tractures of spinal origin. By proper tenotomies, manipulation, and subsequent use of apparatus, the girl was now walking quite as well as ever.

Dr. Henry Ling Taylor read a paper entitled, "The Effect of Osteitis of the Knee on the Growth of the Limb." From measurements of the femoræ, tibiæ, feet, and patella during or after osteitis of the knee in forty cases where the disease had begun in childhood, the following conclusions were reached:

1. The affected limb, if approximately straight, was longer in the first four years in the large majority of cases. In observed cases of adolescents and adults it was from one to several inches shorter when the disease had lasted over seven years.

2. The affected femur was nearly always longer in the first four years, and the lengthening of the limb mainly due to lengthening of the femur. In the older cases, after a duration of seven years or more, the femur was markedly shortened.

3. The tibiæ were usually equal in length in the early stages; later the tibia of the affected side might be slightly longer for a time, but oftener shorter. The shortening increased considerably in the older cases and after the subsidence of inflammation.

4. With limbs of equal length and a duration of several years the femur of the affected side was found longer and the tibia shorter than its mate. 5. The foot and patella showed a difference in favor of the sound side after one year, and frequently before.

6. The stimulation of growth in the affected femur was accompanied by a retardation in the tibia, foot, and other parts; growth in the femur itself was finally retarded. The result after many years was often considerable shortening of the limb.

Dr. T. Halsted Myers said that his observations were almost identical with those given by the reader of the paper. In fifteen cases observed by him the lengthening was generally in the femur, and in some cases the femur lengthened while the tibia shortened; in others both bones were lengthened. This occurred during the active stages of the disease, but he could not speak positively as to the ultimate result. He thought it probable that if the knee recovered with good motion there was less shortening, and wished to ask Dr. Taylor whether he noticed that limbs left with stiff joints shortened more than the others? The proper functioning of the joint after the cure of the disease was a most important element in securing the best nutrition and development of the limb.

Dr. H. A. Parish stated that there was no doubt about ultimate shortening in the majority of cases. He cited, however, the case of a girl, aged sixteen years, disease of thirteen years' duration, remarkable for great lengthening during the active stage of the disease. After a partial excision ten years ago, and recently a supra-condylar osteotomy of the femur and a cuneiform section of the tibia for the relief of flexion deformity, there existed only three eights of an inch shortening, with limb at angle of 175 degrees.

Dr. V. P. Gibney said that years ago Dr. Berry had called attention to the subject of the reader's paper, and from examination of fifty cases had found the femur had grown in length. In his own practice he had been disappointed not to find lengthening. While lengthening was generally believed to be the rule, it could be readily understood how shortening might occur from interference with the nerve-supply by pressure of the head of the tibia on the popliteal space. He referred to a patient seen ten years ago, who had an inch and a half lengthening after a long course of protection treatment. The girl was still young and the joint disease cured; she was allowed to use the limb freely, and atrophy set in. At the same time the joint of the healthy limb was protected, and after four or five years the normal femur lengthened and the diseased one shortened, so that one fourth inch difference was the final result.

Dr. Taylor, referring to Dr. Myers' question, said that lengthening of the femur was the rule while the disease was active, and it was probable that more shortening occurred in the deformed and badly. managed cases. In the latter the final result would usually be considerable shortening in adult life. He referred to the work of Leusden, who took measurements of radiograms and reached conclusions nearly identical with his, except that Leusden had no opportunity to study adult cases where the disease had begun in childhood.

Dr. V. P. Gibney asked Dr. Taylor how he accounted for the shortening in neglected cases. Dr. Taylor replied that he considered it due to retarded growth.

Dr. V. P. Gibney said he was at a loss to understand why the bones shortened, and would be glad to look over the statistics presented by Dr. Taylor. He supposed Dr. Berry's cases would be called neglected cases.

Dr. Taylor said that his statistics, in the majority of instances, were not made from neglected cases, though it was probable that most of the adult cases might be called neglected.

H. A. COTTELL, M. D., M. F. COOMES, A. M., M. D., Editors.

No. 1.

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WHAT SHALL WE DO WITH OUR CONSUMPTIVES IN WINTER?

There is no more important question for consideration by the medical man to-day than what he shall do with his consumptive patients in winter. Of course, it is understood that those who are in extremis are better off at home under ordinary circumstances than they would be anywhere else, as there is no hope of recovery and but little hope of prolonging life for any length of time.

But there is that large class of consumptives whose throats are in a fair condition-that is, they have no open sores as the result of breaking down of the tuberculous deposit. They may be hoarse from congestion of the cords or infiltration in the surrounding tissues, and especially the epiglottis, but so long as there is no open surface in the tissue about the larynx, and so long as the epiglottis is not excessively infiltrated, the patient may be considered in a fair condition so far as the throat is concerned. It matters not how much they are expectorating and how much they are debilitated, so long as they are on their feet with the tissues of the larynx closed up, they will be far better in an equable, dry, sunny climate with moderate altitude than it is possible for them to be anywhere around in the Mississippi or Missouri valleys. These people should be instructed in the early stage of the disease

as to its dangerous character and as to the possibilities of arresting it by the selection of a proper climate. If there is any one fact established concerning the treatment of pulmonary tuberculosis, it is that climate is of more value than all the drugs that can be administered. The fact of the matter is, but few people survive any great length of time in our climate who have tuberculosis after the breaking down of the lung tissue begins, as they are doomed to an early demise if they remain here-hence the duty of the physician is plain and simple. He should freely and frankly tell his patient what his condition is and what will be best for him. It might be said that what is best is not known. We deny this. As we have said before, it is absolutely and positively certain that proper climate is the best remedy for him to avail himself of-hence there should be no hesitation about advising the consumptive patient to seek a suitable climate.

Some physicians may be avaricious enough to hesitate about sending a patient away for fear of losing a fee. Such an individual had better quit the practice of medicine, as no man has any right whatever to rob a fellow-being even of a prospective hour of life. We frequently see cases that might be much benefited by timely advice as to the seeking of proper climate, but, either through ignorance or selfishness, or possibly we had better say avariciousness, the doctor has kept them at home.

As to climate, there can be no question but what the southeastern side of the Blue Ridge Mountains is one of the most desirable climates in the world for consumptives. The elevation is moderate-the most desirable climate for all-year-round homes; the pure atmosphere, the moderate elevation, the absence of extremes in temperature, and the eternal sunshine make this territory valuable for consumptives. Take Asheville as center. It is easily accessible, can be reached from any portion of the Mississippi and Missouri valleys in from sixteen to twenty-four hours. The through service from Chicago and St. Louis, via the Southern Railway, makes it possible for the patient to have the most rapid and pleasant transportation-hence we unhesitatingly say a mistake can not be made in recommending any consumptive to go to this climate.

IT is worthy of note that none of the fatalities resulting from tetanus following vaccination in the United States resulted from virus manufactured by Parke, Davis & Co.

Current Surgical and Medical Selections.

THE American Electro-Therapeutic Association will hold its twelfth annual meeting at the Kaaterskill, Catskill Mountains, N. Y., on Tuesday, Wednesday, and Thursday, September 2, 3, and 4, 1902. The officers are: President, Dr. Fred H. Morse, Melrose, Mass.; Secretary, Dr. George E. Bill, Harrisburg, Pa.; Treasurer, Dr. R. J. Nunn, Savannah, Ga.

Four Hundred Dollar PRIZE. Dr. J. B. Mattison, Medical Director of Brooklyn Home for Narcotic Inebriates, offers a prize of $400 for the best paper on the subject, “Does the Habitual Subdermic Use of Morphia Cause Organic Disease? If so, What?" Contest to be open two years from December 1, 1901, to any physician, in any language, award to be determined by a committee composed of Dr. T. D. Crothers, Hartford, Conn., editor Journal of Inebriety, Chairman; Dr. J. M. Van Cott, Professor of Pathology, Long Island College Hospital, Brooklyn; and Dr. Wharton Sinkler, Neurologist to the State Asylum for the Chronic Insane, Philadelphia. All papers to be in the hands of the Chairman by or before December 1, 1903, to become the property of the American Association for the Study and Cure of Inebriety, and to be published in such journals as the committee may select.

A DISCUSSION ON THE NATURAL HISTORY OF FIBROIDS AND RECENT IMPROVEMENTS IN THEIR TREATMENT.-(British Medical Journal.) Alban Doran, in opening the discussion, considered the following questions: 1. The natural history of uterine fibroid. It is not a fibroma. It is always more or less a myoma, consisting of muscular fiber like the uterus, and while nobody would think of treating a fibroma with internal medication, it is a fact that ergot acts to some extent on the myomatous tissue as it does on the uterine muscle. It may, therefore, be very beneficial, but these forms are not rarely associated with cardiac disease, and then ergot is contraindicated. A more important practical point is the relation of the ovaries to fibroid disease. While no definite changes have been detected in the ovaries, the experience of a formerly popular operation shows that the removal in certain cases reduces the fibroid or checks the bleeding. The results, however, are not uniform, but are of some interest to us as bearing on the question whether the ovaries should be left in cases of hysterectomy for this cause. 2. We are not quite clear as to the nature of the hemorrhagic discharge in fibroid disease. 3. One of the most puzzling questions is in regard to their growth. The prognosis on this point is extremely difficult. Undoubtedly spontaneous disappearance may occur or the tumor may at least remain stationary, while all other pelvic and abdominal tumors are clinically, if not also pathologically, malignant. The influence of the