808 



SCIENCE 



[N. S. Vol. XXXI. No. 804 



ers. Two others are to be opened shortly 

 and there is provision for four others. In 

 1908 the total attendance was 4,921,718, of 

 which the Rivington and Centre Street 

 baths counted 1,942,657, though the facil- 

 ities there are less than in the others. 

 There are a few schools provided with 

 showers, and the Department of Parks 

 maintains a few. Brooklyn has five inte- 

 rior baths and provision for two others, 

 and seven floating baths. There are about 

 a score of privately maintained free baths 

 in New York and Brooklyn. 



II. THE INDIVIDUAL 



This need of constructive or preventive 

 medicine as related to the community is 

 no less important than its relation to the 

 individual. It is not enough for the indi- 

 vidual to have his disease cured, pre- 

 vented, or even to render him immune. 

 Something more is needed. Perhaps the 

 case can be made clearer by an individual 

 instance. 



A young man, aged twenty-nine, came to 

 a physician for advice. He had broken 

 down from so-called "overwork." Suc- 

 cessive visits to excellent sanitaria had put 

 him on his feet temporarily, but when 

 going back to his regular conditions of 

 work and living, he again succumbed to 

 them. A careful examination failed to 

 indicate any particular pathological con- 

 ditions demanding treatment, excepting 

 those that are usually associated with con- 

 secutive fatigue. His heredity was excel- 

 lent. The cardiac, pijlmonary, digestive 

 and excretory organs seemed to be normal, 

 in both structure and function. Blood 

 pressure was fair; the arteries were soft 

 and elastic; reflexes were normal. But he 

 was unable to think consecutively, or even 

 to write a brief personal note, without 

 producing mental confusion. In writing 

 he was constantly obliged to refer to the 



first part of his sentence to see what he 

 had said. In conversation he would fre- 

 quently forget entirely all that had pre- 

 ceded and would have to be reminded of 

 the subject. His history showed that hLs 

 habits of work were injudicious. He had 

 become so completely absorbed in his work 

 as to keep it before him during meal times ; 

 he would take it home with him, carry it 

 on Sundays and holidays. The problem 

 consisted not merely or mainly in inducing 

 him to take such steps as would lead to a 

 recovery from the fatigue, but in discov- 

 ering those habits of life under which he 

 would work most effectively; in discover- 

 ing what hours of labor would produce 

 the best results; what kind and quantity 

 of recreation, as well as intellectual inter- 

 ests, he should cultivate; and discovering 

 how under his particular conditions it was 

 possible for him to establish and maintain 

 these habits. 



A course of ordinary sanitarium treat- 

 ment was established at first, his physician 

 being daily, and at times almost con- 

 stantly with him, for at this period it was 

 not possible for him to develop sufficient 

 initiative to carry out the details of his 

 prescribed activities. He was given gentle, 

 outdoor exercise for considerable and 

 definite periods each day. His dietary 

 was studied with reference to his own 

 idiosyncrasies which were rather definite, 

 but which up to that time were unknown 

 to himself. As he recovered from his 

 fatigue, he was given courses in reading, 

 at first fifteen minutes twice a day. It 

 was reading of a kind that involved defi- 

 nite attention and logical thought, but of 

 a character wholly different from that re- 

 quired by his regular occupation. At the 

 end of three months he was in a. normal 

 condition; but if he had been allowed to 

 return to his work at that time, he would 

 have been in the same condition as he had 



