the valuable commercial products, and shall operate its plant by the steam power which is obtained by the combustion of such worthless parts of the dry refuse as may be left after sorting out the salable portions, and that will, in addition, bring to this point such proportions of ashes from houses as can be utilized for fuel for the destructor, will then have all its waste disposed of in a way entirely sanitary and will realize a profit in the operation which, in a comparatively short time, will repay not only the cost of the works and their operation, but will return in steam power, when utilized for electrical purposes, a very considerable amount of profit.

Fourth. When the quantity of garbage produced is insufficient in amount or impracticable for treatment by reduction methods there can be erected a general waste disposal station, which will receive everything in a mixed condition, and, by employing the best available destructive agencies, transform the worthless matter into electrical energy, to be used as principal or auxiliary power for street lighting or other useful municipal purposes.

Fifth. Any small city or town can employ destructive methods for its waste disposal, with guaranteed immunity from nuisance, at a smaller relative cost for operating the works than has been known since the beginning of this treatment, twelve years ago.

SALT WATER AND FIRES.

Ninety-eight fire companies have petitioned the authorities of this city to do just what the Insurance Monitor urged a quarter of a century ago: utilize the water which surrounds this city in putting out its fires. Those old diagrams, showing the elevations and just where hydrants could be profitably placed, may be found in our early files. But we were ahead of the times, and the underwriters of those days believed that the water damage would outweigh the benefits. The experience of other cities has taught them better. It is cheaper to put out a fire with salt water than to let it burn, and cheaper to use salt water than to depend on private capital to supply the fresh.

Underwriters want no Ramapo jobs in this or any other city if public ownership of the water supply is possible. Lack of municipal control has been the curse of the volunteer department. To put out fires is the business of the city and the water, like the engines, should belong to the city.

THE ARID REGION OF THE UNITED STATES FOR

PULMONARY TUBERCULOSIS.

By J. O. COBB, M. D., of Fort Stanton, New Mexico; Passed-Assistant Surgeon, United States Marine Hospital Service.

I take an opportunity in this paper to answer the great many inquiries that have come to me from physicians and others by giving information through the Medical News* direct to physicians relative to this section as a climate for their consumptive patients. As I have no local interest I can probably speak without coloring my statements with Western prejudices.

What actual knowledge I possess of the arid region has been gained by a residence here this summer, last spring, and last winter, during which latter season I was sent through Arizona and New Mexico to inspect Government reservations for the purpose of recommending the selection of a site for a sanatorium for consumptive patients of the Marine Hospital Service. In this connection I wish to call attention to some of the points of interest which impressed me while on this trip, and which may be useful to the physician in sending his consumptive patients out here for the climatic cure of the disease.

First and last, I am firmly convinced that any part of Arizona, Colorado, New Mexico, Mexico, or Western Texas above 2,000 feet elevation is as good as another part for the acute case without complications, other things, of course, being equal, such as proper food, etc. I know that a large percentage of such patients sent here rapidly and permanently recover. Let me emphasize that for men in the acute stage one place is as good as another in the sections named so far as altitude is concerned. If the patient has friends, or if it is known that he can obtain all the necessary care at any particular place in the sections above named, let him be sent there. For women, those in an advanced stage and those with a tendency to hemorrhage, care must be exercised to select a site at a medium altitude; patients with stenosis must never go to a high altitude.

* Of October 21st, of which this is a reprint.

I believe that for the average patient the climate of El Paso is as good as that of Colorado Springs; Albuquerque as good as Fort Stanton; Tucson and Phoenix as good as Prescott; Chihauhua and Aguas Calientes as good as the City of Mexico. These places represent the average of each section, and if the physician has a patient in either, and he has all the other absolutely necessary requisites for his comfort, care, proper food, and peace of mind, then one need not worry, for all will have been done that can be done. I have met numbers of patients out here who have tried each place, and, of course, wherever one began to improve that was the place of all others. It is surprising what a vast fund of knowledge relative to climate, rainfall, altitude, and a thousand other unnecessary things these poor unfortunates pick up. I recall a case in Phoenix which I found to be fairly typical of the consumptive sent out to this country. This man, who was just ahead of me at the ticket office, interested me by calling for a ticket to Chicago, and seeing that he was very sick with tuberculosis I naturally made an opportunity to speak to him and inquire why he was returning to Chicago. He explained that thirty-three days before he had landed at Albuquerque, and as he could not notice any difference after a week's stay there, and being told that it was too high, he went on to El Paso, and from there still lower to Tucson. As I was much impressed with that beautiful little city, I asked him why he left Tucson. "Oh," he said, "it was too dry, and they have such awful dust storms." I asked him how many storms they had while he was there, and he said only one, but he knew he should die if he had to live through another. So he had come to Phoenix, and was leaving there because the place was ruined by too much irrigation of the alfalfa fields, and was, therefore, too wet.

Who was responsible for sending this poor, foolish man out here without sensible instructions to aid him to bear up against all the natural drawbacks to be found in a newly settled country? If one expects the climate to do all he will be wofully deceived. If the cases are diagnosticated early and the patient sent here promptly, I believe at least eighty per cent. will recover with outdoor life, good food, and attention. Of course many patients will recover with only climate as an aid in spite of all hardships. Truly, though, I have been unable to find many of these.

Do not fail to impress upon your patient that he is to come out here to make it a business to get well. He must understand that

the towns are small, nearly all the hotels poor, and the boardinghouses even worse. There is very little beautiful scenery outside of Colorado. There is much that is dry, brown, dusty, and some that can be called grand though sombre. The barrenness of the arid region in Arizona and New Mexico is appalling to the newcomer. The monotony of the ever-present sunshine, the dust, and the high winds make the sick and the well long for a drop of rain; and then add to this poor food and unsatisfactory accommodations, and it requires some courage on the part of the patient to remain here. Then let it be understood that coming here is a serious business, and that the stories of hunting and fishing (the latter especially) and other sports are exaggerated, and generally entirely untrue. Then, too, in all arid regions of the world dust and winds prevail, and I can see no reason to deny that there is a great deal of dust and high winds all over the sections under discussion. Let it be understood that there are many unpleasant features, and the disappointment will not be so great.

The consumptive must not come here believing that it is warm just because there is so much sunshine. At Las Cruces last January it was a little too warm at mid-day for long walks, while in the evening one required a heavy overcoat, and at night heavy blankets. There is a very marked difference between the mid-day and midnight temperature, and it is absolutely necessary to come prepared for cold weather, and flannels will have to be worn all the time.

I have noticed one thing out here which is very disgusting, and that is that the pillows and bedding have the odor of perspiration so peculiar to the consumptive. Every health-seeker should buy pillows and blankets and carry them wherever he goes if he desires comfort and cleanliness. Every place seems to have the abominable cotton-padded "comfortables," which cannot be and never are washed. In a large hotel I found that I had to spend a night under one of these foul things, and I noticed next morning that it had several large spots of dried sputum on it. If one wishes to feel comfortable and be free from disgusting odors let him carry his own pillows and blankets. Besides, if one always has the same covering there is not so much danger of catching cold.

Never believe that the room offered to you has been properly disinfected; also, never believe that a consumptive has not preceded you. I call attention to this for I believe that many persons with mild cases become reinfected here by occupying rooms which

were formerly in possession of persons ill in the last stages, and I have heard of a few individuals who had come out with relatives and later contracted the disease, probably by occupying infected

rooms.

Physicians should especially direct their patients in the management of the sputum. I never dreamed that man was such a filthy animal until I visited Tucson, El Paso, and the other places where consumptives go by hundreds. I never saw anything more disgusting than the walks in the plaza at El Paso. The efficient president of the Board of Health of that city has made many enemies and brought a great deal of abuse and ridicule upon himself by fighting this dangerous nuisance, and at last he has succeeded in having a law passed forbidding spitting in the streets. lieve he has sufficient temerity to enfore the law. At any rate, it is our duty to aid him by careful instructions to our patients. The patients should be taught not to cough in public places, and to use the sanitary sputum-cup or pocket-bottle.

There has grown up in the Western country a spirit of exaggeration in respect to each locality that, to say the least, borders on the untruthful. Each place has all the virtues, while its nearest neighbor is nothing but a death trap. The expression is often heard that no consumptive was ever known to get well there. Even the doctors join in such silly expressions, and often display a spirit that I am sure is engendered by their own local interest. I am sorry to say this, but I believe it to be true. Especially is this true of their actions toward places of different altitudes from their own. Then, too, wherever one goes every citizen can tell you the average rainfall of his section for years, and he is ever ready to direct your attention to the statistics of other localities. that are wetter, but never to those that are drier, for his desire to furnish you with necessary information never reaches that far.

The places mostly frequented range between 2,000 and 7,000 feet in altitude, and some are as high as 8,000 feet. The greater the altitude the greater the rainfall, and consequently the less dust and more luxurious vegetation; the lower the altitude the greater the barrenness and prevalence of dust storms. Don't let your patients worry about the rainfall, for there is practically none in winter anyway, and in summer what falls is in downpours which runs away or is rapidly absorbed. The country would be much better if there were more rain.

I want to impress upon physicians the importance of mapping