mirror into the dark pharynx, we obtain a splendid view which is entirely different from that ordinarily seen.

"The first thing that strikes the observer is the disappearance of different colors. The whole larynx shows a reddish tint of varying intensity. When we place the lamp at the level of the incisura thyreoidea, then the vocal bands and all parts above them appear of a beautiful red color (of course the epiglottis is dark). But when we place the lamp near the cricoid cartilage, then we get a better survey of the whole subglottic region down to the bifurcation of the trachea, and this view is often more satisfactory than that obtained by the common method. But it must be observed that we have to become accustomed to this peculiar view of the larynx, for it may be said we see mostly in the negative. What in ordinary illumination impressed us as a thickening or enlargement of a solid mass,

in translumination strikes us as a dark object. The rays of light cannot penetrate, and we infer that a solid mass, or a mass subject to the same optical laws, must intervene. We will therefore be able to define more precisely the contour of a tumor, because we see how the mass differentiates itself sharply by its dark outlines from the other parts in view." These words were written by me in 1890, and it should be added, that this last assertion holds good mostly for tumors at the anterior wall of the larynx or trachea. But the writer has also observed a tumor on the posterior wall (i. e., its anterior portion) extending from the arytenoid downward, where he was able to discern its circumference more clearly by means of translumination than by the ordinary method. That was, of course, in the prebronchoscopic era. Yet even now

adays it may be of benefit to resort to translumination in such rare cases.

A detailed differentiation, however, is not possible, as everything appears red when the light is conducted thru the circulating blood; or dark, when it is not. (Compare the phalanges of your fingers, when the sun strikes them). For that reason we ought to be able to differentiate between a solid tumor and a cyst.

Voltolini's supposition that by his method it might be possible to determine the vertical diameter of the vocal cords and eventually the character of a neoplasm on these parts, has not been verified. It was his idea that benign tumors stand out from the vocal cords, while cancer, for example, sends its epithelial proliferations directly into the tissue; but his method did not clear up that point.

It will be advantageous, in some cases, to again try translumination of the larynx, which has apparently been forgotten in certain quarters. Occasionally it may undoubtedly prove of benefit. In by far the majority of other cases, however, where the indirect method is of no avail, we shall have to resort to the procedures originated by Killian, of Berlin, Kirstein and others, namely, direct laryngoscopy, tracheoscopy and bronchoscopy.

At the same meeting at which the writer demonstrated the above method, he also showed the translumination of the antrum of Highmore, this being the first public demonstration of its kind in the U. S. In this connection a few remarks, which are of historical rather than of practical value, may be added here.

The diagnosis of a maxillary empyema had been a difficult matter, in most cases even impossible up to the time when Hart

2

mann of Berlin, Krieg, Ziem, Moritz Schmidt, and other laryngologists published their observations. Ziem and Bresgen tried to aspirate the pus thru the ostium maxillare, while Moritz Schmidt recommended exploratory puncture thru the thin wall separating the antrum from the inferior meatus of the nose, a method still in use at the present day. At that time (i. e., 1888) Voltolini made known his translumination of the antrum, which was taken up quickly by Heryng, the writer, Vohsen of Frankfurt on the Main and others. Vohsen originated the translumination of the frontal sinus, but, as was to be expected all the instruments devised for these methods of examination were improved and simplified here as well as abroad.

In my first publication I considered translumination of the maxillary sinus a most valuable aid to diagnosis; but even at that early date I remarked that one can not absolutely rely on it in every instance. We are often misled by certain formations. of the bones, etc. It is only when we see the pus coming out of the antrum or of any other sinus, or evacuate it thru an exploratory puncture, that we can state positively: In this case there is an empyema. I still hold the same view.

1 Medicinisches Correspondenzblatt des wuerttembergischen aerztlichen Landesvereins, Nos. 34 and 35, 1888.

2 Berliner Klin. Wochenschrift, No. 11, 1889. Ibidem, 1888, No. 50.

4 Rudolph Voltolini: Die Krankheiten der Nase, page 466. Breslau, 1888.

Theodor Heryng: Die elktrische Durchleuchtung der Highmorshoehle. Berliner Klin. Wochenschrift, 1889, p. 774.

W. Freudenthal: Die Durchleuchtung in der Laryngologie, N. Y. Med. Monatsschr., Nov., 1889 and Translumination of the Larynx and of the Antrum of Highmore. Med. Record, May 17, 1890.

59 East 75th Street.

SANITATION OF A CANADIAN

MILITARY CAMP.1

BY

JOHN W. S. McCULLOUGH, M. D., D. P. H., D. A. D. M. S., Major C. A. M. C., Sanitation M. D. No. 2,

Toronto, Can.

Introduction.-In view of the forthcoming establishment of a large number of military camps in the United States to accommodate the first draft of American soldiers, a brief description of one of the newest Canadian military camps, that known as Camp Borden, will doubtless prove of some interest.

The camp is in Military District No. 2 and is situated in Simcoe County, Ontario, about 60 miles northwest of Toronto. It comprises about 18,000 acres of sandy, grass-covered plain about 10 miles from the town of Alliston and 12 miles from Barrie.

The area in general is level. It is traversed by two small rivers, the Pine running in a direction northeasterly and the Mad from west to east at the northerly limit of the camp. The character of the soil is well adapted for the purpose of a camp. It is dry and porous, admitting of excellent drainage. It is well removed from low lying lands, and from any large urban center of population. There is an absence of marsh or stagnant water and its elevation of from 750 to 850 feet above sea level permits of excellent drainage.

Transportation.-Transportation is an

easy matter as two railways, the Grand Trunk and Canadian Pacific, have stations inside the camp limits and within a quarter of a mile from headquarters. The country

1Read at meeting of Canadian Public. Health Association, Quebec.

roads are gravelled and above the average. Water. The one indispensable requisite of a satisfactory camp is a pure and adequate supply of water. This is thoroly well met in the camp by artesian wells, six in number, giving a daily supply of one and three-quarter million gallons. During the month of July of this year the weather was unusually hot and dry, yet 35,000 men were able to use all the water they required without materially diminishing the outflow from the wells. The water is pumped by means of two electrically driven pumps with a capacity of 1,000 gallons a minute. The water is pumped to two 100,000 gallon tanks placed at an elevation of 130 feet above camp level, thus providing adequate pressure. The water is practically sterile, of moderate hardness, clear and cold.

Sewage.-Disposal of sewage and other liquid wastes is provided for as follows: Each battalion has 5% of flush closets of the "range" type placed in stucco-covered buildings.

A full complement of showers is provided for both officers and men, separate latrine and shower buildings being supplied to each unit. The sewers are deeply laid being of 12" x 15" and 18" glazed tile.

Kitchen liquid waste is all passed to the sewers, each kitchen being supplied with a large sink and each unit with a screened concrete saucer into which garbage liquids are drained.

The sewers, of which there are several miles in the camp, lead to a large sedimentation tank adjacent to the Pine River. This tank, which is of one of the finest types of construction I have seen, is about 30 feet deep, 80 feet long, 60 feet interior measurement and has a capacity of about 200,000 gallons. The effluent is to be chlorinated.

In certain outlying parts of the camp such as the Musketry School and the School of Infantry where sewage is not provided, buckets are used. These are placed in wired latrine buildings and the contents. removed daily or oftener, by the sanitary contractor and conveyed to a distance of about a mile from any part of the camp in use. In the trenches where mimic warfare is conducted, buckets are used and the most rigid supervision of sanitary detail enforced.

Solid Wastes.-Non-combustible material such as tin cans, bottles, wire, etc., is removed by the sanitary contractor to an area away from the used portion of the camp. They are sprayed with oil and incinerated at intervals. Bones are placed in securely covered barrels provided for the purpose and removed by a party who purchased them by tender. Manure from the stables of each unit is placed in covered ventilated receptacles and removed once a day. Kitchen waste, including remnants of food, peelings, paper, boxes of wood or pasteboard, is destroyed in the type of incinerator called the "Reid." This is a metal box about four feet in diameter lined with firebrick and, if handled with a little care, gives satisfactory results.

In England the Horsfall Incinerator is used for the same purpose about one hundred pounds of coal being used as fuel each day. Before this metal type was introduced the various units had constructed incinerators in a variety of styles, made of sods, concrete or brick which are familiar to military men. In connection with the type now in use several of the units have established coils inside the incinerator to heat water either for the purpose of bathing or for boiling the dishes.

Kitchens.-The kitchens, of which

there are four to a battalion with an extra one for each brigade headquarters are constructed in groups of two. They are wirescreened from about three feet of the ground and have spring screen doors. In some cases the floor is of wood, in others of sand and gravel and in some is made of

concrete.

Refrigerators.-Many of the units have constructed dug-outs in which meat and other foods are kept and in some cases refrigerators have been placed thus ensuring proper preservation of butter, milk, meat, fruit and other perishable goods.

Dishes.-Because of the fact that most of the communicable diseases, such as diphtheria and influenza, scarlet fever, measles and meningitis, are conveyed from mouth to mouth, common cups have been abolished in canteen. If used at all, these articles, as well as all dishes and kitchen utensils used in common, are required to be boiled after each using. We consider this means of prevention so valuable, especially when troops are in barracks, that it is very strictly enforced.

Communicable Diseases.-The isolation and quarantine of each communicable disease is strictly observed both as to cases and contacts. It is of interest in this connection to observe how easily affections such for example as meningitis or diphtheria are controlled among soldiers in contrast to that of civilian life. In the latter the public and not infrequently the physician in attendance fail to notify these diseases in order to avoid quarantine but the medical officer of the battalion as well as both officers and men do not want such cases in their lines and get them out as soon as possible. The result is that first cases of this character are promptly diagnosed, notified and isolated, and in consequence the

incidence of the common communicable diseases is less in military than in civil life. But there are a few communicable diseases among soldiers, the record of which we sanitary officers are not proud of. These are syphilis, gonorrhea and pneumonia. During the ten months from October, 1915 to July, 1916 inclusive, in say some 50,000 men we had over the whole of M. D. No. 2, 1,439 cases of communicable disease. These included 90 cases of pneumonia, 51 of scarlet fever, 261 of measles, 47 of diphtheria, 96 typhoid fever, 90 of syphilis, and 550 of gonorrhea. There were 23 deaths and of these 18 or 78% were from pneumonia, which has displaced typhoid fever in point of mortality in military camps. While gonorrhea and syphilis do not compete with other communicable affections in mortality the remote effects are so serious that prevention in all three affections are engaging the earnest attention of our sanitary and medical officers Cerebrospinal-meningitis does not cause us any great concern and, while we had 96 cases of typhoid fever all during the winter months 86 of these occurred among uninoculated troops in Parry Sound and were due to a polluted water supply.

Typhoid Inoculation and Vaccination. -All troops not already inoculated and vaccinated receive their injections of mixed typhoid and paratyphoid vaccine at intervals of seven days, the smallpox vaccination being given on the day preceding the last inoculation. The value of typhoid inoculation has been fully justified by the low typhoid rate among our troops at the front.

Laboratory Facilities.-A laboratory is established both at the Base Hospital in Toronto and at Camp Borden. The one at camp is used for water examination, inoculation and vaccination, and that at