6,000 feet or more. If the patient goes there early, benefit is almost assured.

In the second place, we know in the ordinary cases of phthisis pulmonalis much of the phenomena and the rapidity of the progress oftentimes depends upon a mixed infection. Many of the symptoms are not due to the bacillus tuberculæ, its processes or its effects, but they are due to a mixed infection; emaciation, hectic fever, great wasting, destruction of tissue are often as much or more due to this than it is to the primary lesion, and in such climates the conditions are not favorable for mixed infection; consequently I think such a climate offers very great advantages. In addition to this, the elevation necessitates conditions that are favorable in the way of lung gymnastics, etc.; the rarity of the atmosphere requires fuller, deeper, even more frequent inhalations, consequently aeration is better accomplished, lung tissue is used which is not used in lower altitudes. It is used more fully and more deeply, and hence nutrition in it is better. In every way I think these people are benefited. In the first place, they are away from the source of infection.

I would like to interject just here a thing that has been in my mind for many years, as to how we are to be protected from the resorts of phthisis pulmonalis. How it is where the germs are not destroyed by atmospheric conditions readily; how it is after a great number of persons have accumulated in some towns, how we are to protect people going to those places for other troubles, as it is undoubtedly true that we may contract the disease if we have a favorable nidus; if we are in a favorable condition, we may receive the germ simply from the dried sputum being pulverized and getting into the atmosphere we breathe. There is no question in my mind but it is dangerous to occupy a house or a room constantly that has been occupied by a subject of phthisis pulmonalis if the sputum is not destroyed. Again, at those places or resorts usually no care is taken to dispose of the sputum, and such places may become really sources of danger in the way of infection, and it will be a question in my mind. whether it is proper to send a case of phthisis pulmonalis to one of the so-called health resorts for consumption because of his more abundant opportunities to get the disease there. As illustrating this I think I made a mistake less than a year ago: Finding a young woman the subject of phthisis pulmonalis, I sent her to Asheville, North Carolina, and under the care of a good physician she has improved, the local

manifestations have subsided, she has regained twenty pounds in weight, and she is in better general health than she has been for many years. A younger sister (after the older sister was sent to Asheville) came home from school with an ordinary bronchitis; neither the sputum nor the physical signs showed any evidence of phthisis pulmonalis. Being anxious to get all the family together, and regarding Asheville as a much better climate for phthisis pulmonalis, and also for bronchial troubles than this, I consented to her joining her sister in North Carolina. At that time no tuberculosis had been recognized. That young woman was dead with phthisis pulmonalis in less than six months. Now it is a question with me if she had been sent to a different climate, where such cases are not so abundant, where she would have thrown off the local condition of bronchitis, a climate unsuited to the production of the tubercle bacillus, where she would not have been expossd to it, she might have been a woman in health to-day. So I think there is danger in this line. Fortunately many of these places have such atmospheric conditions as to destroy readily the germs, and it may be that some of them will be kept reasonably safe on that ground, but not sufficient attention is paid, in my judgment, to the care of the sputum in these cases.

I believe that phthisis pulmonalis could be limited and might be absolutely controlled if all the sputum coming from these cases was destroyed so that it would no longer be possible for the germ from it to infect any other animal.

Dr. F. C. Wilson: Doctor Bailey has covered one of the features of the treatment of tuberculosis quite fully, and I can substantiate every thing he says. More particularly am I glad he called attention to the effect of an elevated climate upon pulmonary gymnastics in the way of bettering the condition of the lung tissue itself. The fuller and freer expansion of the lung I have always believed is one of the chief advantages to be obtained by an elevated climate. A man is forced to take in twice or three times the amount of air that he would at the sea level, and of course this can only be accomplished by distending the lung tissues, by opening cells that have been collapsed; and of course this necessarily betters the circulation, aside from the improvement in the condition of the blood itself, which observation shows conclusively to be accomplished by an elevated climate, increasing the blood corpuscles, etc. There is a freer circulation in the lung tissue that when collapsed could only be supplied by stagnating vessels, and better nutri

tion of the tissue will increase the resistive power of the tissues, and the improvement in the constitution of the blood will also increase the resistive power, the antagonistic power of the blood to these germs. While the red blood corpuscles are increased, the white corpuscles are also increased. The pugnacious cells, so to speak, the cells that help to destroy these germs in the system, are multiplied, and of course the ability of the system to overcome or counteract the disease is correspondingly increased.

I can substantiate, too, before I overlook it, the danger which we are liable to in sending patients to many of these so-called health resorts. While Dr. Bailey was speaking I had in mind a case that contracted the disease in Asheville. And it may be of interest to mention another case coming under my personal observation. Α gentleman went to Asheville, not for tuberculosis, but simply to recuperate. He had no evidences of tuberculosis at the time he went there, but really had some heart trouble, of which he had complained for some time. He came back shortly afterward, had a hemorrhage from the lungs, developed a well-marked case of tuberculosis, and has since died from it. I believe the disease was contracted in Asheville while living in a house that had previously been occupied by tuberculous subjects, and boarding in a house with consumptive patients; he no doubt contracted the disease in this way. About eighteen months ago I sent a patient who is already the subject of tuberculosis to Asheville; after reaching there he wrote me asking some advice as to the best method of disinfecting houses in which tuberculous patients. had lived. I gave him the necessary advice and urged the thorough disinfection of any quarters that he might occupy before he entered them. He again wrote asking for specific advice and direction for accomplishing this. He said at that time that he could not find in Asheville a place that had not been occupied by consumptive patients. He advised me afterward, however, that he was fortunate enough to secure a perfectly new house—one which had never been occupiedand the urgency of the case compelled him to secure it at once, and by this procedure he no doubt escaped the danger of infection.

Now as to the other plans of treatment: I will say nothing concerning the older methods of treatment, the administration of cod-liver oil, reconstructives, and agents of that kind, but simply touch upon the more modern methods by germicides, etc. Creosote is one of the standard remedies which has been in use for a long time, and no doubt

with marked success, and probably its efficacy depends upon its germicidal power. I have found that much benefit may be derived from it, but only when the system is thoroughly saturated with it. In my practice I give it in gradually increasing doses up to the point of toleration. Of course we have to be careful in our administration of a remedy like that not to injure the stomach. It belongs to that class of drugs known as corrosives, and should be given after meals in gradually increasing doses, disguised as far as this can be accomplished. It may be given after meals in capsules, or a better way, I find, is to give it in hot milk. If you take creosote and stir it in milk which is heated almost to the boiling point it thoroughly breaks up the creosote, subdivides it into minute atoms, and then it emulsifies each individual atom so that it may be swallowed in a form that is really ready for absorption, and in this way you may give much larger doses than in any other way in which I have had experience. I have had some patients who have taken as high as fifty or sixty drops of the Beechwood creosote three times a day without any inconvenience. In any other way, in capsules or any other method of emulsion even, I have found that you can not give more than ten, fifteen, or eighteen drops without the patient experiencing some inconvenience, such as irritation of the stomach; but when given in hot milk I have had no complaint. I have also had some experience with the other methods of treatment, by means of the different serums, attended by some success, and of course much disappointment. In the early stages I believe in treatment by the serums, samples of which we have in that of Paquin, of St. Louis, and also Fish, of St. Louis, with Von Ruck's anti-phthisical serum, Klebs' modification of tuberculin, etc. These preparations have all been used, and no doubt a little time will demonstrate what they are really worth. It seems to me we can expect but very little benefit from the use of serums in advanced cases of the disease, though I have seen some marked amelioration where even the third stage had been reached; but this arrest of the disease, which is sometimes apparent, is rarely ever permanent. These cases, as a rule, sooner or later succumb in spite of any treatment that is given. Of course some instances occur where even under the ordinary plans of treatment nature seems to arrest the disease. I have made post mortems time and again in cases that died of other diseases in old age and found evidences of the presence of tuberculosis in earlier life. That shows that nature can and does, no doubt, in many instances, cure

these cases, but in the great majority of cases in the third stage you find that in spite of the serum or any other plan of treatment they go on and finally succumb. In many cases where we hoped a cure had been effected, we have found that later on, a year or more afterward, we have been disappointed to hear that death has taken place.

The treatment of tuberculosis by means of serum depends upon its administration to render assistance to nature by the addition or supplementing to the system a material with which nature makes an effort to control this disease. When the germs are introduced into the system there is at once set up a contest for supremacy; nature brings up a material that is deleterious to the presence of these germs, that is antidotal to the toxin that is given off from these germs. In their development and growth these germs give off certain elements, a material which is poisonous to the system and which is no doubt responsible for many of the constitutional symptoms that manifest themselves, and the system is constantly aiming to counteract this, to antidote this material which is generated in the system by active living cells, that is, an antitoxin, an antidote to the toxic principle given off by these germs. Now the serums which are given in this disease are merely products of the animal system generating this same material in more abundant quantities, and being extracted from the animal's system is simply added to the human system, supplementing this material and throwing the balance of power on the side of the system as against the germs themselves.

Now it is claimed that many of these serums are not actually destructive to the germs themselves. It is, however, claimed for one. that has recently been put upon the market by Fish, of St. Louis, that it not only has all the power of those previously introduced, but that it is also actually destructive to the germs themselves; that it will destroy the germs as well as counteract the toxic effect of the presence of these germs. I have not had sufficient experience with it to say whether the statement is true or not, but experiments upon animals seem to prove that it is destructive to the germs themselves, and if such be the case it has that advantage over former serums used, but time alone can tell what will be accomplished by it. Cases must be subjected to observation for a much longer time than has elapsed since this preparation was put upon the market to tell what its real value is.

In answer to a question, I will say that the serums may be administered in various ways: by the hypodermic is the most successful and