server notes the effects of various climates and localities upon health. The scientific sanitarian should account for such results. The author of the paper has told us that certain places in California are free from malarial diseases, while in other localities it exists abundantly. My friend says "bacteria malaria." Another might say, simply "malaria "an entity or nonenity that the most careful and scientific researches in chemistry or microscopy have failed to demonstrate. In all localities where periodic diseases prevail with any considerable intensity, three factors exist, alternating heat and cold, associated with moisture; the moist heat of the day enervating, the damp cold of night emptying the superficial capillaries until internal engagement involves periodic disease. Moist heat enervates more than dry heat. Moist cold chills more than dry cold. Where there is alternating heat and cold with moisture there will be found malaria.

Dr. HENRY B. BAKER, of Lansing, Michigan, asked attention to the fact that three speakers, including the author of the paper, had coincided in mentioning localities and climates as favorable to freedom from malaria and to recovery from phthisis, the prominent character of which was small daily range of temperature; that is, slight difference between the day and night temperature. This is true of California and the ocean climates. On the other hand, in the inland States the malarial region is the region where there is great difference between the day and the night temperature. And going from the North toward the South the malaria increases somewhat in proportion as the difference between the day and the night temperature increases.

DR. WOOD HUTCHINSON, of Des Moines, Iowa: There seems to me no inconsistency between either Dr. Bell's or Dr. Hibberd's statements and the germ theory of the origin of phthisis. The "dirty moist air" of the former is the chosen home and necessary environment of bacteria, while the "ocean air" is above all others essentially free from germs, inasmuch as they are too solid bodies to be carried over long ocean distances. California atmosphere ought to be germless on account of the ocean on the West, and the desert and frozen mountain chain on the East; and this undoubtedly is one of the factors in its value for the treatment of phthisis. The leading factor, however, in the efficacy of climate upon disease germs lies in the

VOL. II. L-2.

fact that it encourages out-door exercise and improves the physique in every way. This is the one property in which the Engadine, Cuba, Los Angeles, and Madeira have in common. The most effective germicide is a vigorous healthy organism. Life is the deadliest enemy of disease and decay, and what we are endeavoring to accomplish with our cod-liver oil and hypophosphites, is done much more effectually by mild, invigorating climates. The vitality of the body is raised to where it can destroy any disease germ, whether tubercular or malarial.

SOME REMARKS UPON BERGEON'S TREATMENT, WITH NOTES OF THREE CASES.

BY ARTHUR E. GRESHAM, M. D.

IT is but sixteen months, or thereabouts, since Dr. Bergeon, of Lyons, first instructed the profession in the use of his (then) new system of pulmonary therapeutics. Since that time, many physicians, in both this and the old country, have been experimenting with a system more or less approximating that enunciated by Dr. Bergeon.

Excepting the productions of the daily press in some of the Eastern cities, the published results of this treatment have been comparatively few, and those somewhat devoid of details -points upon which the professor laid so much stress. Right and left, physicians have thrown up the treatment, and openly condemned it as being useless. Comparatively few have, apparently, detected much benefit from its use. Public institutions in which it was used now know it no longer.

There appear to be some points-particularly insisted upon by the originator and his colleagues-which seem, from the published accounts, to have been overlooked; or which experimenters have thought not worth remembering, or have considered their own methods superior to those adopted by Dr. Bergeon for a period of two years.

First, according to Dr. J. F. Bennet, a colleague of Dr. Bergeon, the treatment is not recommended with a view to destroying the bacillus tuberculosis; for says Dr. Bennet (British Medical Journal, Dec. 18, 1886), "I may remark that although the bacilli diminish in number, they do not disappear from the

sputa, even in the cases most completely cured. This, says Dr. Bergeon, seems to imply that their presence is not the fons et origo mali in phthisis. He says that he does not propose his plan as a microbicide treatment, but merely as one that succeeds."

Secondly, with respect to the gas used, the following is found in the paper above referred to: "Dr. Bergeon has tried on animals, as stated previously, many chemical agentschlorine, turpentine, ether, ammonia-bromine-but they all produce irritation of the intestinal mucous membrane, and even gangrene, and he has had to abandon them. The only agent beyond the natural sulphuretted hydrogen of mineral waters that he has found quite innocuous and efficient, is the fluid sulphuret of carbon, the preparation that has been found so successful in destroying the philloxera on vines. A teaspoonful is put into a glass tube, stopped at both ends with cotton, and the carbonic acid gas is passed through the tube, having previously been washed by passing it through a bottle of pure water." Now, in not one of the published results of experiments with this treatment, has any reference been made to the use of sulphuret of carbon, where the natural sulphurous waters were not obtainable. It may, nevertheless, have been tried by many.

Shortly after the treatment was first brought into general use, the writer, amongst numerous other experimenters, adopted Dr. Bergeon's method, but used, as others were doing, artificially prepared gases. At the end of three weeks, no improvement having taken place, it was determined to make a change, and bisulphide of carbon was then employed in place of the artificially prepared sulphuretted hydrogen. From the time this was substituted, improvement was marked, the weight and general appearance of the patients attesting to the amount of benefit derived from the altered treatment.

The amount of bisulphide employed was from m x-m x x for each application, the gas being injected almost continuously and slowly for a period varying between ten and twenty minutes. It was found necessary to inject exceedingly slowly at first, otherwise the bisulphide, so volatile, caused smarting around the anus. Within a few minutes of beginning to inject, a sulphurous odor was easily detected in the patients' breaths. Whilst employing the sulphuretted hydrogen gas, partial syncope occurred on one or two occasions, presumably

from some of the gas having passed through the lungs to the arterial system.

When 20, had fistula
Had severe attack of

Following are notes of three cases upon which the bisulphide of carbon treatment was employed: X, aet. 44, janitor during past year. in ano and was operated upon for same. pleurisy with effusion which caused collapse of lung on left side. For many years suffered from chronic bronchitis, with much muco-purulent discharge. Physical examination revealed: Left side flattened anteriorly, and movement materially lessened. Supra and infra-clavicular fossæ very marked. Heart impulse diffuse and plainly visible. Face and body much emaciated.

Absolute dullness from left apex to third rib. Right side fairly resonant. Moist râles at middle of inner border of left scapula. Temperature 99°; pulse 86; weight 114 lbs. Cough very troublesome and expectoration copious. At the end of three weeks the patient's condition seemed unchanged except that he had lost one pound in weight. The bisulphide was then commenced, his weight being 113 pounds. Four weeks later the same scales registered 1172 lbs., in spite of a week of diarrhea. The treatment was still continued, but the patient never passed 118 lbs. His pulse was reduced to 75, and strengthened and his appetite improved. All through the treatment, the patient was obliged to work five hours each day in dust, so that no opportunity was given the gas to exert its influence upon him unopposed.

Y, aet. 20, was taken ill a year ago. Family history good. Had slight hæmoptysis. Examination of chest not noted. Weight 116 lbs. ; temperature 98.60°; respirations 38, and very shallow; pulse 100; night sweats occasionally; appetite fair. Two weeks later showed the weight to be 117 lbs.; pulse 100; respirations 30; appetite ravenous. The patient left the city and discontinued treatment.

Z, aet. 24, hotel night clerk, comes of a very scrofulous family, four brothers having died of the disease. Had hæmop. tysis seven and a half years ago, and scrofulous abscess of the neck, also pupura hæmorrhagica. Physical examination showed both apices to be consolidated, râles below each clavicle; pulse 104; temperature 100.40°; weight 136; chest expansion two inches. No night-sweats; cough only on exertion. Ex

pectoration scanty. No hectic, and the kidneys free from disease. Four weeks later reveals: weight 139; pulse 77; temperature 98.70°; general appearance good, the patient feeling more active and less easily fatigued; appetite exceedingly good. After this the patient had two intercurrent attacks of pleurisy, which pulled him down again. The gas was then discontinued on account of the patient leaving the city.

Since Bergeon claimed benefit for all kinds of lung cases, the gas was tried, without choosing any particular class of case, upon all, whether bronchitic, chronic pneumonic, or actual tubercular disease. From the above notes it will be seen that improvement occurred in all, despite their being advanced cases. It is worthy of note that in the last mentioned case the gas was administered during the attacks of pleurisy, and almost immediately and entirely removed the pain from the patient's side.

Although the writer is ready to admit that the rectal treatment will only aid the majority of cases up to a certain point, yet he does not believe in throwing over the treatment as altogether useless.

Is it not a point gained, if when drugs by the stomach have failed to restore a disorganized digestion, we can improve the processes of nutrition by means of this special treatment? Is it nothing that in many cases we can reduce the temperature and pulse-rate, the night-sweats and insomnia, without constantly resorting to, and saturating the system with, quinine, etc., when undesirable so to do? Supposing the improvement to be but temporary-a few weeks in duration-may not those few weeks, in many less advanced cases, be the means of tiding over a critical point in the history of the disease, and of enabling once more to assert itself, the "vis medicatrix naturæ"? 75 North Spring street.

AN excellent authority, The Druggists' Circular, maintains that the vaunted raw meat extracts are made by taking beef or sheep blood, coagulating the fibrine by churning, and after straining it out adding an equal measure of the white of raw eggs. Decomposition is delayed by the use of boric or salicylic acid or alcohol.