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of utility, it is capable of doing much harm. Teach them that the objections to it are not so much in its use as in its abuse. Set them an example by applying it intelligently and humanely. Appeal to the common sense of those who pervert its use, and wound the pride of those who mercilessly make star-gazers of their animals. Impress upon them. the importance of a loose rein in ascending hills, and of taking advantage of the value of unchecking their horses when tired, and of checking them after miles have been traveled with a drooping head. Invoke the law to release the device when the horse is tied, as he often is, for hours in front of business houses, churches, and places of amusement. In some cities of our Union municipal ordinances exist, compelling owners to uncheck their animals when halted for any length of time. Each one of us in our respective communities can do much to generalize this humane practice. This Assembly can well afford to vary its efforts for the good of man by calling attention to the legitimate use of the checkrein, and asking for legislative aid to correct its abuses.

IMPORTANT FACTS AND PRACTICAL DIFFICULTIES ENCOUNTERED IN ENFORCING SANITATION.

By G. W. DAVIS, M.D.

As we retrospect the last twenty years of medical history, we find nothing that has increased in interest more certainly and forcibly than the important and benevolent fact that the future of medicine is to be very largely in the field of sanitation.

The student who has kept in constant touch with the prodigious progress of the times, has seen precept and theory, one after another, fall before the indefatigable research of the pathologist and bacteriologist, however much the accuracy of the latter may be questioned, as it is at the present time.

Our revered medical teachers taught us many things which have since disappeared like the baseless fabric of a vision; and instead there has arisen a new era, new methods of treatment, not only in internal medicine and surgery, but also in the rapidly expansive field of preventive medicine.

The arduous and unselfish labor that is being bestowed in this lifesaving department of a lofty and scientific profession must forever remain to, and be considered by, the future medical historian as highly praiseworthy and monumental."

It is in the memory of, perhaps, all of us, that it is not more than, possibly, ten years since scientific research imparted to the profession. any actual or even satisfactory idea of the immediate cause of those diseases known as infectious. Their contagiousness was disbelieved by many; physicians having an extensive experience with this class of diseases had observed their special incidence in particular localities, yet more in certain dwellings, still the causes were, by many, presumed to be entirely due to unsanitary conditions.

The decomposed animal and vegetable matter in basements, sewers, and low, damp places, was supposed to be almost the only causative influence. To-day, such unsanitary environments are promptly acknowl

edged to exert an influence favorable to the production of such affections; but experienced observers of zymotic diseases give such influences a secondary place, and consider them as exciting causes rather than the immediate cause.

The important fact just here is, in my judgment, that the damage which the presence of decomposing organic matter produces in the cause and propagation of such diseases should not be lightly treated or lost sight of. Otherwise, the laborious sanitarian and the efficient health officer will frequently be deprived of an argument and power of exceeding value in disseminating knowledge of sanitation, or sanitary measures, and the suppression of outbreaks of contagious diseases, or to supply a reasonable or satisfactory explanation of the existence of sporadic cases.

Thus briefly disposing of the importance of decomposing material, or products, in favoring the occurrence of infection, there is another important fact deserving attention, and it is what is known as the immediate cause of diseases due to bacteria, or the products of their metabolism.

Take, for example, diphtheria, which is more constantly present either endemically or sporadically, and more frequently possesses greater virulency, than any of the other infectious maladies.

The important fact in connection with this terrible disease is that its prevention, if not ultimate annihilation, will be preeminently due to the conscientious sanitarian and health officer; but these, however conscientious and efficient, cannot possibly succeed without the intelligent coöperation of the entire medical profession. Upon the individual physician rests the responsibility to correctly diagnose diphtheritic cases, and promptly report them to the proper officials.

The fact of the inability of some to immediately recognize acute infectious diseases is, unfortunately, one of the first and important practical difficulties in dealing with such cases and enforcing sanitative measures. Several years after Löffler discovered the bacillus which he asserted to be the cause of diphtheria, investigators in many laboratories asserted, with equal earnestness, that this bacillus is present in many cases of diphtheria, yet claiming that in other cases it is not necessary to the production of the diphtheritic exudate.

At this time there are men prominent in the medical profession who do not accept the microbic theory of disease.

When we remember that with the most skillful it is difficult in many cases to clinically differentiate diphtheria from other acute affections of the upper air passages, that it does not in all cases produce an exudate, that an exudate does not always signify diphtheria, we think we can be clearly understood, when we state at this point, that an important fact becomes peculiarly accentuated, that the physician should use every clinical means within his reach to thoroughly familiarize himself with the subjective and objective symptoms of all acutely infectious diseases, and not, as is being strenuously urged, depend entirely upon microscopic examination for a positive confirmation of diagnosis.

The bacilli coli (which are found constantly in greater or less numbers in the large bowel) are believed by a few to be essentially the same as the typhoid fever germ, and to develop a like pathogenic characteristic when the condition is favorable.

In fact, it is freely urged that the diphtheria bacilli are discovered

among a very large number of microbes occupying apparently healthy mouths.

It has been recently stated by a well-known clinician that it is "absolutely certain there are two forms of diphtheria, which present to the eye similar changes in the mucous membrane, and both are characterized by the appearance of a pseudo membrane, at times dirty white and again yellow-white in color. Viewed at the bedside, we will find in both a like prostration, a febrile condition, swelling of the sub-maxillary glands, and disturbance of respiration. The exudate of one will reveal nests of bacilli which are found in true diphtheria, while in the other there are no bacilli, but instead the so-called staphylo and streptococci. The first variety is highly fatal, while the second, so far as the danger to life is concerned, is comparatively harmless."

With regard to the latter statement, another exceedingly clever authority says: "This is wrong, for even these causes may," and I add do, "produce fatal blood-poisoning if not prevented by proper treatment." In these two forms of the disease, though the one is true and the other false, the tendency, however, of both is to fatality. Therefore, only a clear knowledge of the symptoms of these forms can reveal their real character, and thus possibly avert the spread of either or both forms. of infection.

In a recent circular sent to all the United States Marine Hospital stations by the Surgeon-General of the Marine Hospital Service, it is stated: "In a majority of cases a bacteriologic examination is necessary to determine the character of the disease, requiring from twelve to eighteen hours to make proper cultures." And again, "If the case is one of diphtheria, cultures should be taken every five or six days after disappearance of the membrane." This is to determine when the bacillus diphtheria disappears. In a well-appointed army or navy medical service, or in cities where there are specialists in bacteriology, where laboratories are accessible to, and where the physicians generally are more familiar with the microscopic technique, this can and should be done.

In the country or in smaller towns, where an epidemic of diphtheria frequently has its origin, the use of this means is, in a large majority of cases, impossible, and in this important fact lies another of the practical difficulties in dealing with, and enforcing sanitation in this class of infectious troubles. An observing physician's eyes, keener and surer than a microscopic lens, sees and knows a pathologic lesion as well as perversion of function.

The problem of railway-train, street-car, and workshop sanitation will now, though briefly, claim our attention. Indeed, the characteristics regarding sanitation in these directions are so complex and difficult, involving, as they do, so many mechanical questions, that we cannot do more, in a paper of this kind, than mention the important fact that the first principle involved in passenger-coach, street-car, and workshop sanitation is absolute cleanliness. If, through this convention, an additional or profounder impression can be made upon those who should, from a humanitarian point of view, properly provide the best possible means for the safety and health of those who are, or may become, patrons or employés, it can be said, not boastingly, but because we respect the welfare of our fellowmen, our meeting will not have been in vain. If the prime necessity of the first principles can be inculcated, it will not be long, through the wonderful inventive powers for which the

American people are so well known, before the scientific and highest sanitary method of heating, and ventilating, and lighting all vehicles used in public transportation will have been reached, and another of the many practical difficulties of enforcing sanitation removed. In my judgment, the question of how to heat, light, and ventilate a car must be the collective result of the sanitarian, architect, and mechanic.

Finally, we come to consider the importance of sanitary legislation. The experience of many able in the line of sanitary work has been peculiar, if not often exasperating, in their endeavors to have legislators enact even a modicum of sanitary measures or laws. Beginning with a condition of almost absolute sanitary chaos, as regards legal sanitary measures, laborers in the field of preventive medicine are beginning to reap the reward of their indefatigable perseverance and industry. There exist in the minds of the profession and legislators diametrically opposing views as to which is the wisest thing to do: to first enact sanitary laws, or begin with the education of the masses.

I agree with those who believe that we should begin at the highest notch in the scale. Sanitary ideas, like all advanced ideas, must begin high up and move downward. Law, as a rule, is the most effectual educator. I would not be understood by this that we should urge a great number of statutory enactments, but only such as contain the basic principles of sanitation, wholesome, clearly understood, and that will effectually enable boards of health of State, county, and city, and health officers, to obviate many of the existing practical difficulties in enforcing sanitation.

When this foundation stone of the sanitary structure has been well laid, then we can proceed more rapidly to educate the public. The ignorance of the masses as to the importance of sanitation is one of the difficulties encountered in enforcing it, and not, I think, as had been thought, due to stubbornness or maliciousness.

In concluding, is it too much to claim that the labor of this convention, of the individuals who have taken part, and of each in his own locality, may all be no insignificant factors in the realization of that highest sanitary destiny to which we are, I trust, surely and gladly hastening?

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ADULTERATION OF FOOD AND DRUGS.

The following chapter of the Statutes enacted by the last Legislature is so important, as well as beneficent, that it is deemed best, in the interest. of public health, to give it as wide publication as possible. It is not generally known that the Act included a penalty for the sale of milk from a diseased animal, but Section 3 (b), (5) explains that the sale of such milk makes the person guilty of a misdemeanor, and liable to a fine not exceeding one hundred nor less than twenty-five dollars, or imprisonment in the county jail not exceeding one hundred nor less than thirty days, or both. Milk from cows afflicted with tuberculosis or any other disease, comes under this statute:

CHAPTER LXXVI.

An Act to Provide Against the Adulteration of Food and Drugs.
[Approved March 26, 1895.]

The People of the State of California, represented in Senate and Assembly, do enact as follows: SECTION 1. No person shall, within this State, manufacture for sale, offer for sale, or sell any drug or article of food which is adulterated within the meaning of this Act.

SEC. 2. The term "drug," as used in this Act, shall include all medicines for internal or external use, antiseptics, disinfectants, and cosmetics. The term " food," as used herein, shall include all articles used for food or drink by man, whether simple, mixed, or compound.

SEC. 3. Any article shall be deemed to be adulterated within the meaning of this Act:

(a) In the case of drugs: (1) If, when sold under or by a name recognized in the United States Pharmacopoeia, it differs from the standard of strength, quality, or purity laid down therein. (2) If, when sold under or by a name not recognized in the United States Pharmacopoeia, but which is found in some other pharmacopoeia or other standard work on materia medica, it differs materially from the standard of strength, quality, or purity laid down in such work. (3) If its strength, quality, or purity falls below the professed standard under which it is sold.

(b) In the case of food: (1) If any substance or substances have been mixed with it, so as to lower or depreciate, or injuriously affect its quality, strength, or purity. (2) If any inferior or cheaper substance or substances have been substituted wholly or in part for it. (3) If any valuable or necessary constituent or ingredient has been wholly or in part abstracted from it. (4) If it is an imitation of, or is sold under the name of, another article. (5) If it consists wholly, or in part, of a diseased, decomposed, putrid, infected, tainted, or rotten animal or vegetable substance or article, whether manufactured or not; or in the case of milk, if it is the produce of a diseased animal. (6) If it is colored, coated, polished, or powdered, whereby damage or inferiority is concealed, or if by any means it is made to appear better or of greater value than it really is. (7) If it contains any added substance or ingredient which is poisonous or injurious to health. Provided, that the provisions of this Act shall not apply to mixtures or compounds recognized as ordinary articles or ingredients of articles of food, if each and every package sold or offered for sale be distinctly labeled as mixtures or compounds, with the name and per cent of each ingredient therein, and are not injurious to health.

SEC. 4. Every person manufacturing, exposing, or offering for sale, or delivering to a purchaser, any drug or article of food included in the provisions of this Act, shall furnish to any person interested, or demanding the same, who shall apply to him for the purpose, and shall tender him the value of the same, a sample sufficient for analysis of any such drug or article of food which is in his possession.

SEC. 5. Whoever refuses to comply, upon demand, with the requirements of section four, and whoever violates any of the provisions of this Act, shall be guilty of a misdemeanor, and shall be fined not exceeding one hundred nor less than twenty-five dollars, or imprisoned in the county jail not exceeding one hundred nor less than thirty days, or both. And any person found guilty of manufacturing, offering for sale, or selling, an adulterated article of food or drug, under the provisions of this Act shall be adjudged to pay, in addition to the penalties herein before provided for, all the necessary costs and expenses incurred in inspecting and analyzing such adulterated articles of which said person may have been found guilty of manufacturing, selling, or offering for sale. SEC. 6. This Act shall be in force and take effect from and after its passage.

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