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fluids could not sterilize it. He is therefore preaching against what he believes to be ineffective disinfection, with the hope of starting a new and effective system of isolating the carrier. Our own Chapin of Rhode Island has conclusively proved that far better results are obtained in diphtheria if we ignore things on which the bacilli promptly die anyhow, and devote our attention to the convalescents until we are sure they cease to be carriers. All this is of extreme importance, for it shows that we allow children to go back to school too soon, and permit convalescents generally to spread disease broadcast while the health authorities are spending time and money poisoning the dead germs on the house walls. When Chapin presented his evdence to the Section on Hygiene of the A. M. A. some years ago, he was amazingly misunderstood and denounced, but he is now coming into his own. We can confidently predict as great a change in preventive methods in every disease as has occurred in yellow fever, but not until the exact ways of transmission are known. The sooner this is accomplished the better, for we have permitted an enormous amount of disease by our delay in recognizing the "carriers" and by wasting our time on the germs which had died.

Street cleaning is second only in sanitary importance to the sewage problems. of every large city. Now that practically every self respecting community has in operation a sewage system of more or less efficiency, the question of how to secure. and maintain clean streets must be taken up and answered. It is no idle statement that unclean streets are more responsible for the propagation of present day diseases

than any other one factor. To go into comparative consideration of the various dangers of urban living is not necessary; the evident evils of filthy thoroughfares tell their own story all too plainly. The fact remains that our Boards of Health, health officers and sanitarians can never expect great or lasting reductions in the mortality rates of the air borne diseases, until clean streets are a verity instead of an ideal. The proposition is a many sided one, and presents problems that must have the best thought of the engineers, the mechanicians, the contractors, the bacteriologists, the chemists, the physicians and the sanitarians. Fortunately the development of the automobile bids fair to decrease the most serious feature of unclean streets by forcing that noble but none the less execrably filthy beast, the horse, into the background. Few realize it, but it is a fact that the feces of the horse are more dangerous, bacteriologically, than those of any other animal; in fact are second only to human feces in pathogenic possibilities. The automobile is, therefore, helping to solve other problems than those of transportation, and the probable improvement in the sanitary conditions of city streets. that will follow the wider use of automobiles will constitute not the least of the ultimate benefits of the horseless vehicle.

The so-called antiseptic barber shop of to-day is in reality a myth. Even the best of the better barber shops fall far short of the aseptic precautions that ordinary common sense would seem to dictate. That this is a fact will be borne out by the simplest investigation one cares to make of practically every one of the up-to-date shops of to-day. It is not meant to imply

that any of these shops fail to keep their utensils clean or to use clean linen, but it is meant that a real state of antiseptic cleanliness is almost never obtained. Our knowledge of the need of antiseptic methods, raises the question whether or not the use of a common brush, soap and razor is not a fairly frequent source of skin infections, and as a consequence the prime cause in many of the skin lesions constantly being met. It is not unreasonable to fear that the shaving stick, brush or razor used on a person whose face is broken out with any of the common forms of eczema, acne or the more severe skin lesions, is extremely liable to be a factor in the spread of such diseases, unless these implements are properly subjected after each shave to some effective sterilizing process.

In many shops, however, the latest method of applying soap is now being used. This is in the form of a powder applied to the brush that has previously been wet. Surely a step in the right direction. for each customer thus has at least his individual soap. It may not be feasible to have individual brush and razor always, but it is always possible to have these implements rendered absolutely sterile before use, since this can be easily and effectively accomplished by thorough immersion in boiling water.

The time is surely coming when every man with ordinary development of the precautionary sense will refuse to patronize any barber shop that fails to use reasonable aseptic and antiseptic methods. As a matter of fact the safety razor deserves all the praise it is given, if for no other reason than that it has helped to deliver many a man from the dangers of indiscriminate barbering.

Plague infection of the ground squirrels of the Pacific Coast is proving to be a much more serious matter than was thought when it was first discovered that the flea had carried the bacilli from the city rats to these country rodents. Dr. Colby Rucker, of the Public Health Service, whose efficient work in San Francisco

has been mentioned in connection with the Plague crusade of Dr. Rupert Blue, has been organizing a scouting expedition to determine just how far the infection has spread, and preliminary reports of his work show a somewhat alarming condition-infected squirrels having been found in widely separated places in one county with evidences that other counties are also involved. Plague is therefore a disease to be expected in human beings for some time to come in the United States for the bacillus has obtained a foothold. As the extermination of the squirrels is apparently impossible, the spread of the disease throughout the continent by the squirrels, prairie dogs and other rodents, depends solely upon whether they have sufficient tolerance to keep the bacilli alive, or whether they will die off so quickly as to prevent the germs being carried, as happened in the efforts to kill off the rabbits of Australasia. It is now known that the bacilli are normal inhabitants of certain rodents in Eastern Asia, only occasionally making excursions into the bodies of rats, and always dying out in their new homes, incidentally destroying some millions of rats and human beings. The rats are known to have enough tolerance to spread the bacilli, and it is feared our feral rodents will do the same.

The appalling results of contempt for sanitation are illustrated by this wide spread of plague bacilli in America. San Francisco's labor unions elected to the

mayorality a fiddler who has since been sent to prison for crimes connected with his administration. It was he, who, at the probable instigation of certain business men afraid of publicity, not only denied the presence of plague in the city, but punished those who said there was. At the very time that well directed efforts would have completely destroyed the infection, it was concealed and allowed to spread until it began killing the inhabitants. It has now escaped beyond their borders, and if the fears of its further spread across the continent are realized they will be the causes of an appalling number of deaths. They have at least created a situation full of menace to the rest of the country, and the question naturally arises as to whether one community is to be permitted to jeopardize others in this criminal manner. Several times in England it has been found that the rats, near the docks of ships from plague countries, were infected, but prompt measures eliminated the danger at

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The main lesson from San Francisco's conduct is the necessity of electing men of intelligence-attainments and honorto positions requiring high executive ability. All men are not equal, and low morality is generally a result of low mentality. English workingmen for generations refused to be represented in Parliament by anyone except a "gentleman"-gentle born. They are now sending their own representatives and it is hoped the experiment will turn out better than in San Francisco, a city which, in spite of its noble and brave conduct after the fire and earthquake, must accept the contempt of the civilized world for permitting plague to enter the

country and create a menacing situation which may require hundreds of millions of dollars to save our lives, if the infected ground squirrels are not promptly destroyed. Neglect or defiance of sanitation is dangerous business, at any time, but to jeopardize the whole nation for the sake of a little temporary business, shows that the guilty people are not possessed of sufficient common sense and forethought to be entrusted with the franchise. It is hoped that all cities will learn a lesson from San Francisco's crime, elect only "gentlemen". of proved executive ability and honor to offices requiring those characteristics and then support the sanitarians in their efforts to protect the community. It is the cheapest in the long run, as common sense should have taught, but in electing the notorious fiddler they showed that they were not possessed of common sense at that time. It is quite proper for laboring men to organize for their own protection, but if they aspire to rule as in San Francisco, they must not do injury to the health of the country or there will be an overwhelming demand for their suppression.

Wisdom from the mouth of babes comes at unexpected times, but it is not anything new for children to prefer an unwise therapeutic nihilism. Their objection to being dosed is perhaps an animal instinct inherited from ancestors who did nothing but rest and starve when ill, allowing nature to preserve the most resistant. Indeed it is not so long ago that our own survival compelled us to kill the sick, for men had all they could attend to in keeping themselves alive. Perhaps this brutal custom improved the physique of savage races by preventing the procreation of

those who became ill. Some, if not all, species of monkeys deliberately worry the sick to death if not actually killing them. Be that as it may, it is undoubtedly true that sick children have the animal desire to do nothing, and sometimes they are right. A little boy, convalescent from whooping cough worried his mother so much by an occasional cough, that she said, "My dear boy, what can I do for you?" "Just let me alone until I get well." Could we not take this to heart and could not all mothers too, in the case of convalescents, without being accused of therapeutic nihilism?

Caisson disease seems destined to be of increasing importance because the progress of civilization and the congestion of population are creating more and more. need of tunnels and bridges, the construction of which requires the laborers to work in compressed air at great depths. The cause and prevention of the disease are well known and yet, in spite of all precautions, cases continue to be produced and show the need of further investigation. It seems a simple matter yet there are curious accidents proving that it is far from simple and that there are individual as well as seasonal variations in susceptibility. Under compression more gases are dissolved in the blood and if decompression is rapid, these gases must escape as when a champagne cork is withdrawn, and the bubbles of gas in unyielding cavities press upon nerve tissue, and arteries, causing paralysis which may be temporary if the gas is reabsorbed or permanent if the tissues are lacerated or lose vitality. Prevention is merely such slow decompression that the gases escape by the lungs and do not bubble out elsewhere.


body fluids act like champagne which has become flat from a leakage through the cork.


Newly discovered factors in caisson disease are of considerable importance. has long been known that the longer the exposure to compressed air, the more gases must be dissolved in the blood and the longer must be the period spent in the air lock. Seasonal epidemics have an unknown relation to the outside temperature and the barometric readings which in some way influence the escape of surplus gases from the blood. Still, it seems remarkable that the state of the weather should have the least effect if the workman has gotten rid of the surplus gas before he leaves the chamber. It is said that light exercise aids the escape of gases, as we would suspect from the increased circulation of blood. Workmen are often prostrated as a result of the exercise. taken after leaving the locks, and it seems a wise precaution to compel light exercise during decompression but complete rest for a short time after emergence.

The last thing discovered is the fact that big or obese men suffer more often than the little or spare. (Boycott and Damant, Journal of Hygiene, Sept. 1908.) This is no doubt due to the greater difficulty of getting rid of the gases in the bodies of the bigger men. Such workmen must therefore spend a longer time in the air locks and the pressure must be reduced more slowly than for the others. Perhaps big men should be excluded from such employments. As the disease is really a traumatism and absolutely incurable after the damage is inflicted, prevention must be carried to the greatest extreme, though it must be confessed that men will always take unwise risks and that cases will always occur.




REYNOLD WEBB WILCOX, M. D., LL. D., Formerly Professor of Medicine at the New York Post-Graduate Medical School and Hospital; Physician to St. Mark's Hospital.

Ten years ago matters in the medical profession were pursuing the even tenor of their way; there were no clouds above the horizon. No important question was agitating the medical mind. No recent revolt against the existing order of affairs had created animosities. But in this medical calm those who thought, and not only thought, but acted, believed that the time had arrived when a new organization should be formed which should attempt to reach a higher ideal than that which had either been conceived for or attained by a medical body. An aristocracy of membership as well as the highest standard of scientific achievement was the end toward which their efforts were exerted. Incidentally, social intercourse should occupy an important position, and that a new fraternity should comprise the five boroughs of the greater city.

To accomplish these results a method of government was adopted which should be representative in constitution, deliberative in plan but efficient in action, which should. eliminate the personal and the partisan, but which should be effective in carrying out the high ideals of the founders of this Association.

'Presidential Address, delivered Feb. 21st, 1910, before the Medical Association of the Greater City of New York.

The minor details of administration, the financial questions and the initiative of scientific work have been confided to the Council where frank suggestion, free discussion and prompt action are secured. The results come before the Association for criticism and approval or rejection. In this way, the time of the meeting, valuable for professional betterment, is not encroached upon. A high standard of membership has been insisted upon, predicated upon the ascertained reputation as a gentleman and as possessing scientific attainments, and, further, as legitimately practising some branch of the art and science of medicine. It was at the outset believed that five hundred should be the limit of membership, but a waiting list of men amply qualified by character, education and accomplishment, made it necessary to set seven hundred and fifty as the number beyond which this Association may not go. With a membership of character and position, selecting a representative Council imbued only with a purpose to faithfully carry out the wishes of the Association, we have been singularly free from the scandals which have fostered animosities in the larger societies, and which have brought the profession into general disrepute from their having been noticed and unfavorably commented upon in the lay press. It is unlikely that our harmony will ever be disturbed by this cause.

No less careful attention has been directed toward the scientific work of the Association. Topics have been carefully chosen upon which the papers would either elucidate the newer problems of medicine or present real advances in the subjects in which the interest is always vital. The limitations have been such that the major importance would appeal to those working in

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