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BULLETIN REEDUCATION 
 
 No. 32 Scries No. f, 
 
 The 
 
 Agricultural and Industrial 
 
 Community for Arrested 
 
 Cases of Tuberculosis and 
 
 Their Families 
 
 V 
 
 A STUDY 
 
 JUNE 
 1919 
 
 Issued by the 
 
 FEDERAL BOARD FOR VOCATIONAL EDUCATION 
 
 WASHINGTON 
 
 WASHINGTON [GOVERNMENT PaiHTINQ OFFICE : MM 
 
FEDERAL BOARD FOR VOCATIONAL EDUCATION. 
 
 MEMBERS. 
 
 David F. IIoistox, CJiairmon, 
 
 Secretary of Afjriculture. 
 William C. Ricdfield, 
 
 Secretary of Commerce. 
 William B. Wilson, 
 
 Secretary of Labor. 
 P. P. Claxton, 
 
 Commissioner of Education. 
 
 Jamks p. Mwnuok, Vi^-e Cli<iir)iian, 
 Manufacture and Coiiimcrce. 
 
 Calvin F. McIntosh, 
 Agriculture. 
 
 Abthl-r E. Holdkr, 
 Labor. 
 
 EXECUTIVE STAFF. 
 
 C. A. Pnossun?, Director. 
 Layton S. Uawkins, Chief Vocational Educational Division. 
 Chmilks H. Winslow, Chief Research Division. 
 H. L. Smith, Chief Rehabilitation Division. 
 L. H. Carris, Assistant Chief Vocational Edncation Diinsion. 
 W. G. Hummel, Agricnltnral Education. 
 F. G. Nichols, Commercial Education. 
 Anna E. Richardson, Home Economics Education. 
 J. C. Wright, Trade and Industrial Education. 
 
 (2) 
 

 FOREWORD. 
 
 At the very outset of its work with the (lis(;liai-^(Ml clisiil>led solfliers 
 afflicted with tubcrcidosis the Federal Board Tecognized that the 
 problem of reeducation and placement in employment of these men 
 is one that requires the best expert advice and assistance, which tlie 
 country affords. In order to provide this the National Tuberculosis 
 Association was requested to detail to the office of the Federal Board 
 its field secretary, Dr. H. A. Pattison, who has been giving his entire 
 attention to this phase of the work of the Board under the vocational 
 rehabilitation act. 
 
 To direct and assist in the discharge of this responsibility an advi- 
 sory committee of persons of long experience and national reputa- 
 tion in the field of tuberculosis was appointed, all of whose members 
 have given of their services with enthusiasm. The members of this 
 advisory committee appointed by the National Tuberculosis Asso- 
 ciation are: Fred M. Stein, chairman; W. H. Baldwin, Dr. H. M. 
 Biggs, Dr. Vincent Y. Bowditch, Col. George E. Bushnell, Dr. 
 Charles J. Hatfield, Dr. A. J. Lanza, Dr. David R. Lyman, Dr. 
 James A. Miller, Mr. Douglas McMurtrie, and Dr. George M. Price. 
 
 Any study of the problems relating to the campaign against tuber- 
 culosis inevitably leads to a consideration of the colony as a possible, 
 and perhaps necessary, part of the campaign. The study as presented 
 here was made under the direction of the Advisory Committee to the 
 Federal Board, which committee passed the following resolution : 
 
 That it is the sense of the Advisory Committee that the plan for 
 an industrial conmiunity for tuberculous people who are able to work 
 is replete with interest and deserves further study. It is recom- 
 mended that the plan be published and that discussion be invited 
 from all agencies interested in the subject. 
 
 Criticisms, opinions, or suggestions will be veiy much appreciated 
 and should be sent to the National Tuberculosis Association, 381 
 Fourth Avenue, New York City, or to the Federal Board for Voca- 
 tional Education, Washington, D. C. 
 
 C. A. Peosser, Director. 
 (3) 
 
THE AGRICULTURAL AND INDUSTRIAL COMMUNITY FOR ARRESTED CASES 
 OF TUBERCULOSIS AND THEIR FAMILIES. 
 
 i'.y J I. A. J'Ai-iJ.soN, M. I). 
 
 [lasiiod under direction of tho Advisory Committee of tlio National Tu^)orcuIofjl8 Ahso- 
 cialion as a contribution to the study of liiobloma relating to the reiiahilltation of the 
 tuberculous.] 
 
 Within the past 10 years a number of investigations have been 
 made of the conditions — physical, industrial, and social — of patients 
 Vidio have undergone treatment for tiil)crculosis in sanatoria. The 
 end in view has been tO' secure first-hand, accurate knowledge of their 
 physical condition within a certain number of years after discharge 
 as compared with their condition on discharge, their living condi- 
 tions, their earning power, employment and its conditions, the ex- 
 pectations of health and life after discharge, the general value of 
 sanatorium treatment, and tlie uncovering of weaknesses in pres:ent 
 methods. (See Appendix.) 
 
 The evidence is overwhelming that the campaign against tubercu- 
 losis has not yet developed adequate plans and facilities for the post- 
 sanatorimn treatment of j^atients. It is being more and more clearly 
 established that it is the environment of the sanatorium graduate 
 and his method of spending his time after working hours that most 
 frequently determine his fat© rather than the work itself, ^^^lile in 
 the sanatorium it is comparatively easy to follow the prescribed 
 regimen. All patients are doing the same things. Even the physi- 
 cians, nurses, and other employees conform to many of the rules laid 
 down for the guidance of the patients. Often the nurses, physicians, 
 and employees have themselves had active tuberculosis, and there is, 
 therefore, a sympathetic understanding between the two groups. 
 But when the patient returns to his home he is a man apart if he 
 continues to live as he lived in the institution. Unless his family is 
 an exceptional one the family life will not be adapted to the man ; he 
 must adapt himself to the life of his family. He wants to partici- 
 pate in the activities his friends enjoy. It may be "movies," card 
 parties, dances, picnics, tramping trips, bowling, baseball, or what 
 not, but nearly all involve the element of contest, and the recently 
 arrested case of tuberculosis can not safely compete with his sound 
 companions. The almost inevitable result is reactivation of the 
 disease. 
 
 If he could work and mingle with men in like condition when he 
 leaves the sanatorium his chances for permanent arrest would be 
 
 (5) 
 
greatly iucrcased. The months and sometimes the years required 
 to bring about permanent arrest must be oaivfully guarded. The 
 ■work, the rest, the phiy, the whole daily round nuist be so arranged 
 as to contribute to the establislunent of a s-ound health. The value 
 of commingling of quic.sccnt rases is demonstrated at Saranac Lake 
 where so many have remained and entered the commercial and ci\'ic 
 life of the village. Tuberculous men and women who have lived 
 comfortably, prosperousl}', and happily for from 1 to 25 years are 
 found there. Tlie doctor, nurse, architect, tity engineer, public 
 stenographer, i>hotographer, jeweler, liveryman, ehauil'eur, waitress, 
 tailor, clerk, and merchanl. have worked out their physical and 
 economic salvation, iluch the same thing is observed at Colorado 
 Springs, Albuqner<iue, and Phoenix. 
 
 !Many men and "women arc able to resume their former occupations 
 if their surroundings are hygienically favorable. The particular 
 position or job which was hold is often the cause of breakdown, and 
 not the occupation as such. Some can regain their health only l)y 
 finding entirely new vocations. Practically all, however, require 
 part-time work under medical and nursing supervision in a well- 
 chosen environment until they are hardened up to do a full day's 
 work every day. There is at present little provision for such " in- 
 dustrial convalescence." The sanatoria themselves offer a few open- 
 ings for their ex-patients, but these provide for a very small per- 
 centage. The garment shop of the Committee for the Care of the 
 Jewish Tubercidous is consj^icuous alike for its success and its lone- 
 liness in the field. Similar shops should be established in other 
 large cities. 
 
 But there would still remain a group that needed different treat- 
 ment. If tuberculosis is, as some one has put it, " a disease of wages," 
 it is also a disease of congested areas. There can be no question that 
 many thousands of tubercidous people and their families would be 
 vastly better off in suitable rural regions. Their children, almost 
 always infected, would have a better chance to halt successfully the 
 growth of implanted germs. , 
 
 For years past the literature of tuberculosis has contained refer- 
 ences to the need of some sort of "colony" in which sanatorium 
 graduates might find the environment needed to restore the fullest 
 measure of liealth. At first the references indicated a vague groping 
 for a solution of problems not fully comprehended. The earliest 
 thought was of the agricultural colony, but it was soon realized that 
 the farm alone was not sufficient. The urban dweller has little 
 inclination to till the soil; nor is it easy for the substandard man to 
 learn a vocation so wholly new as fanning. Then, too, experienee 
 has proved that many tuberculous people get on better in factories 
 than out of doors, and very much better in sedentary clerical posi- 
 
tions than in factories. This of course in not hocausc outdoor life 
 is not in itself more desirable and more bcnencial than indoor life, 
 but because most outdoor occupations require severe physical exer- 
 tion, and often subjccjt the worlcer to undue exposure to lieavy rains, 
 extremes of heat and cold, strong winds, etc. Hence diversified 
 occupations must be available and the trend of opinion has been 
 directed toward the coml)incd indiistrinl and agricidtiiral community. 
 
 It is interesting- to follow the development of ideas. I sliall refer 
 only briefly in the text of this bulletin, however, to the literature 
 on the subject. Those who are particularly interested will fmd in 
 the appendix extracts from reports, magazines, and books. 
 
 In 1908 Dr. A. M. Forster put theory into practice by providing 
 supervised farm work at Eudowood for selected cases. The scheme 
 has been continued under Dr. M. F. Sloan and has been successful 
 medically and economically. The work has consisted in hotbed 
 planting, transplanting, gathering, and assorting vegetables; can- 
 ning; poultry, hog, sheep, and rabbit raising; berrying and fruit 
 culture ; grain raising, silo filling, dairying, and repairing buildings 
 and fences. 
 
 It seems a misnomer, however, to call this development a " colony," 
 for during the 10 years previous to 1918 but 120 patients had re- 
 ceived this saipplementary treatment. It is rather a department or 
 adjunct of a well-rounded sanatorium project, and an example which 
 many other superintendents and trustees might well emulate. 
 
 At the sixth annual meeting of the National Tuberculosis Asso- 
 ciation Dr. Forster, discussing aftercare, remarked that " in conjunc- 
 tion with sanatoria and hospitals there should be developed colonies 
 where cases may, to a large extent, continue under the advantages of 
 institutional care, and at the same time be either entirely or largely 
 self-supporting." During the same discussion. Dr. H. Holbrook 
 Curtis said : 
 
 I have no trouble in tliinklug of what to do with patients who are to be 
 cured ; but I find that there is no provision made In any sanatorium with which 
 I am connected, or ever heard of, as to what the patient should do for liimself 
 after he left. It is my opinion that farms should be established and these 
 farms should be supported by the State. 
 
 Again, at the eighth annual meeting of the National Tuberculosis 
 Association, Dr. Forster, discussing a paper, remarlvs that — 
 
 Dr. Vogeler, in one of his conclusions, says that the farm colony idea is im- 
 practicable. I am not sure by what subtle means of deduction he has reached 
 that conclusion. I do not believe that he has tried the farm colony or that he 
 can cite any case Avhere the farm colony has failed. I think he is putting the 
 case a little too strongly. At Eudowood, where the farm colony idea lias been 
 A'cry carefully worked out and put into practice, I believe the opinion is that 
 during the six years of its existence it has been highly sticcessfuL 
 
 Another of Dr. Yogeler's objections is that we can not get city people to work 
 in the country. He should go further and explain just why you can not get city 
 
8 
 
 pooplo to work in the (ouiury. Various e(T<irts it> iiisiituto a iiuivoiuont luit-k to 
 the laiul liave I'aileil lar^^oly tlirouirh hick of syiupatlu'tio appreciation of the 
 point of view of the city slum tlwellc-r. As I pointed out in the pai)er to wliicli 
 Dr. Voyeler has referred, it is out of the qiu'stion to loolc for success where you 
 take tlie city ilweller into tlie country and tliere leave liini unaided to work out 
 the problems «>f his new environment. 
 
 However visionary our ideas nuiy be as to the merits of agriculture as a 
 permanent form of employment, there can he no arjjument as to the value of the 
 farm colony as a means of prolonging the term of treatment. With the present 
 cost of sanatorium treatment it is not justifiable to keep patients in idleness 
 after they are in physical condition to do some labor. 
 
 At the first annual meeting of the national association. Dr. Herbert 
 HuxonKing had thought further than the fann colony for a solution 
 of the prolileni, but nieroh' speculated "on the results "which could be 
 obtained, theoretically at least, in the ideal sanatorium with pro- 
 vision for industrial features."^ 
 
 Dr. S. Adolphus Knoi)f suggested, in 1912, '' intermediate stations " 
 where the recovered tuberculous patient could find work with which 
 he is familiar. (Api^endix.) 
 
 Dr. Charles F. Bolduan at the tenth annual meeting remarked : 
 
 Industrial colonies in the country, open-air factories in the cities, cooperation 
 with those providing outdoor employn)ent — all have carefully to be considered, 
 and probably all will have to be utilized to meet this great need. 
 
 Discussing Dr. Bolduan's paper. Dr. F. H. Heise, of Trudeau, said : 
 
 When you consider that the tuberculous patient, and especially the poor 
 tuberculous patient with a family, is one of the hardest things on earth to keep 
 isolated — that is, to keep away from his family and friends — you realize that 
 if you want to get right down to the bottom of it you have to provide for the 
 patient and make some provision for the family who are close to him. Probably 
 this might take the form of industrial colonies where the patient could main- 
 tain himself and where the family could be employed to help maintain them- 
 selves. A company at Saranac Lake at the present time has awarded a prize 
 of .$500 for s<mie method of solving such a problem; that is, of giving employ- 
 ment to the tul)erculous patient after he has left the sanatorium, to make him 
 happy and comfortable, and give him a chance to carry out the treatment that 
 he knows he needs and ought to take. 
 
 The "World TVar has stimulated interest in the colony idea for dis- 
 abled soldiers and sailors, particularly in England, and there has 
 appeared a rather extensive literature, as will be seen by reference to 
 the appendix. I would direct attention, however, particularly to a 
 statement by the commissioner of immigration at the port of New 
 York, who says : 
 
 All of the warring countries are emphasizing the necessity of returning the 
 soldiers to the land. In England, Australia, and Canada the farm colony is 
 
 1 Such an institution, let us say, should consist of three main divisions, infirmary, 
 pavilion, and industrial doparlment, the first two forming complete units each, the last 
 divided into as many distinct units as there are branches of industries undertaken. For 
 instance, agriculture in its various l)i-unclifs ; stock -raisins', includin}? poultry farming, hoe 
 culture, etc. ; ciTtaln manufacturing industries, and the administration of the institution 
 itself in its various phases. (Dr. II. M. King.) 
 
9 
 
 being (lovclopod. I*l\perl« liave ,suI)iniU(;(l Uiat tlio Koldicr will not. t;il<t; up an 
 unbroken piece of land iMolat(!d from iils fellows. Official commissions in Kn^j- 
 land and Australia are developing plans by which the St:al:e will kcII 1o the 
 returning sol<li<H'S ready-rnad*; fiirniK of lioni .'*. t,o 30 acres which one inini cim 
 cultivate. Fiirnis are grouix-d iis ii <'oniiriun]l.y with cducationiil, rcfi-f-ntional, 
 and cooperative agencies lor marketing and buying. Men are sold funns witli 
 a house, barn, and sumci(>nl; capital on onsy terms, tlur State (idvancjng nine- 
 tenths of tlie capital to be repaid on long-term installments. 'J'lie oxiterience of 
 Australia and of Denmark dem(mstratos the success of this jdari. In the Unified 
 States such colonies should be located iu New Kngland, the Southern, Central, 
 and Western States, eacli adjusted to a special kind of farming. 
 
 Attention is also directed to the opinion of P. C. Varrier-Joncs, 
 who has made the Papworth Hall Colony for the Tuberculous a 
 
 success : 
 
 What is the remedy? What but to graft on to our existing sanatoria the 
 colony principle of employing patients at their own or allied trades. 
 
 There is not the slightest doubt that soldiers will stay in a village com- 
 munity, always provided that the amenities of life ai"e there. Social surround- 
 ings, healthy environment, steady, and not too laborious work, freedom of con- 
 science, home life remodeled on sound, healthy lines, all these things should be 
 within their reach. 
 
 The scheme is an ambitious one, but this is the day of gi'eat enterprises. We 
 hear a good deal about the establishment of village communities for disabled 
 men. For no class of the disabled is a life sheltered, and yet active, protected 
 and yet self-respecting, so necessary as for the tuberculous. The man who has 
 suffered the loss of a limb, or the loss of sight, may still ilnd a place in his old 
 surroundings, if properly assisted and trained; the man suffering from shell 
 shock may need long convalescent treatment away from the stress of town life, 
 but eventually he will probably be able to resume his old occupation ; the con- 
 sumptive, alone, if seriously attacked by disease, can never hope for even a 
 modicum of health and strength in crowded streets and ordinary workshops ; 
 the consumptive alone, of all this sad procession of broken lives, can never 
 return to normal conditions without endangering his family and his fellow- 
 workmen, without involving not only himself but others in disaster. 
 
 Let communities be started iu which our consumptive soldier can live in Ms 
 own home, shielded from the fierce competition of the outside world, a self- 
 respecting worker, an economic asset. Let employment be found, the model 
 fnctory erected, the hours of toil properly regulated, a fair wage paid. In such 
 villages his children can be carefully protected from infection by open-air 
 schools supervised by a competent health-visiting staff. The man's leisure 
 hours can be made glad by recreation arranged by the colonists' own committee, 
 and his life agreeably spent. "A mere Utopian dream," they say, " and how do 
 you knoM' that the consumptive ex-soldier will submit even to such conditions?" 
 I say that he has already done so, that requests for admission to the Papworth 
 Colony now far exceed the accommodation. " In that case," the critic answers, 
 " the demand will always be greater than you can possibly meet." The demand 
 is great. Is that a reason why we should not try to meet it? We sincerely 
 want to do well by these men; shall we stop at wanting, and put forward no 
 practical solution? "But the expense will be ruinous!" So is the evil; so too 
 the cost of the eviL 
 
 If one village community of this kind can be slioicn to carry icithin it the 
 germ of success, the idea will surely fructify and similar communities iQill 
 118663°— 19 2 
 
10 
 
 spnH*; up lOU-ttd ccH^tinff »o*uiti>ria (»• in other suitable spots. A. large wuntry 
 l^uus4.>, suiToiuwlod by gtiriit'iis aiul gmssliiuiLs, as at I'apworrh, form.s em oxofl- 
 leut nucleus, and sm-h houses ofu«i <'oino into the market la these days of 
 fhuuyo. The viUufe'e c-nn to a hir^'e extent be built by the colonists themselves. 
 They iK'j^iu l>y buildini? shelter.s, ihey may go on to buiUling cottages — sijecially 
 tlesigntnl slieltera and cottages; and then to makii»g the furni(ur>> for thase 
 slielters uiul cottages. The joy <>f so«'hjg \iseful and beautiful things gnnving 
 untler thv4r liands, the developnuiit of uiusvle and vitality which cohk's wiLh 
 work carritHl out without fatigue, ihe clieerful surroundings, the senst' of com- 
 radeship; and, best of all, tin" prosix'ct of a return to a happy family life, are 
 most powerful aids to nature in driving out the ravager, where tliis is still 
 possibh>, or in limiting his ravages when he is too securely entrenched to l>i> 
 dislodged. 
 
 Examination of the literature will indicate that no one ha.s pre- 
 senteil any ver^' concrete plan or program for a complete village Avith 
 the exception of one man in this country and one in P^.ngland. The 
 former is Dr. Bayard T. Crane, president of the Kiithiiid Private 
 Sanatorium Association. This association is composed of doctors, 
 nurses, and majiagtrs of eight private sanatoria and boarding houses 
 in Jutland, Mass. Tt is not a stock company, hut is incori>orated under 
 the laws of Massachusetts as a charitable and bene\olent associatioji, 
 not for profit. It is under the jurisdiction of the State board of Chari- 
 ties and is supported by voluntary contributions. 
 
 The association owns 00 acres of arable and wooded land upoa 
 "which are a farmhouse, barn, and some stock, dairy, and farm impl(^- 
 ments. A rcsddontial. recreation, and workshop building, 00 by 85 
 feet, has been built and partially equipped. On the first floor there 
 is an office and gift shop; a large recreation room with an adjoining 
 workroom which may l)e combined into an auditorium seating al)()Ut 
 200 people, and there is also a large glassed-in porcli. The basement 
 contains the heating plant, storage room, and carpenter shop, and also 
 a pottery glazing equipment. The third floor has a complete house- 
 keeping arrangement with living quarters for eight men. There are 
 separate apartments for the matron and cook. There is also a library 
 with 500 volumes. Effort is made to ]irovide for remunerative occu- 
 pation either for aiTested cases or members of their families. The 
 matron's husband, for example, is a patient, and another patient's 
 daughter acts as secretary and stenographer. !Men who reside in this 
 buihling are all ar)'ested cases and receive remuneration for the work 
 they do, and all nonresident patients who are able to work more than 
 10 hours a week are paid. 
 
 At present the work done in this building is chiefl)' occupational 
 therapy — weaving, ba.sketrj', pottery, etc. An autobus owned by the 
 
 Note. — " Tt is kinder to the returned tuberculous s<ildier and better for the 
 cnmmunity that whenever po.ssihlc he shoiild be given i'very facility to earn his 
 living and taught a trade if rifce.ssary. Tiu^ vilhiirc coinniuiiity sy.'^tem appeals 
 to present several advantages for this purpose." ( From an editorial in the 
 Journal of the American Medical Association, Feb. 8, 1919.) 
 
11 
 
 association brings from the various sanatoria in tlio town lliose 
 patients that arc able to take this form of therapy. 
 
 Last snnnrn^r alxmt 40 ao'os wci'c inuler cnltivati<Hj, and a con- 
 sideral)le anioiuit of the work was done by tlie patients. 
 
 No direct charges arc nisuhi to the patients for the benefits of this 
 plan. The privilege is <ij)en to about 90 nonresident patients in the 
 town. Some bedside instruction is also given in the corLstitueut 
 sanatoria. 
 
 On contiguous property a sanatorium for 125 patients is under 
 construction by the Central New England Sanatorium (Inc.), also 
 a corporation not for ]:)rofit. This sanatorium is equipped tf> main- 
 tain a sanatorium essentially for middle-class or wagtveai'iiing men 
 and women of limited means who will pay a certain part of the per 
 capita cost. It is planii.ed to provide under model conditions physical 
 and medical care of a particularly fine character. 
 
 The Crane plan, however, does not, I apprehend, contemplate a 
 complete and distinct community unit. The colony is in and a part of 
 the village of Rutland. 
 
 The celebrated British landscape architect and planner of estates 
 and cities, Thomas H. Mawson, has presented a plan for " Industrial 
 villages for partially disabled soldiers and sailoi^ " in a book en- 
 titled "An Imperial Obligation." (See appendix.) 
 
 Industrial communities have developed rapidly in this country. 
 Many of them have grown about a single industry for the sake of that 
 industry, such as a steel mill, coal or mineral mine, etc. The converse 
 proposition is the one I wish to offer — the develoyrrhent of industries 
 around a GOTnmunity for the sake of thai' community^ whidi is to be 
 made up chiefly of arrested cases of tuberculosis among soldiers, sail- 
 ors, and civilians. Those soldiers and sailors who are substandard 
 physically because of other forms of disability than tuberculosis 
 would not be debarred, but the totally disabled epileptic or mentally 
 deranged could not be received. There would also Ije perfectly well 
 people occupying executive positions or placed in jobs such as were 
 required to keep processes going. 
 
 This piX)position is an ambitious scheme which one might well 
 approach with trepidation, but I have nevertheless addressed myself 
 to the absorbing task of suggesting the main features of a plan. 
 
 The community should be complete within itself, yet of course, 
 and necessarily, in immediate touch with other neighboring villages 
 and cities. 
 
 Topographically it should be well situated upon elevated, hilly 
 ground with several acres of woodland, and, if possible, with an 
 active but small river winding through it. The tract should be 
 located within 100 or 200 miles of some large city and not in an iso- 
 lated corner of a far- western State. Pioneering has been fatal to 
 
12 
 
 some colony projects uiul ulinost certainly woiikl be disastrous to this 
 one. It should be upon a line of railroad and preferably a main line, 
 with ready accossibility to raw materials and markets. 
 
 The villa<;e proper should be laid out acoordin*^ to modern ideas 
 of town planning to care for live or six liiindrcd p()i)ulation almost 
 immediately. Avilli possibilities for expansion to 4,000. Its <x<*'^f'i'!d 
 features, in my opinion, should conform to those of other Amcrii-an 
 towns, rather than to English garden cities. "^Miile the homes should 
 be diverse in design, the architectural tout ensemble should be harmo- 
 nious and artistic. In this it would ditVcr decidedly from the ordi- 
 nary American communities which lune grown without phin or fore- 
 Ihought. It would differ likewise, in that its water sui)ply and 
 sewerage system would bo modern and complete from the standpoint 
 of sanitary engineering. 
 
 The department of health should be model in every respect and be 
 given a j^lace of honor coecjual in importance with the industrial 
 phases of the community. Conservation and restoration of man 
 jjower would be given first consideration. 
 
 There would be <liagnostic, j)athological, and research laboratories. 
 The director of the department would be given as many medical 
 assistants and public health nurses as the growth of the community 
 required. Every person (man, Avoman, or child) who came to take 
 up residence would be given a complete physical examination, in- 
 cluding steroscopic chest plates and biologic tests. Periodic reex- 
 eminations and special examinations when indicated by the appear- 
 ance of symptoms would preserve a life history of the " human ma- 
 chine," making it possible to reduce greatly the morbidity and mor- 
 tality rates in comi^arison with other industrial towns of like size. 
 
 Under such conditions an unusual opportunity would be ofl'ered 
 for the development and application of psychological, trade, effi- 
 ciency, and fatigue tests. 
 
 The population would be drawn largely from the sanatoria of 
 neighboring states. If located near New York City, for example, 
 there are about 140 sanatoria in New York, New Jersey, Pennsyl- 
 vania, and Maryland from which to draw cases. There were be- 
 tween liO.OOO and 25.000 admissions to these sanatoria in 1917, and 
 presumably about an equal number of discharges. There are also 
 many tuberculous people in our cities who for one reason or another 
 can not be given sanatorium tieatment, yet who could avail them- 
 selves of the opportunities offered in a colony for part-time employ- 
 ment under medical supervision. Several sanatorium superinten- 
 dents with whom the colony idea has been discussed are strongly 
 of the opinion that there would be a constant waiting list of those 
 wanting residence. 
 
13 
 
 Wliilc the populiitioji must Ijc drawn from many sanaU^ria and 
 dispensaries, a sanatorium should be built in or near the village. 
 The community sanatorinni woidd l)e phmrKMl to ('m})ody the licst 
 ideas in construction and management. There is now under 
 way a movement to classify sanatoria according to certain 
 standards of cni(;icncy. Tl)is new sanaloi-ium Avonld he plannerl 
 to represent tlie liigliest ])rcsent-day standards, which means that 
 it would not be "monumental" in character, but one of simplicity, 
 comfort, and utility. If more than one institution were needed, dif- 
 ferent types of construction could be shown. Ultimately there 
 would be a small general hospital with a wing or department for 
 infectious and contagious diseases. 
 
 Miss J. S. Whitney and Mr. Philip P. Jacobs, of the National Tu- 
 berculosis Association, and others suggest that since this community 
 is for arrested cases of tuberculosis and is to be a health town there 
 should be no sanatorium, but rather, a general hospital. Those cases 
 that developed symptoms of reactivation would be given treatment in 
 their own homes or emergency treatment in a special ward of the 
 hospital imtil the flare-up subsided. This is an excellent suggestion 
 worthy of carefid. consideration. For the full rounding out of the 
 educational features of the community, however, a sanatorium would, 
 in my opinion, be an ultimate if not immediate necessity. 
 
 Schools of the open-air type would be an important demonstration 
 feature. One of the aims would be the training o£ aiTested cases of 
 tuberculosis to take positions as teachers in open-air schools of other 
 cities. 
 
 Special training courses would prepare men and women to give 
 occupational therapy and prevocational training in sanatoria, thus 
 sending forth missionaries to prepare sanatorium patients for the 
 colony. The results obtained by the Reconstruction Division of the 
 Army with occupational therapj^ make it safe to prophesy that simi- 
 lar measures will be more rapidly adopted in civilian sanatoria than 
 heretofore. Male instructors are needed now and there are few to be 
 found. Sanatorium graduates may be trained in our village for this 
 work. 
 
 Another educational feature would be special postgraduate courses 
 for physicians similar to the Trudeau School. There would also be 
 special courses for lay workers in the antituberculosis campaign. 
 The tuberculosis institutes of the National Tuberculosis Association 
 might well hold half of each course in such a community. 
 
 Of prime importance to the success of the project are its industries, 
 for, after all, man must live, if not by the sweat of his brow, at least 
 by " insensible perspiration." Experience has proved that arrested 
 cases of tuberculosis can " carry on " in industries of lighter character 
 
14 
 
 if the environment and Uio regimen are proper. One lias onlj' (o 
 fiflanco ihrongh (lie Kcgjister of American Manufacturers to realize 
 the poasibilities. Those sex^nred would depend npon the location 
 of the connnunity and the "leads" discovered and followed up 
 l»y tlK> director of industries. Undoubtedly the trustees would have 
 to develop one or more shops. Manufacturers, however, would be 
 ^iven inducements tx) embark in business in the village. Ijct it be 
 clearly understood that a dominant industry must be assured before 
 phiii^ring iuto town dcNelopment. Snbsidiary enterprises will not be 
 diilicidt to iind. 
 
 One specific possibility shoidd be mentioned, and that is a printing 
 establishment built for or by the National Tuberculosis Association, 
 which itself contracts for tens of thousands of dollars' worth ol' 
 printing annually. Other printing contracts could be secured from 
 iieighboring St^ite associations and from sanatoria. 
 
 Once industries are started that give emj^loyment to 100 or more 
 people a conununity of some sort is assured. Other contributoiy 
 occupations at once become a certainty. Houses must be built for 
 the families of workers, streets laid out, and sidewalks made. Stores 
 jnust be developed along with ail the other various and sundry actixi- 
 ties that go to make up a village, a town, or a city. Consider the 
 possibilities of employment outside the factories as the community 
 grows. 
 
 Physicians. ^ Butdiers. Hotel employees. 
 
 A surgeon. Druj^.^ists, Maids. 
 
 Kurses. Stationers. Coolcs. 
 
 Tiiachers. .Tewders. ChaulTours. 
 
 A lawyer or two. Photo-^rraphers. Station apents. 
 
 Bank clerks. Clerks. Telegraphers. 
 
 A Protestant clergj'man. Plumbers. Telephone operators. 
 
 A Catholic clergj-nian. l*ainters. Common laboror.s. 
 
 Hardware merclianls Enj^ineers. 
 
 Grocors. r>arhers. 
 
 "We have not touched upon the agricultursil possibilities. The first 
 thought of the general practitioner, and, until recently, of some 
 tuberculosis experts has been "light outdoor work" related to agri- 
 culture, horticulture, or animal husbandry. Theoretically the idea 
 is sound, hut heretofore has not been practicable for the majority of 
 cases, l)ecause they are tradesmen, professional or industrial workers 
 untrained in farming. That lack of training, as well as insufficient 
 capital, makes it impossible for them to go into business themselves. 
 To Avork for others means long hours, hard work, and poor pay. 
 
 My conception of a farm colony that has any chance of success is 
 one in which colonists are grouped upon a large farm tract, which 
 has been subdivided into smaller tracts, ranging in extent from 2 or 3 
 to 30 or 40 acres, all under the management of a farm expert. 
 
15 
 
 Euc;li man W()ul<l IjC/ iraiiicd to specialize alorij^ ccrl/aiii liucis and 
 1)0 ])ai(l !i noiiiiiial wage witli subsistence wliilc leaj-ning general 
 fartniii<.i^. T!io]t(\ would bo general crop pnxbjcl.ion, glass and truck 
 gardening, dairying, hog and poultry i-aising, beekeeping, and 
 Jinrsory and greenhouse development. 
 
 The i:)r()duce would supply the village and any surplus W(njld be 
 shipped to outside markets. The farm hands would also be fc^tiders 
 to tlie village commercial life. As patients becan)e proficient and 
 physically capable, they would b(5 encouraged to rent or purchase 
 farms within a few miles of the village where they would he entirely 
 independent, but within reach of counsel when needed. 
 
 John Molitor in Housing in Relation to Health and Morals, writes : 
 
 Wliatevei' we are trying to accomplisli or to do for the benefit of the people 
 leads us by one path or another to tUo bousing problem. The place in which 
 man or woman dwells is vital to the character of health and of all that follows 
 from bad Iicalth. We find that depressed vitality is a most fruitful cause of 
 social evil ; bad housing is one of the direct causes of depressed vitality. 
 
 Cleanliness is not only a condition of health but of self-resi;)ect. Cleanliness, 
 healtli, morals, self-respect, and manners are all Immensely depressed by bad 
 housing, and are correspondingly raised when the environment is improved. 
 
 Not alone in the congested areas of our great cities are there to be 
 found bad bousing conditions. The writer d.uring a j)ractice in a 
 small community has had to drive chickens from the accouchment 
 room, unprotected by a screen door. Every country doctor is familiar 
 with the all too common practice of farmers' wives who fill the sasli 
 crevices of bedroom windows with cotton or paper to keep out the 
 winter's cold. 
 
 The Dunn County (Wis.) survey indicated a higher death rate 
 from tuberculosis in 10 rural townships than the city of Milwaukee 
 and several lesser cities of Wisconsin. The White County (111.) 
 survey discovered an amazing incidence of tuberculosis. 
 
 The industrial and agricultural community would make possible a 
 demonstration of ideal rural housing conditions. All cottages would 
 be so designed as to permit porch sleeping for the tuberculous mem- 
 ber and at least open bedroorn sleeping for the rest of the family. 
 
 We are confronted with the question as to how the inception and 
 growth of such a community is to be brought about. Should it be 
 inaugurated by a governmental agency? In my opinion, no. The 
 scheme as suggested here must be planned comprehensively at the 
 very beginning and progi*ess continuously under essentially the same 
 management. Changing political administrations would probably 
 mean changes in the governing board with consequent changes* in the 
 general policy, which would result ultimately in a patchwork town. 
 This is not infrequently to be observed, in the school systems of our 
 cities. The experiment (let us frankly tenn it an experiment) must 
 
16 
 
 bo vorv flexiblo aiul it is certain tluit direct <jovenimontal control 
 conld not bo ehistic enough nnd re,siK)nsivc> e.nouij:h to the new condi- 
 tions constantly arising which woukl confront the directore. 
 
 A'isnalization of the. origin and gi'owth of the community will make 
 it apparent that the ordinary political organization of our American 
 towns would tend to bo destnictivo of the main objcctivo. The am- 
 bitions and vagaries of village and city politicians could not be in- 
 trusted with internal control, at least until the community has been 
 long enough in existence to lun e developed its own peculiar charac- 
 ter and trailitions. 
 
 It is suggested by a legal friend ^ that — 
 
 Tlie keynote of the entire plan should be " social cooperation." Each of those 
 tiTiiis is to ln> Considered in its fullest sense. It is evident that unless there is 
 such an altruistic cooperation between (1) the individuals who are to be bene- 
 fited, and (2) the nuinicipal and (3) social orfranization of the villaj;e or city, 
 and (4) the employers of labor in the community the experiment is bound to 
 result in failure. For instance, in the matter of emitloyment by manufac- 
 turers and others who may be induced to use the services of the arrested cases 
 it will not do to assume that such employers will be altruistic without a social 
 compact which at the same time is a legal contract to use to the utmost pos- 
 sible limit the services of arrested cases. It is conceived that such a contract 
 can be made in connection with the leasing of ground and construction of 
 buildings, if employers cf labor with this spirit of cooperation can be secured. 
 
 But it is also very clear that such general cooperation can not be secured 
 through the use of the ordinary village or city form of government, because such 
 a municipality can not legally enter into and enforce the necessary contractual 
 rights. Involved in this problem, of course, is the absolutely essential matter of 
 each employer being required by contract, with proper forfeiture clauses, to 
 furnish constantly to the arrested cases such sanitary working conditions speci- 
 fied by the National Tuberculosis Association as most advantageous and least 
 liable to bring on the recurrence of active infection. 
 
 The only way to have complete control of the situation until it is ascertained 
 that the whole plan will not be defeated by the sale of lands and the organization 
 of municipal control under the laws respecting the organization and conduct 
 of municipal corporations of the State in which the village or city will be 
 located, is to maintain the underlying fee-simple title in a semipublic organiza- 
 tion which will take the burden and control upon itself. At the outset of the 
 experiment, and probably for a long time, this involves a surrender to the 
 idea of "social cooperation" of certain of the civic riglits of each qualified 
 voter in so far as munieipal affairs are concerned, liut it is submitted that one 
 who is not uilling to surrender such rights in order to aid the experiment need 
 not ask for the benefits of the experiment. There will be no compulsion in 
 respect to this matter. 
 
 It will be said that the idea of not parting with the title to the land is a 
 repetition of the experiment made at the city of Pullman, 111., near Chicago, 
 but it is conceived that a very radical difference can be accomplished by work- 
 ing out a proper legal program; such a program in tentative form might be as 
 follows : 
 
 ((I) The control of the manufacturers and other employers of labor is of 
 prime importance, and, therefore, the trustees who assumed the burden of the 
 
 > Judge John A. Street, Los Angeles, Calif. 
 
17 
 
 experiment properly could lease l;iri(.I,s .s(;lected by Jiiunufiicturlii;,' plants for 
 such lonff periods of time inid at sncli low rciitalH us woiilrl imliief rii!iriufii<"f iirers 
 to come to the villuKO and construct plants of tiie cliaractcrr wliidi would be 
 advantageous. f-luital)le rencjwiil terms of sucJi leases could Im; Included in the 
 lease and suitable clauses inserted to enable the trustees to purcbase the plant 
 at fair valuation in case of business failure or otber conditions which would 
 make it desirable to do so. All of this can be worked out on a practical basis 
 beyond question. The proper class of construction and agreements respeetlng 
 employment of arrested cases should be included in tlie same contract. 
 
 (I)) It is conceived that similar leases to individuals who will build homes 
 and stores, warehouses, etc., can be worked out so tbat the interest of the 
 individual in the land, as far as a transfer to another person is coneern(Kl, will 
 have practically the same value as if the fee-simple title was vested In the 
 Individual who builds, 
 
 (c) The question of building and maintaining schools, fire stations, a build- 
 ing to serve the same public purposes as a city hall, the maintenance of public 
 parks, and other such matters as are connnonly carried on by a city govern- 
 ment is rather complex. It is suggested that a clause in each lease providing for 
 an equitable annual assessment of rent against each parcel to cover the same 
 purpose as taxation might be worked out and placed in each contract respecting 
 land. It is also suggested that the cost of paving streets, installing sidewalks, 
 curbing, and sewers, installing a complete lighting system for public and private 
 lighting, and a gas plant for fuel could all be worked out by equitable apportion- 
 ment against all leaseholders within the confines of the village, or the lighting, 
 water, and gas systems could be capitalized at cost and each private user pay 
 monthly bills as usual in ordinary municipalities. 
 
 The foregoing program necessarily requires expert advice and service, which 
 it is conceived would be contributed without cost by leading experts in all 
 departments in view of the fact that, as far as the trustees are concerned, the 
 whole matter would not be organized for financial benefit but for service to the 
 Nation. 
 
 The writer suggests that the necessary funds should be sought 
 among the agencies that have concerned themselves "with the needs 
 of war and reconstruction. The funds appropriated would be 
 placed in control of five trustees, men of large affairs and broad 
 vision in business and the professions. If possible, let there be two 
 Ijusiness men, one medical expert in tuberculosis, a lawyer, and an 
 educator. 
 
 The trustees shall purchase the land, secure and approve plans, 
 contract for buildings and public works, and invest fmids mtrusted 
 to them. They shall lay down a fundamental policy for the guid- 
 ance of the executive staff, which would be organized somewhat as 
 follows : 
 
 Managing director. 
 
 Director of industry and public works. 
 
 Director of department of public health. 
 
 Director of department of education and publicity. 
 
 Auditor {citj clerk). 
 It will be seen that these five are somewhat comparable to the com- 
 missioners in the commission-manager form of government. 
 118663°— 19 3 
 
18 
 
 l'\)r the ordinary village ci>nmiuiuty ihis organization would l)o 
 looked upon in the present day iis somewhat top-heavy and expensive. 
 But for the development and administration of the type of village 
 and the e.-qienditure t)f the amoimt of money involved such a staff 
 would be rciiuired. There would be immediate need also for other 
 executive oflicers, such as the head farmer, resident physician of the 
 f^anatoriuni, etc., while sooner or later a director of recreation and 
 city engineer would pi'obahly be needed. 
 
 The following is a list of properties and developments that may be 
 required. Most of them are fundamental necessities. Some of them 
 might be built through other means than appropriation by the spon- 
 sors of the project. Certain l)uildings, for examj)le, would be built 
 bv the man or firm or corporation that would occupy them: 
 
 Pumping ami power i)lunt. 
 
 Fiiv house and tHiuipnient. 
 
 Laundry building and equipment. 
 
 IloLel (one wing of ultimate buildiufO. 
 
 Hotel oquipmont 
 
 Garage. 
 
 r'ac-L(iry building. 
 
 I'rinting e.stablislniieut. 
 
 Hail road sidings. 
 
 Auto trucks. 
 
 Storage wai-eliouse. 
 
 Salaries, wages, legal and engineering 
 fees, traveling expenses during de- 
 velopment period, 7J per cent of csti- 
 niiited cost of development. 
 
 Contingent fund, 10 per cent of total 
 estimated cost of development. 
 
 has been outlined two 
 
 I^nd, 1,000 acres. 
 
 Thirty acres of immedbite village im- 
 provements — house and storm 
 sewers, water pipes, streets, side- 
 walks, electric lighting, planting, etc. 
 
 Oneliuudred cottages for woi-kers. 
 
 r'ifteeu houses for town and sliop 
 administration officers. 
 
 Temporary office buildings during con- 
 struction. 
 
 Office equipment 
 
 Farm buildings and equipment. 
 
 Foundation stock, cattle, horses, hogs, 
 sheep, poultrj'. 
 
 Store buildings. 
 
 General liospital or .sanatorium. 
 
 School building (four rooms). 
 
 Tn estimating the cost of such a project a- 
 imiin factors are involved : 
 
 First, town planning and development. The \ ill age would be 
 planned to care for a population of 3,500 to 4,000. The unmediate 
 development is for approximately 220 workers, or a total population 
 of 550 to 600. Costs ha^'e been based upon estimates given by ^ncn 
 with special experience in particular phases of the problem — ^architects, 
 consulting engineer, in-actical farmer, aud dean of an agricultural 
 college, etc. The initial development cost under present conditions is 
 $1,643,098. The year-to-year growth would depend upon the number 
 of applicants for residence and the indu.stries that could be secured to 
 supply work for applicants. 
 
 It is estimated that tlie village could be made to take care of an 
 increase of 100 per cent in populati(jn by the exi)e!Kliture of from 
 $600,000 to $800,000, thereby very materially reducing the investment 
 per capita. 
 
19 
 
 The second cost factor is rriaintcr)ancc expense. It is didicult to 
 estimate the cost ol" adniinistei'iiig a j)hint such as tliis. The li^uies 
 I am able to gather lead me to believe that the requii-ements for such 
 an orfi;anization as has been described, includinf^ salaries of executive 
 staff, clerical assistance, school-teachers and supplies, public health 
 nurse, counsel fees, cost of lighting and cleaning and oiling streets, 
 garbage and ash collection, maintenance of fire department, -water 
 department, etc., would be nearly, if not quite, $00,000. No estimates 
 can be offered as to farm expenses, but it is reasonable to expect that 
 within a year or two the farm would be at least self-supporting. 
 
 Rentals from houses, dormitories, stores, garage, and laundry 
 building, fees for garbage and ash collection, charges for electric cur- 
 rent, etc., will bring a return of not less than $00,000 per annum. 
 After deducting insurance premiums, county taxes, and repairs there 
 would remain a substantial balance to help offset administrative ex- 
 penses. As the town grew, the expenses would not increase propor- 
 tionately and in a few years the corporation should be self-support- 
 ing, though return on the investment would be rather too much to 
 hope for. 
 
 During the first months of residence most of the families and 
 single persons would not be wholly self-supporting ; some subsistence 
 aid must be contributed, and the total maximum fund which it is 
 estimated would be required during the first year is $56,050. In ar- 
 riving at this figure, as in determining development costs, we have 
 sought to cover maximum needs. The method of investigation and 
 the results appear in the appendix. 
 
 Can all this be accomplished? There should be few indeed in 
 this year of 1919 to assert tliat it can not be done. Was it not Dis- 
 raeli who said, " The impossible will be accomplished to-morrow " ? 
 There have always been learned (if not wise) men who have denied 
 the truth of scientific discoveries or declared some proposed new 
 forward step to be impossible of achievement. Scientists " proved "■ 
 the impossibility of flying, but the Wright brothers flew. There is 
 a large group of Prussians who boldly proclaimed that the Americans 
 wouldn't fight, couldn't raise an slyuij if they would fight, and 
 couldn't get the army to France, even if they could raise one. They 
 were obliged to witness the accomplishment of this " mipossibility." 
 
 Certain insurance companies have found it profitable to accept 
 substandard lives as insurance, risks. The Committee for the Care 
 of the Jewish Tuberculous and some industrial corporations have 
 found it profitable to make use of substandard lives in industry. Is 
 it not worth while to invest a few hundred dollars in each of one 
 thousand or more substandard lives in developing a demonstration 
 of a model town? 
 
20 
 
 Thomas Adams sfivs:* 
 
 One of the chief causes of past inililTorence to bad coiminmity ilcvelopment 
 has been the erroneous assumption that it consists of, or is best left to talce 
 place as, a "natural p:ro\vth." Surely If anything is artiticial it is the modern 
 city or town. If anything needs the application of science and of sane, expert, 
 and governinental dire<tion to promote healthy and to prevent unhealthy forms 
 of development, it is the industrial eoiunnmlty of the present day. 
 
 We have not failed to build up wholesome industrial communities; we have 
 not tried to build them. We have left their bulldiiig t<> proceed not only with- 
 out planning or direction, but with encouragement to land speculation and 
 wasteful systems of land development and with protection to the claimants of 
 artiticial rights in property, oven when the lives and health of the people have 
 been injuroil as a result. 
 
 We do not want reform of our system of land and housing development; we 
 want to begin to employ system. AVe do not want to endanger legitimate 
 Interests in property, but to establish them. We do not want to inaugurate 
 socialistic extremes, but to forestall them. We do not want to lessen liberty, 
 but to make it more widespread. And, recognizing that life is more important 
 than property, that the aim of all production is life aud not money, and that 
 real national wealth is to be measured by the health of the people, we Lave 
 either to control the right to property so that it shall not endanger the right 
 to live in wholesome surroundings or face inevitable decay. 
 
 Dean Georjre W. Kircliway, Federal director of the United Slates 
 Employment Bureau for the State of New York, is quoted as saying 
 (New York Evening Sun, Jan. 30, 1919) : 
 
 We should embark upon more public works and improvements as soon as 
 possible. Surely if we can spend billions upon billions in treasure for the tak- 
 ing of human lives in defense of our country in war time we can afford still 
 better the expenditure of a portion of those vast sums in the undertakings of 
 peace, which will benefit commerce and industry and. still better, leave a 
 lasting heritage of health and happiness for our own citizenry and the genera- 
 tions yet to come. 
 
 AH that is needed, in my opinion, is stated by Mr. Adams: 
 
 The things that are demanded of public loaders to-day are courage, rapid 
 decision, and imagination, rather than the timid, indecisive, and dilatory 
 methods of the legal mind that control our policies under normal conditions. 
 We have to take risks whether we will or not. We have to cease raking up 
 ashes of precedents. We have to think in terms of big ideas as well as big 
 sums of money. 
 
 1 nousc and Town Development In War Time. By Thomas Adams, town planning 
 ad%-iscr, Canadian commission of construction. 
 
ArrENDix I. 
 
 EXTRACTS FROM REPORTS, PERIODICALS, BOOKS, ETC., IN REF- 
 ERENCE TO COLONIES FOR THE DISABLED. 
 
 [From Momorandum to Advisory Committee on Tuljorculosis, Feb. 0, 1010 : The e8tal> 
 lislunent of productive vocalioiuil workKliops for t)JO rcliabllitation of IuIktcuIouh.] 
 
 In 3913 the departmont of health of New York City undertook a study " to 
 secure Jirst-hand accurate knowledge in regard to patients within five years 
 after discharge from sanatoria ; to learn their present physical condition as 
 compared with that on discliarge ; their living conditions ; capacity for work 
 and earnings; employm-ent and its conditions; expectations as to health and 
 life after discharge from sanatoria, etc., in the hope that such knowledge might 
 perhaps result in a comprehensive plan for tlie more cai'eful and coiuprehensive 
 care of patients on discliarge, to the end that whatever good had been accom- 
 plished by sanatorium treatment miglat not subsequently be lost through ignor- 
 ance of what was further required." 
 
 With the permission and cooperation of the autliorities in charge, tlie names 
 and last addresses of patients discharged from the municipal sanatorium at 
 Otisville, the State sanatorium at Ray Brook, and tlie Montefiore Home Country 
 Sanatorium at Bedford Hills were obtained as basic records. Altogether the 
 names of 97S patients were obtained iu this way. 
 
 Among the significant findings concerning the working capacity of 273 patients 
 discharged during the years 1005 to 1910, inclusive, it was learned that of 62 
 cases discliarged as cured, but 4-1 were working ; of 75 discharged as arrested, 
 53 \vere working ; of 89 classified as improved, 50 were working ; and of 47 un- 
 improved, 18 were working. 
 
 " This shows very strikingly the tremendous liandicaiJ* produced by tubercu- 
 losis, for we see that even of the patients discharged as ' cured,' the large pro- 
 portion were unable to work. There is little doubt but that this is largely in- 
 fluenced by the patients' enforced return to the crovrded (and for him) un- 
 healthful city. Experience at Otisville lias shown that kept in the country, un- 
 der conditions similar to those of the sanatorium, a large proportion of tlie 
 patients continue able to Avork." 
 
 It was found that over one-third Avere living under conditions wliich made 
 continued improvement impossible. They were found in dark tenements, many 
 of which were without any direct connection with the outer air ; many rooms 
 opened upon air shafts only ; in 51 places of abode chances of improvement were 
 further lessened by neglect and dirt ; 12 per cent of the patients slept in the 
 same bed with other members of the family. 
 
 It was found that the majority of sanatorium patients permanently learned dur- 
 ing their residence the principles of health, and as far as their means permitted 
 tliey tried to carry these principles into their daily lives at home and at work. 
 Many of those wlio did not attributed their failure to do so to high rents, high 
 cost of living, high cost of food, and bad factory conditions. 
 
 Undernourishment was apparent among many families coming within the 
 scope of the investigation. 
 
 (21) 
 
22 • 
 
 Further svicial contrnl was riH'oiniuemleil, in Ix' tibtainod by iiiereasi'd saiia- 
 torhuu facilities, in'miittiii}; a limuer stay in tlie institutiun ; by prKviciiiij? 
 I'ettor ailaiitability to occupation and trade; l\v the trial of country colonies as 
 a pos.sil>le lielp In tlie solution of tb»> problem of occupation and of increased 
 li-nvrtb of care and treatment in order to build solidly for liealtlj; by a con- 
 tinued follow-up service, including iusti'uctiou, friendly supervision, and periodic 
 riH»xand nation. • * * 
 
 A similar study of the present condition of l.liriO patients dlschnrged fnuu the 
 Massafhiisetts State Sanatoria from May. 1!»12, to May, 1914, was made in 
 l)tH-eml)er, 15)10. A brief sununary shows the followiuR facts: 
 
 (1 ) Of l.OHG patients discbar;red from the Massachusetts State Sanatoria 
 from May, 1912, to May, 1914. on admission 17 per cent were incipient, 3G per 
 cent moderately advanced, and 46 per cent far advanced. 
 
 (2) On the lir.st visit to these patients in their homes, in each case within 
 liiree mouths after discharj^e fi'om a sanatorium, 28 per cent were in good con- 
 diiion, 5(1 iH?r cent living. 11 per cent dead, and fl per cent had left the State 
 or disappeared. 
 
 (3) At pre.sent (meaning by this. December, 1!)1G) we Ihid that 29 per cent 
 are in good condition and at worii, 11 per cent living, 45 per cent dead, and 13 
 Iier cent disappeai'ed. 
 
 (4) Of the 312 patients now in good condition and at worli, on their admis- 
 sion to a sanatorium, 35 per cent were incipient, 43 per cent moderately advanced, 
 and 22 per cent far advanced. 
 
 (5) On discliarge these 312 patients were classified as 58 per cent quiescent 
 or arrested and 30 per cent as improved. 
 
 (6) Comparing tliose patients who stayed in a sanatorium under six months 
 with those who stayed longer than this we find, as would be expected, lliat 
 distinctly better results were obtained among those patients who-se period of 
 stay at the sanatoria was the longer. 
 
 The report contends tliat sanatoria are distinctly worth while, but some 
 system whereby patients can be looked up, visited, and advised after their 
 discharge is an essential part of sjinatorium treatment. No .suggestions relative 
 to individual rehabilij^^ation are offered. 
 
 " During tlie last five years the joint board of sanitary control of New York 
 Las had the supervision of the tuberculo.s'is benefits in several locals of the 
 International Ladies Garment Workers' Union, with a membership of about 
 20,000. We have had about 350 to 400 cases under oiu' jurisdiction, and 215 
 of them have been placed in various boarding houses and sanatoria for a more 
 or less lengthy sojourn. Our records show that of the 215 cases, 92, or nearly 
 43 per cent, have returned to their o^vn industry, 37 joined other trades, while 
 8 left tlie State, 13 died, 6 are still under treatment, and the fate of 59 is 
 nidcnown. This shows that by far the largest number of our posttuberculous 
 workers have rejoined their industry or gone to other trades." 
 
 Dr. George :\I. Price, medical director, reports tliat the most difficult problem 
 is what to do with those men or women wiio have been at sanatoria or other 
 places and have had their disease arrested or cured. In a great many cases 
 it was felt that these workers were not fit to undertalce .strenuous toil in their 
 own Industry and should have had either graduated work in their own trade 
 or some lighter occupations in other trades. " It was also imperative," he con- 
 tinues, " to have a complete control and supervision over these work(?rs, to 
 have them examined periodically, to see their families, and, in general, to con- 
 trol their reliabilitation and their reentrance into industrial and social life." 
 lie ndvi.ses tlie establishment of numerous " jiosttuberculous workshops" as 
 one of the methods to be used in the i-olutiou of tlie problem, but points out 
 
23 
 
 that there are a number of workoj's who are ixirlmjw uiihl. U) work inHhle of 
 shops, and for whom It may be neces.sury to establish Industrial farfn oolonieH. 
 
 DistMK'tly better rc^Hults are rei)<)rlyed by Dr. D, U. Lyn)un In dealhi^ with a 
 vei-y dillijnuit clasa of patients tliun those found in New York City unri Massu- 
 duis(>tts. 
 
 At the close of the hrst 10 y<'ars of worit at tlie Cnylord I''ani) Sun.-itorium, 
 WallJn.t?ford, Conn., it was found tliat about 22 of their ],J]2 eases liad be«!n 
 lost track of. "Wiiile $400,477 liiid been expended on the institution (including 
 5 per cent interest on construction find equiitment), the discharged patienta 
 had already earned $1,339,000, or almost $940,000 more than the entire ex- 
 penditure in their beh-alf. 
 
 The records show that factory worltei-s held their conrlltion distinctly l>ettf;r, 
 and the office work-ers far l>etter than did outdoor workers. 
 
 Dr. Lyman ascribes the excellent economic and piiysical results chiefly to 
 wages and environment. Of 344 men who had stated their earnings, only 13 
 M'ere earning $10 or less a week. Two-thirds were earning over $li^> a week. 
 The average for the 344 was $21.37. (The average weekly earnings of all 
 patients, both men and women, at Otisviile, New York City's sanatorium, wan 
 but $9.81. An allowance of $9 a week for women doing their own housework 
 was included in this average.) 
 
 The following statement by Dr. Lyman regarding the prejudices of fellow 
 workmen is interesting and significant : 
 
 " We asked each of our old patients this question : Has the fact that you 
 have been at a sanatorium given rise to any unpleasant experiences with your 
 neighbors or fellow employees? Six hundred and thirty -three an.swered this 
 question ; 500 stated that they had never had any tx'ouble of the kind, and 
 quite a few of the 43 who reported such experiences stated that they had been 
 of a very trivial character ; in other words, the facts as shown from these let- 
 ters are quite different from the general conception of the situation." Un- 
 fortunately, a similar question relative to employers was not asked. 
 
 The report emphasizes the necessity of a more highly developed follow-up 
 service to " procure more permanent results from the patient, and to aid in 
 amassing data on housing, living, and industrial conditions, to control tuber- 
 culosis, the chief determining factors of the incidence of disease in that 
 locality — ^the problem usually varying with the locality." * * * 
 
 IDepartment of Health, City of New York, Monograplx Series No. 8, October, 1913, 
 
 pp. 32, 34.] 
 
 The majority of sanatoria seem disinclined to keep patients longer than 
 six months, the plea advanced by some being that in this length of time the 
 patient will gain what the sanatorium can give him and also that a greater num- 
 ber can be admitted aiid so benefited. We believe it should strongly be urged that 
 curable cases be kept for a longer period or until completely recovered.. The 
 establishment of industrial colonies mentioned below might obviate the neces- 
 sity for this, but pending their establishment a longer period in the sanatorium 
 for curable cases would seem advisable. 
 
 " Country colonies for tuberculous individuals, or for patients with their 
 families, might well be tried as a possible help in the solution of the problem 
 of occupation and of increased length and care and treatment in order to 
 build solidly for health. Those restored could then return to normal life, 
 while the incurable, according to their condition, could be ti'ansferred to 
 hospitals or other colonies, where proper living conditions, medical and sanitary 
 care, and suitable occupations would be provided for patient and family. 
 There would seem to be opportuuity in such colonies for valuable experimenta- 
 
24 
 
 tion in flower and fruit and vt'.irotulde culture, trurlc farniinix. i>oultry, squab 
 raisin;:, etc., and even in some industries winch could be conducted in the open 
 air or in roofe<.l-over places, practically open air." 
 
 [Fourth Annoal Meeting, Nntlonal Tuberculosis Association, Dr. Charlis J. Ilutfitld.] 
 
 Early attention has been .iriven by the directors of sanatoria to the possibility 
 of developing convalescent farms to n'ceive cases on disrharj;e, and a few inter- 
 esting experiui(»nts liave been made. Of. tlie.se the Saranac Lalcc Industrial Set- 
 tlement is an example. The settlement was established in May, 1907, on a plot 
 of ground on the outskirts of the village. The following is a partial quotation 
 from the article in "Charities and the Commons," by Jlr. W. E. D. Scott: "The 
 purpose of the .settlement was to try to find proper hyj.'ienic work and conditions 
 inuler wliich convalescent con.sumptives miglit earn .sullicicnt wages to enable 
 tlh-ni to prolong their stay in tlie neighborliood of (h-i sanatorium until further 
 I»rogress in recovery was made certain. At the same time, it was IioikhI that the 
 education in some healthful pursuit might make tiie future life of the indi- 
 vidual an indei)endent one. During the lirst six months of the settlement's 
 existence 31 persons had either temporary or continuous employment. The 
 w.iges paid ranged from 15 to 20 cents an hour. Tlie industries tried were 
 gardenintr, poultry, leather work, diet kitchen, .sewing, mending, and an exchange 
 for the sale of articles made by invalids in their liomes." Unfortunately the 
 ex'periuient was discontinued after a trial of less th.in a year, because the late 
 tinancial stringency made impossible the raising of the necessary funds for 
 maintenance. Owing to the .short period of operation, no detiuite conclusions 
 could be reachetl. The element in the plan that provided for the education of 
 indoor workers in outdoor occupations is especially noteworthy, and should be 
 carefully considered in all experiments of the kind. * * * 
 
 IJefore leaving the consideration of farm colonies as a partial solution of the 
 prolilem of giving employment to convalescent consumptives, it may be well to 
 enumerate some of the obstacles to their success. In the first place, the capital 
 invested is almost always very large in proportion to the number of ex-patients 
 tliat can be benefited; thus the per capita cost of maintenance is greatly in- 
 creased by the interest on. the investment. Then the class of patients who can 
 take up the work with profit to themselves and to the farm is relatively small. 
 By far the greater number of the inmates in our charitable and semicharitable 
 institutions are city and town bred. They have no ability or taste for farm 
 work. A stay at the convalescent farm means a prolongation of separation from 
 the families, unless, indeed, as at the Stony Wold Sanatorium, provision is 
 made for families also; and if the families are provide<l for, still fewer 
 patients can be accommodated. * * * 
 
 Farm colonies for consumptive convalescents should be thoroughly tested. 
 The plan of educating indoor workers in outdoor occupations should be kept 
 in jnind. When po.ssible the families of ex-patients should be looked after, and 
 should be encouraged to assume the care of the sick member. 
 
 [Biglitb Annual Meclins, National Tuberculosis Association, I>r. S. Adulpbus Knopf, 
 
 p. 167.] 
 
 Suitable work some time prior to and after the arrest or cure of tlie di.sease 
 is, to my mind, of incalculable value to the-patient. By suitable work I mean 
 to suit the physique and the mind of the patient; work which makes him 
 happy and contenteil — In other words, a pleasant occupation. 
 
 Such occujnition therapy during the convalescent stage, under proper super- 
 vision, will help to solve the problem of what to do with the countless number 
 of patients who can not remain long enough in institutions. I would, there- 
 
25 
 
 foro, vory Rtron;;?ly advocate a moverru-nt creating what I would wIhIi to call 
 " iiitoriiiodiate slalions." Here the roeovorod tiil)erfMiloti.s piitieiit kIioiiUI, if 
 at all possible, find work with which he is familiar, with which he. has before 
 earned his liviuf^, and with wliicli he will have to earn Ids living tlu-R'afler. 
 'JMius, for example, if a man has been a tailor, let liim do soitif liillorinfr; 
 if ho has been u shoemaker, let him do shoemaking ; if lie has l;ceii a book- 
 binder, let him do bookbinding; and so on. It Roes without sayinR that these 
 intermediate stations should be models of sanitation and that all work which 
 can be so done should be done outdoors. Such intermediate stations should be 
 institutions supported by the Stale or municipalities, for it Is the common- 
 wealth which will be particularly benefit t-d by a greatly reduced number of 
 relapses. Thus a true financial gain will in tin; end accrue to the comnion- 
 AA'oaKh from the establishment of such intcu-mediate health or sanitary work 
 stations. 
 
 [Maj. r. Ilovion-Smilh Hartley, C. V. O., ]\I. D., F. R. C. P., honorary advisc-r on tiiijfr- 
 culosis to the ministry of pensions antl to the comniitlcc on inKiUiitional treatment 
 appointed by the minister of pensions.] 
 
 Writing on " Tuberculosis in its relation to the war " he says : 
 When the sanatorium movement was first initiated it was hoped that the 
 arrest or improvement in the disease thus obtained in many cases would be 
 permanent. It was soon found, however, that from one cause or another, and 
 after a longer or sliorter interval, a large proportion of cases broke down again. 
 A movement, initiated by Sir Robert Philip, of Edinburgh, has consequently 
 sprung up to start what are knovv'n as " farm colonies," to wliich the patient 
 may be drafted after leaving the sanatorium, and where he may stay for a 
 year, it being hoped that by prolonged treatment of this kind the arrest of 
 las disease may be consolidated, and a much larger proportion of cases remain 
 well after discharge. During his stay training v/ould be combined with treat- 
 ment, and the patient would learn market gardening, agricultural work, pig- 
 keeping, beekeeping, poultry farming, and to some degree dairy work, and 
 possibly forestry, so that on leaving he would be in a position to take up a 
 small holding or large allotment, or possibly work a small farm on cooperative 
 principles, with other patients whose friendship he has made while in the 
 institution. In other cases the patient would return to his former occupa- 
 tion, provided it can be carried on under good environment. No doubt, too, 
 as such colonies develop training in certain trades, which can afterwards be 
 carried on under healthy conditions, will be added, and such industrial train- 
 ing may become the most important element in the scheme, the colony thus 
 becoming an "open-air training colonj^ " rather than a simple "farm colony." 
 (Recalled to Life, No. 2, September, 1917.) 
 
 [British Medical Journal, London, lOlS, I, Feb. 2.] 
 
 This journal refers to farm colonies in the treatment of tuberculosis as 
 follows : 
 
 Experience at the Royal Victoria Hospital, Edinburgh, has shown that in a 
 considerable number of cases complete arrest of tuberculosis could not be 
 attained within the ordinary time limit of sanatorium residence. It was found 
 that within four or five years some 50 per cent of patients apparently cured 
 had relapsed. The average duration of sanatorium treatment was six months. 
 If, under the present insurance act, the treatment is reduced to three months 
 
26 
 
 the results will l>o much worsr. Kvoii ii iIk- dur:itioii of sanaturiuiu trentinoiit 
 is u<»t rtHluotHl it wmilil be dt^iralile in from -0 to Ho per ceiu of the cases lo 
 coutiuue the treutaient in a farm colony. For a certain number of patients 
 tlie only lioiu^fnl outlook after cure is to continue an outdoor lif<'. Tiie work 
 of the Koyul Victoria H«»spital Farm Colony, establishtHl in 1910, 1ms been 
 very Siitisfactorj iu spite of the disturbances of the war. Almost nil the 
 patients were kept iu residence for 12 mouths and discharged with the disease 
 arrestetl and with a lirst-rate working capiicity ; and these were all cases in 
 which sanatorium treatment, eveu exceeding; six mouths, failed to 8t>cure di'- 
 cisive results. Tiiey were typical cast-s, whidi woulil have gone to swell tlie roll 
 of sanatt>rium failures. 
 
 [Modern rio.spltal, September, l'.)IS: lied Tii.iiit,'le TulxTCulosls Farm Colony.] 
 
 The Natiomd t'ouncil of Youuk Men's Christian Associations has purchastvl 
 30 acres of land at Kiuson, iu Dorset, where it has established a farm colony 
 for tuberculous soldiers. Ouly {)atieuts iu the early stages of tlie disease are 
 accepted. The men live in wooden chalets, distributed over u sheltered and 
 wooded portion of the estate, Each chalet is divided into two sections, e;i(h 
 containing two beds. The central building contains dining and recreation 
 rooms, kitchen, and oflices. The work is graduated. It con.sists of cultivating 
 vegetables and fruits, keeping bees, rearing of poultry and pigs, etc. More 
 exten-sive farming operations, however, will be undertaken later. The colonists 
 receive 1 shilling each working day. Tlie aim of tlie institution is not only to 
 cure the patients but to give them a training which will enable them practically 
 to begin life again. 
 
 [Extract from British Journal df TiilxTculosis, by Andrew Trimble.] 
 
 The " old methods," tried and found wanting before the war, are being 
 strained to tlie utmost, and the death I'ate steadily increases. Three months' or 
 eA-en six months' treatment at a sanatorium, followt^d by a return to the conditions 
 under which the disease was contracted, has b(^n shown to be worse than useless. 
 Has not tlie time arrived to take stock of the po.sition, find out where our present 
 system fails, and, in tlie light of experience, try to make good its defects? The 
 principles of sanatorium ti'eatment are sound enough ; it is the application of 
 these principles in the case of the workingmau that is at fault. Our sanatoria 
 are filled, for the most part, with cases more suitable for hospital than for 
 sanatorium treatment; but they are religiously put through the regulation three 
 months' treatment and then as religiously discharged ; for the whole thing has 
 become a ritual. What becomes of these cases? They go to swell the ranks of 
 the unemployed and unemployable, and thus become a burden to the community. 
 They constitute by far tlie greatest number of cases of tuberculosis, fill the out- 
 patient departments of our ho.spitals and dispensaries, and are the means of 
 spreading the dis«*ase and gathering in ever-new victims. Is this state of affairs 
 to be allowed to remain unchanged? Granted that better means of early diag- 
 nosis will improve the situation, with the medical profession as now constituted, 
 It will take at least a generation before any uew means will be generally 
 adopted. We must, however, act now, and, at any rate in the case of our dis- 
 charged soldiers and sailors, see that the old methods are not applied. For- 
 tunately, the pensions ministry is becoming aware of the magnitude of the 
 danger, and public opinion is gradually hardening to the view that there must 
 be less tinkering with the question and a more thorough method of tackling it 
 adopted. Elquality of opiwrlunily must be given to all cases of tuberculosis 
 
27 
 
 (ii«clmrf?(>(l from tlio servioe«. Proloii^'fd trfjatnionfc must b(^ avail«bl(;, first at 
 a saiiJitonuin ctoloiiy and tlion ut an huhiMtrial colony. Aflc-rwai-ds tin; canea 
 imist I)(^ l'ollow(!d up by a rational .systoiri of aftor can;; nothing .short of this 
 .slioidd b(> tok'i-atcMl. A community, which would becoiiui larf^cly H(!ir-HU|M""'tirig 
 in timo, .should bo stiirted — a colony HU(;h as that in courses of conHtruction at 
 I'apworth, in Cambridgeshire — wlujre ex-service men sufreriiig from tubercu- 
 lo.sis may reside, their xlifliculties appreciated and overcome, their lives made 
 Ii:q)py l)y the thou;:?ht that they are not wandering about in a hopeless fashion, 
 unemployed and, above all, shunned by their fellows, but are enKaged In re- 
 munerative woi*k, for however small a number of hours daily, assisted by the 
 State, and no loniccer constitntinft- a danf,'or to the general community. Kotldng 
 short of such a comi)rehenHive scheme should find favor with the mass of 
 mtKlical and lay opinion, other than that already pi-e.judif^ed by in*(H'onceived 
 o[)inions. Let us bear in mind that it is impossible to turn a mechanic into a 
 farm laborer, and that a light open-air job is not the same thing as farmv/orlj, 
 and that in any case light jobs u;sually mean light wage.^j at the end of the week, 
 llather let us help to demonstrate that many trades, when carried on under ideal 
 conditions, can be undertaken by consumj)tives without any detriment to their 
 health. We may thus help to bring about the time when all cases of tubercu- 
 losis will be treated at a colony, and not be allowed to drift back to sun-ound- 
 ings in which they can infect others. The day of a short stay at a sanal oriiim 
 and a quick return to the workaday world is, we hope, fast receding, and this 
 will come about all the more quickly if we face the facts and refrain from 
 hiding our heads in the sands of complacency. It must be recognized that a 
 consumptive workingman vi'ith the disease arrested is only capable of doing a 
 certain percentage of the work of that accomplished by a healthy man ; this 
 must be accepted as a fundamental truth. Subsidize the man's labor and let 
 him live under ideal conditions. Let the pensions now given to tuberculous 
 ex-soldiers be used for this purpose — for the man's own use — while he is 
 shielded from the iierce competition to which he must otherwise succumb. 
 When treatment and prevention go hand in hand, the " arrest " of tuberculosis 
 will be in sight. 
 
 [War Pensions Gazette, January, lOlS : Advantages of the colony treatment over tlie 
 
 sanatorium.] 
 
 It is a matter of general knov/ledge that while manj' consumptives of the 
 better classes are restored permanently to health and capacity for work as the 
 result of treatment and education iu a sanatorium, yet, on the otlier hand, the 
 statistics of sanatoria for the working classes give a discouraging picture of 
 what institutional treatment can effect for them. But the factors which make 
 for failure are equally well appreciated ; these are too short a duration of treat- 
 ment in the sanatorium, discharge in a State of incomplete cure, and return to 
 unfavox'able conditions, such as unhealthy occupation, uncertain or inadequate 
 wage, or unsatisfactory housing. To teach the consumptiTe of the working 
 classes an occupation which promises him his normal standard of livelihood, 
 and a healthy environment, would be to solve, at any rate to a large extent, the 
 diflk'ult problem which he presents. Alternatively, to give him some 12 months' 
 treatment instead of two or three, and meanwhile io make an adequate provi- 
 sion for his dependents, would, apart from any reeducation, impxove his out- 
 look materially. He would return to his home farther advaiiced on the road to 
 reco-very, so that with some aftercare, such as shortening the hours of work, and 
 for a time at least some financial assistance, he might in many instances reLurn 
 to his ordinary occupation with no little success. 
 
28 
 
 Ai;riculiural work of stuue kind is most coimnonly iiropostHl — senonil fanninfr, 
 market gardening;, fruit growing, poultry rearing, etc. Latterly the success iu 
 rotvlucating the disablefl soldier has suggested the teaching of some of tlu> 
 tradt>s wliifli can be followed without detriment to healtli, such as carpentry, 
 simple mechanics, various kiiuls <>r luuulicrafts. 
 
 [Rritish Journal of Tuberculosis: A symposium.] 
 
 The British Journal of Tuberculosis has endeavored during the strenuous 
 years of war to concentrate attention on practical aspects of tlie conllict against 
 tuberculosis. The light for the prevention and arrest of tuberculosis calls for 
 n systematically arranged, scieutilically conducted, continuou.sly applied, com- 
 plete service. In this campaign highly organized forces and effectively coordi- 
 nated schemes for attack are essential if any real success is to be attained. 
 I>uring recent days many have advocated the establishment of colonics for the 
 (uberculou.s. The tuberculosis colony uudoulitetlly deserves a place in any com- 
 plete system for dealing with tuberculous and tuberculously disposed cases. 
 IJut wide differences of opinion exist regarding the nature, organization, admin- 
 istration, scope, limitations, and general effectiveness of a tuberculosis colony. 
 There are but few experiments sufficiently complete to afford grounds for the 
 formation of governing principles. We have therefore gathered a number of 
 expressions of opinion from experts who, as serious students of the problem or 
 from actual experience and experiment, are in a position to present diita and 
 afford advice which we believe will lie invaluable in directing the way toward 
 rational conclusions. (Editor.) 
 
 Until some one has the courage, whether by means of a colony or otherwise, 
 to tackle this mass of infection — that is, the mass of middle cases, of men who 
 can only do 30 to 50 per cent of the worlv of a normal man — it is not much good 
 talking about the eradication of tuberculosis. The colony, therefore, should 
 really be a community, with a central institution for advanced patients where 
 they may be nursed and tended to the last. A separate part of the estate should 
 be marked off where varied and definite trades should bo arranged, so that each 
 patient may be engaged in an occupation which is as nearly like his old trade as 
 possible; and tliese patients should be housed in specially constructed open-air 
 shelters. Between those two extremes there sliouUl be a connecting link, the 
 training .settlement for the mass of middle cases, which may in the one event 
 be passed into the industrial part of the community, or in the other be cared 
 for in the central institution. (From Sir Clifford Allbutt and P. C. Varrier- 
 Jones. ) 
 
 The conception of the farm colony for the treatment of tuberculosis offers, 
 in my view, more hope of success than is likely to be attained by .sanatorium 
 treatment. I have always held the opinion, which is strengthened by experi- 
 ence, that the results attained by the latter method are in no sense conmien- 
 surate with the cost entailed, and I do feel assured that in time it will be gen- 
 erally recognized that large sums laid out on preventive measures, including 
 prominently better housing conditions, will be generally adopted in preference 
 to a continuation of our present methods. 
 
 For the greater part of the year a very small numb>^r of workers is sufficient 
 for the agricultural necessities. Experience in connection with Polton Farm 
 Colony indicates that besides the ordinary branches of agriculture, with, in 
 
29 
 
 ndflition, the in(histry of pip; brocdiiit; on a lar^r^ sculo, there in tho necessity 
 for some other productive opeii-nir o<'C'iij)atlon which would l<ccp tlie p<;rsons 
 under tn^atment employed tlirouKhout tix; wliolo year. Uwl'iil industries, there- 
 fore, connected with joinery, ciibinetinaidriK, fret\vorl<, hootnial<irij?, and such 
 hl<e, seem essential additions to tho conception of a farm colony as Buch, 
 (From A. Maxwell Williamson.) 
 
 One of the roasonfl for tho d(\siKiiaiion "farm colony" wn« lo (■■iialiie the 
 colonist to obtain employment without being labeled nn Invalid, thereby tend- 
 ing to reduce his marlvct value. But while farming operations form a flistinc- 
 tive featur(>, other industries are not excluded, such as forestry, with its vari- 
 ous ramilications, market gardening, industrial workshops, etc. Nor is any 
 colony complete without an open-air school for children. Hairmyres Colony 
 embraces the above features and holds in it all the elements of success. It is 
 capable of indefinite expansion. Patients that no longer require the services 
 of a nursing staff: are transferred to the colony, thus relieving pressure on the 
 sanatorium. The sclieme is a practical one, based on sound economic and 
 educative lines. Its object is to so treat and train a patient for a prolonged 
 period under medical supervision, and thus enable him to earn a livelihood 
 under suitable conditions, the risk of relapse being reduced to the minimum. 
 It conserves and maintains working capacity. The great variety of occupa- 
 tions created by the activities of a well-organized colony arouse and sustain 
 interest, thereby reflecting on the physical and mental well-being of the col- 
 onist. That restless dissatisfaction, frequently a disquieting feature in sana- 
 toriums, is seldom met with. 
 
 There are three strong arguments against the colony system which can be 
 obliterated by legislation, viz, (1) inability to commandeer for treatment the 
 very early cases of tuberculosis, (2) to retain those eases without interruption 
 till a permanent arrestment, or otherwise, is effected, (3) the vexed question of 
 dealing with dependents. None of these arguments, however, detract from the 
 efficiency of the scheme for the attainment of the object for which it was 
 created. (A. H. Macpherson.) 
 
 Such colonies must be founded on a much broader basis than the " farm 
 colony " of the past, which has been of limited iitility where the majority of 
 patients was drawn from a rural population, and has been even less useful for 
 cases coming from an urban district. (Godfrey Brookes Dixon.) 
 
 Sanatorium treatment must in many cases be followed by proper aftercare, 
 and this could be best provided in a colony. There are, however, many intrinsic 
 and administrative obstacles. It is notoriously difficult to persuade the town 
 dweller, and especially when he is a skilled artisan accustomed to a high rate of 
 wages, to adopt a country life and an outdoor occupation even for a year or tr^-o. 
 Many of the colonists would wish to leave, without regard to medical advice, as 
 soon as they thought they had acquired sufficient knowledge to make their 
 services of any real commercial value. Adequate provision and accommodation 
 would have to be made for the dependents of married patients, which would 
 mean a considerable financial outlay, for which voluntary enterprise and prob- 
 ably State action is unprepared. The patients could be maintained at less cost 
 in a colony than in a sanatorium, but it is extremely doubtful if colonies could be 
 made self-supporting. Experiments on a small scale do not provide the diffi- 
 culties which will present themselves if large numbers are to be colonized. 
 (AY. G. Kinton.) 
 
30 
 
 The colony sliould laler for piiki'd rases ilischarjred from sanatoria. It is 
 uuUkely that one institntion will be able tt) provide a siillicient nun)lter of such 
 cases, and therefore the colony should represent ii lariie KeoKraphical urea. 
 (Niveu Robertson.) 
 
 I feel convinced that a colony scheme, properly mrried out, will prove 1 1n- 
 best means for the speedy and complete eradication of tuberculosis. To be 
 successfid, h«>wever. it must be made thoron;:hly attractive to patients, and 
 must offer them a hiipitier and fuller life, as well as better chances of recovery 
 or nmelioratUin, than they can pet, as a rule, in the general community. Tli.- 
 Idea! colony would consist of a larpe village commuiiity, where patients of boili 
 sexes, of nil classes and atxee, and at all stages of the disease, would be suitably 
 provided for. The larger the colony the better, as more variety of occupation 
 and interest could be provided to suit individual tastes. The normal residential 
 unit .should be the patient's home, rather than the tuberculosis institutioii ; 
 e.-H-h " home " accommodating patients of different ages and of both sexes under 
 the charge of resixmsible house mother and father. Several "fannlies" might 
 possess a common kitchen, dining room, etc. I believe this plan would luvivi- 
 much more satisfactory than attempting to segregate the sexes. For acute or 
 advanced cases a nursing home or suitable hospital accommodation would be 
 necessary. Special pains should be taken to provide appropriate and congenial 
 occui»ations for the colonist patients. Hours of work should be regulated 
 according to the capacity of the Individual and all labor paid for in proportion 
 to its market value. Ample provision should be made for the education of chil- 
 dren, for hygienic Instruction, for the training of patients in arts and crafts, and 
 in all that pertains to good citizenship. There must also be proper provision for 
 healthy amusements and religious worship. Self-government should be intro- 
 duced as far as possible in conjunction with expert advice and direction, and the 
 residents must be encouraged in every way to take an interest and pride in the 
 welfare and pr6.«T3erity of their colony. The general layout of the village should 
 be arranged on garden city lines, and all buildings, residential and other, must 
 be designed and funiished with a view primai'ily to health, thorough ventilatioti. 
 and ease in cleansing. Were a suflicieut number of such tubei'culosis colonies 
 established it would become possible, I believe, without much hardship, to segre- 
 gate all infectious cases out of the general community, and thus put a stop to 
 the spread of tuberculous disease. (J. D. Esslemeut.) 
 
 [War Pensions Gazette, March, 1919, p. 279.] 
 The West Riding of Yorkshire County Council have decided to cairy out a 
 large scheme of land settlement for ex-service men. Tlie sum of £100,000 has 
 been voted to finance it, and a salary of £1,000 is offered for a land agent 
 capable of supervising the undertaking. It was stated that the board of agri- 
 culture had promised their active support, and that, though there was still 
 much uncertainty as to the niimbers to be provided for, yet a census had beeii 
 taken of the army in France, which showed that 4 per cent of the men 
 serving there desired to settle on the land. 
 
 [Gertrude R. Stein, employment secretarj, Ited Cross Institute for Crippled and Disabled 
 Men, who has recently returned from an extensive investigation in allied countries.] 
 
 The more I think of this problem the more I beli(»ve that a garden city 
 such as Letchworth Village is one of the few constructive solutions of the 
 
31 
 
 tuhorciiloHis prohlftm. The difficulty, of. course, Is In conf^ivf^atiiiK so many 
 tuixM'cnlouM fumilicH toj^ollicr tliut tlie w(!ll in(!ml)ors of tli<! fiiinily niitclit r('s«>nt; 
 1h(! fiu't tliat the town is Iviiown a.s VjoinR just for tiiljcrculou.s jx^oiilo. Towns 
 like Donvoi- and Colorado S])rinp;s ar(> largely inliablt<;d by tnberrrulous people, 
 however, and it does not soA)m to liave injured their prot^ress. 
 
 In traveling abroad I visited a great many of the garden suburbs, but none 
 of them impressed ine as constructive and big as did Letchworth Village. 
 Those living in the garden suburbs must usually travel long distances iri 
 getting to their work placH", while in Letchworth Village the men all live right 
 near their factory. In fact, this is one of the special featun^s of the place. 
 In most cases, I should say, the workmen only have a five-minutes' walk to their 
 factory. 
 
 You see, this town had the tremendous advantage of being planned before; 
 it was built, and Bot just having little parts tacked on, as most of our cities 
 have grown up. By this general planning it has meant that there will always 
 be much open space around the town — in this case, forests. The houses are 
 built distant enough from one another that all the rooms are light and airy. 
 The ]*ents, as I remember, were particularly low. This is, of course, due to the 
 system, to the communal plan on which the company is being run. Tiiere is no 
 speculation connected with this scheme, and all tlie profits that there are go 
 back into improving the property. 
 
 The project has struck me as one of the most ideal things that I have 
 ever seen. The buildings are beautiful, well arranged, and the people look 
 happy and satisfied. 
 
 It would be wonderful if something of this kind could be started for the 
 tuberculous in this country. 
 
 [John Galsworthy in Reveille.] 
 
 A third plan, which miglit have to be adopted : A system of Government 
 workshops for townsmen, and of rural colonies for countrymen, employing only 
 the disabled, at standard wages, and refusing no disabled man who at any time 
 presented himself. Not disciplinary institutions, in any w'ay, just ordinary 
 industries — the men living or lodging with their families, outside, in the u.sul;1 
 way. Such workshops and colonies would, of course, need formation and sup- 
 port on the most elastic scale, suited to good times and bad. They might well in 
 some years be almost empty, in others full to overflowing. But if tliey existed 
 we should all know that the right to work and a decent life has been perma- 
 nently secured to every disabled man. They would probably be self-supporting, 
 and would automatically form training scliools for men who wished to pass ou 
 to work again in oi>en competition, as the Lord Roberts workshops do now on a 
 small scale. 
 
 [British Medical Journal. Dec. 21, 1918.] 
 
 A far larger undertaking, which sooner or later will have to be faced, lies 
 before the county and borough councils. It is ou all hands agreetl that the 
 establishment of farm and industrial colonies, where sufferers in every stage of 
 the disease can be properly hoiised and profitably employed, is \irgently needed. 
 Tlie idea is no longer the Utopian dream that some gloomy critics have ridi- 
 culed. It has been translated into practical being, and one of the most success- 
 ful of such colonies is to be seen at Papworth Hall, near Cambridge. 
 
32 
 
 [Loiter from J. Foster S.nrlos, lU-lrlit votailonal offlcor of the Federal Board.] 
 
 Ever siiU'O we niet iit tlio distiict vncatioiial Kduvrs* rdiilVronco in Wiisliini,'- 
 ton. (he midille of December, I have been thinking over tlie question of tlie 
 right kind of colony for men convalescent from tui>erculosis. We have a great 
 many soldiers suffering from tuberculosis who are treated well in the sanatoria 
 within our -district, but who, having their disease arrested, are discharged long 
 before they acquire any real physical strength or endurance. A discourag- 
 ingly large percentage of tliese men are breaking down later on because of 
 the absolute necessity of their doing too heavy work to earn a living. 
 
 To my mind what is nei'ded is as follows: A large acreage; buildings in lirst- 
 class condition, especially small cottages where men could, if necessary, bring 
 their families; the entire colony to be under the direction of a business man- 
 ager and competent medical ofliccr, with a staff including an agricultural ex- 
 pert and such other experts as would be necessary to carry out competent and 
 practical instruction along all the lines of work offered. 
 
 As to the lines of work, inasmuch as most of our tuberculosis cases are from 
 the country or small towns, farming would come lirst, especially emphasizing 
 the lighter forms of farming, such as dairying, poultry raising, small fruits, 
 animal husbandry, farm accounting, and simple bookkeeping. There should 
 also be well-equipped shops to toach meclianical trades, such as blacksmithing, 
 auto repairing, farm-tractor operating and repairing, light machine-shop work, 
 carpentry, cabinetmaking, wood carving, and as great a variety of the wage- 
 earning hand crafts as could be developed. There should also be a good com- 
 mercial course, including typewriting, bookkeeping, business management, busi- 
 ness law, etc. 
 
 I recognize that this contemplates a large plant and a considerable staff, 
 but it seems to me that men going there after their tuberculosis is arrested 
 could not only regain their health in a substantial manner but at the same 
 time learn useful trades and occupations, so that when they have completed 
 their year or more of attendance they would be fitted to carry on without the 
 liability of breaking down. 
 
 While such a colony would be expen.sive at first, tlie work accomplished would 
 bring in a steadily increasing revenue, and men going to the colony should re- 
 ceive, aside from their treatment and the care and oversight given them, a 
 small wage and a percentage of profit sharing on the work they do. This would 
 bring in a fair amount if not an entirely suliicient revenue to carry on the 
 plant and at the same time put these men on an apparently self-supporting 
 basis and eliminate the charity phase of the moral question. We find many 
 of our soldiers resenting the charity idea and working to get on their own 
 again, and it would seem to me that this might be accomplished in some such 
 way as above. 
 
 [Noel Dean P.ardswell, M. V. O., M. 1'., VAin., F. K. C. T., London, late medical superin- 
 tendent Kin;,' Edwaid VII Sanatorium, medical adviser to insurance committee for 
 county of London.] 
 
 Broadly speaking, there are two alternative policies relative to the treat- 
 ment of the consumptive worker ; either the patient must be kept at an insti- 
 tution until he is cured and can return with reasonable confidence to his for- 
 mer life and employment — this may be a matter of years — or, following a 
 shorter course of sanatorium treatment, we must so change his environment 
 as to render his conditions at home and at woik sucli that recovery from 
 tuberculosis is possible. It is the realization of these facts that has led to the 
 
33 
 
 evolution of nftcr-fiiro orf^iinizjil ions iind, moi-c ff'fiil ly, 1o llif forifr'iit ion of 
 colonies for consuinpliv<'S. 
 
 The Uvo typcfi of coiifmniptire colony. — The term " rolrmy " is iiw^d to 
 (loscTlbe two types of Institutions. Tlicso two colony sclicnics, Uiou^li linviriK 
 much in common, present certiiin disf iiulivc features wliifli stiiiridy <l!ff<T- 
 ontiiate the one from the other. 
 
 Scheme 1, associated with the name of Sir Robort F'Iiili|), jtrovidcs for jm 
 institution for the exclusive reception of the early and most curabh; cases, 
 with a view to friving tiiem prolonged treatment and a triiiniiiK in some agri- 
 cultural employment. Though linked up with the sanatorium from wiiich the 
 colonists are drawn and with the other elements of a comprehensiv*; anti- 
 tuberculosis adnnnistration, it is desif;ned as a separate institution. Equipped 
 upon simpler lines than sanatorium, it is less costly to administer. More- 
 over, the patients, by performing useful work in the institution and in the 
 grounds, gardens, and farm, are able to reduce somewhat the cost of their 
 maintenance. To give the favorable case some 12 or 18 months' institutional 
 treatment in place of the more usual period of three to four months should, 
 apart from any question of reeducatioji, appreciably improve his outlook. 
 The patient returns home, having made substantial progress on the road to 
 i-ecovery. With some aftercare he may be expected, in many instances, to 
 altempt successfully a return to his ordinary life and employment. 
 
 Scheme 2 is more comprehensive in scope, in that it makes provision for 
 all kinds of cases, irrespective of the extent and character of their disease. 
 Thus it comprises, under the same administration, a sanatorium, a colony as 
 in Scheme 1 for vocational training, and a home for advanced cases. The 
 opportunity for occupation and vocational training, however, is not limited 
 to the most favorable cases, but is offered to every patient who desires it 
 and who has a prospect of some degree of restoration of working capacity. 
 Further, recognizing that many patients can never be so restored to health as 
 to be able to hold their own in the open labor market, the colony seeks to 
 establish suitable trades and industries which, by offering remunerative em- 
 ployment under favorable conditions, will not only give scope for reeduca- 
 tion, but encourage the permanent settlement in the neighborhood of the 
 colony of ex-patients and their families, thus forming the nucleus of a com- 
 munity living under the healthy conditions of a garden city. It is hoped 
 that by this means the voluntary segregation of the consumptive will gi-ad- 
 ually be achieved. 
 
 A description of one of these colonies will be of interest. 
 
 The Papworth Colony, directed by Dr. Varrier-Jones, is a development of 
 tlie earlier pnterprise carried out at Bourn. Its characteristic features have 
 already been referred to. 
 
 The colony comprises a large mansion, with grounds of 16 acres, which include 
 a large walled-in kitchen, garden, and orchard, and 100 acres (now greatly in- 
 creased) of agricultural land. The mansion is devoted to administrative pur- 
 poses and to the accommodation of advanced cases. Accommodation for the more 
 favorable cases is furnished by shelters built in the grounds. To pro^-ide means 
 of useful employment for the patients, a carpenter shop, forge, and mechanical 
 workshops are in course of construction. Already the cai-penter's department 
 is well developed, and is in a position to execute orders for open-air shelters and 
 other portable wooden structures. This department is managed by an ex- 
 patient, a skilled carpenter, and is run on business lines; the actual work is 
 carried out entirely by the patients. The making of parts for the Cambridge 
 Scientific Instrument Co. is another enterprise which has passed the experi- 
 
34 
 
 lueutal stage. CH>portuuity for tLe employmi'Ut of some women patients; is HHip- 
 pliiHl by a neifiliboring fruit an«l jam-nuilcinir industry. Tlio pardeus and land 
 oCfer au a;;n"ieultural training tu tiiose wlio elect for it. With a view to tlio 
 pej-manent settlement of eJt -patients tlie colony has acquired some model cottjiges 
 formerly occupii'U by employees on the estate; the erection of further cottages 
 will be tlie work of tlie patients. Already applications by former patients for 
 cottages exceed the available acconnnodation. (Lancet, Aug. 3, 1918.^ 
 
 [Literary I)igi>st : I>cscrii>tion of Knliaiu I'lace Colony for disablcnl uien.] 
 
 Vocational training for disabled men in village centers is taken ui) by Ihe 
 Red Cross of England, following th(> example of France and Italy. In March 
 or April the first of these centers will open at Enhani Place, near Andover. A 
 grant of $.50,000 has been made Ity the British Red Cross Society for the building 
 i:nd equipmetit of the medical block. Other agencies contributing help are tlie 
 Ministry of I'enslons and the Board of Agriculture. A center wliere 1,000 men 
 can be provided for will involve an expenditure of !?.'00,000 says the Lond(m 
 Weekly Times, but existing huiltlings are to be found at Knliam where 1.50 men 
 can l>e -started on the wa.v to restoration. The picture is one to consider for our 
 own disabled soldiers: 
 
 " Enhaui Place is a large, handsome hou.se in the middle of some of the most 
 beautiful scenery in Hampshire. The whole estate covers 1,027 acres, and con- 
 tains four farms, three big houses, two .smaller ones, a village hall, post oflic?. 
 smithy, and over 20 cottages. The village centers council chose it with a view 
 not only to what may be called its practical advantages, but to its suitability 
 for men with siiattered nerves needing rest and fresh air. 
 
 " The future occupants of the center will be those who are suffering from the 
 effects of shell shock, or are crippled by wounds, or have lo.st a limb, or are r<'- 
 covering from illness, or have been recommended a country' life. It is not pi"o- 
 posed to receive men who can not reasonably be expected to recover any capa<'ity 
 for work. Some of the new villagers will be instructed in various branches of 
 farming and gardening, dairy work, and poultry keeping. Others will l)e taught 
 carpentry, furniture and boot making, tailoring, motor repairing, biiilding, paint- 
 ing, and phimbing. The intention of the council is to establish many small 
 workshops and classes rather than a few large ones, the aim being to bring out 
 each man's individuality and provide opportunity for his tastes. The commu- 
 nity hopes to supply most of its own wants and to lay out its own land. The 
 characteristics of tlie " institution " are to be avoided. The men themselves 
 will have a voice in the management of the center, and the real communal iden 
 will be fostered. 
 
 " It will be gathered that the essence of tlie scheme is to combine cuiTitive 
 treatment with vocational training. A man will be put on the road to i-ecover;- 
 while he is 'finding his feet' industrially. Nor is it intendefl that during thi 
 period the patient and pupil should he segregated from his wife and faniil,- , 
 if he possesses them. As soon as funds allow, more cottages will be bui!i. 
 .so that the family man will be able to get a home and a piece of land on fair 
 terms during his iToare.ss to recovery, which, in many cases, may take a long 
 time. 
 
 *' So far as his disability \\ill allow, the disabled man must be brought f'> 
 his full iK)tentiaI value as a unit of the Nation." Such is the ideal expressed 
 by the village centers council. 
 
35 
 
 I'l.AN >'01{ INDUHTIilAr, VII,l,A(iKS AS Ol '11,1 MJ) JiV 'IIIOMA,* II. MAVVSON |\ ",\S 
 
 iM l'i;itlAI, (ir.l.MIA IHU'V." 
 
 'riic vision: TIio (]is.'il»i<'<| soldier pl.'iciMJ iiiiioii^ ji l.tractlve HiirroutHlint^H, drafted 
 into couyeiiial uiid |ti'olil;il^)(r* fiiiplo.viiKMil, jukI contrilmtintc in llf nntional 
 v.x'lfare as u useful cil;iz«n of his coiiiiiiuriit.v. 
 Cliaruct(Ti sties of tlio villago*: 
 Artistic ami j)ractic"al. 
 Unity of purpose. 
 
 Paranuxiiit industry, but diversity of occupations. 
 Abundant lioiisinj;' facilities and vvoi'king facilities. 
 Cottaf;es j-atlier tlian coinniunily blocks f)r flats, 
 Cliurcbes and ji^ood sciioois. 
 Tlie inhabitants: 
 
 Any who are below tlie normal in pliysical power — not totally disabled. 
 
 Some able-bodied persons nuist be admitted for those tasks wbich i-c(|uire 
 
 the full measure of physical and mental strength. 
 Widows and children of soldiers. 
 The occupations : 
 
 Varied to suit tlie mental capacity and different decrees of disu!)ility of 
 
 those employed. 
 Individualized handicrafts to a limited extent only. 
 Centralized industry of some article of commerce desi.ifned .mi sound 
 
 artistic and constructive principles. 
 Factory processes which may be carried on in the workers' lK)mes. 
 Factory work on the usual scale. 
 
 Small workshops, where processes are subdivided amon^ a few people. 
 Agriculture on a small scale, as market gardens, nurseries, dairies, poultry 
 
 raising. 
 Buying and - selling needed materials, collecting and disiril)uting the 
 
 products. 
 Local agencies for large mercantile and insurance companies, railways, 
 
 Government departments, as post office, etc. 
 (This last would afford opportunity for the blind as telephone operators and 
 
 typists. ) 
 Requirements of the selected industry. 
 Suitable to the locality. 
 Suitable to the disabilities of the men. 
 
 A great variety of branches and possibilities of application. 
 Opportunities for piecework at home as well as factory proces.ses. 
 The size of the village : / 
 
 Many small villages have an advantage over a few large ones. 
 About 3,000 people is suggested as a proper niuuber. 
 Location of the village : 
 
 Not too far distant from former liomes of the disabled. 
 
 Easily accessible for obtaining raw materials, and with easy nipans of 
 
 egress for the finished articles. 
 With good railroad connections, good main roads. 
 Control of the villages : 
 
 Through a central committee with the assistance of district and local com- 
 mittees for each village. This local comiiiittee would act as a public 
 
 utility committee, with a pa'd executive. 
 Residence in the villages would be purely voluntary. 
 
3G 
 
 Control of the villa.ues — Coiitimu'd. 
 
 lU'Utiii}; cottages, establishing shops or some business, taking up sninlF 
 hi-lilings or niarliet jjarileus, must be done on exactly the same terms as 
 in any other town. 
 Villagers would meet their expenses in the !?ame way as in otlicr towns, 
 the difTerenee being that necessities, power, water, etc., would be sup- 
 pliiHl to them on specially advantageous terms. 
 Care must be taken of the property. Rents must be paid. 
 Types of the villages: 
 
 1. Suburban colonies — near industrial centers. 
 
 2. An old village with an established imlnstry reconstructed. 
 
 3. A new village, cho.sen and planned on the best lines fur its .special 
 
 adaptability to the purposes. 
 Things to avoid in planning the village: 
 Anything artificial or superficial. 
 
 A village of institutions half-hospital and half-barracks. 
 Anything which would tend to the pauperization or exploitation of the 
 villagers. 
 How to finance the project : 
 
 1. Financing the original construction : 
 
 (a) Government aid. 
 
 (6) Supplementary aid from philanthropic sources. 
 (c) Donations for memorials in various forms, as a block of flat-., a 
 single cottage, a street, a park, churches, clubs, etc. 
 
 2. Organizing the industries on a self-supporting basis : 
 
 (o) Government loans. 
 
 {b) Semiphilanthropic loans. 
 
 (c) Small investments from the woikmen themselves. 
 
 3. The maintenance when established: 
 
 Marketing the products. 
 
 Attracting outside visitors, who will buy the small articles of the 
 home industries. 
 Will it payt — It will restore the man power of the nation among those in 
 whom it has been sadly reduced. 
 
 It will make a small, but by no means negligible contribution to the solution 
 of the financial problems of the after care of the disabled soldier. 
 
 It will help toward the payment of that " debt of honor," which we owe to 
 those who have fought our battles for us. 
 
Appendix II. 
 
 A Discussion of the Tuberculosis Community by Tuberculosis Specialists and 
 
 Tuberculous I'atients. 
 
 [Report by Dr. l<\ H. Ilciso of tlir; (li.-«ns;-,i<iii on lli.; j.aijor " Hw^'^cniiuf; a comblD<-d 
 indu.strial and ii^;riciil( iiial <(Jintniini(y for (lie I uIi'T'-iiIouh." J 
 
 The subject of a tuberculosis comniuiiily was presented by Dr. IT. A. Pat- 
 tison, at the Sarnnac Lake Club, on Thursday night, April 15, 1019, in the 
 pn>sence of approximately 25 pliysicians of Saranac Lake and the Trudenu 
 Sanatorium, and a few other interested persons. After Dr. Pattison's reading 
 of his excellent exposition of the subject, the matter was discussed quite fully 
 and freely, the following comments and questions being most frequently ex- 
 pressed : 
 
 Dr. Lawrason Brown and Dr. C. C. Trembley : Immediately after the reading 
 of the paper, Drs. Brown and Trembley discussed the fact that Saranac Lake 
 itself could be considered as a tuberculosis community, inasmuch as most of 
 the business in Saranac Lake is conducted by people who have had tuberculosis 
 and who have remained in Saranac Lake to cater to the wants of other patients 
 who make Saranac Lake their temporary home. It was also suggested by 
 Dr. Brown that the community idea would be very good, inasmuch as it has 
 been the experience in Canada and is beginning to be found in the United 
 States! that the Government is unable to hold its tuberculous soldiers in sana- 
 toria, especially if vocational employment was not given the men, and that the 
 community idea would in all probability help to solve the problem of the after 
 care of the soldier who has contracted tuberculosis but who wishes to take off 
 Ills uniform and enter civil life again, affording him excellent means of taking 
 care of himself and at the same time providing certain funds for his main- 
 tenance. 
 
 Mr. Feustman (of Scopes & Feustman, architects in Saranac Lake), ex- 
 pressed the thought that the community idea appealed to him as being very 
 ideal, and that the community could be made very beautiful. He saw no rea- 
 son why a community established along such lines (as advanced by Dr. Pattison) 
 could not be made equally as successful as other industrial communities. 
 
 Dr. Trembley later expressed the belief that, if life was made livable and 
 there were several varieties of occupation in the community, and provided there 
 was a sufficient reserve fund to make up the deficiencies in earning power of 
 those able to work only part time so that they could live comfortably, the plan 
 ought to work out quite well. Dr. Trembley divided the patients in Saranac 
 Lake into three types: (1) Those who eventually will be able to go back 
 and resume work of a certain amount and character, (2) those who have a 
 hope of returning after a period of time more or less indefinite, and (3) those 
 who have no hope of being able to work again. 
 
 Mr. R. M. Obenchain, executive secretary of the Saranac Lake. Society for 
 the Control of Tuberculosis, and bureau of information, etc., stated that in 
 his belief, inasmuch as the care of the health of the patients of the community 
 would be an essential factor, patients would therefore be attracted by it and 
 would be anxious to go there if able to work. 
 
 (37) 
 
38 
 
 Dr. Ili-itwu exproesetl the belief that Saraimc Lake wouUl not be a very choice 
 location for a tuberculosis colony, because it is nol situated on the main line of 
 any railroail and is not wilbin very short haulinj: distance of areas of produc- 
 tion of jrood at:ri«-ultural crops and food. lie thofi;;iit the colony sliould bi> 
 estaltlisiu'd on a main line, in a re^rion where tlie climatic conditions are favt)r- 
 able »Mu>n:.'b to j;ro\v a variety of crop.s. He tliouKlit Saranac LaUe and similar 
 places could be used h8 preparatory places for patients to qualify for entrance 
 later to the commuinty. 
 
 Dr. R. C. Patterson (of Saranac Lake) advanced two tiieorctical objections, 
 ns he ternie<l them; (1) that he questioned whether or not the marketing of 
 articles made by the tiiberculous would be an easy matter, (2) he luentioneil 
 the possible ohje<'tion of the labor \inions to any such plan. 
 
 Dr. Brown incidentally mentioned that, at base hospital No. 16, New Haven. 
 Conn., where there is vocational training for the tuberculous .soldiers, enouicli 
 iroods can not be proiluce<l to meet the public demand. 
 
 Dr. H. A. Bray (resilient iibysiclan, Ray Brook Sanatorium) advancctl liis 
 opinion tbat the sanatoria tlieni.selves would offer a jrood ti*'ld for markctiii;; 
 the produ<-ts of the connnunity iiahistry or induslrins, such as books, ]irintlMt,', 
 pottery, dishes, .spvitum cups, and thinj^s of like nature. 
 
 Dr. U, C. Patterson advanced his belief that the various beneficial imlons, 
 labor unions, and other beneficial societies, would be relieve<l of a great deal of 
 the burden of benefit payments, insurances, etc., on account of the patient's 
 being able to take up remunerative employment at a time when he wouUl not 
 be able to return to his home and do a full day's work. 
 
 Jlr. Obenchain then questioned what could be dime with the arreste<l case 
 who came to the colony for employment and later became active, especially if 
 he were not a re-sldent of the State in which the colony was locattn;!. 
 
 Dr. Brown asked how cases would be selected for eligibility to the colony, 
 what, if any, centers would be established as clearing houses, and what men's 
 opinions ought to be accepted for eligibility, expressin:,' his own belief that a 
 medical man should pass upon eligibility. 
 
 Dr. R. C. Patterson asked what would become of tiie patient who had worketl 
 for a year and then became totally unfit for work. Would hp boiome a com- 
 munity charge, and woulil the cmnmunity support him? 
 
 Dr. Bray asked whether or not the colony was for soidifM's and sailors alone, 
 and expressed the opinion that there should be an understanding that the 
 colony would retain the privilege of sending back any case accepted for em- 
 ployment, provided such a course was seen fit. He also expressed the opinion 
 that perhaps the tuberculosis case does not wish to be segregated. 
 
 (The consensus of opinion of those present, however, seemed to be that this 
 difficulty would be almost negligible.) 
 
 Dr. Patterson suggested the addition of rcforestration, that i.s, the growing 
 of seedlings for transplantation, to the intorosts of Iho colony, nnd Dr. Brown 
 suggested the addition of forestry work. 
 
 Then, inasmuch as it was the consensus of oi)inion that a large endowment 
 would be necessary to make good the deficiency in the earning power of the 
 patients, Dr. Brown questioned where the endowment would come from, whether 
 from tlie Red Cross or .some such foundation as the Rockefeller Foundation, 
 etc., and gave it as his opinion that tJie R»^l Cro.ss wouhl probably be the best 
 agency to do the work. 
 
 * * * ^t # i^ * 
 
 Through the courtesy of Dr. F. H. Hei.se the colony idea was explained to 
 the as.sembled patients of Trudeau Sanatorium for the purpose of learning what 
 
39 
 
 response luiiL;! it ho (;xpof;tx)(l. ii'om jjaticiii.H LlioinscWvo.s U) llu; ojiportuiiitics 
 offered in suf:h a eornrauiiity. The following day t,h(> project was also explained 
 to groups of pfitients at Ilay Broolt, the New Yorit State Sanatorium. 
 
 ]\lis.s J. S. W]»il;ney has made the following report of tlie diHcuHsion and of 
 int(>fviews witli j)atienl,H: 
 
 The lirwt question raised was wIicjIlHjr tlie products of a factory in such a 
 coiiununily would ho irairketahle. 'i''liis brought out consid(!ral)le discussion, tht; 
 gist or wlucli was tluit it depinuhNl on tlie kind of produ<.'t. 
 
 One patient suggested that, since the aiTcsted cases of tubercialosis are not able 
 to work full time, a' seven-hour day should be inauguratCMl, thus giving three; 
 and a half hours work in the morning and three and a half in the afternoon. 
 
 A particular point was in regard to the class of people who could be induced 
 to come to such a community. One pntient said " that it was very well for labor-v 
 ing men, but where would the man who was making $60 or $80 a week find em- 
 ployment in such a community?" 
 
 Another suggestion made was that they would be branded as tuberculous 
 patients if they went into a community where practically only the tuberculous 
 were admitted. The consensus of opinion, however, was that it would be a 
 great advantage in the first few months after leaving the sanatorium to be 
 in a place where there were ex-patients. They felt that there would l>e the 
 same incentive and inspiration in a community of that sort that there is at 
 Trudeau at present. If they returned to tlieir own homes they would lie 
 branded and shunned. 
 
 A young Jew, who was married and bad one child, had been a bookkeeper. 
 His home had always been in Brooklyn. He said, " You can count on me and 
 also my wife as being very glad to leave the city and go to a country commu- 
 nity." They had always wanted to do it but had never been able to go anywhere 
 in the country where he could find employment. 
 
 Later when the formal discussion had closed and most of the patients had 
 left, several remained to get more information about certain points. One 
 young woman came up to us and said she wished to be enrolled now, as the 
 first citizen of that community. Tlie idea seemed to be accepted with enthu- 
 siasm, and it was a surprise to Dr. Heise, Dr. Pattison, and myself to see how 
 immediate and spontaneous the favorable reaction was. It almost put upon us 
 an obligation to make the idea a reality. 
 
 About 30 patients handed in their names to me as interested in the project. 
 I saw a great many of them that evening by themselves and talked with them 
 separately about it. 
 
 One young Virginian who bad spent 10 months overseas, bad been gassed, and 
 attributed his tuberculosis to this, said be would like to go to such a community 
 and grow up with it and do what he could to favor its development. Prior 
 to going overseas he had been a timekeeper in a big munition factory, making 
 $75 per month. 
 
 A minister who had been a missionary in China would be glad to move to 
 such a community at once. He is a widower and has four children. He felt 
 that it would be the best place for him and also for his children. He said 
 that if there was no opportunity in the beginning for him to practice his own 
 profession, be would be glad to go there and help in any possible way the de- 
 velopment of such a plan. 
 
 A young doctor, who is now classed as an ex-patient, was very enthusiastic 
 about the plan, and although he said he might not go there, as he had his future 
 plans well arranged, he felt that for most of the patients at Trudeau it would 
 be a great boon. 
 
40 
 
 A Vdunfr couplo, l>oth ox-pat ii'iits, who expect to marry soon, came in tcv 
 gether to talk to nie. To both of them it seemed an ideal arraiij^emeut in their 
 case, and both of them exjiressed themselves as williii!; to ko immediately to 
 such n colony were it already establisht'd. Their ea;:erness was pathetic. Bodi 
 will have to leave Trudeau soon and neitlier has any delinite plans. The {iirl 
 said that she did not want to po liome because she felt sure that not only her 
 friends but Iter family would consitler her almost a leper. 
 
 This couple raised the question of whether any cottages would be furnished 
 or not. They seemed to think that it would be a very good idea if some fur- 
 nished cottages could be rented, and tliat after a certain amount had been paid, 
 the furiuture would becDUie tlie prtiperty of the renter. 
 
 Dr. I'attison, in company willi Mr. OI)eiuliain, of the bureau of Information at 
 Saranac, interviewed several residents of the town. One man was a Jew aged 
 3G. He is a furrier with a wife and four children, lie had migrated from 
 Russia to New York City and had lived there two years before coming to 
 Saranac. lie had been in business at Saranac for 15 years. His opinion was 
 that if a place was a healthful locality for the tuberculous, it must be a health- 
 ful place for well people to live in because greater precautions were taken there 
 against infection. He ami his family have kei)t well; he has made money; 
 owns his own home, and has just bought a new car. 
 
 Another Jew, who is a second-hand clothes man, has been living in Saranac 
 for several years. He had previously lived for four or five years in one of the 
 cities of New York State. Ho thinks he has a good opportunity in business at 
 Saranac, and says he makes a fair living for his family. 
 
 Another Jew, aged 37 and single, came from Syracuse to Saranac 14 years 
 ago. »He .says he makes as much or more here than he did in Syracuse, and 
 would not want to go back to the city. 
 
 Still another Jew, who came here from New York City and has lived in 
 Saranac for four years, says he would be the first applicant for a job in sucli 
 an industrial commuuity. He was formerly in charge of the upkeep of ma- 
 chines in a glove factory at $35 a week. He is now doing odd jolis of repairing, 
 such as sewing machines, etc. He does not make much here because there is 
 so little call for his kind of work. 
 
 At Hay Brook I found the same eagerness in regard to the idea. Many of the 
 younger girls said that they w(>re quite .sure their families would move to such 
 a comnumity if it meant an improvement in the girl's healtli or would be an 
 advantage to her in any way. 
 
 Among the married women there were several whose children, sometimes two, 
 three, four, or five in the family, were in orphan's homes, while the mother was 
 at the sanatorium. One womau said her husband had also bad tuberculosis 
 and he was not able to do steady work. A home for them in such a community 
 wouhl mean a great deal. 
 
 Two Italian women, one of whom spoke very little English, were most en- 
 thusiastic about the idea. They had both worked in factories prior to going 
 to the sanatorium and would be L'^lad (jf an opportunity to <lo any kiinl of factory 
 work. 
 
 [Extracts from a group of lottcrs written liy tubiTculous patients to the S'ntlonnl Tul)er- 
 culosis Association concerning the proposition of a tuberculosis community.] 
 
 I most heartily indorse the scheme you proposed to-day. Such a comimmity 
 would supply the logical stepping stone to " full-time " work, without which 
 we must acknowledge our physical unfitness or our being tuberculous when 
 applying for work. Either one of these is going to make our return to a useful 
 
41 
 
 life infinitely moi-e difriciiK;. I iiiii iiboiil 1,o l(!iivo tlio sanatoi'Iiiiii, and a r-om- 
 miinit.y of this sort, would Holvo my \)\'^ jtrohlorn. I know tiio sifiialion thai 1h 
 confroritin;,' Jiio now, hcK-uuso I was ciir-cd once ijcforc. (A yoimt? woman.) 
 
 I tliink it an excellent jiian to ronii a villa;^o whore tubereulou.s pcoiile fan 
 live and find work. For more than two years I liave been working four hours 
 a (lay in the sanatorium at Trudeau. Could I find work in a community sik-Ji 
 as you propose, my mother could be witli me and I could have 8f>mc home life. 
 (A younj? woman.) 
 
 Personally I sliould be delighted to be among those privileged to enjoy the 
 advantages to be had by an arrested tubercular patient of a few years spent 
 in a tuberculosis community such as described by Dr. Pattison to-day in JiLs 
 talk to the Trudeau patients. 
 
 It seems to me that such an arrangement and such safeguarding of one's 
 healtli by life in such a place is the only really sensible course to be considered 
 by any arrested tuberculosis patient who realizes the seriousness and insidious- 
 noss of tuberculosis. (A j'oung woman.) 
 
 It is tlio most practical plan of help without pauperizing that has ever come 
 to my notice and I would consider it a privilege to be associated with any such 
 undertaking. (A young woman.) 
 
 From personal feeling and conversation with others I am thoroughly con- 
 vinced that the establishment of a community where tubercular patients un- 
 able to work full time could find limited work under good living conditions 
 would be a boon very greatly appreciated and that no difhculty would be found 
 in filling such a community to its full capacity. (A young man.) 
 
 Your talk of this afternoon in regard to the community you are planning for 
 arrested cases of tuberculosis has made a deep impression upon me, and I 
 must say that the majority with whom I have spoken on the subject agree 
 that the project is highly feasible. 
 
 When we consider the number of affected people who leave the cities and 
 strike out for the open, whether it be the West or some place in the mountains, 
 to spend the rest of their lives, where the opportunities are not to be com- 
 pared, nor so well adapted to their condition as those you propose, I believe 
 there will be little or no difiiculty in getting all the people you wish to go 
 to the town under consideration. 
 
 There would be some who would hesitate to bring their families to such a 
 community because of a fear of exposing them to tuberculosis, but I believe 
 that the statistics from such places as Saranac, w^hich show that the tuber- 
 cular mortality among the native population is lower than the average, would 
 soon set such fears at rest. 
 
 Your project, I believe, will be a boon to the tubercular, not only, but a 
 welcome relief to physicians of sanatoria, who if advised of the work and 
 kept advised of the progress of the town, would send plenty of arrested cases 
 there, many of whom, I believe, would become permanent residents. 
 
 I, for one, would be glad to cast my lot in such a town, and wish you every 
 success that the project may become a reality. (A young maii. ) 
 
42 
 
 I was deeply iinpressoil wilh tlu' i<lr:i as expressed by Dr. raltisuii to-day 
 in repird to iunu^jurathi^ a tuberculosia ooiiiiminity. It appeals to lue as 
 belug very logical for this reason, besides which there iire many others in 
 Its favor. From my own case — when I lejive this place I will be without a 
 position at which I will be able to make a living equal to that which I made 
 when tflken sick. I live iu U»e city of New York, wiilch place can not alTord 
 the beneiit of outdoor sleeping, much less the pure, cloflii air of Odd's own 
 creation, (he country. Th«>re are many wl»o would not be satislie<l to leave 
 the gay wlute way, not even for tlie l)enelit of llieir hejilth, but you can count 
 my family and myself as on»» wlio would gladly acceiit tlie opportunity to l)e 
 a i)ioneer family in such a community. (A mairied man.) 
 
 This seems to nie to be the most encouraging thing I have ever heard of 
 for tubercular patients. I for one am certainly heartily in favor of such 
 a move. 
 
 I venture to say that the large.st per cent of patients feel as I do about 
 the euterprise. I have been told tliat I can go back and do a full day's 
 work anywhere I want to, but I am afraid to take the chance of living again 
 Avith well people and doing as I know I would have to do. So I am leaving 
 this week for Denver and will try to get into some business out there for 
 myself whereby I can comfortably support myself. 
 
 I have been for more than a year the bookkeeper for the above sanatorium, 
 but feel that it is up to me to get out into the world and make the l)est living 
 that I can. Tlie chanci's are that if it is found out that I am a lunger 
 my chances for good positions will be greatly dinnnisiied with business lirms. 
 (A young man.) 
 
 At present I personally wish llierc were just such a place that I might 
 turn to, for, although the doctor has recomnu<fided that I return to my 
 former position as a school-teacher, I should prefer to forego home life and 
 a high salary iu order to insure future good health. (A young woman.) 
 
 I think that the plan you have worked out for the solution of the post 
 sanatorium treatment of tuberculosis so transcends in importance any con- 
 sideration of cost that you ought to proceed absolutely regardless of cost 
 factors. I really believe that some such .scheme as you have outlined is the 
 only .solution of the problem. After all, what you propose is not revolutionary, 
 merely a step or two further than the many housing projects which have 
 been launched in this country and in England. (An architect who himself 
 bas had tuberculosis.) 
 
Appendix III. 
 
 AN INVESTIGATION OF THE PROBABLE MAXIMUM AMOUNT RE- 
 QUIRED AS SUBSISTENCE AID DURING ONE YEAR FOR A GIVEN 
 NUMBER OF TUBERCULOUS PERSONS AND THEIR FAMILIES. 
 
 [Study mndo Ivy MIhs J. S. Wliitiipy, Rcscni-fli Snrrcfiiry National 'J'iif>er<:uloHi!* AMHOciatlon.] 
 In se(.'urin.i; dalu tlio I'ollowiny, sclu'cJulc was iiswl : 
 
 1. Sanatorium 2. Date 
 
 3. Patient 4. Age i 
 
 5. S(>x_' 6. Marital state 
 
 7. Main occupation 8. Olhor occupations. 
 
 9. Faniilv outline: 
 
 Sex. 
 
 Age. 
 
 Occupation. 
 
 Normal weekly 
 earning:g. 
 
 Weekly earnings 
 
 since patient's 
 
 illuesa. 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 Total 
 
 
 
 
 
 Minimum amount to be furnished by family in col 
 normial weekly earninejs, less onfi-ha.lf natieTir'n < 
 
 ony (based upon 
 3arnings) 
 
 
 Total weekly budget at" the mii 
 studios of Bureau of Labor Stati 
 of Boston, and othfr ovonnizati 
 
 limum comfort le 
 sties, Industrial C 
 ons) 
 
 vel (based upon 
 onference Board 
 
 
 Amount of help n 
 
 eeded weeidy. 
 
 
 
 
 
 
 SITMMAEY OF SCHEDULES OBTAINED. 
 
 Numher of schedules. — One hundred and eleven schedules wei*e secured at 
 two sanatoria ; 56 were for men and 55 for women. 
 
 Of the total number of schedules 54 were for single men and women, or 
 widows without family; 10 schedules were for single men and women whose 
 immediate families might make a home with the son or daughter ; and 47 
 schedules were for married men and women, making a total of 57 which may be 
 designated as the " family group." 
 
 Nnmbcr of individuaJs. — In all there were 253 individuals represented, includ- 
 ing children and dependent relatives. On the 57 family schedules alone were in- 
 eluded 199 individuals, or an average of 3.5 persons to each family. 
 
 Average age. — The average age of the patients in the married gi'oup was 
 slightly over 30 years, and for the single group 25 year«. 
 
 (43) 
 
4-i 
 
 Theoretical hmUjet. — A biulfiot cif $1,500 a j ear, which is i\ uiiniiuuiu l)Ud.wt fur 
 a fiimily of five, was adopted. This is fur a family of hiisl)and, wife, and three 
 children under 14, making 3.3 units, the children being considered as part units 
 according to their subsistence cost as compared with that of a worliing man. 
 This means a weelciy budget of .$28.85 for a family of five. On this basi.s the 
 budgets for the vari(»us families were made up. If the family was larger than 
 live, the proportionate parts of a unit were adiled atconling to the age of the 
 extra members of tlie family. When there were less than live in the family the 
 proportionate amount was deducted. 
 
 I'loporiion needing astfiatancc in fiunily (/roup. — On the basis of weelily needs 
 outlined above, 25 of the families were found to be able to meet their own cost 
 of living, so that no maintenance would have to be supplied by the community. 
 (The wages used in this compilation were in every case those which the patient 
 or men)bers of his family were receiving just before the illness began.) Many 
 of these 25 families are, of course, those in whicli the wife was the patient and 
 the normal earning capacity of the husband was unimpaired. In 32 families 
 the total earning capacity of the family would not meet its required budget. 
 Fifty-six per cent, then, of the families scheduled would need assistance from 
 the coninninity. 
 
 Amount of maintenunce needed in family group. — The total weekly budgets 
 for the.se 32 families amounted to $752.78. The total amount of financial assist- 
 ance needed weekly by them from the community was $274.06, or 3G} per cent 
 of their total cost of living. 
 
 Total iiccirUj cost of maintenance in family group. — On the basis of something 
 over 100 families who would be the pioneer members of the community, there 
 would be practically twice as many as have been scheduled. The maintenance 
 fund shown above would then have to be doubled, making $548 weekly. This 
 would amount in a year to $28,496. 
 
 Proportion needing assistance in single group. — In the case of single men and 
 women an arbitrary budget of $16 a week was established. There w-eie only 
 seven in the single group who would not need assistance. In this numljer are 
 included several women who were waitresses, or in domestic service, and who 
 might earn a living in the employer's family even working on a part-time basis. 
 Forty-seven, or S7 per cent, would need financial assistance. 
 
 Amount of maintenanee needed in single group. — The weekly needs of the 47 
 would amount to $752 and the assistance needed to complete their necess;iry 
 budgets would total $265, which is 35 per cent of the necessary cost of living. 
 
 Total yearly cost of maintenance in single group. — If this group scheduled 
 were doubled in the community, the weekly amount required would be $530, 
 which in a year would total $27,500. 
 
 SUMMARY. 
 
 Single men and women and family groups would enter about evenly into the 
 community. Eighty-seven per cent of the former and 50 per cent of tiie latter 
 group would need financial help from the community to assist in their mainte- 
 nance. The amount required in the single group would be about 35 per cent 
 of the total budget and for the family group about 36i per cent. The total 
 amount required for both groups for a year would be $56,056. This amount 
 represents the maximum need since the time covered is an entire year. IDxperi- 
 ence in the Jewish garment shop shows that patients can resume more than 
 half-time work within 12 month.s. As they are able to increase their earning 
 capacity the supplementary amount required decreases correspondingly. 
 
45 
 
 The followinf,'' arc the nialn occiii)Mtii 
 Cloncul and odico work: 
 
 Clerks 10 
 
 Stenographers 9 
 
 Draftsmjiu I 
 
 ISookkeepers 7 
 
 I 'roIVssional ; 
 
 (Jriiduate uurse 1 
 
 ]\Iiiiis(or 1 
 
 Physician 1 
 
 TtNicliers 3 
 
 School principal 1 
 
 Illustrator 1 
 
 Trade and transportation : 
 
 Salesmen 4 
 
 Saleswoman 1 
 
 Railroad brakeman 1 
 
 Ilailroad engineer 1 
 
 Motor engineers '2 
 
 Chauffeur 1 
 
 Motorman 1 
 
 Telephone operators 3 
 
 Domestic and personal service : 
 
 Children's nurses 3 
 
 Waitress 1 
 
 Dressmaker 1 
 
 Housewives , 18 
 
 ons of llif! p;iti(>ntH Kf'h<!du!ed ; 
 i'\'i/"tory or)er!iLlvoH : 
 
 (;!l()ve . 1 
 
 Kin'Lting 2 
 
 Woolen clothing 4 
 
 Collar 
 
 Shoe 
 
 Steel 
 
 Neckwear 
 
 Ammunition _, 
 Miscellaneous 
 Skilled trades: 
 Electrician 
 
 Carpenter 1 
 
 Machinists 
 
 Toolmaker 
 
 Pattern maker 
 
 Riveter 
 
 Millwright's helper 
 
 Retoucher 
 
 
 
 1 
 
 1 
 
 1 
 
 1 
 
 1 
 
 Pipe fitter 1 
 
 Stove mounter 1 
 
 Printing and publishing: 
 
 Pressmen 2 
 
 Folder 1 
 
 Printer 1 
 
 Lithographer 1 
 
 Government service : 
 
 Army 1 
 
46 
 
 PUBLICATIONS OF THE VEDKKAL BOARD FOR VOCATIONAL 
 
 EDUCATION. 
 
 Th© Vocational Summftry, published monthly by the Federal Board for Vocational Educa- 
 tion (vol. 1. No. 1. May. 1918). 
 
 Bulletin No. 1. Statement of Policiea. 
 'Bulletin No. 2. Training Conscripted Men for Service as Badio and Buzzer Operators in the 
 United States Army (Inttirnutional Code). 
 
 Bulletin No. 3. Emergrenoy Training: In Shipbuilding — Evening and Part-Time Classes for 
 Shipyard Workers. 
 •Bulletin No. 4. Mechanical and Technical Training for Conscripted Men (Air Division, 
 U. S. Signal Corps). 
 
 Bulletin No. 5. (Reeducation Series No. 1.) Vocational Kehabilitation of Bisabled Sol- 
 diers and Sailors. (Also printed as S. D«c. 166.) 
 
 Bulletin No. 6. (Reeducation Series No. 2.) Training of Teachers for Occupational 
 Therapy for the Rehabilitation of Disabled Soldiers and Sailors. (Also printed as S. 
 Doc. 167.) 
 •Bulletin No. 7. Emergency War Training for Motor-Truck Drivers and Chauffeurs. 
 •Bulletin No. 8. Emergency War Training for Machine-Shop Occupations, Blacksmlthlng, 
 
 Sheet-Metal Working, and Pipe Fitting. 
 •Bulletin No. 9. Emergency V/ar Training for Electricians, Telephone Repairmen, Linemen. 
 
 and Cable Splicers. 
 •Bulletin No. 10. Emergency War Training for Gas-£ngine, Motor-Oar, and Motorcycle Re- 
 pairmen. 
 •Bulletin No. 11. Emergency War Training for Oxy-Acetylene Welders. 
 
 •Bulletin No. 12. Emergency War Training for Airplane Mechanics — Engine Bepainnen, 
 Woodworkers. Riggers, and Sheet Metal Workers. 
 
 Bulletin No. 13. (Agricultural Series No. 1.) Agricultural Education — Organization and 
 Administration. 
 
 Bulletin No. 14. (Agricultural Series No, 2.) Reference Material for Vocational AgrlcuU 
 tural Instruction. 
 
 Bulletin No. 15. (Reeducation Series No. 3.) The Evolution of National Systems of Voca- 
 tional Reeducation for Disabled Soldiers and Sailors. 
 •Bulletin No. 16. Emergency War Training for Radio Mechanics and Radio Operators. 
 
 Bulletin No. 17. (Trade and Industrial Series No. 1.) Trade and Industrial Education- 
 Organization and Administration. 
 
 Bulletin No. 18, (Trade and Industrial Series No, 2.) Evening Industrial Schools, 
 
 Bulletin No. 19, (Trade and Industrial Series No. 3.) Part-Time Trade and Industrial 
 Education, 
 
 Bulletin No. 20. (Trade and Industrial Series No. 4.) Buildings and Equipment for Schools 
 and Classes in Trade and Industrial Subjects. 
 
 Bulletin No. 21. (Agricultural Series No. 3.) The Home Project as a Phase of Vocational 
 Agricultural Eduation. 
 
 Bulletin No. 22. (Commercial Education Series No. 1.) Retail Selling. 
 
 Bulletin No. 23. (Home Economics Series No. 1.) Clothing for the Family. 
 
 Bulletin No, 24, (Commercial Education Series No, 4,) Vocational Education for Foreign 
 Trade and Shipping. 
 
 Bulletin No. 25. (Reeducation Series No. 4.) Ward Occupations. 
 
 Bulletin No. 26. (Agricultural Series No. 4.) Agricultural Education — Some Problems in 
 State Suprvision. 
 
 Bulletin No. 27. (Agricultural Series No, 5.) The Training of Teachers of Vocational 
 Agriculture. 
 
 Bulletin No. 28. (Home Economics Series No, 2,) Home Economics Education — Organiza- 
 tion and Administration, 
 
 Bulletin No. 29. (Reeducation Series No, 5.) Treatment and Training for the Tuberculous, 
 
 Bulletin No. 30. (Trade and Industrial Series No, 5.) Evening and Part-Time Schools in 
 the Textile Industry of the Southern States, 
 
 Bulletin No. 31. (Trade and Industrial Series No, C.) Training in Safety and Hygiene in 
 the Building Trades. 
 
 Bulletin No. 32. (Reeducation Series No, 6,) The Agricultural and Industrial Community 
 for Arrested Cases of Tuberculosis and Their Families, 
 
 All communications should be addressed to 
 
 The Federal Board for Vocational Edncation, Washington, D. C. 
 
 • Emergency war training for conscripted and enlisted men. 
 
Any undertaking hoteeter Worthy must he preceded by dreams. 
 
 We must have first the men who dream dreams and see visions. 
 
 Afterwards we are ready for those who can, if they will, convert 
 
 the beautiful conceptions into technical perfection so that there 
 
 arises an equally beautiful result. 
 
 — Towner. 
 ■j!r -iV tV 
 
 Dreams grow holy put into action; worl^ grows fair through 
 
 starry dreaming. 
 
 But where each flows on unmingling, both are fruitless and 
 
 in Vain, 
 
 — Proctor. 
 
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