this. Sometimes a comparatively short distance will accomplish Everyone acknowledges that a low temperature is much easier to endure back in the country in a dry, pure air, especially at a little elevation. A certain amount of altitude in New England (a few hundred feet) undoubtedly offers some advantage, although practically we think less of this than formerly, since we have seen so many cures in recent years in what would formerly be considered less favored places, near the seashore and not far above its level. Newton, only 7 or 8 miles from Boston, I consider a very good place of this class, and Melrose on the other side, and some other suburbs. Even in Boston itself (surely not an ideal location and not to be lived in, if possible to get out of it) I have occasionally seen patients recover with proper treatment in spite of the smoke, seashore, dense population, and so forth. All of which shows again that how you live is more important than where you live. This, however, is not saying that the question of locality should be left out of consideration, by any means. The very first enquiry to be made with reference to a locality is about the soil, and especially about its dampness. A running river or brook, or a lake or pond with abrupt or precipitous shores is all right, but any suggestion of meadow or marsh or standing shallow water, or constant or frequent dampness, should at once be vetoed. Even on this point, however, we cannot take such extreme ground as formerly, where dampness of soil went hand in hand with exclusion of fresh air in the modern sense. I have tried to point out fairly some of the advantages and disadvantages of the New England climate in which to treat consumption, freely admitting its disadvantages and inconveniences. Now are there any places to which we can send those patients who can go away, where they can avoid these disadvantages? If they cannot stand the cold in the East, and the thermometer often goes very low in Colorado too, although the cold there is easier to bear, we can send them to Arizona or New Mexico, or California, etc.; but in some of these places we often have intense heat at times with its disadvantages, or the bad dust storms and alkali inconveniences, the tremendous and hard-tobear transition from sunlight to shade and from day to night: the dried-up and parched condition of the country, which appeal powerfully to the mentality (sentimentality if you prefer it) of the exiled New Englander and make him hanker after the beautiful and luxuriant verdure of his native hills. Work is doing what we are forced to do. Play may be doing the same thing if we do it for fun. A pleasure trip to these western resorts is delightful. An enforced residence there to get well of consumption may be very burdensome, even if the pocket-book is fat. Homesickness is a veritable disease. How powerfully the missing of home comforts and friends can affect our physical functions, can be readily imagined, when we consider the great influence of the mind over the body, as shown in the various cults of which the Christian Science doctrine seems to be the most popular just now. Many other things might be mentioned to prove that there is no absolutely ideal place in every respect for the cure of consumption in this world, although it can be cured in very many places. Each place has its disadvantages, and if we could avoid these (an impossibility) by traveling in proper succession from one place to another, we should even then have the disadvantages of travel and of breaking up and re-establishing homes too frequently, and this feature is by no means to be lightly considered. In other words, for consumptives there is no place which is a perfect Heaven, and none which is the other thing, in spite of the very earnest representations often made by those who want to further their own interests in real estate or otherwise by booming certain health resorts. In giving advice, we must try to weigh carefully in each case the pros and cons as suited to that particular case. We must individualize the patient, taking into consideration first of all the best means of rescuing him from his perilous condition, and not neglecting to administer to his comfort at the same time if we can consistently do so. Still, a New Englander must not think so much of his own comfort in avoiding the cold as to overlook still greater inconveniences elsewhere. The careful study in advance of these inconveniences may teach him to bear with greater patience the treatment that he can bear nearer his home, not expecting perfection anywhere. What has the sanatorium treatment actually done for consumptives in New England? I will answer for the Massachusetts State Sanatorium at Rutland, with which I am most familiar, having been for eight years in constant attendance as one of its visiting physicians, and one of the two who had the entire supervisory charge of its treatment. It is a State institution about 50 miles west of Boston, in a very thinly-populated section of country, at an elevation of about 1,300 feet, owning 365 acres of land, and accommodating almost 400 patients of both sexes. We would like to take only incipient cases, but as enough of these do not apply, we fill up the rest of the beds with cases more advanced. I will not burden you with tedious statistics, as these can be found in its printed annual reports. I will merely say in a general way that if we could have confined ourselves strictly to incipient cases, the rest being treated elsewhere, we should have apparently cured from two-thirds to three-fourths of our patients. Taking the other cases into account, of course our total percentage is lower. From investigations of the subsequent histories of our apparently cured cases we learn that perhaps roughly three-fourths of them have stayed cured, in spite of ignorance and poverty in many instances, and also in spite of the unfavorable surroundings in which many of them have been forced to live by circumstances. Not a bad showing, when we consider that in the early years of my professional life, practically almost all of such patients died, no matter how early they were seen. All sanatorium physicians throughout the world are clamoring for early cases to treat, not early in the old sense, but really and truly early cases in the modern sense. Why? Because they find that they can cure most of these, while the treatment of advanced cases is tedious and trying and hopeless in proportion to the advancement of the case, and they know that the early cases are apt soon to drift into this condition, if not checked. Here is the chance for some bright young Hippocrates to immortalize himself, by institution studies and experiments which shall result (perhaps years hence) in our ability to cure advanced cases right along. We cannot do this in New England, and I notice that the honest doctors in the so-called health resorts do not claim this ability there. Frequently we find in the medical journals touching appeals from physicians and town officers in Colorado, California and many other Western States begging Eastern physicians not to send or allow to go there (as many of them do), advanced cases with slender purses, as they are sure to be public charges or dependent on individual charity sooner or later, with little prospect of recovery. Some advanced cases do recover in New England and more in Colorado and certain other places in the West, but after all the majority of them die, wherever they are. Which brings us back again to the idea which all of us who have much to do with tuberculosis are constantly running up against, of the tremendous necessity for the early recognition of the disease, often before the appearance of the tubercle bacilli in the sputum. In addition to the benefit it has derived from the curing and improvement of so many consumptives, the State of Massachusetts has already received abundant testimony to the good which its Sanatorium has done to the community in an educational way. Its graduates, so to speak, have scattered themselves all over the State, preaching to all with whom they come in contact, the gospel of fresh air and hygiene for consumptives, and presenting themselves as living examples of its efficacy. The educational results are far-reaching, not only in the cure of the disease, but especially in its prevention in those predisposed and tending that way. How about the home treatment of tuberculosis in New England? Can it be successfully carried out? I think that depends very largely on the character of the individual to be treated. The greatest advantage of sanatorium treatment lies in the fact that the patient is, (in a nice sense), constantly under the physician's thumb. He is obliged to obey orders or to leave and is watched to see if he does obey. In other words, discipline is omnipresent. Then again, we are all greatly influenced by our environment. When we are in Rome, we like to do as the Romans do. It is much easier to be good, if everybody else about us is good too. On the other hand, if we are at home and everybody else is leading a life which is unsuitable to our needs, it is harder for us to be independent among them and to go our own way alone. Here comes in the question of character. Some good resolute soul will stand up valiantly and fight the good fight, and another will not, but will weakly yield. The question of proxy may here come in to prevent this latter catastrophe, and one person may furnish the necessary good stiff backbone for another. In home treatment the patient must be much more intelligent and must have a clearer grasp of what is necessary to be done, and of the principles involved; as he has to make up for a considerable lack of supervision. The physician also must be willing and able to devote more time to this supervision, than has hitherto been considered necessary, unless perhaps by long practice in this line he has made himself competent to get a quicker insight into the needs and difficulties of each individual, or unless (and better still) there is a good nurse in attendance who has had a sanatorium training or its equivalent. These points will apply in any region, but particularly in a country like New England in the winter, where generally considerable wise planning and careful arrangement of detail are necessary to ensure success. If these things can be attended to skilfully, the home treatment of tuberculosis can often be managed in New England with great satisfaction. PROPER USE OF STIMULANTS.-I may use a stimulant in an emergency if I have reason to believe that nature may later be able to repay the loan with interest; but it has no part in restoring the vital harmony. On the contrary, it further disturbs it. Why do not you regulars, who profess to use every means of cure, investigate homeopathy, and do it according to the rules laid down by its masters, not by your own misconception of the idea? If it were all humbug it would be easily proven. If limited in scope, define its limitations. Steal the thunder by establishing chairs of homeopathy in your colleges, departments of homeopathy in your journals, under men who are qualified by thorough homeopathic training. Vincent, The Medical World, Nov. 1906. DR. CABOT'S ADDRESS BEFORE THE BOSTON HOMOEO- Editor New England Medical Gazette. My Dear Sir:-The address above named, as reprinted in the Cleveland Medical and Surgical Reporter for January, 1907, prompts me to the following remarks. Homeopaths as a body and other physicians as a body agree upon all of medicine else than homoeopathy. Only at very great disadvantage can one discuss homoeopathy, unless there be stated or understood some accurate definition of the particular cure of which simlia similibus curantur is the law. That particular cure is an immediate change from what is abnormal to what is normal (or approximately normal) in vital processes-whether those processes be such as are evidenced in conditions of the physical body, or be such as are evidenced in a formed idea, or be such as are evidenced in a formed love, affection, wish or feeling. That the law is evidenced in the world of thought and in the world of feeling, as well as in that of the physical body, is wherein lies its universality. Why do homoeopaths, cultivating the whole field of medicine, identify themselves by name with homoeopathy? Because the cure just defined transcends the possibilities of any or all medicine else than that under the law of similars; and he who believes in homoeopathy would, by identifying himself by name with it, make known his position upon what is far and away the most important issue in the medical world today. So far as concerns membership in medical societies, there is not the least incongruity in the thought of a society in which homoeopaths and those who are not homoeopaths should cooperate in all of medicine else than homoeopathy. Running his eye down the roster of such a society one might say, "This man is a homoeopath; that man is not; the next two are; the next seven are not," etc. La Porte, Indiana. CHAS. S. MACK, M.D. DURING lactation, while the babe cries, takes the breast with avidity, nurses well, vomits copiously, is exhausted, dozes, rallies, craves for a fresh supply, and does not seem to thrive; the poor mother may be a physical and moral wreck as well, full of anxiety and apprehensions; her lochia is thin and watery, her taste is bitter, she is constipated, her abdomen is tympanitic, and like her child has no power to retain or digest milk. Under these circumstances, both mother and child should receive Aethusa. Fornias, Hahnemannian Monthly, Nov. 1906. |