it will be seen that at no very distant date more careful methods of bark collection and replanting of now denuded areas will be needed."

The chittem-bark tree (Rhamnus purshiana) is usually destroyed in the process of peeling the bark, as no new bark is formed.

The least that physicians can do is to use their influence to induce a frequent replanting of these trees. The Forest Service of the U. S. Department of Agriculture should be encouraged in its efforts to extend the acreage of the above and other trees from which medicinal barks are secured. Before we are aware of it we will be forced to repent of our folly-Lancet-Clinic.

CARBON DIOXIDE SNOW AS AN ANESTHETIC CAUTERANT.

In an article of great practical value and interest, Gottheil shows the following advantages of CO2.

1. Obtainability. Carbon dioxide is a commercial product extensively used for soda-water fountains in drug and candy stores. A number of firms supply it in steel-pressure cylinders, and it is readily gotten anywhere. It is not even necessary to keep it on hand; it can be drawn at the drug store as required in a towel or chamois skin; it can be kept for hours and carried to where it is needed. In fact, the druggist could draw it on prescription and send it to the office or the patient's home.

Cheapness. A 20-gallon tank costs, delivered, between $2 and $3, and with careful use will last a long time. The number of "drawings" possibly depends partly, of course, on the waste each time, and partly on the varying amount of gas in individual cylinders. But it is at least 30, and it may be over 100. The cost of individual treatments is insignificant, and the only apparatus required is a towel and a couple of roller bandages.

3. Applicability. The gas can be drawn as a solid, varying in density from a loose snow to a more or less brittle chalk-like mass. The snow can be moulded into shape with the protected hand, or by means of glass or metal tubes with pistons, into cylinders or any desired shape. But I invariably have it drawn hard, and whittle it down. At one time a broad, flat freezing surface, perhaps curved to fit depressions and covering a square inch, is required; at another, a fine long point to attack a minute lesion is needed. Either one is readily gotten with an ordinary penknife.

The above note from American Medicine ex

presses the essential facts about this simple escharotic. Dr. Gottheil's article appeared in the International Journal of Surgery, March, 1909.

Dr. Heidingsfeld, of Cincinnati, has described its use in the Lancet-Clinic. Dr. Pusey, of Chicago, has written in great detail and we advise anyone using the snow to read Dr. Pusey's reprint.

The writer has used it very successfully in cases of hairy nevus and of purple birthmark in infants. I can go down to the Francis Pharmacy, make a snowstick of the size of a large thumb and use it in the office all within fifteen minutes. Such a stick will dissolve into carbonic acid in 30 minutes or sooner if in a warm room.

For infants 10 seconds pressure on a birthmark freezes the area hard. The blister follows and the scab falls off in a week or ten days. The snow has a wide range of usefulness but should only be used after experience on one's own arm, or after a careful reading and study. Indianapolis Medical Journal.

DISEASE AND DEATH IN INDIANA IN MAY.

Monthly reports to the State Board of Health show that rheumatism was the most prevalent disease. Tonsilitis first in prevalence in April, was second in May. The order of prevalence of certain diseases was: rheumatism, tonsilitis, bronchitis, measles, influenza. pneumonia, diarrhea, pleuritis, scarlet fever, whooping-cough, intermittent and remittent fever, typhoid fever, diphtheria and membranous croup.

The deaths numbered 2,793, annual rate 12 per 1,000. In the same month last year, 2,694 deaths, rate 11.8. Deaths under one year of age 341, or 1 per cent. of total. 65 and over, 867 or 32.9 per cent. of total. Hydrophobia caused 1 death at Indianapolis. The victim was bitten by a mad-dog 11 months before her death. Northern Sanitary Division, death rate 11.7; Central Division 13.3, and Southern Division 10.4. City rate 14.4; Country rate 10.5. Death rate of certain cities was: Indianapolis, 14.5; Evansville, 11.3; Ft. Wayne, 14.2; Terre Haute, 18.9; South Bend, 14.8.

Tuberculosis caused 384 deaths, 179 males, 205 females. Of the males 28 were married and in the age period of 18-40, and left 56 orphans. Of the females 67 were in the same age period and left 134 orphans. Total number of orphans made by tuberculosis in one month, 190. Suppose this number of mothers and fathers were killed on the railroads. Would apathy reign?

Diphtheria caused 5 deaths in 21 counties and 56 cases, against 9 deaths in 13 counties with 37 cases last year. Typhoid fever caused 35 deaths in 29 counties with 80 cases. Smallpox caused one death at Richmond, with 88 cases reported from 13 counties, against 275 cases in 33 counties with no deaths in the same month last year.

Births in April numbered 4,163, males 2,166, females 1,997. In the same month last year 4,417, males 2,270, females 2,147. Rate this month 18.5, in same month last year 19.7.Indianapolis Medical Journal.

Prolonged lactation is often injurious both to the child and the mother, especially to the mother. Many a weakly, overworked woman has kept her babe at the breast until it was perhaps two or three years old, and until her nervous system was greatly reduced, because of a dislike to wean it, or because of fear of conception. The following facts may be stated as the usual results of prolonged lactation:

Lactation tends to prevent conception by its influence on the ovaries in retarding their return to the state in which ovulation is perfect. After weaning, the evolution of the ovaries becomes more rapid than it is during any period of lactation. After a long-contin ued lactation, its sudden cessation is liable to be followed by rapid evolution of the ovaries and uterus, giving rise to symptoms of ovari an and uterine hyperemia.

Long continued lactation may cause superinvolution of the ovaries and uterus, resulting under favorable circumstances, in complete or partial prolapse of the uterus.

Prolonged lactation is of no value to the child after its first year, and it is a constant drain upon an often already over-taxed mother, reducing her vitality, which fact acts in harmony with the above-named causes to produce permanent chronic uterine or ovarian disorders. Ellingwoods Therapeutist.

Miscellany

FOUR THOUSAND CONSUMPTIVES STARVE YEARLY.

Many Indigent Dying Cases Are Being Sent to the Southwest.

Cruel and inhuman practices are alleged in a statement given out today by the National

Association for the Study and Prevention of Tuberculosis against the eastern doctors who persist in sending dying cases of consumption to the Southwest.

Fully 7,180 persons hopelessly diseased with tuberculosis annually come to die in the states of California, Arizona, New Mexico, Texas and Colorado, most of them by order of their phy. sicians. The statement, which is based upon the testimony of well-known experts, and all available statistics, shows that at least 50 per cent. of those who go to the Southwest every year for their health are so far advanced in their disease, that they cannot hope for a cure in any climate, under any circumstances. More than this, at least 60 per cent. of these advanced cases are so poor that they have not sufficient means to provide for the proper necessaries of life, which means that 4,315 consumptives are either starved to death, or forced to accept charitable relief every year.

It is not an uncommon thing, the National Association declares, for whole families, who can hardly eke out a living in the East, to migrate to the West in the hope of saving the life of some member of the family. In most instances, the abject poverty of such cases forces them to beg, or to live on a very low level. Often consumptives who cannot afford the proper traveling accommodations are found dead on the trains before reaching their destination. The resources of almost every charitable organization in the Southwest are drained every year to care for cases which would be self-supporting in their Eastern homes.

It cost, on an average, at least $50 per month for the support of a consumptive in the Southwest, including some medical attention. The National Association strongly urges no one to go to this section who has not sufficient funds to care for himself at least one year, in addition to what his family might require of him during this time. It is also urged that no persons who are far advanced with tuberculosis go to so distant a climate.

Consumption can be cured, or arrested in any section of the United States, and the percentage of cures in the East and the West is nearly the same. Any physician, therefore, who sends a person to the Southwest without sufficient funds, or in an advanced or dying stage of the disease, is guilty of cruelty to his patient. Renewed efforts are being made to stop this practice, and to encourage the building of small local hospitals in every city and town of the country. Attempts are also being made in Southern California and in Texas to exclude indigent consumptives or to send them back to the East.

EIGHT MILLION DOLLARS APPROPRIATED TO PREVENT TUBERCULOSIS. State Legislatures in Consumption Crusade. Appropriations of over $4,000,000 for the suppression of consumption have been made by twenty-eight legislatures in session during the past year, according to a statement issued today by the National Association for the Study

and Prevention of Tuberculosis.

Since January 1, 1909, forty-three state and territorial legislatures have been in session. Of this number, twenty-eight have passed laws pertaining to tuberculosis; eight others have considered such legislation, and in only seven states no measures about consumption were presented. In all, 101 laws relating to the prevention or treatment of human tuberculosis were considered and out of this number sixtyfour were passed.

Of the sixty-four laws passed, fourteen were in reference to building new state institutions. New state sanatoria for tuberculosis will be built in Pennsylvania, Connecticut, where three will be erected, Arkansas, Oregon, South Dakota, North Dakota and Florida. In New York, North Carolina, Indiana, Massachusetts, New Hampshire and Maine, appropriations have been made for enlarging sanatoria, already being built or in operation. There are now twenty-seven states where such institutions have been established. Every state east of the Mississippi, except Illinois, West Virginia, Kentucky, Tennessee, South Carolina and Mississippi have provided hospitals for tuberculosis patients.

Five states, Illinois, New York, Ohio, Minnesota and Iowa, passed laws giving their county officers power to erect tuberculosis sanatoria without resorting to a special vote. In Maine, Connecticut, Rhode Island, New Jer sey, Michigan, Iowa and Kansas, laws providing for the strict reporting and registration of tuberculosis were passed. Only five other states, including the District of Columbia, have such laws. The National Association considers laws of this character as the first requisite in an organized movement against tuberculosis.

Laws prohibiting promiscuous spitting in public places were passed in Maine, Pennsylvania, New Jersey, Kansas and Connecticut. Spitters in these states will be prosecuted and fined.

Ten states have this year granted nearly $100,000 to be spent only for the education of the public about tuberculosis. In some states traveling exhibitions will be used, while in others lectures and literature will be the chief means of education. The states making provisions of this sort are California, New Jersey, Kansas, New York, Rhode Island, Iowa, Min

nesota, Porto Rico, Delaware and Texas.

The statement of the National Association calls particular attention to one fact which shows the remarkable interest in anti-tuberculosis work, evoked during the past year, namely, that fully one-third of the $4,000,000 appropriated this year is by special legislation and for new work. The last Congress appro

priated, in addition to this sum, nearly $1,000,

000 for the maintenance of the three federal sanatoria in New Mexico and Colorado. It is estimated besides that the numerous county and municipal appropriations made or to be made for tuberculosis work for next year will aggregate at least $3,000,000, making the official public expenditures in the United States for the wiping out of tuberculosis at least $8,000,000.

PUBLIC HEALTH REPORTS.

A WORKING PLAN FOR COLORED ANTI-TUBERCULOSIS LEAGUES.

There was published in the Public Health Reports of May 28, 1909, Volume XXIV, No. 22, a plan for the organization of colored anti-tuberculosis leagues, which contemplated the organization of a league in each state, with a branch in every colored church.

Experience has shown that after such leagues are formed difficulty arises in getting to work in an effective way, because the work is new in character and those engaged in it have had but little, if any, experience. It is to meet this difficulty and supply a practical guide for the work of the leagues that this is written.

Organization of a State League.

The object of the state league is to organize the church leagues, to bind them together and render more effective their work. The caring for patients and work of a similar character are properly the function of the church leagues.

There need be but little ceremony in organizing a state league. A few leading colored men and women, preferably from different parts of the state, but not necessarily so, meet and proceed to organize the state league.

The constitution and by-laws for state leagues should be adopted, followed by the election of a president, a secretary, and a treas

urer.

It is desirable that the constitution and bylaws recommended in "The Plan" be adopted in all essential particulars, so that there will be uniformity in organization and work. They have been adopted in all the states that have organized thus far, and it is believed future organizations should also adopt them.

The president then appoints a committee, the president and secretary being members of

it, to select a vice-president for each county in the state. (The plan contemplates that there shall be a vice-president for each county, whose duty it is to organize a branch league in each colored church in the county.)

The selection of the county vice-presidents should be made with a good deal of care. Suitable persons who will actively carry on the work should be chosen for these positions. The vice-presidents should be authorized to appoint one or more representatives in each community to help them organize the leagues in the churches and arouse interest in the work.

It cannot be impressed too strongly on the vice-presidents that the success of the church leagues in their districts will depend upon the amount of attention given the work. The organization of a branch league in a church is merely the starting point; the real work is done. after the organization is completed.

The president and secretary of the state league should call for regular reports from the county vice-presidents, showing the number of church leagues in their respective counties and a statement of the work done in each.

If any of the church leagues are not prospering, the president or the secretary of the state league should visit or write to them and learn what is the trouble, and give needed advice and encouragement. Officers of the state league should consult frequently and freely with their state board of health and enlist its sympathy and aid in their work. The closer the leagues keep in touch with the health au thorities the better will be the results obtained. Both the state and local health officers will be glad to give their best efforts to help along this work. They are in a position to do a great deal to assist both state and church leagues, and the leagues should work in harmony with them.

Church Branch Leagues.

Organization. In order that the members of the church in which it is proposed to organize the branch league may understand thoroughly the objects of the legaue, the minister or other competent person should explain clearly the purpose of the league and what it is expected to accomplish. He should inform them that relatively many more colored people die of consumption than white people; that very few colored people get well of the disease, partly because they do not know how to take care of themselves and partly because many neglect to do so; and that the object of the league is to teach the well how to preserve their health and prevent their contracting consumption and other diseases, and the sick how to regain their health. If too poor to take the necessary treatment, it is the purpose of

the league to help its members to do so. After the foregoing has been thoroughly explained, the church branch of the state league should be formed by the adoption of the constitution and by-laws given for church leagues in the plan of organization published in the Public Health Reports of May 28, 1909. After this has been done, the officers required by the by-laws should be elected.

The certificate of membership given to each person joining the league has printed on it information and instructions which, if followed, will tend to protect the individual from consumption.

In organizing the church league, it is well to have a number of the certificates on hand to supply the members as soon as they pay their dues. The form of the certificate will be found in the plan of organization for these leagues. The certificate can be printed at a local printing office, but if this is not practicable, or it is preferred to buy them, very handsome certificates printed in black and red, with a large red seal, and the name of the state and church branch league, can be bought for about 6 cents each, by the hundred.

The amount of the annual dues to be paid by each member can be changed by the league to suit the necessities of the community. The dues should be so small that no one will be kept out of the league by not being able to pay them. However, as the dues will be the chief source of revenue with which the league expects to do its work, they should not be made smaller than is actually necessary.

The money paid into the league as dues goes to form a fund that is disbursed by the church league collecting it to help those of its members. who contract consumption. How much this help will be will depend upon the amount of money the league has at its disposal and the needs of the individual. But whether this help is much or little the having the certificate of membership and belonging to the league will give information that will teach one to pro tect himself and his family from disease. This means less sickness, consequently less loss of time from work, therefore more money, more comforts and more happiness for all concerned.

The vice-presidents and organizers should see that the four standing committees required by the by-laws of the church leagues are promptly appointed and that they understand their duties.

As the work of each church league will at first consist largely of educating its members as to the cause of tuberculosis and the way to live to keep from getting it, the committees. and especially the ones having charge of "sick," "sanitation" and "information" should be especially active. They should learn all that is

possible about their respective subjects so that they can teach the other members.

In joining the church league one also be comes a member of the State Colored AntiTuberculosis League. Members of ti.. state league and church branch leagues wear a button showing their connection with the leagues.

Membership.-Membership in the church leagues should not be confined to the members of the church organizing the league. As a rule it is better that the members of each church join their own church league, but if for any reason their church has no league there should be no objection to their joining the league of some other church. Those who are not members of any church should also be allowed to join the league.

Details of the work of a church league.--As soon as the church league is organized the president should appoint the four standing committees required by the by-laws to serve for one year, viz.: "Finance," "Information," "Sick," and "Sanitation." The details of the work to be done may then be considered. One of the first of these is to ascertain how many of the members have or are suspected of hav ing tuberculosis. This duty devolves upon the committee on the sick, which should get from the secretary a list of the members, giving the name and address of each. This list should be gone over and every member carefully consid ered. It is probable that the greater number of the members are personally known to the committee, and thus it can be told at once whether they are sick or well.

The committee is not expected to decide whether these members have tuberculosis. Their duty is to make out the list of the sick and ailing. The physician will decide the nature of the sickness.

It is desirable to find cases of consumption in the earliest stages, for these may be cured, and if all members who are not strong and healthy are examined by the physician it is possible that cases of early consumption will be found.

Each ailing member should be visited by some of the committee and more careful inquiry made as to the nature of the trouble and the member urged to go to a physician or a dispensary for examination. This is especially true if the member has been losing flesh, or has had a cough for some time, or has throat trouble, or is sickly and frail. If upon exam ination the physician finds that the member has consumption, the patient should get a certifi cate stating that fact. The physician will also tell the patient what treatment is necessary.

The certificate will be presented to the committee by the patient, and the committee will

make more careful inquiry into the condition of the patient, the treatment considered necessary by the physician, the patient's means, the number of people he has depending upon him, etc., so that the facts may be presented to the executive board in accordance with the requirements of Article VII of the by-laws.

The list of the sick should be most carefully guarded and no one allowed to see it but the officers of the league and the health officers. This knowledge should be regarded as a sacred confidence that should not be divulged except to the persons mentioned above, as many might object to having it known that they have tuberculosis.

Under no circumstances should the list be allowed to fall into the hands of "patent medicine" concerns which might urge their nostrums on the patients, much to their annoyance and also to their detriment, if they become induced to take the "patent medicines."

The measures necessary for the treatment of a patient who has tuberculosis must be determined by the physician, but it is the duty of the executive board to decide how much and what kind of help the league can give the patient in carrying out this treatment.

It is not proposed to discuss here the question of treatment in a sanatorium which is the ideal way of handling all cases of tuberculosis, for in a sanatorium the sick cease to be a menace to the community and can be under supervision and treatment all the time. Unfortunately, at present sanatoria are not available for the great mass of the people; and even if they were, many would be unable to go to them.

For the purpose of the league, consumptives may be divided into three classes:

First. The patients who are in the earlier stages of the disease and are able to go about their work while taking treatment.

Second. Cases in which it is necessary to stop work and remain quiet if they are to get well.

Third. Cases in which the disease has progressed so far that it is hopeless to attempt a cure, but for which much can be done to make the patients comfortable and prevent them from scattering the germs of the disease.

As stated above, what is necessary in each case will depend upon the condition of the patient and his surroundings. Much also depends upon the means the league has at its disposal to help the individual. Most church leagues find that they have very little money; therefore the help given must be limited. However, there are certain things that can be done even by the poorest leagues.

Information as to the way in which the dis