UBERCULOSIS 
A Primer and Philosophy 
MCDUGALD MCLEAN TUBERCULOSIS 
A 
Primer and Philosophy 
Patient and Public 
FOR 
BY 
McDugald McLean, B.A., B.Sc. (Oxford), 
M.D. (Johns Hopkins) 
JOURNAL OF OUTDOOR LIFE 
370 Seventh Ave. 
New York J «•* 
Copyright 
McD. McLean 
1922 
Revised Edition, 1924 
Copyright by 
National Tuberculosis Association 
Printed in the 
United States of America To 
E. W. M. 
and 
S. W. M. 
"I marvel that God made you mine, 
For when He frowns 'tis then ye shine." CONTENTS 
Preface to Second Edition ix 
Preface to First Edition xi 
PART I-A PRIMER OF TUBERCULOSIS 
I. When and How We Get Our In- 
fections 1 
Infection and disease-Most dangerous 
period - Primary infection - Congenital 
infection and heredity-Local disposition 
and constitutional disposition. 
II. The Bacillus and the Lung . . 9 
The tubercle bacillus-Structure and 
function of the lungs. 
III. The Nature of the Disease . . 12 
Nature's defense-Immunity-Tendency 
to relapse-Infants, children, adults. 
IV. Danger Signals 16 
Wisdom and folly-Early symptoms ob- 
scure - Classification of symptoms - 
Forms of tuberculosis and mistakes in 
diagnosis. 
V. Good and Bad Advice 22 
Pleasant vs. good advice-Physicians 
and advice-Sanatorium or home treat- 
ment-Arrestment of disease and change 
of occupation-General advice. 
VI. Morale 31 
Evil effects of worry-Serenity-Religion 
and philosophy-Physiological effects of 
emotions-Cause of depressive emotions 
-Self control. 
V CONTENTS 
VII. Prevention and Cure .... 38 
Prevent infection-A house disease-? 
Light, ventilation and heat-Informa- 
tion, perseverance and legislation needed 
-Prevent infection from becoming mani- 
fest disease-Enumeration of preventive 
measures-Remarkable progress: United 
States, England, Denmark. 
VIII. Climate and Altitude .... 51 
Exaggerated importance-Scientific basis 
-Statistics-Essentials-A good climate 
-Advice on climate. 
IX. Helpful Suggestions 60 
Dry heat-Appetite-Cough-Bowels- 
Mouth - Sleep-Amusements - Food - 
Proteins, carbohydrates and fats-The 
calory. 
X. Miscellaneous 72 
The daily routine-Temperature-Pulse 
-Rest-Exercise-Tuberculin-Artificial 
pneumothorax - Medicines -• Alcohol - 
Tobacco. 
PART II-REFLECTIONS OF A DOCTOR 
PATIENT 
I. Historical 87 
1600 B.C.-Hippocrates-Barren period 
-Progress in nineteenth century-Koch 
and the great campaign for the preven- 
tion and cure of tuberculosis-Sanatoria 
-Dr. Trudeau-National Tuberculosis 
Association - Tuberculin and artificial 
pneumothorax - Tuberculosis: Extent, 
races, animals. 
vi CONTENTS 
II. Physician and Patient .... 98 
Qualifications of physician - Mutual 
understanding-Cooperation-Candor- 
Caveat, Doctor. 
III. Phthisiophobia and the Careless 
Consumptive 104 
Ignorance and selfishness-No danger to 
adults-Children-No mental and moral 
perversion-Stupid prejudice-Summary 
of evils-The careless consumptive. 
IV. Health vs. Patent Medicines, 
Charlatans, and Christian Sci- 
ence 113 
Patent medicines-Charlatans-Christian 
Science-Signs of the time. 
V. Temperaments and Tuberculosis . 124 
Varying reactions to tuberculosis-Alice 
Freeman Palmer-The mettle of the pa- 
tient-A. chance for mental activity. 
VI. Distinguished "T. B.'s" .... 133 
Trudeau-Adirondack Cottage Sanita- 
rium-Grancher-Dettweiler-Laennec- 
Lanier-.Stevenson-Schiller-Motfere- 
Artemus Ward-Wright-Wesley. 
Appendix 153 
Weight according to age and height- 
Vitamins in foods-Common foods classi- 
fied-Table of food values-Books fosr 
tuberculosis patients. 
vii PREFACE TO SECOND EDITION 
The usefulness of Doctor McLean's primer and 
philosophy on tuberculosis has been so amply dem- 
onstrated in the first edition that the publishers 
have decided to issue a second edition with the 
consent of the estate of Doctor McLean. 
Dr. McDugald McLean made a valiant fight 
against tuberculosis, but succumbed to the disease 
in 1922. 
It is the sincere wish of the "Journal of the 
Outdoor Life" that this volume receive a wide read- 
ing by physicians and tuberculosis patients. 
Philip P. Jacobs. 
March 20, 1924, 
IX PREFACE TO FIRST EDITION 
The purpose of this little volume is to give the 
patient something that will interest and encourage 
him, and at the same time include such general in- 
formation as he and the public should have-a sum- 
mary of the best opinion and advice of our leading 
specialists, digested by six years of experience as a 
patient and assistant, and a careful study of the 
current literature and standard texts on the subject. 
In no sense is it intended to take the place of the 
doctor. It would be disastrous to give the patient 
any set of rules and let him attempt to direct his 
own case. There are three things in the treatment 
of tuberculosis: Rest, Morale and Advice-and the 
last should be first. Without it the patient is like 
a mariner without a compass, a blind man trying 
to cross Broadway at 42nd Street. If the reader 
gets the idea from these pages that the first duty 
of a "t. b.," and the safest and cheapest course, is 
to seek the advice and direction of a competent 
specialist, this little book will be amply justified. 
My experience with tuberculosis has been 
varied, and has extended over a period of six years 
now, and into California, New Mexico, New York 
and Asheville. During this time I had ample leisure 
to meditate upon tuberculosis from the viewpoint 
xi PREFACE TO FIRST EDITION 
of a patient and a doctor, and to witness the ebb 
and flow of individual and sanatorium morale, the 
tragedies and the triumphs in the chase of the cure, 
and to take part in that life both as a patient and 
as an assistant in the sanatorium. In Part II 
I have recorded some observations and reflections 
from these experiences. 
I hope that this little volume may be of some 
practical help and encouragement to the many pa- 
tients going through "the course," and that it may 
help to spread the information that is necessary 
for the prevention of this disease. When every 
one is thoroughly awake to the situation that tu- 
berculosis can be more EASILY and SUCCESS- 
FULLY and CHEAPLY PREVENTED than 
CURED, a big advance toward this end will have 
been made. 
McD. McLean, 
Asheville, N. C. 
xii PART I 
A PRIMER OF TUBERCULOSIS I 
WHEN AND HOW WE GET OUR 
INFECTIONS 
"Keep out of indoors." 
-Koons. 
When. A summary of the best evidence on the 
infection with tubercle bacilli indicates that about 
75% of people who have reached the age of fifteen 
years have been infected. This does not mean that 
75% have been sick in bed with tuberculosis. A 
large majority of this 75% are entirely unaware of 
such infection, which is revealed only by a positive 
tuberculin reaction. Practically 100% of those 
who live to be thirty years old receive such infec- 
tion. In the first year of life positive tuberculin 
reactions are found in about 9%, by the fifth year 
in about 45%, by the tenth year in about 66%, 
and by the fifteenth year in about 75%. These 
figures are based on city inhabitants and largely 
the poorer classes. They would undoubtedly be 
lower for the better classes and rural population. 
Infection and Disease. It is, perhaps, well to 
point out here the difference between infection with 
tubercle bacilli and the clinical disease tuberculosis. 
1 TUBERCULOSIS 
The former may occur without producing symptoms 
sufficient for the one affected to be aware of it, and 
the infection may be so successfully overcome that 
it will never cause any trouble. By clinical tubercu- 
losis is meant the disease with manifest symptoms 
of fever, cough, loss of appetite and weight, etc. 
Most Dangerous Period. A large majority of 
people who break down with clinical tuberculosis 
do so between the ages of eighteen to thirty years. 
A sharp rise in the mortality from tuberculosis oc- 
curs at the age of puberty. That this new physio- 
logical strain is a factor is indicated by the fact 
that the rise occurs earlier in girls than in boys, 
corresponding with puberty in the two sexes. The 
period from 18 to 30 years is one of strenuous life, 
dissipation and excesses in various forms, physical 
and mental overstrain in beginning business and 
professional careers, and worry over initial failures. 
It is this physiological and physical strain and men- 
tal stress and anxiety that cause so many break- 
downs during this period of life, when resistance 
is lowered and the old foci of infection are fanned 
into activity by these unusual hardships. 
Tuberculosis is a very deadly disease in infants. 
While only about 15% react positively to tubercu- 
lin in the first two years of life, the mortality rate 
is so high (75 to 80%) that the actual number of 
deaths equals, or exceeds, that of any other year 
of life. In adults positive tuberculin reactions are 
2 INFECTIONS 
found in 75 to 100%, but the mortality rate has 
dropped to about 25%. There is a sharp fall in 
the annual death rate with the third year of life 
and it continues to fall till about the fifteenth year, 
when there is a sharp rise at the age of puberty. 
This rise continues to about the twentieth year 
when the number of deaths again equals that of 
the first two years. From the twentieth to the 
forty-fifth year the annual rate is high and about 
equal to that of the first two years. From the third 
to the twentieth year the average rate is about one- 
third that of the first two years and that of the 
twentieth to forty-fifth years. 
How. Infection takes place through exposure 
to tubercle bacilli. The bacilli gain entrance into 
our bodies in three ways: 
(a) Breathing air which has been contaminated 
by the spray from coughing and sneezing of tu- 
berculous patients, and from the dust of dried 
tuberculous sputum. 
(b) Drinking infected milk and eating in- 
fected food. The milk may come from a tubercu- 
lous cow, or it may be infected from outside 
sources, as food is, by flies, dirty fingers, cough- 
ing over it, etc. 
(c) Other sources of infection such as inocula- 
tion through abrasions of the skin and wounds 
are probably responsible for a small percentage of 
cases. 
3 TUBERCULOSIS 
It is estimated that about 92% of the infec- 
tions come from man to man, and about 8% from 
tuberculous cows. 
Primary Injection. Primary infection from the 
gastro-intestinal tract is estimated to occur in as 
high as 25% of cases. About half of the infec- 
tions from the intestinal tract are caused by the 
bovine bacillus and about half by the human bacil- 
lus. Inhalation infection probably accounts for 
most of the remaining cases, although recent inves- 
tigations indicate that the ingestion method and 
inoculation through abrasions of the skin are prob- 
ably more frequent sources than generally con- 
sidered. 
Congenital Injection and Heredity. Congenital 
infection is very rare, and comes from the mother 
through a tuberculous placenta. Tuberculosis is 
not inherited. There is no evidence that it comes 
from the germ plasm, or that it is transmitted from 
the father. On the contrary, there is good evi- 
dence that children of tuberculous parents inherit 
an increased resistance to infection, as far as any 
specific inheritance is concerned. One will nat- 
urally ask then, why do children from tuberculous 
families develop tuberculosis more often than those 
from non-tuberculous families? The answer is be- 
cause they are much more frequently and con- 
stantly exposed to infection by careless and ig- 
norant parents and other relatives. 
4 INFECTIONS 
No Absolute Immunity. There is no absolute' 
immunity to tuberculosis in man, although a rela- 
tive racial immunity seems to be well established, 
especially among the Jews and other white civilized 
races that have been in contact with it for many 
centuries. 
It is now established that the first seat of dis- 
ease is in the lymphatic glands, where the bacilli 
may lie for many years. If the number and viru- 
lence of the bacilli are sufficiently great, or if the 
resisting power is unusually low, disease may fol- 
low infection in a short time; otherwise, complete 
healing may take place without the development 
of any recognizable symptoms. 
Local Disposition and Constitutional Predispo- 
sition. Certain factors and diseases render the 
lungs and various organs and parts of the body 
more susceptible to the development and spread of 
tuberculosis in them, and they are included in the 
term "local disposition." Chief among such fac- 
tors are: (1) prolonged physical and mental over- 
strain; (2) under-nutrition and unhygienic sur- 
roundings-long residence in poorly ventilated 
quarters greatly lowers resistance; (3) measles, 
whooping cough, and influenza; (4) diabetes; 
(5) pregnancy. 
A constitutional predisposition or tendency to 
develop tuberculosis in certain types of individuals 
and families has been noted for centuries. The in- 
5 TUBERCULOSIS 
dividual with the habitus phthisicus is described as 
pale, thin and feeble, with frail bony framework, 
long, narrow and flat chest with wide intercostal 
spaces, and a small heart and aorta. Such a per- 
son, however, is prone to develop not only tuber- 
culosis, but also any other infectious disease to 
which he is exposed. The inheritance of such nu- 
tritional faults and malformation of the bony 
framework and poor development of the heart and 
blood-vessels cannot be considered as a specific in- 
heritance of a tendency to tuberculosis any more 
than a tendency to various other infections. And 
there is no conclusive evidence that children of tu- 
berculous parents inherit the habitus phthisicus in 
a higher percentage than children of non-tuber- 
culous parents. 
Exposure to Injection. It is probable that in- 
fection rarely, or never, occurs in the open, hence 
tuberculosis has been aptly called a "house dis- 
ease." Frequent contact, on the part of children, 
with tuberculous persons who are careless in their 
habits and toilet, and who live in unhygienic quar- 
ters, leads to multiple re-infections and is of great 
importance in the development of the disease. It 
is doubtful, however, that this is an important fac- 
tor in the case of adults. Doctors, nurses, and at- 
tendants at tuberculosis sanatoria do not develop 
tuberculosis any more frequently than they do in 
other fields of activity. An extensive investigation 
6 INFECTIONS 
of married couples, where one of the partners is 
tuberculous, revealed the fact that there is no 
higher incidence among the non-tuberculous part- 
ners than there would be in a similar group of the 
general population. Clinical tuberculosis in adults 
comes chiefly from an old focus of infection which 
is lighted up by some over-strain, malnutrition, or 
other infection. The fact that the great majority 
of our soldiers who developed tuberculosis did so 
within a month or two after entering upon active 
duties shows that old foci were fanned into activity 
rather than that new infection was acquired, for 
this is too short a time for new infection to reach 
the stage of clinical disease. 
Dr. E. R. Baldwin* summarizes present views 
on infection as follows: "The doctrine of inherited 
or acquired susceptibility is in doubt ... all 
infants are susceptible, and susceptibility lessens 
with increase in age; adults are comparatively in- 
susceptible when without general or local lowered 
resistance and repeated or prolonged exposure. As 
to sources of infection . . . the sputum is of 
overwhelming importance . . . cow's milk is 
an important factor . . . mother's milk, the 
urine, feces, and other excretions of tuberculous 
invalids are not frequent sources of infection. As 
to means of transmission there is a growing belief 
in the importance of infected food, especially milk, 
for infants and children rather than for adults; 
7 TUBERCULOSIS 
. . . to adults dust and coughed spray are of 
more importance than infected food. . . . 
Pulmonary tuberculosis is often secondary to the 
lymphatic form (glandular) contracted in early 
life. . . . It is doubtful that a second infec- 
tion from outside the body is a frequent occurrence 
after clinical healing of pulmonary tuberculosis in 
adults; ..." 
* Modern Medicine, Osler and McCrae, Vol. I, p. 338. 
8 II 
THE BACILLUS AND THE LUNG 
"It is not what you have in your lungs 
but what you have in your head that deter- 
mines whether you will get well or not." 
-"San saying." 
The Tubercle Bacillus. The tubercle bacillus 
is a microscopic fungus, or plant, about one ten- 
thousandth to one five-thousandth of an inch long, 
and one-fifth to one-fourth as broad. It is rod 
shaped and motionless, and is a strict parasite, not 
having a habitat outside of man and animals, 
though it may exist for months in nature. It mul- 
tiplies with great rapidity by dividing into two 
parts again and again, many millions being formed 
and expectorated daily, and produces poisons which 
kill the tissues around it. A healthy body is not 
favorable soil for the bacilli to grow in, but they 
may lie inactive in glands within the chest and in 
scar tissue surrounding old foci of infection for a 
long time (practically indefinitely) and then begin 
to multiply and grow again when by some chance 
such as prolonged over-strain, poor nutrition, etc., 
the tissues become favorable soil again. A striking 
peculiarity of this plant is the fact that light kills 
9 TUBERCULOSIS 
it. It can remain alive and virulent for many 
months in darkness, dampness, dirt and cold, but 
it has not the "character" to endure exposure to 
light, and succumbs within a few minutes to a few 
days, depending on the degree of light. 
Structure and Function of Lungs. In order to 
explain better the soil in which the bacilli grow, I 
give a brief description of the structure and func- 
tion of the lungs, the scene of activity in pulmonary 
tuberculosis. 
Man is endowed with a pair of lungs. The 
right one normally has three lobes and the left 
two, but the two lungs are about the same size and 
weight. They are covered by a thin tissue called 
the pleura which is reflected back over them from 
the chest wall which it also lines, and so forms a 
blind sac called the pleural cavity. The windpipe, 
or trachea, extends from the back of the throat 
down the middle of the chest and gives off a main 
branch, or bronchus, to each lung. These bronchi 
in turn give off many smaller bronchi, like the 
branches of a tree, and finally the innumerable 
smallest branches, called bronchioles, each termi- 
nating in a bunch of air cells, called a lobule, which 
is regarded as the unit of lung structure. These 
lobules are very tiny, about one twro-hundredth of 
an inch in diameter, and there are millions of them. 
Their walls are composed of a very thin but tough 
layer of tissue, and are surrounded by a network 
of capillary blood vessels. Here the respiratory 
10 THE BACILLUS AND THE LUNG 
exchange takes place, when the oxygen of the in- 
spired air is exchanged for the carbon dioxide in 
the blood. This exchange takes place in accordance 
with the physical principle known as osmosis, i.e., 
the percolation and intermixture of gases or liquids 
through permeable walls. 
The normal individual inhales about one hun- 
dred and fifty gallons of air per hour, and the 
heart pumps about a hundred gallons of blood 
through the lungs in the same length of time-a 
marvelous performance and mechanism which de- 
serves far more consideration than usually ac- 
corded it, especially when handicapped by tuber- 
culosis! 
11 Ill 
THE NATURE OF THE DISEASE 
"So gird up your hopes- 
He loses who mopes." 
-Forbes. 
Tuberculosis differs from most other infectious 
diseases, such as small-pox, typhoid fever, pneu- 
monia, etc., in that these diseases run a definite and 
limited course, usually a few weeks, and then the 
patient is either well or has begun a new life in the 
next world. Not so, though, with tuberculosis! 
The tubercle bacilli are able to live in our tissues 
indefinitely, and when the chance comes, to spread 
to other tissues and organs and set up clinical tu- 
berculosis. • 
When infection occurs in the lung, tiny little 
nodules, or tubercles, appear which consist of 
cheesy masses of dead tissue and bacilli. Sur- 
rounding the tubercle is a layer of cells thrown 
out by the body to protect itself from the invading 
germ. If the poisons produced by the germs are 
sufficient to kill these cells, the disease spreads. 
Lung tissue thus destroyed is not replaced by lung 
tissue, but b'tT scar tissue, which is the material 
12 NATURE OF THE DISEASE 
used by nature in the repair of all tissues. One 
may lose the use of five-sixths of the lung tissue 
and still live, such is the margin of safety with 
which we are endowed. 
Nature's Defense.-Nature attempts to isolate 
and wall off the bacilli and focus of infection as 
follows. At first she throws an area of inflamma- 
tion around the focus, as stated above, and this 
is later replaced by a wall of scar tissue which, if 
successfully established, completely checks the dis- 
ease and holds the bacilli under control. In some 
cases that do not advance very far the bacilli may 
be killed and the focus of infection absorbed, leav- 
ing only a tiny scar. In other cases nature de- 
posits lime salts around the focus which later be- 
come calcified and form little stony walls about 
the focus, or replace it with stony formation, which 
Dr. Lawrason Brown has called the "grave-stones" 
of the dead bacilli. 
Slow Process. The formation of this scar tissue 
is a slow process, and this is why the tuberculous 
patient must be so careful about rest and exercise 
even many months after the cessation of such 
symptoms as fever and cough, as it requires at 
least a year or two for this scar tissue to become 
strong enough to withstand the ordinary strains 
of life put upon it. In the beginning the forma- 
tion of this scar tissue is a spider web affair, or 
like the formation of ice upon a pond. If the pa- 
13 TUBERCULOSIS 
tient has severe coughing spells, or exercises too 
much and thus increases the respiratory movement 
and blood pressure, the fibrous tissue strands are 
broken and the formation of the scar tissue is de- 
layed and made uneven and excessive in amount, 
as the formation of the ice on the pond is dis- 
turbed by the ripples and waves. 
Immunity. Nature also elaborates certain sub- 
stances in the cells and tissue juices of the body 
which tend to check the growth of the bacilli and 
to kill them. The nature of these substances is 
not yet clearly understood. Upon them depends 
the relative degree of immunity which is estab- 
lished in tuberculosis. In smallpox and typhoid 
fever, for instance, the immunity established is 
complete, and the patient has these diseases only 
once. In pneumonia, for example, there is appar- 
ently no immunity established, or rather it is very 
transitory, and the patient may suffer from fre- 
quent attacks. 
Koch discovered the significant fact that if an 
animal is infected with tuberculosis, and later a 
second inoculation made, the focus of infection 
from the second inoculation remains localized, ul- 
cerates, sloughs out and heals, leaving only a scar, 
and does not spread to the underlying lymph glands 
and other tissues as the first infection always does. 
This clearly shows that the first infection produces 
a certain amount of immunity which is able to 
14 NATURE OF THE DISEASE 
prevent the spread of subsequent infections, but 
is not sufficient to control the original infection. 
This experiment led him to the discovery of 
tuberculin, and the attempt to produce immunity 
by giving tuberculin treatment, but such attempts 
have yielded small results so far. 
Tendency to Relapse. Tuberculosis is a dis- 
ease which tends to relapse. This occurs when 
some over-strain or infection, etc., is able to fan 
the old foci into renewed activity, or when through 
lowered resistance the bacilli are enabled to invade 
new areas. Hence a person who has been "cured" 
should not consider himself as entirely free from 
living bacilli. This should be no cause for worry, 
but rather looked upon as a "safety first" re- 
minder, for it is not incompatible with the enjoy- 
ment of health and activities. 
Infants, Children, Adults. In infancy the most 
common form of tuberculosis is generalized miliary 
tuberculosis and tuberculous meningitis, and is 
practically always fatal. In children tuberculosis 
of the glands, bones and joints is the common 
form, and chances of recovery are excellent if 
proper care and treatment are carried out. In 
adults pulmonary tuberculosis is by far the most 
common form. It has a pronounced tendency to 
become chronic, is certainly amenable to treatment, 
and the earlier the treatment is begun the better 
are the chances of recovery. 
15 IV 
DANGER SIGNALS 
"Let thine ear now be attentive, and 
thine eyes open." 
"The prudent man joreseeth the evil and 
hideth himselj ; but the simple pass on and 
are punished." 
Wisdom and Folly. Tuberculosis, in a large 
majority of cases, comes on gradually and insidi- 
ously, and there are signals, as a rule, months 
ahead of the "breakdown," to warn us if we have 
our ears attentive and eyes open, as the writer ex- 
horts us in the quotation above. It is upon these 
warning signals that I wish to dwell for a few 
pages now, and to emphasize the wisdom of heed- 
ing them, and to point out the folly, loss of time 
and money, and disastrous results that may ensue 
if we refuse to give ear to them, and fail to seek 
and follow the advice of a physician competent to 
direct in these matters. 
It is of the greatest importance to realize that 
if tuberculosis is taken in hand at the time of these 
early warnings a serious "breakdown" can be pre- 
vented, and a complete arrestment of the disease 
16 DANGER SIGNALS 
obtained in a few months of proper treatment in 
as high as 80 or 90% of cases, while if one waits 
until the break comes, the period of treatment is 
three to ten times as long and the results obtained 
much less satisfactory. And yet there are many 
who, when aware of these early symptoms, say 
that they just can't afford to stop and take a few 
months off, when the most elementary considera- 
tions of finance and prudence should convince them 
that they can ill afford not to do so. On the one 
hand, the law of chances that they will not break 
down is strongly against them, and on the other 
hand the chances of averting the breakdown and 
replacing their health on a stable foundation are 
overwhelmingly in their favor. If we could get 
such favorable odds in any financial adventure, 
there would be a headlong rush for them; but 
when "health" is the stake, we develop indefensible 
and simple-minded nearsightedness and stumble 
along at a snail's pace toward the goal. 
It is not my desire to disturb the mental equi- 
librium of nervous types of individuals by reciting 
the early symptoms of tuberculosis, but if I can 
scare some into having an early diagnosis made, 
and treatment begun, the result will far outweigh 
any groundless fears that may be aroused. 
Early Symptoms Obscure. The earliest symp- 
toms of tuberculosis are by no means always easy 
to recognize and identify. The patient may not 
17 TUBERCULOSIS 
be aware that anything is wrong more than a vague 
feeling that things are different from what they 
used to be. If he is asked the question, "How 
long has it been since you felt perfectly well?" he 
will often be surprised to discover that it has really 
been months, or even years. 
To enumerate more specifically, we may men- 
tion the following symptoms which should arouse 
suspicion: 
(1) Change of mental attitude-more irritable 
disposition-tendency to be upset and worried by 
small things which formerly would not disturb your 
equilibrium. 
(2) Lack of endurance with slow recovery from 
fatigue. 
(3) "Don't care" attitude-tasks that were for- 
merly easy and pleasant become difficult and un- 
interesting. 
(4) Capricious appetite, with unexplainable loss 
of weight of five or ten pounds. 
(5) Unstable pulse of 85 or more in men, and 
90 or over in women. 
(6) Frequent colds which "hang on" and slow 
recovery from other diseases. Symptoms of tuber- 
culosis are apt to appear for first time during such 
periods. 
(7) Cough which persists for a month or more. 
(8) Temperature of 99.4 or over on several 
successive days. 
18 DANGER SIGNALS 
(9) Spitting of blood which does not definitely 
come from nose or mouth nearly always indicates 
tuberculosis. 
(10) Pleurisy which is not definitely associated 
with pneumonia or an injury is practically always 
tuberculous. 
(11) Fistulae are very often of tuberculous 
origin. 
(12) Unexplainable hoarseness. 
(13) Enlarged glands, especially in children. 
(14) Exposure to infection, especially in child- 
hood. 
(15) Night sweats. 
Many of these symptoms, of course, appear in 
other infections and diseases, but if a definite and 
undoubted diagnosis cannot be made, tuberculosis 
should be suspected and carefully looked for. 
Classification of Symptoms. Dr. Pottenger* 
has very conveniently arranged the symptoms of 
tuberculosis in three groups as follows: 
(1) Symptoms due to toxemia 
Run-down feeling 
Lack of endurance 
Loss of strength 
Nervous instability 
Digestive disturbances 
Loss of weight 
*Pottenger, F. M.: Clinical Tuberculosis, C. V. Mosby 
Co., 1917. 
19 TUBERCULOSIS 
Increased pulse rate 
Night sweats 
Fever 
Blood changes 
(2) Reflex origin 
Cough 
Pains in chest and shoulder 
Digestive disturbances 
Circulatory disturbances 
Flushing of face 
(3) Tuberculous process per se 
Frequent and protracted colds 
Pleurisy 
Haemoptysis 
Sputum 
Hoarseness 
Fever 
Feelings Deceptive. The toxic symptoms are 
usually the first to appear, and also to disappear. 
It is this group of symptoms which make the pa- 
tient realize that he is sick. It is important to 
know that active tuberculosis may be present with- 
out manifesting toxic symptoms, at least symptoms 
that the patient will recognize; and also to realize 
that the patient is not well as soon as these toxic 
symptoms disappear, although he may feel per- 
fectly well. It takes much longer for the other 
two groups of symptoms to disappear, and for heal- 
ing to take place in the lungs. 
20 DANGER SIGNALS 
Forms of Tuberculosis and Mistakes in Diag- 
nosis. Tuberculosis assumes various forms and may 
often be mistaken for other diseases, especially in 
the early stages. (1) Catarrhal form-this is prob- 
ably the most frequent source of mistaken diag- 
noses-often diagnosed as colds, bronchitis, colds 
in the chest, etc. (2) Febrile, or malarial form- 
often diagnosed, especially in malarial districts, as 
malaria. (3) Dyspeptic form-may be called in- 
digestion, etc. (4) Pleuritic form-importance of 
pleurisy is often minimized; patients are told they 
will be all right in a week or two, or that they are 
threatened with tuberculosis, when in fact they 
have it. About 90% of all cases of pleurisy are 
tuberculous, when not associated with pneumonia. 
(5) Anaemic form-may be diagnosed as anaemia, 
or as chlorosis in girls and women. (6) Nervous 
form-often called neurasthenia. (7) Laryngeal 
form-may be passed over as sore throat, or simple 
laryngitis. (8) Haemoptotic form-as in the case 
of pleurisy the patient may be told that a little 
spitting of blood does not amount to anything, that 
he is all right, when in fact it is the herald of 
tuberculosis. (9) Traumatic form-tuberculosis 
sometimes develops at the site of an injury. 
It is impossible to over-emphasize the impor- 
tance of early diagnosis and treatment in tuber- 
culosis. If your family physician is in doubt about 
the diagnosis, don't hesitate to consult a specialist. 
21 V 
GOOD AND BAD ADVICE 
"When a man's knowledge is not in order 
the more of it he has the greater will be his 
confusion." 
Pleasant vs. Good Advice. All shades and 
qualities of advice can be had for the asking-and 
often without the asking. Ignorance of the issues 
at stake does not restrain these voluble advisers 
from proffering their well-meant but misdirecting 
and meddlesome advice with great assurance and 
insistence. Ne'er-do-wells and failures in all walks 
of life are notorious advisers. One danger from 
such advice is the tendency to accept it when it 
coincides with our whims and pleasure in prefer- 
ence to the best advice, which may not be so con- 
venient and pleasant to take. 
Groundless Advice. The habit of laymen, espe- 
cially "ex-t.bs.," of giving advice to tuberculous 
patients when they are absolutely ignorant of the 
pathology and physiology of the disease, and espe- 
cially of the patient's physical condition, is a per- 
nicious one. Truly, in this province, "fools rush 
22 GOOD AND BAD ADVICE 
in where angels fear to tread." Such advice is 
nearly always based on the fact that they know 
Mr. A. who did so and so, or went to a certain 
place, and either got well or didn't get well. When 
we consider the fact that many patients get well 
in spite of numerous follies and dangerous prac- 
tices, and on the other hand that many die under 
the very best treatment and conditions, it should 
be evident that the few cases which come within 
the ken of the laymen should really have no influ- 
ence in the matter. 
Physicians and Advice. All physicians, unfor- 
tunately, are not qualified to give good advice- 
certainly not the best advice-in tuberculosis. Dr. 
Pottenger says, "The general apathy of the pro- 
fession toward tuberculosis, and neglect to study 
it as its seriousness and frequency deserve, lead to 
a lack of confidence in their ability to diagnose 
and treat it satisfactorily." And some make this 
situation worse by neglecting to send doubtful cases 
to a physician who has made a careful study of the 
disease and understands it thoroughly. It is a de- 
plorable and inexcusable practice to lull the pa- 
tient into a false security by telling him that there 
is nothing the matter, that he is just in a run-down 
condition, or has weak lungs, etc., while waiting 
for absolutely unmistakable physical signs and the 
appearance of bacilli in the sputum. Such a course 
reduces the patient's chances from 80 or 90% to 
23 TUBERCULOSIS 
SO or 60%. Dr. Elsner* has stated the situation 
as follows: "To wait for definite physical signs (in 
tuberculosis) before making a diagnosis darkens 
prognosis, for the patient's chances are reduced 
thereby. To anticipate the final development in 
cases which are strongly suggestive adds to the 
patient's chances. Positive physical signs are never 
early evidence of lung infection; they mean that 
the case is advanced." Cheap advice which leads 
to delayed diagnosis and mistakes in treatment 
proves in the end to be very dear. 
Sanatorium or Home Treatment? One of the 
first and most important questions to be decided is 
whether the patient should be treated in a sana- 
torium or at home. Rules cannot be laid down 
for all cases. It must be decided separately for 
each case, and the advice of an expert should be 
sought in the matter. In general it may be said 
that, if other things are equal, the sanatorium offers 
twenty to thirty per cent better chances than the 
home, and possibly even higher percentages in 
some cases. Advice in this matter depends on: 
(1) stage and duration of the disease; (2) finan- 
cial condition; (3) temperament, habits, social con- 
dition, family ties of patient; (4) age. 
It is manifestly unwise to send a hopeless case 
* Monographic Medicine, D. Appleton & Co., 1916. Vol. 
VI. 
24 GOOD AND BAD ADVICE 
to a distant sanatorium, and yet this is by no 
means an infrequent occurrence. Infants are best 
treated at home. Children do best in special insti- 
tutions where there are arrangements for amuse- 
ment, suitable instruction, and careful supervision. 
People over sixty do not adjust themselves to sana- 
torium regime without considerable friction and 
often needless irritation. Finances and tempera- 
ment are important considerations. It is unwise 
to send an unwilling patient away from home to 
worry over his finances and worry over the separa- 
tion from his family. 
On the other hand, the freedom from home cares 
and interruptions, and temptations of friends, and 
tendency to stop the regime of treatment too soon 
at home, and especially the educative features and 
daily visits and encouragement of the physicians 
are distinct advantages of the sanatorium. The 
"atmosphere" is congenial and sympathetic, and 
the patient is not made to feel uncomfortable by 
well "friends" who are a bit timid and over-cautious 
about their own safety, or thoughtless and selfish 
in their attitude toward him. Everybody is doing 
the same thing and this makes it easier for him 
to do it. New friends and faces, constant changes, 
and the daily routine make the time pass rapidly. 
He sees the mistakes and follies of some that cause 
relapses and prolong the cure, and he has the asso- 
ciation and example of others who are improving 
25 TUBERCULOSIS 
and leaving as "cures" to stimulate him to put up 
his best fight. 
Specific Directions. Specific directions as to 
rest and exercise, diet, symptomatic treatment, etc., 
must come from the doctor in charge of the case, 
and they will vary according to the stage and 
progress of the disease. No course of treatment can 
be outlined for three or four months in advance, 
and the patient sent off into the wilderness with 
a camping outfit to regain his health. The patient 
should have constant medical supervision and en- 
couragement, and the symptomatic treatment must 
be changed from time to time to meet whatever 
demands may arise. 
The defeatist attitude, or laissez faire policy, of 
some physicians and patients is pernicious and will 
reduce one's chances to about half of those offered 
by a vigorous and persistent plan of treatment in- 
stituted at the earliest possible moment. 
Arrestment of Disease and Change of Occupa- 
tion. It is important to realize that no patient can 
be considered "cured" in less than two years after 
the disappearance of symptoms. The question of 
occupation then arises. Can he safely return to 
his old one, or should he take up some outdoor 
work? As a rule, it is much better to return to 
the old one, unless it is a peculiarly unhealthful 
or laborious one. It is a mistake to change from 
easy congenial work to something out of doors for 
26 GOOD AND BAD ADVICE 
which the patient has no aptitude, and which 
usually involves a decrease of income and increase 
of worry and dissatisfaction. His occupation will 
take one-third, or less, of his time. His outcome 
will depend more on the judicious use of the other 
two-thirds, or more, of his time as regards rest, 
amusements, meals, etc. On this subject Dr. David 
A. Stewart, of the Manitoba Sanatorium, has laid 
down the following general principles: 
(1) Work for those with arrested disease must 
not be physically heavy. 
(2) Possibly the most deeply rooted wrong idea 
concerning work for tuberculous persons is that out- 
door occupations are essential. 
(3) It is particularly desirable that a tuber- 
culous person should earn a good wage so as to 
make good living conditions possible. 
(4) A tuberculous patient needs a permanent 
occupation. 
(5) If at all possible, it is better for a man to 
return to his old occupation, or some modification 
of it. 
(6) A suitable job for a tuberculous patient 
should be one which makes it possible for him to 
live at his own home. 
General Advice. (1) Be hopeful and cheerful, 
for your disease is curable. Avoid worry and 
27 TUBERCULOSIS 
anxieties which prolong, and may prevent, the cure. 
(2) Do not tell all your troubles and fears to 
the other patients and people, and dwell on and 
magnify them in your own mind. They have 
troubles enough of their own, and such thoughts 
and conversations are depressing. The doctor is 
the proper one to hear such complaints, and to 
advise accordingly. 
(3) Stay in the open air and sunshine as much 
as possible. Protect your head from the direct 
rays of the sun and never remain in the sun until 
you feel weak, faint, or enervated; and do not 
allow the sun to run up your temperature by stay- 
ing in it too long at a time. In cold weather wrap 
up carefully and do not allow yourself to become 
chilled while sitting or sleeping out. 
(4) Never sleep or stay in a hot, close room, 
and do not shut out the night air-it is generally 
purer than the day air. Maintain the best ven- 
tilation possible both day and night, and let in all 
the light possible. 
(5) Protect yourself from cold damp winds and 
draughts, but do not close up your room in order 
to accomplish this-use wind shields or screens. 
(6) Dress comfortably, and avoid any excess of 
heavy clothing. It is advisable to wear linen-mesh 
underwear next to the skin in order to insure good 
ventilation. It is much better to put on warm outer 
28 GOOD AND BAD ADVICE 
garments than under garments. Keep your feet 
dry and warm. 
(7) Harden yourself gradually to outdoor con- 
ditions and you will be in much better shape to 
resist colds and other intercurrent infections. 
(8) Do not eat when you are tired and wor- 
ried, and do not hurry through the meal. Rest for 
half an hour before and after the principal meals, 
and this will aid both the digestive and mental 
processes. 
(9) Never allow yourself to become tired. Al- 
ways stop and rest at the first symptoms of fatigue, 
either mental or physical. Avoid hurry and strain 
of any kind. 
(10) Sleep nine hours or ten every night, or at 
least lie in bed that long. If you cannot sleep all 
this time, do not worry about it, but lie in a per- 
fectly relaxed condition, physically and mentally, 
and you will get all the rest that you require. Such 
a relaxed condition is also a much better soporific 
than any drugs. 
(11) Do not take any medicine (patent or 
other) unless prescribed by your doctor; and dis- 
continue any medicine that interferes with your 
appetite and digestion. 
(12) Control your cough as much as possible. 
Unnecessary and violent coughing is harmful. A 
determined will-power and persistent effort can ac- 
29 TUBERCULOSIS 
complish much toward this end. I can testify that 
the will-power, stimulated by pleurisy, is a most 
effective remedy for controlling a cough. It makes 
no difference how strong the desire may be, if the 
pleurisy is severe enough the cough will be reduced 
to a mere aspirating grunt. Exercise your will- 
power independently of pleurisy! VI 
MORALE 
"Moral condition as regards discipline, 
confidence, indecision, courage " 
-Dictionary. 
"He that ruleth himselj is greater than 
he that taketh a city." 
-Solomon. 
Morale is one of those things, like electricity, 
which is frequently mentioned, but not fully com- 
prehended. When it is low, things go wrong, no- 
body seems to take any interest or care about you, 
you are worried by trivial things, listless, diverted 
from your objective-you have a "rotten day." 
When it is high, you get on well with everybody, 
speak an encouraging word or do a kindness to 
someone, note some progress; on the whole there 
is a feeling of satisfaction with your efforts and a 
determination to do better tomorrow-a "good 
day." It is a storage battery of nerve force, a 
surplus of confidence and purpose on deposit, a 
reserve fund of discipline and courage which makes 
31 TUBERCULOSIS 
your supply exceed the demands of the day. It 
imparts decision to action, firmness of will, radiates 
vitality-it is the mainspring of success. 
Important Factor. It is just as important a 
factor for the patient as it is for the soldier. We 
have seen what a tragic spectacle Russia has pre- 
sented by allowing the morale of her army and of 
her people to be completely undermined. And we 
read in the dispatches from Austria that the morale 
of the people was so low that the Government 
feared Bolshevism; and again that the German 
Military Staff had undertaken some costly feat in 
order to keep up the morale of the people. As 
soon as the Germans believed that they were not 
going to win, they went to pieces. Calculations 
based on a military point of view prophesied vic- 
tory late in 1919 or in 1920, but they failed to 
consider the effects of morale. In defeat the Allied 
morale was stubborn and inflexible, but when the 
Germans faced defeat their morale crumbled, and 
the end came quickly. When a doctor sees the 
morale of his patient ebbing away, and discontent- 
ment, worry, peevishness, and fear gaining ground, 
he should be just as solicitous over his patient as 
the Allies were over Russia, for the patient stands 
just about as much chance against the invading 
bacilli as the Bolshevik army did against the in- 
vading Germans. 
Evil Effects of Worry. It is of the greatest 
32 MORALE 
importance that the patient be aware of the evil 
effects of worry, peevishness, and a fault-finding 
habit. He is not playing the game fairly under 
such conditions, and does not put himself in po- 
sition to receive the best results from any form of 
treatment. A spirit of healthy-mindedness, opti- 
mism, and courage is a great asset, and one that 
should be assiduously cultivated. Health of body 
and mind act and react on each other-"a merry 
heart doeth good like a medicine." 
Serenity. Serenity sums up the qualities of 
mind which the patient should aim at, and it is an 
art that can be attained and improved by practice. 
The secret of serenity is the ability to control our 
attention. One can attain the ability to turn off 
the current of his thoughts as he would turn off 
the electric light. And when his thoughts turn 
toward despondency, grief or morbid fears, he 
should turn off this current and turn on a current 
of cheerfulness, courage, patience, and optimism. 
The little Sunday-school song, "Count your bless- 
ings, name them one by one," is a good way to 
accomplish this. 
Religion and Philosophy. William James, the 
great psychologist, has said that we should culti- 
vate and practice a religion of healthy-mindedness, 
courage, patience, optimism, and reverence. We 
should certainly have some religion and philosophy 
which will serve as light-houses to keep us out of 
33 TUBERCULOSIS 
the Slough of Despond. The philosophy of the 
Bible, of Marcus Aurelius, of Emerson, is an excel- 
lent tonic of mental hygiene. 
One Day at a Time. There is a tendency for 
many patients to cross their bridges before they 
get to them-to suffer many things in their minds 
that they are never called upon to endure. This 
is not only useless and foolish worry, but it exerts 
a bad influence on the course of the disease by 
its depressing action on the physiological functions 
of the body. A good way to avoid such unneces- 
sary worry is to live one day at a time, or if neces- 
sary one hour at a time. We can gradually gain 
self-control and confidence in this way, remember- 
ing the adage, "the more haste, the less speed." 
We should learn to pass our crises unruffled, no 
matter what happens, and then we shall be much 
more apt to pass them successfully. 
Physiological Effects of Emotions. The effect 
of emotions on the nervous mechanism of the body 
is well known. Shame or embarrassment causes a 
dilatation of the blood-vessels of the face with a 
rush of blood into the dilated vessels, and the re- 
sult is known as blushing. Fear produces the op- 
posite effect, a constriction of these blood-vessels, 
with a resulting pallor of the face. A shock may 
produce fainting by causing a dilatation of the 
abdominal vessels with a rush of blood away from 
the brain into these dilated vessels, and the result- 
34 MORALE 
ing anaemia of the brain is responsible for the 
fainting. Grief or joy may cause a flow of tears 
which come from little glands situated just above 
the eyes and are due to the nervous stimulation 
by these emotions. Sudden news, good or bad, 
may cause a complete loss of appetite temporarily. 
Worry has a very marked effect on digestion by 
exerting a depressing effect on the glands that sup- 
ply the digestive juices to the stomach and intes- 
tines. Most interesting and instructive experiments 
have been done on animals in which it has been 
observed that such emotions as fear and anger may 
cause a cessation of the peristaltic movements of 
the intestines, which are very necessary for the 
proper digestion of food and functioning of the 
intestines. 
Cause of Depressive Emotions. Robert Burton, 
in his Anatomy of Melancholy written in 1661, 
gives an amusing account of the search for the 
cause or seat of melancholy, or depressive emo- 
tions. Various insects and small animals with sup- 
posedly morose dispositions were dissected in the 
effort to locate the cause of these emotions. Now 
we are aware of the fact that the toxines and poi- 
sons produced by various infections and diseases 
may produce these depressive emotions by their 
action on the nerve centres. It is therefore all the 
more necessary for the tuberculous patient to exert 
a greater effort to be cheerful and agreeable to 
35 TUBERCULOSIS 
those about him, and to strengthen his will-power 
(by using it) in order that he may overcome this 
added tendency to depressive emotions and peevish- 
ness which comes from the toxines of his disease. 
A cheerful, optimistic, courageous disposition will 
more than offset the effect of the toxines on his 
physiological functions in most cases. 
Toxic Effects Increased by Depressive Emotions. 
One effect of toxines is to produce an inhibition of 
the functions of the internal organs, and this effect 
is increased and prolonged by such depressive states 
as pain, anxiety, fear, disappointment, discourage- 
ment, and general nervous depression. We repeat 
again that hope, cheerfulness, contentment, and a 
whole-hearted co-operation on the part of the pa- 
tient are very important factors in the prognosis of 
any case. 
Selj-Control. Dr. Lawrason Brown sums up the 
situation as follows: "After all, the most impor- 
tant thing is to be able to control one's self. If a 
man does not develop self-control while he is 'cur- 
ing' so that when he is asked to do things he knows 
he should not, and to which he cannot say no, then 
this time has been lost. Unless a patient can say 
no when the occasion arises, his chances for get- 
ting well are very slight. He can tear down in one 
day or in an hour what it has taken him months 
to build up." 
36 MORALE 
"He that ruleth himself is greater than he that 
taketh a city," and incidentally he is in much bet- 
ter shape to "take the city." 
"To look up and not down, 
To look forward and not back, 
To look out and not in, and 
To lend a hand." 
37 VII 
PREVENTION AND CURE 
"It may well be claimed that the care of 
individual and family health is the first and 
most patriotic duty of a citizen." 
-Taft. 
"To successfully combat consumption as 
a disease of the masses requires the com- 
bined action of a wise government, well- 
trained physicians, and an intelligent 
people." 
-Knopf. 
Is it possible to relegate tuberculosis to the 
background as smallpox and yellow fever have 
been? Tuberculosis, the greatest scourge in all 
history! When everyone is thoroughly awake to 
the situation that it can be much more easily and 
cheaply prevented than cured, and translates pres- 
ent knowledge of the subject into action, a big 
advance toward this end will be made. The re- 
sults of preventive measures are incomparably bet- 
ter than the patch work and repair of manifest 
disease. Hospitals and almshouses are much more 
expensive institutions to support than would be the 
38 PREVENTION AND CURE 
necessary measures and personnel to enforce effec- 
tive prevention. And how much better it is for 
the individual to be able to support himself than 
to be an object of charity! 
When the tubercle bacillus was discovered in 
1882, many prophesied that tuberculosis would be 
a back number in one generation. This prophecy 
has not been fulfilled, neither have the very simple 
conditions laid down for the eradication of tuber- 
culosis been carried out. And so the possibility of 
eradicating tuberculosis still remains, though some- 
what disfigured by inadequate effort and doubts, 
and still lacking the education, means, and legis- 
lation necessary to give it a fair trial. 
Pasteur, the great French scientist, said: "It 
is within the power of man to rid himself of all 
parasitic diseases." The wonderful results that 
have been obtained from preventive measures in 
such diseases as smallpox, yellow fever, typhoid 
and dysentery in the army, typhus epidemics, and 
malaria add confirmation to his statement. The 
disease death rate per thousand per year for wars 
in which the United States has engaged in recent 
years shows the following remarkable drop due to 
the discovery and enforcement of preventive meas- 
ures in the army. Mexican War, 110 per 1000; 
Civil War (North), 65 per 1000; Spanish War, 26 
per 1000; World War, 17 per 1000. Such achieve- 
ments surely add color to the reality of this pos- 
39 TUBERCULOSIS 
sibility, and should stimulate efforts to give it a 
thoroughly fair trial. 
The prevention of tuberculosis essentially falls 
under two heads: (/I) prevent infection from tak- 
ing place; (B) after infection has occurred prevent 
it from becoming clinical tuberculosis. In view of 
the fact that under present conditions 75 to 100% 
of adults are infected, the latter consideration be- 
comes the more immediate and practical, while the 
former remains the ideal. 
(A) Prevent Injection. It is reasonable to sup- 
pose that this could be accomplished almost in one 
generation if every tuberculous individual would 
observe carefully the simple precautions: 
(1) Never expectorate anywhere or in anything 
except waterproof cups that can be burned. 
(2) Never cough or sneeze without holding a 
paper or gauze square over the mouth and nose; 
use the square only once, and then place it in a 
paper bag and burn bag and contents. 
(3) Wash mouth, face, and hands frequently, 
and take care not to infect the food and dishes 
that children and associates use. 
This would account for about 90% of tuber- 
culosis. The other 10% comes from cows, and the 
obvious remedy is to slaughter all tuberculous cows, 
and pasteurize all milk that does not come from 
tuberculin tested herds. 
A House Disease. It is well recognized now 
40 PREVENTION AND CURE 
that tuberculosis is essentially a house disease, and 
is probably never contracted in the open. Direct 
sunlight is the best disinfectant that we have, and 
also the cheapest, therefore we should make the 
greatest possible use of it. Dark, damp, dirty, and 
poorly ventilated rooms and houses should not be 
tolerated. Tubercle bacilli can live in such rooms 
and remain virulent for many months, whereas in 
strong direct sunlight they are killed in a short 
time; in diffused or reflected light they die more 
slowly, depending on the degree of light. We go 
to Sunday school and sing "Let the blessed sun- 
shine in" and then come home and shut it out, and 
further vitiate the atmosphere in our houses by 
cutting off all ventilation, and then turn on too 
much heat. 
Light, Ventilation and Heat. The maximum 
amount of light, good ventilation, and not too much 
heat are not only excellent precautions against tu- 
berculosis, but also against headaches, languor, 
colds, and all other infectious diseases. 
Careless spitting and coughing furnish the ma- 
terial for the spread of infection; and poverty, in- 
sanitary surroundings, crowding, dissipation, and 
overwork are the bellows that fan infection into 
active disease. Infants and children who are ex- 
posed to such conditions have no chance of escap- 
ing infection; and adults who live under and 
tolerate them, especially during the period of life 
41 TUBERCULOSIS 
(18 to 30 years of age) when clinical tuberculosis 
most frequently develops, greatly increase the dan- 
ger of their old foci of infection breaking out into 
manifest disease. 
Information, Perseverance and Legislation 
Needed. We know the cause of the disease, 
namely, the parasitic tubercle bacillus which can- 
not live very long outside of its animal hosts; and 
we know the sources of infection, namely, careless 
spitting and coughing, and infected cows and food. 
Some of us need only information on the above 
points; some lack the initiative and perseverance 
necessary to carry them out; and some need the 
restraining influence and forceful help of legisla- 
tion, and even isolation. 
The very simplicity of these measures con- 
founds us, and we go on tolerating ignorance, care- 
lessness, and viciousness, and look for a specific 
cure, when, even if we had the cure, the preventive 
measures which we now neglect would still be im- 
portant and necessary. 
(5) Prevent Infection from Becoming Manifest 
Disease. This is the immediate and practical 
problem that confronts us. The Journal of the Out- 
door Life has laid down the five fundamental prin- 
ciples on which the control of tuberculosis must be 
based, namely: 
(1) The discovery of the case and reporting of 
same to the health authorities. 
42 PREVENTION AND CURE 
(2) The facilities for the care and instruction 
of curable cases shall be adequate and shall be 
properly equipped and maintained. 
(3 The segregation of the infectious and com- 
municable case. On this point there is not unanim- 
ity of opinion, but all agree that isolation of the 
careless, dangerous case is a necessary health 
measure. 
(4) The education and treatment of the non- 
infectious case by dispensaries, visiting nurses, etc. 
(5) Education of general public, first, in regard 
to nature and prevention of tuberculosis, and, sec- 
ond, how to maintain a strong resistance to disease. 
More specific measures include: (a) Preventoria 
for babies of poor or careless families in which they 
are exposed to massive infection and frequent rein- 
fections which play an important part in the de- 
velopment of the disease. In these institutions and 
in private families that adopt these children for a 
few years as they do under the Grancher Society in 
France, these children are safeguarded against ex- 
posure to infection, (b) Fresh air schools and 
colonies for children that show evidence of tuber- 
culous disease. Here, these children are assured of 
proper treatment and nourishment, and the amount 
of study and work that is safe for their physical 
conditions. 
For adults a sane amount of restraint must be 
applied to their mode of living and activities, espe- 
43 TUBERCULOSIS 
cially during the period of 18 to 30 years of age 
when the great majority of breakdowns occur. 
Dissipation, irregular hours, variable time, quantity, 
and quality of meals, overwork, high tension, and 
worry must be replaced by self-control, regular 
habits, sanitary living and working quarters, peri- 
odic health examinations, serenity, and healthful 
outdoor recreation if the more susceptible individ- 
uals are to pass this period safely. 
Summary. We have stated that the dangerous 
period for acquiring tuberculous infection is in in- 
fancy and childhood, and that early clinical tuber- 
culosis in adults usually comes from old foci of 
infection contracted in childhood. Therefore we 
should concentrate attention on the following: 
(A) Prevent infection from taking place by pro- 
tecting children from careless consumptives and sus- 
picious cases who may be inclined to kiss and fondle 
them; keep them out of contaminated rooms, and by 
no means allow them to play and crawl around on 
such floors and put various objects in their mouths; 
do not let them take infected food and milk, or eat 
from dishes used by consumptives unless they have 
been thoroughly scalded. Under no conditions 
should a baby be nursed by a tuberculous mother 
or attended by a tuberculous nurse. 
(B) When infection has occurred, give careful 
attention to the thorough cure and healing of the 
foci. Remember that this will take a year or two, 
44 PREVENTION AND CURE 
and must be followed by careful living, proper food, 
life in the open as much as possible-in short, main- 
tain a high degree of resistance. 
Enumeration oj Preventive Measures. (1) Burn 
all sputum-most important-and all articles that 
come in contact with the mouth, such as toothpicks, 
fruit cores, cigar butts, etc. 
(2) Always cover mouth and nose with paper 
or gauze when you cough or sneeze, and burn the 
squares-most important! This practice should also 
be observed in colds and other respiratory infec- 
tions. 
(3) Do not use infected food-at least in the 
raw state. If there is any question about the milk 
supply, it should be boiled or pasteurized, especially 
for children. If possible, it is much safer to use 
milk from tuberculin tested cows. 
(4) Protect children from careless consump- 
tives and contaminated rooms. 
(5) Let in maximum amount of light, and al- 
ways have good ventilation and not too much heat- 
not over 68 degrees. 
(6) Sun the clothing and bedding of patient 
frequently; boil nightclothes and bedding when 
they are washed. 
(7) Patient should wash his mouth, face, and 
hands frequently and use soap freely. 
(8) Always use moist broom and cloth for 
sweeping and dusting in patient's room. 
45 TUBERCULOSIS 
(9) Live hygienically; give attention to proper 
amount and cooking of food; avoid late hours, dis- 
sipation, and over-strain; employ leisure time in 
healthful outdoor amusement; keep "fit." 
(10) Periodic examination for those in any 
way exposed to infection, and for under-nourished, 
weakly children. 
(11) Early diagnosis and adequate treatment; 
never neglect a cold that hangs on, for it may be 
the beginning of tuberculosis. 
(12) When a patient vacates a room, have it 
thoroughly cleaned as follows: first, fumigate with 
formaldehyde gas; then wipe down ceiling, walls, 
and floor with some antiseptic solution such as cre- 
sol, or liquor cresolis compositus; and finally give 
walls and floor a thorough scrubbing with hot car- 
bolized soap-suds (two tablespoonfuls carbolic acid 
to quart of water); then open up room to maximum 
amount of light and air for two days. It will be 
perfectly safe after such treatment. If you move 
to another house, take care to find out if there 
have been any tuberculous inhabitants in it, and 
if so, whether it has been disinfected as above. 
Repapering, painting, varnishing, or calcimining 
the walls and ceiling are safe methods, but more 
expensive than the above measures. 
Remarkable Progress. Hippocrates wrote more 
than twenty-two hundred years ago, "The disease 
which proved most dangerous and produced the 
46 PREVENTION AND CURE 
greatest number of deaths was consumption." And 
this statement held true until a year or so ago. A 
few years ago Dr. John H. Pryor said, "We must 
care for the consumptive in the right place, in the 
right way, and at the right time until he is cured; 
instead of, as now, in the wrong place, at the wrong 
time, in the wrong way until he is dead." These 
statements can no longer be made with entire 
truth and justice. No disease has responded more 
favorably to the meagre sanitary and preventive 
measures that have been partially and half-heartedly 
adopted than has tuberculosis. 
United States. The death rate from tuberculo- 
sis in the United States in 1890 was 254.4 per 
100,000 population; in 1900 201.2; in 1910 it was 
160.3-a drop from one-seventh of all deaths in 
1890 to one-tenth in 1910. And in 1922 the death 
rate was 97.0 per 100,000, a drop of 62% in 32 
years, and tuberculosis has dropped from first place 
to third place as a cause of death. When we con- 
sider the history of tuberculosis for the past twenty- 
five hundred years this is a truly remarkable 
achievement for thirty years. 
International Statistics. In contrast to these 
figures for the United States, Coni quotes some in- 
teresting international statistics in the Journal of 
the American Medical Association, April 27, 1918, 
which show the appalling results from tuberculosis 
in countries where little is done to prevent it. His 
47 TUBERCULOSIS 
table shows the death rate to be: Spain, 500 per 
100,000 population; France, 390; Austria, 270; and 
Italy 180. 
England. In England the death rate from tu- 
berculosis declined 54% between 1850 and 1916, 
following upon the establishment of dispensaries 
for the early diagnosis of cases, visiting nurses, 
notification of cases, establishment of sanatoria, 
and isolation of advanced cases. 
Denmark. Denmark is in many respects a 
model which it would be well for other countries to 
follow. She has many excellent sanitary laws, in- 
cluding laws in regard to the control of tuberculous 
cattle. Her health authorities can inspect and con- 
demn (when desirable) dwellings, slaughter houses, 
plans of construction, equipment, cleaning of school 
buildings, milk and meat supplies, etc. Disinfec- 
tion of the house after the death of a tuberculous 
patient, the removal of a patient from his house, 
or the removal of children from their homes when 
they are exposed by careless parents, are within the 
discretion of the Department of Health. Notifica- 
tion of cases is compulsory. Spitting in public 
places, and overcrowding in factories and work- 
shops are prevented by law. Educational matter 
on the dangers of infection and the means of pre- 
vention is widely distributed. 
Cure. One hundred years ago Laennec, the 
great French clinician, said, "The cure of consump- 
48 PREVENTION AND CURE 
tion may be possible for nature, but it is not so 
for medicine." No doubt he was impelled to say 
this after reflecting on the measures then in vogue, 
which included purgatives, emetics, blisters, bleed- 
ing, and the inhalation of various gases, including 
the air of cow stables. Unfortunately many credu- 
lous souls still waste much time and money on medi- 
cines foisted upon the public by unscrupulous pro- 
prietors. 
It is unanimously agreed that the most impor- 
tant factor in the cure of tuberculosis is adequate 
rest. Next in importance comes careful supervision 
by a competent doctor. Competent, in this case, 
includes not only knowledge and experience, but 
a personality that is able to make the patient co- 
operate. Indeed, this might be put ahead of num- 
ber one, or at least might be considered as an 
essential preliminary, for adequate rest is not likely 
to be obtained without competent supervision. 
Diet, exercise, fresh air, climate, morale, tuberculin, 
and other special measures are important aids. 
Time is a factor that must not be overlooked or 
curtailed. Healing is a slow process, and we must 
make provision for an extended and variable pe- 
riod of "taking the cure." 
There is no longer any reason for a fatalistic 
attitude toward tuberculosis. It is readily curable 
when taken in a reasonably early stage. It re- 
quires repeated exposure for the infection to gain 
49 TUBERCULOSIS 
headway, and the disease develops slowly, as a 
rule, offering chances for arrestment if we would 
only take advantage of them early and persevere 
until a thorough arrestment is obtained. Advanced 
cases are by no means hopeless. While there is a 
tendency for the disease to be progressive after it 
has reached an advanced stage, still many arrests 
are obtained in such cases, and not infrequently in 
seemingly hopeless cases. The chances of cure are 
proportional to early treatment, and the earlier the 
treatment the better are the results, not only as 
regards the chances of securing an arrestment, but 
also as to the permanency of the results. 
The "cure" in tuberculosis is not as complete 
as in pneumonia, for instance. Tubercle bacilli re- 
main within the scar tissue which is formed around 
the foci of infection, and it must be remembered 
that relapse is always possible, even after many 
years. "Cure, then, is possible, and to maintain it 
requires not an invalid's life always scared of a 
relapse, but a constant remembrance of the facts 
learned and a denial of certain indulgences, both of 
pleasure and of work, which have been found to be 
unsafe for the recovered consumptive." * 
The National Tuberculosis Association was 
formed in 1904, and among the several hundred 
present on this occasion more than one-third were 
"ex-t.b.'s"-robust proofs of the curability of 
tuberculosis. 
♦ Pamphlet 106, National Tuberculosis Association. 
50 yni 
CLIMATE AND ALTITUDE 
"As soon as man finds himself spitting 
and hacking on arising in the morning, he 
should immediately take possession of a 
cow and go up into the mountains and live 
on the fruit of the cow." 
-Celsus (B.C. 25-A.D. 50). 
Not Essential. It is, perhaps, well to say at the 
beginning of this chapter that climate and altitude 
are not essentials in the treatment of tuberculosis, 
but that they increase the chance of recovery is gen- 
erally accepted by the best authorities on the sub- 
ject today. 
Belief. A belief in the beneficial effects of cli- 
mate and altitude upon tuberculosis has existed 
from the earliest times in which descriptions of the 
disease unmistakably fit tuberculosis. Erroneous 
beliefs and mistakes in practice have crept into 
medicine from time to time, but none have sur- 
vived the test of twenty centuries or more. It 
would seem then that this belief in climate must 
rest on firm foundations. 
Exaggerated Importance. A few years ago cli- 
51 TUBERCULOSIS 
mate was given first place in the treatment of 
tuberculosis. This idea became firmly established 
in the minds of the people. They went West, or 
were sent West, in all conditions and under all cir- 
cumstances, and some of them regained their health 
a larger percentage probably than would have done 
so had they remained in their old environment. But 
many did not, and it was unquestionably bad ad- 
vice, and a fatal mistake for many of them to come 
in the condition and under the circumstances in 
which they came. Such indiscriminate advice, for- 
tunately, is rarely given by doctors today; but one 
still meets patients in the Southwest who were ad- 
vised to "go West and rough it." This advice is 
always wrong in tuberculosis, and means failure in 
many cases that could have been saved at home 
under proper management and treatment. 
Reaction. With the advent of sanatorium treat- 
ment and the marked improvement in the results 
obtained, not only in the good climates, but also in 
the bad ones, some physicians began to question 
the value of climate, and to assert that it was of no 
importance at all. On the other hand, some of the 
champions of climate (a few of the pseudo-special- 
ists in the Southwest with more enthusiasm than 
information), began to seize upon each physiologi- 
cal change produced by altitude and to point to it 
as "the factor" which produced the favorable re- 
sults, and to say that "clinical experience" had 
52 CLIMATE AND ALTITUDE 
proved it. As the value of "clinical experience" 
depends on the training and intelligence of the one 
"experiencing it" much of this experience was nat- 
urally erroneous and worthless, and so these poor 
advocates of a good cause did more harm than 
good for the cause. Dr. Alexius M. Forster * has 
suggested that if Bernard Shaw had chosen this 
subject for the plot of "The Doctor's Dilemma" he 
could have produced a much more amusing satire. 
Scientific Basis. One may ask then is this belief 
in climate and altitude purely empirical, or is there 
also a scientific basis for it? Undoubtedly this 
basis has been established. It is beyond the scope 
of this little book to enter a discussion of the rela- 
tive merits and demerits of the changes produced 
by altitude upon the lungs, the conformation of the 
chest, the heart, the blood, and metabolism-suffice 
it to say that it is a well-established law of nature 
that when the body processes are called upon to 
meet an increased demand, they respond with an 
over-production; and it is this over-production that 
brings about the benefit in suitable cases that are 
able to react sufficiently to the stimulating influence 
of high altitude. Patients with an acute active 
process with much softening and breaking down of 
tissue, organic heart lesions, arteriosclerosis, kidney 
trouble, emphysema, diabetes, toxic myocarditis, 
♦ Transactions, National Tuberculosis Association Meet- 
ing, 1911, p. 212. 
53 TUBERCULOSIS 
and vasomotor weakness should not go to high al- 
titudes. 
The important factors in high altitudes (over 
4,000 feet) are the great amount of sunshine, low 
humidity, coolness, and pure atmosphere, with a 
marked stimulating effect on the organism, and in- 
creased appetite and activity of the metabolic 
processes. Lower altitudes (under 3,000 feet) are 
warmer, less stimulating, more humid, put less 
strain on the organism, and are more sedative in 
effects. Such altitudes are suitable for the class 
of patients mentioned above who should avoid alti- 
tudes over 2,500 to 3,000 feet. 
When a change of environment is under consid- 
eration it is very important, therefore, to select the 
climate and altitude best suited for each individual 
case in accordance with the condition of the lungs 
and the general condition of the patient. 
Statistics. Dr. E. S. Bullock * made a careful 
study of statistics based on three sanatoria in the 
Southwest at an altitude of approximately 6,000 feet 
and representing about three thousand patients, 
and of four sanatoria in the East with the same 
number of patients. Only those patients who ob- 
tained an arrestment of the disease were considered 
in these statistics. He found that the patients 
treated in the Southwest had better chances for 
ter chances. 
♦Journal Am. Med. Assoc., June 19, 1909. 
54 CLIMATE AND ALTITUDE 
obtaining an arrestment of the disease as follows: 
(a) Incipient class, 9% better; (b) Moderately 
advanced, 17% better; (c) Far advanced, 6% bet- 
Essentials. It is agreed that the proper manage- 
ment and supervision of a patient is vastly more 
important than climate. Hence a patient should 
not leave his home in search of a better climate 
unless finances and temperament and family ties 
warrant it. Professor McSwain, formerly a pro- 
fessor at my Alma Mater, and a most intelligent 
and close observer, after many years of experience 
in various climates in "chasing the cure," sums up 
the situation in this incisive statement: "If a 
change of climate is to be decided upon, there are 
more important things not to be overlooked. It 
is not fair to the big-hearted people of the West, 
it is not fair to the sick man to send him here with- 
out means expecting him to make his own living 
and get well. This usually means that he will die 
a burden on the charity of strangers, his death 
hastened by hardship and privation. Climate is 
something, but rest, fresh air, good food, and free- 
dom from care must be added if climate is to do its 
perfect work." 
Finances and House-Keeping Cottages. The 
minimum cost of obtaining sanatorium treatment in 
a good institution in the Southwest is about one 
hundred dollars a month. The cost of obtaining 
adequate medical supervision and the proper hous- 
55 TUBERCULOSIS 
ing and food outside of a sanatorium would average 
more than this. Some of the sanatoria are now 
providing house-keeping cottages for their patients. 
This offers a more economical plan for a relatively 
large class of patients and helps to solve the prob- 
lems of temperament, nostalgia, and food. 
A Good. Climate. The elements which make up 
a good climate and which should be considered in 
selecting a climate are: (a) sunshine, (b) tempera- 
ture, (c) humidity, (d) wind, (e) pure atmosphere. 
A maximum amount of sunshine is desirable. It 
sterilizes the atmosphere, has a favorable influence 
upon the physical feelings and mental attitude of 
the patient, and has some therapeutic value, espe- 
cially in tuberculosis of the skin, joints, and bones. 
Extremes in temperature are undesirable. A wide 
variation (20 to 40 degrees) in the daily tempera- 
ture has a favorable and stimulating effect. Cold 
dry air is a good tonic. Low humidity is favorable 
-here again extremes are not desirable. Damp, 
cold winds, and hot, dusty ones are to be avoided. 
A dry cold wind, if not continued long enough to 
"get on the nerves," is not harmful. An atmos- 
phere free from dust, smoke, fogs, and gaseous and 
bacterial contamination is desirable. Altitudes of 
from four to six thousand feet possess climates 
which combine more of these good qualities than 
are to be found in climates of lower altitudes. 
The mere "change of climate," scene, and con- 
56 CLIMATE AND ALTITUDE 
ditions, as a rule, has a favorable physiological ef- 
fect on the patient, and the psychological effect is 
more pronounced and important. Every one is 
familiar with the effect of good weather on the 
mental attitude and the difference of feeling, rang- 
ing from depressing languor to exhilirating energy 
and optimism, with a change from bad to good 
weather. Dr. King * says in "The Battle With 
Tuberculosis," "Ask yourself the following ques- 
tions: 'On which days am I more likely to follow 
the out-of-doors treatment-clear days or rainy 
days, calm days or stormy days?' 'On which days 
are my spirits the more buoyant-sunshiny days or 
cloudy and wet days?' 'On which days do I have 
the better appetite-when the perspiration trickles 
down my face or when I can appreciate a light 
wrap?' 'On which days do I most feel the joy of 
living-when the smoke turns a somersault over 
the side of the chimney, or when it rises like a fluffy 
pillar straight up into the blue of heaven?'-more 
sunshine and less cloud and rain, more calm and 
less storm, greater dryness and less humidity, and 
an equable barometric pressure offer obvious cli- 
matic advantages." 
It is a significant fact that all of the workers in 
tuberculosis who are located in good climates are 
impressed with the value of climate. And it is fair 
* King, D. McDougall, The Battle with Tuberculosis and 
How to Win It. J. B. Lippincott Co. 
57 TUBERCULOSIS 
to say, I am sure, that a large majority of those 
located in bad climates admit the possibility of fav- 
orable influences in good climates. 
Advice on Climate. To sum up the best advice 
on climate and altitude, I would repeat that they 
are not essentials in the treatment of tuberculosis. 
It is agreed that the proper management and super- 
vision of a patient is vastly more important than 
climate. However, if one can avail himself of its 
favorable influence without too great a sacrifice of 
finances and too great a disturbance of his mental 
equilibrium consequent upon the separation from 
his family, friends, etc., and can be assured that 
he will be as carefully looked after in the new en- 
vironment as in the old, it is certainly advisable 
for him to make the change. 
I agree heartily with Dr. Francine when he says, 
"Without attempting to dogmatize upon the ques- 
tion of climate, one important fact stands out, i. e., 
the sooner the general practitioner or internist 
ceases to advise change of climate promiscuously, 
the better it will be for consumptives in general and 
for those of small means in particular. Too often 
the physician out of thoughtlessness or from habit, 
and with self-complacent irresponsibility, advises a 
change of climate to those who can ill afford it, or 
who are not really proper cases from a medical 
point of view to send away. . . . Such advice can- 
not be too strongly condemned, both from a pro- 
58 CLIMATE AND ALTITUDE 
fessional and humanitarian standpoint. But the 
fact remains, I believe, that the change of climate 
in suitable cases ... is of distinct advantage, pro- 
vided always that the patient's financial resources 
are amply adequate." 
I quote in conclusion the late Dr. Trudeau's * 
opinion: "My experience for the past twenty-five 
years has in no way altered my opinions as to the 
beneficial influence of climate in the treatment of 
pulmonary tuberculosis. ... It is true that good 
results may be obtained without change of climate, 
but where a change of climate can be added to the 
other well-known factors which make up a favorable 
environment for the patient, better results can un- 
doubtedly be obtained, and a judicious change from 
one climate to another will often turn the tide in a 
case which has ceased to improve and carry it to a 
successful issue." 
* Transactions National Tuberculosis Association Meet- 
ing, 1911, p. 217 
59 IX 
" . . . forsan et haec olim meminisse 
iuvabit." 
-Vergil. 
HELPFUL SUGGESTIONS 
("Sometime, perhaps, it will be pleas- 
ing to remember these things.") 
Tuberculosis is a curable disease, and the largest 
part of the job lies with the patient. Close attention 
to detail and full co-operation are essential. Viola- 
tion of these principles brings its own punishment 
by retarding your improvement and seriously jeop- 
ardizing your chances of recovery. A gloomy, 
worrying, fault-finding disposition is a big handi- 
cap in the fight. An optimistic, cheerful mood will 
aid greatly and hasten a favorable outcome. 
Some patients are prone to worry over trivial 
symptoms and things which could easily be ex- 
plained by the doctor if he only knew of them. You 
should feel perfectly free to tell your troubles and 
symptoms to the doctor. 
Paper Bags and Napkins. Pin some paper nap- 
kins, cut into quarter size squares, on vour bed 
60 HELPFUL SUGGESTIONS 
to use in covering your mouth and nose when you 
cough, etc. Also pin a paper bag on the bed to 
receive these squares after they have been used, and 
to receive toothpicks and other things that come in 
contact with your mouth. 
Dry Heat. The most convenient and effective 
way of applying dry heat is simply to use your 
electric light. Get a tin shade long enough to come 
below the tip of the light bulb and put it on the 
light, and then place it over the spot you wish to 
treat. Put a layer of blanket around the shade in 
order to hold in the heat, and turn on the light. 
You will have constant heat as hot as you can stand 
it simply by turning on and off the light. I found 
this the most effective way to relieve pleurisy, ex- 
cepting codeine or morphine, which one does not 
want to use on all occasions. It is much more 
agreeable than a mustard plaster and leaves no 
blister behind. It is a thousand times more effi- 
cient than antiphlogistine, much easier to apply, 
and more agreeable for the patient, and costs about 
one-thousandth as much. {Note-The American 
Medical Association after examining antiphlogistine 
reported that it was entirely inert.) 
Appetite. Contrary to common belief a raw egg 
can often be taken without causing nausea when 
even the sight or smell of a cooked one produces it. 
I am not an advocate of raw eggs, except in the 
above circumstances, as it has been shown that 
61 TUBERCULOSIS 
cooked eggs are twenty to thirty per cent more di- 
gestible than raw ones. 
A little cold egg-bread, or cracker, crumbled in 
your sweet milk may enable you to take it when it 
seems impossible to take the plain milk. 
I found Ovaltine (for sale at most drug stores), 
a powdered form of malted barley, milk and eggs, a 
palatable and nourishing drink when most other 
things seemed impossible. 
Cough. Much unnecessary coughing is done by 
patients who do not realize that it is strenuous ex- 
ercise and may cause much harm. A certain 
amount of coughing is unavoidable in patients who 
raise much sputum, but it is surprising how much 
control over your cough a determined will-power 
can have. For instance, in pleurisy one's cough 
is reduced to a mere aspirating grunt, if the pain 
is severe. 
It is very desirable to control your cough with- 
out drugs, for any drug that is efficient will upset 
your appetite and digestion when taken regularly 
every day. Hot water, or almost any hot drink, 
sipped along as necessary, is the best and simplest 
remedy. It may be necessary to stop talking and 
laughing, or to lie down, or even go to bed for a 
few days in order to subdue a persistent cough. If 
these measures fail, consult your doctor about drugs. 
If you are troubled after eating by coughing 
until you vomit your meal, or part of it, the fol- 
62 HELPFUL SUGGESTIONS 
lowing will help you: Before meals drink a cup 
of hot water, change your position and try to clear 
your bronchi and cavities of all sputum which may 
have accumulated there. Take little liquid with 
your meal and rest in reclining position one-half 
to an hour after the meal. It is very important 
to retain what you eat. 
If you are troubled with severe coughing spells 
on sitting up in bed in the morning, you can se- 
cure much relief by getting up by degrees. First, 
drink a cup of hot water, then raise up to about 
thirty degrees. At this stage you will cough a 
little; then wash face and hands, and then raise 
up a notch higher and eat breakfast. Rest a while 
after breakfast and then sit up to any position you 
like. In this way you can avoid the exhausting 
cough which comes on if you sit up straight all at 
once. 
Fullness and Shortness of Breath on Eating. If 
you feel uncomfortably full and short of breath on 
eating, or immediately after, the following proce- 
dure will probably relieve you: Take four small 
meals a day, and very little liquid with your meal; 
five drops tincture nux vomica before meals (ask 
your doctor about this); confine your food to ce- 
reals (with little milk), bread and butter, fresh 
vegetables (except greens), eggs, little meat, honey, 
and stewed fruits. 
Substitute for Bed-Pan. If you find the bed- 
63 TUBERCULOSIS 
pan uncomfortable and difficult, the following sub- 
stitute will probably be quite satisfactory: Put a 
chair that is several inches lower than the bed up 
against the bed, spread out several layers of news- 
paper from edge of bed to chair, turn on your side 
and allow buttox to extend well over edge of bed, 
flex your knees up toward chest so as to imitate 
sitting posture, and you will find results very sat- 
isfactory. Use ordinary urinal at same time. 
Bowels. It is of great importance to keep the 
bowels well regulated-one or two normal move- 
ments a day being maintained. The patient should 
not rely on drugs for this purpose, but should ac- 
complish this with a well-balanced diet, taking 
enough green vegetables, such as spinach and cab- 
bage, stewed prunes, honey, bran-bread, and fresh 
fruits to accomplish this end. Mineral oil, night 
and morning, may be used to supplement this regi- 
men if necessary. It is purely a lubricant and is 
not digested or absorbed. An occasional mild laxa- 
tive, such as cascara, may be necessary; and castor 
oil, when occasion demands, has a wholesome 
effect. 
It is a great help and highly important to have 
a regular time for this purpose, preferably just after 
breakfast each morning. The habit can be estab- 
lished usually within a week or two. The patient 
should go to stool at the same time each morning 
and sit for 15 or 20 minutes, and if there is no 
64 HELPFUL SUGGESTIONS 
movement he should then use a suppository or 
enema for a few times until the habit is estab- 
lished. 
Water. The patient should have a pitcher of 
fresh water by his bed all the time and drink freely 
-six or eight glasses a day, unless he has a heart 
or kidney complication which would contraindicate 
this. About an hour after meals and before re- 
tiring are the best times for drinking. A large 
amount of water tends to dilute the poisons of the 
disease and to wash them out of the system, as 
well as being a great help to the bowels. 
Mouth. "Mine own mouth shall condemn me," 
and yet the mouth is often the most neglected part 
of our anatomy. A foul mouth, pyorrhea, and de- 
cayed teeth not only have a very bad influence on 
the appetite and digestion, but may be the source 
of very serious infection in the heart or kidneys, 
and in "rheumatism." We should give careful at- 
tention daily to cleansing the teeth, brushing them 
after each meal, and using a good toothpaste once 
a day, preferably at night. The mouth harbors 
many bacteria, and often pathogenic ones. If the 
gums or teeth are in poor condition, it is well to 
use a potassium chlorate mouth wash several times 
a day, and to gargle with Dobell's solution morning 
and night, in addition to the care of the teeth as 
mentioned above. 
Sleep. Some patients are inclined to worry un- 
65 TUBERCULOSIS 
duly because they cannot sleep as much as they 
think they should-and the more they worry the 
less they sleep. If they would only leave off the 
worry, they would get all the rest they require, 
whether they sleep or not, for it is possible to rest 
without sleep if they lie in a perfectly relaxed con- 
dition physically and mentally. And, incidentally, 
such a relaxed attitude is the best soporific of which 
we know. Stop worrying a while and try and see 
if it doesn't work! 
Amusements Amusements are often the cause 
of set-backs in tuberculosis-probably more often 
than work. The patient must realize that amuse- 
ments, as well as work, count on his allotted exer- 
cise, and that when he has used up this amount in 
either work or play he cannot then go and indulge 
in the other with impunity. Pool and billiards 
are bad forms of exercise for the consumptive; and 
in addition to this the atmosphere of the room is 
often vitiated by smoke, dust, and poor ventilation. 
Games of chance, however small the stake, are too 
seductive and exciting for the "t. b.," and they, to- 
gether with pool and billiards, should be postponed 
for at least two years after the "cure." A rubber of 
bridge, whist, solitaire, "42," etc., are not objection- 
able, if not overdone. Chess is too concentrating 
-I have seen temperature raised two degrees by 
a game of chess. It is much better to cultivate an 
outdoor hobby-an interest in plants, birds, land- 
66 HELPFUL SUGGESTIONS 
scape gardening, architecture, astronomy, etc., and 
such diversions will prove to be far more interest- 
ing and satisfying than those mentioned above. 
Food. (See Appendix for table of food values 
and vitamins.) Wherever a number of people are 
gathered together in a boarding house, it is cus- 
tomary and popular to complain of the food. This 
habit is especially contagious among the sick. The 
situation is further complicated by the fact that the 
demands on metabolism are increased, while at the 
same time the appetite and digestion are very apt 
to be upset by the toxines of the disease. It be- 
hooves the cook, therefore, to make the food as 
tempting as possible, and the patient to do his best 
to eat it, and to imitate the ox and ass in the fol- 
lowing lines: 
"Does the ass bray when he hath grass? 
Or loweth the ox over his fodder?" 
Food is a most important factor in tuberculosis. 
It should be varied and savoury, but the use of 
strong condiments for this purpose is harmful. 
Milk, meat, eggs, bacon, butter, ripe olives, nuts, 
potatoes, peas, beans, spinach, cabbage, lettuce, to- 
matoes, honey, prunes, peaches, apricots, and fresh 
fruits, such as apples, bananas, grapes, and oranges 
make a good list to select from. Milk, meat, and 
eggs are the mainstays, and prunes and honey are 
excellent adjuvants both on account of their high 
food value and laxative qualities. Spinach and 
67 TUBERCULOSIS 
cabbage are good fillers and aid the movement of 
the bowels by adding bulk to the intestinal contents. 
When repugnance to food is marked, a liquid 
diet may be necessary. The following sample menu 
should be approved or modified by your doctor: 
. Breakfast (About 700 calories) 
One cup Ovaltine (8 ounces), contains malted 
barley, eggs, and milk. 
One glass milk (8 ounces), may use on cereal 
or crumble crackers or egg-bread in it. 
One egg (raw if necessary). 
One piece buttered toast. 
Dinner (About 700 calories) 
Thick soup (8 ounces), pea, tomato, potato, etc. 
Scraped beef, or beef juice (2 ounces). 
Prune souffle, or apple sauce, with or without 
cream. 
One glass milk or buttermilk. 
One egg. 
Supper (About 850 calories) 
Gruel (4 ounces) with butter or milk, or chicken 
broth and crackers. 
Junket (4 ounces). 
One cup Ovaltine. 
Malted milk flip (see below). 
Lunch (4 p. m. or bedtime, about 230 calories) 
One cup Ovaltine, or glass of milk and one egg. 
68 HELPFUL SUGGESTIONS 
A malted milk egg flip is very nourishing and 
may be taken once a day or every other day. It 
is prepared as follows: One egg, four ounces milk, 
two teaspoonfuls malted milk, vanilla flavoring, 
shake well, and then add large tablespoonful choco- 
late ice cream. If you have no shaker the egg 
may be whipped separately, the malted milk dis- 
solved, and then mixed as above. 
A piece or two of candy may be taken just after 
meals, but not between meals. 
Proteins, Carbohydrates, and Fats. Foodstuffs 
are divided into three main classes, namely, pro- 
teins, carbohydrates, and fats. We get our supply 
of proteins chiefly from meat, milk, eggs, beans, 
and peas; carbohydrates from sugar, bread, pota- 
toes, fruits, cereals, and milk; fats from bacon, 
butter, cream, oils, and nuts. Certain minerals 
are also necessary, chief of which are sodium, which 
we get in common table salt, and calcium and iron, 
which are found in meat, milk, eggs, and vegetables. 
Proteins are needed chiefly for the repair and 
growth of our tissue cells; carbohydrates and fats 
chiefly to furnish the fuel necessary for our energy. 
In recent years it has also been discovered that 
certain constituents of our food, known as vitamins, 
are essential to health. 
The Calory. The unit for the measure of food 
values is called the calory, which is the amount of 
heat required to raise one liter of water (about one 
69 TUBERCULOSIS 
quart) from 0 degrees C. to 1 degree C., or from 
32 to 33.8 degrees F. 
1 gram* of protein = 4 calories, approximately. 
1 gram of carbohydrates = 4 calories, approxi- 
mately. 
1 gram of fat - 9 calories, approximately. 
One should try to maintain about the normal 
weight for his age and height. (See Appendix for 
table of weights.) A few pounds under or over this 
is of no consequence; but marked under- or over- 
weight (15 or 20 pounds) should be avoided when 
possible. The stuffing methods of a few years ago 
are unscientific and have wisely been abandoned. 
A marked gain in weight is not at all necessary for 
improvement, and by no means does it always indi- 
cate improvement in tuberculosis. 
One should take an amount equal to 2,500 to 
3,500 calories a day, divided about as follows: 
Protein, 500 or 600 calories (125 to 150 grams t); 
carbohydrate, 1,500 to 1,800 calories (375 to 450 
grams); fat, 900 to 1,200 calories (100 to 125 
grams); or roughly the equivalent of one-half 
pound meat, six glasses milk, two eggs, quarter 
pound potatoes, six slices bread, two saucers prunes, 
and three squares of butter a day. The tendency 
in tuberculosis is to eat too little, and one should 
* 30 grams = 1 oz., approximately, 
fib. -460 grams, approximately. 
1 oz. = 30 grams, approximately. 
70 HELPFUL SUGGESTIONS 
see to it that one gets enough nourishing food to 
maintain one's weight. But remember that over- 
eating is as great an evil as under-eating. If you 
give an automobile too much gas you choke the 
engine. Dr. Brown well says, "To eat as little as 
will enable you to hold your weight and strength 
is the important thing." 
71 X 
MISCELLANEOUS 
"Success lies not in achieving what you 
aim at, but in aiming at what you ought to 
achieve." 
The Daily Routine. The following routine has 
been found to give the best results and this, or 
something similar, is in force in most sanatoria: 
7:30 Awake. Take temperature. Glass of 
hot water, or hot milk if desired. Warm water for 
washing. Cold sponge if ordered. 
8:00 Breakfast. 
8:30 Evacuation of bowels. 
8:45 Outdoors on chair, or in bed on porch. 
10:00 Exercise when ordered. 
10:30 Extra nourishment when ordered. 
12:30 Rest, reclining on chair or in bed. 
Temperature. 
1:00 Dinner. 
2:00-4:00 Silent rest hour, lying flat in bed 
or on chair. 
3:30 Extra nourishment when ordered. 
4:00 Temperature. Exercises when ordered. 
5:30 Rest, reclining on chair or in bed. 
72 MISCELLANEOUS 
6:00 Supper. 
6:30 Outside. 
8:00 Temperature. 
9:00 Extra nourishment when ordered. 
9:30 Bed. 
Once or twice a week hot bath followed by cold 
sponge. 
Temperature. The temperature and pulse are 
the most convenient guides for the patient. Though 
by no means infallible indices of what is happen- 
ing in the lung, still for practical purposes they are 
fairly safe advisers. It should be understood that 
their warnings come after some mischief has been 
started, but usually in time to prevent serious dam- 
age if they are heeded. 
Normal Temperature. The normal tempera- 
ture is usually given as 98.6, but this does not take 
into account the daily variation between morning 
and evening temperatures which is usually a de- 
gree to a degree and a half. In my experience the 
average morning temperature for afebrile patients 
is between 97.2 and 98, and the afternoon tempera- 
ture between 97.8 and 98.6. Variations above and 
below these figures may, and do, occur in normal 
healthy individuals. 
How Temperature Is Regulated. The tempera- 
ture of the body is kept constant by the circulation 
of the blood which is controlled by a center in the 
73 TUBERCULOSIS 
brain. In tuberculosis this brain-center is hyper- 
sensitive, or more easily irritated than in health, 
and hence does not regulate the body temperature 
as easily as in health. It is on this account that 
such things as good or bad news, games of chance, 
constipation or diarrhea, a slight cold, etc., may 
cause a sharp rise in temperature, which may worry 
the patient, but should not fool the doctor, as the 
curve of such temperatures differs from that caused 
by tuberculosis. 
When to Take It. The temperature should be 
taken immediately on awakening in the morning 
before the mental and physical activities of the day 
are begun, in order to get the lowest point. A 
temperature of 98.6 at this time usually means as 
much fever as 99.4 in the afternoon does. It should 
be taken again at 12, 4, and 8. If you have been 
free from fever for some time it is not necessary 
to keep on taking your temperature every day. 
Once a week at 8, 12, 4, and 8 will do. 
How to Take It. After exercise the patient 
should rest for half an hour before taking tempera- 
ture or pulse. Do not take either cold or hot drinks 
shortly before taking the temperature, and do not 
take the thermometer out at frequent intervals to 
see what the mercury is doing. Keep thermometer 
under tongue for five minutes regardless of whether 
it be a one- or two-minute one. In cold weather, 
especially if wind is blowing and you have been 
74 MISCELLANEOUS 
talking, keep mouth shut for fifteen minutes before 
taking temperature. Also, warm the thermometer 
on top of tongue before placing it under the tongue. 
In very cold weather, up North and East, mouth 
temperatures are not very reliable and the tem- 
perature should be taken per rectum. It should 
be remembered that rectal temperatures are nor- 
mally 0.6 to 1 degree higher than mouth tempera- 
tures. 
Something or Nothing? Before leaving the sub- 
ject of temperature I should like to call attention 
to a very common mistake that most patients and 
many doctors make when they say, "I have a tem- 
perature," or "no temperature" when they mean 
"fever" or "no fever." Everybody and everything 
has a temperature, the atmosphere has a tempera- 
ture, and hence it is incorrect to say "I have no 
temperature," and axiomatic to say "I have a tem- 
perature." In the words of Socrates, "Do I seem 
to say something, or nothing at all?" 
Pulse. The pulse is a more sensitive indicator 
than the temperature, but also a more unreliable 
one, as it is more easily affected by other factors 
besides the disease. If you could take your pulse 
while asleep it would not tell any stories, but even 
the mere act of counting it often increases the 
rate, especially in nervous patients. 
An instance. I recall how it defeated me on 
one occasion when attempting to cheat on my 
75 TUBERCULOSIS 
friend, Bill L. Bill had a new stop watch and had 
collected a dime from most of his friends by bet- 
ting them that they could not guess within ten 
seconds of a minute. When he made his proposi- 
tion to me I thought how easy it would be just to 
count my pulse and collect his dime. But, alas, 
the excitement of this trick increased my pulse rate, 
and Bill increased his wealth. Don't bank on your 
pulse too much! 
Normal Pulse. The pulse varies with age and 
with the individual. A fair average for normal is 
between 70 and 80. Women have a faster pulse 
than men. The smaller the animal the faster the 
pulse. The elephant's pulse is 26 and the mouse's 
250 per minute. 
Rest. Rest is recognized now as the most im- 
portant factor in the treatment of tuberculosis. 
Prolonged rest in bed is the quickest and surest 
road to the arrestment of the disease. It is the 
best measure to combat the toxemia and the fever 
which is caused by it, the cough, the disturbances 
of digestion, and the increased demands on meta- 
bolism; and it allows the healing process in the 
lungs to take place more quickly and with less dis- 
turbance and danger of back-sets. 
The popular notion that rest in bed will cause 
the patient to lose his appetite and weight and 
bring on constipation is an erroneous one. These 
things are caused by the toxines of the disease and 
76 MISCELLANEOUS 
by the fever, and not by the rest. When fever is 
present and the toxines of the disease are being 
washed out into the blood, the demands on meta- 
bolism are greatly increased, while at the same 
time the digestive organs are upset and their effi- 
ciency lowered. All of which means more work 
for the heart and lungs, and under increased dif- 
ficulties. Exercise in the face of these conditions 
is simply adding fuel to the fire. 
The amount of extra work thrown upon the 
heart and lungs by the simple exertion of sitting 
up, and still more in standing up, is astonishing. 
The unit of measure of this work is called the foot- 
pound, i. e., the energy required to raise one pound 
one foot. The normal heart does about two and 
a half foot-pounds of work at each beat. The 
mere act of standing up will increase the patient's 
pulse usually ten beats or more per minute, or 600 
beats per hour, which equals 1,500 foot-pounds of 
extra work, or about the equivalent of bringing in 
an armful of wood, a thing which the patient very 
wisely would not think of doing. 
Exercise. After an adequate period of rest, 
which will vary with the individual case and the 
stage of the disease, there comes a time in the 
course of treatment when regulated exercise gradu- 
ally and systematically taken is beneficial. Exer- 
cise is "dangerous medicine" in tuberculosis, and 
the patient should no more take upon himself the 
77 TUBERCULOSIS 
responsibility of determining the time and amount 
of his exercise than he should of administering 
tuberculin to himself. One's feelings are a decep- 
tive and dangerous guide on this point, as the dam- 
age from too much exercise may not become ap- 
parent to the patient until days, or even weeks, 
after it has been done. 
For those patients on exercise the following 
rules are very important: 
Exercise means walking. Special permission 
must be obtained for any other form of exercise. 
(1) Never get tired. Always stop at the first 
symptoms of fatigue, physical or mental. 
(2) None if you are uncomfortably short of 
breath, or if your pulse is fast. Ask the doctor if 
pulse is over 90. 
(3) None if your afternoon temperature the 
day before was over 99.4, or if your morning tem- 
perature that day was over 98.6. 
(4) None if there is any trace of blood in your 
sputum. 
(5) None for one hour after meals. 
(6) No hill or mountain climbing without spe- 
cial permission. 
(7) If you are caught out in the rain, don't 
hurry; never run on any account. It won't hurt 
you to get wet if you keep on walking and change 
your clothes immediately when you get home, first 
78 MISCELLANEOUS 
drying yourself carefully with a towel or taking 
an alcohol rub. 
(8) Exercise regularly and systematically, rain 
or shine. 
Tuberculin. Tuberculin is a two-edged sword 
which should be used only by a careful, experienced 
physician who is fully cognizant of its dangers and 
of its action, and who has a definite and intelligent 
conception of what he is trying to accomplish with 
it. The patient should be under the most careful 
observation during such treatment and an accurate 
record of his pulse, temperature, expectoration, ap- 
petite, and weight kept; also the focal reaction in 
the lung should be carefully observed. Only in this 
way can the patient be adequately safeguarded 
against the dangers of tuberculin. In some cases 
it undoubtedly causes marked benefit-chiefly in 
chronic cases that are at a standstill, and in early 
cases where the defensive mechanism of the body 
is capable of being stimulated to put forth a greater 
degree of resistance. It is also claimed by some 
authorities that the degree of immunity in children 
can be increased by tuberculin treatment. 
The possibility of beneficial results from tuber- 
culin are based on: (1) The inflammatory reaction 
which it produces around the tuberculous foci. If 
the right degree of inflammation is produced, it 
promotes the healing of the foci; too much in- 
flammation causes harm; and too little has no ef- 
79 TUBERCULOSIS 
feet. (2) The possibility of increasing one's re- 
sistance by stimulating cells which are capable of 
a greater response than they are giving to the 
stimulation which comes from the disease. (3) The 
possibility of increasing one's tolerance to the tox- 
ines of the disease. 
If a physician is not prepared or willing to keep 
the accurate record mentioned above, and to ob- 
serve carefully the focal reactions, he should not 
give tuberculin; nor should the patient take it from 
one who does not observe these precautions. 
Artificial Pneumothorax. Artificial pneumo- 
thorax consists in injecting air, or gas, into the 
pleural cavity in order to collapse the lung. This 
brings about: (1) more or less complete rest of the 
lung, and allows the healing process to go on un- 
interrupted by its normal movements; (2) a marked 
slowing of the blood and lymph flow in the lung, 
with a diminished absorption of the toxic products 
of the disease; (3) a tendency to check the spread 
of the disease, and to prevent the aspiration of in- 
fectious material into the other lung. The effect 
on the temperature, amount of sputum, cough, and 
appetite is often very prompt and striking. This 
form of treatment sometimes brings about the ar- 
restment of the disease in otherwise quite hopeless 
cases. 
The inherent dangers of the treatment are very 
small, if careful technique is observed. The ob- 
80 MISCELLANEOUS 
literation of the pleural cavity by the adhesion of 
the two pleurae, which frequently follows after the 
cessation of treatment, is an objectionable feature, 
and renders it impossible to use this form of treat- 
ment later on if it should become desirable to do 
so. It is better, therefore, to bring about the ar- 
restment of the disease without a pneumothorax if 
possible, and reserve this measure for future emer- 
gencies. If, however, after several months of care- 
ful treatment the disease is steadily progressive, an 
artificial pneumothorax should be seriously consid- 
ered and instituted, unless there are complications 
of the heart or of the other lung which forbid it. 
Medicines. Up to the present time no medicine 
has been found that has anything more than an 
indirect effect in the treatment of tuberculosis, for 
the most part through allaying troublesome symp- 
toms. The patient should not take any medicine 
unless it is prescribed by his physician, and any 
medicine that disturbs the appetite and digestion 
should be discontinued. 
Alcohol. I take the following facts from 
"Alcohol: Its Action on the Human Organism," a 
recent Government Report by the committee of the 
Liquor Control Board of England. On the com- 
mittee were Professor Cushny, a world-renowned 
authority on pharmacology (or the action of 
drugs); Professor Sherington, a well-known au- 
thority on physiology; and Professor McDougall, 
81 TUBERCULOSIS 
of the Department of Psychology of Oxford Uni- 
versity. There were other men, distinguished in 
business and politics, on the committee, but these 
three names guarantee the scientific and dispas- 
sionate nature of the report. 
"There is no evidence of injurious action of 
moderate doses, well diluted, and taken at intervals 
long enough to eliminate the effects of the previous 
one; but bad effects follow when it is not so taken. 
It is devoid of any beneficial effects in any form 
whatever, except as a narcotic in certain abnormal 
states, as excessive fatigue from loss of appetite or 
inability to sleep. 
"There is no mutual exclusion between the 
properties of a food and a drug (or poison)-alco- 
hol is both. As a food it is oxidized completely, 
furnishing heat and energy for muscular work, but 
it cannot be stored as fats and carbohydrates are. 
On account of its drug action it can be used as 
a food only in a restricted sense-it is not a true 
food stuff. It has no accessory action on meta- 
bolism. 
"Its chief action is on the nervous system. 
Even moderate doses involve some impairment of 
the higher nervous functions. It is purely a nar- 
cotic and not a stimulant-the feeling of well being 
is due to a blunting of the higher faculties, and 
general loss of control. Small doses have no ap- 
preciable effect on digestion or on the heart-larger 
82 MISCELLANEOUS 
doses depress or paralyze them. The feeling of 
warmth is due to dilatation of the skin blood- 
vessels, but the actual result is a more rapid loss 
of heat." 
In the light of these facts one must admit that 
it is much the safest policy to abstain entirely; 
since, (a) no possible good can come from it; (b) it 
is a potent factor for harm if abused, and its influ- 
ence in this direction is subtle and hard to resist. 
Tobacco. The effect of tobacco on the appe- 
tite and digestion, and on the heart and blood- 
vessels is unquestionably harmful. The importance 
of these effects, however slight, is magnified in tu- 
berculosis when so much depends on the proper 
performance of these functions. The toxines of 
tuberculosis affect the heart, and the nicotine of 
tobacco is simply adding fuel to the fire. The seda- 
tive effect of tobacco is relatively slight as com- 
pared with that of morphin and alcohol, and the 
habit can be comparatively easily broken by the 
exercise of a little will-power, and it is advisable 
for the consumptive to do this. In able-bodied 
men smoking is associated with a loss of lung ca- 
pacity of about ten per cent. 
83 PART II 
REFLECTIONS OF A DOCTOR-PATIENT I 
HISTORICAL 
"The more attention you give to the tu- 
berculosis problem the more it grows in size." 
-Trudeau. 
1600 B. C. Recent investigations by paleo- 
pathologists on Egyptian mummies indicate that 
tuberculosis was a flourishing disease as early as 
1600 B. C. They advanced the interesting hy- 
pothesis that the Egyptians recognized the favor- 
able influence of climatic resorts on this disease, 
basing this opinion on the fact that larger numbers 
of mummies showing tuberculous changes are found 
in certain localities with good climates than in 
other places, and assuming that these patients went 
to these places for the benefit of the climate. 
Hippocrates. The first accurate description of 
the signs and symptoms of tuberculosis recorded is 
by Hippocrates (460-377 B. C.), known as the 
"Father of Medicine." The belief was held by the 
Greeks at this time that this disease was contagious. 
Hippocrates left numerous writings on medical sub- 
jects. The following aphorism by him gives an in- 
teresting light on his views on medicine: 
87 TUBERCULOSIS 
"Quae medicamenta non sanant, ea fer- 
rum sanat; quae ferrum non sanat, ea ignis 
sanat; quae vero ignis non sanat, ea insana- 
bilia reputare oportet." 
("What medicines do not cure, the knife 
cures; what the knife does not cure, fire 
cures; what, in truth, fire does not cure, it is 
proper to consider these things incurable.") 
Barren Period. No advance over Hippocrates' 
ideas was made for several centuries. Galen (131- 
201 A. D.) recommended the high lands of Phrygia 
and a milk diet. Pliny's (23-79 A. D.) enthusiasm 
over the pine forests has a modern echo in the 
sanatoria located in the pine forests of North Caro- 
lina. Following this period there was a long bar- 
ren age of about fourteen centuries during which 
no advance is recorded. In the seventeenth cen- 
tury Sylvius and Morton noted the connection of 
tuberculous nodules with tuberculosis. They also 
believed that it was hereditary and contagious. 
Progress in Nineteenth Century. Bayle (1810) 
was the founder of the modern pathology of tuber- 
culosis. He described accurately the stages of de- 
velopment, and recognized the miliary tubercle as 
the starting point. 
Laennec (1819), a Frenchman, recognized the 
tuberculous nature of scrofula, and gave an ac- 
curate description of the transformation of tubercles 
toward ulceration. His greatest gift to medicine, 
88 HISTORICAL 
though, was the "art of auscultation" (the method 
of listening to the chest with a stethoscope, which 
is today the most reliable method of obtaining in- 
formation of what is happening in the chest). He 
was the first to recognize pneumothorax in a living 
patient, and he described accurately its physical 
signs. He was one of the great masters of medi- 
cine, although he was taken off by an early death 
from tuberculosis. 
In 1840 Dr. Bodington, an obscure practitioner 
living in Sutton Coldfield, England, published an 
essay on "The Cure of Pulmonary Consumption on 
Principles Natural, Rational, and Successful" in 
which he emphasized especially fresh air day and 
night, generous diet, and careful medical supervi- 
sion. He stated that cold air is never too intensive 
for a consumptive, and that his apartment should 
be kept well aired. His views received very bitter 
and contemptuous opposition. He was regarded as 
a lunatic; his patients were driven from him, and 
by the irony of fate, he was compelled to turn his 
institution into an insane asylum. 
Virchow (1847-50), a German, added valuable 
data on microscopic studies. 
Villemin (1865-68), a Frenchman, established 
the transmissible and infectious character of the 
disease by a series of brilliant experiments on 
animals. He concluded that tuberculosis was trans- 
89 TUBERCULOSIS 
mitted from man to man by a "virus" present in 
the sputum. 
Koch and the Great Campaign for the Preven- 
tion and Cure of Tuberculosis. The greatest name 
in the history of tuberculosis is Robert Koch, a 
German, who discovered the tubercle bacillus in 
1882, grew it on artificial media and stained it, and 
established the fact that it was the cause of tuber- 
culosis. Dr. Trudeau said: "In 1882 Robert Koch 
announced to the world his discovery of the tubercle 
bacillus. His paper (probably the most far-reach- 
ing in its importance to the welfare of the human 
race of any original communication) at once threw 
a flood of light on the darkest page of medicine, a 
light which revealed the microscopic fungus which 
is the cause of tuberculosis, and gave a new im- 
pulse and opened a new horizon to medical 
thought." 
From this information and stimulus began the 
great campaign for the prevention and cure of tu- 
berculosis, with the establishment of dispensaries, 
sanatoria, national and international conferences, 
state and city laboratories where any patient can 
have his sputum examined free of charge, etc. The 
results of this campaign have been most encour- 
aging indeed. The death rate from tuberculosis 
(all forms) in the United States Registration Area 
was 254.4 per 100,000 population in 1890. In 1910 
it was 160.3 per 100,000; and in 1922 it was 97.0 
90 HISTORICAL 
per 100,000, and tuberculosis has dropped from 
first place to third place as a cause of death. (See 
chapter on Prevention and Cure.) Koch died in 
1910, and has been honored by the erection of a 
statue to him in Berlin. 
Cornet established the importance of dust from 
dried sputum as a source of infection. 
Fluegge modified this air-borne view by show- 
ing that the moist droplets from cough spray and 
sneezing were a more important source than the 
dry dust. 
Von Behring called attention to the alimentary 
tract as a source of infection from infected milk 
and food, especially in children. 
Sanatoria. The sanatorium idea was orig- 
inated by Brehmer. He established at Goebers- 
dorf, Germany, in 1859, the first sanatorium. He 
located it in the mountains and laid out attractive 
paths for his patients to take regular walks-a 
regimen of graduated exercise after a fashion. His 
patients undoubtedly got more exercise than they 
should have, but this regulated open-air regimen 
produced so much better results than were being 
obtained otherwise that the plan, in spite of much 
opposition at first, gradually became popular and 
highly esteemed. His distinguished patient, Dr. 
Dettweiler, was impressed with the favorable influ- 
ence that "rest" had upon the patients under these 
outdoor conditions and became one of the earliest 
91 TUBERCULOSIS 
advocates of rest in the treatment of tuberculosis, 
which is recognized today as the most important 
factor in its treatment. 
Dr. Trudeau. Dr. Trudeau, in our country, 
was among the first to break away from the "hot- 
house" treatment (the plan of keeping the patient 
in a room with all the windows and doors closed, 
and with a fire going, as he describes the treatment 
that his brother received in 1865), and to advo- 
cate the outdoor life and open-air treatment. This 
he did by personal example in going to the Adiron- 
dacks, where he later established the now famous 
Adirondack Cottage Sanitarium * He also proved 
the advantages of outdoor life by the following in- 
teresting experiment. He infected ten rabbits with 
tuberculosis, five of which he placed in a cellar 
with damp, sunless atmosphere and poor food, and 
the other five he placed in a wire pen with access 
to the open air and sunshine. The results were 
very striking. The disease progressed very rapidly 
in the five rabbits in the cellar and four of them 
died within three months; while four of the five 
out in the open recovered. 
* Now the Trudeau Sanatorium. The Trudeau School of 
Tuberculosis was established in connection with this sana- 
torium in 1917. Its purpose is to offer the opportunity 
to physicians to become more thoroughly acquainted with 
the best methods of diagnosis and treatment of tubercu- 
losis, and to have a little personal experience in this line- 
features that have been entirely too much neglected by our 
medical schools in the past. 
92 HISTORICAL 
Other American Workers. Among other Ameri- 
can workers in tuberculosis who deserve mention 
for their important studies and contributions are: 
Benjamin Rush, who contributed several papers of 
importance which were among the first to be pub- 
lished in America; Samuel G. Morton, a pupil of 
Laennec, published in 1834 a volume on Pulmonary 
Consumption which was the first issued in the 
United States; William W. Gerhardt added impor- 
tant studies on tuberculous meningitis; Henry I. 
Bowditch was interested in tuberculosis throughout 
his long and active life, and his labors in New Eng- 
land added important contributions to the disease; 
Austin Flint's contributions to the physical signs 
and symptoms of tuberculosis was a work of great 
merit and is still of value. 
National Tuberculosis Association. The Na- 
tional Tuberculosis Association was formed in 1904. 
Its purpose is the study and prevention of tuber- 
culosis. Dr. E. L. Trudeau was the first president, 
and such distinguished men as the late President 
Roosevelt and Sir William Osler have been num- 
bered among its honorary vice-presidents. Anyone 
who is interested in the campaign against tubercu- 
losis is eligible for membership, and the dues are 
five dollars a year. The address of the Association 
is 370 Seventh Avenue, New York. 
The Association has promoted and stimulated 
the organized movement against tuberculosis in 
93 TUBERCULOSIS 
every possible way. Some of the notable achieve- 
ments are: 
(1) Organized and conducted the Sixth Inter- 
national Congress of Tuberculosis at Washington in 
1908. 
(2) Started the first traveling tuberculosis ex- 
hibit, and continued it for eight years. This exhibit 
demonstrated the value of this method of educa- 
tion, and resulted in the creation of thousands of 
similar exhibits, large and small. 
(3) Promoted the Tuberculosis Christmas Seal 
sale from a limited sale of 30,000,000 in 1910 to 
over 400,000,000 in 1923. 
(4) Printed and distributed educational leaflets, 
posters, and booklets on tuberculosis aggregating 
several million copies. 
(5) Established the American Review of Tu- 
berculosis, the only strictly scientific journal on 
tuberculosis published in English in America. 
(6) Established the Framingham Health and 
Tuberculosis Demonstration. 
(7) Co-operated with the American Medical 
Association in exposing "fraudulent cures" for tu- 
berculosis. 
(8) Rendered valuable aid to the Government 
in handling the tuberculosis situation during the 
war. 
(9) Organized state and local tuberculosis as- 
sociations now covering every state and all the 
94 HISTORICAL 
large centers of population in the United States, 
approximately 1,400 in all. 
(10) Expended through these national, state 
and local associations, $25,000,000 in education 
and organization, which in turn has resulted in the 
securing of appropriations from public funds 
amounting to $150,000,000 for the establishment 
of tuberculosis agencies with a total annual main- 
tenance budget of over $30,000,000. 
(11) Developed the idea of public health nurs- 
ing from small beginnings to one of the most sig- 
nificant means of disease prevention today known. 
There are now about 12,000 public health nurses 
in the United States. 
(12) Inaugurated and developed the first and 
most successful campaign for child health educa- 
tion through the public schools. This Modern 
Health Crusade has enrolled over 8,000,000 boys 
and girls. 
(13) Promoted health as an individual and 
community asset throughout the country, resulting 
in the ever-increasing co-operation of public au- 
thorities to assume their rightful share of respon- 
sibility. 
Tuberculin and Artificial Pneumothorax. In 
addition to the "rest-hygienic-dietetic-open-air" 
treatment which has been developed in the last 
twenty-five or thirty years, two other measures 
stand out above all other remedies that have been 
95 TUBERCULOSIS 
tried during this time, namely, tuberculin and arti- 
ficial pneumothorax. Koch discovered tuberculin 
in 1890 and there have been vigorous controversies 
as to its therapeutic value since then. The con- 
sensus of opinion of those who have studied tuber- 
culin most carefully is that it is of definite value 
in certain selected cases when administered by one 
who thoroughly understands its limitations and 
dangers. As a diagnostic test it is of the greatest 
importance, both in human beings, and more espe- 
cially in testing dairy cattle. 
Forlanini, an Italian, first suggested the use of 
artificial pneumothorax in 1882, i. e., the method 
of injecting air into the pleural cavity in order to 
collapse the lung and give it absolute rest. He first 
tried it in 1892, and reported a case successfully 
treated in 1894. Dr. Murphy, of Chicago, in 1898 
independently conceived the idea, and reported five 
cases so treated. Since that time many thousands 
of cases have been so treated, and many of them 
have received striking benefit and recovery. 
Tuberculosis-Extent, Races, Animals. Tuber- 
culosis has claimed the greatest total of victims of 
any disease, although in the last few years it has 
been reduced from first place to third place as the 
cause of death, and is still falling and will continue 
to fall as the methods of prevention become better 
known and universally adopted, and the earliest 
possible diagnosis and treatment instituted. It ex- 
96 HISTORICAL 
ists in all latitudes and altitudes and climates, 
but is most prevalent in temperate zones and low- 
lands. This is accounted for largely by the fact 
that the population is more dense in these regions, 
and consequently the environment more insanitary. 
All races are subject to it. The Indians, Negroes, 
Hawaiians, Australian Bushmen, and all primitive 
races seem more susceptible, or at least succumb 
more readily to it, than the white European races 
who have been associated with it many centuries, 
and have developed a relative racial immunity. It 
is practically unknown in wild animals and birds, 
because they are not in contact with the bacillus, 
but when they are kept in captivity they develop 
it. All domestic animals and birds are liable to 
infection. Dairy cattle and swine are the most 
susceptible, and investigations have found as high 
as 10 to 15% of dairy cattle infected in some re- 
gions. Sheep, goats, horses, dogs, cats, rats, and 
mice are more difficult to infect, and seem to have 
a fairly high degree of immunity. 
Types oj bacilli. Three types of tubercle bacilli 
are distinguished: human, bovine, and avian. The 
human type is the most virulent for human beings; 
the bovine type most virulent for other mammals; 
it is difficult to infect mammals with the avian type. 
97 II 
PHYSICIAN AND PATIENT 
" . . s The secret springs of action 
Which lie between the surface and the show 
Are disregarded ; with self-satisfaction 
We judge our neighbors, and they often go not 
understood" 
"When thou feelest sick call upon God, and 
bring the physician; for a prudent man scorneth 
not the remedies of the earth." The same author, 
a contemporary of Hippocrates (about 400 B. C.), 
also says, "The skill of a physician shall lift up his 
head, and in the sight of great men he shall be in 
admiration." 
Physicians at this time seem to have been held 
in high esteem. They were required to sign the 
Hippocratic Oath, which indicates an effort to 
maintain a high standard in the profession, and to 
exclude charlatans and quacks who seem to have 
been numerous in those days, and are still with us 
owing to the laxness of our laws in regard to such 
parasites. The oath is partly as follows: "I swear 
by Apollo . . . and by Aesculapius . . . 
that I will follow that system of regimen which, 
98 PHYSICIAN AND PATIENT 
according to my judgment, I consider for the bene- 
fit of my patients; and abstain from whatever is 
deleterious and mischievous; . . . With purity 
and with holiness I will pass my life and practise 
my art. . . . Whatever . . . I see or hear 
I will not divulge, as reckoning that all such things 
should be kept secret. ..." An excellent 
motto for today, and some physicians still adhere 
to it. 
Qualifications of Physician. The important 
thing for the patient is to secure a competent physi- 
cian. The one who undertakes to treat tubercu- 
losis should have not only a comprehensive knowl- 
edge of the disease, but also a thorough under- 
standing of human psychology. He must remem- 
ber that he is dealing with human beings, and not 
with experimental rabbits. And above all he must 
have firmness and personality enough to make the 
patient and attendants co-operate in the treatment. 
Mutual interest, sympathy, and kindness is a much 
more satisfactory policy than compulsion. But 
some few patients have the attitude of the Irish- 
man toward volunteering, who, when asked why 
he did not volunteer for the army, said: "Sure it's 
me who would go willingly if they would only com- 
pel me." 
When other things are equal, the more optimis- 
tic and enthusiastic the physician and patient are, 
the better will be the results. In such a tedious 
99 TUBERCULOSIS 
and chronic disease as tuberculosis, patience, cour- 
age, and character are large factors in the outcome. 
Since there is as yet no specific remedy, such as 
quinine in malaria or serum in diphtheria, we must 
make use of every possible aid however small it 
may seem, and indifference must be replaced by 
interest and hope. 
Mutual Understanding. I quote the verse at 
the head of the chapter to show the relationship 
which should not exist between physician and pa- 
tient. If the best results are to be obtained in any 
given case there must be a mutual and sympathetic 
understanding and interest between physician and 
patient, and perfect candor in all matters. It is 
very easy for the patient to mislead the physician 
by giving him false information, or by withholding 
information, but such a course works harm only to 
the patient. I have seen patients do things which 
they knew they should not do, and then put down 
on their charts a normal temperature and pulse 
when they had fever and an increased pulse rate, 
in order that the physician might not suspect that 
they had disobeyed instructions. If they could 
fool the disease as well as the physician by such 
a course, it would be well and good, but they should 
not be deceived, the disease is not mocked, and 
they will have to reap what they sow. Success de- 
pends on thorough co-operation of physician and 
patient, and a larger share of the responsibility 
100 PHYSICIAN AND PATIENT 
rests with the patient, for if he does not carry out 
faithfully his instructions, the best advice is only 
wasted on him. 
Confidence Necessary. Full confidence in the 
physician is necessary if the best results are to be 
obtained. If this is not possible, it is an injustice 
both to the physician and to the patient to remain 
under his care. It is therefore better to go to 
another physician in whom you have complete con- 
fidence and with whom you will co-operate fully. 
Co-operation. Proper and successful co-opera- 
tion depends on intelligence, close attention to de- 
tails, and individualization. The patient should 
have a definite idea of why he is called upon to 
forego certain apparently harmless pleasures, to 
endure privations and hardships, and to adhere to 
a certain regimen of treatment. The physician 
should not ask or expect him to carry out meas- 
ures faithfully for which he can give no adequate 
explanation. There are no grounds for secrecy in 
this disease, and the "take this medicine and ask 
no questions" attitude is a relic of supernaturalism 
and savors of quackery. The patient should be 
acquainted with the course of the disease, and pre- 
pared for the ups and downs that are sure to come 
if the disease is advanced. These periods of activ- 
ity should not be called by misleading and eu- 
phemistic names, but should be explained on a 
physiological and pathological basis, and the pa- 
101 TUBERCULOSIS 
tient should know that they are often unavoidable 
and not incompatible with a satisfactory progress 
toward recovery. His doubts and fears should be 
met in a sensible manner by the physician, and 
not left to the false explanations and meddlesome 
advice of his neighbors. 
Candor. The dealings between physician and 
patient should be marked by perfect candor. The 
patient should know the truth, and be prepared to 
receive it and carry out instructions. Anxious 
friends and relatives sometimes request the doctor 
not to tell the patient if he finds evidence of tuber- 
culosis. And later when the patient finds it out, 
he says with regretful tone, "How differently I 
would have acted if I had only known." The pa- 
tient should know that in early cases several months 
of treatment are necessary, followed by many 
months of careful living; and in advanced cases 
many months of treatment will probably be nec- 
essary. He should know that it is a preventable, 
communicable, and curable disease. 
Dr. F. M. Pottenger, who has had over twenty 
years' experience in treating tuberculosis, says: "I 
have never yet seen a patient who was seriously 
injured by telling him, in a proper and humane 
way, that he had tuberculosis. Imagine a physi- 
cian telling his patient with appendicitis that he 
has 'cramps' or 'colic'. Imagine what his surgeon 
friends would say! Yet many of these same sur- 
102 PHYSICIAN AND PATIENT 
geons are informing their tuberculous patients that 
they have 'weak lungs,' 'throat trouble,' and other 
equally deceptive conditions. It is not sparing the 
patient to withhold from him the diagnosis of early 
tuberculosis and allow him to progress to an ad- 
vanced condition. The patient's interests, as well 
as those of his associates, demand that the truth 
be known." 
Caveat, Doctor. As a physician who has been 
in the pew of a patient for five years, let me be- 
seech some of my former colleagues to be more con- 
siderate about adding unnecessary expense to the 
patient's already overburdened budget. The time 
is past for prescribing useless drugs merely to 
make the patient think that something is being 
done. Explanation and education are better and 
much cheaper. Consider! twenty dollars worth of 
antiphlogistine prescribed in one month by a well- 
known "specialist" for a patient who was making 
heavy financial sacrifices to remain under his care 
(this happened to my next-door neighbor)-caveat, 
doctor, the layman is becoming educated! 
103 Ill 
PHTHISIOPHOBIA AND THE CARELESS 
CONSUMPTIVE 
"0 wad some power the gijtie gie us 
To see our sei's as others see us! 
It wad jrae monie a blunder jree us, 
And joolish notion." 
-Burns. 
Ignorance and Selfishness. Phthisiophobia, or 
an unreasonable fear of tuberculosis, is based on 
ignorance and selfishness, and is responsible for 
much undignified conduct and inhumanity towards 
careful and conscientious consumptives. It may be 
taken as a partial index of general ignorance con- 
cerning tuberculosis. Such an attitude has caused 
some patients to become unduly sensitive about 
taking the necessary precautions against the spread 
of the disease, and it has induced others, less 
scrupulous, to attempt to conceal their disease by 
failing to observe any precautions which might at- 
tract attention to themselves. The remedy for 
these unnecessary evils is an intelligent and hu- 
mane attitude both on the part of the public and 
on the part of the consumptive. We need a cam- 
104 PHTHISIOPHOBIA 
paign of education that will protect the cleanly 
consumptive from prejudice and ostracize the care- 
less man-not only consumptive, but also the care- 
less and promiscuous spitter, and the individual 
who coughs and sneezes in the presence of others 
without covering his mouth and nose when he has 
a cold, bronchitis, or other respiratory infections 
which are much more easily contracted than tu- 
berculosis. 
No Danger to Adults. Adults have a marked 
resistance to tuberculosis, and their disease prob- 
ably always comes from old foci acquired in child- 
hood, and not from ordinary contact with con- 
sumptives. There is certainly no danger to the 
adult from a careful, cleanly, conscientious con- 
sumptive. The last war has offered unprecedented 
opportunities to observe the effects of the close as- 
sociation of tuberculous soldiers with healthy ones. 
Colonel Bushnell says: "Here is an experiment on 
a large scale; thousands of consumptives were put 
in closest contact with millions of healthy soldiers, 
and the result after four years is that it cannot 
be shown that such proximity did the well men 
any harm." 
Children. For infants and children, however, 
there is real danger, and no precautions are too 
great for them. They should be most carefully pro- 
tected from repeated and massive infections, and 
should live under the best hygienic conditions pos- 
105 TUBERCULOSIS 
sible, as regards fresh air, sunlight, and good food, 
in order that they may be able to convert any 
slight infections which they may get into beneficent 
vaccinations which will increase their immunity to 
the disease. These precautions for children, how- 
ever, in no way justify healthy adults in inconsid- 
erate selfishness for their own safety (which is not 
in danger) and in social and business ostracism 
which is sometimes practiced. I quote the follow- 
ing from a pamphlet issued by the National Tu- 
berculosis Association: "The best preventive meas- 
ures against infection for those around the patient 
are healthy bodies and cheerful minds. . . . 
There need be absolutely no danger to anyone liv- 
ing with him, . . . and it is entirely unneces- 
sary as well as very cruel to treat these patients, 
as is so often done, as though they had small-pox 
and could infect you at once." 
Inconsiderate and Ignorant Fears. I mention 
the following absolutely unnecessary inconvenience 
and additional expense to which I was subjected 
by college students (not primitive, superstitious in- 
dividuals, mind you, but inconsiderate, ignorant 
college students in the year of our Lord 1918). I 
sent for the college barber (about two blocks dis- 
tant from my home) to cut my hair, and he sent 
word that personally he was not afraid to cut my 
hair, but that the students had told him that if he 
did they would not patronize him any more. And 
106 PHTHISIOPHOBIA 
so I had to send into the city (six miles) for a 
barber. 
In 1803 Chateaubriand wrote in Rome: "I am 
in great difficulty; I had hoped to get two thou- 
sand crowns for my carriages, but, by a law of the 
time of the Goths, consumption is declared in Rome 
a contagious disease and as Madame de Beaumont 
drove two or three times in my carriages nobody is 
willing to buy them." 
George Sand wrote in 1839 of Chopin, with 
whom she was traveling: "Poor Chopin, who had 
had a cough since he left Paris, became worse. We 
sent for a doctor-two doctors-three doctors- 
each more stupid than the other, who started to 
spread the news in the island that the sick man was 
a consumptive in the last stages. ... We were re- 
garded as plague-infected; and, furthermore, as 
heathen, as we did not go to mass. The owner of 
the little house which we had rented turned us out 
brutally ... at Barcelona the landlord demanded 
to be paid for the bed on which Chopin had slept, 
on the pretext that it must be burned." (Chopin 
did not die until ten years later.) 
No Mental and Moral Perversion. Dr. Knopf 
has called attention to the unjust criticism that con- 
sumptives are afflicted with mental and moral 
aberrations, and so deserve social ostracism on this 
ground. He quotes the opinion of the leading phy- 
sicians who have had large experience with ,con- 
107 TUBERCULOSIS 
sumptives, and it is hardly necessary to add that 
they all deny these charges. Dr. Osler said: "I 
have never noticed among consumptives any 
greater tendency to immorality or crime than in 
other individuals. I should rather say the con- 
trary. ... I should say emphatically that the 
average consumptive is neither inclined to brute 
selfishness nor any special distortion of the ethical 
perceptions." Dr. Trudeau said: "I have seen all 
the finer traits of human nature developed to the 
fullest extent by the burdens which chronic and 
fatal illness, often slow in its progress, adds to the 
sum total of what men and women usually have to 
endure in life. I have seen certainly more patience, 
courage, self-denial, and unselfish devotion to others 
in consumptives than I have noticed in the major- 
ity of healthy human beings. . . . History is full 
of instances which prove that tuberculosis does not 
interfere with the development to the highest de- 
gree of the intellectual, the moral, and the ethical 
sides of man's nature." 
Stupid Prejudice. One often meets insane 
prejudice and near-sighted opposition to the estab- 
lishment of a sanatorium on the part of town and 
village boards. And yet it has been proven over 
and over that sanatoria are a great help for a com- 
munity instead of a danger. In the two German 
villages of Goebersdorf and Falkenstein, where the 
sanatoria were established, and where five of 
108 PHTHISIOPHOBIA 
the most flourishing institutions have existed for 
fifty years or more, the mortality from tuberculosis 
among the inhabitants has decreased by one-third. 
This is due to the fact that the villagers voluntar- 
ily imitate the hygienic precautions which are in 
force in the sanatoria. And Saranac Lake has be- 
come a flourishing locality since Dr. Trudeau estab- 
lished the Adirondack Cottage Sanitarium there, 
increasing from a tiny village with a saw mill, a 
small hotel for guides, and a few scattered houses, 
when he went there, to a modern health resort of 
about 6,000 inhabitants. 
Saranac Lake. In a recent careful survey of 
Saranac Lake, where 20% of the population have 
tuberculosis, Mr. Forrest B. Ames has shown that 
outside of tuberculosis families the infection of the 
resident population is less than in the average com- 
munity. And he says: "Educational influence 
emanating from near-by sanatoria, and locally the 
'open door' for the tuberculous into unrestricted in- 
dustrial and social activities have done much to re- 
move fear and ignorance and to create an intelligent 
public mind toward the disease. With this sane 
attitude existent the problems connected with the 
control of tuberculosis are becoming less and less 
difficult of solution." * 
♦A Tuberculosis Survey of the Residents of Saranac 
Lake, N, Y.-American Review of Tuberculosis, June, 1918. 
109 TUBERCULOSIS 
Summary of Evils. The Swedish National 
Anti-Tuberculosis League has summarized the evils 
of phthisiophobia as follows: 
Phthisiophobia 
-paralyzes the struggle against tuberculosis. 
-renders all measures against tuberculosis more 
difficult. 
-facilitates the spread of infection. 
-causes us to overlook the real danger. 
-is a sign of shameful cowardice. 
-causes cruel behaviour to consumptives. 
-is an enemy to society that must be opposed. 
The Careless Consumptive. The habitually 
careless, incorrigible, and vicious consumptives 
should not be tolerated. They are public nuisances 
and dangers to the community and should be forci- 
bly segregated. The International Congress on 
Tuberculosis held in Washington in 1908 unani- 
mously agreed that the one great essential for the 
prevention of tuberculosis is proper control of all 
open cases (z.e., cases with bacilli in sputum), in- 
cluding forcible segregation of those who cannot be 
kept under proper control in their homes. And yet 
only seven of our states have passed any special 
laws looking toward the segregation of the crim- 
inally careless consumptive-New Jersey in 1911, 
and New York, Wisconsin, Minnesota in 1913, . . . 
Virginia in 1916, Rhode Island in 1917 and Iowa 
in 1919. 
110 PHTHISIOPHOBIA 
Dr. David R. Lyman in an excellent article on 
"The Control of the Careless Consumptive" in the 
March, 1918, number of the American Review of 
Tuberculosis cites a number of cases in point. 
"Case 7. Married man with wife and two young 
children; man positive case, and no precautions 
whatever taken by patient or any of family. Pa- 
tient refused any kind of treatment. All four slept 
in same bed,. 
"Case 2. Married woman; open case; refused 
sanatorium treatment, and refused to observe or- 
dinary rules of cleanliness-spits on floor, etc. The 
visiting nurse stated, "Her two children had the 
measles when I called, and the little boy was in 
bed with his mother." 
"Case 10. Girl; open case; immoral character; 
refuses sanatorium treatment; and other children in 
family, probably tuberculous, not allowed to be 
examined. It is easy to see what a menace she is to 
any community. 
"Case 3. Peter , man who bums around 
town, spitting any and everywhere; was at a sana- 
torium, but was discharged on account of his in- 
tolerable conduct; now roams around and does as 
he pleases." 
And he asks, "what is the use of continuing to 
close the stable after the horse has gone? Why 
spend our taxes caring for the developed active 
case in the adult and permit this continued inex- 
1ll TUBERCULOSIS 
cusable infection of children to go on? ... we 
must begin at once to work for the provision of 
quarters where these cases can be committed by the 
health officer for such time as he decides the safety 
of the public demands." 
We know that it is such cases as these men- 
tioned above that are infecting helpless children 
every day; and we know that it is necessary to 
control by force such cases if we are to prevent 
the spread of tuberculosis, and ultimately eradicate 
this preventable disease. The cost of enforcing 
necessary preventive measures, and of maintaining 
institutions for the segregation of the careless, or 
homes for the proper care of exposed children, 
would be no more than the present cost of caring 
for indigent consumptives. And it would be a 
gradually diminishing cost, instead of a gradually 
increasing one as it is now. But we still lack the 
public sentiment and legislation necessary for the 
accomplishment of these ends. Can anyone con- 
tinue to claim, with the least shadow of justice, 
that the right of the adult to do as he pleases is 
greater than the right of the child, who cannot de- 
termine its environment, to be protected from this 
adult-even though it be his parent? 
112 IV 
HEALTH VS. PATENT MEDICINES, CHAR- 
LATANS, AND CHRISTIAN SCIENCE 
"Give me health and a day, and I will 
make the pomp oj emperors ridiculous." 
-Emerson. 
"The American people like to be 
jrazzle-dazzled." 
-Barnum. 
Health is the foundation of success and the key- 
stone in the arch of happiness. The bloom and 
buoyancy of health aid greatly in camouflaging 
physiognomic and mental defects, and render con- 
tagious the good fellowship and contentment of its 
possessor. It is passing strange that most of us 
take no thought of such a vital factor and have no 
intelligent plan for conserving this most valuable 
asset. 
In ths matter of investing a hundred dollars, or 
in a conflict with the law, we seek the advice of one 
qualified by special training and experience to give 
an intelligent opinion; but when signs of failing 
health appear we are willing to take the advice of a 
113 TUBERCULOSIS 
deluded ignoramus whose vacant countenance and 
grateful smile beam upon us from above an adver- 
tisement and assure us that Tanlac has cured his 
stomach trouble, or that Sarsaparilla keeps his 
blood so pure that no malicious germs can obtain 
board and lodging in his tissues. Nuxated Iron 
enabled Jess Willard to lick Jack Johnson, and so 
steadied Ty Cobb's nerves that he reached the dizzy 
heights of leading the American League batting 
average. (Query: What enabled Ty to lead the 
batting average for about ten consecutive years be- 
fore Nuxated Iron discovered him? And why did 
it fail Jess so miserably in his encounter with Jack 
Dempsey?) It is worth noting that the Journal of 
the American Medical Association has collected and 
published at least three testimonials on Tanlac 
which were published after the patient had died 
from the disease of which the testimonial states that 
Tanlac has completely relieved him. 
Patent Medicines. Patent medicines all have 
practically the same ingredients, namely, a narcotic, 
a laxative, and a bitter. These three "stand-bys" 
are advertised to cure everything, and especially 
"incurable diseases." The following story which 
sheds real light on the morals and sincerity of at 
least two opulent harpies of the trade came to light 
several years ago. One of them proposed a bet 
with the other that he could first prepare a medi- 
cine and then obtain testimonials (without pay) 
114 HEALTH VS. PATENT MEDICINES, ETC. 
stating that the medicine had cured any disease 
which the party of the second part might be pleased 
to name. Large stakes were put up, the "medi- 
cine" was advertised, and the testimonials gathered 
in-and in addition to winning the bet the medi- 
cine was a financial success. 
The chief effects of patent medicine upon the 
patient are due to the psychic element which is 
stimulated by the extravagant claims, fraudulent 
advertising, and testimonials emanating from de- 
luded ignorance and well-greased palms. But, of 
TANLAC 
JDatlp <ranfimpt 
HOLYOKE DAILY TRANSCRIPT, FRIDAY, MAY 11, 1917 20 PAGES 
THREE IN ONE FAMILY FUNERALS 
MAKES UNUSUAL CASE WICK-The Funeral of 
Fred Wick was held this 
South Hadley Falls Man Re- morning from his home, 
lieved of Stomach Trouble Granby Road, South Hadley 
Since Taking "Tanlac," Falls. 
the National Tonic. 
Two clippings from the 
same paper! 
I have gained 10 pounds One says "Tanlac" relieved 
Says Fred Wick, and My Mr Wick of " Stomach 
Wife and Son are Also trouble." 
Taking Tanlac and Have The other shows that Mr. 
Been Greatly Benefited Wick was dead and buried! 
1- Which do you believe? 
-Ed. Poster by Am. Med. Assoc. 
115 TUBERCULOSIS 
course, these effects are only temporary if the pa- 
tient has real organic trouble. Dr. Martin demon- 
strated this psychic effect in a well-known experi- 
ment on some of his tuberculous patients. He led 
them to believe that a wonderful serum for the 
cure of tuberculosis had been discovered, and then 
injected -them with a common salt solution. A 
marked improvement in subjective symptoms and 
feelings was noted, and when the injections were 
discontinued a return of the old status appeared. It 
is this psychological element which makes consump- 
tives pitifully easy victims for those parasites who 
advertise worthless consumption cures. 
ALCOHOL COMPARISONS 
1917 
BEER 
(4%%) he 
CHAMPAGNE 
(10%) 
SWAMP ROOT 
(9%) m 
s. s. s. 
(15%) h 
VARNESIS 
(15%) BHSESa 
PINKHAM'S VEGET. COMP. 
(15%) 
PEPTO-MANGAN 
(16%) 
HOOD'S SARSAPARILLA 
(16%) 
TANLAC 
(18%) 
VINOL 
(18%) 
MANOLA 
(18%) ■■MH 
PERUNA 
(20%) BMHHi 
WINE OF CARDUI 
(20%) 
PLANT JUICE 
(20%) M- 
HOSTETTER'S BITTERS 
(25%) 
-Ed. Poster by Am. Med. Assoc. 
116 HEALTH VS. PATENT MEDICINES, ETC. 
The patent-medicine fraternity have shown 
themselves to be absolutely unscrupulous in their 
methods and conscienceless exaggerators and pre- 
varicators in their advertisements. Several hun- 
dred "cures" are being exploited for diseases which 
are absolutely beyond the reach of drugs. Our 
trademark laws give these proprietors a perpetual 
monopoly which makes extensive advertising profit- 
able, and leads to the great abuses which make 
patent medicines a menace to public health. Mod- 
ern advertising methods seek to make the well 
man believe that he needs a "purifier" or stimulant, 
to cause those suffering from trivial ailments to dose 
themselves unnecessarily, and to make the sick be- 
lieve that these medicines are panaceas for what- 
ever ails the public. No one has the moral right, 
nor should he have the legal right, to sell products 
The subjects of these testimonials for a "consumption 
cure" all died of consumption. (Original poster shows five 
photos with testimonials.) 
These testimonials were honestly given. The consump- 
tive optimistic over a new treatment believes he has been 
benefited. Then the testimonial is secured. The victim dies 
but his testimonial lives on! 
Quacks and nostrum exploiters find no difficulty in get- 
ting chemist's certificates-of a kind! Here is the kind fur- 
nished by W. H. Morse for cures for consumption, epilepsy, 
blindness, etc. 
"F. S. Sc. (Lord)" after one's name looks imposing. It 
costs $5.00. 
-Modified from Ed. Poster by Am. Med. Assoc. 
TESTIMONIALS ARE WORTHLESS 
117 TUBERCULOSIS 
under grossly exaggerated and false claims, so as 
to induce the public to magnify imaginary and tri- 
vial ailments and dose itself unnecessarily and in- 
discriminately. Medicines for self-treatment should 
not be secret preparations, should contain no dan- 
gerous or habit-forming drugs, and should not be 
recommended for diseases that are obviously too 
serious for self-treatment. Yet these very things 
furnished the life-blood of the obnoxious business. 
(Such remedies for home use are included in the 
U. S. Pharmacopeia and are available for the pub- 
lic if they only knew it and would call for them.) 
If all patent medicines were abolished not only 
would the general health be improved, but the peo- 
ple would be saved over $100,000,000 annually, 
and, most important of all, those suffering from se- 
rious troubles would not reduce their chances of re- 
covery by delaying proper treatment through trying 
out worthless medicines first. True, the newspapers 
would lose $40,000,000 or more per annum in ad- 
vertisements, but their gain in self-respect should 
be more than worth it. 
Charlatans. Where the qualified physician is 
compelled by knowledge and truthfulness to be con- 
servative and indefinite as to promises of cure, the 
quacks are most cocksure in their false assurances. 
As proof of their claims they offer the testimonial 
of some vain woman who received a bonus of a few 
photographs for sending one along with her testi- 
118 HEALTH VS. PATENT MEDICINES, ETC. 
mony, or that of a renegade doctor 'who is well 
paid for his lies. The patient should not be misled 
by these, but should recognize as sure signs of 
quackery any display of testimonials, claims of a 
new discovery or "special methods," form letters, 
and special and reduced rates. 
When such different agents as a dose of medi- 
cine, a massage, an electric magnet, a blest hand- 
kerchief, or Christian Science are supposed to re- 
lieve the same malady, it should be evident that 
none of them has a specific effect on the malady, 
but that it is relieved by natural methods in due 
course of time. About eighty-five per cent of peo- 
ple will recover from their troubles regardless of 
what is done for them, and so this gives the quacks, 
patent medicine vendors, faith and mental healers 
a pretty good percentage to point to as "their 
cures." But in every serious organic trouble such 
as tuberculosis, nephritis, cancer, heart and blood- 
vessel diseases, etc., patent medicines and quacks 
are positively harmful, and Christian Science be- 
comes harmful in keeping such patients away from 
the proper medical advice and treatment. 
The guardian and adviser on matters of health 
should have a minimum training of four years high 
school, two years college, four years medical school, 
and one year hospital experience, and should not be 
bound by the narrow tenets and practices of any 
system such as Osteopathy, Christian Science, Chi- 
119 TUBERCULOSIS 
ropractic, et al., but should have an unprejudiced 
mind toward any measure that might prove help- 
ful. Only such a qualified adviser should decide 
whether the patient needs a dose of medicine, an 
Osteopathic rub, Christian Science gas, an opera- 
tion, or any definite regimen of treatment. 
Christian Science. Mrs. Eddy, a firm believer 
in malicious animal magnetism (sometimes known 
as witchcraft), suffering from delusions of persecu- 
tion, discharging and bringing suit in turn against 
three of her associates for "wishing evil" on her, 
sued by her own son on grounds of insanity, too 
busy to save her husband's life who, according to 
her own written statement, died from absorbing evil 
thoughts aimed at her by her enemies, was the 
human paragon chosen by God to reveal His meth- 
ods of healing to mankind-methods which Christ 
used, but forgot to impart to His disciples, as one 
would infer from the preface to "Science and 
Health." 
Just why He waited over eighteen hundred years 
to correct this oversight, and until she was well past 
middle age and had been an irascible neurasthenic 
for several years and a patient of Dr. Quimby's, 
who used "mental suggestion" in treating her, she 
does not say. Anyway, after her association with 
and treatment by Dr. Quimby, who used hypnotism 
and mental suggestion in treating many of his pa- 
tients, the "light" dawned upon her, and she was 
120 HEALTH VS. PATENT MEDICINES, ETC. 
quick to capitalize credulity and hope by bolstering 
it up with a religion. 
"E'en ministers they hae been kenn'd 
In holy rapture, 
A rousing whid at times to vend, 
And nail't wi' scripture." 
Dr. William J. Mayo says, "Among all peoples 
in all times, the prevailing religion has been success- 
ful in relieving sickness, so far as mental suggestion 
could give comfort or indirectly affect the physical 
condition. Christian Science has capitalized and 
commercialized the mentally healing virtues of 
Christianity." 
If their healers would acknowledge their limi- 
tations and confine their attempts to the benefits 
that come from mental suggestion, and not try to 
treat serious organic troubles, except under the di- 
rection of a qualified physician, their efforts would 
be laudable. The benefits of Christian Science are 
explainable on physiological grounds, and not on 
the basis of being in "perfect attunement" with the 
Divine "Spirit." The beneficial influence of the 
mind (cheerfulness, hope, courage) has long been 
recognized in medicine, and used before Mrs. Eddy 
"borrowed" the idea from Dr. Quimby. 
The situation is stated tersely by Drs. Fisher 
and Fisk*: "They sometimes succeed in the 'real 
♦Fisher and Fisk: How to Live, Funk & Wagnails Co., 
1915. 
121 TUBERCULOSIS 
cure of imaginary ailments,' and the 'imaginary 
cure of real ailments.' In the latter case the men- 
tal contentment lasts only until the real ailment 
becomes too aggressive to be ignored." It is in 
such cases that their meddlesome interference and 
unfortunate influence is harmful. It is criminal 
to withhold operation, or radium or x-ray for can- 
cer at the earliest stage possible; to tell a con- 
sumptive in the early stages of the disease that his 
trouble is all in his mind and have him go about 
his work as usual and thus reduce his chances of 
securing an arrest of the diseases to almost nothing; 
to give a diabetic or nephritic any and everything 
he may want to eat, etc., ad mortem. 
Even more pernicious is the opposition of Chris- 
tian Scientists to measure against preventable dis- 
eases and hygienic living. In truth, if they had 
their way, we would have a return of the scourges 
of the dark ages. Smallpox, plague, malaria, ty- 
phoid, typhus, dysentery, etc., would rage and 
flourish unopposed, while they sat by and impo- 
tently read "Science and Health" to the victims- 
or probably fled to distant parts and gave "absent 
treatment." Such procedure is not essentially dif- 
ferent from that of the "medicine man" of savage 
tribes who decorates himself in frightful garb and 
beats upon his tom-tom to drive away the evil spir- 
its, except that the noise of the tom-tom is replaced 
by the vaporous verbiage of "Science and Health." 
122 HEALTH VS. PATENT MEDICINES, ETC. 
Signs of the Time. It is encouraging to turn 
from these small groups of misguided, credulous, 
and essentially ignorant faddists who are opposing 
progress toward the goal of public health, "On 
which rests the happiness of the people and the 
power of a country," and read the signs of the time 
in the increasing popularity of sleeping porches 
and hygienic living and working quarters; the pure 
food laws, and demand for uncontaminated water 
supply, certified milk and inspected meat; and to 
note the enlightened opinion behind the organized 
campaign to protect the youth from contagious dis- 
eases. 
Temperance, good food, regular bowels, avoid- 
ance of prolonged physical and mental over-strain, 
proper amount of rest, recreation, fresh air, and a 
cheerful and serene disposition, together with pe- 
riodic physical examinations, are the chief preven- 
tive measures against disease and old age. 
123 V 
TEMPERAMENTS AND TUBERCULOSIS 
"1 like the man who faces what he must 
With step triumphant and a heart of cheer, 
Who fights the daily battle without fear, 
Sees his hopes fail, yet keeps unfaltering trust." 
Varying Reactions to Tuberculosis. The chief 
difference between human machines and other awe- 
inspiring mechanisms created by the genius of man 
lies in their reacting power. No two human 
temperaments will react alike to any given stimu- 
lus, and the same individual will vary according 
to circumstances. It is not surprising then that 
such a spectre as tuberculosis should cause all man- 
ner of reactions exemplifying those immortal words, 
"What fools ye mortals be." 
Fear seizes one; a vision passes before his eyes, 
and he is ready to give up the ghost. Folly per- 
suades another to take "one last fling," which may 
add many months to his period of "chasing the 
cure." Shortsightedness tells one he can't afford to 
stop now, but fails to add that it will take ten 
times as much time and money if he waits for the 
breakdown to come. Discouragement beclouds 
124 TEMPERAMENTS AND TUBERCULOSIS 
good judgment, and adds, "What's the use, I don't 
care what happens." Wisdom lingers with a few 
and says, "It's bad enough to lose your health; don't 
make the situation worse by losing your head." 
If recovery depended upon doing some big and 
spectacular task we would bend every energy to the 
contest; but, since success depends chiefly on re- 
nunciation and apparently doing nothing, many are 
confounded and defeated by the very simplicity and 
tediousness of the task. They are like Naaman the 
Syrian, who, when Elisha told him to wash seven 
times in Jordan, said: "Are not the rivers of 
Damascus better than all the waters of Israel? 
Could I not have washed in them and been clean? 
Behold, I thought he would surely come out to me 
and stand and call on the name of the Lord his 
God, and wave his hand over the place and heal the 
leprosy." So he turned away in a rage, but his 
servants besought him saying, "If the prophet had 
bid thee do some great thing wouldst thou not have 
done it? How much rather then when he saith to 
thee, 'Wash and be clean.' " 
Worry is almost inevitable in the early reactions. 
It is no use telling a patient not to worry. He must 
achieve that state of mind by practice and discip- 
line of his will-power, and not until he accomplishes 
it does he put himself in the fair way to recovery. 
The chief business now is to get well. All other 
considerations must stand aside if he is to put up 
125 TUBERCULOSIS 
his best fight. "Drag your thoughts away from 
your troubles ... by the ear, by the heels, or any 
other way so you manage it." 
Alice Freeman Palmer. The case of Alice Free- 
man Palmer is very instructive. Her busy, suc- 
cessful and interesting life may be briefly sum- 
marized as follows: 
Born on a farm in an obscure border village. 
She learned to read at three; went to school at 
four; and at five looked after the three younger 
children in the family. 
She determined that she would secure the best 
education open to women in her day, "if it took fifty 
years to do it." She decided on the University of 
Michigan, and ended with the degrees of Ph.D., 
D.Litt., and LL.D. 
At twenty-two she was principal of a high school 
in Michigan; at twenty-four professor of history at 
Wellesley; at twenty-six president of Wellesley. 
At thirty-two she resigned the presidency to marry 
Professor Palmer of Harvard. Four years later at 
the urgent request of President Harper she served 
as Dean of Women in the University of Chicago 
for four years. 
At the 1920 election of "Immortals" for the 
Hall of Fame at the University of New York she 
was the only woman elected. 
At the age of twenty-five she developed tuber- 
culosis. Dr. Bowditch of Boston told her that she 
126 TEMPERAMENTS AND TUBERCULOSIS 
must give up her work, and advised a trip to 
Southern France, warning her that unless great 
precautions were observed she would have only a 
few more months to live. On her way home she 
consulted Dr. Willard Parker in New York and re- 
corded this note, "Dr, Parker tells me I can live if 
I have character and courage enough." She devoted 
herself entirely to the task of getting well, and after 
several months of rest cure at home' made a good 
recovery, and never had any further trouble from 
tuberculosis. It was said of her, ''She seldom hur- 
ried, never worried, admitted no regrets for the past 
or anxieties for the future." 
The Metal of the Patient. We do not fully 
appreciate the value of health until we have lost 
it. The mental reaction which then ensues reveals 
the metal of the patient. Some poor souls there- 
upon pine away by dwelling on the mistakes of 
the past and blaming others unduly for their 
share and influence in them, while the more 
philosophic and successful realize the folly of crying 
over "spilt milk" and at once set about to regain 
the lost treasure. The stern philosophy of Marcus 
Aurelius should prove helpful for some: 
"Look on every man who evinces pain or dis- 
satisfaction at any event as on a level with the pig 
that is led out to sacrifice kicking and squealing. .. . 
The healthy mind will cheerfully accept all vicissi- 
tudes of fortune, while that which repines, '0 let me 
127 TUBERCULOSIS 
live,' or, 'Let all men praise my doings,' is on the 
level with the eye that will see nought but green, or 
the teeth which accept only the tenderest morsel, 
which is nought but a token of disease." 
I recall a woman who used to go about the sana- 
torium in her rustling silks and pour forth her woes 
and "beg" for sympathy as if she were the only per- 
son that ever had her plans and pleasures inter- 
rupted by tuberculosis. In contrast there was an- 
other patient, extremely ill, and although he realized 
there was little hope, yet his face was always bright, 
he had a word of encouragement for everyone, he 
radiated cheer and optimism, he was putting up the 
best fight he could. Other patients liked to visit 
him, because they felt that their storage batteries 
of courage and hope had been freshly charged when 
they left. 
Some are inclined to look upon the period of 
cure as a barren waste, as time irreparably lost. 
This will depend on the attitude and reaction of the 
patient. He can make it a period of profit, a period 
of reading, practice in self-control, and emerge a 
better citizen and neighbor, with keener apprecia- 
tion of altruism, more self-reliant, and less depen- 
dent on others for the things that furnish the joy 
of living. Mark Twain offers a good example: 
"I have been sick a-bed, the first time in twenty- 
one years. How little confirmed invalids appreciate 
their advantages. I was able to read the English 
128 TEMPERAMENTS AND TUBERCULOSIS 
edition of the Greville Memoirs throughout without 
interruption, take my meals in bed, neglect all busi- 
ness without a pang, and smoke eighteen cigars a 
day." 
Professor Phelps said of Robert Louis Stevenson, 
a sufferer from tuberculosis for twenty-two years, 
"Prone in bed, when his attention was not diverted 
by a haemorrhage, he lived amid the pageantry of 
gorgeous day dreams, presented on the stage of his 
brain." His joy in and love of life are expressed in 
the following aphorisms by him: "There is no duty 
we so much underrate as the duty of being happy"; 
"To travel hopefully is better than to arrive-the 
true success is in labor"; and, "Keep your fears to 
yourself, but share your courage with others." 
A Chance for Mental Activity. If our physical 
activities are limited, our mental faculties have 
a better chance to flourish. As Cephalus said to 
Socrates, "As the pleasures respecting the body 
become insipid, the desire and pleasure of con- 
versation increase," or, as Mark Twain put it, 
"The chief pleasure consists in the wagging of the 
gladsome jaw and flapping of the sympathetic ear." 
No wonder that many patients fall into boredom 
when separated from business and professional 
duties, because they have never thought of anything 
else, never read what others have thought and said 
about subjects that have interested brilliant minds. 
"Books are true levelers. They give to all who 
129 TUBERCULOSIS 
faithfully use them the society of the best and 
greatest of our race." Don't lock your mind in 
"solid ivory" when such questions as, "If a man 
die shall he live again?" knock for entrance. And 
I am inclined to believe that there are few who 
will not revise their philosophy of life and greatly 
improve their future conduct by such a period of 
trial, of study, and reflection. 
Everybody admires a cheerful loser. Our 
cherished dreams may be rudely broken up, and 
some by delay, some by folly make recovery im- 
possible, and some have to fight a losing battle from 
the start; but we can display fortitude, and spiritual 
victory is possible for all. Dr. Trudeau has ex- 
pressed in a nutshell the kernel of "t. b." philosophy, 
"To cease to rebel and struggle and to learn to be 
content with part of a loaf when we cannot have a 
whole loaf, though a hard lesson to learn, is good 
philosophy for the tuberculous invalid; and to his 
astonishment he often finds that what he considered 
the half loaf, when acquiesced in, proves most satis- 
fying." 
The story of Sidney Lanier and his battle with 
tuberculosis and poverty, and of how he preserved 
his passion for music and poetry and scholarship, is 
one of the most heroic and inspiring in the annals of 
men. He was always hopeful and buoyant. In 
1872 he wrote to his father from San Antonio where 
he was "chasing the cure," "I feel today as if I 
130 TEMPERAMENTS AND TUBERCULOSIS 
had been a dry leather carcass of a man into whom 
someone had pumped strong currents of fresh blood, 
of abounding life, and of vigorous strength. I can- 
not remember when I have felt so crisp, so springy, 
and so gloriously unconscious of lungs." 
It is of no consequence whether we live or not, 
but it is of the greatest importance to practice virtue 
while we do live. But do not give up the ghost at 
every crisis. You may feel like Job when he said, 
"Why did I not give up the ghost when I came out 
of the belly? Hast Thou not poured me out as 
milk, and curdled me like cheese? Yea, he hath 
taken me by the neck and dashed me to pieces." 
But remember that, "After this Job lived an hun- 
dred and forty years, and had 14,000 sheep, 6,000 
camels, 1,000 yoke of oxen, and also seven sons and 
three daughters." And remember that Dr. Tru- 
deau, after eight years of "chasing the cure," much 
of the time in bed, and after many apparently 
hopeless periods, did his greatest work. 
The remarkable case of John Burns, reported in 
the Journal of the Outdoor Life, is another most 
encouraging example. "The first seven years are 
the worst," said Mr. Burns, when asked for particu- 
lars about his case. 
The first year was spent literally in chasing the 
cure, from climate to climate and from doctor to 
sanatorium. He returned home and continued to 
get worse. After a few weeks he entered a local 
131 TUBERCULOSIS 
sanatorium and for six years lay on his back, unable 
even to attend to his toilet, and often having to be 
fed. During these six years he had five hundred 
haemorrhages. 
"Smiling and uncomplaining, he kept on, pa- 
tiently fpllowing the doctor's advice, until now, after 
eight years, he has achieved what is termed 'full 
exercise' and is able to visit his home for a few days 
now and then. He has regained his normal weight 
and is a very healthy looking specimen of the genus 
homo. There is no need for anyone to despair- 
think of John Burns, smile and get well." 
"It's the plugging away that will win you the day, 
So don't be a piker, old pard! 
Just draw on your grit; it's so easy to quit: 
It's the keeping your chin up that's hard." 
132 VI 
DISTINGUISHED "T. B'S." 
"He alone is great 
Who, by a life heroic, conquers fate." 
-Bolton. 
"We are part of all we have met"-certainly no 
one has been introduced to tuberculosis and come 
off an unchanged man! The lessons of patience, 
courage, endurance, and hope turn out some truly 
noble and purged souls-souls attuned to the broad- 
est and most sympathetic interests of mankind, and 
skilled in surmounting obstacles and overcoming 
handicaps. It is my purpose, and pleasure, to 
present a few of these characters for the encourage- 
ment and guidance of those who are apt to become a 
little scorched, instead of purified, in the fiery fur- 
nace. "If thou find aught in the life of man more 
excellent than a mind at peace with itself . . . , 
and at peace with destiny in the lot she assigns thee 
without thy choice . . . if," says Marcus Aurelius, 
"thou canst behold aught more excellent than this, 
turn to it with all thy soul and enjoy the highest to 
the utmost." 
Trudeau. No one can qualify with higher marks 
133 TUBERCULOSIS 
for this chapter than the late Dr. Edward Living- 
ston Trudeau (1848-1915). His experience with 
tuberculosis began in 1865 when he nursed his 
brother through an acute and fatal attack of the 
disease. He said, "It was my first great sorrow,- 
and I have never ceased to feel its influence. In 
after years it developed in me an unquenchable 
sympathy for all tuberculous patients-a sympathy 
which I hope has grown no less through a lifetime 
spent in trying to express it practically." Indeed, 
this was only the beginning of many great sorrows 
and trials which filled his cup of life. A few years 
later the same disease that had taken off his brother 
so quickly banished him from a most promising 
practice in New York to the Adirondack wilds. 
Three of his four children were taken from him; 
one in infancy, and two at the threshold of matur- 
ity-one with tuberculosis, and the other with pneu- 
monia. His labors were frequently interrupted by 
relapses of tuberculosis, causing long periods of 
invalidism. Truly it can be said that "he was a 
man of sorrows, and acquainted with grief," but it 
never broke his indomitable spirit, and only deep- 
ened his symapthy and interest in his fellow suf- 
ferers, and strengthened his desire and determina- 
tion to serve them. 
His ancestors for several generations had been 
physicians, and he finally decided to study medi- 
cine, after drifting a while with his pleasure-loving 
134 DISTINGUISHED "T. B.'S" 
companions. When he announced this decision to 
his club mates one of them offered to bet $500 that 
he would never graduate-and "no one was found to 
take the bet," says Dr. Trudeau. "This was the 
turning point between an easy life of pleasure to one 
of work and responsibility. After this my evenings 
were generally spent in the little hall bedroom with 
my anatomy instead of at the club with my boon 
companions." 
The teaching on tuberculosis at this time (1868) 
was very meagre. The tubercle bacillus had not 
been discovered, and tuberculosis was considered a 
hopeless disease. He tells of his experience in going 
down to New York from Saranac twelve years later 
in order to learn how to stain the tubercle bacillus 
which Koch had discovered in 1882. Even for sev- 
eral years after this "leading" physicians did not 
take much stock in germs, and the tubercle bacillus 
in particular. When he returned from this trip he 
found a Harvard student at Saranac who had come 
to consult Dr. Loomis, a distinguished New York 
physician, who was on a hunting trip there at this 
time. In the meantime Dr. Trudeau examined the 
patient's sputum by his newly learned staining 
method, and found tubercle bacilli in it. This con- 
vinced him that the patient had tuberculosis in spite 
of the fact that the physical signs were slight and 
indefinite. When Dr. Loomis returned from his 
hunting trip, he examined the patient and found no 
135 TUBERCULOSIS 
definite signs. Dr. Trudeau then told him about 
finding the bacilli in the sputum. But Dr. Loomis 
only smiled, and said that he didn't have much faith 
in germs anyway. He sent the patient back to Har- 
vard, and four months later he had a profuse 
haemorrhage, which convinced Dr. Loomis that Dr. 
Trudeau was right. Dr. Loomis was afterwards 
one of Dr. Trudeau's strongest supporters. 
Adirondack Cottage Sanitarium. When Dr. 
Trudeau discovered that he had tuberculosis his 
love of the woods and hunting drove him up to the 
Adirondacks in spite of the protests of his friends 
and physicians. This life in the open and on the 
lake, where he spent the first five years of his illness, 
brought about an arrestment of his disease. He was 
then anxious that other patients should have the 
advantages of this open-air life and mountainous 
climate which had done so much for him. He was 
also favorably impressed with the sanatorium idea 
which Brehmer and Dettweiler had tried with such 
marked success in Germany, and decided to try it 
there at Saranac. Accordingly the Adirondack 
Cottage Sanitarium was started in 1884 with a very 
humble and meagre beginning. This was the 
pioneer institution in this country and he fully dem- 
onstrated and established its value in the treatment 
of tuberculosis. His magnetic personality and un- 
bounded sympathy and interest in his fellow suf- 
ferers attracted all classes of patients to these moun- 
136 DISTINGUISHED "T. B.'S" 
tains, and now Saranac Lake is the most flourishing 
tuberculosis resort in the country. 
He determined that the poor, as well as the rich, 
should have the advantages of this sanatorium, and 
accordingly he gave his services to the institution 
entirely free, and charged for board, etc., far less 
than the cost. This deficit, amounting to from 
$12,000 to $25,000 a year, he made up by begging 
subscriptions from his friends for a period of twenty 
years or more, until in 1914 he had accumulated a 
productive endowment of over $600,000 for the 
sanatorium, in addition to the thoroughly equipped 
laboratory and adequate buildings and grounds- 
truly a great monument to his ceaseless efforts and 
unflagging zeal! 
In the early years of the sanatorium he devoted 
much time and work to research in his laboratory. 
A characteristic light is shed on his ideals in the fol- 
lowing statement about Robert Louis Stevenson, his 
distinguished patient: "He could not, as I could, 
look over and beyond these painful associations with 
which I lived in daily contact at the Sanatorium and 
the Laboratory, and see, as I did in my ideals, the 
glorious hope of future relief to humanity from sick- 
ness, suffering and death which lay in the study of 
disease at the bedside, and of infection and germs 
and sick animals in the Laboratory. This was the 
light which was so bright to me that I never noticed 
the smell of oil which overcame Stevenson." 
137 TUBERCULOSIS 
Dr. Trudeau lived to see the fruits of his labors 
at Saranac returning an hundred fold, and to receive 
the highest honors his colleagues could bestow upon 
him. He was the first President of the National 
Tuberculosis Association; President for the United 
States of the International Congress on Tuberculo- 
sis held in Washington in 1908; and President of the 
American Congress of Physicians in 1910. No one 
was ever held in higher esteem by his patients and 
colleagues. His autobiography, from which I take 
the above incidents, is a most encouraging and in- 
teresting account of a busy, successful, and highly 
useful life handicapped by intermittently active tu- 
berculosis for over forty years. 
Grancher. Professor Jacques Joseph Grancher 
(1843-1907), of Paris, taught and practiced among 
consumptives for twenty-five years, when he was 
taken off by an untimely death from tuberculosis. 
The French have been the pioneers in protecting 
children from tuberculous infection, and it is due 
to Dr. Grancher's clear perception and strong con- 
viction of the importance of this measure. He real- 
ized clearly that by far the most successful point 
at which to attack tuberculosis was in preventing 
the infection of children. He founded the Grancher 
Society whose purpose is to find homes for children 
of poor tuberculous families among healthy peasant 
families, and thus remove these helpless children 
from the danger of infection from their ignorant, 
138 DISTINGUISHED "T. B.'S" 
careless, and often helpless parents. These children 
are returned to their families at the age of thirteen 
if the parent has been cured or has died, and the 
danger of infection thus removed. At the outbreak 
of the War this Society had 810 children under its 
supervision-only a small proportion of the thou- 
sands who need such help, to be sure; but it is 
pointing the way, and enlarging its activities as 
rapidly as it can obtain the co-operation and finan- 
cial help required. At the time of his death Dr. 
Grancher had planned and was working for the 
establishment of a "Sanatorium School" for chil- 
dren with latent tuberculosis, where they could have 
"double rations" of fresh air, rest, good food; and a 
"half ration" of work. The need and usefulness of 
such institutions is now apparent to all-only the 
public interest and funds are lacking!" 
Dettweiler. Dr. Peter Dettweiler (1832-1904) 
was an army surgeon in 1870 when he developed 
tuberculosis and went to Dr. Brehmer's sanatorium 
at Goebersdorf, Germany (the first one established), 
where he recovered his health. He became Dr. 
Brehmer's assistant, and after six years established 
his own sanatorium at Falkenstein, which has been 
since its establishment "the Mecca for students of 
tuberculosis all over the world." He was the first 
to recognize fully the importance of rest in the 
treatment of tuberculosis, and he introduced the 
"open-air rest cure on the reclining chair." He 
139 TUBERCULOSIS 
founded the first sanatorium for the consumptive 
poor, and it is to his initiative that Germany is in- 
debted for her many institutions of this sort. Dr. 
Knopf said of him, "He was a charitable man, of 
unusual cordiality and kindness and strong person- 
ality-a friend, confessor, and physician to his pa- 
tients." Dr. Baldwin said, "He began life as a tu- 
berculous invalid, and in consequence of ill health 
was considerably deprived of advantages; but his 
delicate frame was animated by a determination 
and spirit that surely carries its lesson to those who 
look forward with doubts weighing heavily upon 
them." 
Laennec. Rene Theophile Hyacinthe Laennec 
(1781-1826) was the most important and distin- 
guished internist of the early French school, al- 
though an early victim of tuberculosis. His inven- 
tion of the stethoscope in 1819 opened up the possi- 
bility of accurate diagnosis of diseases of the heart 
and lungs, and at the same time made his name 
immortal. He was the first to recognize pneumo- 
thorax in a living patient, and described accurately 
its signs; the first to discover and describe the 
"anatomical tubercle"; the first to recognize bron- 
chiectasis, haemorrhagic pleurisy, gangrene and 
emphysema of the lungs; and he was the author of 
many terms which are now used in describing the 
physical signs in the chest. He was slight in 
stature, generous, tolerant, modest about his work, 
140 DISTINGUISHED "T. B.'S" 
and stands out as one of the greatest clinicians of 
all ages. 
The medical profession contains many names 
that are worthy of a place in this chapter, but the 
size and scope of this little book permits the selec- 
tion of a few only. This is also true of the field of 
literature; and the following names selected from 
the various walks of life. 
Lanier. Sidney Lanier (1842-1881) was a son 
of the Old South, reared in a cultured and prosper- 
ous family according to the principles of chivalry 
and sociability which were in vogue in the South 
before the War. He graduated from Oglethorpe 
College, Milledgeville, Georgia, at the head of his 
class in July, 1860, and spent the rest of the sum- 
mer on the estate of his grandfather at Montvale 
Springs in the mountains of East Tennessee. A 
glimpse into the life of that time is expressed in 
the following extract from one of his letters: "I 
have up here in the mountains,-kinsfolk, men 
friends, women friends, books, music, wine, hunt- 
ing, fishing, billiards, tenpins, chess, eating, mos- 
quitoless sleeping, mountain scenery, and a month 
of idleness." 
In the fall of the same year he returned to his 
Alma Mater as a tutor. He describes himself at this 
time as "a spare-built boy, of average height and 
under-weight, mostly addicted to hard study, long 
reveries, and exhausting smokes with a German 
141 TUBERCULOSIS 
pipe." The question uppermost in his mind at 
this time was that of a vocation. He had inherited 
the musical genius which was a marked trait in the 
Lanier family-Pepys mentions the "music-loving 
Laniers" in his diary. He had a decided bent and 
extraordinary talent for music and poetry, but they 
were not considered a "man's job" in his day and 
locality. 
His dreams of scholarship, music and poetry, 
however, were interrupted by the War from which 
he emerged broken in health and with the property 
of his family entirely swept away. 
At home, at college, in war, and in prison he 
entertained and charmed his friends and associates 
with his flute. A fellow prisoner of war said, 
"Many a stern eye moistened to hear him, many a 
homesick heart for a time forgot its captivity." He 
secured his release from prison through some gold 
which a friend smuggled into prison in his mouth. 
Extremely emaciated and weak he was rescued from 
death on board the ship in which he was sailing for 
Fortress Monroe by an old friend who chanced to 
be present. She relates the incident as follows: 
"There in that horrible place dear Sidney Lanier 
lay wrapped in an old quilt his thin hands tightly 
clinched, his face drawn and pinched, his eyes fixed 
and staring. ... At last he turned his eyes slowly 
about until he saw Lilia, and he murmured: 'Am 
I dead? Is this Lilia? Is this heaven?' . . . We 
142 DISTINGUISHED "T. B.'S" 
gave him some hot soup and more brandy, and he 
lay quiet until after midnight. Then he asked for 
his flute and began to play. As he played the first 
few notes you should have heard the yell of joy that 
came up from the shivering wretches down below, 
who knew that their comrade was alive. And there 
we sat entranced about him, the colonel and his 
wife, Lilia and I, weeping at the tender music as 
the tones of new warmth and color and hope came 
like liquid melody from his magic flute." 
After the War he was a clerk and teacher in 
Alabama for a while, and then he studied and prac- 
ticed law with his father in Macon, Georgia, until 
1873. His passion for music and poetry finally pre- 
vailed and he went to Baltimore where he played 
the first flute in the Peabody Symphony Orchestra. 
In 1879 he was made lecturer on English Literature 
at the Johns Hopkins University. His health during 
these years was very poor, and he made frequent 
trips to Florida and North Carolina in the effort to 
build up his waning health-spasmodic attempts at 
"chasing the cure." In spite of his poor health he 
made most rapid progress and remarkable achieve- 
ments for such a short time in the field of literature. 
He was a brilliant exponent of music in poetry as 
"The Marshes of Glynn" and "The Song of the 
Chattahooche" attest, and second only to Poe in 
the art of onomatopoeia. 
"His personality is one of the rarest and finest 
143 TUBERCULOSIS 
yet produced in America," says Professor Mims. 
And Dr. Gilman, President of Johns Hopkins, said 
of him, "He always preserved his sweetness of dis- 
position, his cheerfulness, his courtesy, his industry, 
his hope, his ambition. . . 
Stevenson. Robert Louis Stevenson (1850- 
1894) was a peripatetic chaser of the cure, trying 
Davos, Bournemouth, Riviera, the Adirondacks, 
California, and finally Samoa, where he established 
his home in 1890-not a very wise course for a con- 
sumptive to pursue! "Where is Samoa?" asked a 
friend. "Go out of the Golden Gate and take the 
first turn to the left," replied Stevenson. 
His sensitive and idealistic nature made him far 
from a model patient. Dr. Trudeau said of him 
when he was a patient at Saranac: "His view was 
to ignore or avoid as much as possible unpleasant 
facts, and live in a beautiful, strenuous, and ideal 
world of fancy. He did not care to go to the sana- 
torium with me, or to see the laboratory, because to 
him these were unpleasant things." One day, how- 
ever, Dr. Trudeau got him into the laboratory from 
which he escaped at the first opportunity with the 
words, "Trudeau, your light may be very bright to 
you, but to me it smells of oil like the Devil! " 
He was a native of Scotland; developed tuber- 
culosis at the age of twenty-one; four years later he 
was admitted to the bar, but his literary talents far 
outshone his legal lights, and he finally devoted 
144 DISTINGUISHED "T. B.'S" 
himself entirely to literature and "chasing the cure." 
Success first came with the publication of "Treasure 
Island," in 1882, followed by the masterpieces "Dr. 
Jekyll and Mr. Hyde," "The Master of Ballantrae," 
"Kidnapped," etc. 
Schiller. Johann Christoph Friedrich von 
Schiller (1759-1805) was Germany's greatest dra- 
matic poet, if indeed, not her greatest litterateur 
among a field of formidable competitors. He de- 
sired to become a clergyman, but was "kindly kid- 
napped" by Duke Karl of Wuertemberg for his mili- 
tary academy in 1773. However, in 1775, he be- 
gan the study of medicine, and in 1780 was a regi- 
mental surgeon, but he found both his dress and 
duties galling. In 1781, he published "Die 
Rauber," which was a vigorous protest against ex- 
isting political conditions of which he had been a 
victim. He was thereupon forbidden to publish 
anything except medical treatises. However, his 
literary genius was too great to be stifled by any 
such autocratic and bigoted order, and Germany 
was not deprived of her greatest dramas which he 
later produced, "Wallenstein's Tod" and "Wilhelm 
Tell." They made a deep and enduring impression 
on the German mind. 
Democracy never had a more eloquent champion 
and her principles were never more clearly set forth 
than in his "History of the Revolt of the Nether- 
lands," in which he defends Queen Elizabeth of 
145 TUBERCULOSIS 
England for having taken Holland's part against 
the cruelties and oppression of Spain. Whether the 
tubercle bacilli had anything to do with purging his 
mind of modern Prussian bigotry and cruelty I 
won't say, but surely nothing was ever written that 
strikes the present ex-German Emperor more 
squarely in the face than the following quotations 
from "The Revolt of the Netherlands." 
"Policy and humanity demand that a wrong 
perpetrated against a nation should be taken note 
of on all hands and punished. The interests of 
society at large clearly demand that the funda- 
mental laws of states be not violated with impunity; 
society must not remain passive in face of the de- 
liberate provocation of a blind and outrageous 
tyrant. The common interests of mankind must 
direct the impulses of political bodies: European 
society has no other essential purpose. What? A 
whole nation should look on with indifference when 
the blood of her neighbors is spilt by the absurd 
and barbaric whim of a despot?-all values revert 
back to the original conception of right to claim 
support and generous help for an oppressed people 
-the primeval and holy right of unhappy peoples." 
After the publication of "Wilhelm Tell" in 1804 
Schiller was invited to Berlin and "royally" wel- 
comed. On his return from this trip, he was pros- 
trated by illness and died in 1805-having suffered 
from tuberculosis since 1790. 
146 DISTINGUISHED "T. B.'S" 
Moliere. Moliere (1622-1673) holds the same 
place in French literature that Schiller does in Ger- 
man-the greatest dramatist of France, if not her 
greatest literary genius. Shakespeare should have 
had tuberculosis in order to make it unanimous-he 
is the exception which proves the rule that tuber- 
culosis produces the world's greatest dramatists! 
The physician in the time of Moliere, to quote 
Dr. Garrison, "had become a sterile pedant and 
coxcomb, long-robed, big-wigged, square-bonneted, 
pompous, making a vain parade of his Latin, and 
attempting to overawe his patients by long tirades 
of technical drivel, which only concealed his ignor- 
ance of what he supposed to be their diseases." It 
is not strange then that the great dramatist had no 
use for the medical profession, whose ridiculous 
side drew forth his derision in five comedies aimed 
at the doctors. He seems also to have had a per- 
sonal prejudice against them because they could not 
cure his malady (tuberculosis), and because he 
thought that they had killed his only son with their 
"eternal antimony." 
In "Le Malade Imaginaire" occurs the following 
choice bit of satire on the pompous ceremonies of 
medical graduation (which was accompanied and 
followed by several days of feasting on the part of 
the examiners at the expense of the candidate). 
The first doctor asks the question, "Why does opium 
produce sleep?" To which the candidate replies: 
147 TUBERCULOSIS 
Quia est in eo 
Virtus Dormitiva. 
(Because there is in it a sleep- 
giving quality.) 
which is greeted by the obligato chorus: 
Bene, bene, bene, bene respondere 
'Dignus, dignus est intrare 
In nostra docto cor pore! 
(Well, well, well, well answered, 
worthy he is worthy to enter 
into our learned body!) 
He is then plied with various questions, and his 
answer to each one is greeted by the chorus, "Bene, 
bene, etc" 
Moliere met his death on the stage while he was 
playing the role of the hypochondriac invalid in the 
above comedy. During the play he had a severe 
coughing spell which brought on a profuse haemor- 
rhage from which he died in half an hour. 
Artemus Ward. Charles Farrar Browne (1834- 
1867) gained the pen name of "Artemus Ward" by 
publishing in the Cleveland Plain Dealer the very 
humorous and atrociously spelled "sayings of 
Artemus Ward." In 1860 he moved to New York 
and took a position on the editorial staff of Vanity 
Fair. However, he soon entered upon the lecture 
platform as a humorous lecturer. He developed 
tuberculosis in 1864. In 1866 he undertook a lec- 
ture tour in England against the advice of his phy- 
148 DISTINGUISHED "T. B.'S" 
sicians, and lectured almost to the time of his death 
in 1867. Just before his death his friend Robertson 
tried to get him to take a nauseous draught, and 
when he refused saying that he could not take the 
nasty stuff, Robertson urged him saying, "Come, 
now, you know I would do anything for you," to 
which Ward replied, "Then you take it." 
Colonel Henry Watterson, who saw him fre- 
quently at the time Artemus Ward was lecturing in 
London, says of him: "I find from notes jotted 
down at the time, that the last I saw of him was the 
evening of the 21st of December, 1866. He had 
dined with my wife and myself, and, accompanied 
by Arthur Sketchley, who had dropped in after din- 
ner, he bade good-bye and went for his nightly 
grind, as he called it. . . . He was too feeble to walk 
alone. . . . His surgeon had forbidden the use 
of wine or liquor of any sort. Instead he drank 
quantities of water, eating little, and taking no exer- 
cise at all. Nevertheless, he stuck to his lecture and 
contrived to keep up appearances before the crowds 
that flocked to hear him, and even in London his 
critical state of health was not suspected. 
"His was one of those receptive natures which 
enjoy whatever is bright and sunny. ... He 
poured out the wine of life in limpid stream and was 
possessed of rare individuality. It may be fairly 
said that he did much to give permanency and 
respectability to the style of literature of which he 
149 TUBERCULOSIS 
was at once a brilliant illustrator and illustration." 
Wright. Harold Bell Wright, painter, preacher, 
author, "t. b." is said to be the only novelist who 
ever made a million dollars from his books. "It is 
an ill wind that blows nobody good," and no doubt 
the tubercle bacilli are largely responsible for his 
"windfall'" when they blew him from the pulpit to 
the press. 
Wesley. John Wesley, founder of the Methodist 
Church, and probably the most incessant worker 
that has ever inhabited our globe, is another most 
encouraging example. At the age of fifty he suf- 
fered an acute and severe attack of tuberculosis. 
He said in his diary, "I caught cold and developed 
pain in my left chest, a violent cough, and a slow 
fever." And, he adds, "Dr. Fothergill told me, 'If 
anything does thee good it must be the country air, 
with rest, asses' milk, and riding daily.' " (Ex- 
cellent advice, with the exception of the daily rides, 
according to present knowledge. This was in 1753.) 
His brother Charles, the great hymn writer, visited 
him at this time and wrote, "He is still in imminent 
danger, being far gone, and very suddenly, in a 
consumption." It is evident that Wesley did not 
expect to survive this severe illness, as he wrote his 
own very interesting epitaph, as follows: 
150 DISTINGUISHED "T. B.'S" 
Here lieth the Body 
of 
John Wesley, 
A Brand plucked from the burning; 
Who died of a Consumption in the Fifty-first Year 
of his Age, 
not leaving, after his Debts are paid, 
Ten Pounds behind him: 
Praying, 
God be merciful to me, an unprofitable servant! 
His expectations, however, were not realized. 
He made a good recovery and obtained a perman- 
ent arrestment of his disease, and lived to the ripe 
old age of eighty-eight years. It is estimated that 
during his fifty years of itinerant ministry he trav- 
eled 250,000 miles, preached over 40,000 sermons, 
and wrote more than two hundred books and 
pamphlets. 
Mrs. "A" desires that her name be withheld, but 
her example is eminently worthy of record in this 
chapter, and I give it that others may follow suit. 
"Man's inhumanity to man 
Makes countless thousands mourn." 
But Mrs. "A's" humanity and thoughtful kindness 
during her stay in the New Mexico Cottage Sana- 
torium made many of her fellow patients rejoice. 
She not only contributed many valuable books to 
the library, but carried them around to different 
151 TUBERCULOSIS 
patients who were not able to go for them, and 
thus aroused the interest of many in good litera- 
ture. She sent her victrola with a large selection of 
the best records to various patients to be kept for a 
few days, and only at rare intervals would it get 
back to her cottage, when new records would be 
tried and added to the collection, and then it would 
go out for another round of cheer. She sent flowers 
to the sickest ones, and was a source of comfort and 
encouragement to all. Indeed, more than one pa- 
tient shed tears over her departure-a testimony of 
gratitude beyond the pale of words-because they 
felt her genuine interest in them, and because she 
truly fulfilled the ideal in the lines: 
"Who gives himself with his alms feeds three,- 
Himself, his hungering neighbor and Me." 
If the reader desires further encouragement from 
the lives of distinguished "t. b's," he can find it in 
John Paul Jones, Andrew Jackson, Bichat, Keats, 
Stern, Heine, Thoreau, Spinoza, Raphael, Chopin, 
Bastien le Page, John Sterling, Henry Timrod, Alice 
Freeman Palmer, Anton Lang, Kerensky, Roger 
Babson, and many others who achieved fame and 
usefulness in spite of tuberculosis. 
152 APPENDIX 
WEIGHT ACCORDING TO AGE AND HEIGHT 
MIN 
Inches 62 63 64 65 66 67 68 69 70 71 72 73 74 
Age 
15-19... 116 120 124 128 132 136 140 144 148 153 158 163 168 
20-24... 123 127 131 135 139 142 146 150 154 158 163 168 173 
25-29... 126 130 134 138 142 146 150 154 158 163 169 175 181 
30-34... 129 133 137 141 145 149 154 158 163 168 174 180 186 
35-39... 132 136 140 144 148 152 157 162 167 172 178 184 190 
40-44... 134 138 142 146 150 154 159 164 169 175 181 187 193 
45-49... 116 140 144 148 152 156 161 166 171 177 183 190 196 
50-54... 137 141 145 149 153 157 162 167 172 178 184 191 198 
WOMEN 
Inches 60 61 62 63 64 65 66 67 68 69 70 71 72 
Age 
15-19... 109 113 117 120 123 126 130 134 138 141 145 150 155 
20-24... 112 116 120 123 126 129 133 137 141 145 149 153 158 
25-29... 114 118 122 125 129 132 136 140 144 148 152 155 159 
30-34... 117 121 125 128 132 136 140 144 148 152 155 158 160 
35-39... 121 125 129 132 136 140 144 148 152 156 159 162 165 
40-44... 127 129 133 136 139 143 147 151 155 159 162 166 170 
45-49... 128 132 136 139 142 146 151 155 159 163 166 170 174 
50-54... 130 134 138 141 144 148 152 157 162 166 170 174 178 
VITAMINS 
Vitamins ar a constituents of 
our food that are essential to 
health. 
It is not necessary to buy 
"patent medicine" vitamins 
in tablet form. 
A diet containing all the vita- 
mins necessary can easily be 
selected from our every-day 
foods. 
Three vitamins are known at 
present: A, B, and C. 
A deficiency of "A" in the diet 
may result in symptoms of 
rickets. 
A deficiency of "B" may result 
in loss of appetite and symp- 
toms of the disease beriberi. 
A deficiency in "C" may result 
in symptoms of scurvy. 
A deficiency of any of the vita- 
mins in the diet of children 
will result in impaired 
growth. 
-Ed. Poster by Am. Med. Assoe. 
153 APPENDIX 
VITAMINS IN FOODS 
Bread- ABC 
White (Water)... ? * t 
White (Milk) * * ? 
W. Wheat (Water) * ** ? 
W. Wheat (Milk). ** ** ? 
Barley (Whole) .... * ** j 
Corn, Yellow * ** t 
Oats * ** t 
Beef Fat * t t 
Mutton Fat * t t 
Pig Kidney Fat** t t 
Oleomargarine * J t 
Liver ** ** * 
Kidney ** ** *? 
Brains * ** *? 
Sweetbreads * ** * ? 
Fish, Lean J * § 
Fish, Fat * * § 
Fish, Roe * ** *? 
Milk, Fresh t***fl 
Milk, Condensed ... f ** *fl 
Milk, Dried (Whole) t ** *fl 
Milk, Skimmed * ** *fl 
Buttermilk * ** *fl 
Cream t ** *fl 
Cheese ** § § 
Cottage Cheese * § § 
Eggs ** * *? 
Almonds * * j 
Cocoanut * ** t 
Hickory Nuts § ** T 
Peanuts * ** j 
Pecans § * t 
Walnuts § ** t 
Tomatoes (Raw or 
Canned) ** t t 
ABC 
Beans, Kidney .... § t § 
Beans, Navy § t t 
Beans, String (Fresh) ** ** ** 
Cabbage, Fresh, Raw * t *? 
Cabbage, Cooked ... * ** *? 
Carrots, Fresh Raw.. ** ** ** 
Carrots, Cooked ....** * * 
Cauliflower * ** * 
Celery § * § 
Cucumber § * § 
Dandelion Greens ...**** * 
Eggplant, Dried .... § ** § 
Lettuce ** ** t 
Onions § ** ** 
Parsnip t? ** § 
Peas ** ** *? 
Potatoes (15 min.).. § ** *? 
Potatoes (1 hr.)§ ** *? 
Potatoes (Baked) ... § ** * 
Sweet Potatoes ....** * § 
Radish § * § 
Rutabaga t ? ** t ? 
Spinach, Fresh + t § 
Spinach, Dried t ** § 
Squash, Hubbard ... ** § § 
Turnips t? ** § 
Apples * * * 
Bananas *? *? * 
Grape Juice § * * 
Grapefruit § ** ** 
Lemon Juice § ** + 
Orange Juice * ** t 
Prunes § * t 
Raspberries (Fresh or 
Canned) § § f 
** Good source of the Vitamin. 
* Contains the Vitamin. 
t No appreciable amount of the Vitamin. 
t Excellent source of the Vitamin. 
? Doubt as to presence or relative amount. 
§ Evidence lacking or insufficient. 
fl Variable. 
-Ed. Poster by Amer. Med. Assoe. 
154 APPENDIX 
COMMON FOODS CLASSIFIED* 
Poor in 
Fat 
Rich in 
Fat 
Very Rich in. 
Fat 
Very high in 
Protein 
White of Eggs 
Cod Fish 
Lean Beef 
Chicken 
Veal 
High in 
Proteir 
Shell-fish 
Skim Milk 
Lentils 
Peas 
Beans 
Most Fish 
Most Meats 
Most Fowl 
Whole Egg 
Cheese 
Moderate or 
Deficient in 
Protein 
Most 
V egetables 
Bread 
Potatoes 
Fruits 
Sugar 
Peanuts 
Milk 
Cream Soups 
Most Pies 
Doughnuts 
Fat Meats 
Yolk of Eggs 
Most Nuts 
Cream 
Butter 
* This table and the following tables on food values are from 
"How to Live," by Drs. Fisher and Fisk, 15th edition, published 
by Funk and Wagnalls. 
155 APPENDIX 
TABLE OF FOOD VALUES** 
Per cent of 
NAME OF FOOD 
o 
<D 
. co 
3 
.s 
Vegetables 
>uo 
o 
£ 
w 
Artichokes, as purchased, average, 
canned 
15. 
14 
0 
86 
'Asparagus, as purchased, average, 
canned 
19. 
33 
5 
62 
'Asparagus, as purchased, average. 
cooked 
7.19 
18 
63 
19 
'Beans, baked, canned 
2.66 
21 
18 
61 
'Beans, Lima, canned 
4.44 
21 
4 
75 
'Beans, string, cooked 
16.66 
15 
48 
37 
'Beets, edible portion, cooked 
8.7 
2 
23 
75 
'Cabbage, edible portion 
17. 
20 
8 
72 
Carrots, edible portion, average, fresh 
7.6 
10 
8 
82 
Carrots, cooked 
5.81 
11. 
10 
34 
56 
'Cauliflower, as purchased, average... 
23 
15 
62 
'Celery, edible portion, average 
19. 
24 
5 
71 
Corn, sweet, cooked 
3.5 
13 
10 
77 
'Cucumbers, edible portion, average... 
20. 
18 
10 
72 
'Egg plant, edible portion, average.... 
Lentils, cooked 
12. 
3.15 
17 
27 
10 
1 
73 
72 
'Lettuce, edible portion, average 
18. 
25 
14 
61 
'Mushrooms, as purchased, average.... 
7.6 
7.1 
31 
8 
61 
'Onions, fresh, edible portion, average 
13 
5 
82 
'Onions, cooked 
8.4 
12 
40 
48 
'Pasnips, edible portion, average 
5.3 
5.74 
6.3 
10 
7 
83 
56 
Parsnips, cooked 
10 
34 
'Peas, green, canned 
25 
3 
72 
'Peas, green, cooked 
3. 
23 
27 
50 
Potatoes, baked 
3.05 
11 
1 
88 
'Potatoes, boiled 
3.62 
11 
1 
88 
'Potatoes, mashed (creamed) 
3.14 
10 
25 
65 
'Potatoes, steamed 
3.57 
11 
1 
88 
'Potatoes, chips 
.6 
4 
63 
33 
'Potatoes, sweet, cooked 
1.7 
6 
9 
85 
'Pumpkins, edible portion, average . . 
13. 
15 
4 
81 
Radishes, as purchased 
Rhubarb, edible portion, average .... 
17. 
18 
3 
79 
15. 
10 
27 
63 
'Spinach, cooked, as purchased 
6.1 
15 
66 
19 
'Squash, edible portion, average 
7.4 
12 
10 
78 
•Succotash, canned, as purchased, average .. 
3.5 
15 
9 
76 
•Tomatoes, fresh, as purchased, average 
15. 
15 
16 
69 
'Tomatoes, canned 
15.2 
21 
7 
72 
'Turnips, edible portion, average 
8.7 
13 
4 
83 
Vegetable oysters 
9.62 
10 
51 
39 
'Apples, as purchased 
7.3 
3 
7 
<90 
Apples, baked 
3.3 
2 
5 
93 
Apples, sauce 
3.9 
2 
5 
93 
'Apricots, edible portion, average.... 
5.92 
8 
0 
92 
Apricots, cooked 
4.61 
6 
0 
94 
*Bananas, yellow, edible portion, average... 
3.5 
5 
5 
90 
•Blackberries, as purchased, average .. 
5.9 
9 
16 
75 
156 APPENDIX 
TABLE OF FOOD VALUES-Continued 
Blueberries 
4.6 
5.8 
3 
4 
8 
89 
87 
"Blueberries, canned, as purchased 
9 
Cantaloupe 
8.6 
6 
0 
94 
"Cherries, edible portion, average 
4.4 
5 
10 
85 
85 
80 
"Cranberries, as purchased, average 
"Grapes, as purchased, average 
7.5 
4.8 
3 
5 
12 
15 
Grapefruit 
7.57 
7 
4 
89 
Grape juice 
4.2 
9.2 
7.57 
8.77 
o 
o 
100 
<95 
77 
Gooseberries 
5 
6 
"Lemons 
9 
1 i 
Lemon juice 
0 
0 
100 
Nectarines 
5.18 
4 
0 
96 
Olives, ripe 
1.31 
2 
91 
7 
"Oranges, as purchased, average 
9.4 
6 
3 
91 
Oranges, juice 
6.62 
0 
0 
100 
"Peaches, as purchased, average 
10. 
7 
2 
91 
Peaches, sauce 
4.78 
4.80 
4 
9 
94 
Peaches, juice 
0 
0 
100 
"Pears 
5.40 
3.98 
8. 
4 
7 
89 
93 
Pears, sauce 
3 
4 
"Pineapples, edible portion, average 
4 
6 
90 
Raspberries, black 
5.18 
6.29 
10 
14 
Z6 
Raspberries, red 
8 
0 
92 
"Strawberries, as purchased, average 
9.1 
10 
15 
75 
"Watermelon, as purchased, average 
27. 
6 
6 
88 
Fruits (Dried) 
"Apples, as purchased, average 
1.2 
3 
7 
90 
Apricots, as purchased, average 
1.24 
7 
3 
90 
"Dates, edible portion, average 
.99 
2 
7 
91 
"Dates, as purchased 
"Figs, edible portion, average 
1.1 
2 
7 
91 
1.1 
5 
0 
95 
"Prunes, edible portion, average 
1.14 
3 
0 
97 
"Prunes, as purchased 
"Raisins, edible portion, average 
1.35 
3 
0 
97 
1. 
3 
9 
88 
"Raisins, as purchased 
1.1 
3 
9 
88 
Cooked Meats 
tBeef, round, boiled (fat), 1099t 
1.3 
40 
60 
00 
tBeef, round, boiled (lean), 1206t 
2.2 
90 
10 
00 
tBeef, round, boiled (med.), 1188t 
1.6 
60 
40 
00 
tBeef, 5th right rib, roasted, 1538t 
.65 
12 
88 
00 
tBeef, Sth right rib, roasted, 1616t 
1.2 
25 
75 
00 
tBeef, 5th right rib, roasted, 1615J 
.88 
18 
82 
00 
tBeef, ribs, boiled, 1169t 
1.1 
27 
73 
00 
tBeef, ribs, boiled, 1170J 
.87 
21 
7(9 
00 
"Calves foot jelly, as purchased 
"Chicken, as purchased, canned 
"Lamb chops, boiled, edible portion, average. 
4. 
.96 
19 
23 
00 
77 
81 
00 
.96 
24 
76 
00 
"Lamb, leg, roast 
1.8 
40 
60 
00 
tMutton, leg, boiled, 11841 
tPork, ham, boiled (fat), 11741 
tPork, ham, boiled, 11921 
1.2 
35 
65 
00 
.73 
14 
86 
00 
1.1 
28 
72 
00 
tPork, ham, roasted (fat), 14841 
.96 
19 
81 
00 
tPork, ham, roasted (lean), 15111 
1.2 
33 
67 
00 
"Turkey, as purchased, canned 
tVeal, leg, boiled, 11821 
.99 
23 
77 
00 
2.4 
73 
27 
00 
157 APPENDIX 
TABLE OF FOOD VALUES-Continued 
Cakes, Pastry, Pudding and Desserts 
*Cake, chocolate layer, as purchased 
.98 
7 
22 
71 
*Cake, gingerbread, as purchased 
.96 
6 
23 
71 
*Cake, sponge, as purchased 
.89 
7 
25 
68 
Custard, caramel 
2.51 
19 
10 
71 
Custard, milk 
4.29 
26 
56 
18 
Custard, tapioca 
2.45 
9 
12 
79 
'Doughnuts, as purchased 
.8 
6 
45 
49 
*Lady fingers, as purchased 
.95 
10 
12 
78 
'Macaroons, as purchased 
.82 
6 
33 
61 
Pie, apple, as purchased 
1.3 
5 
32 
63 
'Pie, cream, as purchased 
1.1 
5 
32 
63 
'Pie, custard, as purchased 
1.9 
9 
32 
59 
'Pie, lemon, as purchased 
1.35 
6 
36 
58 
'Pie, mince, as purchased 
1.2 
8 
38 
54 
'Pie, squash, as purchased 
1.9 
10 
42 
48 
3.02 
6 
3 
91 
Pudding, brown betty 
2. 
7 
12 
81 
2.65 
8 
13 
79 
Pudding, Indian meal 
2. 
12 
25 
63 
Pudding, apple tapioca 
2.8 
1 
1 
98 
Tapioca, cooked 
3.85 
1 
1 
98 
Cereals 
'Bread, brown, as purchased, average... 
1.5 
9 
7 
84 
'Bread, corn (johnnycake), as purchased, avg. 
1.3 
12 
16 
72 
*Bread, white, home made, as purchased. 
1.3 
13 
6 
81 
Corn flakes, toasted 
.97 
11 
1 
88 
'Corn meal, granular, average 
.96 
10 
5 
85 
*Corn meal, unbolted, edible portion, average 
.92 
9 
11 
80 
'Crackers, graham, as purchased 
.82 
9 
20 
71 
'Crackers, oatmeal, as purchased 
.81 
11 
24 
65 
'Hominy, cooked 
4.2 
11 
2 
87 
.96 
15 
2 
83 
'Macaroni, average, cooked 
3.85 
14 
15 
71 
'Oatmeal, average, boiled 
5.6 
18 
7 
75 
'Popcorn, average 
.86 
11 
11 
78 
'Rice, uncooked 
.98 
9 
1 
90 
*Rice boiled average 
3.1 
10 
1 
89 
'Rice, flakes 
.94 
8 
1 
91 
'Rolls, Vienna, as purchased, average.. 
1.2 
12 
7 
81 
'Shredded wheat 
.94 
13 
4.5 82.5 
'Spaghetti, average 
.97 
12 
1 
87 
* Wheat flour, entire wheat, average. . .. 
.96 
15 
5 
80 
'Wheat flour, graham, average 
.96 
15 
5 
80 
*Wheat flour, patent roller process, family 
and straight grade spring wheat average 
.97 
12 
3 
85 
'Zwieback 
.81 
9 
21 
70 
'Butter, as purchased 
.44 
.5 
99. 
5 ( 
)0 
'Buttermilk, as purchased 
9.7 
34 
12 
t 
54 
'Cheese, American, pale, as purchased 
.77 
25 
73 
2 
'Cheese, cottage, as purchased 
3.12 
76 
8 
16 
'Cheese, full cream, as purchased... 
.82 
25 
73 
2 
'Cheese, Neufchatel, as purchased... 
1.05 
22 
76 
2 
'Cheese, Swiss, as purchased 
.8 
25 
74 
1 
158 APPENDIX 
TABLE OF FOOD VALUES-Continued 
Dairy Products 
*Cheese, pineapple, as purchased.... 
.72 
25 
73 
2 
*Cream 
1.7 
5 
86 
9 
'Kumyss 
6.7 
21 
37 
42 
*Milk, condensed, sweetened, as pur- 
chased 
1.06 
10 
23 
67 
*Milk, condensed, unsweetened (evap. 
cream), as purchased 
2.05 
24 
50 
26 
*Milk, skimmed, as purchased 
9.4 
37 
7 
56 
*Milk, whole, as purchased 
4.9 
19 
52 
29 
'Whey, as purchased 
13. 
15 
10 
75 
Sweets and Pickles 
'Catsup, tomato, as purchased, average 
6. 
10 
3 
87 
'Honey, as purchased 
1.05 
1 
0 
99 
'Marmalade (orange peel) 
1 
5 2. 
5 97 
'Molasses, cane 
1 2 
'Olives, green, edible portion 
1.1 
1' 
84 
15 
'Olives, ripe, edible portion 
1.3 
2 
91 
7 
'Pickles, mixed, as purchased 
14.6 
18 
15 
67 
'Sugar, granulated 
.86 
0 
0 
100 
'Sugar, maple 
1.03 
0 
0 
100 
'Syrup, maple 
1.2 
0 
0 
100 
Nuts 
'Almonds, edible portion, average.. . 
.53 
13 
77 
10 
'Beechnuts 
S2 
13 
'Brazil nuts, edible portion 
.49 
10 
86 
4 
'Butternuts 
16 
'Cocoanuts 
' 37 
'Chestnuts, fresh, edible portion avg.. . 
1.4 
10 
20 
70 
'Filberts, edible portion, average... 
.48 
9 
84 
7 
'Hickory nuts 
.47 
9 
85 
6 
'Peanuts, edible portion, average 
.62 
20 
63 
17 
'Pecans, polished, edible portion 
.46 
6 
87 
7 
'Pine nuts (pignohas), edible portion 
.56 
22 
74 
4 
'Walnuts, California, edible portion.. 
.48 
10 
83 
7 
Miscellaneous 
'Eggs, hen's, boiled 
2.1 
32 
68 
00 
'Eggs, hen's, whites 
6.4 
100 
0 
00 
'Eggs, hen's, yolks 
.94 
17 
83 
00 
'Omelet 
3 3 
34 
60 
'Soup, beef, as purchased, average. . . . 
13 
69 
14 
17 
'Soup, bean, as purchased, average. .. . 
5.4 
20 
20 
60 
'Soup, cream of celery, as purchased, 
average 
6 3 
16 
47 
'Consomme, as purchased 
29 
85 
00 
15 
*Clam chowder, as purchased 
8.25 
17 
18 
65 
_ '* Abstracted from A Graphic Method of 
Irving risher, Journal of A.M.A., Vol. xlviii. or 
>. 1316-1324. 
' Chemical Composition of American 
Food Materials. 
and Bryant. U. S. Department of 
Agriculture 
28, office of Experiment Stations. 
_.t Experiments on Losses in Cooking Meats (1900-03). Grindlev. 
U. b. Department of Agriculture Bulletin 
No. 
141, 
Experiment Stations. 
t Laboratory number of specimens, 
Losses in Cooking Meat. 
as per Experiments on 
159 BOOKS FOR TUBERCULOSIS PATIENTS 
Brown, Lawrason, M.D. 
Rules for Recovery from Pulmonary Tuberculosis. Lea & 
Febiger, 1923, 217 pp. $1.50 
This little book now in the 4th edition has been written to 
help pdtients avoid blunders which are easily made. 
Cabot, R. C. 
What Men Live By. Houghton Mifflin, 1924, 341 pp. $2.50. 
Work, play, love, and religion are the dominant forces in 
man's life. Dr. Cabot analyzes these forces and shows their 
influences in one's life. 
Fisher, Irving, and Fisk, Eugene Lyman 
How to Live. Funk & Wagnails Co., 1919, 461 pp. $1.50. 
The title is a good index of the contents-rules for health 
living based on modern science. Air, food, clothing, poisons, 
alcohol, tobacco, hygiene, work, play, rest and every phase 
of life are considered. 
French, Roy L. 
Home Care of Consumptives. G. P. Putnam's Sons, 1916, 224 
pp. $1.50. 
This book was written by a social worker from personal 
experience with tuberculosis. Designed especially for patients 
and their families. 
Galbreath, T. C. 
T. B. Playing the Lone Game Consumption. Journal of the 
Outdoor Life, 1918, 74 pp. Paper, $.25; Cloth, $.50. 
In this autobiography the author tells how he won his fight 
and shows how any tuberculosis patient may profit by his 
methods. It is a human, soul-stirring and inspiring story, 
one to encourage a faint-hearted patient. 
Hawes, John B., 2nd, M.D. 
Consumption, What It Is and What To Do About It. Small, 
Maynard Co., 1915. 107 pp. $1.25. 
A popular book on tuberculosis by a recognized authority 
who treats of the nature of the disease, home and institu- 
tional treatment, marriage and consumption, tuberculosis in 
childhood, and a host of other topics laymen should know 
about. 
King, D. MacDougall, M.D., M.B. 
The Battle with Tuberculosis and How to Win It. J. B. 
Lippincott Co., 1917, 258 pp. $2.50. 
Employing the analogy of the tubercle bacillus as an attack- 
ing enemy and the patient as defender, the author conveys a 
vast amount of information about home and sanatorium care 
in very readable form. 
160 APPENDIX 
Minor, Charles L., M.D. 
Hints and Helps for Tuberculosis Patients. National Tubercu- 
losis Association, 1921, 16 pp. $.10. 
In compact form this invaluable little pamphlet gives the 
most practical and necessary information for patients or those 
who are caring for them. 
Nostrums and Quackery. American Medical Association, 535 
N. Dearborn St., Chicago, Ill., 1921. $2.00. 
Complete exposure of patent medicines, quack, "consumption 
cures," etc. 
POTTENGER, F.M., M.D. 
Tuberculosis and How to Combat It. C. V. Mosby Co., 1921. 
273 pp. $2.00. 
The book is the result of the author's experience and talks 
with his patients during a good many years. 
Sleeping and Sitting in the Open Air. National Tuberculosis 
Association, 370 Seventh Avenue, New York City, 1917, revised 
1922, 16 pp. Single copies, $.10. 
Simple directions for making the patient comfortable while 
he is taking the cure. 
Tuberculosis Directory 
Published by the National Tuberculosis Association, 1923, 126 
pp. $1.00. 
The Tuberculosis Directory lists approximately 700 tubercu- 
losis hospitals and sanatoria in the United States. Informa- 
tion is given under each institution regarding date of open- 
ing, rates, class of cases admitted, names of superintendents 
and medical directors and methods of application. 
Trudeau, Edward L., M.D. 
An Autobiography. Doubleday. Page Co., 1915, 322 pp. $4.00. 
Dr. Trudeau wove into this book in simple, direct and 
fascinating style all of the essential incidents and experiences 
of his life. It is at once a history of and an inspiration to 
great achievement. 
Webb, Gerald B., M.D., and Ryder, Charles T., M.D. 
Recovery Record for Use in Tuberculosis. Paul B. Hoeber, 
Inc., 1923. 191 pp. $2.00. 
The volume contains about 100 pages of splendid descriptive 
text, and in addition daily charts sufficient for two years for 
recording such features as temperature, pulse and general 
condition. 
What You Should Know About Tuberculosis 
National Tuberculosis Association, 370 Seventh Avenue, New 
York City, revised 1922, 30 pp. Single copies, $.10. 
A pamphlet prepared by a committee of tuberculosis spe- 
cialists and containing useful facts for the tuberculous and 
those living with them. 
161 APPENDIX 
Williams, Helena Lorenz 
The Comeback of Christy Mathewson. Reprinted by permission 
from the Survey Graphic, Dec., 1923, by the National Tuber- 
culosis Association, 370 Seventh Avenue, New York City, 1924, 
16 pp. Single copies, $.10. 
The story of how the famous ball player is taking the cure. 
Williams, Linsly R., M.D. 
Tuberculosis-Nature, Treatment and Prevention (National 
Health Series). Funk & IV agnails Co., 1924. 79 pp. $ .30. 
This is a comprehensive treatise on the subject suitable for 
tuberculosis patients and others who wish to know more 
about tuberculosis. The author is the Managing Director of 
the National Tuberculosis Association. 
Wittich, F. W., M.D. 
Information for the Tuberculous. C. V. Mosby Co., 1918. 
150 #>. $1.50. 
The author, a successful physician as well as a patient, has 
written this book primarily for laymen. It deals with the 
perplexing problems of rest, exercise, food, temperature, 
pulse, drugs, etc., that come in the routine treatment. 
Journal of the Outdoor Life 
National Tuberculosis Association, 370 Seventh Avenue, New 
York City. 
A monthly journal devoted to the interests of tuberculous 
patients. $2.00 per year. 
162