rangements at their homes as regards workinghours and sleeping-porches that we have here, but modifications can be made that will in some way approach these conditions. I do not believe that eight or nine hours' work a day will injure any patient that we discharge and advise to do that much. But you must remember that every hour not spent working must be spent resting, and during the first year following your discharge you should try to spend ten to twelve hours a day in bed. If you wish to stay well you owe it to yourself to see that this is done. Once tuberculosis gets you in its clutches, it hates to let go and furnishes a fight to a finish with a foe worthy of any man.

After you have returned home the problem of following out what you have been told becomes at times a gigantic task. You are constantly forced to listen to the unwise advice of misguided relatives and friends, and I may say that ofttimes it is the members of your own family who are the most persistent in advising you about something of which they know nothing. They tell you to exercise more; that you require more pleasure; that being up late a couple of nights a week will do you no harm. Never forget that you know more about your condition and the way you should live than they do, and show it by doing exactly as you have been advised.

It is our misfortune to learn of most of the cases that relapse and of those that die, and it is discouraging when we realize so many of these people have needlessly sacrificed themselves simply because they have been unwilling to acknowledge the obligation forced upon them by their sanatorium training. On the other hand, it is most encouraging to come across individuals that have stayed well five, ten, or more years, and are working every day. This latter class of patients stay well because they carry out, or at least did carry out for many years, the instructions they heard while undergoing treatment.. The man or woman who stays well is the one who always remembers he or she has the disease, and has the backbone to carry out what each knows to be the right thing to do. Many men and women-considered to have been very sick people are at work today be cause they constantly bear in mind the lessons we are trying to teach you.

Now let us consider the obligation you owe to your family. It occurs very frequently that when one member of a family develops active tuberculosis, other members also come down with the disease. This should not be attributed to any family characteristic or inheritance, but is due chiefly to the carelessness and ignorance of the first victim, who spreads this malady by coughing and spitting promiscuously. We have certainly tried to teach the danger to others of coughing without shielding the mouth and the nose when sneezing, and it has wholly been with the idea that the members of your family should be protected, if you go home before your cough has left you. The younger members of your household are especially the ones to be considered, as they are the ones who will answer as the future victims of the tubercle bacillus. The tuberculous man or woman who will time after

time expose these children to an unprotected cough or sneeze is, I believe, criminally liable should any of these young ones in later life fall heir to the infection.

You can teach the members of your family how to live. You can preach to them the value of fresh air, day and night. You can point out to them, and especially to the young adults, the need of at least eight hours' sleep every night. You can impress upon their minds the dangers of a neglected cold, and that the steady loss of weight, undue tiredness, blood-spitting, and the other familiar symptoms of tuberculosis are not to be regarded lightly, but should send them to a competent physician for examination. you owe to them, and it cannot be said that you have their best interest at heart unless you warn them of these dangers. You may thus be the means of starting a relative under treatment for tuberculosis while the disease is still in its incipiency and when the chances of arrest are so good.

This

It frequently occurs that it is only at a great sacrifice by the other members of the family that the patient gets the opportunity for the return of his health, and having once been put on the road to recovery, he is morally bound to make use of the principles he has learned in order to keep his health, and thus in some way make adequate return to them. There are many, I am firmly convinced, who never look, at this side of the problem, and yet it is one to which all of you should give conscientious thought. When your family or friends try to persuade you to forget the teachings you have listened to here, then is the time especially to stand your ground and enlighten them as to what the treatment of tuberculosis means and, by asserting yourself, prove that your stay in the sanatorium has not been a mere pleasure jaunt, but one of serious business, and that you have learned well the principles expounded. It is in the beginning with your own people you will find it the hardest to do as you should, but once they see you are getting along, and holding your health, they will realize their course was not the proper one, and will then give you all necessary aid. Let me reiterate, however, the necessity for yourself and for your family of protecting your mouth when coughing, and your nose when sneezing, and also for the proper disposal of your sputum.

Now let us see what obligation you owe the community in which you live. The city or town of which you are a citizen has every right to look to you to take more than an ordinary interest in their efforts to eradicate tuberculosis, for the reason that you should know more concerning it than do your neighbors. You can be of assistance in many ways and accomplish perhaps as much as any of the physicians.

You can lend your support to all measures that affect the public health, for many of these relate directly or indirectly to tuberculosis. As an example of such public health measures let me cite the pure-milk ordinance. I have already told you of the frequency of glandular tubercu losis caused by a contaminated milk supply. If you are unable to take an active part in such matters, you can at least give such movements

your moral support and interest those who can be active in the passing of such laws. You can take more or less of an active part in the crusade against the filthy habit of spitting on the sidewalks or in public places. You already know that much tuberculosis is spread through this dirty and uncalled-for practice. You can and should take a great interest in the anti-tuberculosis society in your town and should lend every aid at your command to secure city and State appropriations for the aid of other unfortunate victims of this disease who, due to the lack of facilities, may never have a chance to recover their health.

And, finally, you can be of wonderful aid to the visiting nurse. It is she who is looking after the unfortunate far-advanced victim in all parts of the city, bringing comfort and relief in many ways; it is she who acts as guide and mentor to the other members of the family, watching over them to see that none develop tuberculosis; it is she who, on making her rounds through the various families and houses where her duty calls her, picks out the children and adults appearing below their normal health, and has them examined for possible lung diseases. It is by the demonstration of the amount of good she does that funds are raised to carry on this fight against tuberculosis and it is she who is the

true friend and wise counsellor of many of the unfortunate sick. You may happen to know a sufferer from tuberculosis residing in another part of the town and not under medical care. Give the visiting nurse that much information and she will look after the case, take all the responsibility, and do her utmost to start the individual back on the road to health.

Remember that the visiting nurse is not an officious individual prying into personal affairs for her own amusement, but is doing all this work for your ultimate good and the good of the community. Look upon her as a friend and aid her in every possible way to continue her good work, the extent of which is untold. It is the consensus of opinion among men devoting their lives to tuberculosis that the visiting nurse is a most important cog in the machine for combatting this common foe, and without her aid it is most likely the anti-tuberculosis campaign would be doomed to failure. Each and every one of you can be a missionary to aid the work she does, and you may rest assured it is work well done.

Bear in mind then the responsibilities sanatorium treatment entails upon you, and by so doing you will be true to yourself, and "it must follow as the night the day, thou canst not then be false to any man."

This outline of amusements for the patients of the Hospital of the Tuberculosis League of Pittsburgh, Pittsburgh, Pa., is presented to the readers of the JOURNAL OF THe Outdoor Life in the hope that it may assist in lightening the burden of “taking the cure" in some other institution.

When the writer entered the hospital, patients were permitted once a week and on holidays to congregate in the library where a piano and pianola were located. The piano was not in tune and the pianola needed some repairs, so that it was played without using the expression levers.

It was later repaired and played with expression, but became monotonous to the older patients on account of the lack of variety. When some of these used the period for visiting, the authorities stopped the concerts and nothing was had for some time except occasional music by visitors.

The pianola was tried several more times with same result, but finally one of the employees purchased a Victrola and this was played in some part of the hospital nearly every week. It was later purchased by one of the patients,

which permitted its more frequent use. Single patients or groups of patients purchased new records, and as the Victrola furnished reproduction of a variety of instruments the pianola was forgotten and was later destroyed.

The Hospital is connected with the Medical Department of the University of Pittsburgh, and a lecture-room was established for student recitations and lectures. This room was equipped with a Leitz Projection Apparatus and when one of the patients who had worked in the Mellon Institute of Industrial Research learned that the Institute had prepared lantern-slides showing the work of the Institute, he asked the Hospital authorities for the use of the projector so he could tell the other patients about the Institute, but as he was a throat case he was advised to secure a speaker along with the slides. This was done.

Dr. William Charles White, the Medical Director suggested that other lecturers be secured.

An entertainment course was then arranged for the spring months which consisted of illustrated lectures on manufacturing processes, concerts by various organizations, etc. All of these were furnished free. A patient who had worked Continued on page 356

providing for compulsory state health insurance. There may be difference of opinion in many quarters as to the exact character and practicability of certain of these particular measures. Such difference of opinion is wholesome and proper. As to the principle of health insurance, however, there should be little difference of opinion.

Those who have studied carefully the marvelous efficiency of Germany in the crisis of the last two years are coming

to believe that much of her success and stability has been due not only to her unexcelled scheme of preparedness, but even more to years of preparation through

various lines of social insurance. One contrast will illustrate this point. According to reliable sources the French Government, where no scheme of health insurance has been in vogue, has been compelled, since the beginning of the war, to withdraw more than 100,000 men from the trenches because of developing tuberculosis, all of which was presumably contracted and in some degree evident prior to the war. Information from unbiased and even unfriendly sources indicate, on the other hand, that the number of troops which Germany has been compelled to withdraw on account of tuberculosis has been comparatively negligible (the exact figures are not available). It is reported, It is reported, however, from reliable sources that all but 10 per cent. of those who have been withdrawn from the trenches in Germany

because of tuberculosis have been restored to military duty of some sort. This would indicate that Germany's scheme of health insurance had been a powerful ally in the present war, since her men have been better able to withstand the rigorous life of the trenches because they have been fortified by years of careful medical supervision.

The essence of any scheme of health insurance is prevention, and the method by which prevention is attained is by periodic physical examination. Only when everybody under certain wage limits must be examined, will the absence

of physical defects and impairments to which the human body is subject become evident, and only then will these diseases be subjected to timely and preventive treatment. This is what health insurance proposes to do.

The obligation of anti-tuberculosis associations is clear. Tuberculosis is a disease to which hundreds of minor physical defects and impairments contribute. It is a disease that requires skillful and careful diagnosis and treatment. It is an industrial disease, the burden of whose responsibility rightly belongs upon the employer, the employee and the state. If, therefore, the measure in any state is not particularly satisfactory in detail, anti-tuberculosis workers should strive to make it so and should work for the ideal of health insurance.

National Conference of Charities and Correction at Pittsburgh June 6-13, it has been suggested that a date prior to these meetings would be desirable. Further definite announcement on this point and also with regard to section chairmen will be made later.

Yet in spite of Dr. McDowell's years of pains taking labor, his success and the calm courage of conviction which he showed in the face of opposition, in spite of the written record which he left of his work, history has taken little account of it.

The present memorial will have value as an honor to one to whom honor is due, and to point the student to one of the forgotten mileposts of victory in the long, slow road we are travelling toward the conquest of the white plague.

in Yellowstone National Park secured some slides of the Park and gave a very interesting lecture, and other patients who had post-cards or other pictures of their travels or subjects in which they were interested gave illustrated talks, as the projector would also show these.

These entertainments which were held about every two weeks were discontinued with the advent of warm weather and nothing was regularly substituted.

The course was started again with the approach of winter, the numbers occuring at irregular intervals until after the Christmas season, when they were held once a week. Very little Hospital material was used, owing partially to the cooperation of the University of Pittsburgh and the Carnegie Institute of Technology in furnishing speakers.

On the approach of warm weather, speakers were more difficult to secure, but the patients wished the entertainments to continue.

A former patient who operated a number of photo-play houses suggested about this time that a second-hand Movie Machine could be purchased very cheaply, probably as low as $25. A trial canvass showed that this amount could just about be raised among the patients. After collections had been started running between 5 cts. and $1.00 per patient, average 40 cts., it was learned that a suitable machine would cost at least $60, and as some of the patients had given as much as they could afford, additional contributions were secured from members of the staff, from nurses, employees, former patients and friends of the patients.

It was learned that some moving-picture exchanges in this city would lend films free for such purposes while others wanted $5 or $10 per evening. Even the latter, however, were willing to loan them occasionally free of charge,

so that shows are now held once a week and so far no charge has been made, and as the films are returned in good condition, no charge is anticipated in the future.

A larger hospital with more paying patients could more easily afford to rent films.

Electric fans are used to cool and ventilate the room. It has been proposed to hold the shows out of doors, but this would require more expensive equipment and more current or would mean a still later retiring time if held after dark. The shows now start at 6.45 and continue till about 8.00, which is the usual time for "lights out" in the summer.

Special entertainments are held on Hallowe'en and Christmas. For Hallowe'en masquerading is permitted. The Christmas entertainment has been different for the past 3 years.

Last Christmas a banquet was served in the evening, accompanied by music on the piano and followed by games. A flash-light was taken and each patient received a copy as a present from the Supt., Miss A. E. Stewart. An electriclighted Christmas tree occupied a prominent position in the dining-room.

The preceding year a Christmas tree was also used and a Santa Claus presented each patient with a toy appropriate to the person. A patient interested in races received a toy race-horse, another who had been a telephone man received a toy telephone, etc., which created quite a little enjoyment, especially to the others.

For the year earlier each patient received a tooth-brush with holder and a box of candy.

The use of wireless telegraphy to amuse patients and the telephone system by which bed patients are enabled to listen to the lectures and concerts were described in the February, 1916, issue of this JOURNAL.