The lines upon which cooperation appears to be pos sible at the present time between the medical profession and agencies for social betterment are at least four : I. The promulgation through personal interviews, through public lectures, through leaflets, through news papers and the periodical press, through clubs and classes, through the schools and colleges, and through every other practicable channel of public education, of the idea that the consumptive must properly care for his sputum ; that tuberculosis should be recognized and treated at the earli est possible moment ; that nutritious and suitable food is essential, and that the physical presence of a consumptive who is intelligent and conscientious is not necessarily dan gerous to others.
II. The opening of numerous and not too populous houses of rest for advanced cases — where there shall be every attempt to make easier the closing hours of life, to detect and help any hopeful case, to provide for outdoor exercise and indoor recreation, to permit occasional or even frequent visits from friends under proper precau tions, and in general to create those conditions of cheer fulness and physical comfort that will lead patients readily to enter and to remain whenever the conditions in the pa tient's home are such as do not permit him to remain there with comfort and safety. They may properly be maintained either by local taxation or by private benevolence, and they should be numerous enough to make long journeys un necessary and to remove all inducement to overcrowding.
These houses of rest may profitably be supplemented by endowments or by generous private gifts for individual patients to show how much can be done in even apparently hopeless cases if ideal conditions are attained. The in terests of humanity and of science alike require numerous experiments even with advanced cases to see whether at least some of the more distressing features cannot be still further mitigated.
III. The erection of well-equipped sanatoria for the treatment of lung diseases, favorably situated as to climate, as to altitude, as to remoteness from congested populations, as to scenery, and in all other respects, in order that no known condition favorable to recovery shall be absent if it is feasible to secure it. In these hospitals there should be ample, even lavish, provision for the essentials of treatment. There should be no hesitation to provide everything in the way of grounds, and buildings, and maintenance ; and above all there should be no parsimony as to professional services and no lack of opportunity for laboratory research and experiment.
To the charge that this would be the creation of a favored class of public dependents, it is to be replied that these things are not done solely for the sake of the particular patients who may be cared for, but for the sake of the entire people. We are in the midst of a desperate warfare; and just as we would give every protection to a garrison that was battling for the homes and lives of all, so we would concentrate here, upon the human bodies that are struggling with the bacillus which is our common enemy, every element of strength that will enable them to resist the disease. Every patient saved, or even taught simple hygienic precautions, is multiplied into a regiment for the further conquest of new fields. If we could at one stroke cure all our consumptives, it would undoubtedly be a boon to that particular body of people ; but their gain would be insignificant indeed when compared with the great gain which would accrue to those who are now sound and well, and to generations still unborn, in the removal of the disease which we must still class as the " captain of the men of death." Liberal appropriations, therefore, to enable us finally to make headway against tuberculosis, are preeminently jus tified in the extraordinary position in which we are just now placed. It is no more of a scourge than formerly. The difference is that we know more about it ; and there is added reproach in every year in which that knowledge re mains merely a means of hardship to the consumptive poor, through increasing their difficulties in finding and keep ing employment and in moving from place to place, and does not show itself in the conquest of the plague.
Whether these more expensive and elaborate hospitals for treatable cases should be built and conducted by the state, or by the local municipalities or by private means, is a question which may be decided differently in different communities. In New York, where the state tax at the time of the present writing has passed the vanishing point and become a fiction, while local taxation is a heavy bur den, the policy which has been adopted of at least one state hospital in the Adirondacks seems clearly justified, and it is doubtful whether better results would not be ob tained if the plan of county support of individual patients were entirely abandoned. Similar hospitals erected and endowed by private philanthropy, making special provi sion for those who can afford to pay small sums for main tenance, would admirably supplement this action of the state.