we endeavor to study nature in all her fullness, but in studying diseases and their cure, we seem to forget nature with her indications, and to a very great extent investigate only symptoms. The treatment of disease comes and goes as a fad or as the fashions of dress, while people continue sometimes to recover in spite of so much medication, and sometimes they die from the same cause. The great reason more recover now than formerly is not in the superior drug medication; but in the better knowledge of causes, more attention to and better knowledge of hygiene for the sick home, and a better knowledge of dietetics, and better nursing."

Dr. O'Harra, another writer, says: "If powder, potion and pill were no longer our servants, great as the loss would be, the medical profession would still be left the most exalted part of duty."

Nor is the physiological factor in therapeutics to be ignored by the modern practitioner. The influence of environment and the quiet enforcement of routine, the maintenance of a constant atmosphere of legitimate hope, diversion and sunshine, the kindly, timely ministering to the mind diseased by the physician's presence, in brief, the regulation of the mind and feelings of the afflicted, contribute to recovery in a way peculiar to institutional residence, and is the keynote of success here, as Dr. Mitchell has emphasized it to be in the care of the insane.

I may say in this connection that combining the experience which has come to me from sanitarium life, which suggests by the class of patients taken a family hotel or summer resort where the social elements, under thorough control, are at their best, and my work among the feeble-minded and insane, it seems to me that the next great advance among the latter will be the introduction of sanitarium methods of treatment, with a most decided gain in the percentage of recoveries. Rest, better feeding, hydrotherapy and massage, added to light occupation and exercise, will meet the majority of indications, and give the pharmacist leisure time to become an ex

Dr.

pert in applied dietetics and the remedial use of hot and cold water. Cowles of Somerville justly regards his two gymnasiums for men and women, in care of a specialist, as indispensable features in the treatment of most patients from the better walks of life, and his Turkish bath facilities, added to the cottage plan of the buildings, easily place the McLean Asylum foremost among progressive institutions of its kind.

While seeming to wander from my theme, I have been really indicating the natural therapeusis of sanitarium life. Sanitary and sanatory are the rival adjectives from which we must choose our nomenclature. Chacun a son gout.

"Water as a remedy is at once the most ancient, the most universal, the most flexible and the most potent of all therapeutic measures" and one of the most agreeable and most innocent. "The basis of its physiological action is more clearly defined and more susceptible of proof than that of most known drug remedies." Among the sixty-odd varieties of treatment by baths, inunctions, electrical applications, etc., at the first institution which I notice, may be emphasized the Molière baths, the roof-life and the psychological training. The Molière is a thermo-electric bath given in a cabinet. It is entirely different from a mere steaming or the ordinary hot-air contrivances. In its general therapeutic effect, the Molière resembles the Turkish, but owing to the combination of electricity with heat, perspiration is induced at a lower temperature, and with less taxation to the system. Moreover,

in the Molière, the patient breathes the ordinary atmosphere of the room, while in the Turkish, air at a temperature of two hundred degrees is sometimes taken into the lungs, which in some cases is undesirable. The claims made for this bath are: First, its remarkable power to equalize the circulation, making it of special value to those who suffer from congestion and inflammation of internal organs. Second, its unrivaled efficacy in removing waste material from the system. Thus in neuralgia, rheumatism, gout, catarrh, and malarial affections, it

is one of the most effective measures of treatment. Again in many organic diseases this bath greatly relieves suffering and often prolongs life, as in Bright's disease. For persons weary and debilitated by care or overwork it is a most luxurious and strengthening bath.

The doctor in charge, who is a graduate of Bellevue Hospital Medical College, and his wife, a graduate of the New York Infirmary for Women, known as the Blackwell College, in response to a recent letter of inquiry, says:

The cost of these baths well built of oak, or black walnut, or cherry, all complete, is $300, and they can be set in any room where you can get a waste pipe from them, and a water supply, together with steam, without danger to anything. I consider the bath to be the best and most effective therapeutic agent in the treatment of all diseases that require depuration, and I consider it more powerful than the Turkish bath really; at any rate it is more usable in the great majority of cases, on account of the fact that the heat is not so enervating, and it agrees with many who cannot take the Turkish, because their head is in the open air. The bath can be run to accommodate many, that is, you can take one after the other as fast as is possible to give them good sweating baths, at blood temperature, and the curious part of it is that people perspire more in what is called the "cool" stage than in the hot. I suppose as we run the bath, patient following the other, the average temperature is probably 125°, and you remember that steam can be given so as to make it a Russian bath practically, as well as a dry Molière, the head being out and in the free, cool air. I never saw anything in all my practice that would take down the dropsy occurring in cardiac insufficiency and in the edema of Bright's like the Molière. I consider it particularly good where free change of tissue is desired, where increased metabolism is needed, and particularly in congestion of the capillary surfaces of the mucous membranes of the body. In all catarrhal and inflammatory conditions of the intestinal tracts, and congestion of the liver, where to surcharge the ca

one

pillaries is desirable, I know of no better way than the Molière bath, none that is less enervating.

With reference to the number of general patients in the last ten years I presume we have treated 5000.

The bath is one that should find its way into many private hospitals and asylums.

The most "thoroughly scientific health establishment" in the United States has a plant embracing some 25 buildings. Physiological, microscopical, bacteriological and chemical investigations are constantly being carried on within its walls. The superintendent is one of the remarkable men of our times, versatile, original, energetic, scientific and eminently successful. A graduate of Bellevue, New York, he has studied in the medical schools and hospitals of London, Paris and Vienna, and has won recognition at home and abroad by his researches on respiration and on methods of precision in the investigation of disorders of digestion. He is also an extensive author and inventor. His study of the causes which are responsible for the growing physical weakness of American women, and his anthropometric work are especially to be commended. He has given us tables and apparatus, now in use at Yale University, the University of Montreal, West Point and elsewhere, whereby to "diagnose accurately the neuro-muscular force of an individual and to give a precise prescription of exercise." May we not hope to see similar work especially in the domain of physiological chemistry, and a more thorough comprehension of the body in health, issuing from our own medical schools, which have every facility for this most valuable research?

When to the conveniences of a hotel and the facilities of a thorough medical equipment are added the vis medicatrix of mountain charms, pristine woods, purest of air and water, the wooing of streams, forest and river, then indeed the patient born to wrestle with malicious germs which haunt the low levels of life can look up and take courage. It seems strange that capital has not thus pre-occupied the many favorable loca

tions along the Western Maryland Railroad and the picturesque B. & O. Our State has also an equable climate, a diversity of scenery and a richly productive soil. Such conditions are what any physician in large practice seeks for at class of persons, who, exhausted by society and business exactions, or the cares of housekeeping, cannot give the time, or command the conditions at home, favorable to restoration to health. Sanitarium life possesses great advantages for convalescents, or for patients looking forward to grave surgical operations whom the doctor desires to have put in the best possible hygienic condition to react favorably. I recall a case in the private practice of another which. succumbed to the shock of a perfectly successful operation of lithotomy, because of a violation of the summer rest enjoined by his adviser. At a properly ordered institution, all the conditions, every detail of regimen, makes for the peace of the guest in a way that no mere hotel or summer resort or country home

can ensure.

Furthermore, the educational value. of a residence in a strictly professional health cure needs only to be stated to receive the endorsement of every practitioner who deprecates the ignorance and credulity of the "fool multitude" as Dr. Osler calls them, on which doctors work. Says Dr. Osler: "Common sense in matters medical is rare, and is usually in inverse ratio to the degree of education. Clergymen, for example, are notorious supporters of all the nostrums and humbuggery with which the daily and religious papers abound, and I find that the further away they have wandered from the decrees of the Council of Trent, the more apt are they to be steeped in thaumaturgic and Galenical superstition. As the public becomes

CHLOROFORM IN GASTRIC AFFECTIONS. Stadnitzky (University Medical Magazine), from his experiments with chloroform administered internally to seven young men, concludes that the drug markedly improves all the functions of the stomach, which fact sug

more enlightened, and as we get more sense, dosing will be recognized as a very minor function in the practice of medicine in comparison with the old measures of Asclepiades. Each

class of invalids is trained to reform their unhygienic ways and do works of supererogation healthward." The nervous and neurasthenic learn to live more in their muscles, to select their diet, to conserve nervous energy and cultivate tone; the hypochondriacal and introspective are inspired with a wholesome hatred of drugging and disease; and everybody comes away with the religion of cleanliness for once washed and soaked into them. Very few people take generously to water, and the basis of much ungodliness is dirt. I congratulate the community that at last we are promised an appropriation of $8000 for central public baths.

In conclusion, where will you find the doctor himself taking his needed rest and recreation? Ask the author of "When the Woods are Green," and you will wander far from the madding crowd, if you follow. Who has not learned to feel with the poet :

"The murmur of a waterfall a mile away, The rustle when a robin lights upon a spray, The lapping of a lowland stream on dipping boughs,

The sound of grazing from a herd of gentle

COWS,

The echo from a wooded hill of cuckoo's call, The quiver through the meadow grass at evening fall,

Too subtle are these harmonies, for pen or rule,

Such music is not understood by any school; But when the brain is overwrought, it hath a spell,

Beyond all human skill and power, to make it well."

gests its value in dyspepsia. In each instance the experiment lasted fourteen days, being divided into two equally long stages, during the second of which the subject was given three to ten drops of the drug three times a day.

THE theories put forward to explain immunity are numerous. We shall consider. 1. The exhaustive theory. This supposes that the invading microbe takes from the system a substance necessary for its life and growth, exhausts it and it is never replaced; so that germs of a similar kind, seeking to attack the body, can find no means of subsistence. Concerning this theory, Roosevelt of New York says, "It would be hard to believe that this could be the case if provision were only made for the growth and development of some one species of germ; but when we are called upon to believe that the majority of mankind. comes into the world with a separate and distinct substance suited to the needs of the micro-organisms of smallpox, measles, yellow fever, etc, the imagination is staggered and the reason revolts against such a preposterous idea."

2. The antidote theory supposes that microbes, after entrance to the body, produce a secretion (toxine) which is inimical to their own welfare. Upon it is based the action of antitoxine for diphtheria and tetanus. Reasoning by analogy is here brought into play. The excretions of many, if retained in the body, produce septic intoxication; so the presence of their excretions render the infecting bacteria harmless. This is plausible, but "we know of an organic compound which is not excreted or destroyed by the body within a short time after its introduction into the system." What goes on in the test-tube is not always an index of what occurs in the organism. Pepsin, for example, acts beautifully in the former; but how often have we been disappointed in it in the latter. In the test-tube the excretion product remains; in the system they are carted away as soon as formed.

The third theory may be termed that of the "survival of the fittest." In the

contest between the invading bacteria. and the body, the weak cells of the latter perish; the stronger survive, increase in power and transmit their strength to their progeny, thus following the law of inheritance. It may be called the congenital resistance of the tissues and cells.

It seems now to be conceded by most authorities that immunity to the infections is due to the presence of substances formed by the metabolism of the cells. Investigations pursued in the past four or five years, notably by Vaughan of Ann Arbor, and Aulde of Philadelphia, have brought to light the fact that the bactericidal action of blood serum is due to nuclein, a phosphorized proteid, formed chiefly by the multinuclear colorless corpuscles. It is non-poisonous and stimulates those organs whose function it is to protect the body against disease. Aronson has, in all probability, recently obtained it from antitoxine. He, by the way, does not place faith in the antidotal action of this.

The production of a leucocytosis may be said to be synonymous with the production of immunity, if the white cells are healthy and are stimulated so as to secrete their nuclein. Leucocytosis exists in all infectious diseases where there is a local reaction, notably in croupous pneumonia. In typhoid fever there is none. Cold water will produce it and thus we have an explanation of the good effects of cold baths. Massage has the same property.

Nuclein when injected does not act as a germicide directly, but stimulates the cells to renewed activity.

Attenuated cultures of microbes or their toxins when injected into a living body, have the power of stimulating the cells. The increased metabolism results in an increase of nuclein, and along with it an increased power of resistance.

We see then the action of antitoxine (sic), tuberculin, vaccine virus, erysipelatous cultures, etc. Antitoxine has never yet been obtained directly from cultures in the test-tube.

It is probable that one of the functions

of the liver is the extinction of bacteria and their products, as noted by Ewing (New York Medical Journal, March 2, 1895). Nuclein stimulates this organ and others that have to do with the formation of phagocytosis.

I WISH to report a case in order to exhibit to you a very pretty specimen of hydrosalpinx. The case is also interesting because of the variety of morbid conditions presenting. On March 19, Mrs. H., aged 44, was sent by me to the Virginia Hospital to be prepared for a laparotomy for the removal of some growths. The next day I operated, ably assisted by Dr. Hugh M. Taylor, Dr. Geo. W. Ross administering chloroform. The first morbid condition seen was a pedunculated uterine fibroid weighing between two and a half and three pounds. It was attached to the upper portion of the posterior surface of the womb by a pedicle about two inches long and as broad as my two fingers. The pedicle was transfixed with a double ligature of silk near the uterus, the tumor tied off and the stump cauterized with a Paquelin. The next condition

DIPHTHERITIC CONJUNCTIVITIS TREATED BY SEROTHERAPY.-Dr. Jessup recently communicated a report to the Journal of the American Medical Association of two cases of diphtheritic conjunctivitis treated by Klein's antitoxine. The first case was that of a boy, aged 19 months, with false membrane on the conjunctivae of both eyelids of the left eye, with a patch on the uvula, swelling of the sub-parotid lymph glands and albuminuria. Three injections were made; the total quantity of the antitoxine used was three grammes. The membrane disappeared in five days without leaving any trace on the conjunctivae, though the only local application used was distilled water. In the second patient, also a boy aged 8 months, there were

engaging our attention was this large and very pretty specimen of hydrosalpinx of the right side, which I have here this evening. Its measurements soon after extirpation were thirteen inches in circumference, six inches in length and five in depth. The adhesions to the pelvis and bowels were numerous, rendering its removal without rupturing the delicate covering difficult. It was successfully done, however, the tube tied and the stump cauterized. The ovaries were found in a degenerated state and removed. In addition to the hydrosalpinx, an intra-ligamentous cyst, about half its size, was found on the right side. Unfortunately, in the attempt to remove it, it was ruptured. The patient is doing well with every indication of recovery, this being about the middle of the seventh day since the operation was performed.

membranes on the palpebral conjunctivae of both eyes, enlarged glands and a muco-purulent discharge from the nostrils. Two grammes of the antitoxine were used in two injections and the false membrane disappeared in four days. Hayward examined the membranes in both cases and discovered large quantities of the Löffler bacillus. In his opinion the cure was certainly due to the antitoxine, because these cases are generally accompanied with purulent ophthalmia and ocular lesions which are very slow in healing. Coppey of Brussels has also reported a case in a little girl of one year, with severe ocular diphtheria cured in four days after one injection of Behring's serum.