infected while the ship is in port, and emigrants are inspected before boarding, not only with regard to conditions liable to exclude them from the United States-and these conditions include moral respectability-but so far as practical, with reference to hygienic conditions affecting the well being of fellow passengers. During the voyage immigrants are vaccinated and are daily inspected, while rounds of the steerage are made at least twice daily and every opportunity afforded for medical attention, as in a well ordered hospital. Indeed, all ships are provided with drugs, antitoxin, surgical instruments and even with isolated wards for contagious or delirious. patients.

The food was abundant and of excellent quality and the surgeon is authorized to order liquors, fruits, milk and, indeed, any viand needed from the kitchen of the first cabin passengers. In addition, various luxuries are sold at reasonable rates.

A little consideration will show that steerage passengers on a ship cannot well have the space, either inside or on deck, allotted to those paying two or ten times as much for transportation and that, during stormy weather, it is practically impossible under existing conditions of naval architecture to avoid some degree of crowding, imperfect aeration, lack of privacy and fouling of environment by seasick or careless individuals. So far as the experience of our representative went these imperfections were minimized as much as possible, and were due largely to the previous filthy habits of ignorant human beings who could not be disciplined in the brief time of the passage to observe anti-spitting rules nor to cultivate the habits of modesty enforced by public opinion in America. So far as indecent mingling of the sexes was concerned each family must, of course, establish its own customs and the critical American visitor to the temporary or permanent homes of Europeans of the lower classes, in Europe or after immigration to America, is

often shocked by conditions which are really perfectly innocent. In the instances mentioned, single men and women were separated and the assignment to quarters, by families, were made and were modified during the voyage, so as to respect the conventions. As to familiar handling of women by members of the crew, including stewards, our representative saw no instance and the discipline was such that nothing of the sort would have been possible, unless by an individual violation of law, as on land, and with even more prompt punish

ment.

Ventilation, even of the lower steerage decks, was secured by means of a sail leading to a large canvas tube, a method which would fail only in the infrequent instances. in which the ship's courses and speed were identical with those of the wind.

It cannot be denied that a rough ocean passage, for a third-class passenger, ignorant of hygiene, especially for an orthodox Jew, whose religious belief compels him to carry his stock of provisions for a period of ten or twelve days, entails much hardship, at least according to the standards of critics. Nor can it be denied that with approximately a million such passengers carried yearly, abuses will be found.

It would be a good plan and one which would cost comparatively little and which would probably indirectly save expense to the government, to maintain a force of travelling immigrant inspectors, to facilitate the work of the immigration bureau by rejecting undesirable immigrants at European ports, and to guard the interests of immigrants in transit. Even if the force was not adequate to provide for supervision of each passage, the liability to occasional inspection at unspecified times, would probably suffice to stimulate the steamship companies to maintain a proper stardard of efficiency. But, under present conditions, the hardships of the average immigrant are much less than were suffered by the passengers of the Mayflower.

A NEW world of ideas is in the air! The beginning of the twentieth century marks a very important epoch in the sudden acquisition of great advances in our knowledge of the physical properties and chemical constitution of the atmosphere. Our views of the conception of the dynamics of the air have been completely revolutionized. It can be safely predicted that we are only en the threshold of more important discoveries. Our knowledge of the atmosphere has been greatly enriched by the rapid advances achieved by the combined efforts of astronomers, chemists, physicists, meteorologists and aeronautists. Now, more than ever before in the history of the atmosphere, has its study aroused such an intensity of interest, stimulating progressive minds to greater endeavor, it being a very fruitful and fascinating field for new investigations and discoveries. In the past few years the whole civilized world has fol:owed with attentive interest the recent successful efforts and progress which have been attained in the struggle for the conquest of the atmosphere.

We are now on the eve of the greatest epoch-making discoveries of the atmosphere, more marvelous than heretofore, as scientists are indefatigably searching for the presence of undiscovered gases, lighter than hydrogen, in the atmosphere, which are of far-reaching importance, and which would aid us in solving many phoronomic problems (of an oscillatory nature) ascribed to phenomena attributed solely to the universal æther.

To the physician the study of the atmosphere is of absorbing and instructive interTo him the composition and natural

est.

-LEMIERRE.

variations of the atmosphere and its effects upon the human organism are of supreme importance. The value of a scientific study of the atmosphere, from the standpoint of the biologist, the physiologist, hygienist and medical climatologist, can be readily perceived, if we recall the fact of the great biological importance of its constituents, as well as of the intrinsic energies, which are inherently connected with and control the vast aerial mechanism, without which all living forms would become inmediately extinct, should it ever disappear from our earth as in the case of our nearest satellite, the moon.

Such a knowledge as is attainable of the atmosphere is not only rul! of interest to the student, but of vast practical importance to the climatologist, hygienist and sanitarian.

Climatic diseases are due to, or, materially influenced by, meteorological conditions, and should, therefore, receive the earnest attention of the intelligent, investigating physician.

The purpose of this article is to interest. physicians and stimulate them to inquiry in the investigation of the altitudinal distribution of diseases (ypsographical pathology), in view of ascertaining their prevalence-actual or relative-tracing the influence of meteorological conditions of altitudes upon the organism in health and disease. The purpose, also, is to study the relative prevalence of different diseases at different altitudes.

The physician, from the standpoint of the hygienist, studies the normal and abnormal constituents-gaseous, liquid and solid-of the atmosphere and the natural variations of the latter, being, briefly stated,

the physics of the atmosphere, which consists of the following chief groupings: radiation, heat, atmospheric pressure, wind and proportion of aqueous vapor (hydrometeors), and, in addition to these, we have associated less important chemical, optical, acoustical and electrical phenomena, all of which constitute the study of meteorology. Within each of these groups have evolved a number of more or less important conceptions, the application of which are characterized by separate climates. These are the climatical elements, e.g., the average temperature of the air, the yearly and daily periodical, as well as the absolute maximum and minimum of the temperature of the air, the altitude and the nature of the substratum of the atmosphere, the apportionment of atmospheric pressure, radiation, humidity. etc. The unintelligible comprehension, the irrelevant selection and wrong derivation of these quantities in the publication of communications in regard to the individual climates have frequently injured the progress of climatology.

We now proceed to the biological study of the air of high altitudes and its effects (quasi physiological and pathological) and pathological) upon the living organism.

THE EFFECTS OF RAREFIED AIR OF GREAT AL-
TITUDES UPON THE HUMAN ORGANISM
-THE INFLUENCE OF ALTITUDE ON
THE NUMBER OF RED CORPUS-
CLES OF THE BLOOD.

To the student of medical climatology the study of the alterations of the atmospheric pressure is becoming a subject of engaging importance. The rapid advances of our knowledge of the atmosphere have correspondingly increased our interest in this. medium from a biological standpoint. Recent discoveries of the atmosphere will compel physicians, who desire to keep abreast with the times, to give this subject more than passing attention, as we have a means. at our disposal that will be a benefit to mankind. It is unnecessary to dwell upon the fact that the various diseases of the air passages, including pharyngitis, bronchitis, pneumonia, asthma and a number of others,

are materially influenced by meteorological conditions.

In recent years the effects of rarefied and compressed air have been studied in a number of pulmonary affections. Here is a wide field for original research!

In the absence of the therapeutic application of the rarefied air of altitudes in disease, artificial aerotherapeutics may also be employed. Inhalations of rarefied air by means of the pneumatic cabinet have been found very beneficial by Platt, Quimby, Knopf and others. A reduction of the atmospheric pressure, about half a pound to the square inch, is sufficient. According to Knopf, the seances should be given at first every day, and their duration should be gradually increased from two minutes to six or eight minutes."

Rarefied air as found at great heights induces a condition known as mountain sickness or balloon sickness, and consists of increased heart action, more rapid respiration, headache, followed by graver symptoms as the rarefaction increases, such as vomiting of food, bile, and blood with great pain in the stomach, followed by death. There are frequently minute hæmorrhages into the spinal cord as the result of inspiring rarefied air. The insufficient supply of oxygen in the rarefied air is perhaps the principal causes of the symptoms manifested.*

More or less prolonged residence in a rarefied atmosphere may be associated with an increase in the number of red bloodcells in the peripheral circulation and an increase in the amount of haemoglobin. Many of the symptoms have been attributed to lack of oxygen or to the inability of the blood to absorb oxygen in its more rarefied form, and also to the influence of raɔid evaporation of water that takes place under lessened atmospheric pressure.3

Perhaps the most interesting example of the variation in the number of red corpuscles is that which occurs with changes in altitude. Residence in high altitudes :s

Viault (Le Semaine medical, 1890, p. 464) has shown that living in the mountains two weeks at an altitude of 4392 meters caused an increase in the red corpuscles from 5,000,000 to 7,000,000 per cubic m.m., and in the third week the number reached 8,000,000. From these and similar observations it would seem that a diminished pressure of oxygen in the atmosphere stimulates the hematopoietic organs to greater activity, and it is interesting to compare this result with the effect of an actual loss of blood. In the latter case the production of the red corpuscles in the red marrow is increased, because, apparently, the anæinic condition causes a diminution in the oxygen supply to the hæmatopoietic tissue, and thereby stimulates the erythroblastic cells to a more rapid multiplication. In the case of a sudden diminution in the oxygen pressure, as happens when the altitude is markedly increased, we may suppose that one result is again a slight diminution in the oxygen supply to the tissues, including the red marrow, and in consequence the erythroblasts are again stimulated to greater activity. This variation in hæmoglobin with the altitude is an interesting adaptation which ensures always a normal oxygen capacity for the blood. Inspiration of rarefied air from a spirometer containing rarefied air modifies the blood-pressure curves, causing a greater rise of blood-pressure than when respiration occurs at normal pressure, while during expiration, although the blood-pressure falls, it may remain somewhat above normal. After a time, however, there is a fall of blood-pressure on account of the engorgement of the thoracic vessels and the accompanying depletion of the general circulation, and the distension of the heart and interference with its contractions.

The augmentation appears to be actual, when we suppose, with P. Bert, that the capacity of the absorption of the blood for oxygen is augmented on the high table

H. Howell, Ph D., M.D., 1896, p. 344 and 560.

augmentation of the tension oi oxygen produces opposite effects. We object, nevertheless, to the rapidity of neoiormation and to the return to the normal. The question is still under consideration. According to Vaquez, the hyperglobuiia of ascensions is artificial, solely peripheral; that of the inhabitants of the highlands is really general. We now consider the inhabitants of the higher mountains. They live continually in rarefied air and do not feel ill at ease; they are accustomed to this condition of the atmosphere. We know of the existence of towns of more than 4,000 meters (4390) in the Himalayas, in Peru, and in the Andes there are millions of individuals living at a height of more than 2,000 meters.

How is this adaptation explained? The organism adapts itself to it. The chest is very large, very ample and with a less elevated waist; the respiration is more frequent, the circulation more active (Jourdanet). (Translated from the French by the writer.)

HIGHEST INHABITED PLACES ON THE EARTH -A BIOLOGICAL STUDY OF MAN'S DWELLING-PLACE AT GREAT ALTITUDES.

Most of the works on geographical pathology, medical climatology and physical geography give us but a very meager information or none at all ot the life of man at great mountain heights. In the preparation of this article, when searching for scientific data, which has required ruch patience and time, the writer has availed

himself of German and French works and from other sources, as most of the American and English works lack the desired. information so earnestly sought.

We hear very little, if any. from physicians engaged in the active practice of medicine who are called upon to treat persons who are ill from various diseases prevalent at great altitudes. It certainly would be of interest to know of the actual effects of rarefied air upon different persons in health

Traité D'Hygiène, Atwosphère et Climats, par J. Courmont et Ch. Lesieur, 1906, La vie aux grandes hauteurs, p. 42-43.

and disease. It is certainly an excellent opportunity for making original scientific observations for the physician as well as for others who have scientific training. The observing physician has an opportunity to make good use of his leisure time in performing scientific investigations and recording them in medical as well as in scientific journals.

Although there are places on the earth inhabited by man that are situated at very great elevations, there is naturally a limit as far as the existence of human beings is concerned, for reason of the corresponding diminished amount of oxygen, which is so essential to the life processes of human beings.

It has been proposed to differentiate the climate that is inimical to man of regions above 2,000 to 4,000 meters as mountair climate from the climate of the highlands of the lower terraces, which, on account of the purity and coolness of the air and the vigorous activity, which it offers to the lungs and heart, is characterized as salubrious to man.

To the student of medical climatology, hygiene and medical ypsology (the study of heights), when making a comprehensive study of high regions, from a biological standpoint, it is of scientific interest to know at what great heights man is capable of sustaining his existence for a comparatively indefinite time.

Among the highest inhabited places we will briefly mention the following: The highest permanently inhabited places have scarcely one-half of the atmospheric pressure that prevails on the level of the sea; for Europe it is the meteorological station on the summit of Sonnblick (Tauern); height 3106 meters, average height of barometer 520 millimeters; in America the village St. Vincente in Bolivia; height 4850 meters, height of barometer 436 millimeters; in Asia the monastery Hanle in Tibet; height 4160 meters, height of barometer 433 millimeters. For most persons in altitudes above 4,000 meters the symptoms of mountain sickness begin, characterized by dizziness, difficulty of breathing, lassitude,

palpitation of the heart and nausea; however, all these depend very much upon the disposition and conditions (exertion).

The effect upon the human economy of high altitude varies with the extent of the differences in individual reserve nerve force."

Among the highest inhabited places in the United States, Altman, Colorado, enjoys the distinction of being the highest incorporated town, having a population of about 200, and is located in the mining territory of several well-producing gold mines, at an elevation of 11,200 feet. Corona, Colorado, with an elevation of 11,660 feet, has practically no population in the winter tine beyond the few inhabitants, possibly a half dozen, required to maintain a station. In summer time, however, it is quite a busy place, and the average population is then about 200 persons. There are still other inhabited localities considerably higher, for instance, Pike's Peak,, with an elevation of about 14,147 feet, is inhabited during the summer by a few employees of the mountain railroad. In the summer of 1901 the writer was on top of this high mountain peak. Those persons, who know the scnsation of looking from a high mountain top over hundreds of miles of the earth's surface, have realized the sensation it affords, causing an indelible impression one of the cherished experiences of a lifetime! To the man of science, from the standpoint of geology, one is impressed by the colossal, gigantic accumulation of masses of broken granitic rocks, the result of a mighty upheaval. On account of the poverty of the air at these great heights in dust and watery vapor and the latter's products of condensation one is enabled to view the surrounding landscape at great distances, distant objects appearing apparently near. The intensity of direct solar radiation, as well as that which results from reflection, increases with the height, the temperature of the air, however, being very much diminished.

Klimalehre. Von Prof. Dr. W. Köppen, 1899, p. 98-99.

A Text-Book of the Practice of Medicine. By James M. Anders, M.D., Ph.D., LL.D., 1902, Article: Mountain Sickness, p. 67.