A Monthly Journal of Practical Medicine. VOL. XXXVI. ST. LOUIS, Mo., NOVEMBER, 1908. No. II. THE SIXTH INTERNATIONAL CONGRESS ON TUBERCULOSIS. Pasteur said: "It is in the power of man to cause The sixth triennial meeting of the International Congress on Tuberculosis occurred in the city of Washington, D. C., from September 21 to October 12, 1908. The Congress met in this country upon the invitation of the National Association for the Prevention of Tuberculosis. The Congress was participated in by representatives of thirty-three foreign countries, the only important absentee from the meeting being Japan. The United States was well represented by official delegates from nearly all the States, by delegates from most of the cities and municipal, State and government health departments, and by many other persons, medical and lay, who have been earnest workers in the tuberculosis prevention and cure propaganda. The meeting was held in the new National Museum, the structure which is to house the present contents of the Smithsonian Institution. This building was sufficiently roomy for this meeting, but its half-finished. condition was hardly calculated to enhance the value of the spoken proceedings, owing to the poor acoustics of the several rather hastily-constructed assembly rooms, and owing also to the fact that the artisans working on the building did not see fit to stop their labors during the most important deliberations of this body. In short, the quarters were bad, and hampered in no inconsiderable way the great good that would have been otherwise accomplished here by the delegates had physical conditions been better. As it was, in spite of adverse conditions far-reaching. results will be attained by this Congress. The Congress consisted of the department of exhibits, and, secondly, the department of section meetings for the reading and the formal discussion of papers. The first part, the "exhibition" on tuberculosis, was installed in the corridors of the National Museum. These exhibits represented just what is being done in all the participating countries in fighting the great White Plague. The exhibits were comprehensive and displayed wonderful ingenuity on the part of the organizations which arranged them. They depicted what is being done by research work on tuberculosis. They showed, by a profusion of statistical maps, the alarming prevalence of tuberculosis in the crowded centers of population, the slums of our great cities. Pictorial demonstrations of the manner and method of transmission of the disease covered the walls. Models of tuberculosis sanatoria were there in plenty. Special tents for sleeping outdoors were displayed. The Nathan Strauss pasteurizing system was well-illustrated by a complete pasteurizing plant in full operation-an exhibition that even included dispensing of the pasteurized milk to those who cared to "take a drink.” The various nurses' associations that have been active in fighting tuberculosis in cities, gave exhibits of actual rooms in the quarters of the poor, showing, on the other hand, the condition of a room before the visit of a nurse, and, on the other hand, the improved state of things after the visit of the trained attendant. There were many very attractive pathological specimens, showing the lesions of tuberculosis in all parts of the bodies of both man and cattle. There were very interesting X-ray plates, showing the shadows in the lungs of the tuberculous, and depicting just exactly how much information one can obtain in this way as to the extent of tuberculous foci in lungs. That the X-ray photograph, when properly interpreted, is a valuable supplemental or corroborative aid to early diagnosis of pulmonary tuberculosis was clearly proven by these plates. Possibly the best tent exhibited at this Congress was that shown in the exhibit of the International Typographical Union, the only labor organization in the world which maintains a tuberculosis sanatorium. This tent was a circular affair, with a special top for ventilating, and curtains that could be pulled aside to allow the entrance of fresh air and sunlight. In addition to the Home and Tuberculosis Sanatorium maintained at Colorado Springs by this union, The Typographical Journal, the official organ of the International Typographical Union, informs its membership each month of the progress that is being made in the prevention, treatment and cure of tuberculosis, and the editors are diligent in searching for the latest and most approved thought on this subject. This journal reaches fifty thousand members, and the information is thus disseminated over a wide field. This plan of tuberculosis education is certainly very creditable to the union, and could well be emulated by other labor organizations. The mortality is heavy among printers, and their organization is trying to cut it down. In addition, they are insisting upon hygienic quarters in which to carry on their daily occupation, a position which is well taken, as was crystallized in the latest report of their President, Mr. James M. Lynch, to wit: "We are justified, from every standpoint, in demanding that the employer shall do his share in stamping out tuberculosis." There was a complete "dairy" exhibit, showing a number of cows properly housed in sanitary stables, and the process of clean milking was actually demonstrated every day for the benefit of the Congressists. An interesting exhibit of the United States Government Printing Office showed the method of handling and cleaning cuspidors in that institution, using long pairs of forceps for picking up these cuspidors, also a cleaning trough for cuspidors; a one to five thousand solution of bichloride of mercury was placed in each cuspidor. The exhibit of the tuberculosis. workers of New York City deserves special mention. It showed that by research, by education of the public, by treatment and by legislation, tuberculosis ought to be stamped out among our people. This exhibit gave a comprehensive view of the various hospitals and sanatoria at the disposal of the tuberculosis workers of New York City, for the care and treatment of the tuberculous. These tuberculosis hospitals are: Mount Sinai Hospital, Riverside Hospital of the Health Department, Bellevue Hospital (which is free to all cases), the Metropolitan Hospital on Blackwell's Island, the Sea Breeze Hospital (which is used for the treatment of tuberculosis of joints and bones in children), the Otisville Free Sanatorium of the New York Department of Health (for patients in the early stages), and the Stony Wold Sanatorium (for women and girls in the early stages; this is located in the Adirondacks). Besides the exhibits of these hospitals, it was shown that in New York tuberculosis is treated on ferry boats, on the roofs of tenement houses, by visiting nurses, and by sleeping on the roofs of houses in hammocks. One of the unique methods used by the New York State Charities Aid Association in interesting the public in the tuberculosis question, is that of sending a half dozen phonographs around to the State fairs. Each phonograph is equipped with records made by experienced speakers on the tuberculosis question, one in particular being called "the spit record." This record tells the people just how the sputum indiscriminately thrown out will communicate tuberculosis from the sick to the well. The gentleman in charge of this exhibit informed the writer that already a half million people have heard these records. It is the constant experience of those in charge of these phonographs at State fairs that they gather a crowd, and hold it better than any attraction on the grounds. The educating influence of these phonographs is unquestionably great. Other associations should take up this idea. Another interesting feature shown at the congressional exhibit hall was the so-called "Hygienic Chalice." This is the ordinary church chalice, with a number of waxed paper covers to slip over the edge of the cup, so that each one who drinks from the chalice places his lips only in contact with a fresh "mouth-place," to coin an expression suitable for this action, thus preventing infection from one person to another. The new tenement law of the city of New York promises to accomplish much in stamping out tuberculosis, by giving the poor better living and sleeping quarters than they have had in the past. This law requires all rooms to be well lighted, well ventilated; 70% of the lot only is occu pied by the building, the height of the building is limited to one and onehalf times the width of the street, the yards of interior lots will be 13 feet wide and I foot for each additional story (six-story buildings); there must be large courts, 12 feet wide; courts must have an intake or tunnel at the bottom for the purpose of having a constant air renewal; no window can be within 61⁄2 feet of another window, and they are generally 121⁄2 feet apart, often 25 feet; no room can be less than 75 square feet, there must be 120 square feet in every apartment; sole access through bed rooms is prohibited; there must be a private watercloset for each family within its own apartment, and cellar walls and floors must be "damp-proof." The exhibits of all the State sanatoria were excellent, particularly that of Rutland, Mass., the first State sanatorium to be founded in the United States. Maps of the temperature, winds, humidity, generál climatological conditions prevailing in that section of Massachusetts were shown; then was shown a neat little model of the grounds and buildings of this celebrated institution. Photograph views of the verandas, with steamer chairs filled with happy, convalescent patients, lined the walls. Placards illustrating the rules of the institution, the hours of "rest" during the day, the hour of retiring, etc., were part of the exhibit. Missouri, while she did not have an exhibit, distributed a book entitled "What Missouri is Doing." It contains an account of the good work that is being done under the auspices of the St. Louis Society for the Relief and Prevention of Tuberculosis. This society was organized in 1904 in a small way and has gradually grown in membership and good work since that time. It has two visiting nurses who are constantly visiting the consumptive poor. The nurses do primarily relief work, but they also teach members of the family how to protect themselves against the disease. The Society is working now to organize an association of tuberculosis clinics. Open-air lectures are given. A Show-Window Tuberculosis Exhibit is used by this Society as an educating influence. There are also some county societies in Missouri, to-wit: the Bates County Society for the Prevention of Tuberculosis, the Moniteau County Society for the Relief and Prevention of Tuberculosis, the Jackson County Society for the Relief and Prevention of Tuberculosis, the Cole County, Howard, Gasconade, Cape Girardeau, Ralls County, Greene County and Buchanan County and St. Joseph Society. The leading institutions for the treatment of tuberculosis in Missouri are the State Sanatorium at Mount Vernon and the Mount St. Rose Hospital of St. Louis. In the section on Municipal Control of the Congress, Dr. William Porter, of St. Louis, Medical Director of the State Sanatorium for Tuberculosis and head of the Mount St. Rose Tuberculosis Hospital of St. Louis, was called upon by the chairman of the section, Surgeon-General Wyman, to speak on the needed factors in handling the tuberculosis problem. He said that Missouri was educating the public of that State; that as a result we had laws enacted, the antispitting law and the new registration law, and thirdly, there were institutions for incipient cases and institntions for advanced ones. Another speaker from Missouri, Mr. E. F. Goltra, head of the St. Louis Society for the Relief and Prevention of Tuberculosis, said that the question of warfare against tuberculosis was a business man's responsibility, and he asked that busineses men should meet it, from the standpoint of both vital and economic loss. The foreign countries, Germany, France, Hungary, Sweden and others, showed what they are doing in fighting tuberculosis. They are educating the well how to stay well, and they are curing the sick by appropriate home and sanatorium treatment. Germany's process of education, according to her exhibit, consists in telling her people what tuberculosis is, how the infection takes place, how one can protect one's self against tuberculosis: first, by measures taken against contracting the disease, and, secondly, by showing the measures for strengthening the body; then by giving advice to persons in great danger; lastly, by giving advice to diseased persons. Excellent tables showed that there are over sixty million people in the German Empire at the present time, and that in the past twelve years, since the tremendous impulse given to the enactment of legislation, and the erection of sanatoria in that country, the disease has been steadily decreasing. It is now evident that tuberculosis shows a considerable decrease nearly everywhere in the German Empire, but especially in those parts where it found its widest spread before. There are at present in Germany 99 public sanatoria in action for the treatment of tuberculosis, one public sanatorium still in process of building, 2 country colonies for the treatment of tuberculosis, 12 nursing homes and homes for invalids (with three in process of construction); there are 36 private sanatoria for the treatment of this disease, 17 sanatoria for tuberculous children, 73 sanatoria for children scrofulous or suspected to be tuberculous. Sweden has done remarkably good work in fighting tuberculosis, and she showed what she has done and what she intends to do in an interesting exhibit, and by the publication of a book dedicated to the International Tuberculosis Congress of 1908. The work in Sweden is carried. on under the auspices of the Swedish National Anti-Tuberculosis Association. Information to the public is spread by this association by means. of public lectures, as well as a public tuberculosis museum at Stockholm. Physicians in Sweden are trained in sanatoria for tuberculosis patients, so that they obtain a good idea of the diagnosis, prophylaxis and hygiene of the disease. By means of the efforts of the national association, many sanatoria have been erected and put in action. Calmette's brilliant idea of developing the use of dispensaries as an effective weapon against tuberculosis has found deep root in Sweden, and many institutions of that |