Pneumonia, which carries off so many people in our large cities, has only recently been classed as an infectious disease, and can be prevented by proper disinfection and quarantine. Nearly every day we learn the etiology of some of the infectious diseases, and the means. of securing immunity from them.

"From the little acorn the great oak grows," and so it is the children form the nations, and if we wish the people of the commonwealth to be healthy and strong, we must begin to train them in childhood, when their organism is plastic, and yields readily to both external and internal influences.

It is to the communities' interest to look after hygienic conditions of its people, to provide a proper water supply; to dispose of garbage and sewage; to keep the streets clean, and to disinfect and quarantine when necessary. It is also our duty to look after the children while in school; their condition of health; to cultivate hygienic habits: to see that they are not overworked, but are trained so they will make useful citizens. In all children the obtaining of good health and a sound constitution is of first importance. Youth is the time for gaining health, not for losing it; for building up sound bodies and constitutions, and not for breaking them down. Of what use is all the education one may gain, if there be no strength to use it afterward in the battle of life?

The great work of the future is preventive medicine. We must strengthen the resistant powers of the system, and remove all predisposing conditions, and then it will be impossible for any of the pathogenic organisms to develop in the human system, for none of them can live in healthy tissue.

We have long sought the "Elixir of Life." Thousands have traveled the wide world over seeking it only to be disappointed. Perhaps that which we may have been seeking for centuries, may be found, not in some far sunny clime, but here in our own native land, by observing the simple laws of Hygiene and Sanitary Science.

Rose Building.

Calcite, when perfectly transparent and free from flaws, has great value for optical purposes. The locality which has yielded the largest quantity of fine calcite crystals is in Ireland, and for this reason crystals of good quality are commonly termed Iceland spar.

"In my opinion, hypertrophy of the prostate is not a senile disease. It begins in early manhood."-Dr. L. Bolton Bangs, Med. Record, April 8.

THE CLIMATIC AND SANATORIUM TREATMENT OF TUBERCULOSIS.* By Dr. John E. White, Nordrach Ranch, Colorado Springs, Colorado.

[Concluded from page 232, July issue.]

Hæmorrhagic cases above all others do well in Colorado. Fully three-fourths of our cures are hæmorrhagic. I mean by this, cases that have had hæmorrhages in the beginning of their disease and not the haemorrhages that come from ruptured aneurisms in old cavities; such hæmorrhages present themselves late and are usually fatal. In hæmorrhagic cases the diseased area is low down in the lung, near or at the root of the lung. Such cases clear up much better in an altitude than the apex cases, because on account of its location, it more easily and more quickly becomes ventilated.

The injurious effects of altitude are greatly exaggerated. Easterners are prone to lay everything to the altitude. I will admit that it is quite a jump from sea level to an altitude of six thousand feet, but in coming into an altitude one must use judgment and good sense. The first effect of an altitude is exhilirating. New comers feel like climbing Pike's Peak the first day. One must rest until the heart and lungs become accustomed to the change. Consumptives should always place themselves under competent medical advice upon entering altitudes, and not be guided by their own ideas. A great fault which we have to find is that we are not consulted until patients have already received set backs that might have been prevented. A rest of from one to six months is necessary before patients can begin to hill climb. They are working while sitting still in an altitude. Oftentimes, there is as much work for the heart and lungs as there would be riding horse back at sea level. Many come to Colorado, curable, but for the want of a little intelligent advice, soon become incurable, and for that. reason, I earnestly advocate the sanatorium for each and every case. Years ago when patients were sent into altitudes abroad they made the journey by interrupted stages. We know to-day that this is unnecessary. The quicker a long journey is over the better, providing the patient will get down to business after arrival. Many patients come to Colorado with bad advice. They have been told that which is agreeable to them, and, that is, that they are not tubercular, but just bordering on it; they have a little catarrh, but no consumption, that is impossible, since no one in the family has died of it. They have been told to exercise, to live on a ranch, and rough it, ride horse back and leave the doctors alone. As a result of such advice patients have to learn by sad experience. Home physicians should co-operate with us and tell their patients with what disease they are suffering and give * Read before the Cleveland Homeopathic Medical Society, June 21, 1905.

them some idea of its nature, treatment, etc., and above everything else to be guided by local medical advice. We are on the ground and know the dangers that beset consumptives in an altitude. We need your co-operation otherwise. We cannot control patients until it is too late.

Patients coming to us with a general understanding of the situation do not lose valuable time. Their cure is half established, although just begun. It is always acknowledged a fatal mistake to keep patients in ignorance of their disease unless they are incurable. If they are curable it is imperative to get their full and hearty support. This is only possible, when they know the nature of the disease from which they are suffering. There is no factor more important in the cure of tuberculosis than the financial condition of the patient. Some one has said that there was but one cure for consumption, and that it was gold. It certainly is a great mistake to send patients with active trouble, and very limited finance away from home. Rest, nourishment and care cost money, and consumptives should have but one occupation, and that is to get well. This occupation cannot be successfully carried on with another occupation. All plans for the future must cease and the final outcome will be largely a financial matter. No matter how bad the case may be, one cannot recover if compelled to worry over financial matters. Many have strange ideas as to the time it takes to effect a cure. After tuberculosis begins, God only knows when it will end. No man can look into the future in any given case and predict such and such a result.

At Nordrach Ranch, we have learned of twenty-seven physicians in various parts of the United tSates, who have recovered in Colorado. and remained well after returning home; of these Dr. McNamara, of this city, was one of the best cures and in a recent letter, he informs me that he weighs over two hundred pounds. If he is present to-night, let him stand up and give his experience in favor of altitude. Dr. Charles Gatchell, of Chicago, was another well known physician who recovered in Colorado, in seventy and seventy-one.

Many patients are sent to us having been told that a vacation of a few weeks in Colorado would completely effect a cure. It is rather a question of months, and perhaps years depending upon the state of the disease and the faithfulness of the patient. Incipient cases, occasionally, become apparent cures in three months, but six months is more often required. We do not like to admit cases at Nordrach Ranch for less than six months. Second stage cases take from one to three years to become apparent cures or to undergo arrest. While third stage cases obtain only a short prolongation of life.

1

The question is often asked, can patients safely return east, after a given improvement in an altitude? In answer I would say that cavity cases rarely encapsulate. Bacilli remain in the walls and are found in the sputa for years after arrest and spring into activity again in low altitudes. The lung collapses and bacilli again find themselves in favorable territory; such cases should remain in the altitudes. On the other hand, solidified areas do encapsulate; in other words the bacilli become boxed up and if the capsule has become well established for several months, such cases will remain well in low altitudes, pro viding an outdoor life is led. A conscientious, well-trained physician with a microscope must decide the question of whether a patient can return home safely. Usually the patient has taken the matter in his own hands and generally pays the penalty.

Another very serious problem in connection with the sanatorium treatment, is to know what to do with our patients after we have arrested the disease and are waiting to effect a cure. At this time they can work, if they have just the right kind of work. Experience teaches us that many relapse after dismissal, if they do not obtain outdoor occupations. Many are compelled to accept any kind of work that they can get to keep the wolf away from the door. Light farm work, such as the care of horses, chickens, gardens, etc., is to be pre-. ferred, but such occupation is scarce and applications are many. I have dreamed of having an industrial farm in connection with Nordrach Ranch, a place where patients could gradually become accustomed to working full time under medical direction, and earn a part or possibly the whole of their expense. Many lose the benefits of sanatorium life by being compelled to work too soon, or by selecting an unsuitable occupation. Sanatoria have solved the problem of how to obtain results; now the problem is how to retain and make permanent the results obtained in sanatoria. Again, many leave sanatoria at the most critical time, that is, at the time when a cure is in sight but not assured. All sanatoria complain of their inability to keep patients long enough. The advice of home physicians would go a long way toward inducing patients to remain the necessary length of time. It is easy enough to fill their places with others, but it is far more satisfactory to complete cures, than to see relapses, when cures were in sight. I would point out the peculiarities of tubercular people; since such peculiarities are often the cause of their death. They certainly differ in the majority of cases from ordinary people. Do the ptomaines of the disease alter their characters? I am unble to say. At any rate there are but few well balanced consumptives. There is always an underlying nervous condition.

Consumptives are neurotic, nervous wrecks before they become tubercular. Our success in handling the disease, depends upon how well we understand these peculiarities, and how we overcome them by persuasion or force. It is comparatively an easy matter to handle tuberculosis; but quite another matter to handle tubercular people. These peculiarities range from slight objections to certain food and fresh air to downright foolishness. I have seen slight peculiarities overcome in the intelligent and a cure established, but I have seen but two fools cured-the other fellow and myself. When a patient has bats in his belfry and bugs in his lungs, there is no hope of a cure, unless he is made a prisoner and cured by force. Harsh as this statement may seem, the time is not far distant when force will be used as a public necessity and safety. We are making rapid strides toward forcible isolation, in either private or public sanatoria. When that time comes we can hope to cope successfully with the problem. Live with a consumptive a month, notice his peculiarities, look at his balance wheel and you can come nearer making a prognosis than you can from a physical examination. A cure depends upon the individual himself; he may be well balanced when it comes to the problems of the day, but when it comes to the care of himself, he is filled with notions which will lead him to his death, unless overcome. While there are many well balanced tubercular people, there are a great many more who do not possess that rare quality, good sense. Education alone can overcome this condition, and we must look to our sanatoria to do the best work.

The first institution abroad was established in 1856, by the famous Dr. Brehmer. The first one in this country was established by Dr. Trudeau, twenty years ago at Saranac Lake, New York; from these two pioneer institutions others have been established, until hundreds are in existence in various parts of the world. I believe, however, that too much money is being expended to build individual institutions. We are liable to bankrupt our resources and still find that we have not enough sanatoria. The last cottage built at Saranac Lake, which is a semi-charitable institution, cost over seven thousand dollars, and accommodates but four patients. No State or city can care for its consumptives at such cost per capita. We have proven to our own satisfaction the advantages of tent life over any building that can be constructed. The tent is practical from every standpoint, and from a financial standpoint it certainly has precedence. With a tent colony, it is necessary to have a central building, in which to care for the patients' daily wants, house the servants, etc., but it is not necessary to go to hundreds of thousands of dollars' expense, which is the ten