stantly; debility and emaciation are present in greater or lesser degree; but in some cases, while the emaciation is marked, the patient's strength continues until the very last phases of the disease, and he is obliged to relinquish his occupation but a few days or weeks before the disease terminates fatally. While hypertrophy of the right heart may develop in the second stage of the disease, there is seldom any decided tendency to œdema or anasarca. The formation of vomica is probably not unusual, but they seem to be generally much smaller than those of tubercular disease, and can have no elective tendency to form at the apices. In uncomplicated cases death occurs from debility and innutrition; but few terminate in this way, as grave complications are almost sure to develop before the disease has time to run its course. When the tubercular diathesis is present, there can be little doubt but that the inhalation of dust may often induce tubercular deposits. In such cases the diagnosis is most difficult, and we have a train of symptoms-emaciation, debility, fever, etc., with general dullness on percussion and marked dyspnoea,-that deceptively point to the existence of miliary disease; but their essentially chronic type will generally be a safeguard against this error. The disease is most common (among coal miners) in persons over forty years of age. It is never well developed in children who are exempt from other lung troubles, as its march is so slow that a child will grow to manhood while the disease is in its infancy. Among axe and knife grinders, etc., its progress is more rapid-in from three to five years it may terminate fatally. Among slate workers it also occurs late in life. In eight cases that I have investigated, death occurred at from 42 to 61 years, averaging 53 years. Among coal miners it may probably exist from ten to twenty-five or thirty years before reaching a fatal termination. It can be distinguished from chronic pneumonia (fibroid phthisis) only by the history of the patient and by the expectoration of nodules of the foreign material. From true tubercular phthisis or consumption it is readily distinguished by the general dullness on percussion, by the absence of fever, emaciation, etc., and by its chronic character from chronic bronchitis by the physical signs, etc. The great importance of distinguishing the true nature of the disease is at once apparent when we consider the favorable prognosis that can generally be given if the patient will change his occupation. It is true that many cases terminate fatally in a short time after a physician is called to attend the patient, but this is generally owing to the fact that the disease had been making stealthy progress for many years before the sufferer became aware that his lungs were affected, and not because the disease is necessarily fatal. No practical means of laying the dust in our mines has yet been devised, but a great improvement has lately been effected in some breakers by ventilating with a small fan. This plan should be adopted at all breakers at which the coal is prepared dry, not only for sanitary purposes, but to enable the boys to properly clean the coal. A sufficient supply of light cannot be obtained when an impenetrable cloud of dust pervades the breaker, even if the structure is supplied with hundreds of windows. Conclusions. From what has been stated in the preceding pages the following conclusions may be summarized: 1. That the sanitary condition of a majority of anthracite mines is excellent. 2. That the very wet condition of some mines is prejudicial to health, but that it cannot be bettered. 3. That at many mines the condition of the road-beds might be greatly improved by draining-off standing water. 4. That the large amount of dust in many breakers is incompatible with the health of those employed therein, and that this evil might be mitigated, if not entirely removed, by ventilating these structures with small fans,-but is this advisable in very cold weather? Treatment of Injured Miners. Every colliery should be provided with a comfortable room above ground, and also one beneath the surface, near the foot of the shaft or slope, where injured miners or laborers can be temporarily placed for treatment or prepared for removal to their homes. A stretcher with pillow; a large quantity of bandages in rolls; a lot of cotton; lime-water and sweet oil or lime-water and linseed oil; alum, tannin, vinegar, or some other astringent and a quantity of Monsells' salt; sponges and clean water; ammonia, and some whiskey, or what is much better, good brandy, are the supplies that should be kept in readiness. In the case of fractured limbs, the injured member should be placed in a natural position, and one comfortable to the sufferer, and carried home on a stretcher. This should also be done in cases of dislocation, but the person may often best wait at the colliery until the arrival of the surgeon. In cases of severe bruises or contused wounds, and internal injuries, the patient may be carried home, great care being taken in moving him; but if his home is distant from the colliery, or if a surgeon can be quickly called, it is best to wait until he arrives. Wounds on the head and other superficial wounds should be sponged out and thoroughly washed with cold water; if there is considerable hemorrhage hot water may be tried; if this fails use a mild astringent, but only in the most urgent case resort to the use of Monsells' salt. When the bleeding comes from an artery the blood will spurt out in jets, and in this case an endeavor should be made to control the hemorrhage by pressure on the artery with the fingers. When the hemorrhage is from the leg or arm a ligature should be applied. This may be readily accomplished by tying a handkerchief or muslin bandage loosely around the limb above the wound and twisting it tight with a stick. When the hemorrhage is from a vein the blood is of a dark color and does not spurt out in jets. In this case the ligature is applied below the wound, if it cannot be controlled by pressure with the fingers. If the patient faints from loss of blood, and the hemorrhage has greatly decreased or stopped, place him flat on his back, do not give him any stimulant, (brandy or whiskey,) and do not attempt to bring him to by dashing water on his face, etc. Let him lie perfectly still until the surgeon arrives. If the hemorrhage has been completely stopped by a ligature, efforts may then be made to bring the patient to, by the use of cold water, ammonia, etc., and a small dose of whiskey, (one to two ounces,) or an ounce of brandy may be given. Place the head low. If there is no hemorrhage and the man is weak and nervous from the severe mental and physical shock which he has sustained, one or two ounces of brandy may be given to enable him to bear the journey home without fainting. The sweet oil and lime-water or linseed oil and lime-water are to be liberally and promptly applied on cotton or lint to all burns, and a little brandy may be given with advantage to enable the sufferer to rally from the shock. When a miner is found unconscious or apparently dead from the effects of black-damp or any other gas he may have inhaled, artificial respiration should be immediately begun and continued for fifteen or twenty minutes at least. Ammonia should be held near the nostrils and brandy given in a liberal dose. Cold water should be thrown on the face, or the face and chest may be slapped vigorously with a wet towel. In all cases of serious injury the patient should not be moved to his home until the physician has arrived. When the injury is not serious, or is of a nature easily understood by the patient, he may be taken home as soon as he feels able to be moved. A seriously injured person should never be surrendered to his relatives until the arrival of the physician, as they are less likely to treat him properly than any one else. They are excited and worried, and not capable of acting with discretion. Old experienced miners, who have seen dozens of acci |