ment in digestion and assimilation, the cessation of all symptoms of disease, the return of normal functions by gain of weight, of color, of nervous and muscular activity, and of respiratory and circulatory power; fourth, that arrest of disease takes place in fifty-eight per cent of tuberculization cases and great improvement in eighty-seven per cent; that in excavation cases arrest occurs in twenty-one per cent, and great improvement in sixty-one per cent; fifth, that the climate is especially beneficial in hemorrhagic phthisis and phthisis in which hereditary predisposition is strongly marked, and is well suited to chronic tuberculosis of the lungs in general; sixth, that males and females seem to do equally well and to profit most between the ages of twenty and thirty, and seventh, that the climate is contraindicated in acute phthisis, catarrhal phthisis, in laryngeal phthisis, in cases of phthisis accompanied by great nervous irritability, in cases of double cavities with fibroid phthisis and in all patients whose pulmonary surface has been so much reduced from any cause that it does not suffice for complete respiratory purposes. Dr. Burney Yeo followed on much the same lines, the objects of treatment by climate being, he stated, to arrest catarrhal conditions of the air passages, to improve nervous and circulatory tone, to increase the activity of the digestive functions and thus stimulating nutrition by promoting the desire and increasing the power to exercise, to raise the moral tone by affording a clear, bright, and cheerful environment, and to diminish by its asepticity bacteriological activity. In conclusion, he stated that a suitable climate relieves or removes catarrhal conditions accompanying the disease in a number of cases; it raises nervous and vascular tone, it increases muscular energy and the ability as well as the desire for exercise; by rendering an open-air life possible, it increases the aëration of the lungs and diminishes the activity of bacterial agencies. It improves the tone and promotes the activity of the digestive functions. In regard to suitable climate, he said that cases treated at the commencement of the disease, and who were otherwise in good health, may be permitted a certain amount of latitude in the choice of climate. Second, for progressive febrile cases, repose in bed or on the couch at home is the best condition practicable for the free access of air and sunshine. Third, for catarrhal cases, soothing climates like Madeira or Teneriffe are best. Fourth, for rheumatic or gouty cases of the fibroid type, dry marine climates or the desert are most suitable. USE OF TUBERCULIN The discussion regarding the therapeutic and diagnostic value of tuberculin was opened by Dr. Heron, who gave a short history of it, and thought it had fallen into disuse owing to its frequent use in unsuitable cases, its administration in too large doses, neglect of the rule that a dose should never be given until the patient's temperature has been normal for the previous twenty four hours at least, neglect of the rule that the dose of tuberculin should never be increased, but rather diminished, when its administration has been followed by a rise of temperature, and the prejudice raised against the remedy among both medical men and patients, because of the severity of the symptoms which not seldom follow upon its use. Of fifty-one cases treated by him, seventeen were lost sight of, and of the remaining thirty four, sixteen were known to be well. Lupus did well up to a certain point and then relapsed. One case of lupus treated by the new tuberculin recovered permanently. Tuberculin was now known to be worse than useless in cases of mixed infection. For diagnosis, tuberculin was most valuable, making very early diagnosis possible, when the chances of recovery were best. Professor Koch said that if the diagnostic injections were properly made in the human subject, it was a valuable method and without danger. The injections should be small enough in weak subjects; not more than 1 mm. was enough to begin with, and no second injection should be given until the temperature was again normal. If the first injection gave a faint reaction a second injection of the same quantity frequently gave a very marked reaction. Over 3,000 cases had come under his observation, and he concluded that the diagnostic test of tuberculin was almost absolute. As a therapeutic agent he had no doubt it was of great value in early uncomplicated cases, and when used in these cases a complete cure frequently resulted. In advanced cases it was necessary that the temperature should be normal before the injections began. The treatment should be continued over a long period, if necessary, with intervals of three or four months, until they gave no reaction. In answer to a question, Professor Koch said the tuberculin was prepared from tubercle bacilli of human origin; but that the, reaction was produced in both man and cattle, and though the bacilli were different they possessed a common "group" reaction. Many members spoke for and against the use of tuberculin, but most were agreed that its diagnostic value was great and harmless, but opinion was much divided on the curative qualities. DISCUSSION ON SANATORIA In opening the discussion on sanatoria, Dr. Clifford Allbutt said that open-air treatment was possible at home, but was best carried out in sanatoria and had been perfected there. The coldest air possible was the best stimulant for the appetite and made forced feeding unnecessary, but it varied for different individuals. What a young man could stand was too cold for an old or a weak one. Two degrees of cure were possible in sanatoria, arrest or oblescence; but the latter was hardly possible with the poor, requiring on the average two winters and one summer; so an economic cure was to be aimed at rather than absolute cure. Six months would be required in the majority of cases. He protested against the emptiness of mind advocated by some reformers and would give amusement and tranquil occupation. Dr. Philip, as a result of ten years' experience, said that each case must be treated per se; rest and exercise must be considered together and regulated by the temperature and the pulse; a full dietary was necessary, but not forced feeding. The location of the sanatorium was not dependent upon the surroundings or ground; it could not be too far from the large centers of population, and it was better if patients were treated in their native air. Dr. Burton-Fanning presented a report of the sanatorium treatment in England, covering 716 patients from sanatoria where patients paid their way. As a result, 92 per cent gained weight; quiesence or definite recovery occurred in 25.1 per cent; of patients without fever or quickened pulse, 63.6 had quiesence or recovery. THE RÖNTGEN RAY IN TUBERCULOSIS In discusssing the use of the Röntgen ray in the diagnosis of pulmonary tuberculosis, Dr. Walsham said that in normal lungs they were quite transparent from apex to base, with the exception of a few ill-defined, shadowy lines to the right of the heart. The movement of the diaphragm like a piston up and down was ordinarily equal on the two sides of the chest, but in disease was much less on the affected side, even when the disease was limited to one apex. In well-developed cases of tuberculosis the diseased areas showed as flocculent shadows punctate in parts. He would say that the rays could not decide the earliest stage of tuberculosis in the lungs, but they would definitely show tuberculosis, and that at a very early stage, THE TUBERCLE BACILLUS Dr. Alfred Moeller, of Belzig, in opening the discussion of the morphological and physiological variations of the bacillus of tuberculosis and its relation to other bacteria resistant to acids and to the streptothrices, said that he had shown that bacteria which were acid fast were not necessarily tubercle bacilli, as, for instance, the smegma bacillus and the bacillus of avian tuberculosis. A series of bacilli resembling the tubercle bacillus had recently been found, including the butter bacillus and the Timothy bacillus. The tubercle bacilli, like all the acid fast bacilli, seemed to belong to the streptothricia. RESOLUTIONS ADOPTED BY THE CONGRESS The last general meeting was held on the afternoon of July 26 and the following resolutions were adopted: 1. That tuberculous sputum is the main agent for the conveyance of the virus of tuberculosis from man to man. Indiscriminate spitting should, therefore, be suppressed. 2. That it is the opinion of this congress that all public hospitals and dispensaries should present every out-patient suffering from phthisis with a leaflet containing instructions with regard to the prevention of consumption, and should supply and insist on the proper use of a pocket spittoon. 3. That the voluntary notification of cases of phthisis attended with tuberculous expectoration and the increased preventive action which it has rendered practicable has been attended by a promising measure of success, and that the extension of notification should be encouraged in all districts in which efficient sanitary administration renders it possible to adopt the consequential measures. 4. That the provision of sanitoria is an indispensable part of the means necessary for the diminution of consumption. 5. In the opinion of this congress, in the light of the work that has been presented at its sittings, medical officers of health should continue to use all the powers at their disposal and relax no efforts to prevent the spread of tuberculosis by milk and meat. 6. That in view of the doubts thrown on the identity of human and bovine tuberculosis, it is expedient that the government be approached and requested to institute an immediate inquiry into this question which is of vital importance to the public health and of great consequence to the agricultural industry. 7.3 7. That the educational work of the great national societies for the prevention of tuberculosis, is deserving of every encouragement and support; it is through their agency that a rational public opinion may be formed, the duties of public health officers made easier to perform, and such local and state legislation as may be required called into existence. 8. That this congress is of the opinion that a permanent international committee should be appointed to collect evidence and report on the measures that have been adopted for the prevention of tuberculosis in different countries, to publish a popular statement of these measures, to keep and publish periodically a record of scientific research in relation to tuberculosis, and to consider and recommend measures of prevention. This congress is further of opinion that such a committee should consist of representatives to be elected by the great national societies formed for the suppression of tuberculosis and also representatives nominated by various governments. It is further of the opinion that all international committees and great national societies whose object is the prevention of tuberculosis should be invited to cooperate. 9. In the opinion of this congress, overcrowding, defective ventilation, damp general unsanitary condition in the houses of the working classes, diminish the chance of curing consumption and aid in pre-disposing and spreading the disease. 10. That while recognizing the great importance of sanatoria in combating with tuberculosis in countries, the attention of governments should be directed towards informing charitable and philanthropic individuals and societies of the necessity for anti-tuberculous dispensaries as the best means of checking tuberculous disease among the industrial and indigent classes. Respectfully, A. R. THOMAS, Passed Assistant Surgeon, U. S. M. H. S. The SURGEON-GENERAL, XV THE BUBONIC PLAGUE There is no disease of modern times so fatal as the plague, and none so persistent in its occupancy when it once gets a good foothold. It has been approaching the west from India and China so menacingly, and appearing at so many unexpected points, that the people, especially the health authorities, should be thoroughly informed in regard to it, in order, if possible, that an outbreak may be averted; or if occurring, should be stamped out as promptly as possible. To that end we present herewith a valuable contribution to the literature of this disease by DR. WALTER WYMAN, Surgeon-General Marine Hospital service, which we are kindly permitted to reprint: LETTER OF TRANSMITTAL TREASURY DEPARTMENT OFFICE OF THE SUPERVISING SURGEON-GENERAL. The Secretary of the Treasury; WASHINGTON, D. C., Jan. 6, 1900. SIR: I have the honor to submit herewith an article on the bubonic plague, being a revision of the article prepared by myself and published in the annual report for 1897. Within the past two years many facts of importance have become known with regard to this insidious epidemic disease, and it is the object of this revision to embody in available form the latest information which may be of practical value to quarantine officers, health officers and others. In this undertaking I have had the assistance of Passed Assistant-Surgeon H. D. Geddings, who was the technical delegate from the United States to the International Plague Conference in Venice in 1897, and subsequently was ordered to the Pasteur Institute in Paris, to familiarize himself with the latest scientific advances in the bacteriology of this disease. Valuable information also has recently been forwarded by Surgeon Eugene Wasdin, now engaged in like manner in the Pasteur Institute. From the facts set forth in the article it is obvious that the greatest care must be exercised in the inspection at quarantine of vessels, even thou g |