roundings are uninviting and depressing. In winter they may be beneficial for such individuals as are philosophic enough to be happy under any circumstances. The air is dry, in fact it is too dry. Meats will dry before putrefaction takes place. But the climate is too depressing and enervating except in winter.

We read much concerning the great achievements of the Government hospitals in New Mexico. Grant that what we read is true, is it the work of the climate alone, or is it the climate plus the skill of the doctors and nurses, coupled with the facilities provided by the Government which produces the results? Cannot the same results be achieved in many and more wholesome places? I believe better results can be obtained elsewhere.

Texas is subject to too sudden severe changes of temperature, accompanied by storms, to be beneficial. Four years ago the thernometer recorded a temperature of six degrees below zero and many cattle perished from cold in the southern part of the state. Sanitary conditions are abominable and typhoid fever is prevalent.

Utah, Nevada, and Wyoming offer no great advantages to the tuberculous patient other than may be obtained in any mountainous or desert part of the west. The rainfall is too great in Utah. Nevada seems to be narrowing down to live stock and mines to the exclusion of everything else.

Oregon and Washington have too much rainy and foggy weather. Lastly, will consider California. I am frequently asked about the climate of this state. It is decidedly in the plural. One county frequently presents two or three distinct climates. The climate cannot. be judged by either latitude or longitude. Mountain ranges, prevailing winds, altitude, and ocean currents conspire to give to California about as many and varied climates as are enjoyed by all the other territory west of the Mississippi. The extreme southernly part of California, except a narrow strip west of the coast range of mountains, is a desert. Here the character of the country is not much different from Arizona. The climate, however, is somewhat influenced by the varying altitudes and the cool breezes at night from the high Sierras. In the extreme south on the Southern Pacific. railroad is Indio. This is rather a unique place, being two hundred sixty-two feet below sea level. Several artesian wells furnish irrigation for a few acres of land. A hotel and a few cottages provide shelter for guests. In February the air is delightful. In July it is stifling hot and the sand and dust blow and drift constantly. To give an idea of the effect of the blowing sand, the railroad company has to pile rocks to a height of several feet against the windward side of the telegraph poles to prevent them from being cut off by the constant sand blast. Within a few months' time an exposed pole will be cut nearly to the middle. The trade winds from the Pacific blow from April to October, causing the winds to be commonly from one point. There is no amusement for the patient while at this place. He has nothing to do but loll about and get homesick. While the climate has its advantages in winter, the

surroundings are such as to make most patients wish to leave as soon as possible. But a short distance from Indio are the great salt beds of Salton, over three hundred feet below sea level.

Needles, on the Santa Fé railroad, is just across the Colorado river from Arizona and quite a distance north of Indio. Needles has cooler nights in summer than most desert places. People begin sleeping in the open air in March. The same objection prevails here that obtains in all the desert country-No place to go! Nothing to do! Gloom, dust and desolation! although there is not quite so much dust here as elsewhere in the desert.

Palm Springs is just on the edge of the Mojave Desert. It is a more inviting place than the two above mentioned. It is not quite so hot and affords a few weeks longer refuge than Indio or Needles.

These three places offer advantages to the philosophic patient with plenty of money, and the knowledge that he can leave whenever he chooses. They are subject to sand storms in summer and frost and atmospheric disturbances at times in winter, which are disagreeable. The bane of all desert places is the overwhelming amount of diet from tinned goods.

Redlands, Colton and neighboring places are on the border of approaching fertility. The summers are hot, but the nights are pleasantly cool for the most part. Irrigation on an extensive scale has produced fruits and flowers and vegetation to please the visitor and make him content.

Los Angeles is nearer the Pacific ocean and has a cooler climate than the above mentioned places.

San Diego, Santa Barbara, Pacific Grove and Santa Cruz are coast towns. There are many intervening resorts on the coast. Many patients thrive here. The sea air has a tonic effect and gives an appetite to many. To those persons having tuberculous throat trouble. the sea air is sometimes irritating. The coast places in summer and the desert in winter make a good combination for many individuals.

Mount Shasta and Lake Tahoe are types of the mountain resorts. There are hundreds of mountain resorts. Many are located in or near the craters of extinct volcanos. Tuscan Springs is a type of these retreats. There are twenty-eight distinctly different springs here. Water ranges from cold to hot. There are saline, sulphur, and iron waters. Many springs are impregnated with antimony or arsenic. California has thousands of mineral springs, which are inaccurately classified and improperly used. That they are destined to become of great therapeutic value, I believe. At present they are a source of mischief in many instances and I mention them in order to advise tuberculous patients to shun them until they are under proper scientific control.

Many patients derive great benefit from buying a camp wagon and spending a year at a time in the various parts of the Pacific coast, going south in winter and north in summer. cable only to people who are not timid and who enjoy the solitude of the

This kind of life is appli

mountains and forests. It may be necessary for a patient to move from place to place to find a suitable climate. Contentment, comfort and abundance of good food are essential. Without one of the three the patient will succumb.

I have known of markedly tuberculous patients going to Alaska, staying a year or two and returning apparently recovered, but their digestion was perfect before they went. Whenever tuberculosis invades the alimentary tract so as to interfere with the digestive function the victim is doomed. I have never seen one recover. Persons with marked laryngeal symptoms are equally unfortunate.

Much good can be accomplished at home by putting patients into tents. I know of the case of a woman in central Ohio who refused to leave home. She consented to live on a farm. Having abundance of money, the husband procured a farm and his wife took up her abode in a tent in a sheltered corner of the yard. After eighteen months she appeared well. I was in a tent this winter on a very stormy day. The mercury stood at five degrees above zero. The structure was a wall tent with single wall and top, 12x14 feet in size. A medium-sized "air tight" heater and a camp cookstove connected to the same pipe kept the room perfectly comfortable with only a moderate fire. Water in a bucket next to an exposed corner and six feet from the stove did not freeze when the thermometer recorded ten degrees below zero outside. In such a tent a patient has abundant pure air day and night. He does not suffer from the cold and if this. camp life were begun in summer he could live in the woods in this way all winter.

The possibilities of benefit from tent life are not thoroughly appreciated and should be made clear to those persons who are unable to travel. I believe that the tent is bound to hold a place of greater importance than the sanitarium built on the large plan. When inclement weather compels the patient to stay indoors, he is not deprived of fresh pure air in the tent. He is not so likely to take cold on going out. A tuberculous patient should be out wherever he can keep his clothing dry. He should ride if the ground is very wet or cold and to avoid fatigue. I believe that a trip in a sleeping car is more hazardous to the patient than a change from a house to a tent even in quite cold weather. Change of climate is seldom made without a cold, even by the robust. Colds are dangerous to the tuberculous patient. A tent can be afforded by almost any patient. It is a far safer habitation for an attendant of a patient than a room in a house. A simple camping outfit, warm cots, and a good tent with plenty of wholesome food, make a satisfactory equipment and one not very costly. In lieu of the tent a camp wagon may be fitted up. But even then a tent is an almost necessary adjunct. It is by far better to send a patient with such an outfit to a distant climate than to depend on chance for suitable accommodations. The place selected should be one affording as much as possible in the way of pleasant surroundings. Contentment and cheerfulness are essential to improvement in any case.

In regard to diet I will make but one statement. I make that because on it hinges a therapeutic question. I believe that plenty of good bacon is better than all the cod-liver oil on earth. Most codliver oil is nothing but nondescript fish oil. The question of which is the more palatable needs no comment.

The patient undergoing climatic treatment should be under the surveillance of a physician to whom should be intrusted any symptomatic treatment.

ORIGINAL ABSTRACTS

GYNECOLOGY.

BY REUBEN PETERSON, A. B., M. D., ANN ARBOR, MICHIGAN.

PROFESSOR OF GYNECOLOGY AND OBSTETRICS IN THE UNIVERSITY OF MICHIGAN.

THE NATURE OF HYDROSALPINX.

CLEMENT WHITE (Journal of Obstetrics and Gynecology of the British Empire, March, 1903) has drawn certain interesting conclusions as to the nature of hydrosalpinx from a clinical study of twenty cases of this disease. He defines hydrosalpinx as a fallopian tube with its abdominal ostium impervious, distended by nonpurulent, nonhemorrhagic fluid. He believes there is an analogy between hydronephrosis and hydrosalpinx, since both may be caused by partial occlusion of the ureter and tube. This was illustrated strikingly in one of his cases where the hydrosalpinx was produced by the blocking of the lumen of the tube by yellowish-white calcareous bodies. Usually the temporary occlusion of the tube is caused by periodic closure of the lumen by congestion of the mucous membrane in connection with the menstrual cycle. This is associated usually with faulty development. Pyosalpinx and hydrosalpinx are in different categories as far as their origin is concerned. The latter can become infected and become converted into a pyosalpinx, but White could find no evidence as to the occurrence of the opposite sequence. Blood may enter a hydrosalpinx and convert it into a hematosalpinx and this may become infected. Inflammations may occur around the hydrosalpinx, but do not produce the condition any more than adhesions produce an ovarian cyst.

From a study of six cases of hydrosalpinx, received at the London Hospital, White concludes that "the frequent absence of history of previous inflammations, though carefully inquired for, coupled with the fact of sterility, lead to the suggestion that the condition of hydrosalpinx is due to a developmental error, and is not in any true sense due to an inflammatory change." The clinical history of a large proportion of cases is not that of a salpingitis, and is often marked by the absence of symptoms. The symptoms which are present are such as are found in cases of maldevelopment, namely, sterility, pain, scanty menses, dysmenorrhea, and dyspareunia.

OBSTETRICS.

BY THOMAS STONE BURR, A. B., M. D., ANN ARBOR, MICHIGAN.

DEMONSTRATOR OF OBSTETRICS AND GYNECOLOGY IN THE UNIVERSITY OF MICHIGAN.

TYPHOID FEVER AND PREGNANCY.

BOYD and Routh (Journal of Obstetrics and Gynecology of the British Empire, April, 1903) report an interesting case of pregnancy complicated by typhoid fever in a multipara aged twenty-eight years. Her previous personal history was negative. At the eighth month, the patient suffered from the usual prodromata of typhoid, namely, headache, dizziness, vomiting, and general malaise, whose increasing severity compelled her to take to her bed three weeks later. The day before delivery her temperature was 102.6° and her pulse 120, of low tension but not dicrotic. The characterictic rose-colored spots developed on the abdomen and back, the spleen was palpable, and the dorsum of the tongue was covered with a thick moist coat, but the edges and tip were clean.

The labor was normal and a live child was born without any signs of typhoid. The temperature of the mother rose during the first twenty-four hours after confinement to 104.8°, but a cold sponge bath every four hours reduced it. The temperature fell by lysis a week later and the patient made an uninterrupted convalescence.

The blood of the mother gave a positive Widal reaction but a negative reaction was obtained from the child's blood. At no time did the child show any signs of typhoid fever.

The authors deduce the following conclusions:

(1) Pregnancy does not influence unfavorably the course of typhoid fever.

(2) Typhoid fever in the ninth month of pregnancy is a rare occurrence, as the two conditions usually coexist in the earlier months of gestation.

(3) The epithelium of the chorionic villi can act as a safe barrier against the passage of pathogenic organisms from mother to fetus.

(4.) Premature delivery during typhoid does not lead to a sudden lowering of temperature and rapid convalescence.

WILLIAM H. MORLEY.

PEDIATRICS.

BY ARTHUR DAVID HOLMES, M. D., C. M., DETROIT, MICHIGAN.

PROFESSOR OF PEDIATRICS IN THE MICHIGAN COLLEGE OF MEDICINE AND SURGERY.

INDICATIONS FOR REMOVING THE TONSILS.

GOLDSMITH (Canada Lancet, February, 1903) gives the indications observed by him for the removal of tonsils. (1) Deafness associated by overgrowths; (2) enlarged tonsils in debilitated children and adults; (3) frequent attacks of tonsillar or peritonsillar inflammation; (4) presence of caseous material in the tonsils causing impaired nutri