heise, Petroff and Sampson). Tr. Nat. Tuberc. Assn., xv, 87, 1919. The influence of anesthesia on experimental tuberculosis in guinea pigs (S. A. Petroff). Tr. Nat. Tuberc. Assn., xv, 292, 1919. The.place of the sanatorium in the study of tuberculosis. Am. Rev. Tuberc. May, 1920. Twenty years’ experience with the subcutaneous tuberculin test (F. H. Heise). Tr. Nat. Tuberc. Assn., xvi, 147, 1920; also Am. Rev. Tuberc., June, 1920. The classification of pulmonary tuberculosis based upon symptoms and physi- cal and x-ray findings (Heise and Sampson). Tr. Nat. Tuberc. Assn., xvi, 79, 1920; also Am. Rev. Tuberc., Aug., 1920. Adrenalin hypersensitiveness in definite and unproved pulmonary tubercu- losis (Heise and Brown). Am. Rev. Tuberc., iv, no. 8, 1920. The occurrence of intestinal tuberculosis in patients with pulmonary tubercu- losis, at the Trudeau Sanatorium (Heise and Sampson). Tr. Nat. Tuberc. Assn., xvi, 114, 1920; also Am. Rev. Tuberc., Aug., 1920. Certain points in the diagnosis and treatment of pulmonary tuberculosis; also Am. Jour. Med. Sci., Sept., 1920, 324. On personal experience and the value of a medical society to its members. Am. Rev. Tuberc., Sept., 1920. Rules for recovery from tuberculosis. Lea and Febiger, Philadelphia, 1916. Specific treatment. In Tuberculosis, by Arnold C. Klebs, published by D. Appleton and Co., New York, 1909, p. 508-588. The symptoms, etc., of tuberculosis. In Modern Medicine, by William Osler, published by Lea and Febiger, Philadelphia, 1907. p. 248-435. The anti-tuberculosis movement in the United States: control and eradica- tion of tuberculosis, by many authors. Published by William Green and Son, Edinburgh and London, 1911, 256-277. CHAPTER LXXV ALFRED MEYER, M.D. VICE-PRESIDENT OF THE NATIONAL TUBERCULOSIS ASSOCIATION FROM I918 TO 1919 LFRED MEYER was born in New York city June 18, A 1854, a son of Isaac and Mathilda Langenbach Meyer. He received a liberal classical education in Columbia Univer- sity, graduating in 1874 with the degree of Bachelor of Arts. He was graduated from the College of Physicians and Surgeons in 1877, and entered at once upon post-graduate work as an intern in the Mount Sinai Hospital, N. Y. Completing his internship, he spent over two years in clinical and laboratory work, mainly in Leipzig and Vienna, with visits to the hospitals of London, Paris, Frankfort, Rome, and Amsterdam. In 1881 Dr. Meyer engaged in general private practice in New York, and for the past twenty-five years has limited himself to consultation work. Besides being clinical professor of medicine at the New York University and Bellevue Hospital Medical Col- lege, he is consulting physician to the Mount Sinai Hospital, the Montefiore Hospital for Chronic Diseases, and the Bedford Sana- torium for Consumptives. Dr. Meyer has long been identified with the anti-tuberculosis movement in New York city and state, and with the national movement throughout the country. For many years he has been a member of the board of directors of the New York City Tuber- culosis Association. He served on the original small committee that prepared for the International Congress on Tuberculosis in Washington, 1908, going abroad in 1906 to stimulate interest in the Congress, and visiting many countries. In the Parliament Building at The Hague Dr. Meyer delivered an address on the plan and scope of the Congress, receiving a silver medal for his exhibit of a dairy illustrating the sanitary production of milk. 461 462 A HISTORY OF NATIONAL TUBERCULOSIS ASSOCIATION After the Congress he was largely instrumental in bringing to New York the great international exhibit which was visited by 750,000 people, and to which undoubtedly may be traced a greatly height- ened interest in the social significance of the disease.. Dr. Meyer is a member of the following medical organizations: The American Medical Association, New York Academy of Medicine, Medical Society of the State of New York, the Harvey Society, New York County Medical Society, the Alumni of Mount Sinai Hospital. The bibliography of Dr. Alfred Meyer follows: The city and its consumptive poor: a plea for a municipal sanatorium outside of the corporate limits. State care of consumptive poor, with an account of the first state sanatorium. Med. Rec., Oct. 28, 1899. State care of the consumptive poor. Med. Rec., Jan. 13, 1900. Relationship of fistula in ano to pulmonary tuberculosis. Mount Sinai Hos- pital Rep., no. 2, 1901. Municipal sanatoria. Med. Rec., Dec. 14, 1901. Tuberculosis in the tenements. N. Y. Med. Jour., July 4, 1903. History and work of the Bedford Sanitarium. Tr. Nat. Tuberc. Assn., i, 438, 1905; Med. Rec., July 8, 1905. ‘ Complement fixation in pulmonary tuberculosis. Tr. Nat. Tuberc. Assn., xii, 219, 1916; also Med. Rec., Aug. 5, 1910. After-care of discharged cases. Med. Rec., Aug. 10, 1912. A case of spontaneous pyopneumothorax complicated by hydro- or pyopneu- mopericardium. Tr. Nat. Tuberc. Assn., xi, 193, 1915; also Med. Rec., Dec. II, 1915. A case of bilateral spontaneous non-tuberculous pneumothorax. Tr. Nat. Tuberc. Assn., xiii, 330, 1917; also N. Y. Med. Jour., June 30, 1917. Influenza in a tuberculosis sanatorium. Med. Rec., April 12, 1919. Intrapleural hypertension for evacuating pus through bronchi in spontaneous pyopneumothorax. Tr. Nat. Tuberc. Assn., xvi, 75, 1920; also Jour. Am. Med. Assn., July 24, 1920. ALFRED MEYER CHAPTER LXXVI PHILIP KING BROWN, M.D. VICE-PRESIDENT OF THE NATIONAL TUBERCULOSIS ASSOCIATION FROM 1920 TO 1921 HILIP KING BROWN, the son of Henry Adams and Char- Pi: Amanda Blake Brown, was born in Napa, Cal., June 24, 1869. He received his preliminary education in San Francisco public schools and in Belmont School, California, and took his academic degrees at Harvard University in 1890 and Harvaid Medical School in 1893. Dr. Brown was an attending physician to the San Francisco Hospital from 1896 to 1918, being in charge of the medical and tuberculosis wards. He is now a con- sulting physician to the Mount Zion Hospital and the Southern Pacific Railroad Hospital. Dr. Brown has accomplished perhaps his greatest and most important work as founder and medical director of Arequipa Sanatorium for early tuberculosis .in wage- earning women, where: he instituted a successful sociological ex- periment in the treatment of tuberculous working girls. He has done other important pioneer work in ergo-therapy in tuberculo- sis and in the blood studies in patients at the San Francisco Lepra- sorium. Dr. Brown has twice been president of the California Academy of Medicine, and is now president of the California Tuberculosis Association. He is a member of the Association of American Physicians and of the Climatological and Clinical Asso- ciation. During the war Dr. Brown served as Deputy Commis- sioner for the Red Cross in France, and as Assistant Medical Director of the Department of Medical Research and Intelligence. The bibliography of Dr. Philip King Brown follows: A study of the blood in 73 cases of bone tuberculosis in children, with reference to prognosis and treatment. Occidental Med. Times, San Francisco, xi, 462, 1897; also Tr. M. Soc. Cal., S. F., 1897, 169-176. Individual factors in hygiene (with R. C. Cabot). Boston Med. and Surg. Jour., 1905, 689; also Detroit Med. Jour., 1905-06, v, 73. \ 463 464 A HISTORY OF NATIONAL TUBERCULOSIS ASSOCIATION Primary infection with tubercle bacilli, with special reference to thoracic glands. Calif. State Jour. of Med., 1913, 346. Early lesions of tuberculosis in the lungs. Tr. Am. Clim. and Clin. Assn., XXix, 34, 1913. Primary infection with tubercle bacilli, with special reference to thoracic glands. Tr. Assn. Am. Phys., 1913, 408-421. Arequipa Sanatorium, a sociological and economic experiment in cases of tu- berculous wage-earning girls. Cal. State Jour. of Med., 1914, 327. Sociologic experiment in treatment of tuberculosis working women. Jour. Sociolog. Med., Easton, Pa., 1915, 209. Potteries of Arequipa Sanatorium. Mod. Hosp., viii, 394, 1917. Tuberculosis in army. Boston Med. and Surg. Jour., 1917, 134. Clinical manifestations of various joint affections and their bearing on diag- nosis. Internat. Clin., i, 93, 1918. Training of nurses and social workers in present emergency. Calif. State Jour. of Med., xvi, 281, June, 1918. Army and tuberculosis. Med. and Surg., St. Louis, April, 1918. Subsequent history of cases discharged apparently cured from Arequipa Sana- torium for wage-earning women during six years. Am. Rev. Tuberc., Feb., 1919. Eighteen years’ experience with ergo-therapy. Tr. Nat. Tuberc. Assn., xiv, 434, 1918. Teamwork in fight against tuberculosis. Jour. Outdoor Life, 1919, 174. PHILIP KING BROWN 30 APPENDICES APPENDIX I ANTI-TUBERCULOSIS WORK DONE DURING AND AFTER THE WORLD WAR BY THE SUR- GEON GENERAL’S OFFICES OF THE UNITED STATES ARMY, THE UNITED STATES NAVY, een UNITED STATES PUBLIC HEALTH UNITED STATES ARMY N April, 1917, the United States entered the world war. I The orders issued from the Surgeon General’s office of the army concerning the general, careful, and thoroughly scientific measures taken to exclude the tuberculous from Army and Navy, have already been referred to in the biographies of Major General Gorgas and Col. George E. Bushnell. It seems desirable, however, to outline briefly here, as an important historical item in the anti-tuberculosis crusade in the United States, the admirable work done under the direction of the Surgeon General’s office by the draft and camp surgeons. We are indebted to Major General Ireland, the present Surgeon General, for the following valuable statistics showing the rejec- tion of selective service men by local and camp examining boards: Among the 3,764,101 men examined, there were 58,916 found actually suffering from pulmonary tuberculosis, 17,055 with suspected tuberculosis, and 9,410 afflicted with tuberculosis of other organs than the lungs. Seven thousand, three hundred and sixty (7,360) were rejected because of defective physical develop- ment, 2,299 for deficient chest measurement, 70,608 because of underweight, and 769 for malnutrition. These four latter con- ditions are well known to be predisposing to tuberculosis. This would mean that 166,417 men were either actually tuberculous, suspected of tuberculosis or, by reason of their physical defects, predisposed to the disease. If we add to this figure 9,674 afflicted with syphilis and its sequela, which also predisposes to tubereu- 467 468 A HISTORY OF NATIONAL TUBERCULOSIS ASSOCIATION losis, we have a total of 176,091 individuals either already tu- berculous or strongly predisposed to developing or contracting the disease, who were prevented from entering the Army. REJECTIONS, SELECTIVE SERVICE MEN, LOCAL AND CAMP EXAMINING BOARDS Local Boards | Camp Boards Total seacdesne ce wawastslsnupeel cae: 549,099 206,622 Pulmonary tuberculosis.................. 44,305 14,611 Suspected tuberculosis................... 16,899 156 Tuberculosis of other organs.............. 8,731 679 Mental deficiency...................005: 33,636 7,963 Defective physical development........... 5,604 1,756 Deficient chest measurement.............. 2,105 194 Underweight «sic ini eoa sure oe me eas aa aes 59,022 11,586 Underheight».¢ sx ecsices weyes cou ca ee hae 6,556 2,060 Malnutrition.................00 eee eee 676 93 Bones and organs of locomotion........... 113,287 58,533 Arthritis eae 5 dibs sa dan cota nk e weltee MAOH OE 3,934 2,539 Syphilis... 604 sto 4 bk Gediend aaa baw aw wees 4,541 4,261 WADES sb osase a etmnacdtais tans acca pre tae groin 4 wisi 425 153 Paresisie code guiic vai ese raldy ne auetedcas 159 135 The actual number of selective service men, first and second registration, examined by the local boards was 3,764,101. The actual number of selective service men, first and second registration, examined by the camp boards was 2,745,073. The statistics for 1,961,692 selective service men as published in ‘‘ Defects Found in Drafted Men” have been raised proportionately to cover the com- plete number 2,745,073. ‘ Thus, the dissemination of tuberculous diseases in the army was guarded against by the exclusion of the tuberculous, and the development of the disease was prevented in the strongly pre- disposed. The majority of the latter would probably have fallen victims to tuberculosis as a result of the stress and strain inevit- ably connected with camp life and warfare. In this way a truly great life-saving work was done by the Surgeon General and his staff, not only during the war by the surgeons in the field, but also at home through the work of the physicians on the draft and camp boards. The National Tuberculosis Association, with the aid of the Surgeon General’s records, took it upon itself to trace as many as possible of the cases definitely declared tuberculous, APPENDIX I 469 so that they could be placed under medical care and in suitable institutions (see page 41). In comparison with the armies of our allies, the number of soldiers who developed or contracted tuberculosis during the war and had to be returned at once, was exceedingly small. Be- cause of a too hasty examination or incorrect interpretation of Roentgen pictures, some men were returned, who upon subse- quent examination here, were found simply to be suffering from chronic bronchitis or residual fraction of pneumonia. To avoid as far as possible a repetition of such errors, Dr. Gerald B. Webb was appointed Colonel and chief consultant in tuberculosis in the American Expeditionary Forces and sent to France in March, 1918. On his arrival Colonel Webb established centers for the correct sifting out of all chest cases, one at Savenay with the New York Post-Graduate Unit, under Colonel Samuel Lloyd; one at Vauclaire with the Mount Sinai Unit, under Colonel Lilienthal; and another center at Guyon with the Pennsylvania Unit. Colonel Webb visited almost every hospital of the American Expeditionary Force, hoping that through his instruc- tion and standardization of diagnostic methods, mistakes might be reduced to a minimum and only positive sputum and hemor- rhage cases sent home. In spite of the admirable work of Dr. Webb, the errors in diagnosis increased because of unforeseen complications which arose in handling the problem of the tuberculous, those afflicted with other chest diseases, and the suspected tuberculous cases. One must draw this conclusion from an article in the Annual Report of 1920 by Colonel Brooke in which he says: “The seemingly large number of cases in the above category was unex- pected and was apparently brought about by two conditions not anticipated at the beginning of the war. First, the acute respiratory infections in 1918, largely influenza and pneumonia, resulted in a residual chronic pulmonary infection usually caused by the hemolytic streptococcus that clinically, even to the physical signs, simulated pulmonary tuberculosis; second, shortly after the signing of the armistice the tuberculosis-hospital centers in France were broken up and a large number of cases were sent home with a tentative diagnosis of tuberculosis that otherwise would have been sifted out overseas.”’ With a foresight that cannot be too highly commended, the 470 A HISTORY OF NATIONAL TUBERCULOSIS ASSOCIATION Surgeon General of the Army, upon the declaration of war, began to plan for the care and treatment of a large number of tuberculous patients who he thought might escape detection upon examination or develop tuberculosis while in the service. At the time war was declared, only the U. S. General Hospital at Fort Bayard, New Mexico, with 500 beds, was available. It was early apparent that it would be necessary to have a series of hospitals located in the east and as near the port of debarkation as possible, thus reducing discomfort and fatigue incident to railroad travel to a minimum. Following this policy, hospi- talization for tuberculous patients was planned and executed as follows: Capacity United States General Hospital, Fort Bayard, New Mexico.......... 1,850 United States General Hospital, No. 8, Otisville, N. Y.............. 1,000 United States General Hospital, No. 16, New Haven, Conn.......... 500 United States General Hospital, No. 17, Markleton, Pa.............. 200 United States General Hospital, No. 18, Waynesville, N. C........... 600 United States General Hospital, No. 19, Oteen, N. C................ 1,300 United States General Hospital, No. 20, Whipple Barracks, Ariz...... 500 United States General Hospital, No. 21, Denver, Colo. (Fitzsimmons). 1,500 United States General Hospital, No. 42, Spartanburg, S.C. ......... 1,000 8,450 No other nation has ever in such a short time constructed, equipped with all necessities and refinements, and placed in opera- tion such an efficient chain of tuberculosis hospitals for military personnel. The number of beds which General Gorgas esti- mated would be necessary to care for the tuberculous sick was fully justified by subsequent admissions. Even though there was some slight delay incident to the Public Health Service taking over these patients, at no time was there any permanent congestion in any of these tuberculosis institutions. When the Public Health hospitals were ready to receive them, the majority was gradually absorbed, but many of these patients remained in Army hospitals as beneficiaries of the Bureau of War Risk In- surance (now U. S. Veterans’ Bureau). As time elapsed it be- came possible to close or turn over to the Public Health Service all of the hospitals above named except the Fitzsimmons General Hospital at Denver, Colo. The bed capacity of this hospital APPENDIX I 471 has been increased from 1,000 to 1,740, and on this date it is caring for 782 beneficiaries of the Veterans’ Bureau. UNITED STATES NAVY With our entrance into the world war the Bureau of Medicine and Surgery of the Department of the U.S. Navy early recog- nized the fact that there would be an increased number of tuber- culous patients and took steps to enlarge its tuberculosis hospital at Fort Lyon, Colo., equipping it with the most modern type of x-ray apparatus, heliotherapy facilities, etc. On October 3, 1921, this hospital was transferred by executive order to the Veterans’ Bureau, which was obligated to care for the discharged personnel of the Government Services, the Navy having decided, as a result of its experience, that it was not economical to continue men in the service after they had developed tuberculosis. Before the War Risk Act of 1917, the Navy was under obligations to care for those who developed tuberculosis, and this was the more imperative because private and state sana- toria were disinclined to care for cases which had been discharged from the Navy. Confronted with a large increase in personnel during the world war, the Navy Department fully realized the importance of eliminating at the recruiting office those men who were suffer- ing with tuberculosis. Every endeavor was made to eliminate by physical examination at training stations cases that had escaped detection at the earlier examination. At the training stations latent cases also were detected as well as those which lighted up after strenuous training. Inasmuch as such men had already been enlisted, the navy accepted the obligation of caring for them and transferred them to the Naval Hospital at Fort Lyon. Briefly, the following is the scheme which has been adopted by the Navy Department for the prevention and treatment of tuberculosis: 1. Elimination of the infected or predisposed individual at the recruiting office. 2. The holding of all recruits for a definite period, usually six months, for medical observation during training period before being sent to sea. 3. Physical examination of all men before being transferred and upon re- enlistment. 472, A HISTORY OF NATIONAL TUBERCULOSIS ASSOCIATION 4. Special attention to carefully balanced ration, ventilation, physical exercise, and general personal hygiene of all men in the navy and Marine Corps. 5. A definite policy of early detection and segregation of all men suffering with tuberculosis. 6. Hospitalization. Formerly at Fort Lyon, now through Veterans’ Bureau facilities. 7. At the present time all enlisted men suffering with tuberculosis are dis- charged from the service as soon as a definite diagnosis of tuberculosis can be made, and in many cases are held as supernumeraries until they can be taken care of by the Veterans’ Bureau. In the case of enlisted men who have entered the navy since February 9, 1922, and those who are not eligible for benefit under the Veterans’ Bureau, hospitalization is still afforded from naval sources. 8. The Bureau could not discharge officers except by retirement and, there- fore, arrangements have been made with the Surgeon General, U. S. Army, to take care of officer patients until they are ordered before a retiring board. The army hospital utilized in this connection is the Fitzsimmons General Hospital, near Denver, Colo. This hospital also receives enlisted men of the navy suffering with tuberculosis. PUBLIC HEALTH SERVICE With the gradual return of all the sick and wounded there was naturally a considerable increase in the number of soldiers and sailors who had either contracted or developed tuberculosis in service as a result of war work or as sequel# of influenza or pneumonia, and in 1919 the U. S. Public Health Service was re- quired to make physical examinations and to furnish medical care for the disabled veterans applying for compensation. To meet the serious emergency which then arose, the medical corps was quickly increased to more than 5,000 physicians, of whom 2,700 were full-time medical officers. Hospitals were rapidly organized and the field force made contact with appli- cants in every county in the United States. One-third of the patients admitted to hospitals were tuberculous. A program for necessary hospital construction was prepared in conjunction with the War Risk Insurance Bureau, proposing 51 new hospitals at a total estimated cost of $85,000,000. Of these, 19 with an aggregate of 9,330 beds, were designed for the tuberculous. While this program, which was published Decem- ber 5, 1919, Public Document No. 481, of the Sixty-sixth Congress, was considered by the Congress as too pretentious, subsequent events indicate that the forecast was approximately correct. APPENDIX I 473 By order of Surgeon General Cumming, authorized by the Secretary of the Treasury, a Section of Tuberculosis was organ- ized in the U.S. Public Health Service at Washington under the direction of Surgeon F. C. Smith, not as a substitute for the Divi- sion of Tuberculosis, which has several times been recommended by the National Tuberculosis Association, but only to meet urgent relief problems related to the care and examination of disabled veterans. Tuberculosis Sections were established as a part of each of the fourteen district offices, the chiefs of which undertook the task of securing from their field medical officers adequate chest examinations and accurate diagnoses. During the first two years approximately 1,000,000 physical examina- tions of all kinds were made. To train medical officers in diagnosis and treatment, to open new hospitals, many of which were of temporary and unsatis- factory construction and unfavorably situated, to facilitate ad- missions, provide a proper standard of treatment, facilitate discharge when treatment was completed and prevent unneces- sary transfers from hospital to hospital, were large problems. By December, 1920, more than 15,000 tuberculosis patients had been discharged from hospitals and nearly 10,000 tuberculous were under treatment, of which 5,300 were in Public Health Service hospitals, 219 in Army and Navy hospitals, about 500 in those belonging to the National Homes for Disabled Volun- teer Soldiers, and the remainder scattered in contract hospitals. The task grew rapidly. One hundred and ninety dentists and about 2,000 trained nurses, reconstruction aides and dietitians were added to the corps. Dispensaries were established and follow-up care of tuberculous patients living at home was under- taken, thousands of standard packages of sputum cups and paper handkerchiefs being distributed. Practically every large service tuberculosis hospital has become a continuous training school for physicians. The one at Oteen, N. C., has conducted a special summer school for nurses as well as medical officers. Several hundred physicians not stationed in hospitals have been given the short course in diagnosis at various points in the field. A report of the schools of instruction con- ducted in the Eighth District, which includes the States of Wis- consin, Illinois and Michigan, was published in Public Health 474 A HISTORY OF NATIONAL TUBERCULOSIS ASSOCIATION Reports December 2, 1921. Chief among the scientific articles offered for publication by Service officers is a report of two years’ research carried out at Hospital No. 41, New Haven, Conn. This monograph, “Small Pneumothorax in Tuberculosis,’’ by Surgeons (Reserve) Nathan Barlow and James C. Thompson, is being published as a bulletin of the Hygienic Laboratory. Valuable codperation has been constantly received from the National Tuberculosis Association, whose Advisory Committee outlined measures which were immediately included in the ob- jectives. An expert in construction, Mr. T. B. Kidner, col- laborated in the preparation of standard hospital plans, a report of which appeared in Public Health Reports June 17, 1921. A number of specialists consented to inspect the tuberculosis hos- pitals and the Supervisor of Medical Service, National Tubercu- losis Association, also makes inspections from time to time at the request of the Surgeon General. The recommendations made by these highly trained men have been of very great assistance in providing proper standards of sanatorium treatment. A large number of well-known members of the Association assisted in conducting training courses in the field. It is regretted that the space here available is insufficient to give the desired credit to the individual members. , VETERANS’ HOSPITALS FOR TUBERCULOSIS OPERATED BY THE U. S. PUBLIC HEALTH SERVICE Bed Capacity No. 24, Palo Alto, California....................... 639 No. 26, Greenville, South Carolina... . 650 No. 27, Alexandria, Louisiana................-..04. 554 No. 41, New Haven, Connecticut.................-. 500 No. 50, Prescott, Arizona.................000eeeee 765* No. 51, Tucson, Arizona............ 0.00.0. e eee eee 290 No. 55, Fort Bayard, New Mexico................. 1,120f No. 59, Tacoma, Washington....................05- 278 No. 60, Oteen, North Carolina................0.04. 1,100f No. 64, Camp Kearney, California.................. 550 No. 79, Dawson Springs, Ky. (not yet open)......... 500 No. 80, Fort Lyon, Colorado. ...............0.00005 750 Excelsior Springs, Mo. (not open yet)........ 200 Walla Walla, Wash. (not yet open).......... 240 Rutland, Mass. (not yet open).............. 300 * New construction is under way to increase the capacity 422 beds. t New construction is under way to increase the capacity 250 beds. ¢ New construction is under way to increase the capacity 200 beds. APPENDIX I 475 In addition to the above named Veterans’ hospitals with an aggregate of approximately 8,000 beds, three of the original Marine hospitals are devoted to tuberculous patients, the largest one, that at Fort Stanton, New Mexico, having 225 beds. All hospitals operated by the Public Health Service have tubercu- losis wards, some of which, among them the large hospitals in Boston, New York, Baltimore and Chicago, contain several hundred beds. The general hospitals serve as observation points to clear up obscure diagnoses, and the tuberculosis wards are clearing stations from which patients are transferred to sana- toria proper. A considerable number of the tuberculous pa- tients under treatment in them, however, are those unsuitable for transfer or who are unwilling to be removed to hospitals outside the city. APPENDIX II PUBLICATIONS OF THE NATIONAL TUBER- CULOSIS ASSOCIATION T WOULD be impossible to give a complete list of all of the I publications of the National Tuberculosis Association since its beginning. Much of the printed matter issued by the Association is of ephemeral value and is designed merely for occasional use. A list of the more stable and permanent publi- cations of the Association, however, is of value in this record. Such a list follows: Transactions of the annual meetings of the National Tuberculosis Associa- tion, beginning with Vol. I, 1905, to and including Vol. XVII, 1921. These annual volumes contain all of the papers read at the annual meetings, lists of members, a record of the meeting, resolutions adopted, reports of the treasurer, managing director, and other reports. Volumes range in size from about 350 pages to nearly 700 pages. A cumulative index of the Transactions has been published, covering the years 1905-1920. Journal of the Outdoor Life, the official organ of the National Tuberculosis Association published monthly since 1904. The Journal of the Outdoor Life is not owned by the National Tuberculosis Association, but since 1910 has been published in close relation with the Association. It is the lay publication of the Association, designed to carry articles of information and inspiration for tuberculosis patients, tuberculosis workers and tuber- culosis specialists. Each volume consists of twelve numbers. Monthly Bulletin of the National Tuberculosis Association, published monthly since 1914. Prior to that date a mimeographed confidential bulletin was published at occasional intervals. The Bulletin is recognized in popular parlance as the ‘‘house organ”’ of the National Tuberculosis Association. It deals primarily with technique of tuberculosis work, that is, with meth- ods and programs and with the news of the National Association. American Review of Tuberculosis, published monthly since March 1917. The Review is the medical organ of the Association. Each volume begins with the March number and consists of twelve issues, separately paged for original articles and abstracts of tuberculosis articles. Pamphlet No. ror, “Sleeping and Sitting in the Open Air,’’ 24 pp., 1917. A pamphlet entitled ‘‘ Directions for Living and Sleeping in the Open Air,”’ 476 APPENDIX II 477 was originally published by the National Tuberculosis Association in 1913. The present pamphlet roi is an adaptation of the original one. Pamphlet No. 102, ‘The Effect of Tuberculosis Institutions on the Value and Desirability of Surrounding Property,” 64 pp., 1914. Pamphlet No. 103, “‘Selling Red Cross Seals,” a symposium presented before the North Atlantic Tuberculosis Conference, 1914, 16 pp., out of print. Pamphlet No. 104, ‘‘Tuberculosis Legislation in the United States,’’ 64 pp., I9I5, out of print. Pamphlet No. 105, ‘‘ Working Men’s Organizations in Local Anti-Tuberculosis Campaigns,” 64 pp., 1916. Pamphlet No. 106, ‘‘ What You Should Know About Tuberculosis,’’ a standard pamphlet prepared by a special committee of the National Tuberculosis Association, 32 pp., 1916. Pamphlet No. 107, ‘‘Dispensary Method and Procedure,” by F. Elisabeth Crowell, 120 pp., 1916. This pamphlet is now being revised. Pamphlet No. 108, ‘‘ Red Cross Seal Percentages,’ out of print. Pamphlet No. 1og, ‘What Tuberculosis Workers Should Know About Dis- charged Soldiers and Rejected Men,’ 16 pp., 1919, out of print. Pamphlet No. 110, ‘‘A Directory of Tuberculosis Associations in the United _ States,’’ 112 pp., 1919. Pamphlet No. 111, ‘‘A Directory of Sanatoria, Hospitals and Day Camps for the Treatment of Tuberculosis in the United States,” 100 pp., 1919. Pamphlet No. 112, ‘‘A Directory of Dispensaries, Clinics, and Classes for the Special Treatment of Tuberculosis in the United States,” 56 pp., 1919. Pamphlet No. 113, “An Outline of Lectures on Tuberculosis,” for nurses, occu- pational aides and social workers, 15 pp., 1921. Modern Health Crusade Manual, 35 pp., 1921. The first Manual of the Modern Health Crusade was published in 1917. In addition to the Manual, the Crusade issues the chore record charts in three editions— standard, primary and senior. It also publishes other material for the Modern Health Crusade. “Hints and Helps for Tuberculosis Patients,” by Dr. Charles L. Minor, 16 pp., 1921, reprinted from the Journal of the Outdoor Life. “Becoming Acquainted with the Enemy Tuberculosis,” a four-page circular published in 1921, in 17 foreign languages and in English. “Sanatorium Administration Standards,” prepared by the Committee of the American Sanatorium Association, reprinted from the Transactions, 1920, 16 pp. “ Diagnostic Standards of the National Tuberculosis Association,” prepared by a committee of the Framingham Community Health and Tuberculosis Demonstration, 1920, 16 pp. Health Plays, a series of 15 playlets entitled ‘‘ Miss Fresh Air, Visiting N urse,”’ “Judith and Ariel,” ‘‘A Pageant of Average Town,” “Health and His Enemies,” ‘The Friends of Health,” ‘The Imps and the Children,” “Don't Care,” ‘The New Child,” ‘‘Good News from Babyland,”’ “ Play- ing Visit,” “The Passing of the Littlest Pageant,” ‘The Theft of Thistle- 478 A HISTORY OF NATIONAL TUBERCULOSIS ASSOCIATION down,” ‘‘The Narrow Door,” ‘‘ David and the Good Health Elves,” and “Wee Davie.” Some of these plays are out of print, but a new edition of these and others is being prepared. “To the Children of America,” originally published by the American Com- mission for the Prevention of Tuberculosis of the Rockefeller Foundation and the Bureau of Tuberculosis of the American Red Cross in France, 20 pp., I9I9. The Framingham Monographs as follows: No. 1—The Program. No. 2—The Sickness Census. No. 3—Vital Statistics. No. 4—Medical Examination Campaigns. No. 5—Tuberculosis Findings. No. 6—Schools and Factories. No. 7—The Children’s Summer Camp. No. 8—Health Letters. The Framingham Community Health and Tuberculosis Demonstration has also published circulars as follows: “‘What Has the Health Demonstration done for Framingham?” “Report of the Committee on Appraisal.” “Framingham Yardsticks.”’ “Tuberculosis Hospital and Sanatorium Construction,” by Thomas Spees Carrington, 182 pp., 1914, out of print. ‘ The Christmas Seal, issued annually since 1908, With the Christmas Seal has been brought out each year a large and increasing volume of posters, circulars, and other literature. APPENDIX III BIBLIOGRAPHY OF THE AUTHOR, S. ADOLPHUS KNOPF, M.D. Koch's lymph in Paris. South. California Pract., Feb., 1891. Les sanatoria, traitement et prophylaxie de la phtisie pulmonaire. Thése pour le Doctorat. Paris, June, 1895. Sanatoria for consumptives. South. California Pract., Oct., 1895. Sanatoria for the treatment and prophylaxis of pulmonary phthisis. N. Y. Med. Jour., Oct. 5 and 12, 1895. Les sanatoria des phtisiques sont-ils un danger pour le voisinage? Revue de la Tuberculose, Dec., 1895. Should we treat pulmonary tuberculosis as a contagious or as a communicable disease? South. California Pract., May, 1896. Are sanatoria for consumptives a danger to the neighborhood? N. Y. Med. Jour., Oct. 3, 1896. La phtisiotherapie et les sanatoria. Presse méd., Oct. 14, 1896. The hygienic, educational, and symptomatic treatment of pulmonary tubercu- losis with a plea for sanatoria. Med. Rec., Feb. 13, 1897. Tuberculosis and the board of health. N.Y. Med. Jour., April 3, 1897. The communicability of tuberculosis and special hospitals for pulmonary con- sumption. Med. Rec., April 3, 1897. Aerotherapeutics and hydrotherapeutics in the treatment and prevention of pulmonary tuberculosis. N.Y. Med. Jour., July 24, 1897. Anti-streptococcic serum in the mixed infection of tuberculosis. Jour. Am. Med. Assn., Sept. 25, 1897. The present status of preventive means against the spread of tuberculosis in the various states of the Union critically reviewed. Jour. Am. Med. Assn., Oct. 30, 1897. The urgent need of sanatoria for the consumptive poor of our large cities. Med. Rec., Nov, 27, 1897. A new binaural stethoscope with armamentarium for complete physical ex- amination. Jour. Am. Med. Assn., Jan. 1, 1898. Ueber Volksheilstatten fiir Lungenkranke in Amerika. Heilstatten Korres- pondenz., Jan. 1, 1898. Ein neues binaurales Stethoskop mit Armamentarium fiir vollstandige Auskul- tation und Perkussion. Zeitschr. f. Krankenpflege, March, 1898. State and municipal care of consumptives. Med. Rec., Sept. 24, 1898. The tuberculosis problem in the United States. North Am. Rev., Feb., 1899; also Lancet, London, May 6, 1899. 479 480 A HISTORY OF NATIONAL TUBERCULOSIS ASSOCIATION Organized charities and tuberculosis. Charities, March 4, 1899. Pulmonary tuberculosis: its modern prophylaxis and the treatment in special institutions and at home. 343 pages. Alvarenga Prize Essay, May, 1899. P. Blakiston’s Son & Co., Philadelphia. Die Tuberkulose als Volkskrankheit und deren Bekampfung. Prize essay of Internat. Tuberc. Congr., Berlin, July, 1899. The compulsory reporting of tuberculosis. N.Y. Med. Jour., Sept. 23, 1899. Early recognition of pulmonary tuberculosis. Jour. Am. Med. Assn., Dec. 9, 1899. Les sanatoria, traitement et prophylaxie de la phtisie pulmonaire. Second edition, 495 pages, Paris, Jan., 1900. The California quarantine against consumption. The Forum, Jan., 1900. Sanatorium treatment at home for patients suffering from pulmonary tuber- culosis. Med. Rec., Jan. 27, 1900. The sanatorium movement. Charities, Feb. 10, 1900. Tenements and tuberculosis. New York Daily News, Feb. 21, 1900; also Jour. Am. Med. Assn., May 12, 1900; The Sanitarian, and Charities, Sept., 1900. L'infection des livres par le bacille de la tuberculose. Presse méd., Feb. 24, 1900. Tuberculosis—diagnosis, prognosis, prophylaxis, and treatment. In Twentieth Century Practice of Medicine, xx, 1900. Wm. Wood & Co., New York. Die Fritherkennung der Tuberkulose. Zeitschrift fiir Tuberk. u. Heilstattenw. , April and July, 1900. The anti-tuberculosis crusade in France. N. Y. Med. Jour., June 9, 1900. On the reporting of tuberculous cases to the health authorities. Med. Press, July 19, 1900. Dispensaries for the poor versus a hospital for consumptives. Charities, Oct. 6, 1900. Some thoughts on overcrowding and tuberculosis. Jour. Am. Med. Assn., Oct. 10, 1900. The ztiology of pulmonary tuberculosis, its course and termination. N. Y. Med. Jour., Oct. 13, 1900. Tuberculosis in prisons and reformatories. Med. Rec., March 2, 1901. Our duties toward the consumptive poor. Med. News, March 9, Igor. Tuberculosis literature for the general practitioner and his work against the great white plague. South. California Pract., April, 1901. The anti-tuberculosis crusade in the United States and the sanatorium move- ment during the year 1900. Zeitschr. f. Tuberk. u. Heilstattenw., April, IgOI. Municipal care of the consumptive poor. Boston Med. and Surg. Jour., May 2, 1901. Tuberculosis as a disease of the masses and how to combat it. American edi- tion, March, 1901. This international prize essay has been translated into the following languages: Arabic, Bohemian, Brazilian, Bulgarian, Chinese (2), Dutch, English, Finnish, French, Hebrew, Hindu (2), Hun- APPENDIX III 481 garian, Icelandic, Italian (2), Japanese, Mexican (Spanish), Norwegian, Polish, Russian (2), Serbian, Spanish, Swedish, Turkish, and French- Canadian. Relation of the medical profession in the twentieth century to the tubercu- losis problem. Jour..Am. Med. Assn., June 15, 1901. The value of local sanatoria in the combat of pulmonary tuberculosis. Med. Record, July 6, 1901. The woman of the tenement and her three great enemies— ignorance, alcohol- ism, and tuberculosis. Jour. Med. and Science, Aug., 1901. A plea for the alien consumptive. Jour. Med. and Science, Aug., 190r. Prevention of tuberculous disease in infancy and childhood. Maryland Med. Jour., Aug., 1901; also Bull. Johns Hopkins Hosp., Sept., 1901. Respiratory exercises in the prevention and treatment of pulmonary diseases. Bull. Johns Hopkins Hosp., Sept., 1901. Ein Aufruf zur Griindung einer deutschen Lungenheilstatte in gross-New York als zweig der New Yorker and Brooklyner deutschen Hospitdler. Zeit- schr. fiir Tuberk. u. Heilstattenw., Oct., 1901. State and individual prophylaxis of tuberculosis during childhood and the need of children’s sanatoria. N.Y. Med. Jour., Nov. 30, 1901; also Zeitschr. f. Tuberk. u. Heilstattenw., Jan., 1902. Sanatorium versus hospital for incipients. Med. Rec., Dec. 21, 1901. A McKinley memorial—A seaside sanatorium with a pavilion for every state for the treatment of American children suffering from tuberculous and scrofulous diseases, or predisposed to consumption. Charities, Oct. 12, 1901; Jour. of Med. and Science, Nov. 1901. The deportation of consumptive immigrants. Charities, Dec. 14, I901. Allure generale de la lutte contre la tuberculose aux Etats Unis. La Lutte Antituberculose, Aug. 31, 1901. Die Massnahmen der stadt New York zur Bekampfung der Tuberkulose. Hyg. Volksblatt, Jan., T902. Official and private phthisiophobia. Med. Rec., Jan. 11, 1902. Some unsolved problems in tenement house life. The Sanitarian, Feb., 1902; also Charities, Feb. 22, 1902. The tuberculosis problem in the United States. North American Rev., March, 1902. The mission of societies for the prevention of consumption in the anti-tubercu- losis crusade. Tr. Can. Med. Assn., April, 1902; also Montreal Med. Jour., April, 1902; N. Y. Med. Jour., April 26, 1902. A few thoughts on the medical and social aspects of tuberculosis at the be- ginning of the twentieth century. v. Leyden’s Festschr., May, 1902. Another chapter on phthisiophobia. Med. News, May 3, 1902. The need of a Masonic sanatorium. Trs., Masonic Standard, May 17, 1902. What shall we do with the consumptive poor? Nat. Hosp. Rec., June, 1902; also Med. Rec., July 5, 1902. The anti-tuberculosis movement in the United States. Tuberculosis, Berlin, i, no. 8, Aug., 1902. 31 482 A HISTORY OF NATIONAL TUBERCULOSIS ASSOCIATION The exclusion of non-pauper tuberculous immigrants and alien tuberculous visitors from American shores. Zeitschr. f. Tuberk. u. Heilstattenw., Oct., 1902. : Prevention of tuberculosis and what every one should know about it; address before New Jersey Sanitarian Assn., Oct. 24, 1902. The Burke Foundation and a plea for proper homes for the convalescent poor. N. Y. Med. Jour., Nov. 1, 1902. \, The present aspect of the tuberculosis problem in the United States. Jour. Am. Med. Assn., Nov. 22, 1902. is Report on the care of the sick poor of the state of New York. With sugges- tions for the establishment of convalescent homes, psychopathic hospitals as reception stations for the insane and special pavilions for the treatment of the tuberculous insane and epileptics; also sanatoria, special hospitals; tuberculosis dispensaries and agricultural colonies for consumptives de- pendent on public charity. Med. News, Dec. 13, 1902. Tuberculosis. Supplement to Twentieth Century Practice of Medicine. William Wood & Co., Jan., 1902. The treatment and care of consumptives at their homes and the value of local sanatoria. Med. Rec., Feb. 21, 1903. A practical talk to nurses of tuberculous patients. Am. Jour. of Nurses, March, 1903. The duties of the individual and the government in the combat of tubercu- losis as a disease of the masses. Charities, March 7, 1903. The special dispensary as a factor in the combat of tuberculosis as a disease of the masses. N. Y. Med. Jour., March 28, 1903. The duties of the school teacher in the combat of tuberculosis as a disease of the masses. Am. Med., July 11, 1903. What shall we do with the consumptive who cannot leave the city during the hot season? N. Y. Med. Jour., July 18, 1903. The mental status of phthisis. Letter to Jour. Am. Med. Assn., Oct. 3, 1903. The treatment and management of post-operative tuberculous patients and a plea for the establishment of seaside sanatoria and convalescent homes. N. Y. Med. Jour., Nov. 28, 1903; Annals of Gynecol. and Pediatry, Dec., 1903. American and international congresses on tuberculosis and tuberculosis ex- hibits, 1904-1905. Am. Med.; also Med. News, Dec. 5, 1903. A multiplicity of tuberculosis congresses. N.Y. Med. Jour., Dec. 12, 1903. A plea for justice to the consumptive—a reply to recent attempts to dis- criminate against the consumptive, not only on account of his physical infirmity but also on account of his alleged mental and moral defects. Med. Rec., Jan. 2, 1904. What labor unions might do to stop the spread of tuberculosis among their members. Weekly Bull. of the Clothing Trades, Jan. 27, 1904. The psychical relation of tuberculosis. Med. Rec., Feb. 13, 1904, and April 30, 1904. Peter Dettweiler—obituary. N. Y. Med. Jour., Feb..20, 1904. APPENDIX III 483 Pulmonary consumption and the possibility of its eradication through the combined efforts of a wide government, well-trained physicians and an intelligent people. Maryland Med. Jour., March, 1904. The first tuberculosis exposition in the United States, held in Baltimore, from Jan. 25 to Feb. 1, 1904. Tuberculosis, Berlin, April, 1904. A few thoughts on the solution of the tuberculosis problem. Critic and Guide, May, 1904. : The tuberculosis epidemic among the street sweepers of the City of New York. N. Y. Med. Jour., May 14, 1904. The patient’s duty. Jour. Outdoor Life, July, 1904. . The place of the sanatorium in the prevention and treatment of tuberculosis. Bull. Vermont State Board of Health, Dec., 1903. The National Association for the Study and Prevention of Tuberculosis. Med. Rec. and N. Y. Med. Jour., July 2, 1904; also Am. Med., July 16, 1904; Zeitschr. f. Tuberk. u Heilstattenw., Bd. vi, no. 3, 1904. Hermann Brehmer and the semi-centennial celebration of Brehmer's sana- torium for the treatment of consumptives, the first institution of its kind. N. Y. Med. Jour., July 2, 1904. The modern tuberculosis dispensary. Med. Rec., July 23, 1904. How may the public school be helpful in the prevention of tuberculosis? N.Y. Med. Jour., Sept. 3, 1904. Every man’s duty regarding tuberculosis. World’s Work, Oct., 1904. The family physician as a factor in the solution of the tuberculosis problem. Jour. Am. Med. Assn., Oct. 22, 1904. Woman’s duty toward the health of the nation. N. Y. Med. Jour., Nov. 5, 1904. The problem of ventilation of our new subway. N. Y. Med. Jour., Nov. 12, 1904. A visit to the American tuberculosis exposition at Baltimore, with short re- ports of the lectures of Hoffman, Flick, Ravenel, Knopf, Adami, Welch, Huber and Osler. Zeitschr. f. Tuberk., April, 1904. Consumptive heroes. Colo. Med. Jour., Sept., 1904. Sanatoria for consumptives. Letter to N. Y. State Jour. Med., Jan., 1905. The tuberculosis problem and Mr. Henry Phipps’ philanthropy. Editorial, N. Y. Med. Jour., Jan. 21, 1905. Geheimrath Dr. Dettweiler. Eulogy pronounced on the occasion of the first J anniversary of his death. Med. Rec., Jan. 28, 1905. 7 Present status of anti-tuberculosis work in the United States. Suggestions for a more effectual codperation of authorities, philanthropists, physi- cians and laymen. Jour. Am. Med. Assn., Feb. 11, 1905. Die antituberkulose Bewegung in den Vereinigten Staaten im Anfang des Jahres, 1905. Zeitschr. f. Tuberk. u. Heilstattenw., vii, no. 1, 1905. The open air treatment at home for tuberculous patients, with a description of a window-tent and a half tent. N.Y. Med. Jour., March 4, 1905. The possible victory over the great white plague. St. Louis Courier of Med., March, 1905. 484 A HISTORY OF NATIONAL TUBERCULOSIS ASSOCIATION Elevated railways in the congested districts of the poor and its bearing on tuberculosis. Editorial N. Y. Med. Jour., March 18, 1905. The tuberculosis sit uation in prisons, with especial reference to the state prison at Sing Sing and the state prison at Columbus, Ohio. Med. Rec., May 13, 1905. Subway ventilation and its bearing on tuberculosis. Editorial, N. Y. Med. Jour., June 17, 1905. Respiratory exercises in the prevention and treatment of pulmonary tubercu- losis. Jour. Outdoor Life, July, 1905. Jewish immunity from consumption. Letter to New Era Illustrated Maga- zine, Aug., 1905. NQ The sanatorium for tuberculous patients and its medical and social mission. N. Y. Med. Jour., Oct. 21, 1905. : The treatment and care of advanced cases of pulmonary tuberculosis. Tr. Nat. Tuberc. Assn., i, 371, 1905; also Med. Rec., Nov. 18, 1905. Early clinical diagnosis of pulmonary tuberculosis. Jour. Med. Soc. of New Jersey, Nov., 1905. The first annual meeting of the National Association for the Study and Pre- vention of Tuberculosis of the United States held at Washington, D. C., May 18 and 19, 1905. Zeitschr. f. Tuberk., Band viii, no. 1, 1905. The marriage of the tuberculous and the size of the family in their bearing on the tuberculosis problem. Am. Med., Jan. 6, 1906. Heilstatten fiir tuberkulose Patienten und deren medizinische und soziale Aufgabe. Tuberculosis, Berlin, v, no. 1; and N. Y. Med. Monatsschr., Jan., 1906. The teacher’s part in the tuberculosis problem. Med. Rec., Feb. 17, 1906. Le sanatorium pour tuberculeux, sa mission medicale et sociale. Zeitschr. f. Tuberk., Band iii, no. 4, 1906. Medicine and law in relation to the alcohol, venereal! disease, and tuberculosis problem. Med. Rec., June 2, 1906. How can the physician and layman accomplish more in the fight against tu- berculosis. Brooklyn Med. Jour., June, 1906. Maxims for the selection of climate in pulmonary, laryngeal, and bone tuber- culosis. N. Y. Med. Jour., July 28, 1906. The early diagnosis and the prognosis of pulmonary tuberculosis. South. California Pract., Aug. 19; also Med. Examiner and Pract., Sept., 1906. Tuberculosis, a social disease. Jour. Am. Med. Assn., June 16, 1906; also Bull. Johns Hopkins Hosp., Dec., 1906. The home treatment of tuberculosis. Proc. 6th Annual Confer. of Sanit. Officers of the State of New York, Oct. 24, 1906; and North Am. Jour. of Homoeopathy, Sept., 1907. The tuberculosis problem in prisons and reformatories. N. Y. Med. Jour., Nov. 17, 1906. Quacks and quackeries—their blighting influence on the lives of the tubercu- lous. Some fake remedies and the harm they do—chloroform and prussic acid combined in one ‘‘cure’’—bad whiskey the basis of many nostrums. APPENDIX II 485 Proc. 32d Annual Meeting of the New Jersey San. Assn., Nov. 16 and 17, 1906; also Jour. Outdoor Life, Jan., 1907. A plea for cremation in tuberculosis and similarly infectious diseases. Jour. Am. Med. Assn., Jan. 26, 1907. Professor Joseph J. Grancher of Paris; the life story of a distinguished phy- sician. Zeitschr. f. Tuberk., Bd. ix, Heft 6, 1907. In memoriam of Professor J. J. Grancher of Paris, France, 1843-1907. N. Y. Med. Jour., Sept. 28, 1907. Aerotherapy in cold weather. N.Y. Med. Jour., May 25, 1907. The mission of the municipal and state sanatorium for the tuberculous, and the urgent need of more institutions of this kind. Texas State Jour. of Med., Dec., 1907. A war upon consumption—the duty of the citizen in the fight against tuber- culosis. Lecture before Kentucky Anti-tuberc. Assn., Louisville, Ky., Dec. 11, 1907. Some thoughts on the etiology, prophylaxis and therapeutics of laryngeal tuberculosis. Med. Rec., Feb. 22, 1908. Sun, air, and water; their use in the preservation of health and the cure of disease. Life and Health, Feb. and June, 1908. The social aspect of tuberculosis. Mobile Med. and Surg. Jour., June, 1908. A plea for more sanatoria for the consumptive poor in all stages of the disease. N. Y. Med. Jour., July 11; also Post-Graduate, July, 1908. How to adapt sanatorium methods to treatment of consumptives at their homes. N. Y. Post-Graduate, Aug., 1907; and Zeitschr. f. Tuberk., Bd. 13, H. 4, 1908. Early diagnosis of tuberculosis. St. Louis Med. Rev., Sept., 1908. The relation of the medical profession to the housing problem. Med. Rec., Sept. 12, 1908. Le sanatorium, le dispensaire et l’hopital special pour le traitement des tuber- culeux. L’Union Medicale du Canada, Aug., 1908; also Tuberculosis, Berlin, no. 9, Sept., 1908. Sunlight and tuberculous disease. N.Y. Med. Jour., Sept. 26, 1908. Explanation of seeming paradoxes in modern phthisiotherapy. Tr. Nat. Tuberc. Assn., iv, 189, 1908; also N. Y. Med. Jour., Sept. 26, 1908. The popular lecture in the crusade against tuberculosis. N. Y. Med. Jour., Oct. 31, 1908. The Red Cross in the anti-tuberculosis war—a plea for contribution through a Christmas stamp. N. Y. Med. Jour., Nov. 28, 1908. L’adaption a domicile du traitement des tuberculeux tel qu’on le preconise dans les sanatoria. L’Union Médicale du Canada, Dec., 1908. Sunlight and solartherapy in its relation to tuberculosis. Am. Med., Aug., 1908. Overcoming the predisposition to tuberculosis and the danger from infection during childhood. Med. Rec., Dec. 5, and Pediatrics, Dec., 1908. Der Internationale Tuberkulosekongress in Washington vom 21. September bis 12. Oktober, 1908. Zeitschr. f. Tuberk., Bd. 13, H. 5, 1908. 486 A HISTORY OF NATIONAL TUBERCULOSIS ASSOCIATION Die moderne Tuberkulosebekimpfung vom sozialmedizinischen Standpunkte betrachtet. N. Y. Med. Monatsschr., Dec., 1908; also Tuberculosis, Berlin, no. 6, 1909. ‘\, The responsibility of the family physician toward tuberculosis. N. Y. Med. Jour., Jan. 2, 1909. The popular lecture in the crusade against tuberculosis. Tuberculosis, Berlin, no. I, 1909. Einiges aus dem internationalen Tuberkulosekongress in Washington. N.Y. Med. Monatsschr., Feb., 1909. Moyens de defense contre la predisposition a la tuberculose et contre l’infection pendant l’enfance. Bull. méd. de Québec, Feb., 1909. A window-tent for the prevention and treatment of tuberculosis. Med. Era, May, 1909. \. The starnook and the window-tent—two devices for the rest cure in the open air and for outdoor sleeping. N. Y. Med. Jour., April 22, 1911. Tuberculosis, a preventable and curable disease, modern methods for the solution of the tuberculosis problem. 394 pages, Moffat, Yard & Co., June, 1909; second edition, 1911. Public measures in the prophylaxis of tuberculosis. Article in Klebs’ Ameri- can Treatise on General Tuberculosis. 130 pages; D. Appleton & Co., July, 1909. The hopeful outlook of the tuberculosis problem in the United States; Inter- state Med. Jour.; also Jour. Outdoor Life, Aug., 1909. Life insurance in its relation to the prevention of tuberculosis. Med. Rec., Aug. 21; also Med. Examiner and Genl. Practitioner, Aug., 1909. Tuberculosis and congestion. Pediatrics, Aug., 1909; also N. Y. Med. Jour., Sept. 4, 1909. A new type of phthisophobia. Jour. Am. Med. Assn., Sept. 25, 1909. Robert Koch—an appreciation. Jour. of Tuberc., London, Oct., 1909. oe The anti-tuberculosis war and the Red Cross Christmas stamp—an appeal. N. Y. Med. Jour., Dec. 11, 1909. What may be done to improve the hygiene of the city dweller. Med. Rec., Jan. 8, 1910. The subjective fremitus as diagnostic means and a new adjuvant in determining the localization and magnitude of the objective fremitus in chest examina- tions. N. Y. Med. Jour., Jan. 22, 1910. Der subjektive Fremitus in der Friihdiagnose der Tuberkulose und die Be- schreibung eines neuen Hilfsmittels zur besseren Erkennung und genau- eren Lokalisierung des objektiven Fremitus. Zeitschr. f. Tuberk., Bd. xv, H. 5, 1910. La tuberculose; French address before the League Anti-tuberculose de Que-: bec. L’Union Médicale du Canada, May, 1910; and Le Soleil, Quebec, May 10, I9gIo. Dr. Edward Livingston Trudeau, zum 25-jahrigen Jubilaum des Adirondack Cottage Sanitarium. Zeitschr. f. Tuberk., xv, no. 6, 1910. APPENDIX III 487 The local hospital-sanatorium as one of the most important phases in the j anti-tuberculosis crusade. Med. Rec., May 21, 1910. Robert Koch—in memoriam. Med. Rec., June 4; also N. Y. med. Monats- schr., June; Zeitschr. f. Tuberk., xvi, no. 2, 1910. Robert Koch—the passing of a pioneer. Estimates by Trudeau, Park and Knopf: Jour. Outdoor Life, July, 1910. State phthisiophilia and state phthisiophobia, with a plea for justice to the consumptive. Tr. Nat. Tuberc. Assn., vi, 139, 1910; also N. Y. Med. Jour., July 9, 1910. Edward Livingston Trudeau—an appreciation. British Jour. of Tuberc., July, 1910. The relation of modern dentistry to the tuberculosis problem. Jour. Am. Med. Assn., Aug. 13, I910. A tuberculosis sermon. Jour. Outdoor Life, Aug.; also The Messiah Pulpit, Sept., 1910. Le fremissement subjectif comme moyen de diagnostic, comme procede nouveau permettant de localiser et de determiner l’amplitude du fremisse- ment objectif dans les examens du pumon. L’Union Méd. du Canada, Dec., 1910. Licht- und schattenseiten antituberkuléser Bestrebungen in den vereinigten Staaten. Med. Monatsschr., Nov., 1910; and Zeitschr. f. Tuberk., xvii, heft 1, 1911. Memorial address on Dr. Robert Koch, by John A. Wyeth, M.D., LI.D., and S. A. Knopf, M.D. Med. Rec., Jan. 21, 1911. The hygiene of public conveyances. Med. Rec., March 18, 1911. The starnook—a new device for the rest-cure in the open air and for outdoor sleeping. Bull. Johns Hopkins Hosp., Aug., 1911. Halving the tax rate on buildings; the relation of congestion to the tubercu- losis problem. A plea for more sanatoria and tuberculosis hospitals and better tenements. Survey, Sept. 23, I9IT. Robert Koch—the father of the modern science of tuberculosis. Bull. Johns Hopkins Hosp., Dec., 1911. Primary sources of tuberculous infection; their relation to eugenics, and the cost of tuberculosis. -_N. Y. Med. Jour., June 29, 1912. The immigration of the tuberculous into the United States. A problem for every nation. Med. Rec., July 13, 1912; Bull. Am. Acad. Med., June, 1913; also Zeitschr. f. Tuberk., xix, no. 2. The relation of atmospheric air to tuberculosis. The 6th International Tu- berculosis Congress held in Washington in 1908, awarded in 1912 to this essay half of the Smithsonian Institution prize of #1500; the other half being awarded to Dr. Guy Hinsdale, of Hot Springs, Va. A revised edition of this essay is in preparation. The unjustified prejudice of tuberculous patients against sanatoria and hos- pitals. Tr. Nat. Tuberc. Assn., viii, 140, 1912; also Med. Rec., Sept. 28, 1912. Some modern medico-sociologic conceptions of the alcohol, venereal diseases, 488 A HISTORY OF NATIONAL TUBERCULOSIS ASSOCIATION and tuberculosis problems. Illinois Med. Jour., Oct., 1912; also Am. Practitioner, Feb., March and April, 1913. Tuberculosis and other diseases in schools and colleges. Open air schools and open air instruction with breathing exercises as preventive measures. N. Y. Med. Jour., Jan. 25, 1913. Some newer problems and some newer phases of the anti-tuberculosis warfare in the United States. Med. Rec., Feb. 1, 1913. Artificial pneumothorax—indications and contraindications. N. Y. Med. Jour., March 22, 1913. Euthanasia in tuberculosis. Med. Rev. of Rev., March, 1913. Discarded battleships to be used as sanatoria and open-air schools. N. Y. Med. Jour., Sept. 13, 1913. Resolutions offered to the Fourth International Congress on School Hygiene, at Buffalo, Aug. 25-30, 1913, on sanatoria for children. Med. Rev., Nov., 1913; also Zeitschr. f. Tuberk. band xxi, H. Jan. 2; Tuberculosis, Berlin, No. 9, 1913, in English, German and French. Rest and exercise for the tuberculous and the predisposed child at school; with practical demonstrations of breathing exercises and a device com- bining open air study and the window tent. Med. Rec., Nov. 15, 1913. The occupations of afebrile tuberculous patients. Med. Rec., Jan. 24, 1914. Some suggestions for a more rational solution of the tuberculosis problem in the United States. Paper read at the National Conference of Race Betterment held at Battle Creek, Mich., Jan. 8-12, 1914; Med. Rev., January, 1914; South. California Pract., Feb., 1914; also Med. Rev. of Rev., June, 1914. / A practical apparatus for the production of therapeutic pneumothorax; with some notes on the modus operandi, indications, and contra-indications. Am. Jour. Med. Sc., March, 1914. The Friedmann serum and the Society of German Sanatorium Physicians. Med. Rec. and N. Y. Med. Jour., April 16, 1914; also Jour. Outdoor Life, May, 1914. The treatment of advanced pulmonary tuberculosis. Tr. Nat. Tuberc. Assn., x, 74, 1914; also Med. Rec., Oct. 31, 1914; Tuberculosis, Berlin, no. 5, 1914. The tuberculosis nurse and the tuberculosis problem. The Nurse, July, 1914. Methodes modernes de combattre la tuberculose, maladie des masses. L’Union Medicle du Canada, Aug., 1914. The modern warfare against tuberculosis as a disease of the masses. Four- teenth annual report of the Canad. Assn. for the Prev. of Tuberc.; also N. Y. Med. Jour., Oct. 3, 1914. The health officer and the tuberculosis problem in rural communities. Med. Rec., Oct. 10, 1914. Is the modern anti-tuberculosis crusade really a failure? A reply to Dr. Thomas J. Mays’ communications. N. Y. Med. Jour., Nov. 7, 1914. Tuberculosis as a cause and result of poverty. Jour. Am. Med. Assn., Nov. 14, 1914. APPENDIX III 489 Phthisiophobia. A caution against exaggerated fear of the tuberculous. N. Y. Times, Dec. 29, 1914; also Pacific Med. Jour., Jan., 1915. Sunlight in the treatment of tuberculosis. Am. Med., Dec., 1914. The tuberculosis problem in rural communities—its modern aspect and the duty of health officers. Pub. Health Rep., Dec. 18, 1914. Ueber die Behandlung der vorgeschrittenen Lungentuberkulose. Zeitschr. f. Tuberk., Band 23, Heft 4, 1915. Tuberculosis as a social disease. Long Island Med. Jour., June, 1915. / The tuberculosis problem and section 1142 of the penal code of the State of New York. N. Y. Med. Jour., June 12, 1915. Birth control and tuberculosis. Survey, July 10, 1915. Woman’s Med. Jour., Sept., 1915. Water in the prevention and cure of tuberculosis—with a plea for public baths for old and young and swimming pools particularly in connection with public schools. Med. Rec., July 31, 1915. Dr. John Henry Huddleston—in memoriam. Med. Rec., Nov. 13, 1915. Tuberculosis infection. Woman's Med. Jour., Jan., 1916. The period of life at which infection from tuberculosis occurs most frequently. How may we diminish the frequency of those infections and prevent them from becoming tuberculous diseases? Med. Rec., Jan. 8, 1916; also Jour. of Pub. Health, Sept., 1916. Edward Livingston Trudeau—in memoriam. Jour. Am. Med. Assn., Jan. ave 1916; also Zeitschr. f. Tuberk., Jan.; British Jour. of Tuberc., April, 1916. Tuberculosis of the lungs—pathology. Article in Reference Handbook of the Medical Sciences. Wm. Wood & Co., 1916. Woman’s duty in the anti-tuberculosis crusade. Med. Rec., July 8, 1916. Woman’s duty in the combat of tuberculosis. Jour. Outdoor Life, Nov., 1916. Birth control, its medical, social, economic, and moral aspects. N. Y. Med. Jour., Nov. 18; Survey, Nov. 18, 1916; Am. Jour. of Pub. Health, Feb., 1917. 2d Edition, 1919, N. Y. Woman's Publ. Co., New York. The story of the window tent. Jour. Outdoor Life, Jan., 1917. Is there any relation between tuberculosis, mental disease, and mental de- ficiency? A plea for justice to the sane and compassion and pity for the insane consumptive. Med. Rec., Jan. 6, 1917. Constructive suggestions toward the control of tuberculosis in times of peace and in times of war. N. Y. Med. Jour., June 23, 1917. Herbert Maxon King—in memoriam. Med. Rec., July 14, 1917; also Jour. Outdoor Life, Aug., 1917. The effects of civilization on the morbidity and mortality of tuberculosis. Med. Rec., July, 1917; also Jour. Sociol. Med., Feb., 1919. What the American soldier now fighting in France should know about tu- berculosis. Med. Rec., Nov. 3, 1917; also Interstate Med. Jour., Nov., 1917; West. Med. Times, Dec., 1917; Jour. Outdoor Life, Jan., 1918; Canad. Jour. of Med. and Surgery, Feb., 1918; Trained Nurse and Hosp. Rev., Feb., 1918. The Same; pocket edition, 1918; also revised edition, 1918. 490 A HISTORY OF NATIONAL TUBERCULOSIS ASSOCIATION Ce que le soldat americain, qui combat actuallement en France, devrait savoir sur la tuberculose. L’Union Médicale du Canada, Nov., 1917. How our army in France can avoid the menace of tuberculosis. Nation, Jan. 10, 1918. Pneumonia among soldiers in camps, cantonments and at the front. Causes, prevention, treatment and after care to prevent tuberculosis. N. Y. Med. Jour., Jan. 26, 1918. “~S. The statue of Edward Livingston Trudeau. N.Y. Med. Jour., Aug. 24, 1918. La pneumonie parmi les soldats dans les camps, les cantonnements et au front— causes, prévention, traitement—précautions 4 prendre aprés la guérison. L’Union Méd. du Canada, Oct., 1918. Prevention of relapses in cases of arrested tuberculosis among soldiers and sailors. Jour. Am. Med. Assn., Feb. 22, 1919; also South. California Pract., July, 1919. Some additional notes on the prevention of relapses in cases of arrested tu- berculosis. June, 1919. : Official provision for the tuberculous soldier and what he should know about his disease. N.Y. Med. Jour., March 15, 1919. La prévention des rechutes parmi les soldats et marins gueris de la tubercu- lose. L’Union Méd. du Canada, June, 1919. The tuberculosis problem after the world war. Med. Rec., July 26; also Jour. Outdoor Life, Sept., 1919. Drug addicts and the tuberculous in one institution. Med. Rec., Aug. 16, 1919. Le probléme de la tuberculose aprés la guerre mondiale. L’Union Méd. du Canada, Sept., 1919. “NY Ideals in the treatment of tuberculosis—the ideal sanatorium, the ideal phy- sician, the ideal nurse, and the ideal patient. N.Y. Med. Jour., Oct. 18, 1919; also Jour. Outdoor Life, Feb., 1920; Am. Rev. Tuberc., April, 1920. Soy Réné Theophile Hyacinthe Laennec and the hundredth anniversary of his book on mediate auscultation. Med. Rec., Dec. 27, 1919. Sir William Osler, Bart—in memoriam. Am. Rev. of Tuberc., May, 1920. Tuberculosis and the life and work of Sir William Osler—a tribute. Brit. Jour. Tuberc., July, 1920. ‘\. The anti-tuberculosis movement in the United States prior to and since the formation of the National Tuberculosis Association. With brief tributes to its departed leaders. Med. Rec., June 26, 1920. International Association of pneumothorax artificialis. Med. Rec., Sept. 11, 1920. Major General William C. Gorgas, M.C., U. S. A..—in memoriam. Am. Rev. Tuberc., Dec., 1920. The soul of the consumptive—a plea for justice. N. Y. Med. Jour., Jan. 1, 1921; also Jour. Outdoor Life, March, 1920. The tuberculosis problem of the present day. Editorial, N. Y. Med. Jour., Jan. I, 1921. APPENDIX III 491 In memoriam—Sir William Osler, Bart. On the first anniversary of his death, Am. Med., Jan., 1921. To the sixtieth birthday of the honorary secretary of the International Anti- tuberculosis Association, Prof. Gotthold Pannwitz, M.D. Tuberculosis, International Anti-tuberculosis Association correspondence, July, 1921. A plea for the sale of Christmas seals on behalf of the anti-tuberculosis cam- paign. Med. Rec., Dec. 3, 1921; also in N. Y. Med. Jour., Dec. 21, 1921. Eugenics and euthenics in their relations to the tuberculosis problem. Med. Rec., Dec. 21, 1921. The present-day tuberculosis problem in Europe and in the United States. Med. Rec., April 22, 1922. The patient’s part in the solution of the tuberculosis problem. Jour. Outdoor Life, April, 1922. A physiological adjuvant in the rest cure of pulmonary tuberculosis. Am. Rev. Tuberc., vi, 5, 1922. INDEX No effort has been made to make an exhaustive index. The references are chiefly to persons, places, and institutions. For those who are interested in the detailed proceedings of the Asso- ciation there is available in pamphlet form a cumulative index of the Transactions covering the years 1905-1920 inclusive. 32 INDEX Adami, J. G., 28. Addams, Jane, I9. Adirondack Cottage Sanitarium, 10. See also Trudeau Sana- torium. Advanced cases, hospitals for, 9-10. Agnes Memorial Sanatorium, 438. Aiken Cottage Sanatorium, 10-11, 129. Alabama, associations and work in, 77-78. Alaska, 78. Allen, Charles L., 19. Altro Manufacturing Company, 20. American Congress for the Preven- tion of Consumption, 22-27 American Congress on Tuberculosis, 22-27. American Red Cross, 35-36, 56-62. American Review of Tuberculosis, 15-16. American Sanatorium Association, 12. Anders, H. S., 30. Anderson, A. A., 315. Andrews, Glenn, 77. Angney, W. M., 28. Animal tuberculosis, 21. Annual meetings, 157-269; Ist, 157- 161, 2nd, 162-166, 3d, 167- 171, 4th, 172-175, 5th, 176- 180, 6th, 181-186, 7th, 187— 192, 8th, 193-199, oth, 200~ 204, roth, 205-209, 11th, 210-215, 2th, 216-222, I3th, 223-231, 14th, 232- 238, 5th, 239-246, 16th, 247-258, 17th, 259-269. Arequipa Sanatorium, 463. Arizona, associations and work in, 78- 0. Arkansas, associations and work in, 80-81. Armstrong, Donald B., 49, 70, 73; biography, 416-418. Associated Tuberculosis Auxiliaries, 118. Association of Tuberculosis Clinics, 391. Associations, 34, 35, 37, 39; first, 18, 124; local, 20, 34-35; number of, 53, 407; state, 37, 44, 76-140; contracts in regard to Christmas seal, 64. See also Congresses and under name of state. Athey, Catherine R., go. Atlantic City meeting, 1904, 31. Auerbach, Murray A., 94. Auxiliaries to clinics, 13. Babcock, Po He 19, 28, 30, 369; iography, 440-442. Baker, W. W., 135. ore Baldwin, E. R., iv, 16, 68, 69, 216, 223; _ biography, 371-375. Baldwin, William Henry, 18; biog- raphy, 398-400. Baltimore Congress, 1904, 27-28. Bang, Bernard, 146, 147. Barlow, W. Jarvis, biography, 448-494. Barlow Sanatorium, 449. Barre granite workers’ survey, 134, 264-265. : Barrel, Finley, 53. Barrick, E. J., 23. Barrier, Dr., 31. Bartlett, P. Challis, 49. Beatty, T. B., 132. Becker, Joseph W., 91. Bell, Clark, 23, 24, 29, 141. Bell Congress, 24, 26, 27. Bend, Beatrice, 13. Bengoechea, Ramon, 146. Bermingham, Edward J., 12. Beyer, H. G., 34, 141, 145. Bicknell, Ernest P., 56, 58, 59, 90. Bigelow, Enos H., 70. Biggs, Hermann M.., 6, 8, 9, 12, 13, 17, 18, 28, 29, 30, 31, 141, 162, 167, 337, 344, 424; biog- ; raphy, 323-329. Billings, Frank, 19, 26, 162, 172; biography, 330-331. 495 496 Billings, John S., 13. Biographies, executives on staff, 406-— 420; honorary vice-presi- dents, 273-312; presidents, 313-392; secretaries, 402— 405; treasurers, 393-401; vice-presidents, 420-464. Bissell, Emily P., 55-56, 85. Black, John, 85. Blackburn, Miss Chauncey, 129. Blackwell’s Island Hospital, 11. Blumenthal, George, 53. Boardman, Mabel T., biography, 443-444. Boston Association for the Relief and Control of Tuberculosis, 14, 102, 103. Boston day camp, 14. Boswell, Henry, 106. Bovine tuberculosis, 21. Bowditch, Henry Ingersoll, 4, 5, 332. Bowditch, Vincent Y., 10, 12, 26, 27, 28, 30, 102, 142, 146, 176; _ biography, 332-335. Bowdoin, W. Graham, Io. Bracken, H. M., 28, 30. , Breed, D. E., 132. Brehmer, Hermann, 315. Bridge, Norman, 30. Brooklyn Bureau of Charities, Com- mittee on the Prevention of Tuberculosis, 118-119. Brown, George, 23. Brown, Lawrason, 15, 16, 17, 27, 70; biography, 456-460. Brown, Philip King, 15; biography, 463-464. Bryant, Joseph D., 18, 324, 337. Bryce, P. H., 28. Buchanan, Mrs. Bethesda Beals, 136, 137. Buckler, H. Warren, 403. Bureau of War Risk Insurance, 43. Bushnell, George E., 30, 394; biog- raphy, 295-301. California, associations and work in, 81-82. Calleja, Camilo, 146. Calmette, A., 147. Cambridge Anti-tuberculosis Associa- tion, 102. Camp Hygeia, La., 98. Camp Norwood, IIl., 92. Camp, S. Car., 128. See also Day camp. INDEX “The Campaign Against Tubercu- losis in the U. S.,’’ 148. Canfield, W. B., 10. Cass, H. M., 130. Catawba State Sanatorium, Va., 135. Cedercrantz, Conrad, 146. Chair of phthisiotherapy, 14. Chair of tuberculosis, 14. Chambers, Miss Erle, 81. Chandler, Willis E., 128. Channing Home, 9. Chapin, Charles V., 70. Chelsea Clinic Auxiliary, 13. Chestnut Hill Home for Consump- tives, 10, 124. Chicago Municipal Tuberculosis Sani- tarium, 20, 92-93, 367-368. Chicago Tuberculosis Association, 90. Chicago Tuberculosis Institute, 19- _ (20, 91-93, 367. | Chicago Visiting Nurse Association, gI. Children’s National Tuberculosis So- ciety, 41. Christian, George B., iv Christmas seal, 40, 55-66; results of sale of, 65-66; Wisconsin, 138. See also Red cross seal. Cincinnati Hospital, 11. Clark, F. A., 53. Clark-Bell congress, 24, 26, 27. Cleveland Anti-tuberculosis League, 356. Cleveland, Grover, biography, 273- 276. Climate, 92, 422. Clinics, auxiliaries to, 13, 117-118; municipal, 325; first pro- phylactic family, 356; trav- eling, 82, 104, 113, 120, 133, 139. See also Dis- pensaries. Clown, health, 42, 261. Codman, Bishop Robert, 99. Cohen, A. J., 18. Coler, Bird S., 14. Colony system, 404. Colorado, associations and work in, 83-84. Colorado School of Tuberculosis, 15. Committee on Federal Legislation, 42. Committee on Framingham Ap- praisal, 70-71; report, 71-73. Committee on Migratory Indigent Consumptive, 241-243, 251-253. INDEX Committee a Red Cross Seal, 227- 228. Committee on the History of the Na- tional Association, 253. Congresses, 22~—28, 141-151. Connecticut, associations and work in, 84-85, 429. Constitution and by-laws, 259. Cooper, George C., 315. Cooperation, 43, 51, 52, 4II. Coromilas, Lambros, 146. Cortelyou, George B., 146, 148, 149. Cosper, W. L., 33. County law, New York, 114; Ohio, 121; Pennsylvania, 125; Texas, 131. Courses in tuberculosis. See Tuber- culosis, study. Cox, Charles P., 18. Craig, F. A., 18. Cross, Ernest S., 10. Crumbine, S. J., 96. Cullis Consumptives’ Home, 9. Cuvellier, T. C., 80. Darlington, Thomas, 27. Davis, Mrs. Martha O., 110. Davis, Nathan S., I9. Day camp, first, 14. Deacon, J. Byron, 118. Dearholt, Hoyt E., 138, 139. Death rates, 76; California, 82; Chi- cago, 93; Colorado, 84; Connecticut, 85; Delaware, 86; Florida, 87; Illinois, g1; Indiana, 94; Kansas, 96; Kentucky, 97; Louisi- ana, 98; Maine, 100; Mary- land, 101; Massachusetts, 103; Michigan, 104; Min- nesota, 105; Mississippi, 107; Missouri, 108; Mon- tana, 109; Nebraska, 110; New Hampshire, 112; New Jersey, 113; New York City, 118, 327; New York state, 115-116, 327; North Carolina, 120; Pennsyl- vania, 125; Pittsburgh, 126; Rhode Island, 128; Tennessee, 131; Utah, 133: Vermont, 135; Virginia, 137; Washington, D. C.,, 86; Washington state, 137; Wisconsin, 139. DeForest, Charles M., 43. 497 Delaware, associations and work in, Dennison, Henry S., 70. Denver Tuberculosis Society, 83. Denys, Josef, 146. Detre, Laislaus, 146. Detroit Society for the Study and Prevention of Tuberculosis, 104. Devine, pecletras T., 18, 30, 31, 147, 158; biograph 0-431. Dewees, Arthur Mo wear oe Diagnosis, standards, 46. Directors. See National Tuberculosis Association. Directory of institutions and societies, 116, 148, 413. Dispensaries, by states prior to 1904, 13; number of, 53, 407. See also Clinics. Dispensary class, first, 12. District of Columbia, associations and work in, 86-87. Dobbin, Etta M., 140. Dock, George, biography, 434-435. Double-barred cross, 62, 152-154. Downes, A. D., 99. Dunbar, Saidie Orr-, 124. Easton, Ernest D., 113. Echeverria, M. J., 146. Edholm, Mrs. K. R. J., 109, 110. Edmonds, T. J., 95. Educational work, 33-34, 42. Edward Sanatorium, Naperville, III., 20, 92, 367, 369. Egan, J. A., 28. Egger, Fritz, 146. Elizabeth © McCormick Memorial Fund, 93. Elliott, J. H., 28. Employees’ Tuberculosis Relief Asso- ciation, 85. Eudowood Sanatorium, 10, IOI, 404. Evans, William A., 19, 90. Exercise, 5 Exhibits, 22, 67, 100, 145; Baltimore, 14, 420; international, 462; traveling, 33, IOI. Ex-service men, II, 123, 132, 474; workshops for, 20, I17. See also War program. Fairfield Sanatorium, Me., 99. Fake cures, 41-42. Falk, Henry L., 89. 498 Farm colony system, 404. Farmingdale Preventorium, 14. Farrand, Livingston, 17, 32, 34, 56, 61, 149, 328, 413, 414; bi- ography, 406-409. Faulkner, James P., 88. Favill, Henry B., 19, 330. Federal Board for Vocational Educa- tion, 143. Financial problems, 35-36. Finley, John H., iv. Fisk, Harvey Edward, 53. Fiske, Haley, 67. Flexner, Simon, 17. Flick, Lawrence F., 12, 16, 18, 22, 28, 29, 30, 31, 34, 67, 68, 124, 141, 142, 143, 150, 158, 162; biography, 421-427. Flint, Austin, 4. Florida, associations and work in, 87. Folks, Homer, 11, 15, 69, 176, 200, _ 334; biography, 351-354. Forchheimer, Dr., 29. Ford, William W., 28. Forestry camp, state convalescent, Wissonsin, oe Forgan, David R., Fort Bayard Hosiital, II, 470. Fort Lyon Naval Hospital, 471. Foster, Frank P., 6, 337. Foster, John P. C., 30, 84; biography, 428-42 9. Framingham Community Health and Tuberculosis Demonstra- tion, 43, 49, 67-75, 445; Committee on Appraisal, 70-71, report, 71-73. Framingham Yardsticks, 73-75. Frankel, Lee K., 68, 69; biography, 445-447. Free hospital, first, 9. Freudenthal, W., 27. Frick, Henry C., 53. Fulton, John S., 28, 30, 100, 142, 144; biography, 419-420. Gallivan, William J., 102. Garrett, Horatio W., 315. Gaylord, Mrs. E. L., 92. Gaylord Farm Sanatorium, 84, 379- 380, 429. Georgia, associations and work in, Gerhardt, William G., 4. Gichner, Joseph E., 28. Gleitzmann, Joseph W., 10 Glenn, John M., biography, 436. INDEX Goodsell-Bedell law, 338. Gorgas, Mrs. W. C., iv. Gorgas, William C., 41; 302-307. Gouverneur Hospital dispensary, 12. Gray, Ethan A., 19, 92 Greenville Association, 128. Gurgel do Amaral, Sylvino, 146. biography, Hamill, Samuel McClintock, 70. Hamman, Pou, 70, 287. Harbitz, F., 146. Harding, Werres G., biography, 308- Harkness, ‘Edward S., 53. Harriman, Mrs. J. Borden, 13. Harris, Emma Gale, 53. Hartford Sanatorium, bag Hastings, Helen M., 12 Hatfield, Charles J., 15, 18, 32, 47, 69, 142, 413, 414; biog- raphy, 410-412. Haugen, Carrie, 121. Hawaii, league and work in, 37, 89. Hayhurst, Emery R., 70. Hazelwood Sanatorium, 96. Health clown, 42, 261. Health plays, 42. Hebron Sanatorium, 99. Heise, Fred H., 15. Heiser, Victor G., 70, 126. Heliotherapy, 15. Henry Phipps Institute, 16-18, 29, 125, 423-424. See also un- der Phipps. Hernandez, Antonio, 127. Hickling, D. Percy, 152. Higginson, Henry L., 53. Hixson, R. H., 87 Hochhauser, Edward, 20. Hoffman, ae L., 30; raphy, 453-4 55. Holden, ot biography, 437- biog- Holton, Heny D., 133. Home for Consumptives, Chestnut Hill, ro, 124. Home Hospital, N. Y., 118 Hope Farm, 85. Hopkins, Leonard, 4. Hopper, Daniel W., to. Hospital for Consumptives of Mary- land, Io, 101. Hospitals. See Sanatoria. Houghteling, Mrs. James L., 19. House of the Good Samaritan, 9. Huber, John B., 27, 31. INDEX Huddleston, John H., 12, 18, 67, 68. Hurty, J. N., 23, 28, 30, 31. Idaho, associations and work in, 89- 0 90. Illinois, associations and work in, 90- 93- Illinois State Medical Society, 90. Indiana, associations and work in, 4. Indians, 109; survey, 110. Indigent migratory consumptive. See Migratory indigent con- sumptive. Institutes, 44-46, 413. International Tuberculosis Congress, 5th, Paris, 22, 34, 141. International Tuberculosis Congress, 6th, Washington, 34, 141- I5I, 420, 424; cost, 142, 150; invitation from U.S., 34, 141; lectures, 147; medal, 148; medal for san- atorium plan, 437; resolu- tions of, 149. International Tuberculosis Congress, 7th, Rome, 150. Iowa, associations and work in, 94-95. Ireland, Merritte W., 41. : Irimescu, S., 146. J. N. Adam Memorial Hospital, 15. Jackson, James, Jr., 4. Jacobi, Abraham, 18, 28, 146. Jacobs, Henry Barton, 3, 10, 28, 29, 30, 34, 100, 127, 141, 287, 424; biography, 402-405. Jacobs, Philip P., 15, 32, 48, 148, 367; biography, 413-415. Jacobsen, Joaquin L., 146. James, Walter B., 18. Janeway, Edward G., 5-6, 9, 18, 25, 28, 158, 181, 296, 314, 441; biography, 336-340. Jee, Shinfwe P. M., 146. Jones, A. W., Jr., 15. Jones, Harriet B., 137. Journal of the Outdoor Life, 15. Journal of Tuberculosis, 15. Kansas, associations and work in, 95- 6 96. Kauffman, I., 18. Kelley, Eugene R., 69. Kennaday, Paul, 28. ; Kentucky, associations and work in, 96-97. 499 Kerr, Robert B., 112. King, Herbert Maxon, Io. Kingsley, Sherman C., 19. Kinyoun, Joseph J., 28. Kitasato, Shibasaburo, 146, 147. Klebs, Arnold C., 18, 25, 28, 30, 31, 330. Knickerbacker, Mrs. H., 53. Knight, Augustus S., 68. Knopf, S. A., 13, 18, 22, 26, 27, 28, 30, 31,93, 253, 424; bibliog- raphy, 479-491. Knox, J. H. Mason, 28. Kober, George M., 157, 210; biog- raphy, 360-365. Koch, Robert, 143, 146, 315, 337. Kranz, James P., 131. Krause, A. K., 15, 16. Kress, George H., 81. Laennec’s pupil, 4. Lafinur, Luis Melian, 146. Lake Kushaqua sanatorium, I1, 337. Lambert, Alexander, 18. Landis, H. R. M., 15, 16, 18, 71, 158. Landouzy, Louis, 143, 146, 147. Larsen, Ejnar, 53. Lea, Henry C., 53. Lerrigo, Charles H., 96. Letulle, Maurice, 147. Lewis, Daniel, 23, 27, 141. Lewis, Paul A., 16, 18. Lewis-Brown Congress, 24, 27. Lewisohn, Adolph, 53. Liceaga, Eduardo, 146. Lindsay, Samuel McC., 18. Litchfield, Lawrence, 142. Local associations, 20, 34-35. Lock, J. S., 97. Loomis, Alfred, 10, 314. Loomis, H. P., 6, 18. Loomis Sanatorium, Io. Loring, Louisa F., 10. Louisiana, associations and work in, 98. Louisville Municipal Sanatorium, 96. Lowman, Mrs. John H., iv. Lowman, John H., 205; biography, 355-359- . Lyman, David R., iv, 18, 28, 239; biog- raphy, 379-381. McBrayer, L. B., 119, 120. McCormick, Cyrus, 53. McCush, Andrew J., 13. McDowell, William A., 5. 500 Macfarland, H. B., 146, 150. Mack, Julian W., 19. McKinley Memorial League, 41. McLaughlin, Allan J., 70. McMahan, Charles F., 10. Macy, V. Everit, 53. Maher, Stephen J., 69, 85. Maine, associations and work in, 99- 100. Maloney, Martin, 53. Mannheimer, George, 16. Maragliano, Prof., 29. Marcley, Walter J., 27. Marionettes, 42. Marshall, Harry Taylor, 28, 126. Marshall, Louis, 53. Maryland, -associations and work in, 14, IOO-IOI, 419, 420. Maryland Hospital for Consumptives, 10, IOI. Maryland Public Health Association, 14. Maryland State Board of Health, 14. Massachusetts, associations and work in, IOI-103. Massachusetts State Medical Society, 102. Massachusetts State Sanatorium, 11, 102. Mather, Samuel, 53. May, Francis E., 53. Mayo, Charles H., 146. Medford Sanatorium, 118. Medical service, standardization, 46. Meetings. See Annual meetings, Congresses. Metropolitan Hospital, N. Y., 11. Metropolitan Life Insurance Com- _Pany, 67-69, 445. Metropolitan Life Insurance Com- pany Sanatorium, 14. Mexicans, special secretary for, 132. Meyer, Alfred, 67, 141; biography, 461-462. Michigan, associations and work in, 103-104. Michigan State Sanatorium, 384. Michigan survey, 104. Migratory indigent consumptive, 79, 83,.113, 132; reports of committee on, 241-243, 251-253. Military examinations for pulmonary tuberculosis, 296-299. Miller, J. A., 15, 17, 117, 325; biog- : raphy, 390-392. Miller, W. McN., 108. INDEX Minnesota, associations and work in, 105-106. Minnick, James, 93. Minor, Charles L., 15, 28, 30, 69, 232, 424;_biography, 376-378. Minot, James J., 102. Mississippi, associations and work in, 106-107. Missouri, associations and work in, 107-108. Modern health crusade, 43-44, 411; Alabama, 77; Arizona, 79; Arkansas, 80; California, 82; Colorado, 83; District of Columbia, 86; Florida, 87; Idaho, 89; Iowa, 95; Kansas, 96; Missouri, 107; Montana, 109; Nevada, 110; New Hampshire, 111; New Mexico, 114; Okla- homa, 122; North Dakota, 130; Utah, 132; Wiscon- sin, 139; Wyoming, 140. Montana, associations and work in, 108-109. Montizambert, Frederick, 146. Morse, Mrs. Sara E., 109. Mortality. See Death rate. Morton, Samuel George, 4. Motion picture service, 42. Mount McGregor Sanatorium, 14. Municipal hospital, first, 11. Musser, J. H., 26. Naperville Sanatorium, 20, 92. Nashville Anti-consumption League, 130. National Association for the Study and Prevention of Tuber- culosis. See National Tu- ' berculosis Association. National Child Health Council, 51. National Health Council, 51, 411. National Tuberculosis Association, 22-66; change of name, 29; directors, 30, 157, 158, 162— 163, 164, 167, 169, 172, 173-174, 176-177, 179, 181, 185, 187-188, I90, 193, 197, 20I, 202, 205, 207- 208, 210, 212-213, 216-217, 220-221, 223-224, 229-230, 232-233, 236, 239, 244, 247, 254-255, 259-261, 266; executive office, 47-49, 266- 267; financial support, 52; government affiliations, 43; INDEX life members, 53; member- ship, 30, 53, 407; objects, 29; Officers, 1905, 30, 157, 1905/06, 160, 164, 1906/07, 169, 1907/08, 173-174, 1908/09, 179, 1909/To, 185, Ig10/II, 190, r9r1/12, 197, 1912/13, 202-203, 1913/14, 207-208, 1914/15, 212-213, 1915/16, 220-221, 1916/17, 229-230, 1917/18, 236, 1918/19, 244, 1919/20, 254-255, 1920/21, 266-267, Ig21/22, 265; organization, 47-49; programs and poli- cies, 50-52; publications, 40, 42, 476-478; relation to local associations, 34-35; resolutions, 158~159, 163, 168, 177-178, 182-184, 188— 189, 194-195, 196, 200-201, 206, 211, 217-219, 224- 226, 233-235, 240-241, 248- 251, 261-265; resolutions in regard to, 28,'29. See also Annual meetings. National White Cross League, 41. Nebraska, associations and work in, 109-II10. Negroes, 17, 77-78, 98, IOI, 120, 129, “131, 132, 135-136. Nelbach, George J., 70, 116. Nelson, Nels A., 119. Neponsit Beach Hospital for Chil- dren, 11, 337. Nevada, associations and work in, 110. New Hampshire, associations and work in, 110-112. New Jersey, associations and work in, 112-113. New Mexico, associations and work in, 113-114. New York Association for Improving the Condition of the Poor, II, 118. New York Charity Organization Soci- ety, 18-19; Committee on Prevention of Tuberculosis, 116. New York City, associations and work in, 6-9, 18-19, I116— 119, 326, 337: , New York City dispensaries, 12-13. New York City Health Department, 6-9; leaflet on consump- tion, 7. : New York Post-Graduate Medical 501 School, chair of phthisio- therapy, 14. New York School of Social Work, 413. New York Society for the Prevention and Relief of Tuberculosis, 13. New York State, associations and work in, 114-116; law op- posed to sanatoria in, 338. New York State Charities Aid Asso- ciation, Committee on Pre- vention of Tuberculosis, 114. New York State Sanatorium, Ray- brook, 115. New York Throat and Nose Hospital dispensary, 12, Newport Association for the Relief and Control of Tubercu- losis, 127. Newsholme, Arthur, 146, 147. Nichols, Estes, 99. Norfolk Anti-tuberculosis League, 135. North Carolina, associations. and work in, 119-120. North Dakota, association and work in, 120-121. Notification. See Reporting of cases. Nurses, tuberculosis, number, 53; pioneer work, 100. Seealso under name of state. Nursing service, standardization, 46. Oakdale Memorial Sanatorium, Mem- phis, 131. Oertel, Theodore Eugene, 28. Officers. See National Tuberculosis Association. Ohio, associations and work in, 121I- 122, Oklahoma, associations and work in, 122-123. Oklahoma surveys, 122. Open-air classes, New York, 117. Open-air schools, 14, 53, 93, 101, 125— 126, 128, 407. Open-air treatment, 4-5. Oranges, Anti-tuberculosis Commit- tee of the, 112. Oregon, associations and work in, 123-124. Orr-Dunbar, Saidie, 124. Osler, Lady, iv. Osler, Sir William, 3, 24, 28, 29, 30, 31, 100, 141, 403, 424; biography, 284-294. Otis, E. O., 14, 25, 27, 30, 31, 102. 502 Otisville, 12, 116. Overlock, M. G., 27. Palmer, George Thomas, 15, 90. Pannwitz, Gotthold, 147. Paracentesis thoracis, 332. Paris Congress, 34, Paterson, Robert G., 122. Pearce, Mrs. H. E., 78. Pearson, Leonard, 21, 30, 147. Pease, Herbert D., 27. Pelton, Miss G. I., 84. Pembroke Sanatorium, III. Pefiaflor, Carmelo, 126. Pennsylvania, associations and work in, 124-126. Pennsylvania Society for the Preven- tion of Tuberculosis, 18, 124-126, 424. Pennsylvania University, 16. Periodicals, 15-16. Perrysburg hospital, 15. Pershing, James H., 241, 251. Phifer, Mrs. R. S., Jr., 107. Philadelphia Protestant Episcopal City Mission, Io. Philip, R. W., 148. Philippine Islands, associations and work in, 37, ee Phipps, Henry, 16, 53, 4 Phipps Institute. See Hoe Phipps Institute. Phipps Model Tenement Houses, 424. Phipps Tuberculosis Dispensary, 423. Physician, tuberculous, forbidden practice in Oklahoma, 338— 339- Piedmont Negro State Sanatorium, Va., 135-136. Pine Breeze Sanatorium, Chatta- nooga, 131. Pioneers, 3-4, 5, 19, 21, 421. Piot, J. B., 146. Pittsburgh, Tuberculosis League of, 125-126. Platt, Henry Barston, biography, 401. Plays, health, 42. Porter, William, 30. Portland Open-Air Sanatorium, 123. Porto Rico, League and work in, 37, 127. Pottenger, F. M., 81. Pratt, Joseph H., 18. . Presbyterian Hospital auxiliary to tuberculosis clinic, 13. Presque Isle Sanatorium, 99. Preventoria, number, 53. INDEX Preventorium, first, 14. Price, Marshall L., 28, 420. Private sanatoria, first, 10. Probst, Charles O., 30, 398. Proctor, Redfield, 134. Programs, standardization, 36-37. Providence open-air school, 14. Prudden, i pokes 6, 8, 9, 18, 324, Pryor, Fone fi, 15: Public ieee ‘nursing. See under Publicity, ne wees also Exhibits. Queens County Tuberculosis Associa- tion, N. Y., 119. Quevli, Christen, biography, 450. Randolph, Agnes D., 135. Rankin, Watson S., biography, 451- 452. Raoul, W. G., 88. Raoul Foundation, 88. Rath, James A., 89. Ravenel, Mazyck P., 28, 30, 31, 193, 424; biography, 347-350. Raybrook Sanatorium, 115. Reco Manufacturing Co., 20-21. Red Cross. See American Red Cross. Red cross seal, 35-36, 55-62, 444; committee on, 227-228. See also Christmas seal. Registration. See Reporting of cases. Rehabilitation of tuberculous, 20-21. Reporting of cases, 5-9, 18, 133, 337, 420, 429. Research work, 17, 40. Resolutions. See National Tubercu- losis Association. Rey, M. Augustin, 147. Rhode Island, associations and work in, 127-128. Rice, Theodore F., 70. Richardson, C. W., 146. Richer, A. J., 28. Richland association, 128. Riis, Jacob A., 55. Riley, Thomas J., 119. Robbins, Anne Smith, 9. Robert Koch Society for the Study of Tuberculosis, 368. Robin, Albert, 86. Robinson, Mrs. Douglas, iv. Rochester, DeLancey, 158. Rockefeller, John D., 53. Rodriguez, Fermin, Jr., 146. INDEX Roosevelt, Theodore, 143, 144, 148, 150; biography, 277-283. Rosenau, M. J., 16. Routzahn, E. c., 33, 145. Rowell, George Cc. 138. Ruhrah, John, 28. Rumsey, Mrs., 13. Rush, Benjamin, 3-4. Rush’ Hospital for Consumption and Allied Diseases, 423. Russell Sage Foundation, 36, 114, 436. Rutland ee palin II, 102. Ryerson, Edwin W., 19. Sachs, Theodore B., 19, 92-93, 330; biography, 366-370. Sachs, Mrs. Theodore B., Iv. Safford, Victor, 69. Sage Foundation, 36, 114, 436. St. Joseph’s Hospital, Providence, 128. St. Louis Municipal Sanatorium, 108. St. Louis Society for the Prevention of Tuberculosis, 107-108. San Juan Sanatorium, P. R., 127. Sanatoria, free, first,9; municipal, 20, for early cases, 12, first, 11; number of, 12, 53, 407; planning, standardization, 46; private, first, 10; state, first, II. Saranac Lake. See Trudeau Sana- torium. ; Saranac Lake Reception Hospital, 373- Schiff, Jacob H., 53. Schrétter, Hermann von, 146. Sea Breeze Sanatorium, I1, 337. Sea View Hospital, 116; preven- torium, 14. Sedgwick, Hubert M., 85. Sersiron, G., 152. Sewall, Henry, 15; biography, 432- 433. Sharon Sanatorium, 10, 102, 333. Shreveport Sanatorium, 98. Sierra, L., 146. Sinks, A. E., Iol. Sixth International Tuberculosis Con- gress. See International Tuberculosis Congress, Oth. Slocum, Harold W., 135. Smith, Andrew H., 18. Smith, F. C., 69. Smith, M. M., 30. Smith, Stephen, 6, 18. 503 Smith, Theobald, 17, 28. Societies. See Associations. Soil moisture, 4. Solly, S. B., 30. South Carolina, associations and work in, 128-129. South Dakota, association and work in, 129-130. Spalding, Mrs. Keith, 367. Spear, Irving Lewis, 136. Spencer, R. V., 103. Sputum examination, by New York health department, 324; value of, 337. Standardization of diagnosis, 46; of hospital planning, 46; of medical service, 46; of nursing service, 46. State board of health, relation to state association, 97. State division of tuberculosis, first, 121. State sanatoria, first, II. Staten Island hospital, 116; preven- torium, 14. Statistics, 53, 407; Alabama, 77; California, 82; Connec- ticut,, 85; Georgia, 88; Idaho, 90; Illinois, 91; Indiana, 94; Iowa, 95; Kansas, 96; Kentucky, 97; Maryland, 101; Massa- chusetts, 103; Michigan, 104; Minnesota, 105; Mis- sissippi, 106; Missouri, 108; Montana, 109; Nebraska, 109; New Hampshire, 111; New Jersey, 112; New Mexico, 114; New York State, 115; North Carolina, 120; North Dakota, 120; Ohio, 121; Oklahoma, 122- 123; Oregon, 123-124; Pennsylvania, 124; Philip- pine Islands, 126; Porto Rico, 127; Rhode Island, 128; South Carolina, 129; South Dakota, 130; Ten- nessee, I31; Texas, 132; Utah, 133; Vermont, 134; Virginia, 135; Washington state, 136-137, 450; West Virginia, 138; Wisconsin, . 139. Stella, Antonio, 146. Sternberg, George M., 29, 30, 196, 424; biography, 393-397. 504 Sternberg, Mrs. George M., iv. Stewart, Alice E., 126. Stewart, Helen R., 70. Stewart, James, 107. Stone, Arthur K. , 69. Stone, Ellen R., 14. Stony Wold Sanatorium, II, 337. Storey, Thomas A., 70. Straight, Mrs. Willard, 13. Straus, Nathan, 14, 326, Strawson, A. J., 90. Strong, Richard P., 126. Surveys, Barre granite workers’, 134, 264-265; Michigan, 104; yaaa 122; Wyoming, Swift, L. Fs ‘53 Sydenstricker, Edgar T., 70. Tate-Thompson, Mrs. E. L. M., 81- 82. Taylor, H. Longstreet, 105. Tendeloo, N. Ph., 146, 147. Tennessee, associations and work in, 130-131. Tennessee Colored Anti-tuberculosis Society, 131. Terra Alta State Sanatorium, West Va., 137. Texas, associations and work in, 131- 132. Thayer, William S., 28, 100, 296. Thomas, Samuel Bell, 23. Thompson, Mrs.E.L.M.Tate-, 81-82. Thurber, Walter D., 100. Tombs, John, 15. Traveling clinics, 82, 104, 113, 120, 133, 139. | Trudeau, Edward Livingston, 10, 12, 28, 29, 30, 31, 143, 158, 160, 372-373, 390, 424; biog- raphy, 313-322. Trudeau Sanatorium, 316, 372. See also Adirondack Cottage Sanitarium. Trudeau School of Tuberculosis, 15, 319. Tubercle bacillus, isolated by Tru- eau, 315. Tuberculin, Koch’s, first therapeutic use, 428. Tuberculin tests, 21. Tuberculosis, communicability, 5-9, 337, 422; diet, 438; study of, 14-15, 16, 42, 125. Tuberculosis Christmas seal. See INDEX Christmas seal; Red cross seal. Tuberculosis Sunday, 42. Tuberculosis week, 42. Tufts College Medical School, chair of tuberculosis, 14. Twombly, Ruth, 13. Ufford, Walter S., 87. Ulloa, Juan J., 146. United States Army, 467-471. United States Army General Hospi- on Fort Bayard, N. M., I, 470. United Sites Navy, 471-472. United States Public Health Service, 43, 126, 127, 133, 472-475; Surgeon General, 70. United States Public Health Service Hospital, Fort Stanton, N. M., 11. Utah, association and work i in, 132- 133. Vargas, Andres Martinez, 147. Vaughan, Victor C., Jr., 103, 247; biography, 382-385. Veeder, Borden S., 16. Vermont, asssociations and work in, 133-135- Vermont Sanatorium, Pittsford, 133- 134. Virginia, associations and work in, 135-1306. von Ruck, Carl, 15. Wallingford Sanatorium, 84. Wallis, James H., 133. Walsh, Joseph, 142. Wanamaker, Rodman, 53. Wanzer, Mrs. E. P., 129-130. War program, 40-41, 467-475. Warburg, Felix M., 53. Warrensville Sanatorium, 356. Washington, associations and work in, % 136-137, 450. Washington Congress. See Inier- national Tuberculosis Con- gress, Oth. Washington, D. C. See District of Columbia. Webb, Gerald B., 15, 259, 469; biog- raphy, 386-389. Webster, George W., I9. Welch, William H., 17, 28, 29, 30, 34, INDEX 505 141, He ees 187, 420, 424; biography, 341-346. Welliver, Judson co fi pone Wells, Gideon, 17. Werle, Theodore J., 104. West Virginia, association and work in, 137-138. Wharton, A. S., 103. White Haven Sanatorium, 423. White, William Charles, 18, 69, 126. Wild, William F., 106. Wildwood Sanatorium, Hartford, 84. Williams, C. Theodore, 143, 147. Wilson, Alexander M., 19. Wing, Frank E., 90, 93. Winnebago Indians, survey, I10. Winslow, C.-E. A., 70. Wisconsin, association and work in, 138-139. Wisconsin University, 139. Wisner, Mrs. Mathilda Janeway, iv. Wladimiroff, A., 146, 147. Woodward, William C., 152. Woolley, Paul G., 146. Working girls, sanatorium for, 463., Workshops, 20-21, 117. Wyman, Walter, 30, 147. Wyoming, association and work in, 140. Wyoming surveys, 140. Young, A. G., 99. Young, W. A., 28.