cases.

Furthermore, if tuberculosis were truly infectious, does it not reflect discredit upon the profession for not having settled the question a hundred years ago thru clinical evidences alone? Very little concern need be fostered in regard to infection so long as the clinical evidence is deficient. Those who were first to conceive the theory were no doubt honest and sincere, but those who took it up and enlarged upon and promulgated it with energy were those who can hear the jingle of coin afar, and in their dreams have bright visions of glory and of gold to come. These are they who sound the cry of infection. The awful danger of living,danger in the theater, the church, railroad train, cabs and street cars! Danger anywhere if there be a case of consumption within ten miles.

These are they whose real purpose lies concealed beneath an assumption of philanthropy. These are they who would tear the helpless sufferers from the embrace of family and friends and consign them to imprisonment for life, because they are the victims of a fatal malady. These are they who seek to so drape the public mind with the black mantle of fear that legal enactments may be easily secured to enforce the diabolic scheme of isolation-a scheme that means millions from the public treasury, and easy and profitable employment for a host of political placehunters. It also means deep despair and rapid death of all who are thus incarcerated.

Experiments made to determine the infectivity of the disease have been so foreign to the manner of our contact with it that they become of no practical value in the consideration of human tuberculosis. Injections of pure culture would make anybody sick. The dog does not contract tuberculosis from his tuberculous master, but enough of the virus may be injected under his skin to overcome the vital resistance. But the human contact is not by the injection of pure culture. We are not swallowing a red-hot poker to find out if it will burn.

Infection not recognizable by clinical experience is very doubtful; in fact, it is

When King Bacillus ascended the throne and all the medical men bowed low, they began at once to unlearn some things by which in former times they were wont to place great store.. Prominent among them was the tuberculous diathesis. At one time it was a feature seen at a glance; now it cannot be seen at all. Still, this same diathesis is as patent to-day as at any previous time, and its import is just the same. Osler quotes Fagge as saying that "these appearances denote nothing more than delicacy of constitution, incomplete growth and imperfect development." In the name of Heaven, what more could be added and not have tuberculosis itself?

I have never yet seen a case of consumption that did not present one or more of these diathetic peculiarities. Biggs (Wood's Hand-Book) says that a susceptibility to the action of the tubercle bacillus may be inherited. He could not base that very truthful statement on any other foundation than the diathetic appearances, which attract attention at once, and which we invariably see tending toward the vortex.

A perfect organism could not, nor would not, get sick. But the liability to disease is proportionate to the degree of departure from the standard of physical perfection; and the form of disease is determined by the direction of that departure. Disease is man's implacable foe, and the active elements, the micro-monsters, like so many murderous bandits, lie ambusht along our pathway, each awaiting opportunity to strike the fatal blow. "The great, white death," tuberculosis, holds relentless and untiring vigil at every point of vantage.

The dairy, the meat-market, the grocery, provision booths and fruit-stands-in fact, wherever food products are found, there is a spot that supplies the conditions necessary to the life of the bacillus : that is, warmth, moisture and protection from light.

Disease germs are all about us, and we take them into the system every day. But we are not at once afflicted, possibly never, because we all possess in varying degree that divine physical endowment, which, for the want of a better name, we call tissue resistance. This is a congenital attribute. It can never be acquired, but is easily lost. While this property holds the balance of power, disease is completely excluded. excluded. No malady can ever trespass

upon our physical domain until etiologic factors outweigh the resistant forces.

Of tuberculosis Osler very truly says: "Next to the germ a vulnerability of tissue, however brought about, whether congenital or acquired, is the most important factor in the etiology of the disease." Bartholow says: "The infective material must fall into a properly prepared organism.''

If these declarations are true, tuberculosis is no more infectious than any other disease. For, if a dozen healthy persons are simultaneously exposed to conditions that depress the vital energies to an extent that drives them to a sickbed, and during that period of exposure are all taking into the system a dozen forms of disease germs, each one will be affected by the disease his system is best fitted to receive.

Why is this? Simply individuality of constitution. Diverse similitude is God's first law. While one man may seem like all other men, yet a vast difference exists in constitution as well as mental perception. For this reason the tissue resistance differs, or, to speak learnedly, the "locus minoris resistentia" is different in each individual.

No individual on earth can by any means develop tuberculosis in the absence of the special conditions essential to the action of the bacillus.

Is it not true that some special systemic condition must precede the ingress of any disease? And if so, by what line of reasoning or assembly of evidence does tuberculosis stand as a contagion?

But where shall we look for the cause of such systemic state? Of all chronic and fatal maladies there are none toward which there can be seen such widespread tendency. And does not this fact suggest a possible cause in the remote past? May not this tendency be the lineal legacy of a diseased and depraved remote ancestry? Dr. John Mason Good, in his lectures at Oxford, upon the Dark Ages, quotes Sanger (History of Prostitution) as saying: "The soldiers returning from the Crusades were saturated with syphilis contracted from the native women of that country. From them it spread with fearful rapidity all over Europe. It invaded all classes, from king to peasant, clergy included. Thousands upon thousands crowded the hospitals or died in secret and went reeking to the grave."

wholesale contamination could not fail to leave behind deep-rooted, constitutional defects.

A poison so virulent and indestructible as syphilis could not fail to fix the imprint of its vicious nature upon the cell structure of its victims, to be transmitted under various modifying influences in the continuity of race to the remotest times. May not this be the reason why the tubercle-bacillus finds such delightful pabulum in the human lung?

As to the treatment of true tubercular disease of the lungs, much of the medication of the past has been worse than useless. Codliver oil, which for so long a time has maintained such an exalted but false reputation, is unquestionably not only useless, but positively injurious. Space will not admit of details, but to put it in short, this oil appropriates all the oxygen taken in by the diseased lungs, leaving nothing to act upon food. When it has reacht the finish of its chemical changes, it has yielded to the diseased body nothing but its equivalent of heatunits. Thus we see the strange anomaly of attempting to extinguish a fire while constantly adding fuel. Administering codliver oil to increase the body temperature, already too high, and the use of antipyretics to bring the temperature down, is a therapeutic antagonism which cannot fail to do harm.

Of all the hypophosphites, the malts and the millions of other things at one time or another acquiring prominence, nothing more can be said than that the patient goes steadily on down to the grave.

It was not until the discovery of the bacillus by Koch that any rational concept of treatment began to dawn upon

us.

ostentation, are performing a wonderful work, as hundreds can testify.

But the grandest opportunity is offered to the sanitariums. It is in these institutions that every facility can be had and employed. A sanitarium located in the best atmosphere possible, and fully equipt for the work, can accomplish much more than treatment anywhere else, provided a truly scientific germicidal course of treatment be pursued. An institution such as the Loomis Sanitarium at Liberty, N. Y., enjoys a grand and glorious opportunity. Its location is surpassingly fitted for the work, and I presume there is nothing wanting in its equipment. With the grand facilities, cottage system, beautiful location, good air and liberal provision, if a truly scientific germicidal treatment were adopted there the results would be wonderful to behold.

E. P. ILIFF, M. D. 472 Broad Street, Newark, N. J.

Report of a Case of Addison's Disease. Editor MEDICAL WORLD: -Permit me to present the following case for consideration: J. B., male, American, single, aged 41; height, 5 feet 7 inches; weight, 175 pounds; fair skin, dark brown hair, blue eyes-an employe in the railroad yards. Never had any sickness except severe typhoid fever 12 years ago. Ever since this sickness had been a little "short-winded" when running or in other violent exercise.

During October and November he called at my office several times for relief of neuralgic pains. At one time it was a severe supra-orbital neuralgia, at another intercostal, again in left shoulder. Temperature was normal, pulse not strong but regular. He was sleeping well, and his appetite was fairly good; complexion dingy, eyes clear. He said he was losing his ambition; thought he got tired easily for the past year or two. At this time he was riding two miles, morning and night, on bicycle, and doing general work in railroad yards.

The morning of December 3 he called at office on his way to work feeling unusually bad. A few days before had been moving a heavy weight when he became suddenly prostrated and breathless. Had to lie down for several hours. Since then had only been able to do very light work.

I found a slight elevation of temperature and a pulse so rapid and feeble that I at once ordered him home and to bed.

Later in the day I visited him at his home and gave him a more careful examination. The heart-beat was rapid, very weak and muffled. I outlined an increased area of dulness over region of heart and diagnosed a pericardial effusion.

I was particularly struck with the peculiar dingy, dirty appearance of his face and hands. They were like those of a person who had just come from a day's work in a smoky railroad shop. The dark hue extended down onto the neck and up to the hair. Beneath the hair and over the body the skin was fair. In the axillae and inguinal regions and around nipples there was a slight darkening.

At the end of a week the precordial dulness disappeared, the temperature was normal and the pulse, though still very weak, was only slightly accelerated. But instead of improving he continued steadily to lose ground. The respiratory murmur was so weak as hardly to be heard, yet on forced inspiration it was clear and distinct over the whole of both lungs. Obstinate constipation and cold extremities were present during the whole course of the disease.

Wandering pains in various parts of the body and sometimes muscular soreness were complained of, but the weak heart and the general prostration were the prominent symptoms.

The urine was examined and found normal.

Repeated examinations of lungs and heart failed to locate any disease to account for his condition. My attention again turned to the peculiar discoloration and I made the diagnosis of Addison's disease.

A day or two later he began to improve. His appetite, which had been fairly good all the time, increast; he gained in strength and by Christmas was able to sit up and even walk around the house.

I now hoped I was mistaken in my diagnosis. December 28 I was called in the night. He had been around the room during the day but shortly after retiring had been suddenly attackt with dyspnea. The attack only lasted 10 or 15 minutes, but left him much prostrated. From this time on he steadily lost ground. His appetite failed, nausea and vomiting began and continued to the end.

Nearly every day, and sometimes many times a day he had short attacks of intense dyspnea. The attacks of dyspnea did not depend on exertion but came at

intervals without apparent cause. The heart grew weaker, the temperature became subnormal.

The nausea and vomiting did not appear to depend on taking food.

His treatment had from the start been largely tonics-digitalis, strychnia, sulfate of strychnia arseniate and other remedies of a like character. Salines and enemas were given to keep the bowels clear. Several other physicians saw the case with me; none felt like making a positive diagnosis.

On January 8, Dr. William A. Edwards saw him and suggested disease of thyroid gland. He was put on thyroid extract. Whether due to, or simply coincident with the administration of the thyroid extract, the attacks of dyspnea ceased, to return only once, shortly before death. The nausea and vomiting continued, and he steadily declined till death came to his relief January 17, 1899. His mind was clear until within a few hours of his death.

I performed the autopsy three hours af ter death. Drs. Magee, McConkey and Fly were present. Body was fairly well nourisht. The thyroid gland was examined and found normal.

The thoracic organs were all found normal excepting very extensive old pleuritic adhesions involving both lungs, probably dating back to his sickness 12 years before and sufficient to account for his being "short-winded." A few small calcareous deposits were found at base of left lung.

The

An examination of abdominal organs showed stomach, bowels, liver, pancreas and kidneys normal. Spleen was somewhat enlarged and quite friable. suprarenal bodies were enlarged, firm and somewhat modulated. Each weighed four drams, or more than double the average normal weight, which, as given by Gray, is one to two drams. On cutting thru them longitudinally a small cavity was observed, but it was apparently empty, tho it may have been a cyst with fluid. Macroscopically the cut surface had the appearance of a fibroid growth, and was smooth and homogeneous. On one of the glands the knife grated on what seemed to be a cretaceous granule, otherwise the two were counterparts of each other. Micro

scopically nothing was seen but a typical fibrous stroma. There was nothing to suggest tuberculous or cancerous degeneration.

It was evidently a fibroid degeneration,

Tinct. passifloræ incarnata 3j Aqua cinnamoni . . . . 3ij M. Shake. Give teaspoonful every two, three or four hours, as required.

The results are, less fever, patients are drowsy, and sleep quietly. The disease runs its course without complications.

My opinion of above treatment is: The salicylic acid and chloral are antiseptic. Chloral and passion flower analgesic and hypnotic, and the acetanilid comp. antithermic. "Shot-gun," sure enuf; but there is no restless tossing, no extra work on heart, no nephritis or dropsy. And you do not have to disturb the patient so often to give medicines. Dr. W. K. HARRIS. McLoud, Oklahoma.

"The January WORLD is especially valuable on account of its free criticisms and discussions. It is good, not bigoted. admitting all schools to it columns. Yet a little more critical spice added to its editorial articles would suit many of us, even tho an occasional contributor would be hit."GEO. OSBORNE, Valley, Neb.

Quinin Rash Simulating Initial Stages of Smallpox.

Editor MEDICAL WORLD:-Since the beginning of winter I have been constantly exposed to smallpox, treating one or more cases at a time almost continuously.

At the beginning of this month (January, 1899), as assistant surgeon for the Mexican Central Railroad, I was stationed at Jimulco, one of the road's surgical stations. On the first day of the month I had a chill, followed by fever, and within the following two days there developt pain and constriction in the lower lobe of my left lung; there was also slight rusty sputum. I diagnosed my case as lobar pneumonia. On the third day I was unable to leave my bed. I then telegraft to the chief surgeon of the road to send another doctor to take charge of the station. The doctor had 300 miles to travel to reach me. When he arrived he found me delirious. Before that, in the preceding 24 hours, I had taken three seven-grain capsules of quinin sulfate and three doses of the following:

The next morning I was conscious, expectorating freely, breathing easily, very little rise of temperature, and felt pretty well generally, except that in all of my extremities-feet, hands, ears, etc.-there was an extremely painful itching and tingling sensation. I rubbed my forehead a little with the palm of my hand, and coarse, red macules, slightly raised above the level of the surrounding skin, appeared. Within ten hours the itching and macules had progressed down my face, neck, chest, and then to every part of my body's visible surface. I, of course, scratched; I could not have refrained from scratching had my life depended upon it. LE

TX The next stage was the appearance of small papules, several developing from each macule.

My case began to look very much like smallpox. At the end of the second day, after the appearance of the macules, there was not an inch of skin free from papules. The itching continued intense. The doctor, who had come to take my place, and I, both thought I had smallpox-and we

had both seen a good many cases of that disease here.

Still, I did not want to go to the company's pest-house until I knew, beyond all possible chance of mistake, that I was in for smallpox.

So soon as the macules had appeared, I had stopt all medicine. We waited for the secondary fever and vesicular stage of the eruption, but neither came. In fact, before the end of the next two days, there was less itching and the eruption seemed to be receding, especially on my forehead. Within four days from the appearance of the papules they had entirely disappeared, and the only reminder I had of the trouble was a good crop of scabs where I had scratched the skin off.

Until this time I had taken but little quinin since my twelfth year, but whenever I had taken a little, it had invariably caused the disagreeable itching and tingling in my extremities, mentioned before, which was much aggravated by cold water, or by touching any cold substance.

So soon as I would discontinue taking quinin, the disagreeable symptoms would promptly disappear. I have tried it time and again, always with the same result.

In this last instance, however, I felt that I had to take quinin, idiosyncrasy or no idiosyncrasy, but I have since decided that quinin is no friend of mine.

W. F. HOLSTEEN, M. D.,

Assistant Surgeon Ferrocarril, Central Mexicano.

Aguascalientes, Mexico.

-

The Question of Vaccination. Hypothetic Medicine.

Editor MEDICAL WORLD:-We have a smallpox scare in our vicinity, and as we have had no dissertation on that topic for a long time, I would like to ask the many members of the WORLD family to express some opinions on the value of vaccination, independent from the commercial value to the physician. The newspapers stated that one physician in Omaha cleared $600 from vaccination alone. The Gleaner, of January, '99, copied an article on "Holy Hypothesis."

The great discoveries of Pasteur, Koch, Virchow and many others are flowers and fruits of innumerable hypotheses, conceived in enthusiasm, controlled by indefatigable patience, abandoned for others, when shown to be uncontrolled by facts. Löffler's bacillus is found often in healthy throats is therefore not a cause of diph