tals for tuberculous patients, and ten have projected State sanatoria. New York City has located a hospital for poor consumptives on Blackwell's Island which I examined recently through the kindness of Commissioner Folks.

In Russia earnest efforts are being made in behalf of the tuberculous poor. Large sums of money have been raised for the purpose of establishing sanatoria in different parts of the empire. At Kieff, Karkhoff, Moscow, and Warsaw influential societies have been organized for combating the spread of phthisis.

There are writers who recommend tentlife for consumptives, and this plan has been put into execution at various places both in this country and in Europe. There are serious objections, however, to this method, more particularly in climates which are damp and changeable. A fall of rain saturates the eanvas and renders the interior cold, humid, and uncomfortable. An atmosphere of this kind is by no means favorable to consumptives. In the prolonged storms to which we are subject in this part of the country, life in tents, for well or sick, is thoroughly unsatisfactory. Moreover, the moisture, which both accumulates and persists, furnishes a nidus for the development not only of the bacillus tuberculosis, but also of other species of micro-organisms.

The application of the most approved methods to the care of the poor consumptives is a subject which interests every large municipality and general hospital. It is, indeed, one of the questions of the day. Questions of finance, and limitations of space enter largely and necessarily into the problem. In this city the Philadelphia Hospital is the ultimate refuge of consumptives belonging to the poorest class. This institution has a long and admirable record, and has undoubtedly accomplished much good in the alleviation of disease. Its main buildings and general wards are, however, far from being well adapted to advanced methods in the treatment of tuberculosis.

A modification of existing conditions has become necessary. The problem is to place our patients amidst surroundings capable of creating a strong impression upon the disease, and arresting its progress in cases not too far advanced. From the necessities of its position as a great city charity this hospital has long been overcrowded. Improvements are now being prosecuted which shall eventually separate the general hospital from the insane asylum and almshouse, and thus afford more ample space as well as far better facilities for the accommodation and treatment of the sick poor of Philadelphia.

There are always many consumptives in the wards of this institution. All periods are represented, but most of the patients. are in an advanced stage of tuberculosis. It is not, as a rule, until they are unable to perform their accustomed work, and until all their resources have utterly failed, that they enter the hospital.

a

For the benefit of this unfortunate class method which I have employed with marked benefit in private practice has been elaborated and adapted to usefulness on a larger scale. larger scale. I have been in the habit, wherever circumstances permitted, of having my patients spend their days, during the milder seasons of the year, in good weather, upon balconies or verandahs built out from the house. In winter, or in stormy weather, hot-houses and conservatories were utilized when practicable. These structures are often arranged in such a manner that the glass sashes can be thrown widely open. According either to the state of the weather or the season of the year the patients could enjoy, for much of the time, the advantages of open-air life or the sunparlor. From this germ, and after repeated consultations with the architect, Mr. Philip H. Johnson, of this city, plans have been perfected which will extend the advantages heretofore only within reach. of the people in easy circumstances to indigent patients of the Philadelphia Hospital.

The intention is to erect pavilions which will permit the adoption of the open-air and sunlight treatment of tuberculosis. City Councils of Philadelphia have appropriated one hundred and fourteen thousand dollars, which will suffice for the construction of six sunlight pavilions, and contracts have been awarded for erecting them without delay.

The wood-work of hot-houses, conservatories, and verandahs constitutes a disadvantage from the fact that it becomes a lodging-place for pathogenic bacteria, and this capability would become all the more marked if numerous tuberculous patients, as in a large hospital, were continuously housed in such an apartment. But the pavilions we are contemplating are of unique design. Their original and distinctive feature is the material of which they are constructed. In brief, steel supports are substituted for wood. The structures will be composed entirely of glass with the exception of steel frames to support the weight and a basis of cut stone and brickwork. The specifications call for materials of the best description. The co-operation of the architect and contractors provides for the stability and economical construction of the edifices; so that, as a whole, the work shall be a finished, complete, and unique one of its kind. The contractors are given to understand that the buildings. must constitute a perfect piece of work, and the materials entering into it are to be first class in every respect. The contractor is required to brace properly and secure all parts of the work against wind, storm, and frost. All materials in the columns are to be of steel, all the rods and bolts of wrought iron. The beams and girders are to be set at uniform distances between established centers. On all the columns brackets and connections are to be provided in order to secure first-class supports for the load. The steel used in the buildings is to be of the best make and uniform quality. All is to be tested in order to comply with the most stringent requirements.

The walls and roofs are to be of plates of glass. Without entering any further into architectural details, the one great and distinctive object to be served by the columns, beams, connections, and other necessary structures is the support of glass sides which can be thrown open and a glass roof which can be raised. The glass sashes move on pivots placed in the supports. These act as air-tight joints; the plates of glass, when thrown open, lock tightly together and permit the entrance of a broad and free stream of air and an abundance of sunlight. Analogous arrangements are made for holding the roof firmly open. By these contrivances when weather and temperature are suitable the patients, even if bedridden, will obtain the inestimable advantages of an open-air treatment. In stormy weather and in winter they are protected from inclemencies. In fair, but cold, seasons the patients receive the benefits of a sun-parlor. The structures are perfectly air-tight, and draughts are excluded. An excellent system of ventilation has been adopted so that when the apartments are closed the air is changed and renewed every twelve minutes. Vitiated air is thrown out into the surrounding atmosphere. Due provision has been made for heating the rooms.

Each pavilion consists of one story, 28 feet in height. The dimensions of each are 48 by 39 feet. Between each two pavilions is an open space of 40 feet, and the six buildings are fronted by a space 600 feet long and 80 feet wide. The ground upon which the pavilions are placed is high and dry. It is to be planted with such shrubbery as will flourish in this location. The salubrious effects of foliage in purifying the atmosphere will be of service to our patients. Vegetation has also an important influence in equalizing the distribution of heat throughout the twenty-four hours.

The main room of each inclosed pavilion is the dormitory, which accommodates 30 patients. If necessary, the corridors can be included, and will give space for 10 more patients in each pavilion. The floor is

granolithic. Each pavilion contains a kitchen, lavatories, bath-rooms, linencloset, and dining-room, 18 x 14 feet in extent, sufficient to seat 18 people at one time. Each bath-room is furnished with two tubs and two shower-baths. Patients can perform their own ablutions, or be bathed by attendants in the bath-rooms or sponged in their beds, according to their condition. The shower-baths are so arranged that the temperature and stream are regulated and varied simply by turning a handle.

Patients will be lodged in the pavilions in accordance with the stage of their disease, those of the same stage being placed together, as far as possible. When their sides and roof are thrown widely open the pavilions will be transformed, to all intents and purposes, into open-air gardens, in which the patients will inhale pure, fresh. air and receive the salutary influences of the sun's rays. Those who are too ill to leave their beds will be relieved by the genial powers of air and sky. It is intended also to place in each pavilion a large, static electrical machine, in order that when they are inclosed ozone may be generated and add its renovating effect to that of the ordinary ventilation. This allotropic condition of oxygen is an efficient aid in promoting nutrition. It is also antidotal to the life and activity of diseasegerms. Tubercle bacilli are less virulent in an atmosphere which contains a suitable proportion of ozone.

These are the broad general outlines of a project which will secure to the consumptives of the Philadelphia Hospital many of the advantages derived from change of climate which, in their cases, is impossible, and which will render these pavilions "hospital sanatoria," as they may truly be termed.

Johns Hopkins Hospital Medical Society. -Dr. John Whitridge Williams has been. elected president of the above society.

Clinical Lectures.

CONGENITAL DISLOCATION OF
THE HIP.1

BY PROF. ADOlf Lorenz,

of the University of Vienna, Austria. GENTLEMEN: I shall be as brief as possible in describing the method by which congenital dislocation of the hip may be reduced. For the success of the operation much depends upon the age of the patient. In young children there is generally but little difficulty. In older children and in adults reduction cannot be accomplished. The patients here to-day are from 2 to 9 years of age. In the case of the oldest we may expect to meet with much trouble, for it is near the age-limit, which in most subjects of double dislocation is from the sixth to the seventh year. In unilateral cases this period is extended to the ninth or tenth year. The oldest patient upon whom I have operated was 23 years of age and the result was a success.

In order to effect reduction all the soft parts, especially the long muscles, must be stretched. The adductors offer most resistance. These were formerly incised, but we were liable to divide too much or too little, and there was also the objection of leaving wound-cavities communicating with the air. For these reasons it is better to employ subcutaneous myotomy or to overstretch the structures. The anterior muscles in particular are very refractory. Their opposition. must be overcome by traction and, if necessary, by hyperextension. The resistance of the posterior muscles is opposed by flexing the thigh and extending the knee. The next step is to pull down the head of the femur to the acetabulum. Then begins the real process of reduction, the placing of the head of the femur within the acetabulum. This may be done by pressing upon the trochanter, but I prefer to make

'Delivered at Jefferson College Hospital, Philadelphia, December 11, 1902. Reported for THE MEDICAL BULLETIN.