monia, anthrax, and possibly tuberculosis, syphilis and Asiatic cholera."

Cancer is without doubt sometimes hereditary. I know personally of an instance where a mother and daughter died at about the same age of cancer of the breast. Manichon, a French authority, is reported in the New York Medical Record of July 3 to have found sixty-nine cases of cancer in twenty-three families. In eleven families the heredity was exclusively in the male line, in five in the female, and in six families both sexes were equally affected. Fourteen families out of twenty-two developed cancer in the stomach. Dr. Mamichon believes that there can be no longer any doubt that cancer is hereditary, and that the influence of heredity determines even the special form the cancer takes.

Syphilis, that most loathsome expression of vileness, which infests and infects irremediably every tissue of the body, is perhaps the most certain of all maladies to be transmitted from parent to child.

Notwithstanding the volumes of fact and argument which Weismann has produced to prove that acquired qualities are not transmissible, the hereditary tendency of intemperance seems to be an established fact. According to the investigations of Dr. T. J. Crothers this element can be distinctly traced in about one-third of all the cases. Dr. Elam, speaking of the misuse of alcohol, in his work entitled "A Physician's Problem," says: "There is no phase of humanity in which hereditary influence is so marked and characteristic." And Ribot is quoted as saying that "The passion known as dipsomania, or alcoholism, is so frequently transmitted that all are agreed in considering its heredity the rule." More than one hundred years ago Erasmus Dadwin said: "It is remarkable that all diseases from drinking spirituous or fermented liquors are liable. to become hereditary even to the third generation, gradually increasing, if the cause be continued, until the family becomes extinct." I know a youth who from babyhood has walked with a staggering gait-his father was a drunkard. Dr. Mattison, medical director of the Brooklyn Home for Narcotic Inebriates, claims that morphinism is hereditary and that not infrequently children born of such inebriates die soon after birth from hereditary taint.

Dr. S. S. Herrick, in the Reference Handbook of Medical Sciences, mentiones among hereditary diseases goitre and cretinism, leprosy, cancer, gout, tuberculosis, rheumatism, epilepsy, chorea, hysteria, insanity, asthma, diabetes, organic disease of the heart,

hemophilia, emphysema, lithiasis, myopia, color blindness, together with numerous cutaneous diseases, and, in general, increased or diminished constitutional susceptibility to infection. If time permitted the testimony of high authorities might be quoted in proof of the hereditary transmissibility of nearly every form of chronic disease.

I wish, however, in closing to allude briefly to one great class of affections which I believe should be considered hereditary. I refer to those disturbances which arise from a lack of perfect adaptation of important organs to present requirements, and the continued presence of other organs, the need of which we have long since outgrown. Our ancestors at one time were quadrupeds. This all scientists admit; and most of them would agree with President G. Stanley Hall that the human organism is not yet fully adapted to the upright position. Why do we find so many valves in the intercostal veins, in the veins about the neck and shoulders, and almost none in the great venous trunks of the body, unless it be that these vessels were originally designed for the horizontal position? If creatures so constructed will persist in standing erect, how can they expect to avoid hemorrhoids? And what long protean lists of disturbances arise from common displacements of the female pelvic organs, none of which our quadrupedal grandmothers were ever called upon to endure! Dr. Holcombe, an eminent New York physician, once said, "It may have been intended that man should walk uprightly, but for a woman it was most certainly never so designed."

The human body is indeed a veritable museum in which the most ancient appliances are preserved and exhibited side by side with the most modern and approved. Great and small, we carry about with us some two hundred vestiges of antique organs no longer useful except as tablets from which to read our remote genealogy. And some of these, like the tonsils and vermiform appendix, are a frequent cause of trouble. All defects of adaptation, and all disturbances arising from these lingering relics of antiquity must be counted in among the hereditary causes of disease. In view of all the conditions, the wonder is not that there are so many defective people; the wonder is, that there are so few.

But my time is up. I have rambled over topics enough to fill a library; and I only hope that just one thought I have presented will not be forgotten, and that is, man's intimate relationship with the great organic world. The fact is there are really no independent existences. All life is one and continuous. And the different king

doms, and orders, and genera, and species, and individuals, are simply different manifestations of the life universal. All life is one. And it spreads on from parent to child, from generation to generation, and from age to age, becoming at every stage in its course more and more diversified. But it is still one. It is like a flame from which ten thousand torches may be lighted, no two of which would be alike, no two burn with the same color, or magnitude, or intensity, and yet all would be one. Differing conditions would make all the differences. And so I may say, we are what we are by reason of conditions. Conditions have fashioned us; conditions control us. Indeed, we are simply a part of the produce of the accumulated conditions of the ages. And the sole duty of the doctor is to help the unfortunate more perfectly to adapt themselves to their environment; for, turn it as we may, adaptation is health, misadaptation misery.

CLIMATE AS A REMEDY FOR CONSUMPTION, WITH SPECIAL NOTES ON THE CLIMATES OF

NEW MEXICO AND TEXAS.

BY WALTER SANDS MILLS, M.D.,

Assistant Visiting Physician Metropolitan Hospital, New York City.

PART FIRST.

General Remarks on the Climatic Treatment of Tuberculosis of the

Lungs.

HE remedial value of a change of climate for consumptives has

received much attention. That a change is good for many such cases is undoubtedly true, although no positive rules as to the particular climate best adapted to all cases can be formulated; each individual patient must be a law unto himself. Any one climate is no more suited to all cases of pulmonary tuberculosis than is any other one remedy to all cases of any other one disease. Moreover, it is a well known clinical fact that cases of tuberculosis may recover in any climate; it is also a well known clinical fact that cases of tuberculosis may originate in any climate.

In seeking a climate for a consumptive the first consideration is purity of the atmosphere; all other qualities are of secondary im

portance. A tuberculous lung is like an open wound, and all open wounds need to be kept scrupulously clean. It is therefore of the utmost importance to the lung-invalid that the air breathed should be as free as possible from all contaminating influences.

Other things being equal, the air in a sparsely settled neighborhood is purer than that in a place of denser population. Again, it has been shown that the air out of doors is purer than that within doors. This is true of air taken, one sample from an ordinary dooryard, and another sample from a room with wide open windows in the adjoining house. These facts have been proven by chemical analysis.

Bacteriologists tell us that direct sunlight is our best germicide. Koch, the discoverer of the "bacillus tuberculosis," says that that dreaded germ will die after two hours' exposure to direct sunlight. The above facts are of the utmost importance, and they all point to the following indications in the climatic treatment of consumption: First, the patient should live where the conditions are such that he can spend the greatest number of hours in the open air. Second, he should live where he can find the greatest amount of sunshine. In such a place, a place combining these two requisites, will be found the purest air. Further than this we cannot generalize for all cases.

Altitude, dryness, and equable temperature, all are of lesser importance. These qualities may be of more or less value in special cases, but pure air is first and should never be made to give place to any of them as a climatic factor.

Many physicians believe a considerable altitude to be a necessary part of a climate suitable for consumptives. The main, if not the only, advantage of a high altitude, per se, is, that on account of the lower atmospheric pressure one is obliged to breathe oftener and deeper in order to get the requisite amount of oxygen. In this way the lungs are more completely distended than they are at sea level, and are made better and stronger by the increased exercise. I believe that just as good results can be gotten, however, by voluntary efforts on the part of the patient at any ordinary height above sea level, and without subjecting him to the possible drawbacks of a high altitude.

Many persons are unable to live at a high altitude on account of the circulatory disturbances that may be produced, disturbances that range all the way from occasional dizziness to complete unconsciousIncreased altitude may also bring on hæmorrhage in lung

ness.

cases

make least

so disposed. Patients with recent hæmorrhage, if about to a change of residence to a higher altitude, should wait at two weeks after the last show of blood before starting; they should then make the ascent a matter of days, stopping at ever-increasing heights a day or two at a time until the desired altitude is reached.

system.

Where not absolutely contra-indicated the first effect felt on going to a high altitude is one of gentle stimulation of the whole The pulse and respiration are increased in frequency, and, Owing to the rarity of the air, the patient finds that he easily gets out of breath. After a longer or a shorter time the system accommodates itself to the new state of affairs and the pulse and respiration drop almost, if not quite, to normal. The patient feels invigorat ed in mind and body and is in a more or less exalted condition. In my five months stay at an altitude of five thousand feet the most troublesome feature was my inability to sleep well for the first ten days or so; after that I had no trouble.

The effects of continued residence far above sea level are not so good. After a varying length of time this constant over-stimulation is liable to result in the patient becoming a nervous wreck. Persons not native to the higher altitudes who have gone there to live, find that the preservation of the health demands an occasional stay at a lower level in order to relieve this nervous tension. Another, and purely mechanical, effect of continued residence at high altitudes is said to be emphysema of the lungs a chronic enlargement of the air vesicles—brought on by continued over-distension. Persons who develop this condition find it uncomfortable again to live at ordinary levels.

Dryness of the atmosphere is a desirable attribute in a climate. otherwise suitable to the consumptive. It is not an essential quality, however, as is amply attested by the recoveries made in our own Florida, which is notoriously damp, and by the recoveries made at Falmouth, England, famous alike for its humidity and for its healthfulness. Even rain, when it does not keep the consumptive too long within doors, is of benefit to him. It clears the air of impurities and increases the amount of oxygen.

Equability of temperature is another factor of climate considered by many to be necessary to the welfare of the consumptive. So far as my own observations have extended I have found no place where the temperature does not occasionally make abrupt changes. I have visited many of the famous health resorts in various parts of