neurasthenia and hysteria. 4. Reflex, embracing ocular, nasopharyngeal, auditory and sexual. In the classification I have given it is not absolute, for one condition may overlap another.

The most common cause of headache, taking all ages into consideration, and the radical change in our American way of eating and living, is some error in gastro-intestinal function, and the use of coffee. I must say that coffee has been the direct and positive cause of a large per cent. of headaches, and how often it is the case in treating this one condition alone, using every means to correct the gastro-intestinal defect, and at the same time overlooking the accustomed coffee, our patient does not improve, but the moment coffee is stopped a marked change takes place almost immediately.

While speaking of headaches from gastro-intestinal origin, I wish to mention a little clinical observation that I have had a few times. Patient constipated, cross, and crabbed and irritable, but no headache till their bowels would or did move. Bowels habitually constipated and no headache during the time, but as soon as the bowels moved the head would begin to ache. Look carefully into that condition of rheumatism and gout that so often have gastro-intestinal symptoms or conditions as their overshadowing symptoms.

The next most common cause of headache is some condition in the eye intrinsic or extrinsic. We all know that nature does not make optically a perfect eye; not that the eye with its refractive error is not able to do what nature requires of it, but modern civilization, in which there is constantly an increase in the use of the eye in doing fine eye work, how often it is the case that slight refractive errors will give obstinate headaches, and in headaches after one has investigated the gastro-intestinal tract, kidneys and blood conditions, and the coffee habit, and these things are negative, then and always look for refractive errors that usually exist, as astigmatism and hypermetrophia, and only occasionally is it weakness or lack of balance of the eye muscles.

While it is not connected with the subject, I will take the liberty of mentioning the opposite of headache from eye strain, that is a state of somnolence coming on very soon after using

the eye, and a condition that is quite as annoying as the headache from eye strain. In the vast majority of cases from eye strain the diagnosis is quite easy or the condition very plain, but in some cases the condition is such an insidious one that a most careful search must be made. If there has been any great variation in physical health we may not wonder at the headache, but it is that innumerable host of patients in all callings of life that go to his or her doctor with the one condition or symptom of headache uppermost in the mind and life, seeking relief for that and that only, and how often is it the only thing the patient gets is a prescription for temporary relief, when the truth is the vast majority of these patients can be relieved if we would only stop long enough to ask the question why? Yet a functional headache may be so persistent as a symptom alone as to lead one to think of an organic disease about the head, as in the case of a young actress in Hamburgh, who suffered with a chronic, persistent headache and the diagnosis of brain tumor was madeoperation, death, and no tumor. The giving of a prescription for headache alone without investigating the cause makes history a tale and a tragedy, and while this is a long paper to offer as a plea for the more conservative study of the one symptom alone, If it will cause any one or some one to stop grasping at the supericial driftwood and study more carefully the under current makng us ask oftener the question why, I will feel that the time has ot been lost, and knowing that many insidious diseases have headache for their early manifestation, if not throughout the .ourse of the disease, and realizing that the vast majority of readaches can be accounted for, I shall take the liberty of quoting ld Dr. Austin Flint, who said:-" Never prescribe for a patient pon the street, and always examine the heart, lungs, and urine."

JUST AS WE WERE GOING TO PRESS with this number, we had the pleasare of a brief but most enjoyable and agreeable call from Dr. H. S. Baketel, representing that most excellent and valuable preparation Antiphlogistine. Our only regret was that he could make but a brief visit. Well, it was as enjoyable as Antiphlogistine spread thickly and smoothly, applied warm to an inflamed part.

HOW SHALL WE LIMIT THE SPREAD OF TUBERCU

LOSIS?

W. T. MARRS, PEORIA HEIGHTS, ILL.

STATE Boards of Health are "viewing with alarm" the widespread and ever-increasing ravages of consumption. The death rate until put by the side of other fatal diseases is almost beyond our comprehension. Clinicians and scientists are very conversant with the disease so far as etiology, pathology, etc. are concerned, but when called upon to combat it in actual practice they can offer no line of treatment that promises any great modicum In fact the most unpretentious country doctor, by reason of favorable environment, handles these cases better than the most astute man of the city. Our increasing knowledge of tuberculosis all proves that the disease must be offset by improved nutrition. A perverted metabolism is always the first causative factor. Cell nutrition gets below par and invites bacillary action. It is a fact well recognized that a suitable soil is the first step in tubercular infection. If nutrition can be kept at or above par "His Majesty," the omnipresent tubercle bacillus is kept at bay. The pre-tubercular period is where we can get in our most ef fective work. Physicians should become skilled in recognizing consumption in its incipiency. There are many premonitory signs by which we can diagnose a condition that is amenable to treatment, but which, if neglected will prove disastrous.

What is the proper treatment? It is an old story, a twicetold tale that smacks of the platitude: Nourish the patient, by forced feeding if required. Fats, oils, butter, etc., should be ingested to the full limit of assimilation. Hagee's cordial of cod liver oil I find to be very palatable and improves nutrition rapidly. Theoretically meats are wrong. In practice they are correct and give good results. If the patient does acquire rheumatism and the uric acid diathesis he has a condition that is opposed to tuberculosis. Very few rheumatic people acquire consumption. The patient should eat in small quantities and often. Persons who work where food is prepared or dispensed

and get the habit of eating often soon find themselves increasing in weight. The patient should acquire a tolerance for milk and eggs whether he likes them or not. A number of cases under my observation have been very much benefitted by good beer. Aside from its food properties there is contained in it sufficient gas and alcohol to blunt the nerves a little and cause the poor fellow to forget some of his troubles.

The tubercular patient should drink pure water copiously. He should eat salty food if necessary in order to acquire a thirst. Let him live out-doors of course, but do not let him kill himself by violent exercise. A sore lung needs rest and repose the same as does a broken bone.

Selected Articles

THE CIRCULATION VIEWED FROM THE

PERIPHERY.*

BY SIR JAMES BARR, M. D., F. R. C. P., F. R. S. E., LIVERPOOL. Senior Physician to the Liverpool Royal Infirmary; Lecturer on Clinical Medicine, Liverpool University, Etc.

THERE are numerous treatises on diseases of the heart and aorta, but until recent years a careful study of the peripheral circulation has been largely left to physiologists and pathologists. The experimental work of Cohnheim will ever remain a landmark in the pathology of the circulation, while to the school of Ludwig physiologists are no less indebted. To physiology medicine owes much, and all great advances are being prosecuted along physiological lines. If there has been any apparent divorce between the scientific basis and the practical application of our art, it is not due to any too rapid advance of physiology, but to physicians being too slow to fructify the field which has been tilled by physi

* Abstract of the Address in Medicine at the 74th annual meeting of the British Medical Association, Toronto, Aug. 22, 1906. Abstracted from the British Medical Journal, Thursday, Aug. 23, 1906. Reprint from St. Louis Medical Review, Sept. 15, 1906.

ologists. I have previously asserted that diseases of the heart most frequently arise from causes acting on the periphery, and hence there is here no room for specialism. The man who only studies the circulation with the aid of a stethoscope is a positive danger to society.

The capillaries through which the interchange of nutritive pabulum and gases takes place between the blood and tissues, play a most important role in the animal economy. Yet they have received very inadequate attention from clinicians. They vary from about 0.5 to 1 millimetre in length, and from 7 to 13 micromillimetres in diameter. They are to a certain extent elastic, or at least they have the capacity of adapting themselves to the amount of blood which is driven through them. Their importance has been aptly described by Leonard Hill, who says: "The blood is brought into intimate relation with the tissues by diffusing through the endothelial wall of the capillaries, and this wall is of great tenuity; thereby takes place that change of material which maintains the combustion of the body and the fire of life."

When Leonard Hill stated that the pressure in the capillaries under certain conditions is often over 100 mm. of mercury, I thought that there must be some error of observation, as I was under the impression that such pressure would rupture these delicate little vessels, but I remembered the old advice: Do not think; try. I tried, and found that Leonard Hill had rather understated the fact, as I found variations from about 50 to 2,000 mm. of water. I also found equally great variations in the velocity of the blood in the capillaries. In textbooks on physiology it is put down from 0.2 to 0.7 mm. per second, but my observations have given records from about 0.5 to 25 mm. per second. Numerous attempts have been made to estimate the capacity and sectional area of the capillaries, but in my opinion these questions are still unsolved. The method adopted of estimating the sectional area of the systemic capillaries is simplicity itself. We all know that with any given force the velocity is inversely as the sectional area. The mean velocity in the aorta has been set down as 320 mm., and in the capillaries as 0.5 mm. in the second: therefore,