Miscellaneous Papers. 319 



is established, and from this systemic point of attack the disease 

 may be extended. 



What is the state of tuberculosis to-day? A very appropriate 

 and suggestive question; one more easily asked than answered. 

 Before Koch, the scientist, came on the field, drugs and food 

 had played their part and gone. Cod-liver oil, phosphorus, 

 hypophosphite, arsenic, iron, digitalis, phenol, quinia, creosote, and 

 coal tar, each has been lauded as a cure-all; to-day they are con- 

 sidered simply as adjuncts. Sulphureted hydrogen gas at one time 

 presented a bold front, but its memory is unsavory. Compressed 

 air, one of the has-beens, is to-day relegated to the dim distance of 

 the past. Climate at this time is in the forefront of the battle that 

 is being waged against the great white plague. 



It was considered that New Mexico possessed the finest climate 

 possible. But what are the facts? The native Indians have per- 

 ished there with this disease by the thousands. We are forced, 

 therefore, to admit that climate is the least essential of the con- 

 sumptive's necessities. The fact is, climatic treatment presents a 

 problem to the physician that is surrounded by many difficulties. 

 It is a question that is complex in character. When required to 

 give advice, a large number of pertinent questions confront us: 

 Will the financial and physical condition warrant the desired 

 change? Would it be advantageous? If the change is to be 

 made, what climate is preferable? Each case must be considered 

 from an individual standpoint. Eschew from your mind the 

 thought that all tuberculosis patients must go west, or that they 

 must have a special climate in which to live. Such an idea is 

 harmful, for it brings distress, blasting of hopes and throttling of 

 courage. Disabuse the minds of the people upon the climate cure, 

 for it is not a concrete, specific thing which can be secured only 

 for the asking. The profession should encourage the building of 

 sanitariums in the East, a much neglected territory. Hundreds of 

 such institutions are needed to care for a large class who are unable 

 to seek a special climate. 



Tuberculosis is, as a rule, a protracted and rebellious disease. 

 Is it incurable ? No. Nor does a cure mean the complete eradi- 

 cation of every lesion, scar, alteration, transformation, or complica- 

 tion in the structure, functions or natural conditions of the organs 

 that may result from the disease. I have no doubt but that the 

 medical profession has suffered from the radical stand taken by 

 Koch. The results obtained did not justify the unqualified posi- 

 tion taken. So long as the pathology and treatment of tuberculo- 



