any cost. He said it had been remarked that more patients had been killed with antipyrin than had died from the grippe, and that he sometimes wondered whether the same thing could not be said of creosote and tuberculosis. His own experience has not been favorable to the use of creosote, and it is his custom to substitute calomel and potash. The speaker said that he had seen patients with consolidation, night-sweats, constant cough, and profuse expectoration, accompanied by loss of strength and flesh, and it might be with hemorrhages, do admirably because they could eat, digest, and sleep, whereas he had seen others similarly affected go down. rapidly because they could not eat, or digest what they had eaten, or sleep. He cited two cases representing this difference: one subject could neither eat nor sleep and ran down rapidly; the other had an excellent appetite and made such an improvement that in a month's time he gained five pounds, the pulse had fallen from 122 to 106, and the temperature from 103° to 100.4° F., with cough and expectoration decidedly diminished, his chest drier, and his strength greatly improved. He had been given no creosote or other drug to destroy the bacillus, but his digestion had been fostered. The speaker also called attention to the care which must be taken not to tax too severely the digestive powers. He spoke of such affections as chronic bronchitis, asthma, fibroid conditions, and emphysema, in which the patient was apt to become bilious and in which the digestion had to be carefully watched, and advised a good dose of calomel. In cases of hemorrhage accompanied by constipation and scanty and high-colored urine, he had used catharsis and diuresis with good effect. The point which Dr. Fisk made was that the digestion is the pièce de résistance in the treatment of pulmonary disease, to be fostered and protected at all hazards, and not to be sacrificed for any desire to destroy that arch enemy, the bacillus.

Aerotherapeutics and Hydrotherapeutics in the Prevention and Treatment of Pulmonary Tuberculosis.-Dr. S. A. Knoff read a paper with this title, in which he spoke of aerotherapeutics and hydrotherapeutics in the treatment and prevention of pulmonary tuberculosis. Preventive medicine was the medicine of the present, and, while he hoped that preventive inoculation and orrhotherpy would be the ultimate treatment for all acute diseases, he expressed doubts as to the discovery of a serum or toxin that would cure pulmonary tuberculosis when it had already worked its destructive process. Continued research to combat the association

of microbes, manifested by acute excerbation, was recommended, his own work in that dircetion with antistreptococcic serum having been encouraging. In describing the anatomical, physiological, and pathological peculiarities of the individual predisposed to pulmonary tuberculosis, the remedies to overcome the insufficient air supply to the respiratory organs, and the abnormally increased sensibility of the general and especially the cutaneous sytem to the slightest changes of temperature, were pointed out. It was shown that the preventive treatment of consumption should begin with the child in utero and be kept up throughout life. A description of a thorough system of aerotherapeutics and hydrotherapeutics, comprising instructions for breathing exercises, rest cure, graduated walks, application of cold water as a tonic, anti-pyretic, analgesic, etc., as indicated in the various stages of the disease, completed the paper.

The Treatment of Tuberculosis by the Antitubercle Serum.— Dr. Guy Hinsdale, in a paper with this title, described the use of the antitubercle serum, in the preparation of which a donkey was first injected with mallein to exclude the presence of glanders, and then received an injection of one cubic centimetre of tuberculin, which dose was doubled every five or six days until two hundred cubic centimetres were received at a dose. Little reaction followed; the temperature rose only one degree or one and a half degrees, with some slight local oedma. After the maximum dose the animal was allowed to rest three weeks for the elimination of tuberculin. It was then bled and the blood allowed to stand in a refrigerator five or six days, when the serum was collected and one-half per cent. of tricresol added to act as a preservative; it was then kept sealed in a cool place. While Dr. Hindsdale considered it too early to make any complete report of the clinical tests of the agent, he described one case in which he had employed the serum in the hope that others would try it. The patient was a married woman, aged twenty-seven years, who had a cough in February, 1896, and began to lose flesh and strength. His notes taken in March of that year were: Left lung normal; right lung, increased vocal fremitus, but not marked; bronchial breathing posteriorly; slight impairment of the percussion note posteriorly; some râles at the apex. In April she weighed one hundred and twenty pounds and was losing flesh, coughed, and had night sweats; consolidation of upper lobe; bronchial breathing on both sides, especially the right; increased vocal resonance. In May there was amphoric breathing

nant.

on the right side; she coughed badly and had fever at night. She was in bed one week and had a hemorrhage. She was then pregShe was confined January 1, 1897. The physical signs all pointed to well-established phthisis. The case was chosen as being a test of the efficacy of any treatment. The sputum was examined, with the discovery of a large quantity of tubercle bacilli. An injection of five minims of the serum was made on January 16th, and again at intervals of two or three days until forty minims were injected March 2d. On March 25th her weight was one hundred and twenty-seven pounds. There was some soreness below the left apex in the back. There was no elevation of temperature, and no unpleasant effects of any kind were noted. The injections were made in the left arm near the insertion of the deltoid, after carefully cleansing the part. There had been general improvement in all respects, and bacteriological examinations on March 9th and 15th showed absence of tubercle bacilli. On May 2, 1897, the percussion note was clear all over the chest, front, and back, and the only abnormal sign was a slightly increased vocal resonance over right apex. Dr. Hinsdale stated that the patient was steadily gaining weight and strength, had little expectoration, and that the progress of the case would be reported next year.

Observations upon Pulmonary Tuberculosis in Colorado.-Dr. S. G. Bonney read a paper with this title, giving an analysis of two hundred recorded cases occurring in private practice, during a period of two years. He selected his cases upon a basis of supposed adaptability to the climate, and classified them with reference. to the probable prognosis at the time of arrival. In stating the results the classification was made according to the physical signs and general condition. The extent and character of the tuberculous involvement and its method of onset were considered, and also the relation of climate to hemorrhage, functional nervous disturbance, and bronchial irritation. The paper concluded with a discussion of complications, with general observations as to management.

Some Personal Observations Upon the Effects of Changes of Climate Upon Men and Animals.-Dr. Richard Cole Newton, in a paper with this title, remarked that "ability to meet the environment" had been defined as "the condition of leadership," and said without doubt it was also the condition of health. He doubted whether the full comprehensiveness of these terms was fully appreciated, and considered that climate, from a therapeutic standpoint

at least, should be defined to mean a man's environment. He considered the great need at the present moment in the study of climatology to be the study of individual cases, and more ascertained' and established facts in relation to the action of climatic changes upon people or animals. From a surgical aspect he considered the virtues of the aseptic climate of the Rocky Mountains and their foothills too well known to require any detailed testimony, wounds always doing well. He had seen a knee-joint opened and a floating cartilage fished out without asceptic precautions or antiseptic treatment, and the man was entrely well in two or three days. He referred to the beneficial action of the climate of New Mexico on consumption and on wounds alike. He cited the instance of a young Indian returning from the Carlisle school, dying of con-sumption, and thought it would appear that phthisis was not an infrequent result of the higher education among the red men as well as among the palefaces, and that we too often lost sight of the fact that phthisis was especially the disease which cut off those who had given up a roving or outdoor life for a stationary or confined existence, and stated that the moving about, even to less salubrious climates, appeared to prevent the onset of this malady. He said that it had been pointed out that the animals in a travelling menagerie were much healthier than those in a zoological garden, and' that reference had been made to the remarkable healthiness of gypsy children. He also referred to the fact that man had been so long a wanderer on the face of the earth, shifting his quarters to hunt for food, escape from or pursue his enemies, and was so stamped with this nomadic tendency, that it showed itself at times. in this craving for change of air, and said that now, like the caged animals in the museum, the Indians were beginning to die of tuberculosis. The paper gave the following conclusions:

1. That the change of climate from the Rocky Mountains to the seaboard is more severe and dangerous than the reverse, especially to young children and horses.

2. That a medium or even a high altitude is beneficial rather than otherwise to nervous disease and the diseases of women, as well as to phthisis, and is not unfavorable to rheumatism.

3. That in the climate of Northern Texas and New Mexico nephritis in all forms is exceedingly rare, while aneurism is somewhat common in the latter territory.

4. That wounds do remarkably well in all parts of the South

west.

5. That the ideally wholesome and satisfactory life is a nomadic

one.

6. That change of climate does not bring change of disposition, or, for that matter, of predisposition. Precious and even invaluable as change of climate often is in a number of diseased conditions, it is not always what is most needed.

He suggested contentment with smaller doses of climate, and that they be supplemented with larger doses of hygiene, both moral and physical.

Dangers of Tuberculous Infection and Their Partial Arrest by Climatic Influences.-Dr. C. F. Gardiner, in a paper with this title, said that in reviewing the evidence of partial arrest of tuberculous infection by climatic influence, all data of a general character had to be taken with great caution. The impression, due to the complaint being so rarely seen there, that in the arid or elevated regions of the world consumption was not communicated from the sick to the well was not at all proved from such unreliable and imperfect statistics as had generally been brought forward. He said that the immunity apparently due to a climate might be really due to manner of life, such as isolation and a life day and night in the open air; or to selected lives, such as the early settlers of any country live, who, to cope with its hardships, had of necessity to be the strongest; and that therefore it was only after a country had been settled for a considerable time that reliable data concerning climatic arrest of infection could with accuracy be computed. He said that although it was a well-established law that consumption among all races and in all climates diminished in progressive ratio as we ascended from the sea level, there was no absolute safety or nonphthisical line to be drawn at a certain elevation, and that a few cases did occur at any elevation. He mentioned three cases he had seen of death from acute tuberculosis in Ute Indians who had never been out of Colorado or Utah.

Institution Treatment of Pulmonary Tuberculosis.-Dr. C. P. Ambler, of Asheville, N. C., read a paper with this title, the conclusof which was that closed institutions for phthisical patients offer the greatest certainty for their cure, inasmuch as better results appear to be a necessary consequence of the superior advantages which well-conducted institutions afford, and that a priori consideration of these advantages would lead us to the conclusion which statistics and experience have both demonstrated and confirmed. At the business meeting of the association which followed the scientific meeting of the second day it was: