Perhaps the greatest obstacle to overcome in the carrying out of measures of quarantine, is public sentiment.

Public sentiment requires all smallpox patients to be sent to a pest house-except in the great State of Wisconsinthough, with rare exception, such patients can be of danger only to the ignorant who have refused vaccination. Public sentiment checked immigration and commerce in the effort to quarantine against cholera; yet this same public sentiment would characterize as barbarous the isolation of consumptives, with every provision for their comfort, in hospitals so arranged as not only to prevent the spread of the disease, but to afford every possible chance for the relief or cure of their inmates.

Many things may still be done to limit the spread of tubercular disease without removing the consumptive from his customary associations.

Fortunately, in the vast majority of instances, we can restrict our attention mainly to the expectoration.

The question of transportation is a vital one. I believe a sleeping car or a palace car on one of our transcontinental trains a dangerous source of infection, as a considerable proportion of travelers are consumptives seeking warmer or drier climates, while a nearly equal number are persons predisposed to the disease but not yet infected. Imagine the two

classes mentioned spending from three or four days to one week in the confined air of one of these cars occupied as well by other reasonably healthy individuals, or spending a number of months at a hotel which is practically a hospital for consumptives. How many physicians are in the habit of advising their patients to seek health in some other more salubrious or favorable location, either on this continent or abroad, thus materially and certainly assisting in the spread of the germs of this disease; a fact that is gradually developing an opinion in certain localities that is not at all favorable to its continuance. It will not be long before a strong pro

test will be urged against such conditions. Wisconsin, California, New Mexico and Colorado are already beginning to realize the evil effect upon their own inhabitants, upon their own security from the disease itself, upon their own prosperity financially, and see plainly the result of such action is the giving up their own prospect of health or longevity for the benefit of the health of others. Can physicians, as exponents of sanitation, maintain their mental equilibrium and advocate such a policy with the expectation that the people will bear with them and not exercise their own mental powers? I think not!

Among other reasons we will mention, the absolute necessity of isolation of any one member of a family; if for no other reason, the question of longevity is of very great importance, not only admitting the marked increase in constitutional delicacy from inheritance, but also acquired from the unsanitary surroundings that usually accompany a serious case of this disease. Also the vital question of marrying or giving in marriage for the purpose of perpetuating these weakened constitutions until at last it becomes simply a "survival of the fittest," or when an entire family perish, thus destroying all hope of ancestry."

"We believe that all citizens have an inherent right to the enjoyment of pure and uncontaminated air and water and soil; that this right should be regarded as belonging to the whole community; and that no one should be allowed to trespass upon it by his carelessness or his avarice or even by his ignorance."

These propositions are recognized by the public but they are not enforced, and the reason of that is, "that the public mind is not sufficiently aware of the dangerous elements around us; does not understand the connection between filth and disease, and is not convinced that undrained land is unwholesome to live upon."

MEASURES ΤΟ PREVENT PHYSICIANS FROM

CONTRACTING CONTAGIOUS DISEASES
WHICH ENTER BY THE AIR PAS-

SAGES.

BY J. J. HOWARD, M. D., OF COLUMBUS.

In order best to guard against the specific cause of diseases which enter by the air passages, it is needful to know much of their etiology. As regards the most important of these diseases, this knowledge is now available. Some degree of resistance to the successful entrance of specific diseases, is the rule in all healthy human beings. This resistance is of at least two kinds. First. The resistance of an unbroken surface. Second. The resistance of the normal tissues and fluids of the body, including the destructive power of the bloodserum on the microscopic cause of diseases. Atmospheric temperature, and other conditions of the atmosphere, have to a great extent controlling influence over the entrance of most of the specific diseases. Simply lowering the temperature of the body is sufficient to cause some animals to contract a specific disease, which otherwise is not contracted. Thus Pasteur caused fowls to contract anthrax by causing the fowls inoculated with anthrax to stand in cold water.

It should be generally known, that as a rule, all inflammatory diseases of the throat, air passages and lungs, are increased by exposure to a cold atmosphere. The same is true of all specific diseases, which generally enter the body by way of the air passages or lungs. Thus diphtheria is most prevalent in the autumn and winter months, there being twice as much sickness from it during the month of November as there is in July. This indicates that exposure to the inhalation of a cold atmosphere increases the danger of contracting diphtheria. The same can truly be said of all diseases which

gain entrance to the system by the air passages. As a prophylactic measure against diphtheria, the physician should avoid exposure to extreme cold, and should guard against chilling his body by the use of proper clothing. During the prevalence of diphtheria, the specific bacillus is undoubtedly widely distributed and is inhaled by a great many people, and very little is needed to precipitate an attack.

Great care is to be exercised during the examination of patients by guarding the face with a rubber tissue mask, avoiding inhaling the infected breath, and using every known. means to guard against infection by keeping the secretions of the mouth and throat healthy by the free use of chlorate of potassium gargles and tablets, and cleansing the throat, face, and hands, with some disinfectant solution after the examination of each case of diphtheria.

When visiting infectious diseases like diphtheria and scarlet fever, the physician should wear a rubber coat and thus avoid becoming a carrier of contagion. For the prevention

of pulmonary tuberculosis, and other tuberculous diseases, the most important measure is the disinfection of all sputa of consumptive patients. If this could be completely accomplished it would probably go far toward lessening the risk of the physician and the entire prevention of the disease. Το avoid the liability of inhaling the dust of rooms occupied, permanently or temporarily, by consumptive persons, the air in which is liable to contain the dust from dried sputa of the consumptive person, one important measure is the providing of cuspidors containing a strong disinfectant. One of the most important measures, however, relates to the ventilation of all occupied rooms, which should be so planned, that the movement of the air in the room should be constantly downward, and out at the floor level. This reduces to a minimum the danger of the particulated cause of consumption, rising from the floor or carpet on which it may have fallen with the sputa of a consumptive person. It is apparent that

no physician can control except to a limited extent the ventilation of rooms into which he goes. All such measures are

proper subjects for action by governments, local, State and national. Much exposure to cold and damp favors the occurrence of consumption. It is also apt to follow the occurrence of pneumonia, and all the inflammatory diseases of the throat and air passages, and all these are apt to follow exposure to a cold atmosphere.

Tubercular diseases are wasting diseases and there seems to be reason for believing that an important factor in their prevention is the maintenance in perfection of the quality of the blood, especially of its albuminous constituents. Good food and plenty of it, avoiding all extremes of exposure to cold and fatigue. The importance of outdoor life for the prevention of consumption is generally accepted. How and why it is effective has not been much dwelt upon; but the increase of appetite for food consequent upon outdoor exposure is well known, as also the fact that the oxidation of effete matters in the body, which in persons who live indoors so frequently stop short of completion, and thus leave in the body irritating substances like uric acid, is more completely effected in persons who remain much in the outdoor air. Theoretically, with our present knowledge, consumption, which is still the most important cause of mortality, is now, next to smallpox, one of the most easily preventable diseases. The next quarter of a century should see it lessen in importance as a cause of deaths until it takes its place alongside of smallpox among diseases whose greatly lessened mortality has been brought about by special methods in general sanitation. Something of the importance of what this implies to mankind throughout the world may be inferred from a comparison of the present mortality rates from consumption and smallpox.

Conveyance of typhoid fever infection by air. It has been estimated that the typhoid infecting germ finds its entrance

22-S.M.S.