to offer a suggestion to Dr. Chapin who read the excellent paper on the care of children in their homes, and that is that he should incorporate in his paper some reference to the use of the nursing bottle, which, in my opinion, can be used to strengthen his argument. It has been found in Buffalo by abolishing the long tube nursing bottle and insisting that the nursing bottle shall be clean, that it has had the most remarkable effect upon the death rate of babies.

Dr. Pryor then presented the report of the Committee on Sanatoria for Consumptives.

REPORT OF THE COMMITTEE ON SANATORIA FOR

CONSUMPTIVES.

There are many reasons why the report of your committee should consist of a presentation of important facts and an appeal for interest and support of somewhat new projects. During the last few years the subject of tuberculosis has been much discussed and no question of a social, economic, medical and charitable nature is of such vital importance to-day, as the problem of the prevention and care of the victims of this disease.

The poor sufferers from so-called consumption, after years of appalling neglect, have aroused the pity of humanity and stimulated a desire to attack a cruel wrong, which ignorance and apathy have allowed to oppress a vast army of dependents. In the course of time this meeting of the State Conference of Charities and Correction may become historic, as marking a distinct epoch in the extension of its aim and work. At last, the saddest thing in the world has become the subject for serious consideration at a meeting devoted to the discussion of enlightened methods for the suppression and relief of suffering and distress.

When this body reached the decision last year, that the consumptive and his woe should be recognized as affording a new field for scientific and humane investigation, a grand stride in

progress was made and the announcement brought a feeling of deep gratitude from those who have struggled and fought in the long crusade against the greatest scourge of humanity.

About eighteen years ago, Koch discovered the bacillus and the cause of tuberculosis. The facts that the disease was infectious and communicable were established. Prevention promised to be successful by simple measures, and the belief and hope that the disease could be eradicated were accepted by the progressive element of the medical profession with great enthusiasm. Sufficient time has elapsed to examine the results of a prolonged attempt to diminish the prevalency of the disease. Undoubtedly the death rate in proportion to the population has declined. In some localities, a decrease of 30 per cent. is claimed. Many times this decrease is ascribed to special efforts aimed at tuberculosis, and it is offered as proof of their successful employment.

There seems to be a tendency to forget that during the last decade civilized countries have felt the results of the greatest wave of sanitary reform known in history. The general death rate declined in a marvelous way. By comparing the figures for 1880 and 1890, it will be found that many European and American cities lowered their death rate from 30 per cent to 50 per cent. In some American cities the death rate has decreased from 22 per cent to 30 per cent in the last five years. The death rate from pulmonary tuberculosis shared in that decrease, which was due to improvements in sanitation and hygiene, particularly among the poor. A scrutiny of the mortality returns in this State reveals the fact that the principal decrease has occurred in New York city, chiefly among the female population. This was largely due to the work of Biggs and others, in checking the spread of the disease in the tenement-house district. The best examples of brilliant results attained by direct and special methods, are those reported by Biggs, and the disgraceful conditions of overcrowding, lack

of sunlight and fresh air, which prevail in these compulsory homes of the poor, afford the chief opportunity for attack and triumph.

The tenement becomes infected and herding together encourages the spread of the germs of disease, while vicious surroundings and insufficient or improper food promotes susceptibility and a tendency to succumb. To-day the chief penalty of tenementhouse life is tuberculosis. Most of the poor dwellers show evidence of tuberculosis during life, or at the autopsy. Segregation, destruction of expectoration and disinfection of contaminated homes, will eliminate the foci of disease so strikingly depicted by Flick of Philadelphia and Biggs of New York. This work can be done by a Board of Health not poisoned by political taint.

The new tenement-house laws, if made operative, and if clean machinery be supplied to enforce them, will have a decided and lasting effect upon the principal cause of illness and destitution.

While prevention along general and special lines has diminished the number of deaths, in proportion to the population in this State, caution must be exercised before accepting frequently repeated fallacious statements. To say that the efforts to eradi-. cate tuberculosis have fulfilled expectations and will win in time, is to approach dangerously near exaggeration and a careless promise. The present campaign in this State lacks system, uniformity and thoroughness. Protection is at best partial, or very inadequate. At present the State Board of Health is attempting to make a census of the consumptives with a view to considering what may be done in the way of prevention and care.

The prediction is fair that no more than an approximate estimate can be obtained. Each physician is requested, not compelled to report the number of cases under his care. Compliance is optional and should the advanced easily recognized cases be reported, a large unknown number of incipient cases will escape.

By collecting the reports of many hospitals, it is found that about 25 per cent of autopsies reveal evidences of healed tuberculosis. These cases, with few exceptions, are unsuspected. Again, there is a decided and growing tendency to conceal the affliction of tuberculosis, for reasons given later. We already possess a method of estimating the number of consumptives in this State - by computing the average duration of the disease from the figures supplied in death certificates.

Each year more than 14,000 human beings perish from tuberculosis of the lungs alone in New York State. Assuming that the average period of misery is only two or three years, and there must be 28,000 or 42,000 victims. The latter figure is probably more correct, because those best informed claim at least 25,000 consumptives, for New York city. But what earthly or heavenly difference will it make in discussing plans for attack or care, whether we have a few thousand, more or less, in this pitiful army marching to the grave. No mysterious ingenious remedy has been discovered which will apply to a mere 25,000 and prove impracticable for twice the number.

For years the purpose has been to educate the public, and create sentiment before remedial action can be taken. Now, what has been the result of education? An awakened interest and readiness to welcome rational procedures, which are not supplied. The public has been taught certain facts with great benefit, and some fallacies which are misleading and cruel. The cry has been tuberculosis is infectious and dangerously communicable. It is unnecessary and easily preventable. Note the words "dangerously communicable," and try to measure their meaning. Are we to understand that it is highly communicable from one person to another, or only slightly so? Why not admit that it is infectious and scarcely at all communicable, if simple precautions are adopted? The danger of contracting the disease from the

poor creature, who suffers through no fault or crime, has been exaggerated until we have an epidemic of hysteria or phthisiophobia. The unfortunate has had new torture added to his misery. He has been denied admission to hospitals, discharged from employment, and even lost the pleasures of friendship on his sick-bed. If it be true that prevention is easy, why add more hardships? There is no place where a person can enjoy greater immunity from tuberculosis than in a hospital or sanatorium, devoted to the treatment of consumptives. The rule is that no servant, attendant, nurse or physician, develops the disease. The time has arrived for the physician and the laity to modify certain extravagant views, and learn to be kind and reasonable, not ultra-scientific and harsh. In this country, a quarantine has been established against tuberculosis as a dangerously communicable disease. For some years the advanced consumptive has been denied admission as an undesirable citizen but the early cases will not be observed and checked, and a precedent has been established. If the threat of some western States to follow this example should be fulfilled, a new phase of an appalling problem must be confronted. It is right that far-away States should resent the unloading of the hopeless, poor consumptive upon them, and one good result of recent protests will be the enforced provision of rational treatment near the home. This means an undertaking of such magnitude that the alleged facts, "the disease is unnecessary and easily preventable," are offered in support of a policy of gradual eradication. There can be nothing gained by hugging a delusion, that fewer people die from pulmonary tuberculosis now than formerly. Remember, that a smaller percentage of the population succumb, but the population has increased and continues to increase rapidly. The actual number of deaths grows slowly each year, and we have reached, and will probably soon pass, the mark of 14,000 per annum. Furthermore,

an act most proper and justifiable—