2. Remove all urinals from cars, substituting water closets or hopper closets with double hinged lid and cover. 3. Instead of the present method of coach cleaning, all coaches should be thoroughly scrubbed with soap and hot water as often as is necessary, and not less than once a week in any case, with thorough disinfection by live steam or chemicals. Wash all wood work at the same time. 4. As to ventilation and heating we have no recommendations to make at the present time, believing that what is in use is wholly adequate for all needs if proper supervision be had by men employed by railway companies for that purpose. 5. Water coolers should be thoroughly cleaned and scalded at the end of each trip, and supplied only with water from a known pure source of supply, and under no circumstances put ice directly in the water, but cool the water if need be by a properly constructed double-walled water tank. These tanks should not be placed in the closets with a pipe running through the closet wall, but on a bracket in the car, or if possible dispensed with altogether, as we believe that water is one of the greatest known carriers of disease. In conclusion I may merely mention the sanitation of depots and depot ground, which being wholly in the hands of local health boards does not properly belong to a subject of this nature, as it is not a matter of public conveyance, but wholly local. HYGIENE OF THE PHYSICIAN HIMSELF. BY H. B. TANNER, M. D., OF KAUKAUNA. The The history of medicine is the story of civilization. standard of the profession is the barometer of the intelligence of the country. When we look to find the highest development of man in his physical and mental attributes we are led at once to ancient Greece, as the Greeks were the most refined and best educated of all the nations of antiquity, as they so excelled in art and literature that their works remain the models for all generations, as they alone of all the ancients questioned all things and dismissed what could not be proved, so their doctors became the founders of a medical system which was vigorous enough to embrace the developments of time. Esculapius, the blameless physician, in this heroic period made medicine a mystery, and he became a god, the god of medicine. His daughter, Hygeia, who will be much in evidence during this session, was crowned the goddess of health. It is the endeavor of the disciples of Hygeia to seek out and determine the causes of disease and formulate rules for their prevention and removal. As the Society will worship at the shrine of Hygeia for the next three days, it is eminently proper that we pause a moment and ascertain if the hygiene of the physician himself is such as will carry conviction to those whom we endeavor to instruct. The hygiene of the physician should be such a personal application of the rules of life and conduct as shall enable him to do the greatest good to the greatest number. The highest mission of the physician is hygienic rather than restorative. To aid in removing every obstacle to the mental and physical development of the human family is the goal sought for. In applying the principles of hygiene to the physician I will first take up the relation of the physician to society at large. By education and opportunity physicians are given unusual influence in the community. They have the training of leaders and hold confidential relations to a large constituency. They cannot escape the responsibilities of citizenship, as they are specially charged with high public duties in connection with the health of the community in which they dwell. Man is distinctively a social creature. In that fact lies his preeminence among created beings, because in that he has the power which no other of the animal creation can use to the same extent, of each working for all, and all for each. And not only that, but, under a proper organization of society, it is permitted of one generation to reap and enjoy the fruits of the labors of the generations that have preceded it, and of planting for the harvest of its successors. So important is this organization for the welfare not only of society itself but of every individual member of it, that it has come to be recognized as a fundamental law in sociology that a man's first duty is to the State, his second to his family, and his last to himself. Now we are each of us, first, and above all other things, members of this organized society which we call the State or government, and we are men and citizens before we are doctors, or lawyers, or preachers, or merchants, or laborers in any special field of activity, and our first duty is for the preservation of that organization and its advancement in the direction which shall secure to each member thereof those rights and privileges and opportunities which shall lead to the greatest good to himself and the community at large. Even from the most selfish standpoint this cannot but seem reasonable, and its truth must appear axiomatic in its simplicity. This, then, being true, even if we have performed our duties faithfully as physicians, we may have yet failed in the first requisite of good citizenship if we have neglected to let our voice be heard in the management of affairs. I am well aware that views quite the contrary are held by many in the profession and out of it. There are those who contend that so long as a doctor has fulfilled his professional obligations, he can, with a clear conscience, fold his hands and thank the Lord that he is not mixed up with the turmoil of politics or public affairs of any kind, and that it is derogatory to the dignity of the profession to allow extraneous matters of a public character to obtrude themselves upon the time and attention of the physician who has already as great a load of responsibility as he can be expected to carry. A moment's reflection will show that this is a very narrow conception of a physician's duties, and a view of life's responsibilities from a very low plane. Because a man is a physician, he is not thereby absolved from his duty as a citizen any more than are those in other callings. The hygiene of the physician himself is best promoted when he is a partisan in public affairs. A partisan in politics, hostile political parties, ever watchful and critical of each other, are the safeguards of liberty. Of course it is not to be supposed that every doctor should turn active politician, but it should be expected that every true physician will have the good of his country at heart and keep himself well informed on all matters subject to legislation by his representatives, and that he will let his opinions be heard and felt when occasion demands. To attain the high position in social and public life that his education entitles him to as a member of one of the learned professions, that of medicine, the most liberal of them all, the physician must needs give heed to his habits. The hygiene of the physician as applied to his habits requires careful attention. The masses look to the physician as authority on medical knowledge. He who professes to try to prolong human life and ameliorate the sufferings of humanity, should be well qualified to advise in regard to all rules of health, and to give this advice proper weight, his personal habits must be such as will lend the weight of authority to any opinion he may give. If the public see that he governs his daily life by those nevererring laws of nature, they will be more ready to follow where he leads. The public conduct of the physician should be distinguished by sobriety and industry, for the personality of the physician, his disposition and habits, form a large part of his success or failure. Habits of intemperance are so easily formed by the wearied physician that a word of caution is expedient. At times, through overwork, an injurious strain upon the physical and mental forces is unavoidable. The physician becomes sleepless, loses appetite, fails in strength, and shows other signs of exhaustion. Shall he at such times spur on his jaded energies by stimulants or relieve his disagreeable sensations by narcotics? It were suicidal for him to do so. A stimulant or a narcotic may temporarily whip up the exhausted energies, but at the expense of more serious disaster later. The real remedies are rest and nutrition. Physicians should live well and avoid exhaustion by making a special study of foods and their effects upon themselves when suffering from extreme weariness. A cup of cocoa, a glass of milk, a cup of bouillon, or coffee, will do as much as a stimulant, and more, because food is thus supplied in addition. The vexed question of tobacco has a bearing upon this point. If the narcotic it contains is promptly eliminated by the system and the indulgence leaves no unpleasant taste in the mouth, an occasional cigar or semi-occasional pipe may prove of benefit. In no other walk of life is it so absolutely necessary to practice personal cleanliness. In the practice of medicine personal cleanliness may well go first and Godliness second. We have only to point to the elaborate directions in the Mosaic laws for the preservation of health through scrupulous attention to cleanliness, for our authority in stating that physicians |