consumptives out-of-door treatment at their homes, if living out of cities, as careful personal supervision gives much better results than a random life in a popular climatic resort.

Prevention. Weakly children and those born of consumptives must receive a generous diet of milk, eggs, meat, and vegetables, and spend most of their time in the open air. Their milk should be heated for fifteen minutes to a temperature of 160° F., in order to kill any germs of tuberculosis, unless the cows have been tested for this disease. The patient must have a separate sleeping room, and refrain from kissing or caressing other members of the family.

The care of the sputum (expectoration) is, however, the essential means of preventing contagion. Out of doors, it should be deposited in a bottle which is cleaned by rinsing in boiling water. Indoors, paper bags or paper boxes made for the purpose are used to receive the sputum, and burned before they become dry. The use of rags, handkerchiefs, and paper napkins is dirty, and apt to cause soiling of the hands and clothes and lead to contagion. Plenty of sunlight in the sick room will cause destruction of the germs of consumption, besides proving beneficial to the patient. No dusting is to be done in the invalid's room; only moist cleansing. All dishes used by a consumptive must be boiled before they are again employed.

ASTHMA. This is a disorder caused by sudden narrowing of the smaller air tubes in the lungs. This

narrowing is produced by swelling of the mucous membrane lining them, or is due to contraction of the tubes through reflex nervous influences. It may accompany bronchitis, or may be uncomplicated. It may be a manifestation of gout.

The sufferers from asthma are usually apparently well in the period between the attacks. The attack often comes on suddenly in the night; the patient wakening with a feeling of suffocation. The difficulty in breathing soon becomes so great that he has to sit up, and often goes to a window and throws it open in the attempt to get his breath. The breathing is very labored and panting. There is little difficulty in drawing the breath, but expiration is very difficult, and usually accompanied by wheezing or whistling sounds. The patient appears to be on the brink of suffocation; the eyeballs protrude; the face is anxious and pale; the muscles of the neck stand out; the lips may be blue; a cold sweat covers the body; the hands and feet are cold, and talking becomes impossible. Altogether, a case of asthma presents a most alarming appearance to the bystander, and the patient seems to be on the verge of dying, yet death has probably never occurred during an attack of this disease. The attacks last from one-half to one or several hours, if not stopped by treatment, and they often return on several successive nights, and then disappear, not to recur for months or years.

Attacks are brought on by the most curious and

diverse means. Atmospheric conditions are most important. Emanations from plants, or animals, are common exciting agencies. Fright or emotion of any kind; certain articles of diet; dust and nasal obstruction are also frequent causes. Patients may be free from the disease in cities and attacked on going into the country. Men are subject to asthma more than women, and the victims belong to families subject to nervous troubles of various kinds. The attack frequently subsides suddenly, just when the patient seems to be on the point of suffocation. There is often coughing and spitting of little yellowish, semitransparent balls of mucus floating in a thinner secretion.

Asthma is not likely to be mistaken for other diseases. The temperature is normal during an attack, and this will enable us to exclude other chest disorders, as bronchitis and pneumonia. Occasionally asthma is a symptom of heart and kidney disease. In the former it occurs after exercise; in the latter the attack continues for a considerable time without relief. But, as in all other serious diseases, a physician's services are essential, and it is our object to supply only such information as would be desirable in emergencies when it is impossible to obtain one.

Treatment.-An attack of asthma is most successfully cut short by means of one-quarter of a grain of morphine sulphate with of a grain of atropine sulphate, taken in a glass of hot water containing a ta

1 Caution. Dangerous. Use only on physician's order.

blespoonful of whisky or brandy. Ten drops of laudanum,1 or a tablespoonful of paregoric, may be used instead of the morphine if the latter is not at hand. Sometimes the inhalation of tobacco smoke from a cigar or pipe will stop an attack in those unaccustomed to its use. In the absence of morphine, or opium in the form of laudanum or paregoric, fifteen drops of chloroform or half a teaspoonful of ether may be swallowed on sugar.

A useful application for use on the outside of the chest consists of mustard, one part, and flour, three parts, mixed into a paste with warm water and placed between single thicknesses of cotton cloth. Various cigarettes and pastilles, usually containing stramonium and saltpeter, are sold by druggists for the use of asthmatic patients. They are often efficient in arresting an attack of asthma, but it is impossible to recommend any one kind, as one brand may agree with one patient better than another. Amyl nitrite is sold in

pearls" or small, glass bulbs, each containing three or four drops, one of which is to be broken in and inhaled from a handkerchief during an attack of asthma. This often affords temporary relief.

To avoid the continuance of the disease it is emphatically advisable to consult a physician who may be

1 This dose is only suitable for strong, healthy adults of average weight and those who are not affected peculiarly by opium. Delicate women and others not coming under the above head should take but half the dose and repeat in an hour if necessary.

able to discover and remove the cause. The diet should consist chiefly of eggs, fish, milk, and vegetables (with the exception of beans, large quantities of potatoes, and roots, as parsnips, beets, turnips, etc.). Meat should be eaten but sparingly, and also pastries, sugar, and starches (as cereals, potato, and bread). The evening meal ought to be light, dinner being served at midday. Any change of climate may stop asthmatic seizures for a time, but the relief is apt to be temporary. Climatic conditions affect different patients differently. Warm, moist air in places destitute of much vegetation (as Florida, Southern California, and the shore of Cape Cod and the Island of Nantucket, in summer) enjoy popularity with many asthmatics, while a dry, high altitude influences others much more favorably.

INFLUENZA; LA GRIPPE.—Influenza is an acute, highly contagious disease due to a special germ, and tending to spread with amazing rapidity over vast areas. It has occurred as a world-wide epidemic at various times in history, and during four periods in the last century. A pandemic of influenza began in the winter of 1889-90, and continued in the form of local epidemics till 1904, the disease suddenly appearing in a community and, after a prevalence of about six weeks, disappearing again. One attack, it is, perhaps, unnecessary to state, does not protect against another. The mortality is about 1 death to The feeble and aged are those who are apt

400 cases.