he was much interested in the study of the climate of the City of Mexico. He was a delegate to the Pan-American congress, and considered it one of the most unhealthy cities in the world. He stated that the city had a very high death rate, and gave as a cause the location of the city in a valley which received the sewage. Dr. Curtin's reason for speaking of this fact was to carry out the idea of Dr. Solly's remarks, that something besides elevation should be considered in the location for cases of tuberculosis.

Dr. J. B. Walker believed that the oil of cloves had not only an influence in modifying the general nutrition, but also that it was beneficial in cell nutrition.

Dr. Solly believed that the oil of cinnamon is perhaps a little better antiseptic, as the oil of cloves is not so well tolerated by the stomach.

Dr. Ingalls, in closing the discussion, said he could not agree with Dr. Solly that the effects of change of location are purely mental; he believed also that the bicarbonate of creosote could be taken in large quantities if started in small doses. He had not used the oil of cloves as an inhalant, and stated that he did not expect to attack the bacillus locally by an inhalation. He was familiar with the views of some that the antiseptics were useful in benefiting the nutrition, and he thought they did benefit the blood by increasing the destructive qualities of the blood for microbes.

Choice of a Summer Residence.-Dr. F. I. Knight, in a paper with this title, compared the New England coast resorts, and said they presented differences of temperature, moisture, wind, and other climatic conditions. He said that to be cool in summer on the New England coast one must be where the south wind blows directly from the sea. As the general direction of the line of the east coast runs mostly northeast, the coast would have the south wind from the water if it were not for the interference of the two capes, Cape Ann and Cape Cod. North of Cape Ann as far as Hampton, N. H., and north of Cape Cod, especially between Cohasset and Boston, the south wind comes overland and is a hot wind; whereas north of Hampton, N. H., and south of Cape Ann toward Boston, on what is called the north shore (i.e., of Massachusetts Bay), he said the south wind comes from the sea; therefore these places are cooler than the former. He spoke also of the island resorts, where the quality of sea air is experienced more constantly and the temperature is more equable, but which differ considerably one from another in average temperature. He stated

that the Isle of Shoals was much cooler than Block Island or Nantucket.

Dr. Bowditch, in discussing Dr. Knight's paper, said that the curiously dry quality of the atmosphere on the Maine coast, in spite of the fact of its being on the sea, was so striking that he thought phthisical patients would do well here, and although he had never dared to recommend it for such patients because he had found that mountainous regions were better, still, if a patient wished to try it, he should not hesitate in telling him to do so.

Dr. Solly, in discussion, said he was very glad to hear Dr. Knight's remarks about these home climates; that in Colorado it was often necessary to send patients back East for the summer; that it was a question very important to know where to send them, and that he had been studying the New England climate in that regard. He wished it were possible to secure meterological reports of these places.

Dr. Alton thought there had been too much generalizing in the matter of climate, and that it would be well to study minutely approximate localities.

Dr. Babcock, in discussing the paper, expressed his belief that the effect of climate in the treatment of tuberculosis is largely due to whether or not the patients are able to spend much time in the open air, and that if patients are to be sent away in the summer they should be sent to climates which are stimulating, and that they must go to localities where they can remain in the open air.

Dr. Taylor stated that the reason why tuberculosis was at one time so prevalent along the Maine coast was on account of the insufficiency of food, its quality, and its preparation, and that since. the improvement in these details tuberculosis is far less prevalent.

Dr. Bonney stated that inasmuch as he had lived in Maine for a number of years, he had observed that there was a considerable difference in the character of the soil in portions of Maine from that in New Hampshire or Massachusetts. He said there was much surface moisture after a rain storm, and that it took much longer for the moisture to dry than in Massachusetts. He spoke of the ready disappearance of the fogs, which came on after a delightful day and would entirely disappear in the morning.

Dr. Knight, in closing the discussion, remarked that the coast of New England was hardly to be recommended except in the summer and autumn. He said in regard to the prevalence of such a disease as tuberculosis that it should be borne constantly in mind.

that it does not exist until introduced, and that it is rather the propagation and development that are to be favored by climatic conditions.

Climate or Environment as a Factor in the Repair of Neurasthenia and Melancholia.-Dr. J. Madison Taylor, in a paper with this title, expressed his personal convictions, based upon cases in his own practice and elsewhere. The paper was designed to elicit comment as to the experience and conviction of other climatologists. The profession is dependent for statistics on this subject upon contributions from those physicians who reside in countries and situations valuable from a climatic point of view. The author's convictions were: 1. That change of climate is of relative insignificance in the treatment of neurasthenic states, although changes of situation quite frequently are of more or less importance. 2. The most important element of change has to do with environment, including not only change of place, but of persons and things. 3. It is important to outline what constitutes the essential points. in this change of environment, so that the average practitioner may keep in mind such imperative conditions and modifications as the varying needs of the individual, his domestic and financial status, make necessary.

The paper made special reference to the undesirability of radical changes inconsistent with the customary life of the patient, and laid stress upon the distinct harm wrought upon a highly sensitive organization thrown out of balance by a prolonged residence on the seacoast or in high mountain regions. It called attention to the hurtfulness of rushing about from place to place in obedience to morbid impulses, the outcome of agitation due to disease.

Diseases of the Nervous System Affected by Climate; Climate Defined. Dr. Sanger Brown, in a paper read by title, stated that benefits derived from change of climate are due: I. To incidental influences, such as relief from responsibility, change of scene, an outdoor life, and regular habits. 2. To the influence of the climate in the promotion of the general health. 3. To the direct effect of the climate upon the disease itself as the healing influence upon the lungs properly attributed to inhalation of the atmosphere of certain districts. The author briefly recapitulated: "In debilitated states of the nervous system, attended with such disturbances of function as simple melancholia, neurasthenia, neuralgia, insomnia, neurosis incident to the menopause and hysteria, a high altitude and the seashore are contraindicated, and while generally in

such cases a clear cold climate is most beneficial, a few cases do better in a mild inland climate. After a certain degree of improvement has taken place, this may frequently be advanced by sea or even mountain air."

Second Day-Wednesday, May 5th.

A Brief Consideration of Some Points in the Management of Consumption. Dr. R. H. Babcock in a paper with this title agreed with Finlayson and others that the consumptive's temperature is not febrile until it reaches 101.3° F., and only then requires treatment. He first advises rest in the open air and regulation of the diet. If this does not reduce the temperature, he advises careful sponging or the use of small doses, one and a half to three grains, of antifebrin, or some other non-depressing antipyretic, an hour before meals, as suggested by Detweiler, for the purpose of promoting the secretion of free hydrochloric acid during digestion, it being absent during fever. Sweating he combats with picrotoxin and camphoric acid. Diarrhoea is due less often than is generally supposed to to intestinal ulceration; he considers it due to intestinal fermentation, and treats it with intestinal antiseptics rather than with opium and astringents. He inquired if laryngeal tuberculosis does not contradict high altitudes, and wished to learn from Colorado members why patients are often retained at that high altitude after having developed laryngeal symptoms. It is his belief that patients having recovered in high altitudes should not return to reside at their former homes in the East, although he has known individuals to do so without apparent harm. He wished to learn if the members did not consider such return unsafe and likely to bring on a fresh outbreak of the disease.

The Clinical Value of the Culture Products of the Bacillus of Tuberculosis.-Dr. Karl von Ruck, of Asheville, N. C., read a paper in which he said that the tubercle bacillus produces substances in the culture which are antagonistic to its life and growth, and that the germs cease to grow and die because of the presence of such peculiar substances. The bodies of the germs contain fats which can be extracted with ether or alcohol, and when the fat is removed they lose their properties of retaining the analine stains. After removing the fats the author has extracted them further and practically reduced them to a small residue, consisting of cellulose. The extractive substances produce immunity in guinea-pigs, and act curatively also. The degree of such action appears to stand

in relation to the amount administered. The purified products of the culture, especially such as Klebs has produced, have given the best clinical results, and several cases are reported illustrative of their actions and limitations. In suitable cases, especially

the earlier stages, the percussion dullness disappears in newly involved area, and the respiration becomes again vesicular, with corresponding general improvement. Their use is not attended by any danger or discomfort to the patient. It was not contended that these remedies should be used to the exclusion of all other valuable means. On the contrary, the author stated that in the treatment of phthisis we are necessarily confronted with complex pathological changes, the results of tuberculous disease, all of which it could not be hoped directly to influence by remedies which were directed against the tubercle bacillus itself. Other factors, such as climate, have to be considered in the question of treatment. The author has also produced a serum from goats, after the method of Maragliano. In a comparative experiment both his and Maragliano's serums acted alike in effect and degree, protecting the guinea pigs from the usually fatal dose of toxins. Some of these goats are now being further immunized with the extract of the tubercle bacillus, but neither serum nor extract has been used in the systematic tratment of human tuberculosis as yet, and they are still under experimental investigation.

Digestion versus Drugs.-Dr. Samuel A. Fisk, of Denver, Col., in a paper with this title, gave prominence to the use of "food and fresh air" in the treatment of the two most serious troubles which affect mankind, insanity and pulmonary tuberculosis, and in contrast called attention to the mass of drugs vaunted in medical publications and out of them for the cure of all diseases. He questioned whether we had advanced at all on the simplicity of "food and fresh air." He admitted that the profession was somewhat to blame for this, and cited the case of a patient who was getting by actual count eighteen different remedies in the course of twentyfour hours; also of another patient who was receiving hypodermic injections and other treatment addressed to the bacilli. Both patients had brown and furred tongue, loss of appetite, constipation, scanty and high-colored urine; both were improved by the administration of a little calomel and attention to the details of ingestion, assimilation, egestion, food, and fresh air.

Dr. Fisk remarked that the bacillus had assumed such monstrous proportions in our eyes that it must be hunted and killed at