HYGIENE OF THE TROLLEY.

By HARVEY B. BASHORE, M. D.

The spreading of trolley lines into all parts of the country has brought about a new factor, which enters into the daily life of almost every one, and it is right, it is just, that these trolley com panies should pay some regard to the well-known sanitary laws. If these are neglected, not only is great annoyance caused to the public, but even sickness and death will be found to be an everpresent result.

Most lines are yet poorly equipped with rolling stock, and as a result the open summer car is used more often and longer than it should be. If riding through fields and woods in one of these cars on a cool September evening does not give one a bad cold, he is certainly immune.

In most places these open cars should probably not be used more than two months in the whole year, and in a great many places in the northern districts, they are undesirable after dark at almost any season. The only good word that can be said for the open car is that ventilation is good, but often it is too good. In wet weather open cars should always be replaced by closed

ones.

The closed car presents the usual defect of inefficient ventilation, and with it inefficient heating in cold weather. A great many cars, especially on suburban lines, are heated with stoves, yet nothing more defective could be imagined, inasmuch as the upper part of the car gets fairly warm while a stratum of cold air settles down about one's feet. Electric heaters placed under the seats answer better, but in very cold weather seem to be inadequate. The proper way would be to have these heaters of sufficient capacity, with a cold air inlet on the outside of the car, so that fresh and heated air could be furnished at the same time; and fresh air is sometimes sadly needed, even on a twenty-minute run, when passengers are packed like "sardines in a box." Fout air, of course, could escape by ventilators at the top of the car.

Another important point in the heating and ventilation is that the ends of the cars should be closed by glass windows and doors; by this means a draft of cold air does not rush through the car every time the door is opened. Then, too, the open-end car is

cruel and unjust to the employees, in that they are exposed to all states of the weather; indeed, it is even dangerous, for a man facing a cold wind at zero temperature will get so benumbed that he has not proper control of the car, and accidents are likely to result, not from the carelessness of the motorman, but from the carelessness of the company.

A point as to the windows: Very often they do not fit tightly, and if you are sitting in front of one, there is a cold draft over the back of your neck, when the car is running rapidly; probably it would be better to have cross seats.

Another thing that should be attended to is the disinfection and cleaning of the cars. Street cars used to stop at city limits, but those days have passed; and now they go far into the back country, where sanitary laws, even if there are any, are lax, and people often leave houses of contagious diseases and travel on these cars with impunity; thus the danger of transmitting contagious diseases has increased with the advent of the trolley, and calls for more thoroughness in the matter of cleanliness and disinfection. Spitting on the floor of public conveyances is still a habit in the rural districts; the rural population is just as slow in sanitary matters as in other things, and one does not need to travel far on a suburban trolley until he is painfully aware of the fact. In many places there is a law against public spitting, and there is no reason why it should not be enforced in the rural districts as well as in the cities.

The trolley car, with its cheapened power, has come to stay, and will become a great factor in broadening and developing the country, but the people should demand that it conform to our modern. sanitary advancement.

CURIOUS CAUSE OF DEATH.

The doctors in Vienna, according to the daily press, have been made interested in the case of a young man, twenty-three years old, who has just died after a six months' painful illness which puzzled the physicians, including German specialists. Shortly before his death his ailment was diagnosed as the result of the hatching of eggs of a blue-bottle fly, which the patient had swallowed, causing perforation of the intestines. The sufferer was then too weak to undergo an operation. An autopsy confirmed the diagnosis. Part of the large intestine was riddled.

PROPAGATION OF LEPROSY.

From the "New York Times."

The article published in "The New York Times," issue of September 23, on the question of the eradication of leprosy from Hawaii by the gradual extinction of the native race, does not give the whole scientific reason why isolation of lepers at Molokai has failed to prevent the spread of the disease. All authorities are agreed that enforced isolation in Hawaii is a complete failure. Moyer says that it did not diminish by segregation; there are just as many now as at the start, fifty years ago. Alvarez, superintendent of the hospitals for the treatment of lepers in Honolulu, wrote me thus:

"The laws of Hawaii fail to stamp out the disease [leprosy], but still they are necessary to keep it in check." He continues:

"We have had strict laws of compulsory segregation for the last thirty years, and the results are anything but encouraging. I be lieve, however, that leprosy, as well as any other contagious disease, could be stamped out by strict isolation, but we find it impossible to isolate every leper as soon as the first symptom appears, and we do not know if the disease is also communicated to others during the long period of incubation, when the most searching investigation would fail to reveal it."

Dr. A. Mouritz, formerly in charge at Molokai, wrote me:

"One of the best fields for observing the grasp that leprosy has on mankind, and the penalty the human race is paying for its apathy in dealing with the disease, can be seen on this island [Molokai], and within twenty-five miles of my home [Mapulehu]. Year in and year out the lepers at the settlements average between 1,100 and 1,200, chiefly Hawaiians, but within the past year or two the disease is making among the foreigners here (white people) considerable inroads. If you have ever lived here you must have learned that segregation is the proposed policy of the Government in dealing with the disease. Yet for years the law was out of the caprice of the politicians; to-day we are reaping the benefits. Segregation is better carried out to-day, but it is far from thorough." President Smith, of the Hawaiian Board of Health, also wrote me as follows:

"Here in Hawaii we have had much experience with leprosy for thirty years, and have sought for, and are still seeking, to find the best means of treating the disease."

Father Conradi, the Belgian priest who took Father Damien's place with the leper boys at Molokai, where he remained seven years, told me while he stopped with me in New York last year that leprosy was becoming less widespread in Hawaii, not because of the law of segregation, which did not prevent the actual contact between the healthy and leprous people, but because the Kanakas are dying out as a race. Damien himself became a leper because there was contact between him and the leper. Yet here in New York our Board of Health sees no danger in allowing lepers to leave quarantine and mingle freely with our people.

In the last number of "The Pacific Medical Journal," San Francisco, the editor says:

"It would seem that we are in error when we claimed in our last issue that there were not more than 100 lepers in the United States. Dr. Ashmead, of New York, states there are 400 lepers in Louisiana, only 23 of whom are isolated. The doctor also states there are at least 100 lepers in New York State. Dr. Ashmead knows a bank teller who is a leper, and handles money every day. It is estimated there are 500 lepers in Havana Province. It is claimed there are Japanese lepers engaged in catching and canning salmon along the Columbia River. Dr. Ashmead claims that there are also many Philippine lepers in California and Washington.

"Hence there must be some other reason besides imperfect segregation to account for the spread of leprosy in Hawaii, where it is estimated to-day there are 4,000 lepers in all."

I have been occupied some years with the study of the relation which may exist between the fish diet of the Japanese and some other nations and leprosy. I think such a relation would be firmly established if the leper bacillus could be cultivated-say on the gold fish, the most Japanese of all fishes. The carp is eaten alive in Japan, which is a fact of general knowledge, though not the gold carp. The latter is exceedingly susceptible of disease; different kind of fungi tackle it as soon as a scale gets off. Sometimes without any such sauce the fish dies away and the scales appear to be all turned up. No cultivation of the leper bacillus outside of the human body has ever been accomplished. I myself have already removed scales from the gold fish and inoculated the latter with the leper bacillus, but without result; the fish died.

United States Consul, Sol Berliner, recently made a report to the State Department at Washington on leprosy in the Canary Islands. His opinion was that the disease is endemic among the people of these islands on account of their eating a good deal of fish.

I beg to say that this belief is quite common to many leper countries, and even medical authorities indorse it. Mr. Jonathan Hutchinson, the distinguished dermatologist of London, and myself, also believe that there is an insidious connection between fish and the propagation of leprosy.

Since the middle ages leprosy has progressively declined in Europe, excepting in fish-eating countries. Norway, Spain, Portugal, the Baltic States of Russia, Iceland, the fishing provinces of France have still leprosy. Leprosy scourges the fish-eating countries of the Orient, Japan and China, where Buddhist law prohibits the killing and eating of animals. In Japan raw living fish are eaten even while the flesh quivers. Mr. Hutchinson believes in the fish alimentation theory of propagation of leprosy. I believe that fish and mosquitoes act together as intermediary hosts for the transference of the leper poison; that mosquitoes that have bitten lepers become food for fishes which then transmit the germs or spores to man when eaten raw.

Professor David Starr Jordan, Chief of the United States Fish Commission to Hawaii, promised me he would take some interest in investigating the question, which interests him very much. He put the matter in the hands of Professor Everman, ichthyologist of the expedition. My brother, Professor William H. Ashmead, of the United States National Museum, was the entomologist who accompanied these gentlemen to Hawaii last summer. Professor Jordan wrote me that he had found, while visiting Japan, that many kinds of fish were eaten raw. The gold fish, which he said was found in every stream, might well be an intermediary host, as might several of the fresh-water minnows.

Now, when we consider the enormous reproductive power of fishes, it will be evident how readily leprous-infected fish might propagate the spores of the disease, even inoculate the fresh-water streams of a whole country. In one lobster there were found 20,000 eggs. Fish produce an incredible number of eggs. A herring has 36,000, a smelt 30,000, a sole 1,000,000, a roach 1,130,000, a sturgeon 3,000,000, a tench, 383,000, a mackerel 546 (their eggs are larger than those of most fish), a perch 992,000, a flounder 1,357. But of all fish a cod of leprous-infected Nova Scotia is the most prolific, according to one naturalist 3,686,000 and according to another 9,444,000.

Were I per cent. of the eggs of a Columbia River salmon now caught by Japanese lepers, and perhaps already infected with the germ, to result in full-grown fish, and were they and their progeny