TECHNICALITIES.

ITEMS of value to nurses in their work will be welcome to this column.

FOOT-BATH.-A wash boiler has been found to be very useful in giving a foot-bath, the water reaching almost to the knees. It is more convenient to use if the patient can sit up or be propped up, but can also be used in bed, protecting well with newspapers.-Nurses' Journal of the Pacific Coast.

INFANT FEEDING.-The number of women unable to nurse is much less than is popularly supposed. Madame Dluski, in a thesis delivered at the Baudelocque Clinic, Paris, expresses the opinion that among 100 healthy women, when the necessary conditions of food and rest are present, 99 are actually able to nurse their offspring.-J. M. CONNOLLY, in Hygiene and Physical Education.

TO PAD A BEDSTEAD.-While caring for an irrational patient on an iron bedstead it is a good plan to take an old comfort, or anything of that description, and wrap it entirely around the head of the bedstead, stitching it with heavy linen thread or twine to the top and bottom and so prevent the patient getting any purchase with her hands on the bars, or wedging her head between them and so getting hurt.-Nurses' Journal of the Pacific Coast.

SOAP AND WOOLENS.-Of special value to the obstetrical nurse who attends to the baby's flannels herself is this receipt for washing wools of all kinds: To I quart of water add 1⁄4 cake of “Ivory” soap and I tablespoonful of borax. Boil until soap is dissolved. Allow to cool, as this process is entirely cold. Use enough of this soap jelly to a basin of water to make a good lather and soak the flannels in it for twelve hours. Rinse in cold water-Nurses' Journal of the Pacific Coast.

SAWDUST VERSUS CASTOR OIL.-An American medical journal quotes a doctor who has found that bread, containing one ounce of finely-sifted beechwood sawdust to the pound of dough, is very effectual in curing old, rebellious constipation. The patients ate this bread exclusively after a preliminary course of castor cil or injections. He warns that the trees must be felled late in the fall or the sawdust will have an unpleasant taste. -Nurses Journal of the Pacific Coast.

PREVENTION OF INFANT MORTALITY.-Every influence which tends to decrease maternal nursing tends to increase infant mortality. For our purposes then it is necessary to seek out and to remove every influence which acts to prevent mothers from nursing their infants, whether that influence be sickness and fatigue; the pressure of poverty, necessitating that the mother return to work at the earliest possible moment; the demands of society; the advice of the ignorant, meddling, busybody neighbor; or whatever other cause may obtain.-J. M. CONNOLLY, in Hygiene and Physical Education.

A CONVENIENT LEG BANDAGE.-While I was caring for a patient suffering from thrombosis, the physician ordered the leg to be wrapped in cotton and bandaged. I found the process of unbandaging and rebandaging every day for the leg to be examined very tiring and painful to the patient.

The wife suggested what I found to be an excellent plan. We took a piece of cheese-cloth about five feet long and eight or nine inches wide and tacked the cotton evenly and securely on the inner side.

Raising the leg, we enveloped the foot, pinning in place with safety pin, and with about three turns wound it around the leg up to the hip to the great comfort and ease of the patient, who no longer dreaded its daily removal.

This method could be used on patients suffering from inflammatory rheumatism or phlebitis.Nurses' Journal of the Pacific Coast.

SPONGE BATHS IN TYPHOID.-Frequent sponging with or without alcohol and tepid water will not only keep a restless patient quiet and comfortable, but will reduce temperature from one to one and one-half degrees, with none of the untoward difficulties of cold tubbing. This sponging should last from fifteen to thirty minutes, according to circumstances. If possible the part sponged should be exposed to the air, sponged copiously, and left to dry uncovered. Though if patient shivers and seems unduly chilled the bath may be continued under a light woollen blanket. The night sponge should be followed by a gentle but thorough rubdown with cocoa butter or an agreeble preparation of lanolin, thus securing quiet, restful sleep. An ice cap to the head will often prevent cerebral excitement.-DR. FRANCES BRADLEY in N. Y. Medical Journal.

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No. 2

WHEN it was first demonstrated that refrigeration could be practiced on a wholesale scale for the prevention of decomposition of foods, the fact was hailed with joy by dieteticians on account of the greater wholesomeness of food expected, by sociologists in anticipation of a lowered cost of the necessities of life, on account of the aggregate enormous saving of waste.

Both of these expectations have been disappointed. Undrawn poultry, rabbits, etc., become tainted with toxins absorbed from the intestine-perhaps also from the urinary passages—and, aside from the tendency to the absorption of various odors by butter, etc., a minor matter hygienically and one that can be prevented by segregation of different kinds of foods, all foodstuffs have been found to deteriorate in flavor. Vegetables and fruits, long kept in cold storage, decay very rapidly after withdrawal, while animal foods generally, meats, eggs, etc., are not only less pleasing in taste and consistence, but seem, even when previously freed from entrails, to be less digestible and even to conduce to toxæmia. Some have gone so far as to claim that there is a distinct group of psychrophilic (cold-loving) bacteria which produce decomposition, with formation of toxins quite after the analogy of ordinary decomposition processes, though more slowly. Whether this is true or whether ordinary saprophytes produce some contamination previously to thorough chilling of the meat, etc., and thereafter continue to have some vital activity, in spite of the temperature of

about zero centigrade, need not be discussed here. The practical fact remains that cold storage results, after a moderate interval, in deterioration, both from the æsthetic and the hygienic standpoints.

From the economic standpoint, also, cold storage has produced exactly the opposite effect to that justly expected. Instead of lowering prices by saving an enormous loss by spoiling, it has enabled foodstuffs to be cornered, like wheat and other grains, and to be held until necessity compelled the uitimate consumer to pay a fancy price for commodities of less value and greater danger than those which formerly only occasionally reached a high rate through the legitimate operation of the law of supply and demand, and which could usually be replaced at such periods by other foodstuffs of analogous dietetic value. The periods in which the ripening of a crop of fruit, etc., produced an excess which could not be held for more than a few days, enabled the thrifty housewife to lay in a winter's store of preserves or dried foodstuffs at a low price, have almost entirely disappeared. If the prevention of periods of excess operated to any considerable degree to the benefit of the actual producer, the increased cost of foodstuffs could be viewed with equanimity. As a matter of fact, the farmer, stock raiser and gardener has benefited very little by the introduction of cold storage. On the contrary, the result has been that the intermediate handler or the mere speculator has reaped enormous unearned profits at the expense of the community.

At the risk of being called a socialist, we would point out that the man who artificially increases the price of any necessity of life, especially food, both by direct deprivation and, still more markedly indirectly by increasing the worry of life, kills more men than are, in the aggregate, sacrificed to direct homicidal attacks. There is some excuse for the murderer, influenced by passion, even for the robber or burglar who, at least, works and incurs in earning a living risks more than equal in the aggregate to the risks to which his prey are subjected. But the cold-blooded, impersonal, wholesale killing of men, women and children by the speculator, for the sake of obtaining, without genuine productive work of any nature, a degree of luxury which is both unearned and unnecessary, is something which naturally, one might almost say justly, gives rise to socialism and anarchism.

It has occurred to us that, not only the economic disadvantages of cold storage, but an equalization of supply and demand and a prevention of panics, might to some extent be secured by a return to the system of government store houses, in vogue thousands of years ago. If, for example, after a careful study of prices current over a series of years, and a judicious selection of a few staple articles of fuel, food, etc., the government erected granaries, cold storage plants, etc., coal bins, etc., at convenient centers of distribution, bought at a specified minimum price and sold at a specified maximum, it would seem that, in the long run, a large revenue would be derived which would reduce taxation, and that, still more important, the fluctuation of prices to an unreasonable degree would be prevented, and that the circulation of money would be equalized both by supplying a market when prices were low and by preventing the diversion of money from the many to the few when prices were high. Obviously, such a scheme could not be applied to every article of commerce, even to those commonly considered necessities, but it would be necessary, to secure the advantages named,

merely to select a few, each of which represents an important group, as wheat, some kind of cheap meat, coal, etc. However, it must be admitted that no such scheme could be carried out without modifying considerably our present views as to the functions of government, that extensive changes of constitutional powers would be prerequisite, and that faithful and intelligent execution would be necessary to prevent abuse and graft.

A much simpler and more practical plan has been formulated as a legislative bill by Assemblyman Lachmann, of this State, making it a misdemeanor to sell any article of cold storage after sixty days. As to the technical legality of such a bill we cannot speak, but it seems to us thoroughly commendable. The period is ample to prevent loss to consumers by temporary glutting of the market with perishable fruits, etc., to allow slaughter houses, etc., to maintain steady work without regard to daily fluctuations in supply and demand, the time limit is probably safe with regard to hygienic considerations, providing of course that undrawn poultry, etc., are not placed in storage, and, at the same time, it is short enough to prevent the cruelest form of speculation in food supplies.

Obviously, if passed, there would be an initial attempt to evade such a law, both by the usual application of legal technicalities and by shipment of stored articles out of the State. The former obstacle is inevitable in attacking any evil which has strong financial backing and influence, but is eventually removed. The latter would be modified by transportation charges alone, and would naturally lead to protective legislation along the same lines by other States. It would be almost too much to hope for the immediate passage and judicial endorsement of this bill, and the general principle may require some modification, but, speaking broadly, we believe that Assemblyman Lachmann has grasped the appropriate weapon for successfully attacking the problem, botlr in its hygienic and economic aspects.

SANITATION IN THE CANAL ZONE.

WITHOUT the sanitary measures instituted by Colonel Gorgas in the Panamanian Isthmus the work now in progress there could never have reached its present stage; it is safe moreover to predict that, should these measures be abolished or materially relaxed, the great artificial waterway now under construction will never see completion. Recent legislation in Congress appears threatening to undo the beneficent and absolutely essential work of Colonel Gorgas and his medical associates; we refer to the Mann bill, which proposes "to provide for the government of the Canal Zone, the construction of the Panama Canal, and for other purposes." It will, we believe, presently appear that under this ingenuous wording the degrading of the medical service in the Isthmus is sought. Lest we appear to overrate the danger we invite our colleagues to the following considerations:

Before the services of Colonel Gorgas were enlisted the Panama Canal Zone was one of the unhealthiest spots on earth; there are those who would find this an unduly conservative distinction, who would hold that the Isthmus has had no rival whatever in this gruesome honor. Since the time of Balboa it has been known as a vast graveyard for those not indigenous to the soil who have gone thither. Humboldt presaged a century ago, after a somewhat curtailed visit, that the Isthmus must always be cursed by yellow fever and malaria. Froude declared that nowhere else on this planct was there concentrated in a single space so much foul disease, such a noisome mass of moral and physical abomination. Peculation did much to nullify the enterprise of the great De Lesseps; and since his day charges of corruption have been frequent enough, how justifiable we need not here discuss. But deterrent political and eronomic factors were and have been negligible by comparison with the hopeless unhealthfulness of the Isthmus and its environs. It has been said that in the construction of the railway from Colon to Panama

every cross-tie represented the tomb of a laborer upon it.

Since De Lesseps' time the world has seen a veritable revolution in sanitation. It has known the martyrdom of Lazear; has come to appreciate the self-abnegating work of Reid and Carroll, than which no unan labors have ever been more self-sacrificing. By them, and Guiteras, Agramonte and Kean, was the role of Stegomyia established as the intermediary in the transmission of yellow fever. As the result of this discovery we no longer fear the dreadful epidemics of "Yellow Jack" which formerly visited our seaboard cities; no one now dreads such invasions from the tropics; they are to-day but hideous memories. It was in Cuba that these men-Lazear and the rest-worked; and in that city Gorgas administered so efficiently that when the Canal project was developed in 1902 he was the logical selection for the direction of its sanitary renaissance.

Gorgas and his subordinates then set most zealously to work; and within amazingly brief space transformed this modern. Golgotha into a region as infection free as any in these United States, and much more salubrious than a great many. The last case of yellow fever occurred in Panama in 1906. During 1907 Gorgas had not a single case of bubonic plague to deal with; in that year he had but one death from smallpox; he had a fifty per cent. reduction from 1906 in malaria, dysentery, pneumonia and other grave diseases. His death rate in 1907 was more than 31 per cent. lower than that in 1906. In the territory over which he has medical surveillance-the Canal Zone and the cities of Panama and Colon-he has had in keeping the health of many thousands of men from widely diversificd parts of the earth, engaged in digging through the swamp lands of what has been probably the most deadly region in existence. In March, 1907, he had under observation 36,000 employees, with 122 deaths; during the same month in 1908 he supervised 43,000 men, with only 45 deaths. The mortality rate of the Canal Zone for

March, 1908, was less than that for the city of New York-which latter is among the lowest, urban or rural, in civilization. Are we not then justified in an observation that the completion of the Panama Canal is absolutely contingent upon the untrammelied continuance of the medical service in the Isthmus?

We regret we have not been able to bring our statistical exposition up to the present time. The reason for this is that by order of the puissant director of governmental affairs in the Canal Zone, the monthly reports issued by Colonel Gorgas, and which have been so instructive to physicians and others interested in the public health, have been discontinued. It has been arranged instead to incorporate description of the sanitary work in the Isthmus with the general governmental report. How adequate is such representation is set forth in the Journal of the Am. Medical Association: Seven numbers of the Canal Record present many pages devoted to reports from the engineering and construction department; there is extended record of the performances of steam shovels, of building construction, of excavation; there are tables showing the height of the tide, the amount of rainfall, the exact height of the Chagues River, the rebuilding of the Panama Railroad, the classification of accounts, the award of contracts, the wage of employees; there is due account of such vital matters as the social doings on the Isthmus, including clubs, lectures, dances, bowling and indoor baseball. But in these seven issues less than one column is devoted to the work of the Department of Sanitation. Yet how eloquent the brief reference, which sets forth that the death-rate in the Canal Zone was reduced from 50.57 per 1,000 in June, 1905, to 16.42 per 1,000 in June, 1909; and that, although there were 97 deaths in June, 1906, when the employees numbered only 28,010, there were in June, 1909, only 37 deaths, although the number of employees had increased to 47,493. "And yet the Canal Commission considers these facts showing one of the most brilliant sanitary

records ever made, of no interest to the public and of little or no importance to sanitarians."

The New York Sun well observes that President Taft, when he was Secretary of War, had the medical department carefully inspected with the result of demonstrating the impossibility of success in sanitation. unless it were allowed to exercise full authority in all matters pertaining to its work. This was done; and there immediately followed the gratifying results here set forth. "Such is the condition to-day (in the Canal Zone) that health and life are safer in what was formerly one of the most unhealthful strips of the earth's surface than they are in the city of New York."

OXYGEN IN MOUNTAIN CLIMBING.

THE chief reason why the world's loftiest peaks have heretofore not been scaled has lain in the mountain sickness or "fever" experienced as the atmosophere becomes progressively rarefied. The basis of this sickness is the insufficiency of oxygen for the needs of human respiration; and the symptoms are: The heart palpitates most painfully; the apex beat being easily seen between the ribs; there is bleeding from the nose; the respiration is rapid and the sufferer gasps for breath; the quick pulse and the dyspnoea are made worse by muscular action; there is also pain in the muscles; there is severe headache, parched throat; intense thirst; loss of appetite, and intense malaise, with nausea; the temperature is apt to rise above 100 degrees F. It is in altitudes above 15,000 feet that these symptoms become marked; they are generally aggravated by activity; and they may continue several days after the ascent, with possibly grave consequences. Even at less altitudes tourists experience this mountain sickness, as in the railway ascent of Rigi or Pike's Peak-which latter is some 14,00€ feet high; in such railway ascensions the malady is emphasized by reason of the rapid diminution of atmospheric pressure and o