Ligonier Banner., Volume 39, Number 10, Ligonier, Noble County, 2 June 1904 — Page 6

The Annual /4 - 'Economic Los ( e 4 OSS to Illmojs From. 3 ° v ‘Tuberculosis eoo L -HOMER M. THOMAS, A. M., M.D., CHICAGO - .- It .is evident that our consideration of this topic must be maére or less conjectural. From the very nature of this subjecf. any conclusion reached must be mor¢ theoretic than demonstrable. Scientific accuracy of statement is not possible. It, therefore, follows that conclusions reached in this paper are not susceptible of scientific demonstration, but must rest for their acceptance upon the -effort’ that has bedn made to avoid any extravagant conclusions. Eyery step made in the compilation which is to follow= has been most carefully considered, both from the standpoint of practical, as well as theoretic, data; and -is therefore. presented in the belief that the Totals reached are in every way conservative, and even much below the actual economic loss sustainéd to lilinois from taberculosis. ; -

‘i Through the untiring efforts of 'statistical experts employei‘i fby the state board of health, it is possible to present for the first time, scientifically accurate data as to the total number of deaths from pulmonary tuberculosis in Iliinois for the years 1992-1903. These totals are as follows: For 1902, the number of deaths from all forms of tuberculosis in Illinois was 6,895. The total number of deaths from pulmonary tlberculosis ‘in. Illinois for "1902 were | 6,011. The total numbey; of deaths-from all forms of tuberculgsis in Illinois for the year 1903 was :4'026 The total number of deaths from pulmonary tuberculosis in 1903 was 6,066. Again, the tote#y number of, deaths from pulmonary tuberculosis in Illinois for the vear 1902 was 884, The total number_of deaths from oOther forms of tuberculosis in Illinois for the year 1903 was 960 : . The mertality from pulmonary tuberculosis by the month fop the year | 1902-1903, is as follows: o Jan. Feb. Mar. Apr. Mav. Jin. 1902, ... G 619 6T6 L B 638 EOE T RSS 1903 .........642 626 696 641 . GM EOT : July. Aug. Sept. Oct. Nov. Dec. 1902 Som A h 42 822 523 497 499 1303 .........558° 5629 . BU& 564 507 551 Computed from the death certificates asqissued for the year 1903, the average duration of illness was 1 year. 5 months, 20 days.. The average age of all thoze dying from pulmonary tuberculogis was 34 years, 10 months, 28 days. 1t isalso of interest to note the number of ‘deaths which occur at the stated ‘age-periods: | * - | 22 Fmo. tolve 1-5 5-10 10-15 1992 .. s e 210 111 143 1808 e 19D 234 107 149 £ 15-20 . 20-30 30-40 ° 40-50 1902 . o.iiiils ap49e GEEEE . aes 967 1803 oo bt RSy T saT . 1010 : ! : Age g Oveér Not : 50-60 GO-70 TO-80 80-90 ' 90 stated . 1902 ,:-....566 . 4929 1% & og & - 40 1903 .0, 845 - 330 DO3O B 9 6 20 THE DEATHS DUE TO TUBERCELOSIS: (ALL FORMS). : K 902 . 1902. Males .ol oo b L aag) 3,660 Females .. 4.0 0 B - 3,366 PERCENTAGE OF TOTAL MORTALITY : DUE TO TUBERCULOSIS, 1902 Loiisigniiadii sl B Do cent 1903 .. il aiiGn il e R per cent. Let us now attempt to estimate the average cost of living as a basis for computation of'the expense of raising’ a child up to 15 years of age» As to: the cost of living, the Daily News Almanac for 1304, on page 348. being a tabulation from’ the November (1903) bulletin of labor, shows the average cost of food in a family of five persons. This, of course. varies with the relative cost of various supplies of different vears, as well as in different sections of the country. It is not .far from $340 per annum. I find the tab--ulation taken from volume 2, report of the United States commissioner of labor. (Carroll D. Wright), page 1986-1992, showing that in Massachusetts, in a famiiy of two, with three children, the total expenditures are divided as follows: S : - Food ...l aaisi st db net cont. Clothing, rent, fuel, lighting..... 36 per cent. *Other purposes......a.iii o 0 218 ber eent. ' Using these proportions with an es“timate from the other table, a family of five persons would expend: 3 "For f003:...................46 per cent. or $340 For clothing, ete..........36 per cént. or 246 For otiver purp05e5........18 per cent. or 132 Being a'tofal afi.cidi il . - eyap This would give an average of $147 annually for each member of the family. In order to be very conservative in our estimate, I figure that it will cost at least twg dollars a week to raise a child untiliit reaches the age of 15 “years.. 3€ased upon this estimate, it would cost $1,500 to rear a child up to 15 years of age. Assuming that up to 20 years of age no loss is involved, be_yond the cost of bringing up those who have died at the rate of $lOO a year for the first 15 years of life, the deaths at those ages repreSent a loss of about‘ $1,187.800. -+ Assuming that for- those living and diseased Between the ages’ of 20 and 60, about 200,000, the impaired condition represents a loss of earning an@saving capacity averaging $l5O for the current year, the total loss “aggregating $30,000,000. Assuming that for those dying befween the ages of 20 and w 0 the/loss of future savings may be estimated as equivalent to a present- value of $l,OOO for each person, those deaths, 5,139, represent a loss of $5,139,000. Assuming thatin those above the ages of 60, or not classified, - no pecuniary loss is invelved heyond ‘ the extra expense of caring for them -in sickness, estimated at about $5O per anhum, about 4500 cases living, we have an extra expense of $225,000. Ifthe different assumptions' are. not ex~travagant, and it does not appear possible for them to be so, they indicate a ‘total annual waste by reason of tuberculosis of $36,551,000. hrad - With the recent arnual death rate in Illinois from tuberculosis of 7.026 deaths, they would probably represent a total of over 300,000 living sufferers from the diseas® at the present time. This may seémfii first sight a liberal estimate, but in determining these ‘there should bé considered the fact referred to. in a later porticn of this _paper, that 60 per cent. of the living “people are or have been infected with _consumption; that the period intended to be covered by this hypothesis-is the entire duration of the disease from the original infection, or from the first evi-

dences of predisposition: whereas, the average duration of; the disease, as shown in the statisfics of those who have died, probably ‘covers, in most cases, only the period of the final and fatal attack; adso, in view ’6’(! the proportion of deaths, this seems’a reasonable estimate. Estimating 300,000 consumptives in the state at the present time is on the basis of omnly six per cent. of the entire population of the state of 5,000,000 people. Counting all whose efficiency is in any degree impaired by the infection of this disease, and even allowing for the most conservative reduction of this estimate, the total annual waste still remains at an enormaous figure. From some recent estimates, I assume that men employed in ordinary occupations involving no unusual strain or hazard, tending to shorten their lives, begin effective service at the age of 20, and retire at about 60. or 70, .say, omw ap average, 63, completing an effective service at about 45 Years. | L

Assuming that such a man is earning $5OO a year, on which one-half is necessary personal expenses, the balance. $250 per annum, accruing to his family; in cage of his death. his family would log\is income ‘of $250, which, treated 28 an annuity ‘ppon_ his life, capitalized at three and one-half per cent. at the date of his death, would represent a loss: !

Should he die at the age iof 20 of $4,900.00. Should he die at the age of 30 of $4.277.00. Should he die at the age of 40. of $3.620.00. Should he die at the age of 50 of $2,535.00. : .Angincom_e of $2,000, of which $l,OOO accrues to the family, would represent ‘a loss: : | 3

In case of death at age of 20 of $19,600.00. In case of death at age of 30 of $17.510.00. In case of death at age of 40 of $14,480.00. In case of death at age of 50 of $10,140.00. Possibly it would be more accurate to regard the probable term of service as having been reduced by the diseacse, say, one-half,srather than cut off entirely: In that case the loss to the family would be represented rather by the income lost during the latter half of the term, but this would be a loss in every case acquiring the disease, rather than-at the time of death. Pecuniary loss in the two cases above cited would be-gs follows: .

Age 20 on<s2so, $1,330.00; on $l,OOO, $5,420.60. Age 30 on $250, $1,372.00: on $l,OOO, $5.490.00. Age 40 on $230, $1,305.00; on $l.OOO, $5.220.00. Age 50 on $250, $1,057.00; on $l,OOO, $4,230.00. In the most hazardous, or more arduous. occupations where the strain is great and the term of service thereby materially shortened, there is less difference against the disease; there might be cases in which there is little to choose between the effects of the occupation and the disease.

In some cases the community brings up the child, in others the family or both contribuie. Yet the investment is not selfish, for those contributing rareIy receive-the direct return; the child is trained for general usefulness from -which the community or others than the contributors receive henefits. <o the loss is properly that of the community, ¢ Any data based on general statistics should be modified as suggested above by considering the: effect of the disease in: shortening the period of efficiency. Damage in case of death or disability caused by accident may be fairly measured by the immediate loss of income for the average term of efficiency. ‘Tuberculosis shortens such terms but does not in afl cases produce immediate disabilitv.

Thus assuming that from the time of incurring the disease, the term of efficiency is shortened one-half; the average loss might be ascertained by some such method as suggested above: but this is apportionable among all who incur the disease rather than among those only who die; it measures the loss of efficieney in entire group. : It is a grewsome task to attempt to reduce down to a cold calculating basis of :dollars alone the value of a human life. Nor can we estimate economically cnly in the most general way, the value to the state of ‘any or all lives lost from tuberculosis. Thempossibilities for good or evil of any life can never be estimated until that life has closed its career. This, however, we do know, that life is the final product of years of preparation” and growth. Being the last it is the most sacred; that which is the most sacred should receive the greatest protection. J

The victims of tuberculosis are mostIy of the active working age. Their deaths coming at the time of the period of their greatest usefulness to the state represents -the largest amount of economic loss. These deaths are injurihg society in .a most vital way. Men and women are taken from us at the zenith of their greatest powers for usefulness and activity. It is estimated that 35 per. cent. of the people who die from tuberculosis are from 15 to 34 years of age and-that 20 per cent. are from 35 to 45:.years of age. Since such is the case, and the economic loss so great and so evident, it follows that we simply cannot afford to allow our state to be devastated by the everyday danger from a disease at once so general and fatal. We ‘ must fight tuberculosis, aim to check its ravages, and finally bring about its. practical eradication. The necessity for protection of our people against such a disease becomes more and more evident. We do not insist that the paramount duty of the state is the care of its sick, but we must bear in mind that to take care of those suffering from tuberculosis is of itself an economic as well as philanthropic: measute. The state generously and faithfully cares for the deaf, dumb, those of feeble mind and insane, and others unfortunately diseased, but at present goes no furtfiér than the care of these. /At present no provision is made for the care of the tuberculous, jwhose ailments are an everyday element of danger to the health of the people of the whole commonwealth. As a result of the deéaths from consumption [»each year, the state at once loses the | vaiuable products andflaqtivities of thou'gands of lives. With these lives the state has a direct money interest. - We know-that 60 per cent. of the living people are, or have been, infected with consumption; that it is infectious and the germs are developed by damp- ’ ness, impure air, bad food, close contact, as in schools, tenements, penitentiaries, etc. This being the case, it would seem that it is a part of the state’s business to give freely of its money to the poer, to the boards of health, that the sick poor may be properly housed, have plenty of fresh air and sunlight, or if that is not feasible, provide sanatoria, or isolation hospitals, that the patients may have the best of care and can be removed from the danger of spreading tubercular “infection. . ‘

THE TREATMENT OF Pulmonary Tuberculosis .y ROBERT B. PREBLE

It is obviously impossible in the brief time suitable for an occasion such as this to enter upon anything like a comnlete discussion of the treatment of -pulmonary tuberculosis. Each case presents its peculiar difficulties - and problems for solution, and I must, therefore, be content with an effort to sketch what appear to me as the most essential principles underlying our attempts ‘to assist nature in: effecting a cure. g - It is impossible for the physician to fulfill his higher and broader duty, his duty to the race, withotit the conscientious and intelligent assistance of the patient. - Each case of tuberculosis is a potential center of radiation from which other cases may arise, and the doctor’s highest mission is to prevent this. Fortunately, there is no conflict between the doctot’s duty to his patient and that to mankind. It is not necessary to isolate the patient in institiutes for twnis purpose, nor should the patient look upon himself as a source of unavoidable danger to his friends. Contact with tubercular: patients can be safely continued for vears, provided only that the suptum is properly disposed of. It is not necessary to here discuss the ' numerous methodsof disposal of the sputum which have been devised, but I wish to draw renewed attention io the fact that sputum sprayed from mouth and'nose when sneezing or coughing is perhaps of even greater danger than that expectorated into cup or cloth. This should be explained to the patient, and the mouth and nose should be carefully covered whenever the patient sneezes or coughs. i ; \

It is perfectly evident; that no patient will properly destroy his sputum unless the reasons for such trouble are explained to him, and such explanation musibepreceded by afrank statement of the nature of his disease. The necessity of the proper disposal of the sputum is now admitted by all, and no doubt were every case of tuberculosis recognized as soon as the tubercle bacilli appear in the sputum, and every bit of sputum properly destroyed. tuberculosis would soon disappear from the world. : :

In taking up the treatment of this disease we should keep clearly before us the limits of possibility in order that we may not attempt the impossi‘fl{er AL believe fully that the drug has not yet been found which has any direct influence upon the bacilli and that all efforts to directly destroy the bacilli destroy the patient; in other words, I am convinced;that’ all of the antiseptics which have been used with this idea in mind, and I do not recall one which has not been used for this purpose, do more harm than good. I do net consider that efforts to discover:.such a drug are absolutely hopeless, but it appears to me more likely ‘that something may .be found which will neutralize the toxines, as the diphtheria antitoxine does the toxine of the diphtheria bacillus, and thus enable the host to resist the influences of the unwelcome guest. It also appeals to me as likely that such a body when found will be a biologieal product of either the human or bovine variety of the tubercle bhacillus. There have been and still are in use a number of these bodies, but even after the passage of years no one of them has been able to establish itself in the confidence of the profession. Because of the chronic courfe of this disease any method must be slow in its establishment, but sufficient time has elapsed to try and find wanting a considerable number of these biolegical products. & There is scarcely a drug in the pharmacopeia, scarcely a method, physical, electrical, hydropathic or mechanical: whi¢h has not been tried again and again in the treatment of pulmonary tuberculosis, and yet out of all this careful and conscientiouseffort no drug or method has emerged triumphant. The only thing‘upon which all are now agreed is that the patient must be supplied with all the necessaries of°life in liberal gquantities and of the best qualities. That the energies of his body must be conserved and strengthened in every way, in order that the healing power inherent in us all may bring about a cure. Drugs and other therapeutic means are fo be employed to combat individual symptoms as they arise, but the disease itself must be-left to nature. ; :

The first and most essential thing is to supply the patient with good, pure air. I believe that, when it is possible, the patient should be removed to some one of the health resorts, where the climatic conditions have proven favorable to these ‘cases, but, unfortunately, a very large percentage of tubercular patients are not. able to stand the expense of such a change. One of the most important new facts in the treatment of this disease is that the patient can be supplied at home with the necessary air. Nothing was more hopeless; than these cdkes so long as it was be-. lieved that a change of climate was absolutely essential. We realize now that much «can be done in the way of supplying an abundance of ai*e:en in so crowded : and otherwise desirable a place as Chicago. If it can be done there, it can be done anywhere. This is not possible in all ‘parts of the city, but there are, fortunately, many: places available to those of even the slenderest means, where an abundance of fresh air can be supplied. There are many outlying districts easily reached_ by a single car fare where the necessary open space can be obtained, and if the family refuses to remove to such a neighborhood, and persists in remaining in a crowded, ill-ventilated flat, the case is practically hopeless. Theé family should take either some flat. or house where there is a back yard, in which a tent, or, still better, a gboard shack, may be erected for the patient. Such a shack can be built at very small expense. It should be so proportioned as to contain about 1,000 cubic feet of space, and should be built of unmatched boards, so as to ~provide an abunaance of ventilation, even when the weather is such as to require the closure of most or all of ~the windows, The floor should be

raised from the ground sufficiently to secure dryness, the sides should be inclosed for about four feet from the floor. Above this line the walls should be of windows, arranged in such a way that they swing out from hinges at the top. The advantages of the arrangement of the windows are that they are inexpensive, and can all be open at once, even in case of rain. Opening outward, they serve as a canopy, and prevent the rain beating in, in a way which sliding windows do not. The roof should be rain proof. In such a building, when the windows are open, the patient is practically out of doors, and yet can be easily protected from rain, and, if necessary, from direct draft. Furthermore, the patient can be gradually = accustomed to the exposure, if that is necessary, and there is no doubt that the doctor will often meet with opposition from the family which can only gradually be overcome as the improving condition of the patient allays the fears and traditional opposition which many people show to an abundance of air. °

- The furnishing of this house should be of the simplest. A rug by the bedside, a table, a chair or two, and the bed. The bed should be a simple iron bed,. with comfortable mattress and springs.. The covering should suit the temperature, and be so arranged as to prevent the patient becoming uncovered during sleep. A sleeping bag or some similar device may be employed for this purpose. The night clothing should be of flannel, certainly so if the patient is sweating at night. ‘lt is obviously useless to,attempt to heat such a structure as the one suggested, and usually the patient will require nothing more than an abundance of clothing. Even in the coldest weather nothing more than a hot-wa-ter bag is required. . The patient should look upon this house as his home, and here hej should spend his nights and those portions of the day which are spent indoors.

The plan, as outlined above, is merely a suggestion, the details must be varied to cuit the circumstances of each case. It may, for example, seem best to keep the patient upon the large, rear porch of a flat building, er upon the roof of the house. In other cases it will be necessary to use a room in the house, although this should be avoided, if possible. The essential thing is to supply the largest possible amount of the best possiblé air. The next important question is that of proper food in sufficient amounts. Because of the great variety of individual tastes and preferences, or the fréquency with which we' find more or less complete failure of appetite and the great differences in the digestive powers of the different patients,it is difficult to lay out any general seheme. Here, even more than with the question of air, supply, is it necessary to individualize. Bach patient should be a subject of special study. The patient should take as much food as ke can di-. gest, and usually this is more than the appetite demands.. The {fcod should be varied in character, simply prepared, and attractively served. Due attention should be paid to supplying the various food elements, but the albuminoids and fats are best supplied in rather larger proportions than in the dietary of a northal individual. Because of {he usually feeble appetite, the food is best served at frequent intervals;‘for example, the three usual meals and a lunch in the middle of the fore= noon, about four in the afterncon, and again before retiring. The amount taken each time must be varied to suit the circumstances, but with patience the amount can be gradually increased until the total in each 24 hours is satisfactory. Care must be taken not to overdo the matter of feeding, and the gastro intestinal tract must be watched for evidences of indigestion, and the faeces should be examined at intervals for undigested- fopd particles. It is manifestly both useless and harmful to put into the digestive tract material in quantities or of qualities which cannot be handled. The directions given to the patient should be very definite and specific, so much of this, so much of that; ete., and at such and such fixed hours. Both patient and doctor should realize that these "directions will often need changing from time to time, and the doctor should see the patient at frequent intervals, to see that all is going well ‘with the digestive organs, and that the food supply is sufficient and of proper character. The proper feeding of these cases is *the most difficult . problem of all, and requires more patience and intelligence than all else combined. = The third question of importance is that of exercise. What patients should exercise, how much, and in what ways? It may be laid down as a general rule thiat cases of tuberculosis with a temperature should nyt exercise. When the temperature disappears, exercises should be empldyed, but the amount and character should be adapted to each case, and' varied from time to time as the case requires. As a general rule, the exercise should be mild, and for short periods, and always in the open air. Patient should always stop well before exhaustion.

Left in Cold Spot. Cyrus Townsend Brady, the author, had occasion to consult his physician for a slight ailment on one of the extremely cold ‘days recently. He was busily engaged in his literary work on the doctor’s arrival. Hurrying into the reception hall from his library, he said: “Doctor, I wish you to get through with me as speedily as possible. I left the hero and heroine by the side of a little babbling brook, and I’'m afraid they will freeze to death if I don’t get back soon.”’—Argonaut. Candles in Mexico. Candles are used extensively in Mexico, owing to the great expense of petroleum. A bookkeeper may be seen making his entries in a great ledger by the light of a single candle. A Mexican printer can work with a candle stuck.in‘to one of his boxes, and two tailors in the small shops can be seen sharing the rays of a single dip. : Somersaulting the Chasm. A new form of looping the loop is promised the Parisians. ‘A French engineer says he will make a motor car run down a slope to a chasm in the ‘track, at the end of which it will mount a springboard and turn a complete somersault, coming down on the other side of the chasm and on a continuation- of the track. :

The Duty of the . ° 5 State in Restricting . Tuberculosis By HAROLD N. MOYER, M. D. With an increasing recognition of the infectious nature of tuberculosis has come a tendency to urge legislation that should restrict the spread of the disease by quarantining the consumptive. The gducational effect of this propaganda is apparent in certain legizlative enactments which have tended to impose bur‘densome restrictions upon the consumptive and his friends. In certain communities to which consumptives commonly resort something like a panic has developed due to the fear of contagion. Teaching of this kind is pernicious in the extreme and will ultimately fail of its aim. A shotgun quarantine and a most rigid segregation would not materially restrict the spread of tuberculosis. Such a view of tuberculosis does not express the underlying factors by which it is propagated. It does not recognize that tuberculosis is a house and factory bred disease, and while the element of personal contagion is present, it is by no means the dominating factor. The most important lesson that recent years have taught in the study of tuberculesis is that individnal resistance is the important factor in preverting its spread. Large numbers of autopsies show that a very large percentage of those who die have at one time in their lives been infected with tuberculosis and have recovered. This shows that the element of exposure is almost universal, and that no matter what care an individual may take to avoid personal contact with consumptives, he will almost inevitably acquire the disease. It alsoshows thatthe element of vital resistance is the most important factor in its treatment and care, as - move than two-thirds of those who get tuberculosis recover spontaneously and never know that they have the disease.

The reported cases of personal contagion show it plays only an insignificant role in the spread of tuberculosis, particularly if we eliminate those cases in which the environment is the same and make proper allowances for lowered family resistance, which is the main factor in what'is understcod by i‘heredity as applied to tuberculosis. A ~ full recognition of these facts would prevent unnecessary laws restricting the movements of the tuberculous. Such laws are essentially cruel and they create in a community an unnecessary dread of the individual affiicted with the disease and consequently lead to great bhardship with no corresponding adyvantage. It is doubtful if any system of compulsory notification would be of value, particularly if it were . coupled with a system of notification by which it would become known that a particular individual was suffering from tuber- | : £ culosis. A further and very good reason i why laws of this kind should not be passed is the doubt which still remains - as to exactly how.tuberculosis is spread. } When the bacillus was first ‘discovered l it was a natural conclusion that the expectoration of consumptives dried and " pulverized and inhaled by healthy indit viduals was the means by which the dis~ease was conveyed. Noone has definitely proven that this is the chief method "of transmitting the disease, but it was so fascinatingly simple that it at once " gained general acceptance. It is still ‘ the favorite theory, though some very I good observers, such as Behring, believe that almost the sole means of \ spreading tuberculosis is by ingesting ‘ the bacilli with the food. In view of these uncertainties and of the folly of attempting to limit by segregation or ‘other means the movements of the chronic tuberculous, restrictive and compulsory statutes should not be en~acted. The work of the state should be limited to the.education of the con- ‘ sumptive and his family with the active ‘ cooperation. of the family physician, | One of the most important problems in the restriction of tuberculosis is the early recognition of the individual case. The significance of the early loss of appetite, sleeplessness, slight cough and the general failure of health is not appreciated until abnormal sounds develop in the chest or there is abundant sputum together with fever and night sweats, the unquestioned signs of tuberculosis. When this stage is reached the opportunities for treatment are lessened and -the possibility of arresting the disease is limited. Such an individual for a number of months after this stage is reached becomes an active culture ground for the breeding of the bacilli. Hence from thé standpoint of restriction -the recognition and cure of the individual case early in the diseaseis most important. In this way the preduction of the contagion is limited and the liability of spreading the infection to others is lessened. One of the most important of the early diagnostic signs is the recognition of the presence of the tuber;'cle bacillus in the sputum. It may be safely asserted that a large proportion of the cases of donsumption in this state do ngt have their sputum examined from {the beginning of the disease to its end. \ While it is easy to make a diagnosis of consumption in the late ‘ stages without examination, it is most important that infected cases should be recognized in their incipiency. The state through the board of health should undertake the examination of sputum. . This could be readily done with a trifing expense and would place the state authorities in touch with a large number of cases of tuberculosis. Many physicians are not equipped for examining sputum, and even where they are it is a considergble burden to put upon the profession in cases of poor patients who cannot afford to pay a proper fee. The state should undertake to exanfine all sputa forwarded to it by individuals or by the profession. In‘ this way a large number of cases would | be brought to the attention of the authorities and an active educational propaganda stdrted. This ghould include printed instructions, of course, through the physician, if one were in attefidance, on the nature of tuberculosis, the means by which it is spread, the care that should be exercised to protect others and the importance to those who are exposed to similar surroundings to avoid them and to live more in the fresh air. In.addition such a general outline of in~struction as would limit the spread of the infection. The effort of the state should be not to supplant the physician

where one is in attendance, but to supplement and to strengthen his efforts in prescribing fresh air, food, etc. State aid in the establishment of sanatoria for consumptives is most im-, portant. It is possible for the state to provide for only a small fraction of the consumptive poor, but the educational value of two or three sanatoria in different parts of the state would be incalculahle. It would be an object lesson to the people of the state in the care of such cases; through it they would learn the value of the open air treatment, good hygiene, and nutritious food as well as'rest.. Fortunately the cost of such sanatoria is not great, as elaborate and expensive buildings are not necessary. A simple though durable construction on ‘the ¢olony plan, in which the patients pass the whole time in the open ajr, or as nearly as'may be, is all that is required. These sanatoria would furnish object lessons to the peopie of the state on the management of tuberculosis which, affer all, must be the main reliance in preventing the spread of the disease. The early and prompt restoraticn of all curable cases is the most important item. ;

Above 21l the profession in the rural district should rise to the importance oi the occasion and there should be established by physicians throughout the state private sanatoria for the treatment of consumption. All that is-re-quired is a suitable site, arrangements for feeding patients and a simple medical equipment. Tents have been demonstrated to be by far the best dwelling places for tuberculous patients, and it is possible to have patients dwell in them the entire year, even in a climate 4S severe as ours. :

The state owes something to its dependents confined in asylums, as well as those in prison. The mortality from tuberculosis in public institutions is far too high. Already steps have been taken in certain institutions to obviate the large death'rate from this disease. The New York state hospital for the ingsane on Ward's Island has demonstrated the value of outdoor treatment for the tuberculous insane, and steps should at once be instituted to meet the requirements of the institutions in the state of Ilknois.

To sum up, the duty of the state in relation to tuberculosis at this time is: (1) The establishment of a state laboratory for the examination of sputum which would be available for both the profession and the citizens of the state. An adjunct to this would be the dissemination of correct ideas on the management of tuberculous cases and the avoidance of infection. : (2) The establishment of one or more sanatoria largely for the educational-ef-fect, and not with the hope of caring for any considerable number of consumptives, but to demonstrate that hygienic and home treatment in our climate is successful and practical: (3) Drastic legislation such as compulsory notification of tuberculous -cases, the quarantine of tuberculosis or other measures which teach that the individual consumptive is a danger to those about him are to be deprecated, and are against the interests, not on,ly of the consumptive himself,‘ but they do not protect his associates. . '

GET SICK ON THE RAILWAY.

Many Travelers Are Curiously” Affected by the Motion of _the Cars.

Seasicikness is not.the only ‘malady from which travelers suffer. Almost as distressing an ailment is that 'whith afflicts many people when making a journey on the railroad. sThese people, says an exchange, find thdt road legs are as essential to them as are sea legs to those crossing the Atlantic. They suffer from the jolting omnibus to the quick-stop-ping electric cars and air-braked trains and frequent opportunities arise for estimating the various amounts of agility, clutching of stay”straps and compensating bodily movements made by the cognoscenti in the particular class of vehicle of which they are for the time endeavoring to form an intégral part. That all forms of traveling are tiring is evident from the cofnmon tendency to sleep in railway carriages. o The vagaries of the traveling public are curious; some cannot. ride except facing the engine or the horses, others cannot.travel at all by railway, some have faint feelings when going at high speed, others are made actually sick, and the utmost confusion has been- caused to some unfortunates by the seats opposite the direction in which the train is moving being occupied, though, curious1y enough, the same feeling is not set up when the passenger can have a seat placed parallel -with the direction of progress. ; . :

There is reason to believe that the action upon the eye muscles of the rapjdly changing parallax and the quick passage of objects that are met and left have much to do with the production of tired feelings and of headaches caused by long journeys, and great relief is often experienced by simply closing the eyes or by refraining from looking eut of the windows, and if reading is to be indulged in the daylight should be chosen and large clear type of print selected. ; Luxury on Wheels. What is considered to be the finest train in the world is owned by a rich American.and his wife. It is composed of their private car, fitted up at a cost of over £20,000, with three sleeping cars, a buffet, smoking car and a luggage van. Practically speaking, it is a hotel on wheels. It is a favorite practice of American millionaires to give train parties, when a number of invited guests travel together for weeks at a time.—London Tit-Bits. : Chinese Gongs. Chinese gongs attain their tone by being hammered in a hot state. When a Chinese gong is struck with a hammer when cold it will break. Experiments have been made in which the human body has withstood the temperature of 240 degrees for several minutes in a heated apartment; this may show how far it is practicable to hammer a gong: in a very warm place.—Jeweler’s Circular Weekly. o ' A Dilemma. ~ “I happened to get into a poker game at the club last night with my best girl's- father.” ~ “Did you win or lose?”’ oy “Both, I'm afraid. I won from him, but I'm afraid that’ll lose me the girl.” —Philadelphia Press, :

GERMANY’S PETRIFIED MILK. Hornlike Product Called Milk Stone Is Put to a Variety -~ 2 of Uses, | -7 7: | Chemistry is incessantly at work te create new industrial -val’ugs from.subsstances heretofore considered valueless, " At the creamery day .reci‘eutl)fi2 held at Vienna, Mr. Maximilian Ripper, assists ant at the chemical agricultural experiment station, delivered a lecture on. “Skimmed Milk.” : E He said that it is a well-known-fact that the success of a creamery, where. the chief sourge of profitis of course butter, does not depend so much upon' the. cost of production and the seiling price of butter as on the profits derived from the skimmed milk. The right market ‘for the milk skimmed for the purpose of butter making is really the vital question of the milk industry. Skimmed milk has been used for various purposes .—for the manufacture of sugar of mill, as food fcr animals,; and for milk champagne,which isskimmed milk mixed with fruit juices and impregnated with carf-}f bonic acid. A rather large percentage of skimmed milk is also separated into, its component parts, which® are then ‘worked up. . The casein serves for the manufacture of cheese; also for glue, putty, and isolating substances. ; But all these different uses of skimmed milk did not solve the guestion ‘most favorably. * 24 This, however, is now expected from .the newly invented “millt stone,” or® galalith, or petrified milk, It is manufactured in the following manner: [ By a chemical process the casein is precipitated as a yellowish-brown powder, which is mixed with formaline. Thereby a hoernlike product is formed, called milk stone® This supstance. witih various admixtures, forms a’ substitute for horn. turtle shell, ivory, celluloig, ‘marble, amber, and hard rubber.” Handles for knives and forks, paper cutters, 1 crayons, pipes, cigar holders, seals, ma;}— ble stone ornaments, and billiard balls are now made of skimmed miik. The insolubility of galalith, its'easy “'ork‘ing, elasticity and proof against fire make it very desirable. Already 20,000 quarts of skimmed milk are daily used for this purpose in Austria. Tl RICHARD GUENTHER. UNDERGROUND LAVATQRIES Places in English City Where the Public May Wash and Have_ | Shoes Polished. .' The public works -com:}hittee of B'jfi mingham, in submitting to the city council a proposition for a’p expenditu&e of $7,300 upon the construction of an additionai underground lavatory, éte., made an announcement showing that where small charges are made there are profit possibilities in. conveniences jof this kind. The committee said that the four underground lavatories, ete., “'fél‘e paying the city a net profit of $2.433 a year. Three of these lavatcries paid ' handsomely and are much appreciated by the public, but the general rate |of profit—B% pr cent. if the cost be $7,300 each—was much cut down by the fpct that one underground lavatory had béen located at a place where there are chly occasionally numbers.of people assembled. There is no city improvement the utility of which American tourists gre so much impressed with when traveling abroad as they are by the undergroynd conveniences mentioned above. and there are few conveniences in life | in which American cities are so lacking. In the United States profit coyld be mpde by. the addition. of boot-blacking stands. LR e To the American traveler, abroadii»forv the first time, it is'always a matter of surprise thdt practically there are no public places where boots are *shined,” and that even in the hotels, exceptinthe few where American travelers- have created the demand, to get shoes shined during the daytime ard o‘therwisev§gn by putting the shoes outside the door at night is difficult and on}y with a good deal of explanation, and|then after a good deal of search for brushes, materials, etc., on the part of some ,porter who has been persuaded by ~ speciak promises that it is worthlwfiile to fake on the unusual job. = | : | ° MARSHAL HALSTEAED. ;

APPRENTICES IN CANADA. Sentiment in Favor of the Eurofiean Binding System Growing in| the Dominion. ! [520 r There is a growing:sentiment m the dominion of Canada in favor of thg European method of binding apprentices. It is claimed that under the present methe@ds young men seldbm attain the thorough, practical training which. is characteristic of the British tradesman. The Employers’ association of Toronto has taken a decided &and in this matter, and an apprenticeship indenture has been adopted wherehy the pa‘gents or guardians of the apprentice agree that for the full term of three years he shall “well and faithfully serve the employer, his secrets keep, his lawfulficox‘n‘-‘ mands and those of°his [foreman| and other superior officer at all times readily and cheerfully obey, and shalfi; give and devote to the employer his-whole time and labor, and he will not dhring his time of employment jbin or b(ico.me a member of any society that claims or attempts to control his'dctions 'f his labor in any way, or other compa ',_asSociation, or society, exce*‘)t the militia, which might at any time during the term of employment call for his alfibe'nce from his regular employment in -the service of the employer.”| The amount of remuneration is stipulated and the employer reserves the right to retain of the wages annually $25 as a guaranty of good behavior or as an indemnity against loss. Spy ol T : W. R. HOLLOWAY. “ British Coal Output in 1903 - According to recently publishéd statistics of the United Kingdom’s output of coal in 1903 there was an increase over 1902 exceeding 3,000,000 &Ons, or about 114 per cent. The gross output reached the record figure of 230;32%391 tons, The gre‘a_te% increase was in. the Yorkshire district. The number of mine employes’ was 842,066, an increase of two per cent. over 1902, s ns LS R ' FRANK W. MAHIN. - Cleverness. - |> Cleverness is serviceali;e for everything, sufficient for - nothing.—Henri« TredericAmlel ~ - oS s

E’ .|' I | The Sanative, Antiseptic, Cleansing, Purifying, and Beautifying Properties of Assisted by CUTICURA Ointment, the great - Skin Cure, are.of Priceless Value. .\ For preserving, purifying, and beautifying the skin, for cleansing the scalp of crusts, scales, and dandrutf, and the stopping of falling hair, for softening, whitening, and soothing red, rough, and sore hands, for baby rashes and chafings, in the form of baths for annoying irritations, ulcerations,and inflammations of women, and many sanative, antiseptic purposes which readily suggest themselves, as well as for all purposes, of the toilet, bath, and nursery, CUTICURA Soap and CUTICURA Ointment are priceless. Sold throughout the world. Cuticurs Soap. 25¢c., Oint- = ment, 50c., Resolvent, 50c. (in form of Chocolate Cpated B . P ieeb fiue de 1a Pabe’; Boston, 137 Colufabus o U T

i’coa’nmfl |_LINE | STEAMERS ||

- YOUR CHANCE FOR : SIIIMEH ENJOYMENT 3-and 4 Days Lake Trip SI3 ‘Chicago to Menominee, Mich. & Ret. -~ Including Berth and Meals. 5 Days Lake Trip $2O Chicago to Mackinac Island & Ret. Including Berth and Meals. Muskegon or 6rand Haven From Ghicago. $2.15 : MILWAUKEE plase $1.50 Write u'bout it R.C. DAVIS, G. P. A. Chicago,lli. ‘

[ L BEVEY

"EQACPKMS B N WESTERN [LST2O4. CANADA = gSyAD - the V’G‘N R A Star Attractions F for 1904 | Milliors of acres of magnificent Grain - ' ‘ | and Grazing Lands to be had as a free { ®ift, or by purchase from Railway TSy g‘ompanies. Land Corporations,etc. The Great Attractions % Good Crops, delightful ciimate, splendid school system, perfect social conditions, exceptional raflwayadvantages, and wealth o g and aflfiuence acquired easily. 10 ’ The lation of WE’T b Si | CANK(KUA increased 128,000 yiEngnNi: 4 gration during the past year, aver 50,000 N R peing Americans. | l‘"' Write to the nearest m‘hthorlud A A 7) Canadian Government Agent for Can;3 dian Atlas and other lnlonmtion: r address SUPERINTENDENT IMMIGRA- | TION, OTTAWA, CANADA :— I .J, B GHTON, 430 Qui Bullding, Chl n, s. %.m%ggm Room 6, g‘ix.l:z-r kn:fn, I::l'n:'wh, Ind. E. T. HOLMES, 815 Juckson Street, Bt. Paul, Minn. M. V. MeINNES, 6th Avenue Theater Rlock, Detroit I Mich. L. 0. CURRIE, Room 12, Callahas Block, Mllwaukee, Wise FnEE HOMESTEADS in Eastern Montans. No bettersoilin America for Wheat, Flax, Corn and Barley. Hay in ahnndnnoe& water, ample rainfall, plenty coal free. No or stumps. Land gently rolling. Secure 1 acres free g.thon buy adjoining land for from $7.50 to *s. peracre; easy terms. Cheap nrates. ms“‘:t{eherbe“ e nn'ri. write, money. T r W R ORI goreuars and |