A FEW WORDS ABOUT THE WHITE MOUNTAINS FOR TUBERCULOSIS.

W. C. E. NOBLES, M. D., LITTLETON, N. H.

The White Mountains of New Hampshire for many years have been visited by thousands of hay fever, bronchial and asthmatic patients. To the writer's knowledge some have tried other localities but only to return where they could get the greatest relief.

For the last few years a new class of patients have made their appearance in ever increasing numbers, the tubercular or bronchial as some term themselves. If you wonder what the result of their trip up here amounts to, you have only to be here for a few days and take a glance at the country, hotels and accommodations in general. and you are soon convinced that the fast increasing arrivals of tubercular patients have made no mistake in their selection of a suitable place prepared by nature, for any individual, no matter how particular he may be. Should one care for altitude, valley or fertile. mountain side, they can have what is desired.

The altitude early affects most patients by causing them to feel drowsy. After this they try to satisfy a ravenous appetite. That is most important, as the vitality of the patient should always be first considered. As they get accustomed to the altitude their drowsiness disappears. The class who can be trusted to follow directions, often improve in a short time. but the class who require discipline, such as living in a sanitarium, should not think of coming here. Many resorts have an insufficient water supply and drainage. Here we take our water from the mountain side 600 feet above the town. This insures as pure a supply as nature can provide. Our streets are partly concreted and macadamized, and this pavement allows a thorough sweeping and flushing from powerful hydrants at frequent intervals.

At Bethlehem, once the social center of the White Mountains, are offered opportunities that are hard to equal. Numerous hotels can be seen, with broad verandas, clean streets and shaded walks, all tending to make the time of an invalid pass more pleasantly. Hotels which used to close in October, now have a sign conspicuously placed, "This Hotel Will Remain Open Through The Winter." The hotel proprietors receive all guests kindly. This prevents patients from feeling as they are apt to where only tuberculars are taken. Those whose strength permits, have the freedom of all places of amusement. The golf links are not to sporty to fatigue an ordinary person, while the base-ball grounds have a comfortable grandstand, where one can sit

without too much exposure and witness a game most any day. Daily concerts are given. Then the stores can be visited, where art, curios, and fancy work are liberally displayed.

Men who are to whip a trout brook in the open or beneath the alders, have excellent opportunities. Bass fishing is also good for those who are not strong enough to tramp a brook.

I mention these forms of diversion, as only a physician who has treated Tuberculars realizes how hard it often is to keep them at a resort or at home and still have them contented.

During the past summer a number of physicians, especially from New York and other eastern cities accompanied their patients, so they could judge if they were properly located. All I met expressed great enthusiasm over this region, often remarking that nature had certainly intended it for Sanitarium purposes.

TWO CASES FROM PRACTICE.*

WM. H. SMITH, M. D., CINCINNATI, O.

I present these two cases, one of purpura hemorrhagia, and one of infantile scurvy, together, chiefly because of the similarity of environment of the patients and of the etiology and treatment of the cases. Both patients were children of families in good circumstances. with ideal home and environment, and both cases were due to errors in diet, or rather to malnutrition. The treatment in both was strictly dietetic.

The first case was one of purpura hemorrhagica. There are a number of diseases and conditions accompanied by purpura or subcutaneous hemorrhages and, whether primary or secondary, little is known or, at least, has been written, in explanation of the direct cause of the external manifestations, viz: hemorrhages in various parts of the body. In the primary purpuras, the hemorrhages are apparently independent and the principal evidence or symptoms. On the other hand, the purpuric conditions are merely secondary to severe infections, as in syphilis, variola, diphtheria, septicemia, etc. In either circumstance, the hemorrhages may occur from the mucous surfaces, as well as subcutaneously. Among the primary purpuras. we have, according to Hecker of Munich, purpura simplex, purpura

*

Read at meeting of the Ohio State Homeopathic Society, Toledo, May 4th and 5th.

rheumatica, purpura hemorrhagica, abdominal purpura, purpura fulminans, scorbutus (which some authorities distinguish or classify separately from true infantile scurvy), paroxysmal haemaglobinuria. and haemophilia.

This case of purpura hemorrhagica occurred in breast-fed female, aged six and one-half months. The purpuric spots started on the wrists and legs simultaneously, and, ultimately, covered most of the trunk. The face alone was exempt. On the trunk, the spots were indurated and as large as a dollar, in several places coalescing. Slight hemorrhages occurred from the nose and intestinal tract and there was haematuria. The condition spread very slowly and covered a period of several weeks. As fast as a few spots would fade, others would form. There was no swelling of the joints, no pain (that is the child was fairly good-natured and did not cry much), and no great gastro-intestinal disturbance. The mother, other than being slightly rheumatic, was in good health. Examination of the mother's milk showed a decided deficiency in fats and carbohydrates. Supplementary feeding did no good, so the child was weaned and placed on beef juice and modified milk. Recovery occurred in two weeks and the beef juice was discontinued. The child died nearly a year later of an acute intestinal affection. An interesting feature in this case was, that nearly one and a half years (sixteen months), to be exact, after the child's attack of purpura hemorrhagica, the mother had a typical attack of purpura rheumatica.

The second case, one of infantile scurvy, I desire to call your attention to, not because of any unusual features, but rather on account of its being such a typical one. Infantile scurvy is a condition of the early years of childhood, characterized by anemia, purpura, pains in the extremities, swelling over the long bones due to subperiosteal hemorrhages, and emaciation. It attacks rich as well as poor, and, in babies, I believe the rich are more often attacked because they are more prone to doctor the milk too much and adhere to too strict a diet.

This disease probably is often overlooked entirely, a diagnosis of other conditions, as rachitis or rheumatism, being made, resulting probably in fatalities where a proper diagnosis would have resulted in a simple line of treatment and a cure. I say simple line of treatment because I know of no disease, so serious, that yields to a proper change of diet so quickly and so satisfactorily as infantile scurvy On the other hand, when unrecognized, and, being unrecognized, the proper dietetic changes will hardly be made, ho disease is more certainly fatal.

While anemia is usually the first symptom to develop, the physician's attention is usually not called until pain in the extremities is noted, usually in the lower. The child holds its legs rigid, refuses to sit up or crawl, and cries every time it is diapered. If the child has teeth, the gums around them will ulcerate. If there are no teeth, purpuric spots occur on the gums. At this stage conical swellings occur along the shaft of the long bones, usually at the lower third. It may occur at the sternum. Hemorrhagic swellings and purpuric spots may occur on the eyelids and other parts of the body and there is often haematuria.

W. F. L., aged ten months, a large, robust looking youngster, was rather above the average in weight and development. Being a child of parents with a good income and living in the residential part of the city, was very much favored, as far as surroundings were concerned. My attention was called to him because he cried every time he was diapered. Careful examination revealed nothing, except that he kept his left leg rigidly flexed. Appetite good, no fever, and slept well, except that he would cry out when he rolled over in his sleep. Some medicine was left with instruction to report in a couple of days. Four days later I was called again and found that he refused to sit up. Still I did not suspect the true state of affairs. On the seventh day, while examining the child, I found a slight swelling of the lower end of the femur and, while looking at his tongue, I noticed the ulcerated gums. A diagnosis of infantile scurvy was promptly made and the patient put on orange juice, raw milk. properly diluted, and beef juice almost raw. In a week all symptoms had disappeared.

The mother had been feeding this child on almost pure top milk thoroughly sterilized-too much fat-insufficient proteid, and then she cooked the life out of it.

REPORT OF THE WORK OF THE OHIO MEDICAL BOARD.

H. E. BEEBE, SIDNEY, OHIO.

I can do no better, as an introductory to this report, than to quote from the present president, Dr. Ravogli, when he in most concise words, submits the Thirteenth Annual Report of the Board to His Excellency, Gov. Harmon, as follows:

"I am proud to state that the members of this Board have worked unselfishly for the welfare of the public and of the medical

profession. Their efforts have been directed toward increasing the standard of medical education, maintaining the dignity of the profession and of eliminating from the right to practice those who are morally and professionally unworthy. Reciprocal relations have been established with many states whose educational qualifications are equivalent to those of Ohio, and the relationship is gradually being extended to the great advantage of the profession at large."

Previous to 1896, when the General Assembly of Ohio enacted the present law creating a Medical Board, there was not much of value in our statutes regulating the practice of medicine. What we had was almost a dead letter due to the meager attention paid to enforcing it. The profession was in rather a chaotic state, since it was not organized nor respected as it is to-day; neither had it wide influence with the public as we think it has at present. At that time any one who had practiced ten years was legally entitled to continue, and as a consequence many inferior practicians were registered. This should have been different for in due time the Board succeeded in bringing a case before the courts and thereby an old decision was changed, making the statutory limit 21 years instead of 10. But before that decision was rendered nearly all the legal practitioners were licensed. More medical colleges graduated inferior students than they do now, as their action was then final.

The Board has been most unjustly criticized by a few, not so many as formerly, who knew little of its powers and workings. These critics demanded that the board at once elevate the profession to an ideal standard, eliminating all objectionable features and members.

Stop and consider that the first year, through the enforcement of the law, approximately 10,000 physicians were legally registered, besides driving from our borders about seven hundred illegal and unqualified. Is not that a fair record? With this large number. though ever so watchful, some not fully entitled to registration are bound to be admitted. When once legalized it is not an easy matter to revoke a certificate. Remember there are but three causes under which a license can be taken away: (1) the liquor or drug habit; (2) felony; (3) gross immorality. Furthermore, decided proof must be in evidence.

There are some modifications needed in the law before all that is desired can be accomplished. The Board has always had the full support of the Governor and Attorney General, and the same is particularly true of the present Attorney General, who takes a special interest in aiding the Board with his council. There is less opposition today than ever before, as there seems to be a spirit of general