sumption costs the people of the United States more than a billion dollars a year, is preparing an exhaustive report for the National Conservation Commission, which will contain not only these figures but similar data on the economic loss to the country from all other preventable diseases. Prof. Fisher is a member of the National Conservation Commission, and for many years has been carrying on studies along these lines. The Commission received letters from physicians all over the country urging it to consider the bearing of public health on the economic efficiency of the nation in its efforts to ascertain the resources of the country. The Commission from the beginning has contemplated reports on the economical aspects of several phases of the Conservation movement which affect the duration and effectiveness of human life, but Prof. Fisher has undertaken to prepare a comprehensive statement of the whole subject of the relations of public health to the general field of Conservation, and especially as to the waste from preventable diseases and unnecessary deaths. Dr. Fisher is professor of political economy at Yale University and chairman of the " Committee of One Hundred" of the American Association for the Advance of Science, which has for a long time been carrying on propaganda for the increase of national health through the elimination of preventable diseases. This Committee of One Hundred is composed of physicians and men engaged in active sociological work in every part of the country, and the results of their investigations and experience are all available to Dr. Fisher, so that his report ought to be the most thorough-going and complete summary of the situation ever made. At the Tuberculosis Congress, Prof. Fisher declared that 133,000 persons die of consumption every year. The cost of medical attendance and the loss of earnings before death average at least $2,400, he said, while if to this is added the money that might have been earned with health, the total loss in each case is about $8,000. He pointed out, also, that the disease. usually attacks young men and women just at the time when they are beginning to earn money, and cuts off their earning power for about three years, on an average, before they die. This subject of the economic value to the country of a general raising of the average health came up in the Governors' conference at the White House in May. Dr. George M. Kober, in his speech on the "Conservation of Life and Health by Improved Water Supply". at the conference, presented figures which showed that the decrease in the "vital assets" of the country through typhoid fever in a single year is more than $350,000,000. Typhoid is spread by poluted water largely, so that the death rate from this disease can be directly reduced by the purification of city drinking water. Dr. Kober quoted statistics to show that the increased value of the water to the city of Albany, where the typhiod fever rate was reduced from 104 in 100,000 to 20 by an efficient filtration plant, amounts to $475,000 a year, of which $350,000 may be considered a real increase to the vital assets of the city. Census Bureau figures show that the average annual death rate from typhoid in cities with contaminated water supplies was reduced from 69.4 per 100,000 to 19.8 by the institution of pure supplies. Dr. Kober cited estimates showing that the average length of human life in the Sixteenth Century was between 18 and 20 years, and that at the close of the Eighteenth Century it was a little more than 30, while to-day it is between 38 and 40-indeed, the span of life since 1880 has been lengthened about six years. DIAGNOSIS AND TREATMENT OF EARLY CASES OF TUBERCULOSIS. Dr. Lawrence F. Flick (Old Dominion Jour. of Med. and Surg.), Philadelphia. Tuberculosis is primarily a lymphatic process. Immunity may follow lymphatic tuberculosis. Lung tuberculosis is of most interest to the physician. It is only when tuberculosis produces disease that it attracts attention. Lung tuberculosis is most frequent next to lymphatic tuberculosis because the tubercle bacilli, which pass from the lymphatic stream into the blood stream, go through the lungs before going through the rest of the body. The apices of the lungs along their posterior pleural border are primarily affected. Development takes place more often in the right side than the left. Diagnosis of lung tuberculosis in the first stage, before there is destruction of tissue, is difficnlt. The process does not produce enough of diseased condition to attract attention. It should be looked for in all persons who have been exposed to fruitful contagion. The subjective symptoms in early tuberculosis of the lungs may be cough, hypersecretion of mucus, loss of appetite, malaise, and hypersensitiveness of the nervous system. The objective symptoms may be rise of temperature, disturbance of pulse rate, and dilated pupils. The physical signs may be slight bronchovesicular breathing over the affected area, a pleuritic rub on expiration, increase in tactile fremitus and vocal resonance, slight bronchophony, and impairment of resonance. The physical signs should be first looked for over the back over the circumscribed area. Tuberculosis is still early both in time and in prognosis, so long as it is limited to one lobe of one lung, or even to two lobes, provided that there is not much destruction of tissue. The symptoms in this more advanced stage usually are malaise, gastric disturbauce, some sense of shortness of breath, a sense of physical incapacity, cough, expectoration, chilliness or a sense of heat, and loss of appetite. The physical signs are bronchial breathing, prolongation of expiratory murmur, pleuritic rub, increase in tactile fremitus and vocal resonance, feeble bronchophony, and impairment of resonance. When the infiltration is dense or there is secondary infection, the symptoms all become more marked, and there is dullness on percussion. When the process has gone on to cavity formation and the cavity is small, tactile fremitus and vocal resonance will have again become normal, and bronchophony has been replaced by whispering pectoriloquy. The percussion note has become tympanitic. As a small cavity drys up the physical signs again become nearly normal, except as to quantity. Absence or deficiency of normal physical signs should raise a question of tuberculosis. Absence of tubercle bacilli from the sputum should not weigh too heavily against the diagnosis. Treatment of early tuberculosis is a retracing of the steps which led to the development of the disease. All that is necessary is a simple life, properly selected diet, fresh air, and such medication as is necessary to restore the human organism to its physiological functions. Recovery from tuberculosis has a restricted meaning. It means an arrest of the process of destruction and restoration to physiological health, but not a condition of sterility from tubercle bacilli. It is uncertain whether recovery ever means freedom from tubercle bacilli. This may take place in lymphatic tuberculosis and tuberculosis of the lungs before destruction of tissue. Recovery from these conditions apparently sometimes gives immunity. When tuberculosis is more advanced and there has already been a deficit in the physiological capacity of the organism, more heroic treatment is necessary. The patient should be put to bed at complete rest for awhile, kept at comparative rest for awhile longer, and then put on gradually increased exercise. Exercise is as important for the latter part of The diet should be care- the treatment as rest is for the first. fully selected to suit the individual. diet is one meal of solid food a day and three quarts of milk and six raw eggs a day. The one meal should consist of beefsteak, roast beef, or roast mutton, with fresh vegetables and fresh fruit. The patlent should be directed to take one hour to eat this meal. Fruit and nuts may be eaten between times. Oxygen is just as necessary as food for proper nutrition, and it is therefore very important that the patient have fresh air for the entire twentyfour hours. He should under no circumstances breathe rebreathed air. If he cannot live out of doors, he should live in a room with cross ventilation. Drafts can do him no harm if he is properly clad. Much can be accomplished by medication. Iodin is the best drug known to me, and I use it in the form of europhen by inunction. Drugs should be used to stimulate physiological action and never to interfere with it. Elimination of poisons and of micro-organisms should be encouraged. Nutrition should be stimulated. Tuberculosis in the early stage can be treated successfully at home in any climate. The home treatment prepares the patient for after-life. When proper discipline cannot be established in the home, the patient should be treated in a sanatorium in the climate in which he has been accustomed to live. After sanatorium treatment has restored the individual to physical health, a course of home treatment should be instituted to teach him how to live in order to keep well. WEATHER AND PNEUMONIA.-C. M. Richter, San Francisco (Journal A. M. A., August 22), discusses the relation of anticyclonic weather to the prevalence of influenza and pneumonia on the northern hemisphere. He deals specially with recent epidemics of pneumonia in Chicago and San Francisco. cause of the small difference between its mean temperature and mean relative humidity of January and July, San Francisco is thought, by the author, to be the best city in the country in which to make research in regard to the influence of weather on disease. The different meteorologic factors and the pneumonia. mortality figures he chartered together for many years and thereby demonstrated that while there was absolutely no relation between temperature and humidity and such mortality, there was a very clear relation between periods of high air pressure and such mortality. He describes the fundamental differences between high and low air pressure, that is, between cyclones and anti-cyclones. By analyzing the epidemics previously spoken of and studying them with reference to the air pressure prevailing contemporaneously he demonstrates that during a prevalence of anti-cyclonic weather pneumonia and influenza are generally prevailing. He concludes that: Pneumonia is not merely a concomitant of the cold weather season. Its prevalence depends on anti-cyclonic weather, summer and winter, on the northern hemisphere, and not on low temperature. There is sufficient reason to assume that the quality of the air of an anti-cyclone changes in conformity with changes in the activity of the sun and that the prevalence of grip and pneumonia is subject to a specific quality of such air. Oliver Wendell Homes and Semmelweis were benefactors to the human race, because they taught physicians how to avoid puerperal fever and its distribution. Semmelweis suffered a kind of martyrdom at the hands of his colleagues, but now a monument rests over his bones. Peace to his ashes; may no sorrow, pain or regret disturb him. Bless his memory. Recamier invented the sharp curette, to curette the uterus, in 1845. Except for diagnosis, curettage of the uterus is a barbarous and cruel operation, producing thousands of invalids annually. In the name of gynecologic curettage thousands of crimes have been committed. Great Fenger died in the noonday of his fame, in the zenith of his mental and physical powers, when honors were falling thick and fast upon him. Ah, great, good, and blunt Fenger, we are lonesome without you. age. Lawson Taft was one of the greatest surgical geniuses of his |