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about 100 cases only. Under Spanish hydrochlorothiazide price rule no at- tempt had been made to isolate these unfortunates, but recently the authorities have taken steps for their separation from the community and for their proper treatment and care. The tubercular form is the usual ALDEN: PUERTO RICO, ITS CLIMATE AND ITS DISEASES. [N. Y. Med. Jour. one. Elephantiasis, which is quite comruon, has of- ten been mistaken for leprosy. It is not to be understood from what has been said that there was no provision under the Spanish order hydrochlorothiazide online regime for the sanitary and medical supervision of the island. Sanitary laws did exist, but they were inadequate and imperfectly executed. esidrix or zaroxolyn There were quarantine officials at the principal seaports, but one quarantine station only, that at San buy cheap hydrochlorothiazide Juan. Puerto Rico was divided into seven departments and seventy-one municipalities, each one of the latter having its board of esidrix 25 mg health, the reports of disease and death being made by the Alcalde to the Secretary of State at San Juan. A royal sub-delegation of medi- cine and surgery at the capital was charged with the licensing of medical practitioners, though some were also licensed by the governor-general. Physicians from the medical schools of Spain seldom had the doctorate degree, but were styled "licensiados." A few physicians had the degree of doctor of medicine from European and American schools. Another class of practitioners were licensed as "practicantes," these being assistants to the physicians proper or doing hydrochlorothiazide mg the rough work of the profession in the moun- tains and among the poor. Midwives were also li- censed as "comadrones." Each hydrochlorothiazide cost district had at least one physician to the poor, employed by the govern- ment at a salary of from $400 to $500 gold. In 1900 there were but 125 physicians in the whole island, or one to nearly 8,000 of the population. Naturally quackery does not flourish. There are a few pre- tenders who profess to be the direct representatives of celebrated deceased physicians, and who practise and prescribe in their name. "Christian Science" is said to have been recently imported. The advent of the United States authorities found sanitary affairs in a very demoralized state, due partly no doubt to the confusion incident to the change of jurisdiction. The medical departments of our services were not slow to see the necessity for systematic organization. The Marine Hospital Ser- vice at once established efficient quarantine, buy esidrix and the commanding general, again at the instance of Lieu- tenant-Colonel Hoff, cheap hydrochlorothiazide the chief surgeon, ordered in June, 1899, the establishment of a Superior Board of Health, composed of one officer from each of the three services, the Army, Navy, and Marine Hos- pital, and two native physicians, with Colonel Hoff as president and Major George buy hydrochlorothiazide online G. Groff as secretary. This board was charged with the supervision of the municipal boards of health, and of all the various interests affecting public health, such as the licensing of medical practitioners, dentists, druggists and nurses, the collection of vita! statistics, the investiga- tion of the causes of disease anil purchase hydrochlorothiazide online recommendation of preventive measures, the sanitary inspection of hos- pitals, schools, and prisons, the inquiry into the hydrochlorothiazide tablets purity of the water supplies, food, drinks, and medi- cines, the establishment of a laboratory for their ex- amination, and the supervision of municipal sanita- tion, of sewers, plumbing, etc. This list gives but the principal duties buy hydrochlorothiazide committed to hydrochlorothiazide online the board, which was armed with powers to act efficiently. The Su- generic hydrochlorothiazide perior Board of Health organized order hydrochlorothiazide under the civil government has taken up the work of the military board. Not only did the Medical Department of the Army during the military occupation of the island have in charge the important duties already inadequately sketched, but under the chief surgeon, Colonel Hoff, as president of the board of charities, it was the prin- cipal agent of the government and the people of the United States in relieving the victims of the great hurricane of 1899. The 2,300 deaths and widespread destitution and disease which followed that great calamity have been referred to. Colonel Hoff re- ports that an average of 183,000 persons were fed daily from September 16, 1899, to January purchase hydrochlorothiazide 22, 1900, chiefly with food supplied by the government. About $115,000 was contributed for food and clothing in the United States. It is estimated that the total relief extended reached a cost of over a million dollars, with practically no expense for personal service. The island has not yet recovered from the effects of the hurricane, and nothing speaks more eloquently of .the sad condition of the poor than their willing- ness to emigrate in large numbers to Hawaii, as they are now doing. But we may confidently hope that the new government, under the wise leadership

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