853

such dangers as may be run by those not notifying the presence of infectious disease. On the whole, then,allowing for slight differences in our law, we agree withMr. Purrington that these persons not infrequently offendagainst the criminal law, and that their prosecution, thoughnot very likely to take place, is desirable owing to the

-enlightening effect it would have on the public. As he

aptly observes in conclusion, " publicity will destroy thecult far more quickly than legislation." Legislation cer-

tainly seems superfluous if the existing law be adequate andH it be adequately enforced.

THE EVILS OF SNOW.

A MORE or less heavy fall of snow is not without its

effects upon the public health in an unfavourable direction,due in general to an augmentation of respiratory diseases.In towns a fall of snow is particularly disagreeable since it soon settles down on the pavements of our streets and in theroadway into a highly chilling muddy slush. It is the

readiness and eagerness with which slush absorbs heat inthe act of liquefying which renders it so dangerousto the health of those who are obliged to walk throughit. Again, it is a notorious fact that however proofa leather boot may be against rain it seldom provesa. barrier against the percolation of water derived fromthe melting of snow. This is probably due to the effect ofthe intense cold of snow making the leather, so to speak,crisp instead of supple owing to the oil in the leatherwhich makes it supple becoming congealed. In this way

. probably leather loses its most valuable quality. A useful

precaution is to grease the boot outside with an oil of

comparatively low melting-point as, for example, goosegrease or some mineral oil. A fall of snow, however, isnot without some compensatory advantages. It rapidlyclarifies and purifies the air. An analysis of snow showsthe presence of an enormous proportion of organicimpurities and bacteria which are swept out of the air bythe descending particles. Again, the friction of snow-

flakes with the air gives rise to the formation of ozone. Thesmell of ozone in the air after a snowfall is very marked.We are pleased to note that our vestry authorities on theoccasion of a moderately heavy fall of snow in London lastTuesday were on the alert to remove the horrible slush as it

accumulated. The City streets were scrupulously cleanwithin a few minutes of the cessation of the fall. This is asit should be, for the presence of a wet freezing mixture inour streets is a source of extreme discomfort and danger t(pedestrians.

-

SANITATION IN HOTELS.

THERE is a praiseworthy tendency at the present time todevote especial attention in a sanitary sense to all places wherethe public aggregate, and perhaps the best example of thistendency is to be found in the regard which is now beingpaid to the conditions under which children at ages sus- ceptible to infectious disease are gathered together in ourpublic elementary schools. It is, however, important thatwe should not in our zeal for the health of the little ones

altogether overlook the conditions under which a not incon-siderable number of adults at the bread-winning ages spenda great part of their existence. In the hotels of our greatand small towns men in the prime of life and having familiesdependent upon them are nightly housed under conditionswhich are often far from satisfactory. The ventilation oftheir bedrooms, especially in the older hotels, is often highlydefective and the other sanitary arrangements are liable tobe if not altogether primitive in principle, approximatelyso in practice. The so-called water-closet often may be

found ventilating only into an inside passage, itself

close and stuffy, while the pan of the closet is old-fashioned in type and the water-supply is nil. Further-

more, the pungent odour which arises when the handle

of these old-fashioned closets is manipulated bearsevidence to the fact that the soil-pipe is imperfectly (ifat all) ventilated and that the "container" is coatedwith filth. Often, too, in this same closet is a defectivelytrapped lavatory basin which yields a highly offensive smell.It is under conditions such as these that opportunities areafforded for contracting disease, opportunities which are

much accentuated by the fact that the lighting of theseclosets is often extremely defective and hence cleanlinessis all but an impossibility. It is difficult to understand whymore attention is not devoted to this matter by the officersof local sanitary authorities. A periodical visit would domuch to bring about a better state of affairs.

IRISH POOR-LAW MEDICAL SERVICE.

ON March 16th a deputation nominated by a public meet-ing recently held in the Royal College of Surgeons in Irelandwas received by the Local Government Board. Sir ThornleyStoker who introduced the deputation said that they came onbehalf of the Irish Poor-law medical officers backed by theauthority of the largest meeting of the Irish medical pro-fession that had ever been held in Ireland. They onlywanted reasonable reforms and by far the most important wasthe question of superannuation. Dr. J. W. Moore referredto the necessity of allowing travelling expenses. SirWilliam Thomson referred to the abuse of visiting ticketswhich were given out without any care. He mentioned onecase in which a dispensary medical officer who was summonedon an urgency ticket travelled 10 miles and was showna pig as his patient. Another medical man was summonedon one occasion to see a cow by a ticket filled in

by the owner. On another occasion he had to go out

to see a donkey. In this case the chairman of the com-

mittee signed the ticket. The Vice. President gave the usualofficial reply that the Local Government Board would givethe matter every consideration. We hope that they will notonly consider the question but see that the lot of the Irishdispensary medical officer is made less hard ; but we areglad to see that the Local Government Board have intimatedto the Cork Board of Guardians that Poor-law medical officersare to have a month’s holiday and that substitutes are to bepaid by the guardians. We would refer our readers to

our issues of Jan. 7th, 14th, and 28th, in which we gavean account of the many hardships under which these practitioners labour.

___

PATHOLOGICAL CHANGES IN THE NERVOUSSYSTEM IN DELIRIUM TREMENS.

IT is not often that cases of delirium tremens end in afatal issue if occurring in otherwise healthy subjects freefrom cardiac, arterial, pulmonary, and renal disease.

Uncomplicated fatal cases are rare, and till recently have notbeen minutely investigated as regards the microscopic andpathological changes which take place in the brain andwhich render these patients restless, terrified, and subjectedto visual and horrifying hallucinations and insomnia, andproduce general muscular weakness and tremor of the hands,lips, tongue, &c. Two such cases recently investigated andpublished by Dr. Ewing! of Columbia University (New York)are noteworthy. In one the patient was a young man, aged25 years, who drank heavily and who was in a state of intoxi- .cation for six weeks, finally dying from delirium tremens withexhaustion and pyrexia; the temperature rose to 104° F.before death. In the other case, a man, aged 29 years, from

1 Archives of Neurology and Psycho-pathology, vol. i., No. 3(pp. 343-5), 1898.