health officers, and in no case will visits be made to such persons by public officials, nor will any public sanitary surveillance of such patients be assumed, unless the patient resides in a tenement-house, boarding-house or hotel, or unless the attending physician requests that an inspection be made of the premises, and in no case where the person resides in a tenement-house, boarding-house or hotel, if the physician requests that no visits be made by inspectors, and is willing himself to deliver circular of information or furnish such equivalent information as is required to prevent the extension of the disease to others.

2. When a local health officer obtains knowledge of the existence of cases of pulmonary tuberculosis residing in tenement-houses, boarding-houses or hotels, unless the case has been reported by a physician, and the latter requests that no visits be made, inspectors, will visit the premises and family, will leave circulars of information and instruct the person suffering from consumption and the family concerning the measures which should be taken to guard against the spread of the disease; and, if it be considered necessary, will make such recommendations for the cleaning or renovation of the apartment as may be required to render it free from contagion.

3. In all cases where it comes to the knowledge of a local health officer that premises which have been occupied by consumptives have been vacated by death or removal, an inspector will visit the premises and direct the removal of infected articles, such as carpets, rugs, bedding, etc., for disinfection, and will make such written recommendations to his immediate superior, concerning the cleaning and renovation of the apartment as may be required. An order embodying these recommendations will then be issued to the owner of the premises and compliance with this order will be enforced for sanitary reasons. No other persons than those there residing at the time will be allowed to occupy such apartments until the order of the health officer has been complied with.

4. The authorities of all public institutions under the jurisdictions of the State department of health, such as hospitals, dispensaries, asylums, prisons, homes, etc., shall be required to furnish to the Department of Health of the State of Missiouri the names and last addresses of every consumptive coming under observation, within seven days of such time. And all cases that remain in above institutions must be kept

Fig. 36. Compression of foot by new stocking.

Fig. 37. Compression of same foot by same stocking worn and washed a number of times. Solid lines show outlines of naked feet; dotted lines show outlines over stocking.

Fig. 38. Range of expansion of average adult feet. Solid lines show outlines of feet in repose; dotted ones, outlines of feet bearing body weight. Fig. 39. Outlines of average feet and foot-wear. Solid lines show outlines of feet; dotted ones, outlines of shoes worn on these feet.

in wards or rooms by themselves, and those uncured leaving the institutions must give home address, and State Board of Health be notified of the same.

The State should be sponsor and distributor for literature teaching the public the following: The public must be taught that consumption is contagious-in what way and to what extent. Consumption is not a contagion as compared to other diseases, which are rapidly so; but it is slow but none the less sure; and comparing smallpox and consumption, we can say where it takes but moments to contract the one, it takes weeks, months, and even years to acquire the other; and while it takes but days for smallpox to run its course it takes months and years for consumption; and comparing their duration one is nearly as intensely contagious as the other. They must be impressed with the fact that the danger lies in the necrosed tissue, that is spat from the lung of their fellows, and that the tissue is divided and sub-divided until it becomes dust, many particles of this dust containing germs, and until this is devitalized there is danger. Also they must be taught that 50 per cent of all new cases of consumption are caused by family relationship implantations, 25 per cent to house contamination, 15 per cent to clothing and utensils contamination, and only 10 per cent to other causes such as occasional contact or breathing sputum dust of the street public conveyances, etc. We must also advise them how to avoid these different sources of contagion. To do this all consumptives must know the name and nature of the disease. A number of people both lay and professional will say, that it is unnecessary and even cruel to pronounce one suffering from an incurable disease. It has been my experience that by far the best course to pursue is to inform the patient of the nature of his disease. It may at first be a shock and a source of mental suffering and anxiety, but the ultimate effect will be for the patients best good. The patient will observe the rules laid down for his own recovery, and the precautions necessary to prevent the reinfection of himself and the infection of others. Knowing his disease, you can induce him to adopt the radical changes in his mode of living, which will tend to his own recovery. But granting that it does cause the patient some mental anxiety and suffering, can it be maintained that this is better than bringing suffering, disease and death to many others, and the reinfection of himself without a chance of his recovery. All the possible harm

it can do the individual, if he is in the incurable stage is to render the few remaining months of his life a little less comfortable. After making it plain to the public that the germ is the cause of the disease, and that this germ must and does come from the sick to the well one, and this germ does not stop on the way to rear its family, but in the language of the day, it lays dead until wafted by some favorable circumstance to its new home, there it raises its family and sends them forth to populate the earth with the one sure cause of the great white plague. We must inform them of the ways by which they may avoid this parasite (family relationship):

1. By the absolute destruction or devitalization of all matter given off from the lungs of the sick one. This can be best accomplished by antiseptics and fire.

2. A high degree of personal cleanliness of the patient himself.

3. A sleeping room occupied only by the patient into which sunshine and air can enter freely.

House contamination is easily controlled, and must be carried out by a conscientious physician or a responsible health officer. Absolute cleanliness is the only safeguard, and houses in which consumptives have lived must be disinfected until the germs are all destroyed. This cause of contagion can by proper disinfection be entirely eliminated in the next few years, food, clothing, and utensils contamination must be trusted to our patient, guided by his physician The contagion from sputum dust contact, etc. can be nearly if not quite done away with by having rules in all places where consumptives are employed, requiring them to properly care for and destroy their sputa. Ordinances have been passed in many cities of this State forbidding spitting in pulic places, which in my opinion can not and are not enforced, for very few Americans can be made to swallow their own sputum. The harm from tuberculous spit in public places comes from depositing it in dark and out of the way places where it is not devitalized, and becomes germ-spreading dust. The State, in the larger cities. where the harm is done, should compel these municipalities to provide spittoons on their streets flushed with running water where the spitters can be compelled to deposite their excreta as they are compelled to deposit other body excretions. Is there any valid reason why the State can not pass this law compelling the reporting and registration of all consumptive