my patient, for the eruption on the latter had ceased to develop and was shrinking away. He was not carried to the pest-house, but in a few days was up and around. This was no case of varioloid, but a most pronounced case of variola vera, with the eruption as thick as possible without being confluent, and no symptom lacking to make a complete picture of this formidable disease up to the fifth day of its development, when it suddenly receded under the use of the variolinum."

Our efforts to secure recognition before our State Board of Health failed pro tem. The defeat is only temporary. We were overcome by the splendid voting ability of the non-medical members of the Board-a veterinary surgeon and a civil engineer. Next time-and there will be a next time-we shall hope for better success. The writer believes in vaccination; it has served the human family well and saved its millions. Indeed, we are in a measure immune to-day because our fathers were vaccinated. Smallpox is milder now than formerly because people are measurably immune. Vaccination is good, variolinum is better.

The writer is somewhat familiar with the regular practice as it is exemplified in this state. Vaccination is their chief and, practically, their only weapon against smallpox. When vaccination fails they have absolutely no effective means with which to stay the progress of the disease. It must run its entire hideous, repulsive course unchecked. The stages of invasion, eruption, vesiculation and pustulation regularly follow in regular sequence under the regular administration of our regular friends. Some of our own people as well as they, attend their cases blissfully unconscious of the fact that variolinum will check the disease in from three to six days. To those unfamiliar with its use these claims may seem extravagant. In truth, they are only what have been demonstrated in competent hands again and again.

Vaccination is only effective as a preventive. Variolinum not only prevents but will check the disease in all stages. Vaccination. is good; variolinum is better.

At a recent meeting the Iowa Homeopathic Medical Society adopted the following definition:

"Vaccination is the introduction of a virus into the system for the prevention of smallpox, and is accomplished either by the administration of a proper preparation of the virus of smallpox through the mouth, or by introducing into the circulation the virus of cowpox by applying it to a freshly made scarification of the skin."

Antiphlogistine renders ready service to the patient and physician by promptness and positiveness of action.

THE INFLUENCE AND LIMITATIONS OF CERTAIN

As

CLIMATIC ELEVATIONS UPON PULMONARY

TUBERCULOSIS.*

BY CHAUNCEY E. TENNANT, M.D.

Denver, Colorado.

S a resident of a portion of the country much frequented by victims of this malady, it is perhaps fitting that I should offer this subject for your consideration. While I have nothing new or startling to present, a brief review of conditions as we have found them to exist, may be of benefit to those of you who contemplate advising a radical change for tubercular patients.

Many able clinicians to-day do not believe it has been successfully proven that the tubercle bacillus is the only cause of phthisis, although we all admit that its presence is a valuable aid in diagnosis, and should always be sought. But it is well known that in the early history of some of these cases, frequent and careful examinations of the sputum yield negative results. Thus it is evident that the individual factors, such as family history, corpulence, and chest measurements, are necessary in the early consideration of each case. Applebaum's observations, published in the Berlin "Kleiner Wochenschrift," 1901, Vol. XXXIX, together with others, show that the earlier stages of phthisis have a well marked anemia, the red blood corpuscles averaging about 3,800,000, hemoglobin 69%, leucocytes about 6,500, and a specific gravity of 1049. Blood examinations will therefore be of considerable value in the early diagnosis.

The great mortality from tuberculosis makes justifiable any measure that will either curb its progress or make possible its eradication. Of all measures yet proposed, perhaps none has met with more uniform approval and been given better clinical verification than the open air method. Especially is this true when a change of environment and elevation is made. But we all recognize that there are limitations to this "out of door treatment," and the sooner we determine the relation of the pathology of the disease to these limitations, the better will be our judgment in the assignment of tuberculous cases to the various health resorts.

Prompt action upon the part of the patient to seek medical advice, and a keen observation on the part of the physician to early detect the tendency to a downward course, are the first essential factors to its successful eradication. A diagnosis once made, the

* Read before the American Institute of Homeopathy.

general custom is, justly, to send the patient to more elevated districts; some but a few miles from home, others to the foot hills, and still others to the distant mountain regions at elevations of from four to ten thousand feet.

We are all aware that any given elevation does not affect all cases alike, the same elevation differing quite considerably in its physiologic action, depending on the humidity, sunshine, and the various aromas. These factors constitute the climatic conditions which are so influential in this particular disease, and which, fortunately, are so widely varied and so accessible in this country.

Thus it will be seen how a certain locality might be peculiarly adapted to some one particular type, and that a case which would progress favorably, and possibly to ultimate recovery, at one elevation and degree of moisture, would rapidly fail in another. Therefore, to be most successful requires first an early and thorough knowledge of the character of the lesion and the individual factors which influence it, and then some data concerning the different localities which are beneficial in these cases.

For the past forty years Colorado has been one of the most popular of the climatic havens for those afflicted with the "White Plague," and has, during this period, given abundant clinical evidence of its influence upon certain well-defined types or stages of disease.

There is a fair proportion of the tubercular cases either benefited or cured by emigration to the West, and especially is this true with cases in their earlier stages. By this I mean at a period so early that there may be little or no cough or expectoration, and consequently negative results in the microscopical examination of the sputum. Physical examination may be negative, or show slight apical dullness and broncho-vesicular breathing. These cases usually present a reduction of corpulence below twenty-four, and a vital capacity below a safe average, although it does not necessarily follow. Such cases generally do well with almost any change in locality and environment, elevation not being absolutely necessary to their recovery. Improvement is usually rapid, and in the course of a year or more they will have recovered sufficiently to return home for at least a short time. But such an attack does not establish immunity, and these cases are not safe from a recurrence of the disease until after some years have elapsed. Frequent reference to the general physical condition, and examinations by the family physician for any returning symptoms, should, if any are found, be the signal for an immediate return to the old haunts.

Often, however, with proper conditions of life prevailing, such

as hygiene, diet and exercise, these cases reach the average expectancy in their own homes in excellent and even vigorous health.

There is a type of pulmonary tuberculosis which is best described as catarrhal. Early in its history it presents few constitutional symptoms and but little vesicular involvement or consolidation, but has a constant hacking cough attended at times with profuse expectoration of mucus. Microscopical examinations of the sputum may, and usually do, give positive results for the bacillus tuberculosis, and the pyogenic organisms are generally present in small numbers. This type is probably the one which has given Colorado its reputation as a health resort; for with the average low percentage of humidity, the involuntary increase in chest expansion with each respiration, and the great number of hours of actual sunshine, associated with aromas from large forests of pine, spruce and other coniferous trees, it has indeed a combination of conditions most favorable to an arrest and recovery of this particular type of the disease.

The pneumonic type which develops unexpectedly in cases that have hitherto enjoyed perfect health, with excellent family history, reacts very favorably to the climatic conditions prevailing about Colorado. It is characterized by the rapidity of the pulmonary destruction attended with early and extensive consolidation, temperature and night sweats. While rapid recovery is not the rule so far as clearing up the pulmonary consolidation, as this often remains for a year or more, the temperature, night sweats, cough and prostration are early relieved. Especially is this true at elevations of from three to five thousand feet. Patients in this condition may be so weak and prostrated as to be brought to Colorado on stretchers, but within two or three months the temperature will become normal and there will be an absence of most of the objective symptoms. This is particularly true with those patients who are willing to live out of doors and endure the changes of temperature and moisture incident to such a life, and it is surprising the amount of lung tissue that may be reclaimed unless fibrous degeneration supervenes.

Should pyogenic infection occur, however, in the consolidated area, the prognosis is very materially altered. For gangrene once established there is but little more hope for recovery in Colorado than other localities, unless it is of recent origin, and occurs during the summer months when our percentage of humidity is very low. In that case it is possible by the selection of a favorable locality among the mountain parks or valleys, and an out of door life, to arrest further progress of the gangrene. But this is in the earliest

stage of this type and especially during the summer months when the degree of moisture in the lung, the time of the year and the locality all play an important part in the chances for recovery.

Should it have progressed to the second stage the patient is almost sure to lose ground, no matter what the environments. Climate and elevation offer nothing more than a temporary stay to its progress. It is of considerable advantage to the individual, however, when fibrous degeneration of the pulmonary connective tissue occurs to a moderate degree, for it temporarily arrests further invasion of the parenchyma, and often, especially during the most favorable season, the moisture will disappear and the result will be an effectual arrest of further progress of the disease. Again there will be several successive aggravations of the disease, each attack being aborted by this limiting degenerate connective tissue, but the patient even then will often yield to the inroads of the pyogenic organism.

The chronic and advanced fibroid cases, where the parenchyma is largely displaced by connective tissue, do not do well in the higher elevations, owing to the necessary increase in chest expansion and the usual association of cardiac hypertrophy and valvular embarrassment.

Through the kindness of our local forecast official, Mr. F. H. Brandenburg, I have secured date regarding precipitation, humidity, temperature and sunshine, for the past thirty years, from which I find that from September to February inclusive, Colorado has an average monthly precipitation of 0.66 of an inch, and an average humidity of 50 per cent. The temperature during this period has averaged forty-one degrees, and the percentage of possible hours of sunshine has been 75. During this same period, with this relatively low precipitation and the higher percentage of humidity, the average number of deaths from tuberculosis by the month, for the past three years, has been one hundred and nine.

During the period from March to August, or the summer months, while statistics show a monthly average rainfall for the past thirty years of 1.67 inches, humidity 48.8 per cent., an average temperature of 58.5 degrees, and the decrease of possible hours of sunshine to 653 per cent., the death average per month for the past three years is ninety-nine, or ten less per month than during the winter months.

The mean daily change of temperature in Colorado will average between five and seven degrees, being (as is the case elsewhere) greater during the winter months. Estimates for the past ten years for Colorado indicate that the mean daily average from September to March, inclusive, is 6.1 degrees, while from April to September it is 4.7 degrees.