premature death can be prevented.

Then the masses,

that are always powerful, and sovereign when they once know their power, will claim and enforce their right to health and life, because even those who are absolutely sure of going straight to heaven are in no hurry to die.

At the same time the public at large must learn that selfishness does not pay under any circumstances. All the members of A's family are highly indignant when they find out that in their neighbor B's house there was a case of some contagious disease kept secret. They are loud in their clamor for the observation of law, for the punishment of the law-breaker. In fact no punishment is severe enough. But when their own family's darling is stricken with the small-pox they use all possible influence to induce the family physician to close one eye, and, if possible, both. And all the time people seem reluctant to realize that no one can live isolated, and that the safety of each is bound up with the safety of others.

When once an ideal combination of uniformly welleducated physicians can find responsive understanding and support among the great masses there is no danger that through clever manipulations of undue influences, and what is usually called "political pull," the sanitary service of the communities would be placed in incompetent hands. At the same time the ridiculously rapid changes in the various health offices, would, no doubt, be likewise abolished. At present, as soon as a physician becomes somewhat conversant with the requirements and duties of public sanitation, another Mayor, another Governor is elected, another party gets hold of the power. When the spoils, among which the various Boards of Health offices, and various public sanitary inspectors' jobs are highly appreciated, become subject to new apportionment, other physicians are taken straight out of their private offices, placed in public ones, and entrusted with the city's or county's sanitary service, without any regard as to whether or not they know anything about it. Usually it is quite sufficient to have had the honor of having been the family physician and friend of the man who happened to be elected Mayor of a great city.

It is obvious that the public health service must have more stability and permanence, be endowed with more

authority and power. Such desirable conditions will begin to materialize when the many efforts that are now made toward the establishment of a national health service shall succeed. Then and not until then will the United States be in a position to take the lead and teach the world a lesson in public sanitation.

With the exception of those absolutely ignorant and a few cranks, hungry for sensation or paradoxes, it is generally known and acknowledged that great things have been accomplished by preventive medicine towards the LIMITATION OF MANY EPIDEMIC AND CONTAGIOUS DISEASES. It is proven beyond the shadow of a doubt that the decided decline in the death rate from infectious diseases is due to preventive measures; that small-pox when not modified by vaccination is still the same deadly disease it was previous to Jenner's discovery; that isolation, quarantine, disinfection, notification of disease, and supervision of the transportation and burial of the dead, have kept diseases like the bubonic plague, the cholera, diphtheria, lepra, the yellow fever, etc., from their former destructive marches from country to country; that the supervision of water supplies and systems of sewerage, and plumbing inspection have done away with endemic typhoid fever in many cities, and made epidemics of this disease impossible wherever the preventive rules are observed and enforced. In this respect all that is necessary is a uniform tightening of the coils around the necks of the many-headed monstersdiseases everywhere in the world-and they must recede.

The nonsensical protests of people, as blind, for instance, as the anti-vaccinationists, may cause delay in some places, but cannot alter the final results. Overwhelming proofs are accumulating, supported by irrefutable official statistics. Marson, for example, reports that during forty-two years of duty as physician of the London Smallpox Hospital, he has never observed a single case of small-pox among the officers and employees of the hospital, who are re-vaccinated when they enter the service, but who are constantly exposed to the infection. The Austrian Government succeeded in diminishing the prevalence of small-pox in Bosnia and Herzegovina from 30,867 cases in the five years from 1887 to 1891, to 303 in the five years from 1894

to 1898, or less than a hundredth part, while in the neighboring countries where vaccination is neglected small-pox still rages. Is it not surprising that any one should have the obstinacy to protest against vaccination? And thus it is with all other accepted preventive measures, which will in time prove their worth, along with many others that are urged by the medical profession upon the people.

More and more diseases are coming into the circle of preventive medicine, and while it took formerly almost centuries to establish facts, to accomplish results, ideas travel now rapidly, and the truth cannot be kept down for any length of time.

Preventive medicine has succeeded in lowering the death rate and consequently has increased the average duration of human life. The average age at which death occurred in 1890 in the United States was 31.1 years, in 1900 it was 35.2 years. Over four years have been added to the allotted span of life by our science in one decade.

[To be continued.]

DIPHTHERIA AND ANTITOXIN.

By HUBERT N. ROWELL, M. D., Berkeley, Cal.

Diphtheria may be rightly classed in the list of conquered as well as conquerable diseases. The dread with which this vicious enemy was once regarded has been supplanted in a great degree by a sense of comparative security. The mortality records of thirty years ago, wherein deaths from "putrid sore throat" were chronicled, have become but grim archives of a dark age.

Without any attempt to dwell upon a subject already well threshed out, the writer desires to add humble testimony to the efficacy of antitoxin in the treatment of diphtheria. My experience with the exclusive use of this agent in the care of diphtheria, extends over the past eight years, before which time my death records were far from satisfactory. Since antitoxin has been employed recovery has been the rule.

Moreover, seven years' experience as Health Officer, in a town of some 14,000 inhabitants, has afforded opportunity for observing the comparative results in patients treated

by internal medication, with others who have been injected with antitoxin.

In each instance noted, the patient was afflicted with genuine specific diphtheria, the diagnosis having been confirmed by culture test. Many other cases, which proved to be non-specific, are eliminated from the present list. At the present writing, I have collected ninety-three cases with but five deaths. These patients were seen in all stages of the disease, from the simple tonsillar patch, to the condition in which intubation was necessary for entrance of air. As a result, so firm is my faith in the absolute curative properties of antitoxin, that I should feel myself culpable in losing a patient seen early in the disease, in whom there was no complicating element, were the antitoxin not employed. Some unfortunate occurrences have done much to prejudice timid or "conservative" practitioners against the employment of antitoxin. The recent experience in an Eastern city, where the manufacture of antitoxin was carried on by the municipality, was described in all its horrible detail, and the description as greedily devoured by the antagonists of antitoxin, and really wrought much harm.

This sad affair, while far from disproving the efficacy of the product properly prepared, only emphasizes the importance of the utmost care in its manufacture, by those thoroughly qualified. In no instance here noted has any unfavorable symptom followed the administration of antitoxin, save an occasional erythema, or slight reactionary fever. Failures are often noted by those who, through timidity, employ too small doses.

My own observations suggest the importance of administering a decided initial dose. It is my habit never to employ less than 2,500 concentrated or "XX" antitoxin units to children over one year of age, up to 4,000 units in older children or adults. If no improvement is noted at the end of twelve hours, 2,000 units should be injected, repeating this procedure every twelve hours until a loosening of the edges of the membrane is apparent. It is an error to delay administration until a culture test has been made, for in benign cases antitoxin produces no harmful effects. The ordinary antiseptic precautions should, of course, be observed, both as to care of the syringe and to the cleansing of the skin surface, preferably between the

scapulæ. All internal medication is to be omitted, except in very asthenic patients, to whom the ordinary dose of strychnine may be given.

Iron, gargles, poultices and bandages may be wholly ignored and entire confidence placed in antitoxin.

The various paralyses occur, by far, less frequently than before the introduction of antitoxin, and the patient makes an uneventful recovery, without the necessity of employing drugs.

Berkeley, December 12, 1902.

Sections.

GENITO-URINARY SURGERY.

By LOUIS GROSS, M. D., San Francisco, Cal.

Clinical Lecturer on Genito Urinary Diseases, College of Physicians and Surgeons; Genito-Urinary Surgeon, Staff California General Hospital. The Diagnostic and Therapeutic Value of Ureteral Catheterization, with Report of a Case. -Dr. Louis Gross (N. Y. Med. Jour., Sept. 13, 1902). After discussing the diagnostic and therapeutic value of ureteral catheterization, Gross reports a case of right-sided pyelitis which was cured by instillations of 10 grams of a 1-1000 solution of nitrate of silver directly into the kidney pelvis. He makes the following deductions:

Diagnostic Value.-To determine: 1. Whether the bladder or the kidney is the seat of the affection. 2. The presence or absence of a kidney. 3. Which kidney is involved. 4. The site of the lesion. 5. The functional capacity of each kidney. 6. The presence of a calculus in the ureter or pelvis of the kidney, and its exact location. 7. The presence of strictures in the ureter and their exact location. 8. The diagnosis and site of ureteral fistula. 9. The presence of a pyroureter. 10. A differential diagnosis between diseases of the kidney and the surrounding organs. 11. At times a tuberculosis of the kidney. 12. The diagnosis of pyelonephritis, pyonephrosis, hydronephrosis, movable kidney, neoplasms of the kidney, renal lithiasis. 13. Abnormal congenital conditions of the ureter.

Therapeutic Value.—1. To cure pyelitis and certain cases of pyonephrosis and hydronephrosis. 2. To drain