,,treasury ,,department ,public ,health and ,marine-,hospital ,service of the ,united ,states ,a ,,working ,,plan ,,for ,,colored ,,antituberculosis ,,leagues ,,by ,c4 ,p4 ,,wertenbaker ,surgeon1 ,united ,states ,public ,health and ,marine-,hospital ,service ,illustration ,,washington ,,government ,,printing ,,office #aiji ,a ,,working ,,plan ,,for ,,colored ,,antituberculosis ,,leagues4 ,reprint ,no4 #ci1 from the ,public ,health ,reports1 ,vol4 ,,xxiv1 ,no4 #cf1 ,september #c1 #aiji4 ,by ,c4 ,p4 ,,wertenbaker1 ,surgeon1 ,united ,states ,public ,health and ,marine-,hospital ,service4 ,there was published in the ,public ,health ,reports of ,may #bh1 #aiji1 ,volume ,,xxiv1 ,no4 #bb1 a plan for the organization of colored antituberculosis leagues1 which contemplated the organization of a league in each ,state1 with a branch in every colored church4 ,experience has shown that after such leagues are formed difficulty arises in getting to work in an effective way1 because the work is new in character and those engaged in it have had but little1 if any1 experience4 ,it is to meet this difficulty and supply a practical guide for the work of the leagues that this is written4 ,,organization ,,of ,a ,,state ,,league4 ,the object of the state league is to organize the church leagues1 to bind them together and render more effective their work4 ,the caring for patients and work of a similar character are properly the function of the church leagues4 ,there need be but little ceremony in organizing a state league4 ,a few leading colored men and women1 preferably from different parts of the ,state1 but not necessarily so1 meet and proceed to organize the state league4 ,the constitution and by-laws for state leagues should be adopted1 followed by the election of a president1 a secretary1 and a treasurer4 ,it is desirable that the constitution and by-laws recommended in 8,the ,plan0 be adopted in all essential particulars1 so that there will be uniformity in organization and work4 ,they have been adopted in all the ,states that have organized thus far1 and it is believed future organizations should also adopt them4 ,the president then appoints a committee1 the president and secretary being members of it1 to select a vice-president for each county in the ,state4 7,the plan contemplates that there shall be a vice-president for each county1 whose duty it is to organize a branch league in each colored church in the county47 ,the selection of the county vice-presidents should be made with a good deal of care4 ,suitable persons who will actively carry on the work should be chosen for these positions4 ,the vice-presidents should be authorized to appoint one or more representatives in each community to help them organize the leagues in the churches and arouse interest in the work4 ,it can not be impressed too strongly on the vice-presidents that the success of the church leagues in their districts will depend upon the amount of attention given the work4 ,the organization of a branch league in a church is merely the starting point2 the real work is done after the organization is completed4 ,the president and secretary of the state league should call for regular reports from the county vice-presidents1 showing the number of church leagues in their respective counties and a statement of the work done in each4 ,if any of the church leagues are not prospering1 the president or the secretary of the state league should visit or write to them and learn what is the trouble1 and give needed advice and encouragement4 ,officers of the state league should consult frequently and freely with their state board of health and enlist its sympathy and aid in their work4 ,the closer the leagues keep in touch with the health authorities the better will be the results obtained4 ,both the state and local health officers will be glad to give their best efforts to help along this work4 ,they are in a position to do a great deal to assist both state and church leagues1 and the leagues should work in harmony with them4 ,,church ,,branch ,,leagues4 ,organization4--,in order that the members of the church in which it is proposed to organize the branch league may understand thoroughly the objects of the league1 the minister or other competent person should explain clearly the purpose of the league and what it is expected to accomplish4 ,he should inform them that relatively many more colored people die of consumption than white people2 that very few colored people get well of the disease1 partly because they do not know how to take care of themselves and partly because many neglect to do so2 and that the object of the league is to teach the well how to preserve their health and prevent their contracting consumption and other diseases1 and the sick how to regain their health4 ,if too poor to take the necessary treatment1 it is the purpose of the league to help its members to do so4 ,after the foregoing has been thoroughly explained1 the church branch of the state league should be formed by the adoption of the constitution and by-laws given for church leagues in the plan of organization published in the ,public ,health ,reports of ,may #bh1 #aiji4 ,after this has been done1 the officers required by the by-laws should be elected4 ,the secretary then takes the name and address of each of the members1 and as soon as a member has paid his dues he is given the certificate of membership1 properly filled out1 and signed by the president and secretary of the church league4 ,the certificate of membership given to each person joining the league has printed on it information and instructions which1 if followed1 will tend to protect the individual from consumption4 ,an attempt has been made to make the certificate large and attractive1 and it is expected that the members will value it to such an extent that they will frame and hang it in a prominent place in the home1 where it can be frequently seen1 and that the sanitary maxims that it contains will be learned and followed4 ,in organizing the church league it is well to have a number of the certificates on hand to supply the members as soon as they pay their dues4 ,the form of the certificate will be found in the plan of organization for these leagues4 ,the certificate can be printed at a local printing office1 but if this is not practicable1 or it is preferred to buy them1 very handsome certificates printed in black and red1 with a large red seal1 and the name of the state and church branch league1 can be bought for about #f cents each1 by the hundred4 ,the amount of the annual dues to be paid by each member can be changed by each league to suit the necessities of the community4 ,the dues should be so small that no one will be kept out of the league by not being able to pay them4 ,however1 as the dues will be the chief source of revenue with which the league expects to do its work1 they should not be made smaller than is actually necessary4 ,the money paid into the league as dues goes to form a fund that is disbursed by the church league collecting it to help those of its members who contract consumption4 ,how much this help will be will depend upon the amount of money the league has at its disposal and the needs of the individual4 ,but whether this help is much or little the having the certificate of membership and belonging to the league will give information that will teach one to protect himself and his family from disease4 ,this means less sickness1 consequently less loss of time from work1 therefore more money1 more comforts1 and more happiness for all concerned4 ,the vice-presidents and organizers should see that the four standing committees required by the by-laws of the church leagues are promptly appointed and that they understand their duties4 ,as the work of each church league will at first consist largely of educating its members as to the cause of tuberculosis and the way to live to keep from getting it1 the committees1 and especially the ones having charge of 8sick10 8sanitation20 and 8information0 should be especially active4 ,they should learn all that is possible about their respective subjects so that they can teach the other members4 ,in joining the church league one also becomes a member of the ,state ,colored ,antituberculosis ,league4 ,members of the state league and church branch leagues wear a button showing their connection with the leagues4 ,membership4--,membership in the church leagues should not be confined to the members of the church organizing the league4 ,as a rule it is better that the members of each church join their own church league1 but if for any reason their church has no league there should be no objection to their joining the league of some other church4 ,those who are not members of any church should also be allowed to join the league4 ,details of the work of a church league4--,as soon as the church league is organized the president should appoint the four standing committees required by the by-laws to serve for one year1 viz3 8,finance10 8,information10 8,sick10 and 8,sanitation40 ,the details of the work to be done may then be considered4 ,one of the first of these is to ascertain how many of the members have or are suspected of having tuberculosis4 ,this duty devolves upon the committee on the sick1 which should get from the secretary a list of the members1 giving the name and address of each4 ,this list should be gone over and every member carefully considered4 ,it is probable that the greater number of the members are personally known to the committee1 and thus it can be told at once whether they are sick or well4 ,the committee is not expected to decide whether these members have tuberculosis4 ,their duty is to make out the list of the sick and ailing4 ,the physician will decide the nature of the sickness4 ,it is desirable to find cases of consumption in the earliest stages1 for these may be cured1 and if all members who are not strong and healthy are examined by the physician it is possible that cases of early consumption will be found4 ,each ailing member should be visited by some of the committee and more careful inquiry made as to the nature of the trouble and the member urged to go to a physician or a dispensary for examination4 ,this is especially true if the member has been losing flesh1 or has had a cough for some time1 or has throat trouble1 or is sickly and frail4 ,if upon examination the physician finds that the member has consumption1 the patient should get a certificate stating that fact4 ,the physician will also tell the patient what treatment is necessary4 ,the certificate will be presented to the committee by the patient1 and the committee will make more careful inquiry into the condition of the patient1 the treatment considered necessary by the physician1 the patient's means1 the number of people he has depending upon him1 etc41 so that the facts may be presented to the executive board in accordance with the requirements of ,article ,,vii of the by-laws4 ,the list of the sick should be most carefully guarded and no one allowed to see it but the officers of the league and the health officers4 ,this knowledge should be regarded as a sacred confidence that should not be divulged except to the persons mentioned above1 as many might object to having it known that they have tuberculosis4 ,under no circumstances should the list be allowed to fall into the hands of 8patent medicine0 concerns which might urge their nostrums on the patients1 much to their annoyance and also to their detriment1 if they become induced to take the 8patent medicines40 ,the measures necessary for the treatment of a patient who has tuberculosis must be determined by the physician1 but it is the duty of the executive board to decide how much and what kind of help the league can give the patient in carrying out this treatment4 ,it is not proposed to discuss here the question of treatment in a sanatorium which is the ideal way of handling all cases of tuberculosis1 for in a sanatorium the sick cease to be a menace to the community and can be under supervision and treatment all the time4 ,unfortunately1 at present sanatoria are not available for the great mass of the people2 and even if they were1 many would be unable to go to them4 ,there is a class of patients who have to depend upon their daily labor for the support of themselves and their families4 ,if they stop work1 their support is cut off4 ,for such as these treatment in a sanatorium is out of the question1 and any treatment they can get must be given in their homes and frequently while they are working4 ,to this class belong the great majority of the negroes2 therefore the work of the church leagues must be directed to such help as can be given under these circumstances4 ,what is necessary in each case will depend upon the condition of the patient1 the stage of the disease1 and the financial circumstances of the individual4 ,for the purposes of the league1 consumptives may be divided into three classes3 ,first4 ,the patients who are in the earlier stages of the disease and are able to go about their work while taking treatment4 ,second4 ,cases in which it is necessary to stop work and remain quiet if they are to get well4 ,third4 ,cases in which the disease has progressed so far that it is hopeless to attempt a cure1 but for which much can be done to make the patients comfortable and prevent them from scattering the germs of the disease4 ,as stated above1 what is necessary in each case will depend upon the condition of the patient and his surroundings4 ,much also depends upon the means the league has at its disposal to help the individual4 ,most church leagues find that they have very little money2 therefore the help given must be limited4 ,however1 there are certain things that can be done even by the poorest leagues4 ,information as to the way in which the disease is spread2 the means to prevent it2 what is necessary to get well if one has it1 etc41 is all printed on the certificate4 ,when the member gets the certificate and has learned all that is printed on it1 the first step has been taken in the education of the individual in regard to tuberculosis1 so it should be the aim of the officers of the leagues to get the certificates in the hands of the members4 ,the officers of the league can see that the instructions on the certificate are understood and carried out4 ,many individuals are careless and must be constantly watched to see that they do not neglect important precautions4 ,probably the most difficult thing the league will have to do will be to induce its members to keep their windows open and let fresh air and sunlight into their rooms4 ,the officers and committees of the league should urge the members to keep the windows of their rooms open1 especially at night1 and to avoid overcrowding their sleeping rooms4 ,whenever a dark room or closed window which should be open is found1 the danger should be pointed out1 and the member urged to correct it4 ,the practice of sleeping with the head and face covered is so deeply rooted in the negro race that it seems almost hopeless to attempt to eradicate it in the present generation4 ,it is a most pernicious habit4 ,the dangers of the practice should be pointed out1 and the members urged to abandon it4 ,children should not be allowed to contract the habit4 ,the careless spitting of consumptives in their homes is a practice dangerous to others4 ,the careless at times spit on the floor1 the walls1 the hearth of the open fire1 or on the stove if one is used4 ,the sputum of the consumptive dries and is carried into the air as dust4 ,this is drawn into the lungs when one breathes4 ,the dangers of this should be emphasized1 and the proper way to dispose of sputum shown4 ,the consumptive should catch all of his sputum and burn it4 ,there are cheap cups made of paper that can be had at small cost1 and these should be used to spit in1 and when they are full they should be burned4 ,the better cups have covers to them1 so that the flies can not get at the sputum4 ,while consumption is a dangerous disease1 the careful consumptive is not dangerous to live with4 ,the careless consumptive1 however1 is dangerous to live with and a menace to those around him4 ,the minister and the officers of the leagues should consult frequently with the health officer of their community4 ,working together they can accomplish much more than by working alone4 ,the minister and officers of the league can teach their people to be careful and not produce unsanitary conditions1 and the health officer can remedy conditions that the people can not correct4 ,the leagues should urge the members to beautify their homes1 no matter how humble they may be4 ,if the home is made more attractive1 interest in it will grow1 and an improvement in the sanitary conditions will naturally follow4 ,teach the members to have grass and flowers in their yards4 ,see that there is no dirt1 trash1 or litter scattered about2 that the loose paling of the fence is nailed on1 and the sagging gate has a new hinge4 ,pull the dirty rags from the broken window pane and burn them4 ,let them put their bed-clothing out in the sun occasionally1 and sweep the dust from under the bed and furniture4 ,open the window and door and let air and sunlight into the rooms4 ,all of these things tend to improve the sanitary conditions1 which means health and happiness4 ,members should be taught that remedies advertised as cures for consumption are not to be relied upon1 and that the only known way to get well is to live in the open air as much as possible1 both day and night1 and to eat nourishing food at regular intervals4 ,the consumptive when possible should go to a physician or a dispensary and follow exactly the instructions given4 ,aside from the help that can be given the individual consumptive1 which will be discussed later on1 there is much that the leagues can do by concerted action to improve the conditions under which the negro lives4 ,probably one of the most important factors in the spread of tuberculosis1 aside from his habits1 is the manner in which the negro is housed4 ,the negro as a rule is a renter4 ,the houses that he can rent are usually located in the poorest and most unhealthy part of the city4 ,they are often poorly constructed1 badly lighted and ventilated1 and frequently in bad repair4 ,the rooms are usually small and dark1 having but one window1 and the top sash is seldom arranged to be lowered4 ,many houses are built on poorly drained ground1 and water stands under them after each rain1 making the rooms damp and cold4 ,these houses are seldom provided with bathing arrangements or water-closets1 thus necessitating the use of privies1 or the back alleys1 with all the dangers attendant upon such conditions4 ,for such houses1 or more frequently for one or two rooms in such a house1 the negro pays proportionately more rent than the white race does for better houses in the same community1 either because better accommodations are not available1 or because he can not1 or will not1 pay for better4 ,the family1 usually consisting of father1 mother1 and several children1 and often friends or relatives1 all live1 eat1 and sleep in these two or three rooms1 frequently with the windows and doors tightly closed1 and in winter a stove going at full blast4 ,in the negro section of the city the streets are usually either badly paved or not paved at all4 ,the sidewalks are either in bad repair or missing4 ,the streets are badly lighted at night1 garbage cans are not emptied regularly1 and the scavenger service is poor4 8,there is a reason for these things10 say the landlords1 the municipal authorities1 and others who have dealings with the negro4 ,the landlord says3 8,negroes are destructive2 they pull down1 but they never improve property4 ,a house rented to negroes will depreciate from #be to #ej per cent in a year4 ,if you put in plumbing they break it1 they deface the walls1 they tear off the shutters and the doors1 they break and burn the fences4 ,it is useless to give them good houses as they neither appreciate them nor take care of them40 ,the municipal authorities say that negroes make no effort to keep their surroundings clean and sanitary4 ,they throw things into the street1 choke the plumbing1 drains1 and sewers with old rags1 trash1 and dirt1 and make no effort to help the authorities keep things in order2 therefore it is useless to try to help them until they learn to help themselves4 ,they say that there are exceptions to these statements1 but that they are true so far as the great mass of the negroes is concerned4 ,reference is made to the subject here to draw attention to the fact that the leagues can do much to change these conditions1 thereby bettering the condition of the race4 ,if the things that are said about the negro by the landlords1 the municipal authorities1 and others are true1 then it is necessary for the negro to change these conditions before there can be hope for much betterment4 ,if they are not true1 steps should be taken to convince the landlords1 municipal authorities1 and others that they are false4 ,it is in this way that the leagues1 though aimed at tuberculosis1 may be the means of bettering the conditions along many lines4 ,if the negro can demonstrate that he is not destructive1 and that he can and does take care of the house in which he lives2 if he will keep his surroundings neat and clean2 if he shows that he is clean and sanitary in his practices1 and that he feels his responsibility as a citizen by trying to keep up the sanitary conditions and the appearances of his home and his city1 he will find that many of his troubles will disappear4 ,if a landlord finds that his property is being cared for by his negro tenant1 the yard1 fences1 etc41 being kept in order1 the rent promptly paid1 and tenant is desirable1 he will be only too glad to keep him1 and to make such alterations in his house as he may desire4 ,if it is demonstrated to the municipal authorities that the negro is as careful of his section of the city as the whites1 his wants will receive consideration4 ,the educated negroes succeed in getting surroundings that are far better than those of the average because they have learned to appreciate the above facts1 and have put them into practice4 ,when the leagues have taught their members that it is not healthy to live in dark1 damp rooms1 with bad sanitary surroundings1 and have educated them to the point where they will refuse to live under such conditions1 then the landlords will build proper houses for them4 ,the leagues working in conjunction with the health officer can get the city authorities to so frame the building ordinances that only sanitary dwellings will be erected in the city4 ,what a church league can do for the individual consumptive4--,in addition to supplying the members of the league with information in regard to tuberculosis and sanitation1 which is the work of the committees1 and trying to induce the members to follow the instructions given them1 there are other things that the league can do for the individual consumptive4 ,the chief difficulty that will be encountered by the leagues is the lack of money to help their sick members4 ,it is hoped1 however1 that as the league demonstrates its value to the community more money will be available1 and the work of helping the sick members can be extended4 ,this work contemplates the 8class method0 of treating patients at their homes1 the establishment of dispensaries1 and ultimately sanatoria and 8tuberculosis farms10 where a patient can earn a living by working on the farm and at the same time be under medical supervision4 ,it is realized that these things are for the future1 but it is well to keep them in mind as one of the ultimate aims of the leagues4 ,now let us consider what can be done for the members who have consumption4 ,the league should buy a number of the paper spit cups mentioned above1 and distribute them to their consumptive members1 and urge their use4 ,these cups are cheap and therefore can be burned after being used4 ,if every consumptive can be induced to use these cups and then burn them much will be done toward stopping the spread of consumption4 ,whenever a case of consumption is discovered the officers of the league should apply to the health officer to disinfect the rooms occupied by the consumptive1 in order to protect the other people in the house from the disease4 ,then if the consumptive is careful he is not likely to reinfect them4 ,also when a consumptive dies the health officer should be asked to disinfect the rooms4 ,consumptives should spend most of their time out of doors1 and if possible should sleep on a porch1 or in a shed1 or tent4 ,all one needs is something to protect against the weather and keep off the rain and snow1 but let in a great deal of fresh air4 ,patients live out of doors all winter in the north1 with the thermometer below zero1 and many have been cured of consumption in this way1 including negroes4 ,the league may help to provide the shack1 shed1 or tent1 or it may furnish sleeping bags1 blankets1 etc41 and in this way help the patient4 ,if the patient is very poor it may be that the league can see that he gets proper food which he might not otherwise have4 ,the committees of the league will doubtless find many other means for helping the patient at small expense4 ,the minister in making his pastoral calls can be of the greatest help both to the patient and to the community by seeing that the patient is properly carrying out his instructions1 and that he has the proper facilities for doing so4 ,dispensary4--,as soon as the church league is formed1 some physician should be designated who will examine all members referred to him1 to decide if they have consumption4 ,usually there will be found one or more physicians who are members of the league1 who will probably act in this capacity4 ,if practicable a tuberculosis dispensary might be established at some convenient point1 possibly in one of the rooms in the church1 where the physicians could be found on certain days at stated hours1 say1 twice a week4 ,here they could see the consumptives1 and examine and advise them as to the treatment necessary4 ,they could also examine other members referred to them to decide whether they had consumption or not4 ,records of the dispensary work should be kept4 ,it is not practicable at this time to go more minutely into the details of the work of these leagues1 which are now in their formative stage4 ,the writer will be glad to lend any aid in his power to any state or church league that may desire it1 and all persons who are interested in this movement are invited to write to him1 expressing any views they may have for the advancement of the work4 ,he will be glad to have any aid1 advice1 or criticisms that may be offered4