mount, with the hope-if any thought whatever is given to it— that the place will not be unsanitary, or if so, that the particular residents will not be affected thereby. Hence, many of our cities, towns and villages are located in extremely unhygienic situations, and the question presses itself with no inconsiderable earnestness, How shall the evil be remedied? The answer has been given. And here a marked distinction must be made between drainage and sewerage, for a city or town sewerage will have no effect on the sanitary condition of the locality. The object of drainage is not the removal of filth, but simply to lessen and maintain at a sufficient depth the level of the ground water. In attempting this two other objects are also gained, the removal of what might become organic impurities, and the movement of the ground air, thus ærating the earth. The results gained will be the removal of the tendency to the diseases which are caused by high saturation levels. The first point to be decided in determining the drainage of a locality or district is the position of the lowest free outlet. It is not always that this is close at hand, but may frequently be found at quite a distance from the point which it is desired to drain. Toward this free outlet the whole drainage of the whole district must tend. The most successful drainage must follow the variations of the surface, and few districts exist in which there are not these variations. The drainage system must also lie on the subsoil, and should not be such as to render the district too dry for successful cultivation. Nature's way, by percolation, is the best way. Open drains, except for very small areas, should be avoided, in no case are they any more than a make-shift for the better and deeper underdraining. In all large towns and cities a perfect system of deep drainage should be co-extensive with that of the sewerage. It will be well if houses, situated on land having a high saturation level, should be raised from the ground in such a way and manner as will give thorough and constant ventilation beneath them. In such ground no cellars should be dug, a drain with some free outlet should surround the house, the cellar or basement windows be kept open as much as possible, and every means be taken to eliminate ground air and substituting atmospheric air. These hints will suffice for the present paper, for every district will afford its own peculiarities, and demand its own method of treatment. Not an uninteresting or valueless collateral study is that of the flora of each particular district, as connected with these soil relations and hence with the hygienic. The magnolia and the palm, aside from the temperature, would die in the soil which will sup port the tall pine and the spreading fir; the oak and the cypress can hardly interchange; nor the bearded wheat and the waterloving rice. To a 'certain extent the flora of a district is not merely an expression of the soil character of that district, but is also an hygienic expression, and partially antidotes otherwise noxious influences. And now, when epidemics are relegated to the microcosmic realm, and the atmosphere is searched for its infinitesimal organisms and spores, and chemical analysis is sure that death lurks in the water we drink, shall we not look more closely to the Hygiene of the District Inhabited, and find there the things for which we search in vain elsewhere? HYGIENE OF OCCUPATION. The subject of personal hygiene as to business followed, or the hygiene of occupation, was assigned to me at a late day; the one appointed by the Institute last year to write up this branch of the subject having been obliged to decline. This being the case, I have not had time to obtain some statistics from Germany and France, which I greatly desired, to make this paper more complete. As it is, the varieties of occupation are so great, and the details under each one more or less full, that I have been obliged to abridge and omit in order to bring these notes within the ordinary limits of an article for the Institute. Hence, I have not considered occupation as affecting longevity, nor have I included occupations ordinarily healthy, but only such as have some particular injurious effect on those who follow them. I have not made the usual classification of employments as affecting the health, for instance, sedentary habits, out-door and in-door employments, those affecting air passages, nutrition, etc., but have simply made a brief note under the heading of each injurious occupation mentioned. With this explanation, I submit to you the following very incomplete notes on the hygiene of occupation. First are grinders, needle makers, file cutters, pin pointers, cutlers, etc., who suffer from breathing the mixed dust of metal and stone rising from their work. This class furnish a large percentage of phthisis among workers in dust. According to Hirt's tables, of all file cutters treated for disease, 62 per cent. had phthisis and 17 per cent. had catarrh; of needle polishers treated, 69 per cent. had phthisis. The disease incident to the work may be several years in development, beginning with a dry, hacking cough, which continues till there is a stringy whitish, followed by a reddish, expectoration, with dyspnoea on slight exertion, weak respiration and mucous ràles. These are the warning symptoms to quit the busi ness while it is safe to do so, and before phthisis becomes fully developed. Wet grinding affords protection to the lungs, but the workmen need water proof covering to avoid rheumatism. But some work, as needle grinding, must be done on dry stones. In this case, the best protection consists in carrying the dust out of the room. This may be done by means of an open shaft leading from the bottom of the stone to the external air, and a revolving fan to blow the dust into it before it rises to the workman's mouth.* Glass grinding and polishing seems to be a more dangerous work than either of the above mentioned. Buck says about 35 per cent. of them have chronic pneumonia; and a much larger proportion of glass cutters have a peculiar form of gingivitis, which destroys the teeth. The symptoms strongly resemble some of those found in lead poisoning; he suspects the 20 per cent. of lead in some kinds of glass may be the cause of the disease. Shovelers at grain elevators are subject to an affection of the lungs which Dr. T. F. Rochester, of Buffalo, was the first to describe and publish in 1880 as the "elevator disease." When grain arrivals in port are very heavy, these shovelers can have constant employment for several days at good wages per hour. Some of them have been known to work 72 hours without any intermission, in the thick dust of grain, taking but little food and drinking freely of bad whiskey to sustain them. The effect in many cases is an acute bronchial catarrh, often lapsing into a bronchial disease that lasts for years, and with symptoms so distinct from other lung diseases that it may properly take the name of "elevator disease." Of course, its habitat is only at large grain depots. The plain preventive is regular hours and meals, less whiskey and more sleep. Operators in cotton factories include a large class of work people. The principal injury from this occupation is done to the air passages in breathing the flying dust or "fluff." Dr. Ludwig, of Breslau, says that among the operatives the sufferers from this cause experience during the first year a continual tickling in the throat, hard coughing, bronchial catarrh, etc. After this comes * The modern use of machinery in the manufacture of some of these articles renders the work almost harmless. cough with pectoral pain, marked anæmia, obstinate debility and loss of appetite, white, viscid sputa, which shows under the microscope cotton fibres. Those liable to pulmonary diseases do not bear up long. In 1836, Coetsem described a form of " pneumonia from cotton dust" occurring in operatives from 13 to 30 years of age, the duration of the malady being from 16 to 22 months, and only four cases out of 250 recovered. Floculent specks in the sputa of these cases were found to be identical with the dust of the operating room. The extended use of machinery relieves the workmen from most of these dangers, but where this is not used, we cannot indicate any means for avoiding the offending substance; yet we think the sensitive suffering subjects among the work people would have a better chance for life and health through strict attention to an improved nutrition, better ventilation of operating rooms, and by not allowing any water closets to open into them, as is too often the case. It may not be out of place here to refer to what we consider the greatest evil in the operating class generally, viz., the employment of girls from 11 to 18 years of age. Investigation into the condition of this class shows what we might expect, a prevalence of derangement of the menstrual function, anæmia, chlorosis, anasarca, oedema of feet, nervous headache, and often the hacking cough, phthisical symptoms and early decline. The only remedy for this is police supervision through legal means. Arsenical poisoning has prevailed most among those who make artificial flowers and those who manufacture a certain kind of green colored wall paper. The effects of the poison on the work people are, gastric irritation, enfeeblement of the muscular force, vesicular eruption on the hands, etc. Those working in artificial flowers can protect their persons to a great degree by scrupulous care in washing the hands after work. As the green wall paper is nearly out of use, it is not necessary to refer to its manufacture. Lead poisoning. It is not necessary to describe painters' colic, which is the principal poisonous effect of lead that we meet with. Several means have been devised to prevent lead poisoning, but none, I believe, are effectual. The only safe course is the substitution of zinc white for lead, in the arts. Match makers. Of all the occupations that expose work people |