History of the Pennsylvania Society PRESIDENT'S ADDRESS After fourteen years of existence it appeared to me that a short retrospect of what the Society has been doing was justified. The Pennsylvania Society for the Prevention of Tubercu- losis, the oldest society of its kind in the world, was organized by Dr. Lawrence F. Flick for the purpose of bringing together physicians and laymen in a campaign against tuberculosis. The meeting of organization was held in Dr. Flick's office at 736 Pine Street, April 22d, 1892. There were about twenty-five people, mostly laymen, at the first meeting. Among these we have the names of Dr. Flick, Dr. Benj. Lee, Mr. E. Leslie Gilliams, Mr. Jules Junker, Mr. Jas. L. Stanton, Miss Caroline Farr, Miss M. T. Green and Miss Anna F. Devereaux. Quite a number of people apparently interested in the move- ment from the tone of their letters, sent regrets at their inability to be present at this first meeting, but joined the society and became active members later. Among these may be mentioned Mr. J. V. P. Turner of the Board of Health, Dr. Chas. S. Turn- bull, Dr. J. C. Wilson, Dr. John H. Musser, Dr. Edw. Nolan, Dr. Judson Daland, Dr. A. H. Davisson, Mr. Samuel Castner, Mr. Joseph Engel and Mrs. Richard P. White. At this first meeting it was decided to organize, and a list of officers was nominated. The first annual meeting of the society took place at 736 Pine Street, May 6th, 1892, and the following officers were elected: President, Dr. Lawrence F. Flick; Vice-President, Mr. Samuel Castner; Treasurer, Dr. Judson Daland; Recording Secretary, Mr. E. Leslie Gilliams. At this meeting the work of the Society was outlined to be the Prevention of Tuberculosis, first, by promulgating the doc- trine of the contagiousness of the disease; second, by instructing the public in the practical methods of avoidance and prevention; third, by visiting the tuberculous poor and supplying them with the necessary materials for protecting themselves against the disease, and instructing them in their use; fourth, by furnishing 3 the tuberculous poor with hospital treatment; fifth, by cooper- ating with Boards of Health in such measures as they might adopt for the prevention of the disease; sixth, by advocating the enactment of appropriate laws for the prevention of the disease. It was decided to issue tracts for the education of the public in the prevention of tuberculosis, and a committee on printing and literature was appointed, with Dr. Benj. Lee as chairman and Dr. J. C. Wilson and Dr. Judson Daland as members. The necessity for legislation relative to the registration of tuberculosis as a communicable disease and relative to the pernicious habit of spitting in public places was recognized, and a committee on legislation was appointed. The need of greater hospital facilities for both early and advanced cases as well as the necessity for means to help the poor at home was discussed and a committee on hospitals and practical aid was appointed. Finally a committee was appointed to wait on the Board of Health in order to secure its cooperation with all these measures. At the committee meeting on printing and literature, May 17th, 1892, Dr. Flick was appointed a committee of one to write three tracts on " How to Avoid Contracting Tuberculosis," " How Consumptives can avoid Giving the Disease to Others" and " In- structions on Disinfection of Sputum, Bed Clothes, Houses, etc." The tract on " How to Avoid Contracting Tuberculosis" was at once written and distribution of it begun about September 1st, 1892. The second tract was published about November, 1892. These tracts were sent to various Boards of Health, Labor Unions, etc., and were put in a certain number of drug stores for distribution. On July 5th, 1892, Dr. E. L. Trudeau, of Saranac Lake, became a member. Early in the first year the Constitution and By-Laws were adopted. "Article V, Expenditures," reading: "Section 1. At each regular meeting of the Board of Directors all money in the treasury beyond that which is necessary for defraying the gen- eral expenses until the next regular meeting of the Board shall be set aside to be used as a Hospital Fund. Section 2. When the money in the Hospital Fund shall amount to $150 or more, a tuberculosis patient shall be placed in a hospital for every $150 in the Fund," was adopted at this time, and in order to make this article at once operative, Mr. Jules Junker, an active interested 4 member of the Society, generously subscribed the amount neces- sary to put the Society in a position of caring for a tuberculous patient. On January 25th, 1893, a public meeting of the Society was held in the New Century Club, and was addressed by Dr. Law- rence F. Flick, Dr. Judson Daland and Mr. E. Leslie Gilliams. A resolution offered by Dr. E. O. Shakespeare urging upon the State Legislature the necessity of the early enactment of laws to prevent the sale of meat and milk from animals affected with tuberculosis, was unanimously adopted. This resolution followed by continuous activity on the part of the Society led to the enactment of the various meat and milk laws and eventually to the establishment, in 1895, of the State Live-Stock Sanitary Board, composed of the Governor, the Sec- retary of Agriculture, a Dairy and Food Commissioner and the State Veterinarian. From the time of the establishment of the office till the present time the State Veterinarian, Dr. Leonard Pearson, has been an active member of the Pennsylvania Society, The second annual meeting of the Society was held Friday, May 5th, at 4.30 p.m., at the Chinese Guild Room. N. E. Cor. Thirteenth and Market Streets. At this time there were over one hundred members in the Society. In April, 1893, the Pennsylvania Society began its efforts to have tuberculosis placed on the registry list of the Board of Health. This movement was actively seconded by Major Veale, at that time Health Officer of the City of Philadelphia. At the second annual meeting a committee of five was appointed to cooperate with the Board of Health. In the Fall of 1893, through the activity of the President of the Pennsylvania Society, the American Public Health Association and the Pan-American Medi- cal Congress passed resolutions endorsing the registration of tuberculosis. In September, 1893, the following resolutions were adopted by the Philadelphia County Medical Society through the efforts of the Pennsylvania Society: Whereas, It has been clearly demonstrated that tuberculosis is con- tagious and, therefore, a preventable disease, and Whereas, The first and one of the most important steps in the pre- vention of disease is to have all cases properly registered, and Whereas, According to the present knowledge about the disease, pre- ventive measures can bring neither distress nor hardship to those who 5 suffer from it nor to their friends, but, on the contrary, must bring great relief and comfort; therefore, be it Resolved, That we heartily recommend to the Board of Health of the City of Philadelphia that Tuberculosis be placed on the list of diseases to be returned to the Board of Health. Resolved, That a committee of five be appointed to wait on the Board of Health and urge upon it the adoption of a rule to this effect • The following were appointed members of this committee: Drs. L. F. Flick, chairman, J. C. Wilson, Ernest Laplace, J. William White and John B. Roberts. On January 12th, 1894, after the Board of Health and the County Medical Society and the Pathological Society all had voted for the registration of tuberculosis, the matter was brought before the College of Physicians and through its influence pre- vented. Though Philadelphia was the first city in the country to actively discuss registration, it was one of the last of the large cities to adopt it. Registration of tuberculosis was adopted in 1904. Following the arguments used for registration in Philadel- phia. the Ohio State Board of Health took up the subject of registration, February, 1894. The same year, 1894, New York passed a compulsory registration act. The tract entitled " How Hotel-Keepers Can Aid in Pre- venting the Spread of Tuberculosis" was published in November, 1893. The following letter and resolution explain themselves: Commonwealth of Pennsylvania, State Board of Health, Executive Office, Philadelphia, May 23d, 1894. To the Society for the Prevention of Tuberculosis, Philadelphia, Pa. Sir: I am instructed by the State Board of Health and Vital Statistics of the Commonwealth of Pennsylvania, to transmit to your honorable body a copy of the following resolution adopted at a regular meeting held at Lancaster. May 10th, 1894. Very respectfully, (Signed) Benjamin Lee, M.D., Secretary and Executive Officer. RESOLUTION. Resolved, That the earnest and judicious efforts of the " Pennsylvania Society for the Prevention of Tuberculosis" to disseminate information 6 among all classes of society, as to the communicability of consumption, and to introduce measures to limit the spread of this infection, deserve the warmest commendation of this Board, and that we recommend all persons who take an intelligent interest in the preservation of the public health throughout the State to become members of the same. In May, 1894, the Academy of Natural Sciences graciously granted the request of the Pennsylvania Society to meet in its Council Room twice each month. In December, 1894, the movement for incorporation of the Society was begun by Dr. Samuel G. Dixon, and the Society was incorporated in 1895. Vigorous efforts were made during the winter of 1894 and 1895 to secure the establishment in Philadelphia of a municipal hospital for the tuberculous poor. On December nth, 1894, a committee composed of Dr. Samuel Dixon, chairman, Dr. Benj. Lee, Major Veale, Mr. Chas. M. Lea, Dr. Howard S. Anders and Dr. Lawrence F. Flick went before the Finance Committee of Philadelphia Councils asking for $100,000 for hospital accommodation for the consumptive poor, this money to be expended as councils saw fit. A committee of the Society also visited Harrisburg to urge the necessary State legislation for the establishment of a state sanatorium for tuberculosis, to be located at a favorable elevation in the mountainous portion of the State. In 1896 and 1897 effort was again made towards the pro- curing of the greatly needed municipal hospital and a sanatorium. At the solicitation of the Pennsylvania Society, in 1894, the State Board of Charities had recommended an appropriation of $50,000 for a state sanatorium, though the Board of Charities was not favorable to the state sanatorium idea. The State Board of Charities suggested that it would be better to inaugurate a sanatorium by private subscription, under the auspices of a tuberculosis society and solicit the State for aid, instead of asking the State to build the sanatorium outright. Following this suggestion of the State Board of Charities, the Society held a special meeting, December 1st, 1896, and decided to establish a sanatorium under its own auspices, called the " Pennsylvania Sanatorium for Pulmonary Diseases," and a com- mittee was appointed to report on a suitable site. This committee, composed of Dr. L. F. Flick, Dr. Benj. Lee, Dr. J. Solis-Cohen, Dr. S. A. Knopf and Dr. Guy Hinsdale, 7 visited White Haven, Glen Summit, Bear Creek and neighboring localities, under the guidance of Dr. S. W. Trimmer and Mr. S. S. Staples, and chose White Haven as the most desirable location. The White Haven tract was offered free of expense to the Society, on the condition that funds be raised for the building and equipment of the institution. The matter was brought to the notice of the State Board of Charities and that body recommended an appropriation of $30,000, provided a like amount could be raised by private subscription. Comparatively little had been raised by the time the Legislature met, and the committee on appropriation of the Legislature reported the bill introduced by the Pennsylvania Society negatively. Again, in 1898, at the instigation of the Pennsylvania Society, the State Board of Charities endorsed an appropriation of $150,- 000 for a state sanatorium, but the State Legislature refused to pass it. Later on in the same year an endeavor was made to combine various medical societies in order to erect a state sana- torium, but unsuccessfully. Apart from the committee the mem- bers of the Society who were actively interested in this sana- torium movement were Dr. H. S. Anders, Dr. A. H. Davisson, Mr. Chas. M. Lea, Mrs. Wm. F. Jenks, Miss Anna F. Devereaux, Miss E. W. Redfield, Miss M. E. B. Hampton and Miss Emma Carroll. Up to 1895, tracts were distributed as follows: Namely, 50,- 000 of tract No. I, entitled " How to Avoid Contracting Tuber- culosis 40,000 of the second, entitled " How Persons Suffering from Tuberculosis Can Avoid Giving the Disease to Others and 10,000 of the third, entitled " How Hotel-Keepers Can Aid in Preventing the Spread of Tuberculosis." This tract was sent to all the principal hotels in the United States. Letters in the archives of the Society show that Boards of Health in almost every State in the Union, physicians in all parts of the South and West, in various parts of Canada, and even so far as the Hawaiian Islands, made application for these tracts. Tract No. 4, " How Storekeepers and Manufacturers Can Help to Prevent the Spread of Tuberculosis," was published in 1897. By this time 70,000 of the earlier tracts has been reprinted and circulated. At the meeting in March, 1896, Dr. H. S. Anders brought forward a resolution relative to the danger from promiscuous spitting and asking that the Board of Health of Philadelphia 8 consider the advisability of issuing circulars or public notices warning against this uncleanly, unnecessary and unhealthy prac- tice. The following month the Board of Health published the tract called " The Spitting Habit" and widely distributed it. Moreover, a sign forbidding spitting on the floor was placed in every street car. At the eighth annual meeting held April, 26th, 1899, Dr. Guy Hinsdale was elected President. In 1898 Dr. S. A. Knopf, one of our most active members, was awarded the Alvarenga prize of the College of Physicians of Philadelphia for his text-book on Pulmonary Tuberculosis; in 1901 he was awarded the first prize of $1000 for his essay, " Tuberculosis as a Disease of the Masses, and How to Combat It," by the International Congress for the Combating of Tuber- culosis as a Disease of the Masses. The first hundred dollars subscribed for the sanatorium under the auspices of the Pennsyl- vania Society was from Dr. and Mrs. Knopf and when the sana- torium idea was abandoned the money was transferred with the consent of the donors and the Pennsylvania Society to the Free Hospital for Poor Consumptives. On December 13th, 1899, The Commonwealth Title In- surance and Trust Company was made Treasurer. Previous to this time Mrs. Wm. F. Jenks had been Treasurer. Her resigna- tion was received with regret and a vote of thanks tendered for her efficient services. A joint meeting of the Philadelphia County Medical Society and the Pennsylvania Society for the Prevention of Tuberculosis was held at the New Century Drawing Room on the evening of Wednesday, January 10th, 1900. The following men spoke: Dr. L. F. Flick, Dr. J. C. Wilson, Hon. W. N. Ashman, Dr. H. S. Anders, Rev. Chas. Dickey, Dr. Guy Hinsdale and Dr. E. O. Otis (Boston). The seal of the Society was adopted in September, 1900. Tract No. 5, entitled " Predisposing Causes of Tuberculosis and How to Avoid or Overcome Them," was printed in 1899. Tract No. 6, entitled " Registration of Tuberculosis," was printed in 1901. These first six tracts were written by Dr. L. F. Flick. In 1901 Dr. M. P. Ravenel represented the Society at the British Congress on Tuberculosis. At this meeting Dr. Koch made the statement that tuberculosis was not transmissible from cattle to man. Though this opinion was almost universally dis- 9 agreed with, our representative brought forward practically the only proofs against it. In 1901 effort was made to have the City Council consider the erection of a hospital for consumptives on the city farm at Roxborough. In 1902 the City authorities took up the building of the tuberculosis pavilions at the Philadelphia Hospital. At the annual meeting, in 1902, Dr. Howard S. Anders was elected President. During the three years (1902 to 1905) of his administration there were three lines agitated and especially emphasized: (a) State control of tuberculosis by means of sanatoria for the con- sumptive poor on the forestry reserve; (b) abatement of the dust evil by better methods of street cleaning and sprinkling, car cleaning and removal of plush cushions from the cars; (c) more efficient anti-spitting ordinances and provisions for their enforce- ment. The first of these met with progressive success up to the point of legislative action and interest; the second in spasmodic beginnings of reform in street cleaning, but the entire abolition of the dirty cushions and simultaneous installation of electric car heaters ; the third in better ordinances and some slight general diminution in careless spitting in public places because of the publicity, but total disregard of consistent efforts at enforcement. In 1904 Dr. Samuel G. Dixon, President of the Academy of Natural Sciences and one of the most active members of the Pennsylvania Society, was made State Commissioner of Health. During the past year three new tracts have been published. No. 7, " Disinfection of Private Houses Following Consumption;" No. 8, " On Spitting," and No. 9, " Plain Facts about Tuber- culosis." In October the International Congress on Tuberculosis took place in Paris, at which we had five delegates, all reading papers. There were fourteen delegates from the United States, and through their efforts backed by the National Association for the Study and Prevention of Tuberculosis the next International Congress on Tuberculosis meets at Washington in 1908. In addition we have had a very successful tuberculosis exhi- bition, which was open for two weeks and was visited by 58,000 people. It was held under the auspices of the National Associa- tion for the Study and Prevention of Tuberculosis and the Penn- 10 sylvania Society. The majority of the exhibits were originally collected by the National Association. This exhibition was in- strumental in educating the people along the lines advocated by the Society. Under its auspices the Society distributed about 60,000 tracts and gave twenty-six lectures, many of which were published in the newspapers. This exhibition was made possible by the generous donations of our friends, most of which were subscribed through the activity of Rev. H. L. Duhring, D.D. At the time the Society was founded there were only three consumptive hospitals in the State; the House of Mercy, 411 Spruce Street (1876), with 12 beds; the Hospital for Diseases of the Lungs, Chestnut Hill (1876), with 40 beds, and the Rush Hospital (1892), with 40 beds; altogether, 92 beds. Since then have been established the Lucien Moss Home, Jewish Hospital (1900), with 39 beds; White Haven Sana- torium of the Free Hospital for Poor Consumptives (1901), with 172 beds; Country Branch of the Rush Hospital at Malvern (1903), with 25 beds; South Mountain Camp Sanatorium at Mt. Alto (1903), with 38 beds; the pavilions of the Philadelphia General Hospital (1903), with 252 beds; the Henry Phipps Institute (1903), with 52 beds; West Mountain Sanatorium at Scranton (1903), with 24 beds; Grand View Institution at Oil City (1905), with 32 beds, and Reading Sanatorium and Pitts- burgh Sanatorium which though started have as yet no definite number of beds; altogether 634 beds additional. Starting with one tuberculosis dispensary in 1892, namely, the Rush Hospital Dispensary, we have to-day six, namely, the Rush, the Henry Phipps Institute, the Scranton, the University of Pennsylvania, the Kensington and the Philadelphia Clinic. In 1892 there was no private sanatorium in the State, we have now Sunnyrest at White Haven with 75 beds, Fern Cliff at White Haven with 30 beds, Dermady at Morton with 35 beds, Mountain Side at Mt. Alto with 20 beds, the Orchards at White Haven with 4 beds, the Radnor-Wayne at Wayne with 20 beds; altogether 184 beds. The total number of beds, therefore, in the State for consumptives is 911. Before the foundation of these sanatoria the Pennsylvania Society was strong in its advocacy of a state sanatorium, but the authorities of the State never passed the necessary legislation. Though the state sanatorium may remain in the minds of many as the ideal method, under ideal political conditions, of 11 handling the poor consumptive, we cannot help but see to-day, under actual political conditions, objections to a state sanatorium. These objections are manifest from a study of the States in which sanatoria have been attempted. In our own Middle States we have the example of a State Legislature voting $350,000 for a state sanatorium and the money lying idle for three years because there are no men to take up the work. We have another one of our Middle States with a number of institutions run by private subscription magnificently managed and a credit to the country, and in the same State a State Institu- tion which, though small, has never yet had its full quota of patients, on account of the general political mismanagement. Again we have a state standing out on account of the ad- vanced education of its inhabitants to which we expected to look up forever as managing ideally its state sanatorium, only to find during the past year that the medical men and the political Board of Management have never been quite in harmony with the result of an eventual necessary break. Other objections to a state sanatorium are that no matter how large the sanatorium a state might establish, it would not be large enough to take care of all the consumptives, and the fact that the State possesses such a sanatorium furnishes an argument to private subscribers against subscription for other sanatoria on the plea that they are already supporting through taxation the state sanatorium. Secondly, one of the principal purposes of sanatoria is the education of the people. This is accomplished better by the dis- tribution of sanatoria throughout the State than by one or two large state sanatoria; in addition, the agitation necessary to pro- cure private subscription necessarily results in a certain amount of education that would be lost in the case of a state sanatorium. Moreover, the Pennsylvania Society is now facing not a theory but a fact. We have twelve public hospitals and sanatoria scattered throughout the State. These hospitals and sanatoria are well managed and cater more to the individual wants of the communities in which they are than would a single state sana- torium. It appears to me, therefore, that the Pennsylvania Society has an evident duty in supporting them by every means in its power. Before the Society was founded the Eastern Penitentiary was pointed out as the example of the influence of solitary con- 12 finement on tuberculosis. Through the activity of one of our members, Dr. W. D. Robinson, this has been changed and the horrible example no longer exists. This short sketch tells some of what has been done under the influence of the Society; there is, however, much left unmen- tioned, namely, the number of societies throughout the country and throughout the world founded on the model of the Pennsyl- vania Society and the good they have accomplished, the number of lives saved by the education derived from tracts, and the num- ber of patients encouraged. These things can never be told. The work the Society has been doing in the past in the various ways looking to the prevention of tuberculosis will be continued this year. In addition we would like to see a tuber- culosis dispensary on the order of those existing in some of the large cities of the United States and inaugurated in Scotland, France and Germany established in every city of 10,000 inhabi- tants in Pennsylvania. These dispensaries look not only to the treatment of the patient in the dispensary but to the thorough investigation of the case in his home, and the improvement of the home surroundings and conditions in whatever way necessary for the cure of the individual and the prevention of further contagion. From experience both here and abroad these dispensaries are the most important element in the crusade against tuberculo- sis, and it is through the combined efforts of these and sanatoria that control of the tuberculosis situation will be established. Joseph Walsh, M.D. 13