should have separate workshops and recreation buildings seems decidedly wrong. That fences and walls are not needed appears to be indicated by the results of those sanatoria that do not have them.

The reviewer requested Scopes and Feustmann, the widely known specialists in sanatorium architecture, to commend on that section of Dr. Slade's book dealing with construction and plan. They give the following interesting opinions relative to the famous lean-to.

There is no more important feature of sanatorium management than that of work by the patients. This is discussed by Dr. Slade in a very sound and fair way. The principle of equal pay for equal work is maintained. "It must be understood," he reminds the reader, "that any work done by patients in their necessary period of treatment is primarily a therapeutic measure, although it serves economy for the administration and is never to be paid for by a money wage." When the patient is sufficiently recovered to earn some wage he should, in my opinion, be discharged as a patient and retained in the institution as a part-time worker. For the sake of clarity and emphasis, the author, if I interpret him correctly, might have divided patients' work into three stages.

1. Therapeutic work performed as a patient for remedial purposes only and without monetary return. The work done under a phy

sician's prescription. 2. Period of industrial convalescence-discharged as a patient, but retained as an employee under strict medical supervision"wages in proportion to quality and volume of services rendered."

3. Full vocational status, with periodic reexaminations-wages equal to those of nontuberculous persons performing the same duties.

It is to be hoped that the title of "Supervising Orderly" will not be adopted to designate the man responsible for the execution of the physician's orders concerning the patient's exercise and work. His duties are much more important and on a higher plane than those of trained orderlies for ward work and in no way comparable to the work of these orderlies. The orderlies should be responsible to the superintendent of nurses, while the supervisor of occupational therapy or reconstruction officer, as he is called in the army hospitals, should be directly responsible to the medical director with such aides as he or she may require.

Perhaps because of limitation of space imposed upon the author, he was not permitted to give more detailed information concerning the furnishing and equipment of a sanatorium, which would be very valuable to trustees in charge of the development of a new institution.

He does take space, however, to discuss diagnosis, physical signs, X-ray in diagnosis, classification of cases and those suitable or

unsuitable for admission to the sanatorium. A good deal of helpful information is given as to the outfit and modus operandi of admission to Otisville sanatorium with a description of patients' routine. Work and exercise, food and drugs are discussed in some detail.

Reproductions of all forms and charts used at Otisville are given in the last chapter. Some years ago the writer had to devise forms for a small municipal sanatorium. Samples from a number of institutions in various parts of the United States and Canada were secured for study. Those used at Otisville and shown in this book by Dr. Slade were considered as best in every way for the small sanatorium and adopted. Apparently Dr. Slade still thinks them better than the large sheets used in most institutions.

H. A. PATTISON.

"In regard to planning, we feel that the author's remarks (note 3, page 24) concerning the King Lean-to are decidedly misleading. If he considers the original basic plan of the King Lean-to to be a certain combination of protected veranda, sitting room, washroom and lockers, then it is quite true that the King idea for housing incipient or ambulant cases has not been improved upon.

"However, one might argue that the basic idea of human habitation is a certain arrangement of foundation, enclosing walls, roof, interior partitions, and doors and windows, but as there is a vast variety in the form of human habitations, so there is a considerable variety in the arrangement, comfort and privacy of the lean-to. The lean-tos or shacks devised by the late Dr. King was a most ingenious solution of a housing unit to provide accommodations for the hardy or incipient tuberculous patient at small cost, and it has served a most useful purpose in many cases. But it had its limitations and as Dr. King was ever an openminded man, he thoroughly recognized these limitations. In fact towards the end of his life, he contemplated razing the original leantots at the annex of the Loomis Sanatorium and replacing them with dormitories providing greater comforts. It might be stated that some sanatorium physicians whose opinions are wellworth taking into consideration, never favored the King lean-to, simply because in their estimation, it did not furnish sufficient comfort and privacy for any class of tuberculous patient. It is due to this objection that architects set to work to improve the original King shack or lean-to and evolved types providing the much needed comfort and which were subsequently erected at the Metropolitan Life Insurance Sanatorium, Mt. McGregor; Muirdale Sanatorium, Wisconsin; the Provincial Sanatorium, Kentville, Nova Scotia; Charles Dalton Sanatorium, Charlottetown, Prince Edward Is

land; William Wirt Winchester Memorial Sanatorium, New Haven, Conn., and a number of others. These improved types have a warm dressing room placed immediately back of the open ward or veranda so that a patient can step from his bed into a warm place without going over half a dozen steps. That these improved lean-tos have come up to the expectations of their projectors, is attested by the warm recommendations they have received from many sanatorium directors. The statement regarding the inability to improve the King shack is all the more misleading because accompanied by plans showing the original King lean-to as used at the Municipal Sanatorium, Otisville, N. Y. Those having in mind the erection of shacks and not being aware of the improved types above referred to, are very likely to gain the impression that the plans in the pamphlet embody the last word in shack planning and construction, and this idea should be vigorously combatted.

"The plans used by Dr. Slade to illustrate the article, i. e. type Darlington and type Billings' Court, and the plans and elevations on page 33, were furnished by Scopes & Feustmann and were the first shacks erected at Otisville.

"We agree with Dr. Slade that housing units or shacks or whatever is used for the accommodation of patients, should not be of uniform capacity. This statement should be made, however, with the reservation that it would apply particularly to a sanatorium using shacks as units where the patients are thrown more together. The same argument may be used here as is used in providing wards of varying sizes in a tuberculosis hospital for advanced cases. Dr. Slade gives twelve patients as sufficient on a side of one floor, for the capacity of a sleeping porch. We would prefer makking this eight. If the sanatorium provided more privacy such as individual rooms for all patients, as well as outdoor sleeping space for all patients, the remarks in regard to the different-sized united would not apply. Of course, the fact should be borne in mind that Dr. Slade's whole article is based on the peculiar experiences gathered at Otisville. The development at Otisville has been most haphazard and if the New York Municipal Sanatorium had had a properly developed scheme in the beginning, with proper provision for future growth, their view-point in planning would probably have been an entirely different one."

TO THE EDITOR:

1. (a) For what kind of cases is the internal administration of tincture of iodine indicated? Is any literature available on this subject?

1 (b) Are iodine injections beneficial for a T. B. who runs a temperature of 99° to 99.4° and if the sputum examination is negative of T. B. but positive streptococcus and staphylococcus germs.

1. (c) Is the danger greater with streptococcus?

2. (a) Is there a possibility of hot weather raising a T. B. a temperature even if one remains quiet?

2. (b) Can any one be practically quiescent and still run a temperature of 99° to 99.4°.

2. (c) Have you ever heard of a T. B. who had to exercise in order to regulate their temperature?

J. S. T., Texas.

1. (a, b and c) We consider these purely medical questions, which should be taken up only by a physician.

2. (a and b) It is possible for a case of pulmonary tuberculosis to be quiescent, and that the temperature is due to some other cause. However, in the absence of other definite

cause, a temperature of 99.4° would in our mind indicate presumably a low grade of activity.

(c) There are very rare cases of pulmonary tuberculosis having temperature who lose it upon exercising. However, we seriously advise against any patient with fever taking it upon himself to exercise in the hope of losing it.

TO THE EDITOR:

1. (a) I heard there is a new vaccine founded by Dr. Peterson of Mobile, Alabama. I would like to know more about it; some physicians are most enthusiastic about it; has anything been proven in regard to its use and results?

1. (b) Could you tell me if there is any literature available in regard to Dr. Peterson's vaccine and where may it be procured?

2. (a) Has anyone with a positive complement fixation of the blood any cause to worry? Is it any more dangerous than a positive T. B.?

(b) What does complement fixation mean? (c) Is any literature available on complement fixation? If so, where may it be procured?

P. E., Texas.

1. (a) This is answered elsewhere in the Question Box of this issue.

(b) We have no literature about this preparation and no knowledge as to where it can be procured.

2. (a) We see no reason why a person with a positive complement fixation need worry for this reason alone. The whole clinical picture, including the extent and intensity of the lesion together with many other factors, must be considered before any reliable opinion can be arrived at as to the ultimate outcome of the disease. No one detail is sufficient in itself for this.

(b) It means that there are circulating in the blood some chemical or physical properties which presumably have been liberated by reason of the tubercle bacilli having gained residence within the body. Further than this the meaning of complement fixation in tuberculosis is as yet not entirely settled.

(c) In most of the medical journals the question of complement fixation is dealt with from time to time. However, we do not think that anyone without a medical or chemical education could comprehend the meanings of the terms or understand the conclusions reported as resulting from the research, and consequently we do not advise laymen to read them.

TO THE EDITOR:

I have had sanatorium treatment and am under the guidance of a physician now, but want a complete outline of iodine treatment. A. S., Texas.

We think all such measures should be resorted to only under the direction of a physician, and consequently we cannot advise for or against this form of treatment in any individual case or group of cases and cannot outline any schedule of treatment.

TO THE EDITOR:

Will you kindly give me through your columns your opinion of Dr. Peterson's cure for tuberculosis? This cure, I understand, is gotten up in the form of a vaccine made from a culture of the sputum. Dr. Peterson lives in Mobile, Ala. His formula for making his vaccine is a secret and is not given out to the medical profession. If it is really a cure I would go to Mobile and put myself under his care, as I am an advanced case and have tried a number of so-called cures without receiving any benefit.

F. O., Texas.

Many thousands of experimental vaccines and cultures have been tried from time to time by reputable investigators, whose findings have always been published among the medical profession.

It is quite a safe assumption that any "secret" formula for the cure of tuberculosis

Some years ago I had an operation on my neck because of a T.B. gland. Also tonsils removed. A short time ago I had a severe quinsy attack, and the tonsils as big as ever. Since then I have had trouble off and on with the same gland. Would that mean a possible secondary infection there? Also still troubled with pleurisy.

2. Do you know if the Sanatorium at Springfield, Ill., lets patients

(b) After they become arrested take up T.B. training there?

(c) Wouldn't that be beneficial work for an arrested case besides being of service to others?

(c) Do you think an arrested case would be strong enough for a regular three-year hospital course? Wouldn't it be more of a risk, as one wouldn't, of course, get so much air? ILLINOIS.

1. Possibly. Suggest consulting your physician.

2. (a) Do not know. Suggest writing them. (b) Yes.

(c) Depends upon the individual case. Yes, it would.

There is a certain chirapractor in our city who has a machine with which he gives oxylene treatments. He has quite a number of testimonials by both M.D.s and chiropractors. These treatments are supposed to cure tuberculosis or to be at least a great benefit to a tubercular patient.

Will you kindly tell me frankly anything you may know about these treatments for the lungs?

I am enclosing self-addressed envelope for reply as I would be very grateful to you for an early reply. My reason for doing so is that I can hardly wait for the publication of your next number.

C. R.

We have yet to hear of any authentic cures or benefits by the treatment you mention, whereas we do know of hundreds and thousands of cases where people get well according to the rest, fresh air, good food routine, together with simple medication for minor symptoms as they may arise, and mental as well as physical relaxation.

TO THE EDITOR:

1. You stated once in the "Question Box" that tuberculin was of value sometimes, "in certain conditions." Is chronic T.B. pleurisy a condition which (providing no other symptoms contra-indicate it) would generally be considered a suitable one for the trial of tuberculin?

2. What risk, if any, attends the administration of tuberculin?

3. Is tuberculin, in suitable cases, given freely by the majority of T.B. specialists, or is its use usually withheld until other treatment fails?

4. (a) Is a temperature caused by chronic pleurisy generally especially persistent and hard to overcome?

(b) When the temperature, caused by chronic pleurisy, runs between 99 and 100, is exercise contra-indicated as when the activity is in the lung itself, or is more latitude in respect to exercise generally allowed?

5. What is the general treatment, or mode of life, usually recommended when chronic pleurisy has been left as an aftermath of T.B. of the lungs-(the lungs themselves being apparently healed)?

1. Had a very bad T.B. ulcer in the larnyx in August, 1917; by January 1st it was practically healed, and by June was stronger and felt better than I ever did in my life.

About February 1st, 1918, began to notice short breathing, and by June was very bad and could just walk. The doctor told me it was caused by tightening of the false vocal cord, but none seem to know the cause or cure; in fact, have not found anyone who has seen one before. Some say cut, and the specialists say if that is done it will never heal.

Can you tell me any treatment for it or who to see in that line?

2. Can tuberculosis be active in lung or throat with temperature normal or sub-normal? C.

P. S. The ulcer has never given any trouble since healed.

1. Unfortunately, we can give you no further advice than to consult a reliable physician who has had experience with such cases.

2. Yes, such cases are not uncommon, though rise of temperature usually accompanies activity.