the ordinary text-book, which gives an incomplete description of a multitude of methods and leaves the inexperienced operators in doubt as to which has been proven best.

DISEASES OF THE LIVER, GALL-BLADDER, AND BILE-DUCTS. By H. D. Rolleston, A. M., M. D. (Cantab.), F. R. C. P., Physician to St. George's Hospital, London; formerly Examiner in Medicine at the University of Durham, England. Octavo volume of 794 pages, fully illustrated, including seven colored insert plates. Philadelphia, New York, London: W. B. Saunders & Company, 1904. Cloth, $6.00 net.

The subject of diseases of the liver and bile passages is one which has assumed a constantly increasing importance within the last decade. The author of this volume has produced the most voluminous treatise on the subject published in English and it is destined to become an authority upon the subject. The entire subject is treated in an exhaustive manner and the text includes a large number of clinical cases which will prove of great value to the practitioner in diagnosing individual cases. The work is well illustrated, including seven insert plates of great merit, and the mechanical appearance of the work is in keeping with the high standard of the text and the excellence of the Saunder's publications.

FIRST LESSONS IN THE SYMPTOMATOLOGY OF LEADING HOMEOPATHIC REMEDIES. By H. R. Arndt, M. D., San Francisco. 271 pages. Boericke & Tafel, Philadelphia.

This is a handy little volume containing the pathogenic and clinical symptoms which the author thinks should be learned by students before they take up the comparative study of the materia medica. We believe that it will prove of value not only to students but to the busy practitioner who wishes to add to his knowledge of drugs.

GALLSTONES AND THEIR SURGICAL TREATMENT. By B. G. A. Moynihan, M. S. (Lond.), F. R. C. S., Senior Assistant Surgeon to Leeds General Infirmary, England. Octavo volume of 386 pages, illustrated with text-cuts, some in colors, and nine colored insert plates. Philadelphia, New York, London: W. B. Saunders & Company, 1904. Cloth, $4.00 net.

This book contains the material upon which was based the course of lectures delivered by the author at the Medical Graduates' College in London in 1904. Although it is limited to a consideration of the diseases of the gall bladder and ducts, yet it is a most excellent companion volume to the above volume by Rolleston. The author takes

the advanced ground that in the future, surgical treatment will be adopted in a much earlier stage of gall bladder disease than has hitherto been customary. The book is especially valuable in the clear and concise details given for the preparation and the performance of the various gall stone operations. The illustrations are beautiful, many being in color.

ATLAS AND EPITOME OF GENERAL PATHOLOGIC HISTOLOGY. By Dr. H. Duerck, of Munich. Edited, with additions, by Ludwig Hektoen, M. D., Professor of Pathology, Rush Medical College, in affiliation with the University of Chicago. With 172 colored figures on 77 lithographic plates, 36 text-cuts, many in colors, and 371 pages of text. Philadelphia, New York, London: W. B. Saunders & Company, 1904. Cloth, $5.00 net.

Saunders' Medical Hand Atlases are a valuable addition to any library and this volume is no exception. The illustrations have been made from original specimens and an experienced eye will not fail to detect the advance that has been made in photo-chemical technique. The text is concisely stated and the American Editor has incorporated much useful matter.

A MANUAL OF PERSONAL HYGIENE. Proper Living upon a Physiologic Basis. By American Authors. Edited by Walter L. Pyle, A. M., M. D., Assistant Surgeon to the Wills Eye Hospital, Philadelphia. Second Edition, Revised and Enlarged. 12mo volume of 441 pages, fully illustrated. Philadelphia, New York, London: W. B. Saunders & Company, 1904. Bound in Silk, $1.50 net.

This is really the third edition of Dr. Pyle's very excellent manual; he having first published it in 1900 and reprinted it in 1901, this edition being thoroughly revised and brought up-to-date. The additions are important, consisting of chapters on Domestic Hygiene and on Home Gymnastics, besides an Appendix containing methods of Hydrotherapy, Thermotherapy, Mechanotherapy, and First Aid measures in medical and surgical accidents and emergencies.

He has associated with him as contributors, Drs. D. H. Bergey, J. W. Courtney, George Howard Fox, E. Fletcher Ingals, D. Alexander Randall, G. N. Stewart and Chas. G. Stockton.

***

Once again it has been decided, this time by a Massachusetts Court, that a hospital organized exclusively for charity is held not to be liable for injury to a patient caused by the negligence of its carefully selected nurses.

The Editor cordially invites the readers of the Reporter to contribute to this Department and make it a valuable medium for communication between them. To this end we earnestly solicit the following:

Questions, Comments and Criticisms on all topics of interest to the physician in his daily work, from both the medical and business standpoint.

Reports of Society Meetings, Personal Items, Hospital Reports and all News of interest to members of our school.

Clinical Reports, giving experience in the use of the products of our advertisers,

ALUMNI NOTES.

*** The Editor would like to have copies of the annual announcements of the College from the earliest announcement issued up to 1900. He would also like copies of the issues of the Argus, Argonaut and Indicator, which, as is known by our alumni, were published at intervals in the early nineties. He would be glad to have these and will refund postage used in sending them to him. The file owned by the College was accidentally destroyed, and we are endeavoring to obtain as complete a list as possible. All enclosures will be gratefully acknowledged.

city.

*** Israel Millstone, '00, has removed to 2212 St. Clair St., this

*** F. W. Stewart, '91, has removed from Milan, Ohio, to Seattle, Wash.

**** George A. Hildebrand, '01, has removed his residence to 955 Prospect Street.

*** The present address of Walter K. Hoffman, '01, is 417 S. Main St., Dayton, Ohio.

*** Lucy A. Robinson-Taylor, '75, has removed from this city to Roseville, Warren Co., Ill.

*** H. W. Pyle, '97, of Oberlin, O., is spending the winter with his wife and family in California.

*** A. E. Wheeler, '80, from away off in Los Angeles, Cal., sends his best wishes to the College.

*** E. P. Banning, '92, Ft. Wayne, read a paper at the Allen County (Ind.) Homeopathic Medical Society.

*** C. A. Overholt, '98, has removed to Mecca, Indiana. We understand he has recently gone into the ministry.

*** F. A. Krill, '82, who had been practicing for a number of years at San Luis Obispo, is reported dead by the post-office authorities.

*** M. H. Castle, '03, 1019 Rose Building, announces as a specialty the administration of anaesthetics, using either nitrous oxide and oxygen, ether chloride, ether, or chloroform.

H

Cleveland Medical and Surgical Reporter.

Contributions are solicited upon any subject connected with the practice of medicine or the allied sciences, and the only restrictions placed upon them are that they shall be free from personalities and given to the REPORTER exclusively. The Editor of the REPORTER is not responsible for any opinion expressed by contributors.

Vol. XIII.

APRIL, 1905.

Original Articles.

SANATORIUM TREATMENT OF TUBERCULOSIS. *

No. 4.

By A. B. Schneider, M. D., Professor of Theory and Practice of Medicine and Physical Diagnosis, Cleveland Homeopathic Medical College.

Within the limits necessarily imposed upon this paper a full presentation of this subject is manifestly impossible. Much that is important has failed of consideration and the salient points have been treated very briefly.

In the modern treatment of tuberculosis three factors are considered of greater relative importance than drug administration. These are in the order of effectiveness, pure air, nutrition and rest. Each of these terms indicates only a small, although the most important part of the factor it stands for.

Under the caption pure air must be considered the many physical and climatic conditions which modify the physiologic activities. It is doubtless unnecessary to call attention to the fact that pure air and fresh air are not synonymous terms; or that localities presenting great or sudden changes in temperature, or excessive moisture, or such as are with difficulty accessible, although the air be pure, are not suitable abiding places for invalids. Extremes of temperature, if equally maintained, apparently cause the tubercular patient little trouble, for the reports of the Adirondack Sanatorium indicate that the cases treated there do better in winter than in summer, while on the other hand, the hot and arid desert sands of Egypt have proven so beneficial that an English tubercular colony has been recently established a few miles from Cairo.

The patient is encouraged to live as much as possible in the open air and in the northern sanatoria temperatures far below freezing are not allowed to interfere with his daily routine. Wrapped in furs and with a hot water bottle at his feet the seasoned subject spends his allotted time in his chair on the open veranda in apparent comfort.

* Read before the 3d Parlor Conference of the Associated Charities of Cleveland.

At night the same rigid discipline is enforced and it is only during the stormiest weather that the windows of the sleeping rooms and wards are not freely open. In warm weather the beds are frequently rolled out on to the broad verandas and the patient spends his nights as well as days in the open air.

Altitude as a factor is much over-rated, especially by the laity. For the majority of consumptives a moderate altitude-1,000 to 2,000 feet above sea-level-presents sufficient reduction in atmospheric pressure to stimulate the action of the heart and lungs without causing marked acceleration of pulse or shortness of breath, or predisposition to pulmonary hemorrhage. While it is true that germs steadily diminish as altitude increases, it is hardly probable that the difference between ordinary sanatoria altitudes is important in this regard. Some cases improve only in altitudes of 5,000 or 6,000 feet, while others make greatest progress in coast climates. Children are especially benefited by sojourn at the sea-shore and in the large cities of Europe splendid provision is made for the transportation to and maintenance at sea-side sanatoria.

Sunshine is an important factor and other conditions being equal, the locality presenting the greatest number of clear days and the driest atmosphere will benefit the tubercular patient most. The proximity of extensive forests shields from high winds and equalizes temperature, and if the forests be coniferous, impregnates the air with balsamic matter which exerts a soothing and healing influence on the respiratory mucous membrane.

Nutrition of the tubercular patient involves literally a stuffing process. In no disease is the excess of tissue waste over repair so great and in no disease is a return to health so dependent upon the ability of the organism to digest and assimilate considerable quantities of nutritious food; and in no disease is an increase in body weight so certain an index of improvement. It is needless to say that the consumptive's diet should be of the most nutritious and easily digestible character and of sufficient variety to tempt the frequently feeble and ofttimes capricious appetite. The usual order is three lunches in addition to the three regular meals, and after the patient has made the agreeable discovery that his ability to digest and assimilate food is greater than his appetite indicates, he enters into eager competition with his neighbor for the highest score on weighing-day.

Rest in bed is insisted upon as long as there is marked elevation of temperature. When the fever subsides the patient is allowed to dress, spending most of his time in a reclining chair or hammock. Gentle breathing exercises are instituted and short walks are added.