tively pleasant and conducive to soundest and sweetest sleep. Frequenters of Turkish baths know how delightful a stream of cold water feels upon the outstretched arm or neck, while all the rest of the body is immersed in over-warm water, and just as pleasantly a stream of fresh air will equalize the temperature of the system by cooling the exposed forehead when the cover of a warm bed begins to accumulate a surplus of caloric. To the lungs themselves, cool air is always welcome. The laboratory of the organism seems to find it far easier to raise than to lower the temperature of solid fluid or gaseous ingesta, and while hot beverages undoubtedly impair the functional energy of the digestive organs, millions of animals and birds indulge with impunity in the luxury. of the coldest spring-water, and while hunters and travellers may be benefited by the bracing effect of a north wind, perhaps eighty degrees colder than the normal temperature of the system, an atmosphere only thirty degrees above the average of that temperature would soon produce languor, drowsiness, and fainting fits. Cold air is a tonic and antiseptic, and its efficacy in counteracting tendencies favoring the progress of zymotic diseases is illustrated by the well-known phenomena of climatic fevers reaching their epidemic phase towards the end of summer and disappearing after the first hard frost. Dr. L. D. Barkan, of Brooklyn, N. Y., who had a rare opportunity for studying the therapeutic influence of cold air in warm climates, found that not only fevers, but all sorts of digestive disorders, cutaneous eruptions, etc., can be more easily cured in open air than on the conventional hot-house plan, even cæteris non paribus, i. e., under conditions unfairly handicapping the chances of the fresh air method. While serving in the TurcoServian war, he says: "I kept the window in almost every room in my hospital constantly open, even during the night; and I had the satisfaction of observing that while in other hospitals small-pox and other contagious diseases prevailed, in my hospital they seemed to find no suitable soil for their further development; and notwithstanding that from want of room I was often obliged to put patients suffering from small-pox, typhus, erysipelas, diphtheria, etc., together with other patients in the same ward, these diseases did not spread. A favorite experiment of mine, and one from which I never saw any but favorable results, was to send patients suffering from grave diseases a distance of six miles to another and more roomy hospital. They were removed even in winter when

the weather was not too excessively cold, but were, of course, well wrapped up, and every precaution was taken to prevent them from receiving any injury on the way."

The vitality of savages (in the festering coast-jungles of Equatorial Africa, for instance), their immunity from zymotic diseases, and their recovery from desperate wounds, could probably be explained in the same way they pass their days in the open air, and their tenuous huts give them the full benefit of every breath of cool night-air.

But these observations apply still more especially to the cure of respiratory disorders. In the treatment of lung diseases cold air becomes, in the truest sense, a topical remedy, a specific admitting of local and direct application. Every breath of fresh air comes in direct contact with every portion of the respiratory apparatus, penetrates the pores of all its tissues and exercises its influence in stimulating the elimination of effete matter and morbid germs, and in the course of seven night hours a process of unrivalled expurgative efficacy can thus be repeated from eight thousand to nine thousand five hundred times. In all but the last stage of pulmonary consumption, i. e., given a remnant of sixty per cent. of available lung-tissue, the remedy can be warranted to answer the purpose of arresting the progress of the disorder, and preventing the development of cognate affections. For the last twenty years I have been constantly liable to the contagion of catarrh (miscalled cold-as clearly a germ-disease as consumption or small-pox), and I believe that many of my fellow-victims must have reached a stage of experience enabling them to recognize the first symptoms of actual infection; slight hoarseness, irritation of the fauces and nasal ducts, and a peculiar feeling of stuffiness about the lower part of the forehead. In a close bedroom the first inkling of those symptoms will be followed by an obstreperous catarrh as surely as day follows the dawn, but in certainly more than a hundred cases a cool night and the transfer of my bed to the neighborhood of the airiest window has enabled me to nip the mischief in the bud. The symptoms of hoarseness on the following morning may yet be perceptible after a protracted vocal effort, but will diminish from hour to hour; the obstruction of the nasal ducts has disappeared; the "cold" is broken.

Consumptives who pass the winter in the tropics, and the summer (all but a dog's day week or two) in their northern city

homes, might find it much to their advantage to reverse that plan. Catarrhs may be caught, but not cured, in May or June as easily as in December; while in midwinter, though contagion, with certain constitutions, is all but inevitable, the progress of the trouble can be prevented as easily as the development of a hiccough. It is true that there are persons blessed with catarrh-proof constitutions, with lungs resisting contagion as an unwounded skin may resist the effect of a virus, which in contact with a sore would produce a malignant inflammation. But any precedent of respiratory troubles generally entails liability to the danger of reinfection, and for the victims of a catarrhal diathesis the difficulty of prevention. makes cure, indeed, the less impossible alternative. They may ventilate their own dwellings by all methods known to Siemens and Pettenkofer, they may flee from the city to the country and from the country to the wilderness, but the spectre will track their flight, and absolute safety from contagion cannot be found outside of a hermit's cabin. City dwellers, whom experience has taught to avoid tenement dens as they would shun the vale of the Upas tree, may meet their doom in a public library, in a lecture hall or meeting-house. Travellers may suffer infection in the cars of the very railroad that promised to accelerate their escape to a land of refuge, where perhaps the spectre will reappear in the medium of a snuffling errand boy or a beldam with a cargo of cough-seed and other country produce.

But the crop of that seed can be subdued in a single night in all but the sultriest weather. From September to May the success of the air-cure plan is infallible enough to attribute the exceptions almost exclusively to the irresolution of the patient. The opening of a side-room window, for instance, will not answer the purpose, till the mercury sinks to less than twenty degrees above zero, when, indeed, a direct draught can be entirely dispensed with, unless the temperature of the bed-room should have been artificially raised. But in less intense frosts the constant renewal of fresh air, secured by a steady current, seems to redouble the expurgative efficacy of a low temperature, and in midsummer, when the "cool" night air deserves that attribute only in contrast to a sweltering afternoon, the effects of the draught should be increased by all possible auxiliary contrivances, such as opening a door between the open windows of two different rooms, and putting the head of the bed in the direct line of the consequent air-current. Then

cover the bed with any requisite number of blankets, and, instead of preventing sleep, that arrangement will prove a specific for otherwise incurable insomnia. The proximate cause of sleeplessness is the engorgement of the cerebral blood-vessels, and the simple plan of keeping the head cool and the feet warm might save cart-loads of narcotic drugs, and so recommends itself to the hygienic instincts of the organism that a few weeks' indulgence will render it, in fact, an almost indispensable condition of sound sleep. The atmosphere of a close bed-room will induce an uneasiness resembling the discomfort of the attempt to breathe under a heavy blanket, and after an evening passed in a sweltering lecture-hall the draught of the cold night wind, playing about the forehead and face, will become a luxury comparable only to the feeling of relief on emerging from a stifling cabin upon the breezy deck of a West Indian steamer.

And for consumptives that hygienic instinct assumes an additional significance. It is still a mooted point if the substance of wasted lung tissues can ever be reproduced; but I am confident that even in the beginning of that stage of the disease marked by the phenomena of night-sweats and hectic chills the progress of pulmonary consumption can be arrested within a month after the commencement of the night-air cure. The sputa will almost at once become less in amount and frequency; outdoor work will seem less fatiguing; asthmatic difficulties will be limited to the "shortwindedness" induced by violent exercise, as in running, or climbing steep hills. Before the end of the first two months-especially of winter months-the patient will be restored to the comparatively satisfactory state of health when the abnormal condition of his organism will reveal itself only in a slightly diminished degree of general vigor. After that coughs will be only transient troubles; a slight hoarseness, with more or less irritation of the bronchial membrane, will end, within a day or two, with a light expectoration, as a proof that the congestion of lung-tissue does not involve any deep-seated affection.

When lung diseases were treated on the old plan of lubricating the bowels of the patient (with fish-oil) and secluding him from every breath of fresh air, consumption was a wholly incurable disorder; its most effectual remedy having been mistaken for its cause. When the dire consequences of that plan induced doctors to send their patients to the South, a small percentage might recover by the

lucky accident of unavoidable draughts, as in travelling, camping, or roughing it in the rickety hostelries of a tropical sea-side resort. The true remedial agency was still hardly suspected, but got an occasional chance to assert itself in a way rather extraneous to the doctor's programme. The out-door exercise plan would have given Nature a daily opportunity to apply an unfailing specific of her own, if the balm of each day had not so often been counteracted by the bane of each night. Invalids who had come thousands of miles to climb the airy heights of a fashionable mountain resort were apt to lose both their labor and their life by passing their nights in the almost air-tight bedrooms of a fashionable hotel. Hospital nurses well know that the crisis of a disease, for better or worse, generally decides itself towards midnight, when the suspended activity of the voluntary muscles gives the self-regulating tendencies of the organism a chance to try conclusions with the disturbers of their harmony. On the whole, therefore, the result of the day versus night plan left the preponderance of influence in the scale of the morbific agencies. For, besides, a portion of each day being passed in a more or less vitiated atmosphere, had to be credited to the account of the adverse tendencies, which already engrossed the more critical half of the twenty-four hours. By the night-cure plan, on the other hand, the entire influence of that important factor is thrown into the opposite scale, and each daylight hour, passed in the open air, or in the neighborhood of an open window, increases the preponderance of chances in favor of permanent recovery.

FELIX L. OSWALD, M.D.

Cincinnati, Ohio.

EXOPHTHALMIC GOITRE.

THE cardinal symptoms of exophthalmic goitre are complex cardiac irritation, exophthalmia and enlargement of the thyroid. gland. These symptoms were brought under one group, about the same time, by Graves in England and Basedow in Germany, and hence the disease is known by the name of each of these investigators.

With our increased means of diagnosis numerous cases of the disease have been observed and recorded within the past decade.