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sputum. The students reacted still more and chewed and smoked more; 
more filth meant less care on the part of the patients. And so on, you can 
readily see this vicious circle. 
I myself soon reacted, I felt bad; fellow-students advised the use of 
tobacco. Instead I frequently bolted lectures and took open air vacations. 
While sitting on the benches I formulated a theory regarding my own ills 
and of those about me; I thought I saw why I felt bad and why I felt so well 
in the mountains a few years before, without having usual winter colds. 
IT saw too why the mountaineers are so healthy and live long in spite of aleohol 
and tobacco. In the course of time this theory was elaborated; a brief ac- 
count was given before this Academy in my paper on Coniosis, in 1911. 
The following year was spent in a smaller and comparatively clean 
medical college, and I got along very well. Next came observations on 
hospital and dispensary cases, noting the influence of enviornment: How 
poor people taken from the heart of the city promptly recover under good 
sanitary surroundings. I clearly saw that in order to reduce the ills of a 
city more hospitals was not the remedy—clean up and stay clean. 
Then came one or two minor periods, followed by a prolonged period of 
observation among the insane, especially at the Northern Indiana Hospital 
for Insane. Did time permit I should like to tell of efforts made to keep 
buildings and wards in good sanitary condition. Even the insane with few 
exceptions can be taught not to spit on the floor. When you see a man so 
ereedy for a chew of tobacco that he will take a quid out of a cuspidor and 
rechew it with a relish you begin to realize what a hold tobacco has. The 
same may be said regarding aleohol when you consider the stories of English 
sailors draming the casks in which bodies of dead English sailors and soldiers 
were sent home. In eities gutter snipes can be seen picking up stubs, and 
there are women who apparently inhale tobacco smoke of others with pleas- 
ure, at least they make no objection. Suppose Aristotle, Plato, Socrates, 
or old Hippocrates came back and could see our men smoking and meeting 
under bad air conditions, what would they say? Has the world gone tobacco 
mad? Should a hospital physician smoke and set a bad example? 
During a year in Europe | acquired a stock of comparative data. It 
was a surprise not to see any tobacco juice on sidewalks. The only time 
I saw a splotch in Continental Europe was in front of the medical school at 
