high mountain resorts have doubtless the widest range of applicability to moderately advanced cases. There are, however, certain other cases that do not improve in these resorts. Early or moderately advanced cases, with manifest cachexia, gastric disturbance, and more or less fever, do not do well in these or, as far as I am aware, in other resorts. A mild marine climate perhaps suits these cachetic cases best.

Cases with laryngeal or intestinal complications should not be sent to the mountains. Cases of much emphysema complicating tuberculous infiltration, or tubercle invading emphysematous lungs will perhaps express better what I mean, are unsuited to altitude resorts. Cases of this latter group are prone to attacks of almost continuous and peculiarly uncontrollable hemorrhage, and are most unpromising. As might be expected, cases with renal complications do not do well in the mountains, and if albuminuria makes its appearance in such resorts the patient should be removed to a warmer climate.

A pe

culiar sensitiveness to cold is a very decided drawback to wintering in the mountains for, although the patient may be mending so far as the local disease is concerned, he or she is always depressed and unhappy. What the consumptive ratient most needs for his cure is the combination of climate and sanatorium treatment. The patient, if le ́t to his owù devices, may make bad use of a good climate, while with skilful guidance in a sanatorium. he may make good use of a bad one. Care without climate is better than climate without care.

"Influence of Climate on Consumption. The question put to us in this discussion is: What influence has climate on the treatment of c consumption, and how far can cases be grouped for treatment in certain climates? The answer to the first part of the question will be: 1. That a

suitable climate relieves or removes the catarrhal conditions accompanying that disease in a number of cases. 2. It raises nervous and vascular tone. 3. It increases muscular energy and the ability as well as the desire for exercise. 4. By rendering an openair life possible, it increases the aeration of the lungs and diminishes the activity of bacterial agencies, one of the most essential conditions of arrest and cure of the disease. 5. It improves the tone and promotes the activity of the digestive functions, and so enables the patient to take the large amount of food which is needed to heighten his state of nutrition. 6. It improves the moral and mental state by surrounding the patient with a bright, cheerful and hopeful environment.

"Grouping of Cases.-Then, as to the answer of the second part of the question, we may say: 1. That cases seen at the very commencement of the disease, and who are otherwise in good health, may be permitted a certain amount of choice in the selection of a climate, provided it allows of many hours being spent daily in the open air, and that they are placed under admittedly hygienic conditions. A choice may be made from climates of altitude, the desert climate, the inland plateaux of South Africa, the sea voyage for those with a decided liking for the sea, and suitably placed sanatoria. 2. For progressive febrile cases, repose in a bed or on a coucn in the best conditions practicable for the access of air and sunshine to their apartments. 3. For advanced cases home is best if the conditions of home life are favorable, or the warm marine climates with cheerful surroundings if home lite is unfavorable or change is urgently desired. 4. For catarrual cases, warm, soothing climates like Madeira or . Teneriffe are best. 5. For rheumatic or gouty cases of the fibroid or pleu

rogenic type-dry, marine climates or the desert climate are suitable. 6. For the so-called "scrofulous cases," if free from catarrh, fairly bracing marine climates; if with catarrh, mild marine climates should be pre⚫scribed. 7. For most other moderately advanced cases, with the limitations already mentioned, the climate of the high mountains, above the cloud belt, is the most curative. I have not made a "hemorrhagic" group because I do not think it would be a natural one; every hemorrhagic case must be, in my opinion, considered apart, and dealt with on its own merits."-Yeo .in British Medical Journal.

MEASURES ADOPTED BY DIFFERENT NATIONS FOR THE PREVENTION OF CONSUMPTION.Prof. P. Brouardel, Dean of the Faculty of Medicine of Paris. The Right Honorable Henry Chaplin, M.P., president of the local government board, who presided, introduced him as the most distinguished authority on sanitary science in Europe. Prof. Brouardel said that the mortality from tuberculosis varied in different countries. In some it was accountable for a sixth, in others a fifth, and in others a fourth of the total mortality. Long before the infectiousness of tuberculosis was discovered the struggle against it was commenced in England. The English, convinced by observation that tuberculosis thrived in damp dwellings, in 1836 passed a law roviding for the construction of healthy houses. Since then more than ten acts of parliament to render salubrious the dwellings of the poor had been passed, and the mortality from tuberculosis had been reduced 40 per cent. The anti-tuberculous education of public opinion which was now progressing, was of great importance. In 1889, under the presidency of the Prince of Wales, the Na

tional Association for the Prevention of Tuberculosis was formed. Its object was further prevention by educating the masses. Germany had founded societies for the construction of sanatoria, and then societies for the propagation of the idea, to popularize sanitary ideas. These societies are smail and scattered in different localities, forming provincial groups. They, too, publish popular pamphlets. In Belgium there is a National League against tuberculosis, with its seat in Brussels; each province has an independent branch. In Norway, the Storthing voted 40,000 crowns for the purpose of printing and distributing a popular work on tuberculosis, by Dr. Klaus Haussen, and 2000 crowns to form a traveling fund for physicians wishing to gain information about the management of sanatoria. In France the Society for the Prevention of Tuberculosis by Popular Education had collected those who could teach with authority, such men as Lavisse, Matignon, Victorien Sardou, Landouzy, etc. They addressed meetings, and explained ne rules of prophylaxis. Prof. Brouardel, as president of the Polytecanic Association, had performed e same service in Paris. This year thirty-eight lectures had been given to 12,000 pupils. Thus, gradually, in all countries, the public were beginning to realize that personal care and cleanliness were necessary, and that a consumptive was only dangerous when necessary precautions were neglected, that the danger lay in the sputum. England had the great merit of recognizing the evils of insalubrious dwellings, and passing laws ordering their destruction; and further of enacting laws for the erection of sanitary dwellings which had been supplmented by the beneficence of private individuals. In 1850 law was passed in France dealing with unhealthy dwellings, and another in 1894.

In

the crowded parts of towns tuberculous foci were created which were a source of danger to the inhabitants. In Paris the mortality from tuberculosis varied in different districts from 10 to 100 per 10,000 inhabitants. Alcoholism he regarded as a most potent factor in propagating tubeiculosis. It rendered the strongest mai powerless to resist the disease. Hence the high mortality from tuberculosis in classes addicted to drink. Tatham's figures showed that taking the mean mortality from tuberculosis at 100, that of bartenders was 257; of brewers. 148; saloon-keepers, 140. The idea that tuberculosis could be cured dated back to Hippocrates, who said: "Phthisis, if treated early enough, gets well." In 1838, Carswell, one of England's most distinguished physicians, wrote: "Pathological anatomy has never, perhaps, given a more decided proof of the cure of disease than of phthisis." Laennec, Guillot and Letulle had proved that in more than half the necropsies performed old healed tubercular lesions were found. Prof. Brouardel had found at the morgue in Paris, where he frequently made necropsies in cases of accidental death, that in half the cases if the person had lived in Paris for ten years ealed tubercular lesions, cretaceous or fibrous, were present. That treatment might be of service in the early stage, M. Calmette conceived the idea that instead of waiting for the workman to come, the doctor should seek him. He opened an anti-tuberculous dispensary at Lille, which had been eminently successful. Another had been established in Paris. Ine best way to ferret out the disease was to have an "agent workman" who would notice when his com.rades began to cough, and advise them to go to the dispensary; who, alive to the dangers of a badly-kept workshop, would superintend its cleansing. Prof. Brouardel

said that in Germany there were eighty-three sanatoria open, or ready to be opened. Of those who left the sanatoria in a satisfactory condition it had been shown that in 1896 46 per cent. were able to work; in 1897, 47 per cent.; in 1898, 58 per cent., and in 1899, 60 per cent. In France several sanatoria had been opened, and others were in process of erection. Since Chauveau showed that it was possible for tuberculous germs in food to produce tubercles in the intestinal tract, attention has been turned to precautions for preventing the consumption of meats and milk from. tuberculous animals. Prof. Brouardel concluded with an eloquent peroration, saying that by a united effort the whole of the civilized world might succeed in exterminating the cruelest scourge that had ever fallen on it.-Journal American Medical Association.

DRUGS IN PULMONARY TUBERCULOSIS.-W. R. Huggard (Philadelphia Medical Journal.)

By improving the general health, as for example, arsenic, quinine, strychnine, lime, phosphorus.

By increasing the local resistance of the affected tissues, as creosote, and its derivatives, salicyl preparations and counter irritants.

By modifying the quantity or character of the secretions, as the balsams, the terebinthinates, the essential oils, morphine and apomorphin and inhalations, especially of formaldehyd.

By controlling symptoms that react prejudicially on the patient. Amongst these are: (a) Digestive ailments. (b) Excessive or needless cough, which shakes and exhausts the patient, causes fever, or prevents sleep. (c) Scanty expectoration and retention of secretions. (d) Fever, which spoils appetite, and prostrates the patient.

By removing complications, such as syphilis.

If digestion is bad, the only drugs indicated are such as will restore it to a normal condition. If digestion is good, the general condition satisfactory, and the patient improving, he refrains from using drugs unless some definite indication is present. Amongst the most important indications for drugs are persistent afternoon pyrexia in spite of absolute rest out of doors; a tendency to recurrent febrile attacks or to slight inflammatory attacks. This tendency is usually combined with impaired nutrition and with a low state of general health. In these conditions arsenic, strychnin, quinine and salol are amongst the most useful tonics. Active softening, excessive cough, over-abundant expectoration, and, more rarely, scanty expectoration, expectoration of extremely purulent or nummular character, require attention; and the drugs useful for these conditions generally seem to have a favorable influence on the course of the disease in addition to the temporary relief from discomfort they may afford. Amongst such drugs are formaldehyd vapor, creosote and its derivatives, except the carbonate of guaiacol, which has generally seemed to be inert, terpin hydrate, oil of cinnamon, myrtol, the balsams, and the lime salts. In sluggish chronic softening, counter-irritation by iodin or by small flying bli3ters is of the greatest use. When an old syphilitic taint is present its removal should be our first care.

REST IN PULMONARY TUBERCULOSIS.-In the Journal of the American Medical Association for September 28, 1901, Dr. W. F. Martin, says:

Having myself been the victim of pulLonary tuberculosis for more than seven years past and becoming thereby deeply interested in all that per

tains to the therapeutics of this disease and watchful of all procedures for its amelioration in others as well, I feel that the subject of exercise in this condition ought to be settled without much difficultý. In no other form of tuberculosis is an active functionating of the part affected permissible. In tuberculosis of hip, knee, spine or any other joint, rest is of prime importance. In glandular tuberculosis any thing like massage is contra-indicated, and who would be daring enough to advocate systematic thinking as a therapeutic measure in tubercular meningitis.

If once a clear conception of the difference necessary in outlining treatment for those predisposed to tuberculosis and those who already have it actively present is grasped, I believe the present haziness on the subject of exercise will disappear.

As a prophylactic measure in those who by reason of inheritance, environment or poor anatomic development are predisposed to pulmonary tuberculosis, exercise of the chest and lungs is of undoubted advantage. When, however, an active process is present in the lungs the quieter such organs can be kept the better.

Soft, weak muscles are made firmer and stronger by systematic exercise. If such muscles become the seat of an inflammatory action no sane physician would prescribe exercise in any form for them.

I fail to see why the analogy is not fairly applicable to the lungs. If the lungs are sluggish, the pulmonary breath sounds are feeble, especially if the chest is contracted and the family history for pulmonary troubles is bad, by all means pescribe graded and systematic pulmonary gymnastics; but, on the other hand, when tuberculosis has already started in the lungs let us follow the rational methods used for treating tuberculosis elsewhere, by putting the lungs as nearly