are given master minds in master bodies, this gift is not for all, and that to spur on the weary faculties is to drive to ruin. Still, if one must plainly see that his talents are far below the maximum, even far below what he had hoped and believed, why should he dissipate what he has in attempting to be what he is not and in fretting because he can not? How many of us exhaust ourselves and wear out our friends by chafing against the chains of the unalterable! Imperturbability is a prince of peace.

Of especial danger is the weakness of being ruled by the feeling-by emotion rather than by reason, by impulse rather than by judgment. In the bitterness of recognized folly and acknowledged frailty, Burns wrote for his own epitaph:

If this was written with the plaintive note of a sensitive spirit prisoner to turbulent passions, it was also written in the light of keen perception. A principle of human development is bound up in the lines. The head is to guide the heart. Impulse and emotions are to be governed by knowledge and wisdom.

Inhibition should never sleep. Exaggeration of the instinct of fear and apprehension not only makes people nervous, but is nervousness itself. The thousand and one needless worries over the future are simply providence for the morrow gone mad. Fear of disease and death is normal, but to allow the mind to dwell on these fearsome things is to become a hypochondriac with no more stability than the leaf on the aspen. To shrink from pain is as natural as hunger and as necessary for the preservation of the race, but to be a slave to suffering is to be a nervous wreck. Pain should be a signal officer only-to inform, never to command. Even the godly emotion of parental love must not be too exuberant. How many mothers become mere bundles of nerves through needless fussing about the children, and how often a father falls into presenility from the constant strain to feather the nest superlatively well. To weep is normal, but the one who never restrains the impulse to cry ultimately becomes flabbily lachrymose, a nuisance to self and others. Every human being has, now and then, a "fit of the blues," but he who allows himself to be regularly dominated by mental depression becomes an enervated personification of gloom, a victim of the most distressing form of nervousness.

To sum it all up, if you wish never to be nervous, live with reason, have a purpose in life and work for it, play joyously, strive not for the unattainable, never regret the unalterable, be not annoyed by trifles, aim to attain neither great knowledge nor great riches, but unlimited common sense, be not self-centered, but love the good and thy neighbor as thyself.

BUBONIC PLAGUE CONFERENCE.-The National Convention of Delegates from the various State Boards of Health called to consider the danger threatened by the possible introduction of the bubonic plague into the United States assembled in Washington, D. C., January 19. This convention was called by the Surgeon-General of the Marine Hospital Service, and was demanded by the State Boards of Health of Connecticut, Colorado, Texas, Louisiana, Minnesota, Maryland, Illinois, New York, and Pennsylvania. Representatives of 19 State Boards of Health were present at the conference. Resolutions were unanimously adopted declaring that the present danger to California and to the United States lies primarily in the persistence, during nearly three years, of a definite nidus of plague infection in that part of San Francisco known as Chinatown; that the gravity of this circumstance has been greatly increased by the gross neglect of official duty by the State Board of Health of California and the obstructive influence of the recent Governor of California, by the failure of the city government of San Francisco to support its city Board of Health, and by the obstacles opposed to the operations of the United States Public Health Service.-Am. Med.

CARCINOMA OF THE MALE BREAST.-In a recent number of the Bulletin of Johns Hopkins Hospital, Dr. L. M. Warfield reports the following data on this interesting subject: The author has collected all the cases reported since 1890; they are but thirty-two. Nine cases are added, of which one was observed by the author. The relative frequency of the disease in the two sexes varies greatly. Out of 307 cases of mammary cancer, only three were in men. As regards age, twenty-five of the fifty-seven cases occurred between the ages of forty and seventy. The youngest was twelve years old, the oldest ninety-one. The duration of the disease varied from thirty-five years, the longest period; the shortest being two weeks. Either breast may be affected indifferently. There was a definite history of injury in eight out of the thirty-seven cases. Pain was only noted nine times; ulceration occurred in thirteen of the cases. In twelve retraction of the nipple was present, and a discharge from the same once only. The axillary glands were enlarged in twenty cases. Microscopically the tumors were precisely alike in both sexes. All the varieties of cancer met with in women may be also be encountered in men, but it seems that atrophic scirrhus is far more common in women. In the latter, too, the nipple is more apt to be less severe in male than in female mammary cancer.

What the State and the Municipality Can do to Create an Environment Favorable to Health.

I

M. V. BALL, M. D.

WARREN, PA.

President Board of Health.

TAKE it that disease is a result of the failure of the organism to adapt itself to its surroundings. Life is a process of adjustment, and in so far as we fail to adjust ourselves to the continual changes in our environment, we degenerate and become the subject or host of parasites and the various organs of our body cease to functionate and die. To prevent disease, therefore, we have either to make our tissues resistant so as to repel invasion, or we must alter our surroundings so as to destroy the disease producing factors.

The efforts of medicine have been largely directed to the endeavor to make the individual disease resistant; or failing in this, to antagonize and neutralize and repair the effects of the evil. Some attention, too, has been given to the environment and measures, on a more or less extended scale, have been put in operation to destroy disease producing agents. Thus recently the active warfare in Havana against the mosquito, which is believed to be the most important disseminator of the yellow fever parasite. Likewise, the efforts of all boards of sanitation in removing nuisances and securing pure food and drink.

Since the investigation of Weissman and his followers, heredity as a cause of disease, has lost much of its importance. Where the structure of the organism is deficient in some of its elements at birth, due either to some interference in nutrition during the process of formation or some mechanical disturbance of the embryological process, the germ cells may become so altered as to reproduce this alteration in succeeding generations; but the greater number of diseases are such as attack the individual during his own lifetime, and do not influence that portion of his organism which transmits his physical characteristics to his children. We are concerned with heredity only in so far as we would avoid the breeding from degenerated stock, from parents who from birth are markedly defective. How much the environment has to do with the production of even such congenital defects, as idiocy and insanity, an environment surrounding the mother during the development of the fetus, no one has as yet thoroughly determined. Whatever seriously affects the nutrition of the mother during pregnancy must have an influence on the fetus. Thus, environment in its broader sense is an important factor in the causation of disease, and one which man has sufficiently under control to shape for good or evil. In the economic and social world, many of the natural and physical forces have been utilized or provided against, and from earliest times man has made himself master of some of them. Deaths still occur from cold and heat, earthquakes, floods and volcanic outbursts, wolves and other wild beasts still attack the habitations, and worst of all, war between man and

man has not ceased to claim its many victims, yet for the most part, civilized man lives in comparative safety, safe from famine, frost, fire and flood and the outbursts of wild animals and savage tribes. Thousands, however, die annually from diseases which are clearly preventable; thousands are killed annually in accidents which are clearly preventable. Indirectly, the individual is responsible himself, but more often the social group, be it city, state or nation, is the offender, at least it is in a position to prevent the disease when the individual alone is powerless.

With our present knowledge, what can an enlightened government do to prevent disease, when it seriously determines to utilize this knowledge?

HOUSING OF THE PEOPLE.

That disease is caused by living in crowded and poorly constructed tenements, municipalities are beginning to recognize and are enacting laws to control the construction of the larger tenements, and are destroying hovels and rookeries which have grown very unsanitary. There should, however, be laws which would require all living houses to be built on streets of ample width, never in courts and alleys. All streets to be provided with shade trees, and at regular intervals of not more than six blocks, an open square or breathing park. The pavement on such streets should be easily cleaned and noiseless. Horseless carriages which, no doubt, will soon become general, should have constructed for them special roadways leaving the regular pavements for the pedestrian solely. The houses themselves, whether tenement or private, should be approved of by a board of sanitary engineers, who shall see to it that each new house constructed shall be as sanitary as our knowledge warrants. The use of wall papers and carpets should be especially condemned, and all fittings and furniture that cannot be thoroughly and frequently cleaned. Whenever tenants remove from apartments, the apartments should be well disinfected before new tenants are allowed to use the same. Laws in regard to plumbing and fire escapes, ventilation and toilet facilities are embodied in the recent New York Tenement House law which has many other features worthy of imitation and which is a step in the right direction. Al houses which have become permeated with insects, vermin, mould and are poorly constructed, and so unhealthy as residences should be condemned, and if not possible to properly repair, should be destroyed as nuisances whether inhabited by the owner or tenants. Sanitary architects should be employed by the city to study up new designs and devices and supply the citizens with the plans in order to bring about not only a city of healthy houses, but also a beautiful city.

THE AIR.

That the air we breathe is very often a conveyor of disease, the laboratory experiments in bacteriology have repeatedly shown. The air is laden with disease germs, not only of tuberculosis, but of pneumonia and influenza, diseases which are responsible for many thousands of deaths annually. The dust, too, of the streets contains germs and spores derived from the manure of the lower animals, and how many intestinal diseases, especially of children are due to the entrance of these germs, con

veyed from the dust to food, and so into the body, it is not possible to say. Wounds suppurate from the action of air-borne bacteria. Again, the air is rendered heavy and impure by the smoke of many factories and engines. All factories and locomotives should be compelled to use smoke consuming devices. The streets should be carefully swept and kept clean continually, and in every way possible should the accumulation of dust be prevented. That the dust and dirt of a big city is a frequent source of disease, causing among other things, catarrhal affections of the nasal passages, no physician can deny. In this respect the cities of Germany are exemplary.

FOOD AND DRINK.

Improper food and drink are very important factors in the causation of disease. Governments attempt to prevent adulteration of food and the sale of meat from diseased animals, and regulate the sale of milk. There are laws, too, in some states, preventing the pollution of streams used for drinking purposes, but these latter laws are not strictly enforced. Milk is an uncertain article of diet. It is unknown whether or not milk from a tuberculous cow will give rise to tuberculous in man. There is, however, a strong presumption that milk from such a cow is dangerous to human beings, and especially infants. That milk from healthy cows speedily undergoes changes and becomes contaminated with myriads of bacteria if not handled in a very careful manner, is a matter well and commonly known. Government regulation of the dairies and handling of milk is of course, in vogue in many places, but everywhere does the law fall short of obtaining a healthy and safe supply of this very important and nutritious article. Under direct municipal ownership we think a better condition of the dairies would be assured. First. The herd should be under constant surveillance of the veterinarian and all supsicious animals should be removed. Second. -The milking should be done under strictly aseptic precautions. The milk should, if possible, be obtained without the use of the hands and in rooms thoroughly clean. The milk should then be sterilized and bottled and consumers advised to use the milk in original containers only. The peddling of milk in bulk should be strictly interdicted, nor should any one but municipal employes be allowed to dispense it.

Water for drinking purposes should be obtained from springs which can be protected from pollution. Its bacterial analysis should be taken frequently and regularly.

Public markets under municipal control and subject to sanitary inspection should be built in convenient portions of the city where meat, fish and fruit are to be found for sale, and at no other place should meat be exposed. Here all such food should be inspected and of course a preliminary inspection should be made at the slaughter-houses. Paris and Berlin have such markets. Too much care cannot be taken with such articles of food as meat and fish

The use of preservatives like borax, formaldehyde and salicylic acid. must certainly be considered dangerous to health. First, because it would