test dose of tuberculin was assailed on the ground that syphilis and actinomycosis, may afford a similar reaction to that met with in tuberculosis. But in such a case of actinomycosis of the liver, reacting to tuberculin, which occurred in the Leipsic surgical clinic, a tuberculous deposit in the lung was demonstrated post mortem. (Quoted by F. Frenkel in the Zeitschrift für Tuberculose u. Heilstetten wesen, 1900. Bd. 1, from the Zeitschrift für Chirurgie, 1896. Bd. XLIII.) And it was asserted positively by Heron (Proceedings London conference loc. cit.) that he had never seen a reaction to tuberculin in a syphilitic patient not suffering from tuberculosis. Enslin (Deutsche Med. Wochenschrift, 1903, XXIX 9; Abstr. Journal American Medical Association, April 4, 1903, p. 944) differentiates between tuberculous and syphilitic parenchymatous keratitis by the absence of a febrile reaction in syphilitic cases, unless complicated by tuberculosis. It is worthy of note that the eight cases of associated tuberculosis and lues reported by Enslin gave a temperature reaction which was characterized by a steep rise and a steep decline. This occurred in two cases after one milligram of tuberculin; in five after injection of one milligram; in one after three milligrams. The very wide experience obtained from the use of tuberculin in testing cattle for tuberculosis, has demonstrated that in apparently healthy animals, if a definite reaction occur, there will be found somewhere in the carcass-in a lymph gland, perhaps, if the lungs and udder be found normal-a tuberculous deposit, if only a sufficiently minute and careful examination be had. And in the human subject it is coming to be generally accepted that a definite reaction, following the administration of ten milligrams or less, is conclusive of the existence of tuberculosis. The margin of possible error appears to lie in the occasional failure of a tuberculous individual to afford a typical reaction to any reasonable dose. Of such failure to react, in a case which later proved tuberculous, I have met with one definite instance. As to the possibility of danger from the use of tuberculin for diagnostic purposes, the opinion of those who have used it most extensively, that it is safe when rationally administered in early stages of tuberculosis, when a diagnosis can not be made with certainty by other means should outweigh the fears of others who either have not used it or whose apprehensions are based on the harm which it unquestionably did, when administered twelve years ago in excessive quantities, and to unsuited cases of phthisis with mixed infection. As a therapeutic agent, Professor Strümpell, in his work on the Practice of Medicine, while opposed to its use as a remedy for the treatment of tuberculosis, commends it, though somewhat guardedly, as a diagnostic agent; and Osler and Anders on this side of the Atlantic both advocate it, and rely upon it in the differentiation of otherwise doubtful cases. Like chloroform, strychnine and other powerful agents, its dosage must be carefully adjusted to the case in hand. Like Vidal's reaction in typhoid fever, it may not be regarded as infallible; but in those cases, and at those stages of tuberculous involvement where other means of diagnosis fail us, we may rely upon tuberculin for an unequivocal reaction and a definite diagnosis in from 93 to 98 per cent of our cases. DISCUSSION. DR. H. W. CROUSE, Victoria: Personally, I am afraid of this test; 1 would not permit it to be used on myself. I believe, from the statement that the doctor has made, that at times a latent case of tuberculosis will develop into an acute case, which may terminate, in all probability, fatally. Anderson, one of the greatest enthusiasts upon the tuberculin test, admits that ten per cent of the cases in which it was used, where a latent condition existed, developed acute tuberculosis; that in ten per cent, where tuberculosis was known to exist, it failed to give any reaction at all; that in the remainder of eighty per cent, it was of benefit. I believe, gentlemen, that we should let a number of our cases alone, and, at least, should not use a remedy that is liable to change a dormant case into an active one. It is well known that frequently, in chronic cases, the bacilli are lying dormant in the peri-lymph spaces, which no doubt would be stimulated into activity by the use of the tuberculin. Dr. Cornick states that in lupus he has observed a reddening and an acute inflammation to take place, showing that the remedy stimulates the dormant bacilli, that all the classical signs of a vicious cycle under the stimulus of this test takes place. If such exists upon the surface, where one can readily observe it, we are led to believe, by analogy, that the same, in all probability, occurs in the lung. He further proves this point by showing that he was able to outline small cavities in the lungs, previously unable to be discovered, after the use of tuberculin, and that in fibroid condition of the tuberculosis he had been able to outline classical signs of cavities after the test. I wish to state that I think a great deal of Dr. Cornick, and value his opinion very highly, but I have a fear, notwithstanding, of the tuberculin, namely: on account of Anderson and other authorities, and the paper which so beautifully summarized the literature upon the subject my friend just read, in which he proves that an acute case may develop from a dormant type of tuberculosis, terminating fatally, after the use of the tuberculin. THE CLIMATE OF FORT DAVIS, TEXAS. W. T. JONES, M. D., FORT DAVIS, TEXAS. Having been solicited by the Chairman and Secretary of the Section on State Medicine and Public Hygiene to prepare a paper upon the Climate of Fort Davis, especially as regards tuberculosis, for this meeting of the State Medical Association, I will endeavor to do so, basing my remarks upon personal observation, after a residence of about three years in said locality. I will preface the paper by saying that I have no "ax to grind"no sanatorium for the treatment of tuberculosis patients, and therefore believe I can give an honest and truthful opinion as to the merits of the climate. I believe it is now generally admitted by a great majority of specialists in lung diseases, especially tuberculosis of the lungs, that a moderately high altitude that is dry, and changes of temperature not too great or sudden, is the ideal climate for such patients. As an evidence of this fact the United States government has established an army hospital and sanatorium for the treatment of pulmonary tuberculosis at Fort Bayard, N. M., where the altitude is 6,040 feet. Fort Davis, the county seat of Jeff Davis county, is the site of a former United States military post. It is located at the foot of the Davis mountains, 5,200 feet above the sea level. Surrounding mountains are 6,000 to 9,000 feet above the sea. It is twenty-two miles north of Marfa, on the Southern Pacific railroad, and has daily stage over an excellent road. The soil is gravelly and exceedingly porous, hence there is good drainage, and no mud, even after heavy rains. The rainy season is from July to Octobernot continuous rains and cloudy days, but occasional showers that cool the atmosphere, which makes it the ideal summer resort. The village is so well protected on the north and west by mountains that it does not suffer from northers and high west winds that prevail during the months of February and March. While the thermometer sometimes gets as low as zero during winter, the situation as above described, and the exceedingly dry atmosphere, make the place a pleasant and desirable winter resort for tuberculosis patients. I have frequently had patients tell me that they suffered less from cold here during the winter than in Southern Texas, which is my own experience. The water is as good as can be found in Texas, being supplied by wells at from forty to eighty feet deep, and from springs. The summers are exceedingly pleasant, the nights being delightfully cool. There are no mosquitoes and absolutely no malaria. The atmosphere is so pure and dry that the bodies of dead animals do not decompose in the usual way, but dry up on the plains. I submit an official statement as to the variation between mean summer and mean winter temperature at some of the most noted resorts in the world. Average number of cloudy days during winter months, United |