their indoor work while regaining health. Brocton is only about two hundred feet above sea level.

Passing into Rhode Island, where we find the most densely populated state in the union, we find a loss of 800 people annually. The most afflicted county is Providence, and the least is Kent, with only 1.3 to the thousand population. This state with its $3,000,000 New State Capitol building, is already considering the feasibility of establishing a State Health Park. Connecticut is on a par with Rhode Island, and has Litchfield nearly or quite as immune from consumption as is Berkshire County in Mass. Leaving old New England with her 10,000 victims of consumption, we will briefly call on the Empire State to find that she carries about 15,000 of her brightest young peo ple to untimely graves every year. We find two institutions devoted to the treatment of tuberculosis. One at Saranac Lake, where Dr. Trudeau is in charge and makes this report: "Studying the gross results on 1,200 patients admitted during the past fifteen years, the result is as follows: 23 per cent were cured, 56 per cent were discharged with disease arrested or much improved, 19 per cent were dis charged as stationary or unimproved, and 2 per cent died in the institution." As I understand it, the Doctor admits patients suffering in all stages of the disease. Another younger institution we find near Liberty, in Sullivan County, from whence as yet we have no publisht reports, but we learn from data from whence we gather our other information, that Sullivan County is almost immune from the disease amongst the nativs of that county. Not withstanding New York is a large State in territory, we find 120 people living there to the square mile, and that there are 2.2 deaths to the thousand inhabitants each year. There are 29 counties in this Commonwealth where the death rate from consumption is recorded to range from 1.1 to 1.6 per thousand. Sullivan, Kings and Alleghany are the least afflicted, only having 1.1 to the thousand.

In Pennsylvania and both Virginias we find that consumption claims about two victims annually to the thousand inhabitants. There are five counties in Pennsylvania where the rate is two and above. In Mifflin county it is recorded at 2.7 per thousand. There are thirty four counties

in Pennsylvania having a rate of 1.5 or less to the thousand. There are three counties reported to have less than one death per thousand per year; these are Union, Elk and Potter counties. Maryland is afflicted to the extent of having 2.4 to the thousand, in the State; Baltimore is on a par with Boston, and Garrett county is reported to only have 0.9 to the thousand. The District of Columbia is the worst afflicted with the "Great White Plague" of any territory of equal size in the Union, having 4.4 to the thousand and Washington City 4.1.

I suppose some of the readers of THE MEDICAL WORLD will be surprised to know that Tennessee loses 2.4 people to the thousand annually from the scourge, and that Hamilton, Washington and Lincoln counties are recorded to lose 3.0 per thousand, while Lauderdale loses 3.3, Obion 3.7, Giles 3 5, Wilson 3 5, Marshall 3.6, Murray 3.7, Sumner 3.8 and Robertson 4.6, while Claiborne and Jackson counties are recorded with less than one death from

consumption to the thousand. Kentucky is very similar in its consumptiv deathrate to Tennessee. Marion County has 3.7, Boyle 3.9, as I find them recorded; while Carter, Clay and Floyd are nearly immune from the scourge. I have thus enumerated the worst afflicted commonwealths in the country, and I denominate these as being within the consumptiv belt, because of the excess of death-rates from consumption.

We find a decreasing mortality from it as we travel from these hotbeds of the disease toward the great west. There are but few counties west of the Missouri River where the nativ population are afflicted to any great extent, and there are many places to be found within the borders of our old American desert (now the Garden of Eden of America), where it is impossible to find a native afflicted with this disease, and where we have proven beyond any doubt that more than ninety per cent. of the present victims of the plague may go and recover health. Of course the earlier they "get there" the quicker will they regain health, if they learn how to use the curativ climate.

One other thought comes to my mind: How many of the physicians know how to prescribe climate cure to their patients? I suppose not one-half of us do. I have learned that we have three general classes suffering from consumption. We have

the fibroid, the hemorrhagic and the catarrhal forms. All need pure air, and to know how to use it. The fibroid cases we have found to get best results by gradually going into high altitudes up to above 7.000 feet, and remaining there until all the air cells in the lungs are completely cured and in a normal condition for that altitude; then if they wish to return to lower altitudes, do it scientifically (commonsensely) by a gradual descent. The "bleeders" should arrange to remain pretty well up; while the catarrhal class, which embraces the large majority of cases, will do best in medium altitudes in the dry arid sections of our country..

Of course I mean in a general way and uncomplicated cases. If a patient has consumption complicated with organic heart troubles we must govern ourselves accordingly in prescribing climatic changes. One might about as well shoot a patient to death with his hypodermic "shooter" as to send him with a hepatized tubercular lung into a high altitude suddenly, especially to any place where the rivers course to the northward and the land slopes in the same direction. I have known several such sufferers to be killed that way. Such cases need to be carefully gotten into the dry air in a low altitude, say to not exceed 2,000 to 2,500 feet above sea level; then as the hepatized lung clears, go gradually higher in order to expand the air cells before they get into a chronic fibroid condition, always using the Huxley definition of science, viz., "organized and trained commonsense.'

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"Of all the journals I take, I first read THE WORLD. It is chuck full of good, and to the point."-O. G. Comstock, M.D., Toledo, O.

Dr. P. H. Strickland, of Lego, Tenn., sends $1 for three binders, and says: "I think our' journal gets better all the time."

"I have found more useful and practical suggestions in THE WORLD than in all other journals."-T. N. Leib, M.D., San Francisco, Cal.

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Editor MEDICAL WORLD:-Two years ago I had a bad case of eczema covering head, ears and arms of a six months old baby. I treated the case two months, used all kinds of formulas with only indifferent success. The family became disgusted and tried two other M.D.'s with the same result. Then a kind neighbor told them her aunt had a child, etc., and had used only two bottles of "capillaris." The family bought three bottles and cured the case completely in three weeks. Before using, the family kept a light burning all night, as they were up with the child every hour or two each night for several months. After using "capillaris" two nights the child slept all night, and has continued to do so ever since. The scalp and skin of arms, ears, etc., healed up clean and soft in three weeks. Please publish formula of "Capillaris" in the "in the December WORLD.

Parkston, S. D.

C. VERNON Fox, M.D.

[We regret that we are unable to give the formula of the nostrum mentioned, and feel sure that you could have cured the case yourself in the same period if you had been permitted. When you get another inveterate case of infantile eczema, use oxid of zinc ointment or oil of cade under an impervious dressing. Keep dressing on constantly and forbid the use of water, and you will be able to dis

charge most cases in about two weeks. ED.]

Editor MEDICAL WORLD:-Frank S., age 45, on September 23, 1901, fell backward from a building a height of eight feet, landing upon his back. He was pickt up helpless, unable to stand on his feet or use his legs, for they were totally paralyzed. He felt no pain whatever, and was perfectly conscious. Had retention of urin from this time up to few days ago; has to void urin every hour or two. Bowels constipated and bloated. Good appetite and feels well except cannot move legs. Would like to ask what injury was done the spine in the fall, the most effectiv treatment, and prognosis

now

Pasadena, Cal. J. W. LAIRD, M.D.

[It is not possible to learn the nature of the injury from the data you give us, but it is clear that rest, massage, and electricity will do more than medicins for your patient. Keep the urin bland by such mild agents as fluid extract of saw palmetto, santal, etc.; free drinking of infusion of pumpkin or water-melon seed often acts charmingly in such cases. Get rid of constipation and gas in intestins by thoro purging with calomel and salines. Restrict the diet till results are satisfactory. Sponge the spine every four hours with pure alcohol. Each morning and night bathe back with hot water, adding brisk massage, and follow immediately with a cold water sponge. Try electricity three times daily. Keep your patient absolutely at rest; use the bed pan. Arsenic and strychnin will be useful. If careful examination reveal any point where possible fracture may have occurred, invoke surgical aid. If no osseous injury is demonstrable, you must give patient a bad prognosis, and relieve symptoms as they arise. It is certain that no drug will act directly upon the primary condition. Let us hear from him again. We are always glad to hear from WORLD readers, and a carefully written and concise history of this case might prove valuable.-ED.]

Editor MEDICAL WORLD:-Mrs. S., aged 52, mother of three children, youngest 13. Past menopause. Has been subject to headaches all her life. A migraine pill or two checks them sometimes. For a year or more has not had the natural use of the left hand and arm. If she gets very tired, the hand and arm are nearly useless;

hand trembles. At the present time feels well on first arising, but is tired after being about three or four hours. Sleeps Sleeps well, appetite good, body well nourisht, bowels regulated by cascara for years.

Dr. S., aged 54. Have to keep cuspidor by the side of the bed, as I expectorate from three to a dozen or twenty times during the night. On arising in the morning have cough and begin to hawk and clean out; after the throat and bronchial tubes have been emptied, there is less expectorat ing and cough during the balance of the day. The expectorated matter varies, sometimes being a thick, white or yellowish mass; or it may be thin, white and almost frothy. Aside from this, I am feeling well.

Now, if the Editor or any of the brethren can give diagnosis or make any suggestions that will be of value in the above cases, they will greatly oblige a brother physician and his better half.

Nebr.

arm.

DR. S

[We would suspect a case of chronic malnutrition from constipation or indigestion. We would change from cascara to salines for a time, and pay particular attention to the urinary function. The chances are that either heart or nerve trouble is the cause of the deficiency in the use of the arm. We would examin the heart repeatedly and carefully. Your data are not sufficient, and it is do ibtful if a correct diagnosis could be made from this distance as to the exact cause of the trouble with the Lithemic diathesis may be an element. After such investigations made, write again. Case No. 2 has probably a chronic laryngitis and bronchitis. Avoid use of tobacco. Keep digestiv functions working properly. Get a good small atomizer and spray the nose and throat thoroly before retiring, and several times during the day. Try inhaling fumes of boiling vinegar. Dissolve lozenges of brown mixture in mouth frequently. We will be glad to hear from you again at any time, but would like more specific details. -ED]

are

Editor MEDICAL WORLD.-We have a girl age 5 who has periodical attacks of indigestion, with clay colored stools. She is constipated, but the urin is normal except for some billiary coloring. She has nocturnal incontinence of urin, and odor is offensiv. Urin generally acid in reac tion. Phosphate of soda and iron relieved

the anemia and constipation, but I cannot get satisfactory urin. The specific gravity is never over 1014. Floyd, Va.

M. L. DALTON, M.D. [You have not yet secured satisfactory metabolism. Continue the phosphate of soda or substitute Rochelle salt for it. Be sure that the iron is assimilated, and that sufficient salines are given to overbalance the astringent effect of the iron. See that she is not over-fed, and that she eats slowly and masticates thoroly. Arsenic and strychnin seem to be indicated. A teaspoonful of 80 grain elixir lactated pepsin before meals will bring good digestion. Atropin will correct nocturnal incontinence of urin if there be no local cause. Examin for hooded clitoris, genital malformation, and worms. Raise foot

of bed six inches every night. Give no fluids after supper. If there is vulvar irritation, insure absolute cleanliness and use some antiseptic dusting powder freely. Avoid drastic cholagogs. See that she does not ingest excessiv quantities of fluids. Bisham's mixture or elixir saw palmetto and santal, together with the atropin, ought to speedily remedy the urinary trouble if you first secure metabolism and general functional activity of the digestiv organs.-ED.]

Enlarged Tonsils.

Editor MEDICAL WORLD:-I read a note in a medical journal that trichlor. ascetic acid applied a few times to enlarged tonsils with a gargle of echthol would cure them. I have been under the impression that removal with the tonsilotome was the only sure method. Have any of the readers of THE WORLD had any experience with the abov, or any other good method, of curing enlarged tonsils without resorting to surgical methods? H. M. OCHILTREE, M.D. Haddam, Kansas.

I am

Editor MEDICAL WORLD:-I am horribly nervous. I cannot perform the most minor operation in surgery without hav ing a tremor of the hands that makes me ashamed of myself. I am but 54 years old, and use neither coffee nor tea. a moderate smoker and use some liquor, but in great moderation. I sleep well, and am large and strong, with good appetite. Weight 215, height 5 feet 8 inches. Married. Very little sexual desire. Coitus. not oftener than six times a year. If called upon to write my name in public, there is

Editor MEDICAL WORLD:-I wish to ask help of you or some of the many readers of THE MEDICAL WORLD. Have been treated by several of our home physicians, and received but little benefit; am now taking a patent medicin, "Swamp Root." My case is renal deficiency, I suppose; also uterin trouble. Kidneys fail to act sufficiently, urin of a very high color; have been bloating considerably for about ten months; feet and lower limbs are worse bloated of an evening; face and hands worse mornings. Have indigestion very badly; for last two weeks cannot eat anything that agrees with me, in the least; am inclined to be bilious a great deal.

Any help from you or any of the readers will be thankfully received.

THE WORLD is a welcome visitor in our home.

that he can attend to that at any time, and the consequence is that it is too often never done. If he sends for a neighbor practitioner, or if he sends a member of his family to a neighbor practitioner, the doctor thus selected feels a sense of modesty that he never feels under any other circumstances, the opinion of the home doctor is deferred to, and the consequence is that but little if anything is done. Many deaths have occurred in doctors families from sheer neglect. Doctors, you know it! And here is a poor doctor's wife driven to "Swamp Root"!!! Isn't this the worst you ever heard of? Yet this poor woman had to try to do something for herself. The ship wreckt mariner cried, "Water, water everywhere, but not a drop to drink." This poor woman may be surrounded by medical talent, but there is none for her, for she is a neglected doctor's wife. We have presented her case in her own simple, pathetic words. Now, brethren, what can you do for her? Of course the first step in her case is the examination of her urin. Is there a doctor in her town that will kindly do this for her? A charity case usually gets more attention than a doctor's wife or child, and a clinic case gets infinitly more attention. It is all because the husband or father doesn't "take hold," frequently because of sentimental feelings, and othersare too modest to do so. The sad result is that the case is neglected.—ED ]

This a leather case with a removable book. It

"works" very successfully, and the book part can be renewed as often as desired at trifling cost. This is one of the few "legal" physicians account books; that is, spaces are made for original entries in words, like any other account, discarding the use of signs. We notice a very clever arrangement at the bottom of each page: a form, which, when filled and signed by the patron, becomes a note. This is a distinct pecuniary advantage to the doctor. Besides the above features are the usual record for obstetric cases, vaccinations, deaths, etc., and cash account.

Practical First Principles-Simplifying the study of normal and abnormal structure and function, and aiding diagnosis. Designed for the use of students and practitioners of medicin. By A. H. P. Leuf, M.D., associate editor of The Medical Council, Philadelphia. Publisht by The Medical 50 illustrations, almost all new and original. Price, $1.00 net.

The title describes it perfectly. It is far from being a ponderous cyclopedia, but every