sider, therefore, the comparatively large per cent. of the population that is swept away annually from the wealthproducing class, we begin to realize with what great import to the State the question of a State sanitarium is freighted.

Many people who are imbued with a great admiration for the polite arts which wealth fosters, fail to appreciate the great economic truth that all the nobler arts and accomplishments, which administer to their happiness are sustained, if not directly at least indirectly, by the labor of the comparatively ignorant

masses.

The sequence, therefore, is very strong which binds the duty not only of men individually but of men collec. tively, in charitable and legislative bodies to the amelioration of these poorer classes, whose labor is of such import to the general spread of civilization and culture. And I know of no field of practical and specific legislation of greater value to the public morals and disposition than that which administers to the general health of the people.

While the laboring classes may not contribute directly from their own meager earnings for the support of State government, they do indirectly contribute, in their poorly recompensed toil, every dollar and penny of the taxes collected from the more prosperous classes. This fact, which is never considered by a short-sighted, selfish taxpayer, who grumbles at the expense of the State incurred for educational purposes, is very rarely considered even by the legislatures themselves. And yet this fact alone is, or should be, a sufficient guarantee 1or such legislation as will reduce the mortality and inefficiency of the laboring classes.

The State hospitals would be for the reception of consumptive cases with the expectation of curing and re

turning to society many of its useful members, who must otherwise perish; and to receive patients who, ou account of surroundings, are especially liable to give rise to other cases of the disease.

State hospitals for the cure of consumption favor its prevention. Not only are patients isolated who may spread the disease, but they receive there a training which, on being returned to their homes, makes them an important aid in disseminating among the people correct ideas of measures for the prevention of cousumption.

Next in importance to the state hospitals for consumptives, is the compulsory reporting of tubercular cases to the Boards of Health, and apartments occupied by persons thus reported and their infected beds and clothes should be periodically disinfected. These Boards of Health should, also, institute the forcible removal, in those instances in which consumptives are unwilling or unable, because of weakness, to observe required precautions, and where such removal is deemed necessary because of the unusual exposure to which others. are subjected. And they should, also, undertake the periodical inspection of all public offices, schools, factories, workshops and places where laboring men congregate, and any sanitary defect immediately remedied.

There is no doubt that the people would readily submit to compulsory notification of tuberculosis of the same rigid order as applies to other infectious diseases.

Notification is the only door by which disinfection. can enter and step between the diseased and the healthy.

Next in importance is the physical education of schoolchildren, conducted by trained medical men, together with theoretical instruction in the higher grades concerning hygiene and the cause and prevention of tuberculous diseases. Schoolchildren, in my opinion, should

be under the constant supervision of a specially trained medical inspector. They should be measured and weighed periodically. Parents should be notified of marked physical defects, and urged, in proper cases, to consult the family physician.

The general public in all the States, through the daily press and by the free circulation of literature by the Boards of Health and anti-tubercular societies, should receive systematic instruction concerning the true nature of tuberculosis, its infectious character and the means of dealing with infective material; and our States and cities should institute rational measures to prevent and overcome these sources of danger.

Notwithstanding the recent statements of Koch, denying the identity of human and bovine tuberculosis, the States should prohibit the sale of milk and flesh from tuberculous animals, should provide for the careful inspection of dairy cattle and the periodical usage of tuberculin test, and should enforce the proper stabling and care of such animals.

In case of consumption, rigid measures like these suggested are not fraught with such inconvenience to the patients and their friends as in the case of other infectious diseases, for complete social isolation is unnecessary. The people, therefore, would all the more readily acquiesce in fostering the successful accomplishment of the purpose for which such legislation would be instituted.

Were such measures, as I have specified, universally adopted by the State and municipal governments, the day might be hastened when consumption would be practically a thing of the past, and the fear of this terrible disease would be banished from the minds of men.

DISCUSSION OF PAPER BY DR. SALIBA.

Dr. Stewart: I would like to say this, that in the State of Georgia we have tuberculosis in many forms and under circumstances, and I think the doctor's paper very admirable, but there is one thing which I would like to mention to the Association which is very important, and that is, climatic change, which I did not hear him mention. In climatic change we have the greatest antagonistic to tubercular infection that can possibly be obtained. I have had a great many cases of tuberculosis which I have subjected to the climatic change, and in every case there has been immediate change toward improvement.

As to his ideas of preventing infection, I think they are admirable. Every patient should be careful in regard to the sputum to prevent it from coming in contact with other people. But, But, so far as the patient himself is concerned the avenue to improvement and recovery is in the climate, and I would like to emphasize one thing, and that is, that no man should try to treat phthisis in the climate in which it originates, as he will fail almost invariably.

As there were other papers on the program on this same subject, it was decided to postpone further discussion of this paper until the other papers were read.

RENAL DECAPSULATION, INDICATIONS, LIMI

TATIONS AND TECHNIQUE.

BY R. R. KIME, M.D., ATLANTA.

Many things in medicine and surgery are as yet unsettled; so it is with renal disease and renal surgery.

In the treatment of renal disease, there is such diversity of opinion on many points that we become confused and find it difficult to reach definite conclusions.

In the evolution of kidney lesions there is more than one factor, and he who better understands the human economy as a whole will be the better able to understand the kidney as an individual organ, and in its relation to the body as a whole.

When we fully understand the function of the kidney with its nerve, vascular and lymphatic supply, then we will be better prepared to understand the etiology and pathology of renal disease.

We must recognize four avenues by which the kidney may be influenced :

1st. The nervous system. 2d. The vascular system.

3d. The lymphatic system.

4th. By continuity of tissue from the bladder through

ureter.

It is self-evident that an organ thus influenced has more than one cause of disease. Then, in the prophylaxis and treatment each must be recognized.

It would be useless in many cases to direct our atten