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live. The first we find controlled by inherited conditions of the mind; the previously transmitted instincts which vary in form from trivial wrong-doing to the crime of murder; they are due to habit formation.

Second, the sphere in which we live, or environments; this is the most fertile field of habit formation.

It therefore behooves us as fathers, mothers and later, as teachers to use our very best endeavors to discipline the child against the formation of deleterious habits which are the ground work of practically all the crime committed today; such discipline should begin at the cradle.

I wish to take the liberty at this time to thank several members of the medical profession for the valuable aid given me in the sale of Liberty Bonds, War Savings Stamps, and protection of the public; Capt. Jacob Goldberg, Lieut. J. Henry Dowd, Sergeants Dewitt H. Sherman and J. F. Rice.

Headquarters of Police, Buffalo, N. Y.

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New Poison Gas. Teulieres, Jour. de Med. de Bordeaux, Feb., calls this gas "sulfure d'ethyl bichlore," which we are unable to translate into chemical terms. Among 1500 men exposed, a third presented insignificant lesions and only 23 cases were serious, involving the eyes. In most cases, the phtophobia subsided in 4 or 5 days, cure being complete in 2-3 weeks, the lesion consisting merely of a rather severe conjunctivitis. In all, there were 3 ulcerations of the cornea and 1 panophthalmitis.

Chyluria. Loumeau, Jour. de Med. de Bordeaux, Feb., reports the case of a man 60 who had had chyluria since a gonorrhoea at the age of 27. Cystotomy revealed the presence of an intra-prostatic adenoma which was enucleated. Death followed and a partial necropsy revealed neither prevertebral adenopathies nor lymphangectases. A single previous examination had shown no filariae but, in view of the fact that the patient was a native of Mauritia, the chyluria was considered as probably of this nature. Renal symphysis with a single ureter was found to exist.

Intestinal Occlusion With Biliary Calculus. Villar, Jour. de Med. de Bordeaux, Feb., operated for intestinal obstruction 8 days after an attack of colic. A mass had been found behind the uterus, by rectal examination. A biliary calculus, the size of a hen's egg, weighing 95 grams, was found in the small intestine. Death ensued the next day. Begouin reported an identical case.

BUFFALO MEDICAL JOURNAL

A Monthly Review of Medicine and Surgery

EDITOR AND PUBLISHER, DR. A. L. BENEDICT, 228 Summer St., corner of Elmwood Ave., Buffalo, (Address for all communications. Please make personal and telephone calls before 1 P. M.)

Third, in age, on the western continent. Independent, but supports professional organizations. News limited mainly to Western N. Y. and Penn.

Subscription $2.00 a year; $3.00 for two years in advance. Changes and errors in address or failure or duplication of delivery, should be reported immediately.

Yearly Volume 74

SEPTEMBER, 1918

Number 2

Water Filtration.

We are all familiar with the kind of economy that has old clothes dyed and repaired at considerable expense and that secures something better than the original but which soon proves unsatisfactory and does not postpone except temporarily, the expense of a brand new outfit. Buffalo did something of this sort a few years ago when the water intake was put upstream. It has required no strictly expert knowledge or experience to show that the tremendous expense has not resulted in complete success from the sanitary standpoint. Anyone with a very moderate knowledge of local hydrography and sanitary science knew in advance that certain advantages would be secured, that a higher average of “purity” would be secured, either in the macroscopic or bacteriologic sense, that depreciation in quality from shore and creek contamination would be less marked and less frequent. It not only could have been but it was predicted with certainty that these advantages could not postpone the ultimate problem of securing a really safe water supply by filtration beyond the time when a thorough understanding of sanitary matters had become so general as to affect popular sentiment.

The joint problem of insuring an adequate water supply for the future and against an accident that might occur at any time, may be conceded to have been solved but it could have been solved by a much cheaper and shorter tunnel. Neither has the establishment of the new intake in any way expedited the construction of a filtration plant nor materially affected the economy of operation of such a plant when established.

However, it is sometimes wise to make the best of a bad bargain. In view of

enormous expense involved in a filtration plant, especially when we consider the financial problems of the present and the immediate future due to war, and the possibility that some system of sewage disposal other than the convenient one of dumping it into the water supply of down-stream communities may be forced upon our attention, it may be wise to stop short of ideal conditions.

We trust that our readers will not accuse us of ignorance of well known sanitary dicta, therefore, in presenting certain practical facts and in suggesting some possible ways of avoiding a very serious financial burden in the near future. First of all, it must be admitted that, no matter what it cost and whether proper forethought was exercised or not, Buffalo has an adequate and excellent water supply for all nonpotable purposes and even for drinking and domestic purposes if we set the calendar back a few years. Even if the city should increase enormously in population and in commercial demand for water, the present water supply is susceptible of large increase at a relatively small expense as compared with a complete change of supply, and any such increase in demand would probably require a separation of potable and non-potable systems if prohibitive expense is to be avoided.

It is by no means certain that sand filtration is the last word in water sanitation. Chlorination has been employed satisfactorily by many communities and is, indeed, in some cases, mainly relied upon as a safeguard against bacterial contamination, even when clarification of mud and sand filtration are jointly practiced. It has proved tolerably satisfactory for Buffalo, as a temporary expedient. Various other methods of purification, at present only of academic interest, may almost instantly be put upon an economic basis on large scale. If, for example, as some optimists already feel confident, electric or some other form of power becomes greatly reduced in expense, almost any water supply that would flow through pipes could be rendered safe, even if not aesthetically desirable, either by transformation into heat or along various lines already demonstrated theoretically.

Some general method of guarding the existing water supply in Lake Erie may become necessary for the mutual protection of other communities than our own and even a local application of this principle at our own expense might prove to be cheaper than some of the more elaborate devices proposed, notably sand filtration. Self purification of water in

a

large volume and of scarcely appreciable current as in the case of Lake Erie, “purifies itself, to use a somewhat oldfashioned sanitary term, within a comparatively few miles, largely by sedimentation and the action of harmless bacteria. Such means would not merely hold the sanitary problem stationary but would set it back, for practical purposes, to a period when the population of the water shed of the lake was comparatively sparse.

A very practical point to be considered is that Buffalo has, for some years, had a low typhoid rate notwithstanding the fact that fully half of the cases are introduced from without, either in the sense of being non-residents, or of having been contracted from extra-mural sources (vacational typhoid), or of being due to milk foods. When further allowance is made for infection by flies and dust into the outskirts of the city, for carriers and direct contact, the amount of typhoid that can be ascribed to our water supply or that could be ascribed to it even if chlorination were not practiced and if warnings to boil when the water becomes dangerous, were not published becomes very small though by no negligible.

Furthermore, we must admit that the only water-borne disease that need be considered for practical purposes, is typhoid. Experience has accumulated to show that inoculation against this disease---as well as the paratyphoids-is almost if not quite as effective as against small pox though the test has not been intentionally carried on a large scale to the extent of deliberately exposing inoculated persons to highly contaminated water. But it is logical to ask whether routine inoculation, a comparatively cheap expedient would not obviate the necessity of elaborate treatment of water supplies especially as the protection would be general and not merely local.

For these several reasons, we believe that practical, if not theoretical wisdom points to a reasonable delay before adopting radical and enormously expensive methods in dealing with our water problem.

means

Post Bellum Problems.

One of the biggest problems that the profession will have to meet, after the war, will be the professional spirit of the returning surgeons. Something like a third of the total active practitioners then in civil life, will come back to pick up their old practices or develop new ones, even if the military surgeons are not increased beyond the limits of those already

commissioned and the number recently called. This is a mis

a statement according to medical directories but we believe it to be true so far as the actually practicing profession is concerned. This is a big problem by itself, as already discussed in the previous issue but it is not nearly so big as that depending on the spirit of the men returning.

These men will have been accustomed to an entirely different kind of discipline from that prevailing in peace, to an entirely different deference to prestige. Many who could not have gained prominence in civil practice, possessed attributes which have led to rapid rise in the army, implying such control of a medical or surgical service as is gained very slowly in civil life and only by a very few. Those who have not been so fortunate will, never-the-less feel disposed to assume the same attitude on their discharge. In spite of all that has been said regarding the relative unimportance of professional work in the limited sense in the army, the great majority will have had practices at least equal to what men claim but seldom realize in civil life. Not only will these men have had a large and wide experience, extending into various specialties and without reference to war surgery itself, to conditions seldom encountered in private practice by any one man except a specialist or one known to have a peculiar interest in a rare condition, but they will have become expert in various diagnostic and therapeutic technics usually left in civil life to a comparatively small number. Perhaps the greatest distinguishing feature will be the habituation to very early and long hours, to rapid though careful work, to a large clientele which comes without effort and which is subject to almost perfect control.

Thus far in the country's participation in the war, the influence of the withdrawal of large numbers of practitioners, is difficult to judge. From some places, the expected report of a prosperous and busy profession, is verified'; from others comes the report of a dull winter and spring in spite of the removal of competition. It is impossible as yet, perhaps for the duration of the war, to harmonize conflicting reports and to judge as to actual conditions. It is self-evident, that unless other factors have acted to reduce professional work for those staying at home, there must be an average greater demand for professional services than for many years previously. With the meeting of two bodies of medical men, both accustomed to larger practices than prevailed before the war, there is bound to be sharp competition, which can scarcely be relieved even by the retention of many in the government service. We are apt to forget that the withdrawal of physicians from private into public service, even in

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