ing to the small provinces where they almost invariably return, to die of tuberculosis contracted here from their unsanitary methods of living, over-crowding, and poor food. Their avoidance of public dispensaries and fear of hospitals make them conceal illness or else spend their frugal savings on poor doctors who fill them with useless and expensive medicines until their money is gone and then unwise friends send them, dying, to Italy to spread the disease. If the heads of tuberculosis dispensaries, students in the schools for social workers, and associated charities secretaries working in Italian districts could gather statistics before next summer and present them at the Congress, a splendid work might be done for Italians both in Italy and in this country, a history of social conditions such as no doctor is able to gather. This presentation in English would be no bar as some of the wealthiest permanent residents in Rome are English and American, or an interpreter could be found to condense the information and, in any event, it would find a place in written form in the proceedings. The time seems to be ripe for making an effort to help the Italian with his many fine qualities to find his proper place in America, which, for the southern Italian, who is essentially a farmer, is certainly not the congested districts of large cities, where his unskilled labor brings him a mere pittance when the few months he can find work is considered. Yours truly,

M. ALICE GALLAGHER,

Steams Settlement House, 281 Watertown St., Nonantum, Mass.

This letter was forwarded Dr. Stella, who is doing splendid work among the Italians in New York, and he replied in part, as follows:

As far as I know, neither has the programme of the International Tuberculosis been completed, nor has the subject presented in your letter been introduced. I think it would be important to have some section give attention to this and I will be glad to take up the matter directly with the secretary-general in Rome. In this connection, I would like to arrange some sort of draft of what could be done along this line, so that in asking for recognition at the Congress we could present something concrete on which to base our claim.

Cannot the visiting tuberculosis nurses of the United States suggest an outline for this section's programme and collect material to make it a success? We would all like to know how to get hold of the tuberculous Italian and his family before it is too late and why he shuns our clinics and our attempts to help him. There are many Italians in this country and their tuberculosis mortality is high, considering that consumption was formerly a rather uncommon disease in Italy. The proportion of these cases enrolled at tuberculosis clinics is small. Why? What is the best way to win their interest and co-operation?

Will not all nurses whose work lies among the Italians write Dr. Stella, 214 East Sixteenth Street, New York, Miss Gallagher, or this department, offering suggestions, facts, or their personal services in research work for the next six months? A visiting nurse's duties permit

her to glean facts only as a side issue, but there is much information. to be gained during a nursing call, and a special note-book reserved for this material (facts on housing, eating, drinking, sleeping, working, habits, prejudices, superstitions, etc., ad infinitum) would soon be filled with very interesting data. This, later, might be worked into a local report of that particular Italian situation and a dozen or more such reports would be intensely interesting and very, very helpful. We must all of us confess that the Italian problem has thus far been beyond us. Now that the opportunity is offered us to do some really constructive work of inestimable benefit to both Italians and Americans, will not all the nurses respond and at once?

EL PASO'S INDIGENT TOURIST CONSUMPTIVES

BY H. GRACE FRANKLIN, R.N.

Director, Woman's Charity Association School for Mothers

"I THINK the nurses would probably be interested in knowing how you handle indigent tourist tuberculosis patients." Such was a sentence in Miss Foley's letter to me. Need I tell you how I leaped at the word tourist? Have you ever gone trout fishing and seen the trout leap to the fly? Well, I was something like the trout. Tourist! why it expressed the whole situation here in the Southwest. Such is the consumptive and the indigent consumptive. He travels from place to place, often sent by charity, seeking that Mecca of all Meccas-a place in which to get well. Chasing everywhere, yet never settling down to "chase the cure."

During the past twenty months representatives of 15 nations have applied for free medical care in El Paso. Every state in the Union has been represented, and yet only one native-born Texan has applied for aid. Consumptives have arrived here in a dying condition, have applied to the charities, to be sent on to some other town when their condition was such that the only course to pursue was to place them in a hospital. These indigent tourist consumptives are a menace to life, for they are usually the most careless of all human beings. Something should be done to prevent this passing on, and the whole Southwest is planning to organize a league to prevent it.

It is true that our climate is ideal, but it is no place for an indigent consumptive. Nowhere in the United States is living higher, and the consumptive cannot live on fresh air and sunshine alone. One physician of much experience told me that he did not think it advisable for a

consumptive to settle here unless he had an income of $100 per month. Quoting Dr. Robert B. Homan, one of the best known tuberculosis specialists of the Southwest and proprietor of the beautiful and wellequipped Baldwin Sanitarium: "Many patients are sent to this country practically without means, with the expectation of getting on a ranch or somewhere at a very nominal expense. There was never a greater mistake than this. Tuberculosis is a disease that must be combatted by building up the natural resistive forces of the individual, and to do this one must have the very best food, comfortable quarters, and plenty of time for rest as well as medical advice. These cost money anywhere, and the West is no exception. To obtain the best results one must be provided with sufficient means to get the things necessary for his welfare without having to worry about it.

"Some are told that they can come here and obtain light employment out of doors, and thus gain a livelihood and get the advantage of the climate at the same time. This is true in but a very limited number of cases, as there are many applicants for every position of that kind, and one should not be sent to this country with any such expectation unless arrangements for a position are perfected beforehand. None should accept even the lightest employment, at least during the first few months of their stay here, if they have the means to provide what they should have without it."

Patients are spending their last cent to reach the Southwest, and very often are shipped here by friends (?) desiring to get rid of them. This is cruel and inhuman, and the sooner all tuberculosis societies and communities understand that the Southwest will not assume their rightful burden the better it will be for the indigent consumptive. It is heart rending to see these poor, half-starved consumptives going from one place to another seeking charity and there is no relief to give.

There are no city charities in El Paso; all relief agencies are under the control of the county, and to enter the County Hospital one must have been a resident of the county six months. The indigent consumptive has become such a burden upon El Paso that the county health officer and the county judge have decided to "Vag" all indigent consumptives and give them so long to leave town. Better stay away from El Paso.

El Paso has her own burdens, and she cannot care for the paupers of other states. The county judge informed me that the county will furnish but one thing and that is free burial. This isn't cruel. It is justice to El Paso and it is justice to the indigent tuberculosis patient. Far better know conditions before he leaves for the Southwest. El Paso