Master of the lone plantation, ruling his savage men by sheer pluck and brains, he goes through the crowded improvised hospital, dealing out the remedies at hand, although nothing shows that he has a diploma or is registered as a physician. The necessities of such situations compel men to know something of the simpler remedies and their applications to such maladies as are to be coped with there.

What a pity he did not have at hand a few real remedies-emetine, the sulphocarbolates, atropine, and knew how to use ginger and capsicum. Men who take up such duties ought to take a course in primary medicine, and learn how to treat these dangerous affections with safe and effective remedies. One need not go through a four-years' course to learn a few useful things about medicine.

Endeavor to be patient in bearing with the defects and infirmities of others, of what sort soever they be; for that thyself also hast many failings which must be borne with by others. If thou canst not make thyself such an one as thou wouldest, how canst thou expect to have another in all things to thy liking.-Thomas a Kempis.

LOS ANGELES, 1911

The attendance at the 62nd annual session of The American Medical Association held at Los Angeles, in June, was larger than expected, in the neighborhood of three thousand physicians being recorded as present. While the East was sweltering in the most unusual heat, the weather at Los Angeles was generally delightful.

The scientific sessions were of the usual high order, and much important business was transacted. The address of the president, Dr. John D. Murphy, contained many excellent suggestions, and was well received.

The Association is to be congratulated upon its new president, Dr. Abraham Jacobi of New York, one of the best-known and most highly respected physicians in America. For about sixty years Dr. Jacobi has been engaged in the practice of medicine in America and through all has represented the highest ideals of American medicine. A native of Germany, he participated in the Revolution of '48, and was one

of that noble company of expatriates, which included great men like Schurz and Siegel, who found a home and a new fatherland in our midst in the decade before the great War of the Rebellion. Dr. Jacobi is now eighty-one years of age, but in spite of his years he is still engaged in professional work.

Many were doubtless surprised at the changes made among the officers of the Association at this meeting. Dr. George H. Simmons, who has been secretary for many years, was succeeded in that office by Dr. Alexander R. Craig, and Dr. Frank Billings was succeeded as treasurer by Dr. William Allen Pusey. While these changes are in a sense a triumph for the progressive element of the Association, which has demanded that it should be governed in a more democratic way, and that the offices of secretary and editor should be separated, it has been known for some time that a change of this character was contemplated by those actively in control of the management of the Association's affairs. Dr. Craig, formerly an eastern man, has for several months been in The Journal office, in training for the position in store for him. Dr. Simmons, it is hardly necessary to add, will retain the position of editor of the Association journal, which is, after all, the one of greatest power and responsibility in the gift of the organization.

It is interesting to examine the official report: There has been a slight loss in membership, the figure now standing at 33,960. The total number receiving The Journal of the Association on January 1, 1911, was 54,957.

The treasurer's report shows that the Association had a gross revenue of $450,305.47; a net revenue of $119,763.98. After making deductions for Association expenditures, loss on the Association "Directory," a depreciation of about $31,000 on the old building, which is not now used, the Association still has a net income of $51,994.17. In other words, in spite of the unstinting way in which the funds of the Association are distributed, for many purposes, it is still a tremendous money maker. Although a large building

has just been erected as the second "permanent" home of the Association, we find that it now has on hand, in cash, in certificates of deposit and invested in bonds, a total of $118,868.47. This is practically ready money. Its real estate, buildings, and plant are now valued at $288,833.66. These figures give some idea of the financial stability of the Association, and possibly may serve to explain its tremendous power.

The American Medical Association is becoming a highly organized socialistic enterprise. Each year it enters some new field. Thus, in addition to The Journal of the American Medical Association, it now publishes The Archives of Internal Medicine, and The Journal of Diseases of Children, and the announcement is made that it will soon begin publishing The Archives of Surgery. It was also recommended at this meeting (and this report was adopted), by the Reference Committee. on the Reports of Officers, that the publication of a small medical journal be considered by a special committee, also that another committee be appointed to investigate and report at the next annual meeting on the feasibility of publishing a health journal for distribution among the laity.

Apparently our great, Association is not quite satisfied with monopolizing the field of the old-established "scientific" journals that have done so much for the profession, such as The Medical Record and The Annals of Surgery; it wants the earnings of The Medical World, and of possibly some of those other "pestiferous" independent magazines of relatively low price.

Nor does this association, apparently, intend to stop there. A. T. McCormick of Kentucky introduced a preamble and resolution, which were referred to The Board of Trustees, to the effect that, since an "unendurable tax" is being levied on the profession by some of the great publishing houses through the many-volumed system of textbooks which are "padded," "often out of date before finished," etc., etc., therefore The Board of Trustees should consider the practicability of asking the various Sections to select authors to prepare, each, a one-volume textbook on the branches

to which each Section relates, to be published by the Association and sold at cost.

Since the Association is already in the publishing business, why should it not grab off all the "easy money" being made by the great medical-book publishing houses, such as Saunders or Lea? Doubtless more than enough profit could be made to make good the loss from shrinkage of advertising space in The Journal, resulting therefrom. And think of the tremendous additional power of such officialized opinion!

Another important measure introduced by The House of Delegates was the first step in the creation of a relief-fund and the establishment of a physicians' sanatorium.

Any reference to the meeting of the Association, at Los Angeles, which failed to call attention to the hospitality of the profession and people of Los Angeles and the beautiful entertainments provided for the physicians and their families who were in attendance would be lacking. The hospitality of California seems to be wellnigh unbounded.

As usual, Los Angeles was also the place of meeting of many closely associated societies, not the least of these being The American Medical Editors' Association, the banquet of which was easily the most delightful feature of the week. The new president of this Association, succeeding Dr. J. McDonald, Jr., who again assumes the office of secretary and treasurer, is Surgeon General Walter Wyman, of The Public Health and Marine Hospital Service. General Wyman is again the right man in the right place. Success to him in this new office.

CONSISTENCY, THOU ART A JEWEL! JEWEL NO. 4

The American Medical Association, within the last few years, has embarked in the business of publishing medical journals on a wholesale scale; it now owns three publications, another will be started immediately, while two more are contemplated.

The Association also has ventured, in a modest way, in the book-publishing busi

ness; at the last session a resolution was passed, urging the Board of Trustees to begin the publication of textbooks to compete with those supplied by the established publishing houses, the authors of these books to be "elected" by the various Sections and thus receive official designation for their work.

The Association is making money. There is more money to be made by supplying the medical profession with the things it needs. Inasmuch as it is already launched as a socialistic and (theoretically) cooperative organization, we would respectfully suggest the following lines of expansion:

The Association should acquire ownership or control of the leading medical colleges of the country, the faculties to be designated by the governing body of the organization.

It should establish and conduct a chain of hospitals and sanatoria in the leading cities and health-resorts of the country, these to be in charge of men of safe and conservative opinions and tractable dispositions.

The publishing interests of the Association should be gradually enlarged until the media for the communication of scientific information to the rank and file of the profession have come substantially within its control.

The profits derived from pharmaceutical manufacturing being reputed to be considerable, and falling (as shown by the reports of The Council on Pharmacy) into unworthy hands, it is quite proper that the Association should prepare itself to supply its members with all the drugs which under its benign despotism the profession will be permitted to administer to their patients. As the number of remedies now officially regarded as worthy is happily decreasing, and expansion in this field has become unethical, the expense of manufacture would be relatively small and the profits accruing to the Association large.

There is widespread complaint among the surgeon-members of the Association of the charges made for surgical apparatus and supplies. This industry certainly falls naturally into our province.

Why, also, should not the Association embark in the automobile business? Our profession is said to be the largest contributor to the acknowledged prosperity of this rapidly growing industry. A car "for the doctor and by the doctor" would supply a real need.

With the rapidly increasing reserve fund of the Association there seems to be no good reason why it should not enter the banking business, lending money to doctors only of course on good security. The writer could use a thousand or two himself and might not be averse to paying an extra two percent.

The manufacture of hygienic foods offers an enticing field for expansion. A great organization like our own should interest itself in the great problem of dietetics— and how better can it do this than by supplying the people with those things which they may eat-and interdicting all others.

The vista of possibilities for our great organization is an entrancing one, and to enter it means only the taking of another, and still another, step along the road which we have entered upon. The program we have outlined is an entirely consistent

one.

Consistency, thou art a jewel!

THE HOOKWORM DISEASE IN NORTH CAROLINA

In The Maryland Medical Journal, Rankin contributes some further data to his important researches on the prevalence of the hookworm in North Carolina. Examining students in the State colleges, he finds the disease prevalent in every section of the state. The connection with ground-itch, acquired by running barefooted in infected soil, was almost universal. The disease was almost exclusively confined to the whites.

Dr. Rankin attributes to this affection a check of the development, amounting to about twenty-five percent, in the epithelial, muscle and connective-tissue cells. He asks how much more has it affected the more highly specialized and sensitive central nerve-cells? As a direct cause of death it is

rare.

TH

HE need of a higher standard of life is emphasized by the spread of the hookworm disease in the South and the ever-present typhoid in the North. It is left to John D. Rockefeller to call the sleeping masses to wake up to a condition of which most of them never heard before, but that puts nearly two million southern whites out of the labor market. The standard of life of these people is so low that only about one-third of their residences have privies (Public Health Reports, Oct. 1, 1909, No. 40); the remaining two-thirds have no provision for common sanitary decency.

The condition of these poor whites is quite pitiable, but not more pitiable than that of a much greater number of residents in the North, who suffer from the ravages of typhoid in ever-increasing epidemics. (The twelfth census of the United States gives 35,379 deaths from typhoid fever during the census year, or 35.4 per 1000 deaths. Typhoid is a communal filth-disease, of which both guilty and innocent suffer, and it should be exterminated, and it could be, as my readers already know.)

The savage of the olden times lived in the trees, or at least in the woods, and had little need to fear his own excrement; it was one of the least of his enemies,

The barbarian nomad left his excrement to dry on the arid plains.

The Difficult Problem of Disposal of Filth

To civilized man the disposal of his excrement marks his rise or fall. At first the household has no provision for defecation. Then decency requires an outhouse. At last self-preservation requires the destruction of the fecal excrement. We are now in the throes of this last stage of development. In the cities of the United States most of the sewerage is dumped into the rivers, the lakes or the sea. Only rarely is any effort made to destroy the sewerage before it is cast abroad. The cities are in about the same position communally as regards their neighbors as are the two-thirds of the residences of the "poor whites" who have no privies.

Superiority of the Septic Tank

Many methods of destroying sewerage have been tried, but none of them has equalled in efficiency, reliability and adaptability the method of the "septic tank." This appellation is an unfortunate one. Septic has an ominous sound. Its associations are all unfriendly and dangerous.

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The septic tank" is a great purifier, liquefier and sterilizer. It is equally well

adapted to take care of the excrement of the city and of the country household, of the permanent population of peaceful countries and the moving armies of those engaged in war.

The fecal discharges of each individual may be considered to be about 300 Grams (10 ounces) per day. They contain about 150 billion bacteria of more than fifty sorts. Only a portion of these are disease producing. A large part of the bacteria are dead. They make up more than half the total mass.

The fecal discharges of man are far less advantageous to the soil as fertilizers than those of the herbivora or of birds. In any large quantity they are unmanageable. The feces, when dried and put on land, become very offensive when wet. If they contain disease-producing life, the moisture and warmth set the disease-carriers loose and make the use of human excreta for gardens very dangerous. The hookworm, typhoid-germ, and some of the tapeworms are thus scattered and taken to new hosts by way of the vegetation on which they are carried to distant tables-on strawberries, radishes, and other greens.

All methods of artificial sewerage destruction that are safe are too expensive to be practical.

The ordinary sewerage from a household of five people consists of 1500 Grams (50 ounces) of fecal matter, 5000 Cc. of urine, and 100 gallons, more or less, of water containing precipitated soap from the bath and much grease and detritus from the kitchen sink. The grease is the least perishable and the most troublesome to dispose of. Unless it is cooled and retained in some large tank near the sink, it collects in the sewer and holds all sorts of detritus with it, and thus stops the drains and puts the whole sewerage system out of commission. Iron air-tight cooling and grease-collecting catch-basins are now procurable, and, placed near the kitchen sink, protect the system. They must be opened and the grease removed two or three times a year, depending on the care of the cook and the size of the catch-basin. All the rest of the sewerage is perishable and happily contains within itself all the ele

ments necessary for its own destruction and purification.

Location and Description of the Fermentation-Tank

The sewerage portion last referred to should be conducted into a water-tight fermentation-tank, which should hold about twice as much as the maximum daily output from the household. It should be not more than one hundred feet distant from the house and connected with it by hermetically sealed pipes of glazed tile or iron. The catch-basin, the fermentation-tank and these pipes should be kept freely open to the air by vents running above the roof or the surface of the ground. The septic tank and all drains should be below the frost-line and wholly unconnected with the gutters from the roof or any other irregular flooding. Another distinct system should take care of the storm water.

The fermentation, or septic, tank should be about 3 feet deep and preferably longer than wide. The sewerage should enter into it at one end and somewhat below the middle of its height, and the exit should be at the opposite end and at about the middle. These pipes should be not less than 4 or more than 6 inches in diameter, and sealed water-tight into the ends of the watertight buried septic tank. The outlet of the septic tank should rise until it is within a few inches of the top of the tank and then fall as fast as possible toward its outlet.

Mode of Action of the Tank

The operation of the septic tank is constant, uniform and automatic. The house sewerage flows in through a 4-inch pipe, and therefore slowly, even when a bathtub is emptied. All the solid material rolls slowly out and sinks to the bottom of the tank at once. The liquids, according to their specific gravity, rise to the top or sink to the bottom. Some of the fluid flows slowly out at the exit at the opposite end of the tank. The contents of the septic tank are never agitated.

The flora of the septic tank soon becomes established. The struggle to exist results in the consumption of almost every particle of solid matter and the production of soluble