HE climate fad has run itself out,

THE

and there is danger of going to the other extreme and denying that there is any virtue in climate. We know now that cold air is not injurious to the consumptive, yet we all admit that it is not well for him to freeze to death. Moreover, unless we absolutely deny the testimony of all clinicians, it is not wise for consumptives to be in movement, much less to work, while they have any fever whatever the febrile hours should be spent in bed.

Withal, they are at best delicate, weakly folk, and they certainly can spend more time in the sunshine, in that climate where there are the most sunny days. But-and here I repeat a remark I made to Dr. Babcock in 1894-there is more hope for the consumptive who stays at home under the care of his own doctor, than in his resort o any other climate whatsoever. For after a few primary indications are dealt with, there is very, very much in the minute, scrupulous care that watches every symptom, obviates everything that subtracts from the patient's vitality, fosters everything that can add to it. It is a business in which the slenderest of profits must not be disdained, if the credit side of the ledger is to show a balance.

Dress the patient wholly in wool, by night and by day; thin woolens for summer, thick woolens for winter; woolens outside and woolens next the skin; above all, woolens on the feet. The entire body should be bathed at least once a day, and salt-baths and rubs with salted towels urged if the cold plunge is not possible. The duty of breathing fresh, pure air is so well comprehended that it seems almost unnecessary to urge it here-yet-be very sure the patient and attendants comprehend it as a rule they don't, unless you are most explicit and emphatic. Ventilation does not mean airing a sickroom once, or six times a day; it must be continuous. A tent may be very poorly ventilated. The problem of heating an open bedroom, a tent or a veranda, in zero weather, we leave to those who have thrown "climate" overboard.

The most important therapeutic indication has to do with the digestive system. Take the consumptive: feverish, hectic, sweating, wasting and weakening daily, with indigestion, flatulence, bowels disordered, breath bad, tongue foul, the very thought of eating inducing disgust; give him calomel, salines and colonic flushes until his bowels are really completely empty;

then give him two scruples a day of calcium sulphocarbolate until his stools are not abnormally offensive-and note the result. Fever is down, hectic flush gone, sweats have ceased, all gastrointestinal symptoms vanished, appetite is wolfish; he is gaining in streng h and weight every day, and hope and confidence replace the despondent pessimism. From that one measure alone we realize all, and more than, the beneficial results claimed for the specific treatments that have followed each other for a century; and yet all we have done s to eliminate from the case one of its elements-autotoxemia from feca' retention and absorption.

Isn't it curious that while physicians recognize so ful y the evils of inhaling an nfinitesimal quantity of this poisonous material, they should be oblivious to the perils accruing to the presence of pounds of it, swarming with countless pathogenic bacteria, actually inside the patient's body; and the toxins being absorbed into the blood stream with increased velocity, under the st mulus of heat, moisture, putrescible material, and the osmosis stimulated by the radiation of fluid from the skin, leaving the blood thick and hygroscopic?

Is there a Spec fic Treatment? Can we attack the bacilli directly? I don't know. I have my doubts whether we can saturate the I'ving body with any agent so powerful that the life and activities of the bacilli and their malefic allies will be inhibited. But there have been many such agents vaunted-iodine, iodoform, gold mercury, guaiacol and its derivatives, arsen c. If there is any such agent that will do the work without fatal injury to the patient, it is probably sulphydric acid. My choice would be calcium and arsenic sulphides, pushed until the skin exhales the characteristic odor. This is harmless; and I have proved the efficacy of the method. in gonorrheal infection, so why not in tuberculosis?

Of symptoms the first in importance is fever; and for this it would not be easy to devise a more perfect remedy than Burg

graeve's famous triad-aconitine, digitalin and strychnine arsenate. Each of the elements and the combination as a whole are admirably suited to the indication-to quell fever, sustain the heart, incite the vital functions and combat the specific cause, while checking waste and restraining the tendency to exhausting discharges. How much to give? Just enough to do the work: a granule every half to one hour till the fever subsides.

Cases Where Veratrine is of Value

Veratrine increases waste and hence is deemed to be out of place in tuberculosis, a malady in which it is of the first importance to check undue waste. But waste and undue waste are different things. Observation has shown that fever, with evidences of local irritation or inflammation in the neighborhood of tubercular deposits, invariably follows prolonged exercise. This is now explained on the theory of toxic matters either generated about the tubercular foci or carried to the lungs by the blood, and reacting with the products of the tubercle bacilli. Here it would seem as if the stimulation of elimination would be advisable; and in such conditions, with the temperature rising after physical exercise on the part of the patient, a few granules of veratrine, gr. 1-134, repeated every half hour, three to five times, would be of decided advantage. As a rule, however, Burggraeve's triad is better suited to the fevers of the tubercular. We might with advantage get rid of the idea that veratrine in the doses recommended is a depressant. It is nothing of the sort. While it relaxes vascular tension, this in itself is an advantage, as allowing a better supply of blood to be carried into the diseased tissues, where a plentiful supply of material for repair is of the utmost value.

Besides this, relaxation of the terminal arterioles relieves the heart of a part of its work, so that we invariably find the patient not only feeling better but really improved by this medicament.

Cough? The patient must cough up the sputa; it would be death to retain that

disease-laden stuff to decompose in the lungs. Irritative cough needs zinc cyanide or iodoform; dry coughs require emetine; bronchorrhea atropine, benzoic acid or arbutin; sluggish insensitive bronchi that fail to respond to the stimulus of sputa collecting in them need the whip-touch of sanguinarine; fetid discharges are improved by creosote or menthol. All are benefited by thymol iodide in oily solution thrown in form of spray and drawn deeply down "to the bottom of the lungs," twice a day or oftener. How much more this does than to relieve the cough I dare not say in this day of therapeutic disbelief; but try it, and tell me.

In using any of these cough-medicines the dosimetric rule is a good one: Divide the dose into fragments and give one every ten to thirty or sixty minutes, until the effect which you desire has been attained. For instance, the books tell us codeine is onehalf to one-fourth as strong as morphine, hence the dose of codeine to relieve a cough might be put at 1-12 to 1-6 of a grain.

Never mind your books. Take the little granules containing 1-67 grain each; let the patient take one of these, dissolved on the tongue, and repeat every ten to sixty minutes; and see how great is the relief that follows a few of these granules. If this be the case, why give more? Why give enough to disorder the digestion if the little doses will suffice? It is relief the patient wants, not to ascertain how much medicine he can stand. The same thing holds good for the other remedies mentioned. Of zinc cyanide, 1-67 grain repeated every ten or fifteen minutes answers nicely; icdoform the same. Of emetine, certainly this is enough, especially if you use the chemically pure emetine, free from the irritating emetic cephaeline. Of atropine use the valerianate, and in doses of 1-1000

grain, every thirty minutes until the mouth begins to feel dry.

The diet of every patient is a study-to remedy the defects in his digestion and assimilation, strengthen his weak places, teach him how to eat and to digest what he needs, rather than what he likes. Strength must come from focd, properly utilized.

What remains? A thousand things that need attention; but each patient presents his own symptom-complex, requiring its own special management.

One of our most pressing and difficult tasks is to cope with the bad advice so liberally showered on the sick by the ignorance of kindly busybodies. The most dangerous person on earth is the party whose intentions are good but who knows nothing and is too dense to realize it. The advice of, "forget you are sick; think you are well, and throw off every care," has filled tens of thousands of graves with consumptives who might have been cured by their doctors. The patient should never be out of reach of the comforts of home and the care of a doctor. His chances of getting through to the seventieth milestone depend largely on the skill of the chauffeur. If he knows the machine and what can be gotten out of it, the chances are better than if he puts it under the guidance of an ignoramus who doesn't know an auto from a wheelbarrow. I can look back over many a triumph earned by the careful management of consumptives. I can also recall many a case where the patient was advised to drop all treatment and care, forget his disease and live like a well man. Every one of the latter died. In not one case did the "mind cure" kill the bacilli or help the patient.

Do the people who give such advice ever reflect on the consequences? Have they no eyes to see with, no brains to think with, no consciences to reprove them for the rash advice that costs human lives?

ROSTITUTION is one of the most important and vital problems with which society has to deal. It is the worm in society's bud-a cancer on the body social, very near its heart. The subject is tabooed in polite circles, and dealt with by society somewhat after the fashion of the traditional ostrich, seeking safety by burying his head in the sand. When the social evil is mentioned, society either stops its ears and covers its face with its handsto conceal blushes not always quite innocent -or runs away from the issue altogether. He who undertakes to "grasp the bull by the horns" and publicly meet the question fairly and squarely is persona non grata in circles polite and ethical. Where the "shoo-fly" treatment is not indulged in, maudlin sentiment comes into play and is worse than the other.

Prostitution an Unavoidable Disease of

Society

Prostitution is a condition, not a theory. It is an unavoidable disease of society, under present social and economic conditions. That it is a "necessary evil" when reduced to its ultimate is an open question. Under the old patriarchal system it was probably limited in its scope, from the standpoint of professional prostitution. That clandestine prostitution, or some form of illegitimate sexual relations, existed under the old regime is unquestionable. The less wealthy males probably did not supinely submit to the monopoly of the females by their more fortunate brethren. It is probable, also, that the monogamous custom finally evolved by highly developed social systems has in

*Annual Address before the Medical and Surgical Society of Louisville, Kentucky, 1907.

creased the proportion of prostitutes. The facts that no advanced social system can or will tolerate polygamy and that the evolution of monogamy has made for the betterment of society do not disprove this assumption.

History and ethnology show the greatest variation in the attitude of society toward the relations of the sexes. The Moslem of today is a little old-fashioned in his views. Solomon, poet of passion and founder of the first "wife trust," was accounted a wise and God-fearing man, and a just one. History has not reflected harshly on his nine hundred wives and concubines; neither has it wept maudlin tears over them. They seem to have been lost in the glory and glitter of the Wise One's court. The amour of Solomon and Sheba's great and glorious. queen has been glossed over ever so lightly. Even their first assignation, conducted with pomp, romantic glamour, gilded display and circumstance that doubtless excite the

envy of some of the darlings of the modern stage, and which was an advertisement in perpetuity that even the "divine Sarah” herself could not equal, has been swallowed without a grimace. But when many centuries later a band of religious enthusiasts,

who interpreted the Bible literally and desired to worship God in their own way, went theories into practice, there was trouble to Utah and proceeded to put their fanatical

"instanter." Their fallacious social ideas were morally out of tune, according to modern standards.

Mormonism-The Modern Polygamous

"State"

The Mormons were rapidly solving the "superfluous-woman" problem after their