are chronic functional cases of auto-intoxcation. The other class of the anuric intoxicated that we meet is the nephritic-the organically toxemic.

Both classes require two methods of treatment, the immediately palliative and the permanently curative, or if this be impossible the immediately palliative is to be followed or accompanied by the prolonged palliative treatment. To be sure these lines of treatment run so closely together as to be hardly separable. In all cases where we can satisfy ourselves that the kidneys are not diseased we should direct palliation to an increased action of the kidneys. It has seemed to me little short of marvelous to observe the rapid improvement of some melancholic cases under palliative, that is, material doses of caffeine and lithia water which increase the excretion of the toxic substance by the renal route. Admitted that this is purely palliative and that persisted in for a long time the natural and ever present reaction of stimulants must ensue, yet this admission does not contra-indicate the treatment, as it should be accompanied and followed by more permanent treatment, which though successful in its own work has, I regret to say, often failed me when asked to do all, and alone. I believe that action of caffeine in relieving neuralgia, migraine, and hypochondriasis may be well explained by its eliminative action and this action is legitimate under similia, as it most certainly induces in continued doses this very condition which we ask it to relieve. We may follow with the indicated constitutional remedy carefully chosen, bearing always in mind that such a condition is commonly due to an elaborative fault, cellular in origin, and such. faults can only be corrected by our deeper acting remedies.

Without going carefully into a subject which is to me so fascinating that it is difficult to be brief, I will say, conscientiously studied it seems to my mind that sulphur, calc. phos., or kali phos., will one of them usually be found to be the indicated remedy. In addition to remedial treatment nature must, however, cease to be outraged, diet must be regulated and if necessary I would even insist upon a free milk diet for a time, until the days of childhood are so renewed in the organism that unnatural cravings cease to dominate. Rest has been insisted upon in all cases of uremia. In these chronic cases rather insist upon rational and systematic physical exercise. The liver has been called the "sentinel of the human system." Hager and Schiff find nicotine, morphine and strychnine, to be decreased in the circulation one-fourth to one-half in passing through the circulation of the liver. Rogers found that nicotine.

triturated with fresh liver and injected in infusion failed to kiil, whereas the same substance triturated with muscular or renal tissue is unaffected. The same results are noticeable in decrease of the toxins of the system in passing through the liver. Therefore we may infer that the old theory that uremics should never exercise freely as the urine contained after exercise in open air less toxic properties, is in error in that this is not on account of retained urinary solids but on account of better action of the liver and more complete oxygenation of the blood. The portal circulation should be favored by massage of the abdomen and by physical exercise, especially by standing erect with arms outstretched and raising the arms until the hands touch above the head, this to be done at the same time the body is thrown into a condition of rigidity as if lifting a great weight. The bowels must be kept open and the colon free from fermentative changes.

In anuric toxemia with renal disease, the management must be different. In these cases cure is improbable, usually impossible. The prolongation of life with the utmost comfort attainable is the end sought. We must consider the probable functional cause of the organic lesion and the acquired results of said lesion. Our aim as a sequence must be to remove as far as possible the former irritative conditions without which inflammations probably never obtain, and also attempt to remove as well as prevent further pathogenic results.

I believe, when by the consideration of certain theories we are led to an apparently successful treatment we have a rational right to assume that our premises at least point in the right direction. From the germ theory down, the theoretical field has been thoroughly canvassed in the interest of the origin of nephritis. To me the simplest most understandable theory has seemed most probable and hence as years of experience have passed on, my treatment has gradually trended to correct what to me has seemed a cause. We study too many remedies but we do not study the few thoroughly. Given a supposed condition of inefficient cellular metamorphosis, a deficient assimilation and disassimilation, a consequent increase of the toxic waste of the system and therefore increased demand upon the kidneys, this increased demand involving the forcing through the kidneys at times of improperly elaborated products irritant in their nature. This is the simplest theory and to my mind the commonest cause of nephritis.

At the same time that the kidneys have become diseased, in its attempt to protect, the liver has become surcharged with blood, loaded

with toxins, and as a result has after an increased activity, fallen below its normal activity. The heart though poorly nourished is asked to do extra work, is at first really hypertrophied from increased effort, but it later becomes hypertrophy with dilatation and weakened muscle. We may have toxemia occurring at any stage of the disease, and I believe the first stage of the disease often exists before the usually noted urinary symptoms of nephritis are evident. The treatment during the different stages of nephritis must necessarily differ. In the first or at least early stages where we find surcharged liver and hypertrophied heart, we may demand much the same curative treatment as in the later stages; but the earlier preliminary treatment of the case, the treatment that as truly, as the splint on the fractured bone, in its place, gives an opportunity for more permanent results, must necessarily differ from that indicated. later when the despoiler has left more indelible marks. The heart should be modified in its action and made to do steady, efficient work which can only be done with the help of the l'is Medicatrix Artis, for in all but exceptional cases organs once out of their symmetrical harmony with their fellows are at times irregular and unreasoning in their action, as is the throat that tries to swallow itself, the rectum to expel itself and the nose which maketh "great ado about a little matter" until it exhausts its owner with the violence of its sneezes.

In this stage glonoine 4x to 6x is a most commonly indicated remedy, its indications being clear and prominent. Here it is that we find indicated the eliminative action of arsenic, the mercuries and euonymin, arsen. 3x to 6x, the mercuries in the 3x to 6x and euonymin from the Ix to 3x, arsenic and the mercuries having also a homoeopathic action upon cases of incipient nephritis. In this early stage a regulated circulation of a circulatory fluid from which the toxins have been so far as possible eliminated, assisted by a later and persistent use of remedies such as sulphur, calc. phos. and kali phos. will result in an arrest and in a fair number of cases in a cure of the pathological condition and in better health than for a long time past.

But we do not always meet the disease in this stage; it may come to us later when the heart is weakened, the blood impoverished and the nephritic condition marked and advanced. Here a weakened heart and circulation must be judiciously stimulated by digitalis, strophanthus, adonis, crataegus or glonoine, and these remedies supplemented by the same deeper acting remedies that I have mentioned.

With all these cases crises of uremic poisoning may be tided over by the use of heart stimulants, pilocarpine and saline or other laxatives, but so far as possible even these emergencies would best be met by enforced elimination by the kidneys, remembering that in the depurative action of excessive perspiration or watery stools we lessen the watery constituents of the body and in turn the urine, and except this course be used with great care and watchfulness we may precipitate the very dissolution which we seek to avoid. Better action will often be obtained from the use of cold water injections in the bowel, this seeming to relieve the portal circulation at the same time that it increases the flow of urine.

Again, as crude as it may at first thought seem, the bleeding brought about by two leeches, viz.: About thirty grammes will remove from the blood as many extractives as two hundred and eighty grammes of a liquid diarrhea or one hundred litres of perspiration. Abercrombie, Marshall, Hall and others have saved life by this practice. Free oxygen inhalations are of great service. Always avoid a common practice of giving soluble cream of tartar, which adds to the blood the very potassium which we wish to avoid.

The use of charcoal for the production of antisepsis of the bowel has been of no little service. Let it not be understood that in the consideration of this condition I have forgotten the different forms of nephritis, diffuse, interstitial, lardaceous. Rather let me ask any one to carefully review the etiology of the different varieties and reading between the lines see how truly it seems to be in theory and in fact an effort to eliminate the improperly elaborated, and how truly it is in evidence as primal or cellular and not local in origin.

If he who like myself has run the gamut of worry and remedies for many years, will persistently follow in a few cases the use of a few remedies well studied, and based upon these theories, I will hope that he may have from it the same satisfaction in results that has come to me.

CLIMATE AS A REMEDY FOR CONSUMPTION, WITH SPECIAL NOTES ON THE CLIMATES OF NEW MEXICO AND TEXAS.

I

By WALTER SANDS MILLS, M.D.,

Assisting Visiting Physician Metropolitan Hospital, New York City.

PART THIRD,

The Climates of Texas.

HAVE said "The Climates of Texas" advisedly, because Texas is such a vast expanse of country that it must needs have more than one climate.

Texas is the largest of the United States. It bounds New Mexico on the east and partly on the south; it reaches from latitude 36° 30' N. on the north, to 26° N. on the south, from longitude 106° 40' W. on the west, to 93° 10' on the east. The border of the state is irregular in outline and includes an area of over 265,000 square miles —60,000 square miles more than the area of France, 57,000 square miles more than the area of the German Empire. In short, Texas is larger than any European country excepting Russia. Its greatest length is 740 miles, its greatest breadth 825 miles, and it has a coast line on the Gulf of Mexico of over 400 miles.

For the purposes of this paper Texas may be divided into four parts: I. The extreme western portion, with its high altitude and small amount of rainfall.

. II. The central prairie region running north and south through the whole length of the State.

III. The eastern woodlands extending from the northern border to the coast.

IV. The coast region.

In a general way each of these four divisions has a distinct climate. I will not attempt to go into details, but will endeavor to give a brief but comprehensive idea of the distinctive characteristics of each.

From New York I went to Galveston by steamer, thence by train over the Southern Pacific Railroad to El Paso. The run from Galveston to El Paso carries the traveler through the southwestern