to use formaldehyde which does not bleach, or otherwise injure fabrics of any kind. Whereas in apartments which do not contain delicate hangings, decorations in gilt, etc., but are plainly furnished, and in school rooms, holds of vessels, etc., sulphur dioxide may be employed. If the latter is selected there should be four pounds of sulphur burned for each 1,000 cubic feet of space. An apparatus for generating this gas can be quickly prepared in the following manner: On the bottom of an ordinary wash-tub, two or three bricks should be laid, upon which is placed a milk pan, or some other metallic receptacle to hold the sulphur. To protect against fire the tub should contain sufficient water to cover the bricks and the bottom of the vessel holding the sulphur. For the reason just stated the pan holding the sulphur should never be placed directly on the floor of the apartment. If it is impossible to secure a tub, a metallic pail containing the sulphur can be placed in a similar receptacle half filled with water. Such an arrangement, however, is not as satisfactory or safe as a tub for the purpose above referred to. The sulphur should be broken in small pieces about the size of a hickory nut; over this alcohol should be poured and ignited by dropping a lighted match on the mass. Care should be taken by the operator to stand as far as possible from the receptacle at this time. If sufficient alcohol is used this method of igniting the sulphur insures almost complete combustion, which is not obtained by the use of a coal of fire, commonly employed. It is important that the pan should not contain too much sulphur as it interferes with proper combustion. For this reason if the room is large, two or more receptacles are better than one. Recent investigation has demonstrated that the presence of moisture is necessary to secure the desired result from sulphur dioxide; this is provided for when considerable humidity exists and during the warm weather, but in winter when the rooms are closed, and are heated and dry, we should supply some moisture-only a little is necessary. Some simple means can be devised for this purpose; for instance boiling water over a gas or oil stove, or pouring boiling water over a gas or oil stove, or pouring boiling water from one receptacle to another in the apartment to be disinfected. A very practical method of securing the moisture is the evaporation of water in a receptacle placed six or eight inches above the burning sulphur. In all instances the sulphur should be so prepared that it may be ignited immediately after the steam has been supplied.

Formaldehyde is employed in many different ways. For instance an apparatus is in use by which the gas is released by heat from the commercial product, known as formalin containing 25 to 40 per cent of formaldehyde. The gas from the apparatus enters the apartment through a tube passed into the key hole of the door; by this method the gas is rapidly supplied, and the result more effective than when slowly produced. By another means the gas is generated directly from wood alcohol. This, however, is a slow process and requires that the apparatus shall be left in the room until the disinfection is completed. Tablets or cones of various sizes and shapes from which formaldehyde is released by burning are in

plicity and are easily handled. However, they also give off the gas slowly in the closed room. The advantages of a method by which the gas is rapidly produced and can be forced into the apartment by an apparatus operated outside is manifested. In this manner the entire amount of gas required for each disinfection is rapidly expelled from the apparatus; therefore the volume is greater and the germicidal effect presumably more pronounced than when the gas is slowly generated; besides in the methods where the production of formaldehyde, or sulphur dioxide is carried on inside the apartment, and not in view, something may occur to interfere with the production of the This applies more particularly to formaldehyde. Unfortunately a formaldehyde apparatus which can be operated outside the apartment is complicated and expensive, but if it can be procured I believe it to be the most satisfactory method now in use for securing formaldehyde disinfection. Whether sulphur dioxide or formaldehyde is employed, the apartment should remain under disinfection for eight hours. Great care should be observed in entering the apartment at the expiration of this time as the gas still present may prove very irritating to the respiratory tract. A wet sponge or towel applied to the face will prevent this, and gives time to open a window and allow the gas to escape and fresh air to enter. It will be found that a greater length of time will be required to remove the irritating qualities of formaldehyde than sulphur dioxide, and the use of ammonia which has been recommended to neutralize the formaldehyde present has as a rule but a transient effect. The persistence of formaldehyde is particularly apparent, when the contents of drawers, closets, etc., are not removed and spread

out.

In small towns where it is impossible to secure the benefits of steam disinfection, we must depend upon sulphur dioxide or formaldehyde for general disinfection. It must be remembered, however, that neither of these gases will insure deep disinfection. Therefore whatever remains in the room must be spread out and hung up. Clothes lines can be carried from one side of the room to the other, and the material spread out and held by clothes pins. The placing of clothing, etc., over the backs of chairs will not suffice. Material soaked with discharges should be burned if steam disinfection is not available, or, if it is impracticable to disinfect with bichloride of mercury or carbolic acid. Matresses can be saved after disinfection with sulphur or formaldehyde if they have been previously covered with a rubber cloth, over which is placed a comfortable and sheet, provided, of course, no soiling is found. After the disinfection of an apartment it should be well aired for at least fortyeight hours-a longer time may be required where formaldehyde has been used for disinfection.

In the disinfection of cess-pools, drains, privy-vaults, airshafts, etc., I can suggest nothing better or more effective than the free use of chloride of lime, or milk of lime. Care should be taken that the chloride of lime is purchased in tight packages, otherwise its value is impaired. Milk of lime should be made by adding one quart of freshly slacked lime to four or five quarts of water. Air slacked lime should not be used as a disinfectant. The

free use of lime may be employed in the disinfection of fecal matter, discharges, etc., if carbolic acid or bichloride are not available. In these cases the milk of lime, or the chloride of lime in the proportion of eight ounces to a gallon of water can be used. Lime is also a very valuable deodorant.

As health officials we are occasionally called upon to neutralize the very offensive odors which emanate from debris containing the bodies of persons or animals destroyed by fire, fallen buildings, etc., or in other cases where the decomposition of organic matter is in process. Although lime is valuable for this purpose, it does not penetrate as easily or act as efficiently as bromine, which I believe is the best practical deodorant we possess. This agent is sold in solution in tightly sealed bottles which are packed in whiting in tin boxes. It is intensely irritating to the respiratory tract and therefore it should be used with great caution in order to avoid danger. In making a weak solution of this agent to neutralize offensive odors, the unopened bottle containing the bromine should be carefully dropped to the bottom of the cask or receptacle containing the water and then broken with a crowbar, or some heavy implement, and the contents of the cask well stirred. For the purpose above referred to the bottle of bromine should never be opened above the surface of the water. The addition of four ounces of bromine to sixty gallons of water is generally sufficient to act as a deodorant, although a stronger solution may be required. It can be distributed in no better way than by using for this purpose an ordinary garden sprinkling pot. This should be repeated once or twice during twenty-four hours.

In practical disinfection and in public sanitation, too little attention has been given to the value of soap and water; for instance the scrubbing of the floor, walls and desks in school rooms, combined with thorough ventilation is, I believe, superior to the ordinary disinfection. Woodwork which is constantly used or handled, soon becomes greasy and dirty, and it is not improbable that this may protect specific organisms against the action of a disinfectant. Furthermore, I do not believe that the value of air and sunlight as disinfectants is fully appreciated and I am quite sure that modern sanitation will demand that these agents as well as cleanliness shall receive greater consideration in our efforts to preserve the public health.-Medical Review of Reviews.

STREET CAR COLDS.

At a meeting of the St. Louis Medical Society on February 28, Dr. F. C. Ewing read a paper on this subject and offered the following resolutions, which were unanimously adopted by the society:

"Recognizing the fact that many colds and diseases of the respiratory organs are acquired by riding in draughty, ill-ventilated, cold and crowded street cars, wherein the element of time conspires to produce a prolonged chilling of the body, terminating in localized congestion and consequent respiratory catarrhal affections, it is hereby declared to be the sense of the St. Louis Medical Society that street car officials should take measures for a more uniform and equable temperature in our cars, with pro

tection against draughts and especially in such cars as run far out into the suburbs, where passengers must sit still for an extended period of time.

"And it is further declared that such lines of cars as make long runs, compelling long-distance passengers to endure a temperature under 60 degrees F. be condemned as dangerous and a menace to the health of their passengers and their patrons, who are hereby warned to seek other means of conveyance."-Medical Record.

THE AIR IN THE SUBWAYS.

With the prospects of a speedy termination of the frightful upheaval of the New York city streets looming close, the question of its interior ventilation is one of paramount importance.

The recent experiences in the "tuppenny tube," London's latest underground railway, is one which calls for urgent discussion and enhances the desirability of a thorough understanding of what provision is being made by our subway engineers.

In London it has been noted that many passengers, especially those who were riding long distances in the underground electric, suffered from intense headaches and even symptoms of air hunger. So many were affected that an investigation became imperative and it was found that the amount of carbonic dioxide gas in the tunnel was in great excess of the normal limits.

Some recent figures that are presumably authentic we present herewith. During hours of limited traffic:

On platforms at 8:15 A. M...

On platforms (Saturaday), 7 P. M..
In elevator, 10:10 A. M...
In cars, 9:30 A. M., from city.
In cars, 1:30 P. M., from city.
During hours of heavy traffic:
On platforms, 4 to 7 P. M..
In cars, 9:30 A. M., to city..
In cars, 4 to 5 P. M., from city..
In cars, 6 to 6:45 P. M., from city.
In cars, 6:10 P. M., from city....

Carbonic acid

in 10,000 vol

umes of air.

4.23

3.74

7.36

4.33

5.33

..11.04

.16.65

13.74

15.54

.20.46

The carbonic acid tests were made between December II and 15. The range of outside temperature was between 37° and 56° F. The range of temperature on the platforms was between 56° and 76° F. and in the cars. between 66 and 76° F. The barometric pressure throughout the period of the experiment was very constant, ranging between 30.1 inches and 30.2 inches. Readings with the anemometer showed an air movement due to forced draught and train movement of from one mile to five miles per hour. Some of the tests were made with the Chattaway and Wharton apparatus, and some by the Pettenkofer method. One method was employed to check the other, and the mean average result was 16.62 volumes of carbon dioxide in 10,000 volumes of air. This is an amount much above the bearable average.

It has been assumed that, inasmuch as the cars were in such close connection with the surrounding tubular masonry, that an entire renewal of the air would result from the powers of suction. Apparently this has been a forlorn hope, for all that has been accomplished has

Have the engineers of the subway considered this problem sufficiently; and what of our new tunnels under the North River and to Brooklyn, in all of which the problem is destined to be one of extreme seriousness? Underground railways, such as these, permit of the accumulation of enormous quantities of confined air that must be removed or regenerated. It is idle to discharge this question with the familiar "diffusion of gases" theory-the dangers are real and are soon to be met.

The necessity for some definite outlining of plans as to what is to be done by the engineers of the various tunnels to obviate these grave dangers is apparent, and competent sanitary engineers as well as the New York Health Department should be taken into consultation.Medical News.

FILTH DISEASES.

GEO. M. STERNBERG, M. D., LL.D., SURGEON GENERAL U. S. ARMY, RETIRED, EX-PRESIDENT AMERICAN MEDICAL ASSOCIATION, WASHINGTON, D. C.

Bubonic plague, cholera, and typhoid fever have long been classed as "filth diseases," and in a certain sense this is correct, although we now know that the germs of these diseases not only are not generated by filth, but do not multiply in accumulations of filth. They are present, however, in the urine discharges of the sick and when this kind of filth is exposed in the vicinity of human habitations or gains access to supplies of water used for drinking purposes the germs are likely to be conveyed to the alimentary canals of susceptible individuals and thus the disease is propagated.

Laboratory experiments indicate that an increase of these bacteria in drinking water does not occur under ordinary conditions, but they may preserve their vitality and pathogenic potency for some time. In the experiments of Kraus the typhoid bacillus was found to die out in unsterilized well water, at a temperature of 10.5° C. in from five to seven days, while the cholera spirillum did not survive more than two days. At a higher temperature, however, and in water contaminated with sewage the typhoid bacillus and the cholera spirillum may survive for several weeks and in the case of the typhoid bacillus a notable increase may occur for a time.

Until quite recently, the attention of sanitarians was so firmly fixed upon the transmission of cholera and typhoid fever through the agency of contaminated water that certain other modes of transmission were overlooked, or at least underrated. I refer to transmission by insects and of dust. I have for many years insisted upon the part played by flies as carriers of infectious material from moist masses of the excreta of patients suffering from cholera or typhoid fever. There is good reason to believe that the bacillus of dysentery and the bacillus of bubonic plague, are not infrequently carried in the same way and deposited upon articles of food, in milk, etc., destined for human consumption.

The cholera spirillum is quickly killed by desiccation and this disease is probably very rarely, if ever, communicated through the medium of dust. But the germs

ant and without doubt these diseases, under certain circumstances, are extensively propagated by means of dust containing desiccated excreta.

There is good reason to believe that in several of our camps, during the Spanish-American war, this was an important factor in the etiology of typhoid fever epidemics.

A most notable example of the beneficent results following the practical application of sanitary measures. based upon exact knowledge relating to the etiology of an infectious disease is afforded by the recent extinction of yellow fever in the city of Havana, which city has for many years been the headquarters of this disease in the West Indies and the focus from which it has been repeatedly introduced to seaport cities in the United States and elsewhere. According to the reports of the health officials in the city of Havana there has not been a case of yellow fever in the city of Havana for more than a year, and the extinction of the disease is ascribed entirely to the vigorous measures enforced to prevent its transmission by mosquitoes of the species proved by the researches of Reed and Carroll to be the intermediate hosts of the yellow fever parasite-still undiscovered-and the active agents in the transmission of the disease from man to man. Prior to this important demonstration yellow fever was generally regarded as one of the fifth diseases, although there were many facts connected with its epidemic prevalence which appeared to be opposed to this view. In the light of our present knowledge we can no longer class it with typhoid fever, cholera, bubonic plague and dysentery, in which diseases the germ is known to be present in the discharges from the bowels of the sick and which are consequently well named "filth diseases."

For the prevention of these diseases no single agency is more important than the use of properly constructed. sewers for the reception of such filth and its removal from the vicinity of human habitations. Sewers had come into use and had the warm endorsement of sanitarians long before the discovery of the germs of the infectious diseases under discussion and before it was positively known that the infectious agent in these diseases is present in the discharges from the bowels.

But now that we have an exact knowledge of the etiology of these diseases, the reason for the beneficent results attending the use of sewers, in connection with an ample and pure water supply, are apparent. It may be safely. asserted that a city or town having a complete and satisfactory sewer system and a pure water supply is practically immune from epidemics of cholera or typhoid fever

provided, of course, that the sewers are used for the purpose for which they are intended, and that streets and back yards no longer serve as receptacles for filth, as was usual during the pre-sanitary period, even in great cities like London and Paris. The axiom tout a l'égout now governs the practice, not only in Paris, but wherever the fundamental principles of municipal sanitation are understood and sewers have been constructed. Unfortunately the cost of sewer construction, the reluctance of taxpayers to part with their money, and the ignorance or indifference of municipal authorities have conspired to prevent the accomplishment of this fundamental sanitary

measure in very many towns in the United States, and our endemic plague typhoid fever, continues to claim a large annual quota of victims in such localities. Mortality rates in towns and cities throughout the civilized world depend to a large extent upon the purity of the water supply and the efficiency of the system of sewerage disposal, and the constant improvement which is shown by the mortality statistics of countries which have made the most progress in this direction is undoubtedly largely due to these two factors. Med. Mirror.

METHODS OF CLEANING RAILWAY CARS.

The crusade which is being waged against the insanitary conduct of the street and elevated railways of New York has awakened attention to the question of railway hygiene generally. The American public is inclined to be somewhat too easy-going as regards such matters, and so long as the cars travel quickly and are equipped in a fairly comfortable manner the sanitary arrangements are not looked into, or disregarded as of no account. The discontent, however, so recently and so widely manifested by the inhabitants of greater New York with the service and management of its lines of transportation, has opened up the whole subject of the sanitation and ventilation of rail way cars. In view of this attitude on the part of the population of the country, the Medical Record has thought that it would be opportune to make inquiries as to the exact condition of affairs with regard to the methods in vogue of cleaning-car equipment, and of ensuring good hygienic conditions whilst traveling by train. Accordingly, the Pullman Company was communicated with, and the following description was given by its superintendent of the measures taken for the protection of the health of its patrons:

(1) All the cars are thoroughly cleaned at the end of each trip. The upholstery, carpets, and bedding are taken out of the car and the dust is removed from the plush and carpets by means of compressed air; the mattresses and pillows are beaten and aired and the blankets are shaken and aired. (2) The hoppers are flushed automatically each time they are used, and as a part of the process of cleaning given to cars at each end of every trip, the closets and all fixtures therein are thoroughly washed and disinfectant applied. (3) If an invalid occupies a berth in one of our cars, the bedding is removed and disinfected as soon as possible after the berth has been vacated. In the event of an invalid suffering from a known infectious or contagious disease occupying a car, it is thoroughly fumigated under the direction of a local health. officer, and the car is not allowed to return to service until proper permit has been issued by such officer. Cus pidors are also frequently cleaned and disinfected while cars are en route.

For the protection of the traveling public from the danger of infection from consumptives traveling in cars, the following instructions have been in force for more than four years:

"It is therefore important that the Pullman Company should do everything in its power to prevent the spread of the disease, and to that end it is deemed best that all cars which have been occupied by a consumptive shall be

fumigated after such occupancy, and before the car is permitted to make a return trip to its starting point. All cars running to points within regions regarded by consumptive persons as favorable health resorts should be closely watched and cared for, and the car service men instructed to report to the district superintendent at the termination of the trip if any person suffering from consumption or other contagious or infectious disease has occupied a berth in their cars, and if so measures must be taken by the district superintendent to have such car or cars immediately fumigated according to the approved methods now in use by the company. In addition to the foregoing, and in order to prevent, as far as possible, the spread of contagion, all cars in such line should be fumigated at least once a month. The spittoons in all cars occupied by sick persons are to be frequently cleaned."

From a consideration of these rules the fact will be gathered that the Pullman Company's regulations as to cleaning and disinfecting are sufficiently comprehensive and should be effective. It goes without saying that this is a matter of vital importance that every precaution should be taken to avoid spreading disease, and to render railway traveling prejudicial to health in the slightest possible degree. When a large number of people are cooped together in a comparatively limited space for a considerable period of time-as is the case during a long railway journey-the opportunities of contracting the disease are greatly increased, and it is therefore essential that extreme care should be exercised to avoid such event

ualities. It is probable that, on the whole, there is less fear of disease being communicated on long journeys than whilst traveling in New York under the conditions prevailing on the elevated and street railway systems at the present time. The overcrowding which is so prominent and disgustingly unhealthy a feature of the New York local lines, is absent on the main railways. Long distance railway traveling is far superior in the United States as regards comfort and attention to sanitation than in any country, and although the acme has not yet been reached, such improvements are introduced every year as to convince the public that railway officials appreciate the fact that it is to their best interests to consider travelers in every way.-Med. Record.

THE RAILROADS AS CIVILIZERS.

The people of the United States do not realize the momentum of things. Nor do they realize the overwhelming stimulus railroads are giving to the country. Take out railroads and what would the country be? Take out the American spirit and we would drop to the South American level. A score of factors constitute the people. The world stands aghast at Americanism and what it portends. All Europe is quaking at threatened dangers. What are these dangers? That we may force Europeans. to wake up and use their bodily and mental energies to better advantage.

A score of mightly invisible forces are at work among us. Why recount them? Some of them we are not aware of. They are working far beneath the surface. Our eyes see only on the surface, and we overlook the great forces that are re-arranging with almost volcanic fury the agencies which direct and control a whole people.

Ostensibly the whole purpose of our seething activity is to get money or what money buys. So far so good. Incentive must exist before effort can be expected. The peculiar characteristic of Americanism is that its standard of living and its ideal of justice, liberty and right are higher than among other people. Just how it comes we have such a standard does not enter into the underlying thought. The thought lurking behind these lines is that a new and in many respects a different force has developed itself in the human mind.

What there is hidden in this force is unknown and unknowable. American civilization embodies elements and elemental possibilities not yet manifested.

No preceding civilization has shown those peculiar characteristics visible in ours. The puropse of our civilization if it can be guessed at has one or two fundamental elements in common with the theocratic civilization born in Judea, upwards of two thousand years ago. That civilization sought humanity to instill into it the inspiration of Divine origin. Our civilization has for its apparent purpose the enlistment of humanity into the army of industry. The world plunged into the abyss of the dark ages because there was no industry.

We have industry, but the world must have it, and it is to be the business of the United States to see that the world is enlisted industrially. In short, the world is to be and must be set to work.

The railroads are to do it or be the means of it. They have set out upon the task. Nothing can obstruct it. Railroads are being built in every clime, up and down and across South America, across Africa from the Cape to Cairo, and east and west from ocean to ocean, around and over and through its Rockies and Andes not yet named. China is on the eve of railroad development. Belgian, French, German, British and American capital is being piled up in heaps to set the Chinese people moving. All Central Asia is to be cobwebbed. Siberia has had its first smell of railroads. Palestine and the drowsy Bible lands are being penetrated.

The signs abound. The spirit of civilization is embodying itself in steel. The half-ragged, slothful, teeming millions of all lands will soon look on steel rails, stretching their serpentine or arrow like courses around their fatherlands and wonder what it means. They will not suspect. They will think the foreign devils who sweat and tug and toil putting steel rails across their countries are fools.

There is nothing so transforming to a human being as to look behind the horizon that has been holding him. The world is to get acquainted. People are to be told to get hungry-hungry for something they have not got then to make or get something and give it for what they want. This is the business of railroads. Railroads are to be the foundation of the world's awakening.

All this will come gradually, gently. People are tired staying at home. The one thousand millions and more of more or less civilized people beyond Europe and beyond America will go somewhere just as soon as there are arrangements made for them to go. Locomotives and cars will meet that want.

We are on the eve of the grandest development the

world ever saw. Its music will be the hum of industry. Its inspiration will be desire. The time is near when the pent-up forces can break loose and spread.-International Railway Journal.

Notices and Reviews.

"Lectures on Nasal Obstruction." By A. Marmaduke Sheild, M. B. (Camb.), F. R. C. S. (Engl.), Surgeon to St. George's Hospital, London, and Surgeon in charge of the Throat Department. With one colored plate and 27 illustrations in the text. Philadelphia: P. Blakiston's Son & Co. 1901. Pp. 106. Price, $1.50 net. This is a convenient little manual, being the substance of three "clinical" lectures, designed to assist the student or junior practitioner in the recognition of the several conditions, any one or more of which may serve as the cause of nasal obstruction. The points of diagnosis are tersely given, and for each condition as described the proper treatment is briefly outlined, which of necessity is chiefly surgical. The illustrations are particularly meritorious.

In full appreciation of the difficulties and shortcomings of the posterior rhinoscopic examination, the author favors the making of a deliberate digital examination, and under general anesthesia if necessary, after which, if required, an operation can be immediately done. In the matter of treatment the author is at all times radical, and his description of Nasal Polypi iş to be particularly commended as being most thorough and logically correct. EDWIN PYNCHON.

"The Mattison Method in Morphinism." By J. B. Mattison, M. D. New York: E. B. Treat & Co. 1902. $1.00.

This little brochure of some 40 pages gives an epitome of the author's views, gathered in many years' practice devoted to treatment of the drug habits. The number of physicians addicted to morphin, as given by Dr. Mattison, is absolutely astounding.

The following publications are announced by Messrs. W. B. Saunders & Co., Philadelphia, New York and London:

NEW BOOKS.

"The Vermiform Appendix and Its Diseases." By Howard A. Kelly, M. D., Professor of Gynecology, Johns Hopkins University, Baltimore; and E. Hurdon, M. D., Assistant in Gynecology, Johns Hopkins University, Baltimore.

"Myomata of the Uterus." By Howard A. Kelly, M. D., Professor of Gynecology, Johns Hopkins University, Baltimore.

"A Text-Book of Legal Medicine and Toxicology." Edited by Frederick Peterson, M. D., Chief of Clinic, Department of Neurology, College of Physicians and Surgeons of New York City; and Walter S. Haines, M. D., Professor of Chemistry, Pharmacy, and Toxicology, Rush Medical College, in affiliation with the University of Chicago.

"A Text-Book of Operative Surgery." By Warren Stone Bickham, M. D., Assistant Instructor in Operative Surgery, College of Physicians and Surgeons, New York Citv.

"The Practical Application of the Röntgen Rays in Therapeutics and Diagnosis." By William Allen Pusey, M. D., Professor of Dermatology, College of Physicians and Surgeons, Chicago; and Eugene W. Caldwell, B. S., Director of the Edward N. Gibbs Memorial X-ray Labo