ever claims of success have been made by their originators, have stood the test in the hands of unprejudiced observers. McFarland, (Textbook upon the Pathogenic Bacteria, Ed. 1904), after referring to the work of Koch, Tizzoni, Centanni, Bernheim, Paquin, Maragliano and others, has this to say :-"From these discordant observations, the more favorable of which are probably hasty records of inadequate or incomplete experiments, the conclusion that little is to be hoped from immune serums in the treatment of tuberculosis is inevitable."

Marmorek and von Behring hold the lime-light at present in the subject of sera. Von Behring, by virtue of his great work in diphtheria and tetanus, and from his recent results in successfully immunizing cattle against bovine tuberculosis, seems to be entitled to the greater consideration. His proclamation at the International Congress of Tuberculosis in Paris last October has produced a sensation but little less than that with which the announcement of Koch's "lymph" was received. The world has understood him as promising a specific cure for tuberculosis. What he said was "My method is destined, I believe, to protect men with phthisis against the consequences of infection." Arnold Klebs, (Jour. A. M. A., Dec. 16, 1905), in a careful critical review of von Behring's address, as published in the Münchener Medicinische Wochenschrift, concludes as follows:"How much ultimately suffering mankind is to profit can not be predicted, nor can Behring's expressed, though carefully and ambiguously worded expectations mean anything but a plausible, by him yet unproved hypothesis of a curative principle, applicable in human tuberculosis."

The only drugs that are today generally prescribed simply because the patient has consumption, that is with any idea of specific influence, are cod-liver oil and creosote. Cod-liver oil does undoubtedly help those persons whose digestions can tolerate it, but its benefit is due to the fact that it is an easily assimilated fatty food. It never has done more than improve nutrition, thus indirectly influencing the disease. It did valuable service in this way, while we were awaiting the development of a rational treatment. It is still of great service in selected cases, and seems especially suited to the stomach of the negro.

Creosote is a stimulant expectorant, has a sedative influence on the nerve endings of the gastric mucosa, prevents fermentation

in the stomach, and is an intestinal antiseptic. By its action on the bronchial mucous membrane it directly improves and relieves the cough. By its local action on the stomach and intestinal tract it prevents these dyspeptic, fermentative and irritative conditions which interfere so much with the proper assimilation of food. As a result, digestion is better, the appetite improves, and there is a gain in nutrition, the aim of every therapeutic measure of value in this disease. It is due to improved nutrition and strengthened resisting power that we have fever, cough and sweats diminished, and weight increased. I am against the advice found in most works on therapeutics to increase the dose of creosote as long as the stomach will tolerate it. This plan had some excuse as long as it was believed that the drug exerted a direct action on the bacillus ; but since that view has been abandoned, the “limit of tolerance" plan has no rational foundation. We do not give creosote to kill, or inhibit the bacilli, but to get the results enumerated above. Hence, we should regulate the dose to that end, and not go beyond the quantity necessary to attain that end. I have seen more than one poor patient have added to his sufferings a deranged digestion, when a victim of the "limit of tolerance" method of administering this drug. When this limit is ascertained, it is too late, as the damage has already been done, and time and vitality are lost in repairing this damage.

Besides these two drugs we have the whole pharmacopoeia, and I believe we should not hesitate to call on it to meet symptoms as they arise. We must control the cough sufficiently to see that it does not interfere with sleep and rest. We must relieve pain, control sweats, keep the eliminative functions in working order, and help the appetite. In doing this, however, we must not forget that the ultimate end of all our treatment is to improve nutrition, and must therefore never employ any medicine which can have either an immediate or remote effect in deranging digestion, or otherwise interfering with our chief object.

A paper on this subject would be incomplete without mention of the aid furnished to the preceding remedies by hydrotherapy. The powerful effect of water externally applied in improving nutrition is but too little realized. Aberg, Winternitz, Brehmer, Ziemssen, Baruch and many others have long employed this treatment in consumption with the most excellent results. In order to

obtain these results, one must have a thorough knowledge of the physiological action of water, and of the technique of administration. In the hands of the unskilful it is a dangerous remedy, as the slightest mistake in determining the proper measure to be employed, the duration of the treatment, and the temperature of the water will cause a failure to benefit, and may do much damage.

To summarize, the chief points to which I have endeavored to draw your attention are:

First. That every method of treatment of pulmonary tuberculosis, which has stood the test, has for its prime object the improvement of nutrition.

Second. That we cannot become narrow advocates of any one remedy, system, or method, but owe it to our patients to employ every available means that will lead to improved nutrition.

Third. That we must take into consideration every circumstance connected with each individual patient, and modify our remedies, both in their selection and application, according to the needs of the case.

Treat the patient, and the patient will take care of the disease.

Dr. R. S. Lamb congratulated Dr. Randolph upon reading one of the most admirable papers presented before the Society. In regard to the method of overfeeding consumptives, Dr. Lamb feels that it has often been followed at the expense of concurrent diseases of the heart and kidneys in these patients. Both organs are doing their utmost to accomplish the ordinary needs of the system; the increase of fluids and the increased digestive interchanges from overfeeding furnish a burden which cannot be borne.

Dr. Hunt also congratulated Dr. Randolph upon his paper. There were two points Dr. Hunt wished to emphasize, first, that sending consumptives away from home removes them from that sympathy and advice which are important factors in the treatment of the disease; second, that Trudeau employs tuberculin in addition to the rest and dietetic treatment, thus producing an increased resistance, with less likelihood of recurrence.

Dr. Nichols said that Dr. Randolph had taken a very rational view of the dietetic problem in consumption. The powers of digestion and excretion are really better than we give them credit for. The important indication is to increase the body weight; slender persons are less resistant to the tuberculous process, because the oxidation in the tissues is not so good. The body weight and the body tissues must be increased. Milk and eggs alone do not produce the desired effect. Dietetic principles require the

production of 2,300 calories at rest; in tuberculous patients this amount and more is required to replace the waste of disease, or about 2,500 calories. To produce this amount of heat the consumption of four quarts of milk and three dozen eggs per day would be required, which is impossible. The food value of milk and eggs has been overestimated. For the upbuilding of any debilitated person a mixed diet will be better than an exclusively milk and egg diet. Hutchinson is the authority for the value of the mixed diet; the milk and eggs are of value when they are used in addition

He agreed with Dr. Randolph's views upon cod-liver oil; it is only a fatty food and it cannot be given in sufficient quantity to do much good. This being the case, any reliance upon cordials or extracts of cod-liver oil is absurd. The Russell emulsion must be placed upon the same plane with cod-liver oil-it is only a fatty food. The claim that vegetable fats are better digested than animal fats has been disproven by investigation; 95 per cent. of the fats of milk and eggs are digested and only 75 per cent. of vegetable fats.

Dr. Nichols said that the paper was admirable throughout, but his interest was particularly arrested by certain points in dietetics.

Dr. Chappell felt that the most neglected feature in the treatment of tuberculosis is rest. He agrees that the important factors are rest, food and fresh air; but rest is not often enough insisted upon. We let our consumptives go about too much; we even allow tuberculous children to go to school. Absolute rest must be insisted upon at the earliest sign of the disease; he himself had been too neglectful of this point. He decried the practice of subjecting consumptive patients to the wear and tear of long journeys.

Dr. Kober congratulated the Society upon hearing Dr. Randolph's paper and upon Dr. Nichols' discussion of dietetics in consumption. Dr. Kober endeavors, in teaching, to emphasize that as tuberculosis is a wasting disease, the proteids and the other food elements must be forced, but only so far as is safe. The object must be to supply food not only to replace the loss from wear and tear, but also from the waste of disease. The fat ration must be increased from 60 gm. to 80 gm. per day; other foods may be supplied in about the ordinary amount. Delicate cereals are the best of the carbohydrates; potatoes are not so good. These principles apply also to all wasting diseases and to convalescence.

Of course, the necessary supply of fresh air appealed to him with special interest. At the Washington Grove Sanitarium there are at present 12 cases under treatment; unfortunately none is in the incipient stage. One case, however, received fairly early in the disease, has gained greatly and will probably be

cured. There is not much hope for the others, as they were sent to the sanitarium as a last resort, but they have all made some gain. Almost uniformly after the patients are admitted the fever subsides, the heart-action improves, and the strength is augmented.

Rest is the most important item of treatment, especially indicated in pyrexia; under it, all the patients at Washington Grove have made substantial gain in weight.

For

It is a mistake to think that the same advantages can be had in the city as attend treatment in the country. Exhalation from thousands of lungs, chimney products and street dust foul the air, diminish the oxygen and increase the carbon dioxid. these reasons the patients at Washington Grove do better than they could in the city. Those who have been at both places like the surroundings here better than they do the Adirondacks ; there is less rain and it is not so cold.

He closed by reiterating that the food should be fats and carbohydrates to supply increased heat production and increased weight.

Dr. Wilkinson said that while he does not treat tuberculosis, he wished to say a few words in the discussion of the subject. He had lived for three years in El Paso, Texas, and had observed many patients with consumption who had come west for the climatic treatment. Nearly every case with a good family history got absolutely well. He feels convinced that intelligent persons, who are able to go west with means of obtaining a comfortable livelihood, will do infinitely better in the dry, sunshiny climate of the Rocky Mountains than they will here.

Dr. Phillips said that he had never heard a paper read before the Society more rational and comprehensive than the one just presented by Dr. Randolph. The Society was to be congratulated upon this contribution to its transactions. He for one could find nothing to add to the paper, nor was there anything he could subtract.

Dr. Randolph thanked the members for the cordial reception of his paper and for the complimentary remarks made upon it in the discussion.