proves that the process is due to bacterial invasion of the sound eye through ultramicroscopic forms of organisms which are able to pass freely through the vessel walls in any direction. In this case the enucleation was done three weeks after a perforating wound in order to save the other eye, which appeared to be in danger. Under a magnification of 2400 diameters the aqueous humor was seen to be swarming with actively motile bacteria of several types, and it is the author's view that the smaller of these, which are so minute as to be invisible to the ordinary powers of the microscope, are undeveloped forms which carry the infection through the tissue channels to the sound eye. The aqueous humor having a composition peculiar to itself is perhaps the only body fluid which forms a suitable culture medium for these particular organisms, and therefore it is the sound eye which is attacked by the sympathetic infection.

Radium Rays and Their Action on the Normal and Blind Eye.-Greeff reports the result of his official investigation of the optical properties of radium, particularly in respect to the somewhat sensational article entitled "Hope for the Blind," published by London of St. Petersburg. It is perfectly true that radium gives off rays in the dark which are visible to the human eye, but it is necessary to recognize that these rays are of two kinds. In the first place, a species of fluorescence is excited in certain bodies, which then give off indirectly rays of ordinary light; and in the second place, the radium itself throws off peculiar visible emanations called radium rays. Many objects, such as paper, can be excited to the fluorescent state, notably screens coated with platino-cyanate of barium, but it is easily demonstrated that the rays so given off are merely those of ordinary light, as they are obstructed by opaque bodies and throw shadows. In other words, the effect is similar to that produced by placing a lamp or candle behind a screen, and the marvelous feature consists in the fact that radium can continue to serve as source for the light indefinitely without appreciable loss of substance. The true radium rays can be detected by holding the substance a short distance away from the eye after the retina has become habituated to the dark chamber. When the radium is at a distance of about 10 cm. from the eye a peculiar diffuse, sea green radiance suddenly becomes visible, increasing as the eye is approached and diminishing with greater distance from the substance. It is impossible to determine the direction of the rays, as they penetrate all structures and give the same effect if the radium is held at the side of the head as in front. It has been the view of some observers that this effect is the result of fluorescence induced in portions of the eye itself, which thus are excited to throw off ordinary light rays; but this the author denies, for several reasons, e.g. that the radium rays do not bleach the visual purple of the retina. London's experiments are misleading, since he does not particularize exactly the visual condition of his patients. Once the function of the rods and cones is destroyed, the eye becomes entirely unable to transmit visual concepts to the centers. London's patients who had a perception of light when brought before the radium screen would have experienced the same sensation before a screen illuminated by ordinary means, while the radium rays proper cannot be used to give visual picture, since they cannot be refracted. At present there is therefore no prospect of help for the blind through the intervention of radium.

Berliner klinische Wochenschrift, March 21, 1904. The Serum Treatment of Hay Fever.-Lübbert and Prausnitz have collected the statistics regarding the value of the anti-pollen serum developed by Dunbar for the treatment of hay fever. The fact that this form of treatment has given excellent results with patients in all parts of the world in which it has been tried affords strong evidence in favor of the view that hay fever is a definite condition, having a constant exciting cause, though what the nature of the individual predisposition may be still remains unknown. The serum is obtained from horses innoculated with the pollen of various plants, and is used as a liquid and in powder form. So far its subcutaneous injection has not seemed advisable, and its use has been

restricted to local application. Reports have been made on two hundred and eighty-five patients from different countries, with 60 per cent. in which complete relief was given, 29 per cent. of partial cures, and 11 per cent. of failures. From an analysis of the failures it appears that in most of these cases the directions were not adhered to, and that the remedy was tried only a few times and then given up, but a few instances remain in which the treatment seemed wholly without effect. The action of the serum is not curative in the sense that recurrence of the attacks is prevented, and its greatest value is as a prophylactic. Faithfully used during the attacks, however, it quickly relieves the symptoms and cuts short the seizure.

Münchener medizinische Wochenschrift, March 22, 1904. Intestinal Secretory Neuroses.-Geissler reports a case which supports the view that the intestinal secretion can be influenced by nervous disorders and form the cause of diarrhoeas. The patient was a physician who, after several years of dyspepsia and overwork, had become neurasthenic to such a degree that sanatorium treatment was necessary. After a certain length of time of treatment it was observed that small quantities of pure intestinal juice were voided, sometimes immediately following the movements, sometimes by themselves after having caused urgent tenesmus. The juice so obtained was found to be colorless, with an alkaline reaction, and contained albumin. Tested with blood fibrin, it showed peptic activity, and it partially emulsified croton oil, thus giving evidence of fat-digesting ability. Diastatic power was shown by the ability to change starch into sugar and to produce fermentation. Maltose was converted into fermentable sugar, and cane sugar was turned into glucose. The circumstances of the case, and particularly the fact that the fæces never showed undigested food, all contribute to the assumption that the secretion was the result of nervous derangement solely and not of hypermotility.

The Thermal Death Point of Tubercle Bacilli in Milk.— Rullman reports on a series of investigations undertaken to control the results of Hesse and of Smith to the effect that tubercle bacilli in milk are killed by exposure at a temperature of 60° C. for a period of twenty minutes. The fact that this limit is dangerously low is shown by Hesse's observation that when he heated infected milk only to 58° C., instead of to 60°, animals injected with the milk perished of tuberculosis. An accidental difference lishments, and result in the delivery of an unsafe milk. of two degrees in heating may easily occur in large estabThe author used virulent bacilli from fresh sputum with which to infect the milk and started by heating the material according to the method of Hesse. Tuberculosis was induced in the animals injected with the milk so treated, and positive results were also obtained with various specimens of milk heated to successively higher temperatures. Finally a safe limit seemed to be reached by heating for one hour with constant stirring at 68° C., and the author regards this as the procedure to be recommended for routine use. If carefully brought to this temperature and rapidly cooled, very slight, if any, changes are produced in the flavor, the albumin and lecithin, or in the enzyme.

The Etiology of Orchitis Fibrosa.-Lesser studied the autopsy records of the Moabit Hospital from 1896-1902, in order to gain an insight into the etiology of this affection. Of late there has been a tendency to consider that causes other than syphilis, notably gonorrhoea, can induce fibrosis of the testicle, and many authorities concur in this view. Of the 2,979 autopsies of adult males investigated by the author, 133, that is 4.5 per cent. showed the lesion. In 70.6 per cent. of these, unmistakable evidence of a former syphilitic infection existed, but the ordinary average of syphilis in adults is only 9.6 per cent., so that a direct relationship between the two affections cannot be doubted. In regard to the cases in which no satisfactory evidence of syphilis exists after death, the author observes that syphilitic orchitis bears a very close analogy to syphilitic fibrosis of the liver. This condition often is found as the sole syphilitic lesion, yet no pathologist hesitates to ascribe it to its proper cause on this account, although the records show that in over 43 per cent. of the cases the diagnosis is based on the state of the liver alone. The greatest argument against the gonorrhoeal etiology of the affection is found in the period of greatest frequency of its occurrence. To be a sequel of the urethral infection, the disease would have to manifest itself during the years in which gonorrhoea is most frequent, yet this coincidence does not exist, and it is a rarity for fibrous orchitis to be encountered before the thirtieth year. Other conditions, such as trauma, parotitis, tuberculosis, typhoid fever and influenza, have also etiological significance, but the author believes that ordinarily when fibrosis of the testicle is found without involvement of the epididymis or evidence of other etiology, the correct assumption is that the lesion is of syphilitic origin.

Resignation of Dr. Kreider.-Dr. George N. Kreider of Springfield, Ill., major and surgeon, assigned to the Fifth Infantry of the Illinois National Guard, has resigned, and Dr. Arthur F. Wilhelmy of Decatur has been designated to fill the vacancy on the examining board of the regiment caused by the resignation of Dr. Kreider.

Society Reports.

NEW YORK ACADEMY OF MEDICINE.

SECTION ON MEDICINE.

Stated Meeting, Held March 15, 1904.
DR. CHARLES H. LEWIS, CHAIRMAN.

A Case for Diagnosis.-Dr. SIGMUND EBSTEIN presented a man whose present history dated back three years when certain spots appeared on the left foot, especially over the dorsum, which remained for several days and then disappeared for months. The appearance of these spots was accompanied by sharp pains and cramps. Two years ago he had more pains and more spots which lasted for months. Six weeks ago he was seen at the Vanderbilt Clinic when he had several fissures on the ball of the foot. The patient was given salicylate and bromide of sodium in rhubarb and soda mixture.

Dr. PATTERSON, who had examined the case, said it was necessary to determine whether or not the cause was an organic nervous lesion. A very careful physical examination practically gave negative results. There were no areas of anesthesia or disturbances of the temperature sense. On the dorsal aspect of the toes there was partial analgesia. The pain sense was somewhat retarded. He believed the conditions to be differentiated in this case were Raynaud's disease and erythromelalgia. Dr. LEONARD WEBER supported the diagnosis of erythromelalgia, although nine out of ten cases affected the fingers rather than the toes. He could not understand why the toes should not be affected as often as the fingers. He believed it depended upon a sclerosed condition of the arteries of the lower extremities. Again he believed it might be due to some nervous disorder of specific origin.

Dr. WILLIAM M. LESZYNSKY said he would not make a diagnosis of erythromelalgia from the general appearance of the limbs. He believed it was a form of dermatoneurosis.

Dr. HERMANN M. BIGGS said he was reminded of a similar case seen last year in which the process began in the right hand and arm, and was followed by pain, swelling, and cyanosis of the right toe. The process gradually extended and involved the other toes of the right foot in a way similar to the one presented. Then the left foot became affected. Soon gangrene of the second and then the third toe appeared. There was a distinct syphilitic history, but antisyphilitic treatment had no influence upon the disease. He believed the condition was due to some arterial disease.

Dr. MORRIS MANGES thought the peripheral circulation was entirely too good for it to be a case of erythromelalgia. Dr. EBSTEIN said that there was a syphilitic history, but antisyphilitic treatment had no influence upon the condition.

A Case of Trichinosis.-Dr. Wм. B. NOYES showed a patient from the service of Dr. C. H. Lewis at Columbus Hospital. The patient was an Italian who had been nine months in this country. On admission, January 13, 1904, he had been ill five days with diarrhoea four or five stools per day. His eyelids became swollen and this was followed by swelling of the arms and legs. After three or four days the swelling began to subside and then he was seized with severe pains all over the legs and arms. Examination of the chest showed a few sibilant râles on the left side. Temperature was 101° in the morning to 104.4° in the evening, pulse 120, respirations 32. His tongue was coated and dry. The muscles of arms and shoulders were extremely sensitive, but negative to palpation. The urine had a specific gravity 1020 and contained no albumin. The Widal reaction was obtained I to 10. The blood count showed 6700 leucocytes, of which 82 per cent. were polynuclear, 3 per cent. large lymphocytes, 5 per cent. small lymphocytes, 10 per cent. eosinophiles. A diagnosis of trichinosis was suggested

by Dr. Lewis from the pain in the muscles of the arm with the appearance of a myositis and the eosinophilia. The patient said he had had rheumatic pains ever since he had come to this country, but no swelling, and that his diet had consisted largely of pork for months. He remained in the hospital under observation for six weeks. His arm became more sensitive and the biceps contracted. The legs became cedematous and much swollen. On February 1 he found the condition of the patient as follows: He was well nourished, but looked ill. He was able to walk, but very unsteadily. He had marked contractions of the arms and legs. The grip of the right hand was weak, of the left, normal. Flexion was impossible, and only a moderate degree of extension. Forced extension developed rigidity of the arm. The muscles were hard and large, though smaller than before he was sick. The patient was able to dress himself and to perform the finer movements of the hand. There was no rigidity of the neck. Kernig's sign, or rigidity on hyperextension of the legs, was marked. The knee-jerks were lively. Careful examination of sensation showed hyperæsthesia to touch and pain all over, especially marked over the arms. He was as sensitive over the abdomen, especially the lower iliohypogastric region, as elsewhere, The contractures and pain were more in evidence when he was being examined than when he was alone in the ward. The patient gradually improved. All his clinical symptoms resembled the ordinary condition of hysterical contracture with certain hysterical points. On February 3 he made a blood count and found 28.5 per cent. of polynuclear leucocytes, 48 per cent. large lymphocytes, 5 per cent. small lymphocytes, and 16.5 per cent. eosinophiles, and 2 per cent. mast cells. On February 8 he excised a portion of his biceps and found trichinæ, thus confirming the provisional diagnosis of Dr. Lewis. Many sections were examined, and the trichinæ numbered about one to each section. Evidences of considerable myositis was found in the neghborhood of the encysted trichine with an accumulation of mast cells.

This case showed the three stages which writers had divided the clinical history of trichinosis. Stage 1. Intestinal irritation commencing soon after taking the infected meat. Stage 2. Characterized by severe muscular pains with pyrexia. Stage 3. Subsidence of the symp toms during which the trichinæ became encysted in the muscle. The diarrhoea was an early symptom and, if severe, might clear the intestinal tract of all parasites and abort the attack. About the eighth day puffiness of the face and eyelids appeared. The ninth and tenth days after infection pain in the muscle became marked and increased. It was at that stage that the patient was admitted. Almost any muscle might be affected, including the diaphragm, muscles of the eyes, and especially the arm and neck; but the oesophagus was said to be usually exempt. Edema of the trunk and limbs occurred during the fourth or fifth week and might be quite general, but usually spared the genitals. The latter part of the attack of trichinosis might develop into more or less of a typhoid state after the acute symptoms of the early stages had subsided. Pulmonary complications were common. Convalescence might come by the fourth or fifth week as in the case reported, with permanent encystment of the trichinæ. When death occurred it may be at a later stage from some complication. The diagnosis of trichinosis, he said, was always difficult and, in some cases, impossible without a specimen of muscle showing the trichinæ. In the case reported the symptoms were referable to the lungs quite sufficient to explain the fever and other constitutional symptoms, and with the pains in various parts of the body influenza might have been diagnosed. But the persistence of the constitutional symptoms and the development of the general condition known as typhoid state made the diagnosis of typhoid fever in many cases seem probable, though the initial headache, epistaxis, rose-spots, and enlarged spleen

were absent. He said that, in this case, grippe followed by hysteria would have presented a symptom complex agreeing with every symptom of the history excepting eosinophilia. Hysterical contractures, or contracture following brain lesion, would simulate a myositis. He had now a case at the Demilt Dispensary where such a neurotic contracture, presumably hysterical, caused the biceps to be constantly in a state of tonic contracture, resembling a myositis from its hardness and apparent increase in size.

Intraspinal Injection of Lysol Solution in the Treatment of Cerebrospinal Meningitis, with a Report of Three Cases Treated by This Method.-Dr. MORRIS MANGES read this paper. He said that the perusal of the various monographs on the subject showed how very limited was the sphere of our therapeutic agents. So far as he had been able to learn from a review of the literature, methods of treatment had but little influence on the mortality, which, for the epidemic form, was estimated from 20 per cent. to 75 per cent. He said that we were indebted to Seager (Lancet, November 1, 1902) for a new method of treatment, the results of which were most encouraging. This treatment consisted in lumbar puncture and the withdrawal by aspiration from the spinal canal of varying quantities of cerebrospinal fluid, frequently amounting to 50 c.c. Artificial serum was then injected with the same syringe, the needle being left in situ, and the surrounding parts were washed with the serum; lastly, a quantity (from 9 to 12 c.c.) of a 1-per-cent. solution of lysol was injected through the same instrument and the needle withdrawn. The temperature would fall immediately, but rose again after one or two days, when the puncture and injections were to be repeated, and so on until only quite clear and limpid fluid was withdrawn after puncture, and then the injections were stopped. Seager called attention to the painfulness of the procedure, but Dr. Manges' experience in the two cases under his personal observation did not corroborate this. Of the thirty-one cases treated in Lisbon with lysol, 13 died-5 from dilatation of the cerebral ventricles, 2 from pulmonary tuberculosis, 1 from œdema of the glottis, 1 from purulent pneumonia, and 4 from the disease without complications. The 18 that recovered were completely cured.

Of the two cases that came under his personal observation one was a meningococcus infection and the other a virulent streptococcus. While it remained an open question whether the meningococcus case would have recovered without treatment, since the sporadic cases in adults not infrequently do so, yet the fact remained that the patient was losing ground in spite of the various treatments employed. After the first injection he seemed to hold his own, while after the second his recovery was rapid and uneventful. Of the second case he could speak with more assurance since, at the Mount Sinai Hospital, death had resulted in every instance of cerebrospinal meningitis in which the streptococcus was found in the fluid obtained by lumbar puncture. The condition of the child at the time of the first lysol injection was so desperate that no one who saw the case expected the child to survive the night; hence his complete recovery without any after-effects was all the more gratifying. It was to be noted that the washing out of the spinal canal with artificial serum was omitted in both cases The injections were all done without anesthesia except the first one in the child, which was done under slight chloroform narcosis. No pain was complained of and no unpleasant after-effects were noted. Dr. Manges then gave the detailed histories of the two cases under his observation, and also the one treated by Dr. Seff at Lancaster, Pa., while he was home on a vacation. Dr. Seff was a member of the house staff at Mount Sinai Hospital. An Observation on the Selection of Food in Tuberculosis. -Dr. JOHN B. HUBER contributed this observation and showed two maps of the lower portion of Manhattan Island, which were prepared by Miss Lillian Brandt, the

statistician of the Charity Organization Society of New York City. The first of these maps represented by varying degrees of shading the varying densities of population in respective districts. The most densely populated district was thus shown to be the region about Grand and Rivington streets and east of the Bowery. This region was inhabited by Jewish people to the practical exclusion of all other races. It was said that one-fifteenth of all the Jews in the world are in New York City, and from five to seven hundred thousand of them; and the vast majority of these Jews were crowded into this district. Miss Brandt's second map represented the death-rate from consumption in these districts; in this map this same Jewinhabited district was shown to be the one in which consumption was of all the regions in New York City the least rife. These maps tended to corroborate the findings of Korosi, Billings, Fishberg, and others to the effect that the Jews were of all people (except, perhaps, the Quakers) the least prone to tuberculosis. The Jewish people inhabiting this quarter were subject to all such conditions as would tend to tuberculosis, that obtained in all the other districts indicated. Indeed, among the Jews some of these conditions were greatly emphasized. For instance, they worked in sweat-shops, in vitiated atmospheres, bending over their machines for many hours, to the great detriment of normal respiration. These poor Jews were certainly no more cleanly than other people in the same stratum of life. With regard to their homes, this Jewish district was by far the most congested in the city. It occurred to Dr. Huber that there was one factor which existed among these Jews which did not obtain among other races-the "kosher" food. He had been informed by many that the very poor Jews, at least, obeyed implicitly the requirements of the Mosaic law concerning such foodstuffs as were rejected by their religious officials as "tiefa," or "unfit to eat." The percentage thus rejected was variously estimated at from 30 to 50 per cent. of the meat examined. This fact of food examination among the Jews seemed to him to have some bearing upon the opinions held by von Behring, Carrière, Raneuel, Theobald Smith, and others, to the effect that tuberculosis was oftentimes an ingestion disease. According to these workers, the tubercle bacillus in infected meat and milk, after having passed the gauntlet of the gastric juice, might be taken up by the lacteals and be conveyed to the thoracic duct in the chyme, and thence to the vena cava, the right heart, and, finally, the pulmonary parenchyma. There were some who went so far as to maintain that the ingestion of tuberculous foodstuffs was the only method of infection of the human organism; this view be considered absurd and unscientific. Even in inhalation tuberculosis, however, the air vesicles were generally not entered by the bacillus, the mode of dissemination being by means of the bronchial glands and the lymphatics of the upper-air passages, and thence to the vena cava, the right heart, and so to the pulmonary parenchyma, too. In conclusion, he referred to papers by the statistician, Mr. Hoffman, and by Drs. Flick, Ravinel, and Salmon, in the Maryland Medical Journal for February, 1904. In these papers much of the literature concerning ingestion tuberculosis was epitomized; and in them the names of some fifty workers in this field were set down.

On the Sanitary Surveillance of Tuberculosis in New York City. Illustrated by Exhibits Prepared for the St. Louis Exposition.-Dr. HERMANN M. BIGGS read this paper. After referring to the enormous death rate from tuberculosis, more than one-third of the deaths occurring in the best working period of life-fifteen to forty-five-and that nearly 45 per cent. of the deaths in Vienna during this same period were caused by it, he briefly gave an account of the manner of dealing with this dread disease in New York City.

(1) He said that there was a system of compulsory notification and registration. Last year there were re

ported to the Board of Health 14,000 new cases of tuberculosis and 4,000 duplicates. These gave data as to age, sex, color, occupation, etc., and were recorded in two card indices. In one they were indexed according to street and number of residence, and in the other according to the name.

(2) Arrangements had been made with the Board of Health for the free examination of sputum for diagnosis, and had in view several purposes, a more cordial cooperation on the part of the medical profession, and, in this way, a large number of cases would be reported and again it would facilitate the early diagnosis. During the past year more than 11,000 specimens of sputum had been examined in the laboratories of the Department.

(3) The premises where reported patients resided, or where they had been removed, were visited by inspectors to determine the degree and extent of the possible infection of the apartments. Often, as a result, the owner of the premises was given an order requiring renovation, painting, papering, kalsomining of walls and ceilings, etc. In these cases the apartments are placarded forbidding their occupancy by other persons until the order had been complied with.

(4) When consumptives lived on the premises, then inspectors left circulars of information, gave verbal instruction, obtained any data which were lacking, determined the physical condition of the patient and what the sanitary conditions of the premises were, what precautions were being taken, whether the patient was a menace to members of his family or neighbors, etc., all of which facts were recorded on a card.

(5) Strenuous measures had been taken to educate the medical profession and the people as to the essential nature of tuberculosis and the measures to be taken for its prevention. A number of different forms of circulars had been printed, in different languages and for different classes of people. The public press received constantly full information regarding the work of the Department. The Tuberculosis Committee of the Charity Organization Society had rendered most efficient work. A large number of lectures had been given under the auspices of this committee. In various ways and through various channels a knowledge of tuberculosis and its nature and the measures to be adopted for its prevention had been widely disseminated among all classes of the community.

(6) Public institutions were inspected, and the completeness and accuracy of reports determined. Every death reported from tuberculosis was compared with the card index of reported cases, and it was found that 90 per cent. of the cases of tuberculosis had been reported previous to death.

(7) At the beginning of this work in 1894 he had prepared sectional maps of the city showing every house lot on a scale large enough so that reported cases and deaths could be plotted in each lot by conventional signs, indicating the month and year of report. A few blocks had been selected in which the largest number of cases had occurred, and he had them reproduced. On these each case and each death was indicated by a dot, and it was shown that in a single street block as many as 102 cases came to the notice of the Department from April, 1894, to January 1, 1899. The population of this block in January, 1900, was 1,165, showing that nearly 10 per cent. of its population was affected with this disease.

(8) The provisions for the care and treatment of consumptives in New York were lamentably deficient. Strenuous efforts were being made to remedy this.

As a

result of the action of the Department such cases now are only cared for in institutions especially devoted to this purpose. These have accommodations only for about 1,600 patients. The Department last year prepared plans for the erection of a special tuberculosis dispensary, and submitted a request for an appropriation. This was completed and opened March 1. Plans for two different sanitoria for the care of incipient cases have been under consideration.

(9) The Department had enacted ordinances forbidding spitting on sidewalks, floors of street cars and other public conveyances, ferry boats, ferry houses, elevated stations, etc., and considerable progress had been made in enforcing such ordinance, and educating the public up to their enforcement. It seemed to him that the time was coming and must come when public opinion would regard spitting on the floors of public places or conveyances or sidewalks as indecent and not to be tolerated. He firmly believed in the education of the public in this, which was of the greatest importance in the prevention not only of tuberculosis but also of acute respiratory diseases. He summarized some of the results accomplished briefly as follows: (1) Widely disseminated knowledge among all classes of the population as to the nature of tuberculosis and the measures to be taken for its prevention. (2) The provision for increased facilities for the care of these cases. (3) The development of a definite scheme and organization for dealing with tuberculosis. (4) The creation of an enlightened public sentiment toward the problem presented. (5) A reduction in the death rate since 1886 of more than 40 per cent. The tuberculous death rate for the ten years preceding 1886 was nearly 45 per 10,000 of population; for 1886 it was 44.1, and for 1902 it was 26.8.

What was further required in New York he summarized as follows:

1. A still more enlightened public sentiment, less fear of consumptives, and a more intelligent appreciation of where the danger is laid.

2. Better dwellings were needed for the poor; also more light and fresh air and space; better hygienic surroundings, better pavements, cleaner homes, better and more abundant food, etc.

3. The creation of a public sentiment to the effect that spitting on the floor of public conveyances, halls, etc., and on sidewalks, was indecent and not to be tolerated.

4. A closer supervision of consumptives by the sanitary authorities, and more frequent visits to their homes and places of business.

5. The education of the medical profession and public to a more thorough appreciation of the importance of a chronic cough and other signs of beginning tuberculosis in order that an earlier diagnosis might be made.

6. The suppression of the many widely advertised specifics and cures and special methods of treatment for tuberculosis, which served only to enrich their promotors and keep consumptives under unfavorable conditions for long periods of time.

7. More adequate provision for the care and treatment of tuberculous patients in special dispensaries, sanatoria, and recognized hospitals.

8. The more general enforcement of regulations for the compulsary removal and retention of these cases of pulmonary tuberculosis which were a menace to the public because of the inability or unwillingness to observe the necessary precautions.

9. The provision of some means for dealing with the economic features of this problem.

Dr. Biggs said that the removal of every case of tuberculosis meant a considerable expenditure, amounting perhaps to a loss of wages, interest of invested capital, cost of maintenance, etc., to at least $200 to $300. Thus during the year, for the care of two to three hundred cases, from $40,000 to $60,000 may be spent. This would result in the cure of a considerable number, say forty or fifty, the arrest of the disease in others, the sanitary education of all, the affording of comfortable surroundings and conditions for those who must ultimately die. Certainly this represented a large return for the money expended. He did not believe, so far as the ultimate reduction in the death rate was concerned, so much had been gained by such an expenditure as would have been gained by expending half this amount among the poorer classes, in sending medical inspectors and trained nurses to instruct and supervise the conduct of these consumptives at home, and the disinfec