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from absorption very rarely occur. A few weeks ago wecommented on the value of iodine colloid in the treat-ment of anal sinuses, and Mr. Tatchell’s communicationforms a further proof that iodine is a very powerful anti-septic, which is hardly used as much as it might be in

modern surgery. --

TENEMENT HOUSES FOR THE TUBERCULOUSIN NEW YORK.

WE are indebted to the New York Times for an account of Ia scheme initiated in that city by Mrs. W. K. Vanderbilt,senior, who desires to make provision for poor families con-taining a member or members suffering from tuberculousdisease, so that the worker may live with his relatives in

sanitary surroundings within reach of his work. Slum-

dwellings and houses divided into small tenements in

ordinary circumstances in New York, no less than with us,are hot-beds in which the disease cannot be arrested in theindividual or prevented from spreading to others, and it is

felt that charitable treatment in country sanatoriumsmust be temporary and ill-adapted to the necessitiesof those whose dependents require the assistance of theirlabour. For these the ordinary tenement fails to providea reasonably wholesome dwelling within the confines of thecity, although it is recognised to be a profitable investmentfor its owners, and neither municipal nor private enterpriseappears heretofore to have erected anything approaching towhat is required in its stead. For this reason the charity ofMrs. Vanderbilt is directed towards the achievement of

something more than the mere building at her expense ofsanitary flats for 300 or 400 families. Her object is to show,by an experiment on a large scale, that such accommoda-tion may be constructed and managed so as to save humanlives and at the same time bring in a reasonablereturn for the capital involved. Should she succeed in

demonstrating this her example will, no doubt, be

followed and it is quite possible that she may do

so. The plans and elevations of her proposed buildingsdo not indicate any lavishness of expenditure on orna-

mental details or on fads extrinsic to the result aimed at.The site selected is suitable without being of an extra-

ordinary character and lies in the middle of the islandformed by the intersection of Avenues A and B with Seventy-seventh and Seventy-eighth-streets, having at one end of ita small public square and at the other a school play-ground, and on its two sides the streets named. The

proposed buildings are to be divided into blocks of

moderate dimensions, having six floors, including that on theground level, built round rectangular courtyards at the

corners of which are to be staircases open to the air bywhich the " apartments " or small flats of from two to fiverooms are to be approached. Each of these will open

directly upon a staircase and will have at least one windowfacing outwards and another looking into the courtyard, sothat it will always be possible to obtain a current ofair through the tenement. Moreover, each courtyardis to be entered by two open arched entrances ex-

tending upwards from the ground to the level ofthe ceilings of what we know as the first floor, whichhould have the effect of making the courtyard an effectiveair-shaft. The windows of the rooms are to be of good size,those on the outside opening from floor to ceiling and leadingout to balconies. Every flat, as it will have at least one

outside window, will thus have a balcony, and the tenantsare also to enjoy the common use of a roof garden at the topof the block, on which shelters will be provided and otherinducements designed to promote out-of-door life as far aspossible. There will be no common halls or rooms inside the

buildings, these being’ regarded as an insanitary and noxious

feature in the ordinary New York tenement house. The

scheme has been matured and its sanitary details formulatedunder the advice of Dr. Henry L. Shively of the Tuber-culous Clinic of the Presbyterian Hospital, and it is hopedthat he and other medical men will be able to findfor the flats abundant tenants of the class for which theyare intended. The enterprise appears to be a sound one,entered upon in a business-like spirit and without ostenta-tion, and if, as is suggested, it can be carried out so as toafford some small annual interest to the generous lady whofinds the capital it may lead to the development on a largerscale of sanitary houses for the general benefit of the

working poor of the city. Much, however, will no doubtdepend upon the goodwill and intelligence of the familieswho will inhabit the dwellings. Those actually affected withdisease, having, perhaps, had experience in sanatoriums andhaving actually lived under conditions enforced by medicalsupervision, will, no doubt, understand how to avail them-selves of the opportunities afforded, and it is to be hopedthat their families may cooperate with them in giving freeaccess to fresh air and in the maintenance of habits conduciveto sanitation. Such habits will probably be new to manyof them, and we are given to understand that their adoptionwill be the subject of advice, but not, or only to a limitedextent, of compulsion. The free passage of air outside eachtenement by means of open staircases and courtyards (ofwhich, by the way, we have many examples in London) willbe a benefit common to all and incidental to their occu-

pancy, but the opening of windows and the use of the

balcony and the roof garden will be matters for the exerciseof individual discretion. The windows which lead on tothe balconies are an important and characteristic feature,and when the commercial aspects of the venture come to beconsidered by the light of experience it will be interestingto ascertain whether the surface of glass implied is a sourceof appreciable extra expense, and how it affects the

question of warming the rooms of poor people in the

more severe periods of a New York winter. No doubt

heating combined with free ventilation will be aimed

at, but the question of how the warming is to be doneis rather lightly touched upon in the account before us

when we consider that the tenants are likely to desire in aI cold snap " the maximum of warmth with the least possible

personal expenditure upon its attainment, and also that wherethe conditions of life in a particular set of rooms are accord-ing to the will of its occupants, facilities for the admissionof fresh air may coexist with its rigorous exclusion.

THE INFLUENCE OF REST IN THE TREATMENT OFPULMONARY TUBERCULOSIS.

IN another column we publish a paper by Dr. E. E. Preston Graduated Rest in the Treatment of PulmonaryTuberculosis. The writer very properly points out the im-portance of rest as a therapeutic factor, but in our opinionhe rather exaggerates the state of affairs which has

hitherto existed when he says that the rest factor hasbeen in the past ...... far too much obscured." " Bysome observers rest has been too much insisted upon,the patients being allowed to take but very little

exercise, and that only of one kind, namely, walking.Dr. Prest, however, makes some valuable comments on theconditions which demand rest and his paper is a useful

adjunct to what has been written on "graduated labour."In fact, he makes the somewhat paradoxical, though correct,statement: "Graduated rest may be the same thing as

graduated exercise or graduated labour, but insists "thereis a difference in the emphasis." The truth of the matter is,that for success in the treatment of pulmonary tubercu-losis "graduated rest" and "graduated labour" must

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go together. The principles of the " graduated labour "

treatment were well laid down by Dr. M. S. Paterson,medical superintendent of the Brompton Hospital Sana-torium at Frimley, in a paper read before the Medical

Society of London, and he has since shown that if an excessof auto-inoculation has taken place this can be best met byplacing the patient under abslIl’/l.te rest-that is, by observingthe same precautions which are adopted in cases of typhoidfever. Exercise and labour cannot be prescribed unless thetemperature is normal, and until such a condition obtains,rest, as Dr. Prest insists, is of prime importance, and ifexercise is permitted or indulged in too soon harm will

surely follow. -

"TEA" VENIENTE DIE.

IT is often asked whether the early morning cup of tea ispermissible having regard to the chemical qualities andphysiological effects of that beverage, especially under theparticular conditions of the human organism after a night’srest. The early morning cup of tea is a source of

comfort and refreshment to a good many persons when themental and physical faculties are in a more or less lethargicstate. To them a cup of tea is helpful in giving them, so tospeak, a species of courage to face once again the demands andtasks of the day, and that being so it is superfluous for physi-ology and chemistry to preach that the practice may be besetwith troubles connected more or less with the gastric machine.It can hardly be supposed that people who habitually enjoytheir early morning tea suffer from any unpleasant symptomsor effects or they would discard the luxury, but, on the otherhand, it is conceivable that in some cases mischief in thelong run may ensue. It appears to be generally admittedthat when tea is harmful at all (and we assume that it is adelicately infused and not long-boiled preparation that is

chosen) it is when it is taken without food-that is to say,when the stomach is empty. That is a period when obviouslythe astringent substances of the tea may act more effectivelyas irritants to the mucons lining of the stomach and there-fore excite a condition of chronic gastric catarrh. Happily,however, it is the custom of most persons to take milk withtheir tea, which, unless the tea is objectionally strong, neutral-ises the tannin substances and thus precludes their acting asirritants. The most cogent argument against the earlymorning cup of tea is that, as in so many cases at all events,the tea is swallowed before the mouth and teeth are

cleansed, the septic potentialities accumulated in the mouthovernight are washed into the stomach, and a poisoningprocess in the system might thus easily be begun. This is

not improbably a source of gastric catarrh in some indi-

viduals who drink their early morning tea before they leavetheir bed. The mouth, of course, should be clean before food,and especially before warm drink is indulged in. There is,perhaps, another reason why the institution of the earlymorning tea is popular, and that not a physiological one.Its preparation implies the stirring betimes of the domesticsof the household, but this is a side of the matter which

hardly calls for attention in our columns.

GANGRENE OF THE BREAST IN DIABETES.

IN the Australasian Medical Gazette for January Dr. H.Swift has reported a rare complication of diabetes-

gangrene of the breast. On Oct. 6th, 1906, at 1 A.ns. hewas called to a woman, aged 64 years, whom he had attendedat intervals for diabetes and attacks of angina. She com-

plained of intense pain in the region of the left nipple,which she described as like the sensation of a red-hot iron

being bored into the breast. The temperature was 102 - 60 F.

1 THE LANCET, Jan. 25th, 1908, p. 216.

and the pulse was 120 and of fair volume. No definite historyof injury could be obtained, but she remembered that a

swinging door had struck her on the left side some weeksbefore. About one and a half inches below and to the outerside of the nipple was a very tender bluish spot of the sizeof a florin. Morphine was injected and boric fomenta-tions were applied. At 9 A.M. there was a distinct gan-grenous area about two and a half inches in diameter with

large blebs forming over it. The urine was scanty and ofspecific gravity 1055, and contained a large quantity of

sugar and diacetic acid. Milk diet and half a grain ofmorphine every four hours were prescribed. The gangrenespread until on the 10th there was a line of demar-

cation around an area six inches long and four inches

wide. The temperature ranged from 100° to 103°. On thellth a foetid slough was separating and a new focus of

gangrene was extending towards the sternum. The generalcondition was so serious that the case was regarded as hope-less. However, on the 13th the patient was a little better,and a line of demarcation had formed around the new focus

which was about three by two inches. The amount of urineincreased and on Nov. 1st it contained no sugar. The two

areas coalesced into a large discharging one measuring sevenby four inches. All sloughs separated and the wound granu-lated well and healed with a sound cicatrix. It is remark-able that gangrene should have occurred in a part so nearthe heart where, unlike the foot, there is no difficulty in thecirculation. The disappearance of the sugar from the urineis also noteworthy. It has been observed, however, that thesupervention in diabetes of some other disease, such asenteric fever, may be followed by disappearance of the sugarfrom the urine. Possibly the fever which accompanied thegangrene in this case produced a similar result.

AN EPIDEMIC OF 135 CASES OF ACUTEANTERIOR POLIOMYELITIS OCCURRING

IN VICTORIA IN 1908.

DURING April, May, and June of last year an epidemic ofanterior poliomyelitis, far exceeding any previously recordedin the Southern Hemisphere, occurred in Victoria, and Dr.H. Douglas Stephens of the Children’s Hospital in Melbournehas epitomised its main features in the Intercolonial MedicalJozrnccl of Australasia for November, 1908. The disease has

been spreading widely during the last four years. In 1905

it was epidemic in Queensland, in 1906 in Norway andSweden, in 1907 in New York, and in Victoria in 1908. In

this last there was a preponderance of male children affected.Nearly two-thirds of all cases occurred in the first three yearsof life. The disease selected the autumn months (March to.June) as the period of greatest incidence, and the majority ofcases occurred in children living in the most densely popu-lated suburbs round Melbourne. Dr. Stephens believes

that the disease is contagious in a mild degree, and fromhis observations made during the epidemic he finds theincubation period to be somewhere between three and16 days, while the invasion stage varies from zero to

a week, most commonly from 24 to 72 hours. In seven cases

out of 26 recent cases in which lumbar puncture wasobtained, cultures of cocci in pairs and tetrads were success-fully grown from the cerebro-spinal fluid. These gave a

pale lemon-yellow growth, but injection into rabbits and

guinea-pigs caused no pus production. Direct examinationof the centrifugalised fluid in smears in five cases revealedthe presence of poorly staining cocci, extra-cellular, andgenerally as diplococci, analogous to those obtained byGeirswold in the Norwegian epidemics. Dr. Stephens foundin nearly every case a definite history of premonitory febrileillness, and he remarked that in many instances slight coughpreceded the onset of the disease. An examination of the