Reference Handbook of the Medical Sciences Embracing the Entire Range of Scientific Medicine and Allied Science. 3rd edition, Vol. 5. Hea-Lif. Edited by Thomas L. Stedman. New York, W. Wood & Co., 1915, 923 pp.

Oliver, Sir Thomas.-Lead Poisoning from the Industrial, Medical and Social Points of View. Lecture delivered at the Royal Institute of Public Health. New York, P. B. Hoeber, 1914.

Dorland, W. A. Newman-The American Illustrated Dictionary. 8th edition, revised and enlarged. Philadelphia, W. B. Saunders Co., 1915, 1137 pp.

Crile, G. W.-The Origin and Nature of the Emotions. Philadelphia, W. B. Saunders Co., 1915, 240 pp.

The Medical Clinics of Chicago, Vol. 1, Numbers 1, 2, 3. Philadelphia, W. B. Saunders Co., 1915.

Woodruff, Chas. E.-Medical Ethnology. New York, Rebman Co., 1915.

PASTEURIZATION

J. C. Geiger and F. L. Kelley, Berkeley, Calif. (Journal A. M. A., Jan. 22, 1916), report a small epidemic of typhoid traced to a single dairy. A large number of persons partook of the infected milk both in the city of Berkeley and in the smaller one of Richmond, but there were only twelve cases in the latter town and none in the other. This comparative immunity was shown to be due to the pasteurization of the milk supplied in Berkeley and the absence of cases in the other town where the pasteurized milk was used. The absolute protection that pasteurization gave to the thousands of customers receiving the infected milk is an indisputable argument against the use of row milk where it is impossible to secure adequate inspection at frequent intervals.

APPLES

Although the apple is easily the most important of the fruits of its class, there is little widespread information in regard to the chemical changes which attend its ripening. The starch content reaches a maximum in midsummer while the fruit is still on the trees, and then begins to decrease. Some varieties of apples are ready to eat when they are removed from the trees. The larger number, however, are expected to ripen to a considerable extent after that period. For this reason, the varieties which mature more slowly exhibit a superior keeping quality. When once the ripening process has been completed, the fruit tends to become soft, mushy or overripe, and usually at this or some preceding stage, organisms of decay gain entrance to the tissues, and the fruit rots. In the absence of infection with any germs of disease or decay, the fruit loses water and shrivels up into a withered dry mass. Changes of this character go on, no matter whether the fruit remains on the tree or is picked off. Growth ceases, and chemical changes ensue which result in the development of characteristic odor and flavor and later in the disintegration of the flesh of the fruit.

The object of the storage or preservation of fresh fruit so that it will be available beyond its natural "season" is really to slow up the ripening process and so to prolong its period as much as possible. That temperature has an important influence on the rate of ripening is a familiar experience. Beyond this little has been appreciated in regard to the change actually involved. It has even been believed that microorganisms are in part responsible, though in the light of our modern knowledge of biochemical changes in plants it is more reasonable to ascribe an influence to the presence of "ripening enzymes."-The Journal of the American Medical Association.

MEDICAL NEWS

The Health Department's Attitude Towards Alcohol.-On June 29, 1915, at the request of Dr. Goldwater, then the Commissioner of Health, New York, a committee of leading physicians, actuaries, educators, publicists and others interested in the alcohol question, met to advise with the officers of the Health Department as to the most effective method of preventing such disease as alcohol causes or to which it contributes.

The opinion expressed by the committee and the information in the hands of the Department of Health, as to the part played by alcohol as the cause of sickness and death, justified the entrance of the Department of Health into a field previously occupied chiefly by moralists rather than by physicians.

Just as the control of venereal disease is a technical medical matter rather than a question of individual or community morals, so the knowledge of the serious effects of the use of alcohol is to be spread by education. As a measure of personal health and public preparedness against preventable disease and disability, this question should be approached from the medical and social point of view and not from that of morality and religion.

Admitting that the drunkard is a social misfit, our interest is rather with those intemperate users of alcohol who do not become irresponsible or guilty of anti-social acts. Such individuals are almost always ignorant of the fact that alcohol decreases resistance to infectious diseases, such as tuberculosis and pneumonia. Alcohol is a depressant and not a stimulant; it drugs the brain and drops the capacity of the nervous system to obey the will. In this way, the use of alcohol becomes an important factor in industrial accidents. Entirely aside from its action as a contributory cause in infectious diseases and industrial accidents, the intemperate or continuous use of alcohol causes well-recognized degenerative diseases.

The Department of Health has no sympathy with and will take no part in legislative or police restrictions or attempts to limit personal liberty in the use of alcoholic beverages. The spread of accurate information among the people as to the effects of alcohol can be depended upon to accomplish more than laws restricting its manufacture or sale.

In the long run, compulsory prohibition will not prohibit until the public is ready to cease using alcohol when restrictive laws will be superfluous.

The prevention of disease is the most notable contribution of the present generation to civilization. The discontinuance of the use of alcohol will mark a greater advance in public health protection than anything since application of our knowledge of the bacterial origin of disease. Weekly Bulletin, Department of Health, City of New York.

Sanitary Condition of Bottled Waters.-The Bureau of Chemistry for several years has been investigating the sanitary conditions in the production and distribution of bottled mineral and table waters, which are offered for sale in interstate commerce and therefore subject to the Food and Drugs Act. It is recognized that the sale of bottled waters is

dependent largely upon the belief by the public in the purity of the product. The Bureau has recently conferred with a large number of sanitary experts and bacteriologists regarding a desirable standard for judging the sanitary character of bottled waters. As a result of the investigational work and the above mentioned conferences the Bureau believes that the tolerances established by the Public Health Service of the Treasury Department for waters served on interstate carriers is none too rigid for application to bottled waters sold in interstate commerce or imported from foreign countries. The Treasury Department standards are as follows:

1. The total number of bacteria developing on standard agar plates, incubated 24 hours at 37 deg. C., shall not exceed 100 per cubic centimeter; provided, that the estimate shall be made from not less than two plates, showing such numbers and distribution of colonies as to indicate that the estimate is reliable and accurate.

2. Not more than one out of five 10 cc. portions of any sample examined shall show (by the method of the Public Health Service) the presence of organisms of the bacillus coli group.

The American Orthopedic Association announces the appointment of Doctor Mark H. Rogers, Boston, as editor of The American Journal of Orthopedic Surgery, the only periodical in the English language devoted to Orthopedics. This journal, which has now completed 13 volumes as a quarterly publication, will henceforth be issued monthly, the first number in the new form being that of January, 1916.

The office of publication has been transferred from Philadelphia to Ernest Gregory, 126 Massachusetts avenue, Boston. The subscription price is $4.00 per year.

Health Insurance. The bill for health insurance drafted by the American Association for Labor Legislation in co-operation with the American Medical Association has been introduced into the Legislature by Senator Ogden L. Mills.

This bill provides that all manual workers and all others earning less than $100 a month are to be insured for any sickness or accident not covered by workmen's compensation, and that the cost is to be borne, 20 per cent by the State and the remaining 80 per cent equally by employer and employee. Each insured workman is to receive as an insurance benefit, medical care, including surgical, nursing and hospital care, and a supply of the necessary medicines and appliances; a cash benefit for a maximum of twenty-six weeks of sickness in a year; and the family will receive a small funeral benefit on the death of the wage earner. Insurance is to be carried by mutual associations of employers and employes organized according to trade or locality, and supervised by the State.

As a public health measure, this is one of the most important bills which has come before the legislature for many years. The complete morbidity data which will be collected through the operation of such a system as well as the money value it places upon good health, will be a powerful factor in the prevention of sickness among the industrial population.-Weekly Bulletin.

The

Cleveland Medical Journal

Vol. XV

MARCH 1916

No. 3

THE NECESSITY FOR THE BETTER STUDY BY THE MEDICAL PROFESSION OF DISEASES IN THEIR RELATION TO OCCUPATION*

By J. W. SCHERESCHEWSKY,

U. S. Public Health Service, Washington.

I feel deeply both the pleasure and honor of addressing you tonight. Many successive milestones have been passed by our profession in their progress toward the goal of the prevention of unnecessary diseases and death. Your city has been among the foremost to apply in practical fashion the lessons learned from this progress. It is, therefore, with confidence that I bring to your attention the desirability of making further progress in a new sanitary field. By new, I do not mean that this field has but recently been discovered, but rather that our prophylactic activities in the past have been directed against other menaces to life and health.

Tonight, I hope to discuss with you the necessity for a better study by the medical profession of the relations of disease to occupation. While this country has been among the foremost in the general campaign directed against the unnecessary waste of life, we have lagged behind other countries in the study of the relation of occupation to disease. It is only during recent years that we have awakened to the necessity for studying the great question of influence of occupation upon the health of man. This is, perhaps, because in the past the mechanical side of industry has made such an appeal, as a people, to our creative instincts, that in our enthusiasm for the design and construction of automatic. machinery of unparalleled ingenuity, our solicitude for efficiency in production, the urge for the multiplication a thousand fold of individual productive capacity, in our very mechanical exuberance we have lost sight of the man behind the machine. Yet, we are rapidly coming to the realization of the fact that no industry

*Read before the Academy of Medicine of Cleveland, February 18,

per se ought to have a deleterious influence upon individual health, that occupation in no industry should curtail the period of economic productivity.

In other words, we are at length beginning to recognize the true value of the individual to society at large; we are beginning to display the solicitude for the conservation of the health of workers, which the situation has long since merited.

The great European conflict now in progress places bitter emphasis upon the economic value of human life. The warring nations realize only too fully that it is not the gigantic cost in money and material which constitutes the toll exacted by the struggle, but the vast multitude of wasted lives and wrecked bodies. Human life, therefore, always held too cheaply in the past, has now been the subject of valuation, from an economic standpoint, to a level never reached before. Consequently the appeal to the medical profession, who must ever be the originators in human conservation measures, is stronger and more direct than ever before to extend the scope of such measures to cover all fields forming the environment of mankind.

Let us glance briefly at a few facts in connection with this great group of the population, viz., the wage earners, in the interest of whose health, constructive studies and measures are urgently needed. Roughly speaking, there are about 25,000,000 wage earners in this country, each of whom are incapacitated by diseases other than accidents, on the average of eight days a year. This amounts to a direct loss of working time of some 600,000 years annually, and a money loss of some $360,000,000. In addition to this we must add a loss, not as yet estimated, due to premature physical decline or to reduction in productivity, the result of the continuous operation of industrial health hazards. Yet it is probable that at least 40 per cent of this sickness is preventable. Nor is this all! Our attention has repeatedly been directed in recent years to the following facts: While our growing mastery of the infectious diseases, our better application of the principles of preventive medicine has resulted in a steady reduction in the fatality rate for such diseases, together with an increase in the average duration of life, on the other hand, the success which has been crowning our efforts in this direction has partially been neutralized by the circumstance (brought to our attention with increasing frequency, in recent years) of an ap