disadvantages of deranging the digestion and must be used with caution.

Much could be said in regard to the treatment of the various symptoms as they arise, and our success or failure very often depends on our care in meeting the various unfavorable manifestations. In conclusion, I will say but one word. In the successful treatment of phthisis, we must bring to bear upon our patient every influence within our power for his good. Make him live right, and do not depend upon treatment to the exclusion of hygiene.

DISCUSSION.

DR. M. M. SMITH, Austin: I desire to speak upon this question, which to me is a great question and one that concerns not only the medical profession, but the people of the world-the treatment of tuberculosis. When we consider the enormous death rate, and particularly that tuberculosis strikes our most favored ones, so to speak-the young man and young woman in the prime of life-this question should receive our careful attention, and it is one that is receiving the attention of the profession of the world today, as well as our legislative bodies. I shall discuss only very briefly the treatment of tuberculosis, from the reports given us by the sanitarium treatment, and these are very favorable ones. I had the pleasure of visiting during the past summer the Tubercular Sanitarium in the Adirondacks; also the Loomis Sanitarium at New York. I am free to confess that after visiting this institution I was agreeably surprised in reference to their treatment and the condition of their patients and the percentage of recoveries. I was invited to dinner at the Adirondack Sanitarium. I accepted the invitation and was asked to come into the dining room, and saw some seventy-five or eighty-five tubercular patients sitting around at the tables, just like we do at the hotel, and the question of eating my butter and drinking my milk came to my mind, so I left them; in fact, I was a little afraid to eat anything. However, I selected those articles that seemed to be perfectly well cooked. I made some inquiries of the physician in charge and he assured me that during the seventeen years existence, and for many years, had over 100 patients; that there never had been a physician, nurse or attendant that had contracted tuberculosis around the institution, showing that in such institutions, properly conducted, where every precaution is taken, you run small danger of infection. I had much the same experience at the other institutions that I have visited, and I wish to emphasize the point in reference to the treatment of this disease. I would say, put the patient to bed and keep him perfectly

quiet until the fever has disappeared entirely. Some think if they go to bed they will become ill and never be able to get out. When a case is admitted the first thing they do is to run over same carefully, make their examination of their patient, take their temperature, and put them to bed and keep them there until their temperature has disappeared, and at the same time they give them plenty of fresh air and sunshine. Regular diet is a very important matter with them; they see that they retire early and get their usual amount of sleep; they also teach their patients in these institutions to try to make an effort to keep from coughing, and it is remarkable what they have accomplished in the management in this way in teaching them to restrain and make an effort in that direction. Nutritious diet is a most important consideration, and we should especially see that they get plenty of the fats and albumoses, and we should encourage them in their eating; in fact, in addition to their regular meals they serve lunches between meals-their patients get five or six meals each day.

I have outlined in a general way the treatment that is best suited in these cases of consumption as they may arise. Another method of treatment is by forced feeding; they are given all the animal and vegetable food that they will take, in a concentrated form, tablespoonful three times a day, and they encourage them to eat their three meals regular and allow them to have fresh sweet milk and break up as many eggs into same as possible. One patient told me he drank three quarts of milk, and one patient took as many as sixteen raw eggs a day in addition to his regular three meals. Whenever necessity arises they give them a good dose of magnesium sulphate (one ounce). I think that this forced feeding is good. It causes them to increase in weight, and as a result a better condition of the patient is brought about.

DR. W. W. MACGREGOR: My personal experience has extended to where Dr. Smith speaks of in the Adirondacks. In all these tubercular conditions give your patients all they can digest and all they can absorb, and encourage eating, instead of giving them all these hypodermic injections of something we know nothing about.

Tuberculosis is a disease that is due to lack of nutrition, and this is the result of an error of nutrition. All do not have tuberculosis simply because they may have an inherited tendency that may make them susceptible to an acquired tuberculosis; but when they do acquire it, what is the result? They have a loss of vigor, a depression of the vital powers, lack of appetite; they do not eat, are run down, and they acquire this condition.

In the Adirondacks, where I have been, that principle is carried out to give the patient the greatest amount of nutrition that they can digest and absorb, and that is the principle of treating it. I do not take any school or any specific theories or treatment or anti-tubercular toxins-fresh, dry air,

good food, out-door exercise and methodical expansion of the lungs will accomplish much more than drugs.

DR. H. W. CROUSE, Victoria: There is one remedy that I have had some experience with in pulmonary tuberculosis, and have been able to secure good results from its use. This is glandulin, prepared by Dr. Hoffman, of Meerane, Saxony, Germany. It is a preparation made from the desiccated bronchial glands of sheep-a true glandular tissue. cases by this method. I have treated ten You should use the remedy by giving a 5-grain tablet three times a day for three days, then two tablets three times a day for three days, thus progressively increasing the dose until you are using fifteen tablets a day. We have, by this method, the utilization of a remedy theoretically proven-and clinically also-to be of marked advantage. It is but carrying out an organ therapy, suggested theoretically by the use of other remedies, such as mammary substance, in treating uterine fibroid and thyroid gland in cretins. In other words, that all racemose groups of glands have not only an external (in some of them) but a internal secretion of marked benefit to the system. It is a well-known fact that the bronchial glands are among the first pulmonary tissue that become diseased in pulmonary tuberculosis, so that by the giving of a substance which we are able to secure by the utilization of this remedy we are able to meet a deficiency no doubt brought about by the destruction of the bronchial glands. I have taken chronic cases of tuberculosis, where we had a bronchial involvement to a certain extent, no doubt a mixed infection, and have found one case, at least, which markedly improved with this treatment, in Victoria, which has an altitude of only forty feet above the sea.

DR. BOYD CORNICK, San Angelo: I regard the paper as admirable in its outlines for treating pulmonary tuberculosis, but it is all too brief. We can not go into too minute detail in the management of a case of consumption. The most essential thing that occurs to me in the management of a case of pulmonary tuberculosis is that it shall be taken in charge at an early stage, before serious harm has been done before irreparable damage to the lungs or system has occurred. Our cases should have the same careful supervision as at a good sanitarium, where they are under medical observation at all times.

We have to thank Brehmer, Dettweiler and other sanatorium physicians for demonstrating that pulmonary tuberculosis is the most curable of all chronic diseases. The great majority of general medical practitioners still rely too much upon medicaments in treating this disease; upon drugs which at best serve only to palliate symptoms; and they often fail in consequence to appreciate at their true value the curative virtues of diet, in promoting nutrition, of carefully regulated rest and exercise if fever be present, of a 12-Tr.

dry and sunny climate if the patient can possibly avail himself of it at an early stage of his disease, of an open air life by night and by day, which is possible, to an ideal degree, only in a dry climate.

The value of climate is better appreciated now than formerly, and my own personal experience as a tuberculous health seeker, as well as my observations of a great many others in the West, is that a dry climate is worth more in promoting appetite and improving nutrition in pulmonary tuberculosis than all the medicaments in the official pharmacopoeia. Yet many patients fail to derive lasting benefit from it. They have been advised to "rough it," and they often follow this unwise advice literally, when an intercurrent fever cries out for physical quiet or actual rest in bed for a few days in order to avert disaster. The clinical course of tuberculosis varies so greatly from time to time that only by continuous medical supervision of the patient's daily life-his down-sittings and his up-risings, so to speak-can a menacing tuberculous infection be brought in many instances to the stage of eventual complete arrest.

Dettweiler, in protesting against over-medication, said: "The kitchen is my pharmacy." And only when we fully realize that the highest possible nutrition of a tuberculous patient is the goal at which we must aim; and that a strict supervision of the diet, with judicious regulation of rest and exercise according to the presence or absence of fever, together with a dry and sunny climate to promote appetite and digestion, are our most helpful means to this end, then, and not till then, can we hope in private practice to approximate the favorable results of sanatorium treatment.

DR. H. J. CHAPMAN, San Antonio: I appreciate the discussion that my paper has brought forth, and am pleased to see the interest taken in it. I will simply repeat, in closing, what I have already said in the paper. We must bring all the resources of medicine and hygiene to bear on these cases and must keep them under observation until well, no matter if it takes three months or three years.

Again, increase of weight is most valuable, but it is not the whole story; nor is it safe to count a case cured because he has gained several pounds in weight. It is only with the disappearance of the tuberculous lesions-not simply an absence of rales, if the trouble is in the lungs that we may be safe in pronouncing a case well. I have also obtained valuable information as to the extent of apparent cures by giving the full test dose of tuberculin at least six months after all specific medication had been discontinued. I would regard only cases which failed to react as well, no matter how much they had gained in weight or what might be their personal feelings about being well.

A COMPLICATED CASE OF TYPHOID FEVER.

F. B. SHIELDS, M. D.,

VICTORIA, TEXAS.

In this report there will be no attempt at exploiting new drugs or original methods of treatment, but to chronicle a most persistent, pernicious and complicated case of enteric fever.

The history of ten days prior to my first visit of evening: temperature, insomnia, anorexia, diarrhea, intense frontal headache, suggestive of the ambulatory type.

Was called on the morning of January 15th to see J. C., male, age 29; found temperature 102 1-10, pulse 100, respiration 18; frontal headache, intense pain confined to middle third of sternum, which increased markedly upon swallowing either hot or cold liquid.

Inspection, palpation, percussion and auscultation over entire thorax, negative; abdomen flaccid, skin dry and parched, tongue red, pointed, tremulous; fauces larynx, normal; urinalysis showed the usual decrease in secretion, high color and specific gravity; albumen, sugar and casts absent; diazoreaction negative.

The usual treatment-liquid diet, hydrotherapeutic measures, intestinal antisepsis; with codeine internally and heat locally for sternal pain; trional for insomnia.

January 16th: Nervousness and insomnia aggravated, mediastinal pain increased; temperature 104 3-5, pulse 90, respiration 18. Again, a thorough examination of the chest elicited no information whatever. Codeine in large dosage was administered hypodermically by the nurse; otherwise, no change in treatment. While the temperature, pulse, respiration and general condition merit no especial mention for the next few days, the mediastinal agony