vided instructions were given as to the best way of handling the milk. The work of the institute included observations on these things:

(1) The sanitary condition of the farms. and creameries supplying the city with milk. (2) Railway transportation and city delivery. (3) The condition of the milk on delivery, as to the number and varieties of bacteria present. (4) The effect of milk of various degrees of purity upon the health of infants and young children in institutions and tenements during the hot weather. (5) A more definite study of the changes occurring in milk which cause disease. (6) To what degree both the dealer and the farmer could be depended upon for voluntary coöperation in improving the milk supply.

At the outset two persons were sent to observe farms from which milk comes directly here, and to creameries which get the milk of from twenty to fifty farms each, cool it and send it to the city. Over one hundred farms have been examined in eight months, some of them several times, for the purpose of seeing how suggested improvements were carried out.

One of

the inspectors reported that the cows were generally found in good health, but almost no pains were taken to keep them clean, or to have them clean even at milking time. There was no pretense at personal cleanliness made by the men, especially in the matter of washing their hands. Milk pails were simply washed in an ordinary way. No cooling was attempted at the farm, but the milk was delivered at the creamery, when two or three hours old, and then cooled and placed in ice cars for shipment. In some instances the rooms in which milk is stored were uncleanly.

ONE UNUSUALLY DIRTY BARN.

One example in the neighborhood of New York City was a stable accommodating about four hundred cows, situated upon a marsh, and at high tide the water backed up into it. It was a locality closely built up

with small cottages and shanties. The only fresh air the cows got was in a small yard, sufficient for about one-tenth their number so that the cows were kept in the close stables the greater part of the time. The water supply was from a well only a few feet deep in the center of the group of stables, and the drainage of the stable yard was toward the well. As a result the water given to the cows, as well as that with which cans, pails, and other utensils were used, was simply diluted stable drainage. Piles of manure were everywhere. The milk from this stable is what is known as "Kosher milk," and is sold to the population of the lower east side tenement house districts in New York.

On some farms conditions were much more aggravating than those prevailing in other places. Suggestions for improvement were quickly carried out. The majority of the suggestions adopted were not matters calling for great expense, but simply requiring cleanliness, care, and a certain amount of intelligence. At the creameries themselves very great improvements were suggested. It was found very rarely that a creamery was supplied with a sterilizer for bottles or cans, and those in charge were often ignorant of the simplest matters relating to milk contamination, and how it was to be avoided. The report says, further:

"Milk from carefully groomed cows in clean stables, when taken under the best precautions now possible, cooled immediately to below 40 degrees Fahrenheit, and kept at that temperature during transportation by proper icing and sent by express trains to the city, although handled with every precaution against contamination, contains when it reaches the consumer from 10,000 to 100,000 bacteria in each teaspoonful. This for the best milk.

"Now, what of the worst milk? During last summer the milk sold in the groceries of the tenement districts contained, as shown by the examinations made by the bacteriologist, from 4,000,000 to 600,000,000 in cach teaspoonful, and just such milk as this

"Where do these bacteria come from? Do they do any good? Do they do any harm? These are the questions which naturally arise after reading such figures. Most of the bacteria fortunately are not those which induce definite disease. They come from dirty cows, stables, hands, and pails, the dust of the stables, of the atmosphere of the milk house or creamery where milk is mixed and bottled. If the number of bacteria is small they probably do no appreciable harm, but if their number is as large as some of those above mentioned there is abundant evidence that they may do a great deal of mischief, and lead to serious digestive disturbances, especially in infants. The germs which cause various infectious diseases, such as typhoid fever, scarlet fever, diphtheria, tuberculosis, etc., also live, and some rapidly multiply, in milk. Every year a number of outbreaks of these diseases occur, which have been traced to milk contaminated by ignorant or careless milkmen, who have infected the milk by their dirty hands or the dirty water, or in other careless ways.

"Most of this harm results because the men who are handling the milk are entirely ignorant of the manner in which milk becomes infected, and consequently fail to take the simple precautions which would be quite sufficient to prevent such a calamity. Not only diseases of this sort have been trraced to milk, but there occur occasionally cases of acute milk poisoning, which usually happens when the milk has been contaminated by some unusually virulent species of bacteria, and kept under improper conditions, generally at a high temperature."

Another point observed was the relation of milk to the great summer mortality of infants. During the latter part of June three groups of infants living in different sections of the city, and fed entirely upon cow's milk, were selected for observation. In each section a portion of the infants were left upon the grocery milk, which they were

EFFECT OF POLLUTED MILK ON INFANTS.

"A certain amount of illness, chiefly of a diarrheal character, was observed in nearly all the infants during the hot weather, even those who were nursing. There were only two deaths, one from pneumonia and one from diarrhea, among the children who were getting either the highest grade bottled milk or what might be termed good, wholesome milk, and comparatively little serious illness occurred among these infants, and most of them gained regularly in weight during the period of observation. Upon the best milk the average gain amounted during those two hot months to nearly one-quarter pound a week.

"The children who received the grocery milk did much worse in similar surroundings. In many cases the mother stated that the milk had to be returned because it curdled as soon as it was heated. Samples taken from most of the stores contained before heating 4,000,000 to 800,000,000 bacteria to each teaspoonful. The bad effects of this milk was shown not only by a much larger amount of serious illness and many deaths, but also by the general aspect of all the children observed.

"Milk in which the bacterial growth has increased to such a degree as to produce changes recognizable by the senses, i.e., souring, is not salable. souring, is not salable. At summer temperatures such changes occur so quickly that the temptation is very great for dealers. to add antiseptics to milk to prevent the growth of bacteria. In spite of the penalty attached to such a practice, this is something which is done on a large scale all over the country, and last summer, in some towns, almost every milk dealer in the place was under arrest for adding the so-called preservatives to milk. Aside from the inju

rious effects of these substances, which may be serious, such a practice serves to conceal the neglect of cleanliness and proper icing of milk. To keep milk clean costs time and labor, and ice costs money, but antiseptics are very cheap. This question of keeping milk properly cooled until it reaches the consumer brings us to the next topic, viz.:

"In the matter of transporting milk great precautions are taken to preserve milk brought long distances, with the result that some of the very worst milk delivered in New York is brought from the nearest farms.

"From the observations made last summer it appeared that fully 10 per cent. of the milk carried by the Harlem Road during the hottest months was never iced at all during transportation, and much more was iced but very slightly. Milk handled in this way in hot weather is often so changed that it is unfit to be sold, and is refused by the dealers. When, however, the changes have not gone far enough to render it unsalable, it is delivered to the grocers, and sold by them to their customers, to be used, in the majority of cases, for young children and infants. The officials said that the individual farmers were responsible, as they should have iced their milk, while the farmers said that, as individuals, it was impracticable for them to properly ice their milk, as they were only provided with an ordinary freight car, which was allowed to stand out in the hot sun, in the middle of the afternoon.

"The manner of local delivery of milk is also important. Much of it stands about five hours on station platforms before it is collected by the delivery wagons. Many of these wagons use no ice, and even milk which is properly cooled when it arrives. may become so warm in this time as to be greatly injured by active fermentation, which such a temperature induces.

CERTIFICATES FOR CLEAN DAIRIES.

"Whenever a farmer or dealer was found who had adopted the suggestions made for

supplying milk as free from contamination as is commercially possible, and had carried them out to the satisfaction of the inspector who visited his farm and the bacteriologist who examined the milk in New York, he was referred to the commission of the County Medical Society, who issued to him a certificate to that effect, the milk becoming known as 'certified milk.' The farms whose milk has been certified have been kept under observation, and the milk has since been subjected to regular examination by the bacteriologist of the Health Depart

ment.

"Thus far eight dealers have complied with the conditions, and have received certificates for the milk produced at the inspected farms. In most instances this has related only to a few farms of the different dealers, and of course affects only a small part of the milk sold, but the demand for certified milk has been so great that these dealers hope to bring all the farms under their control up to a standard sufficiently high to merit a certificate."

There must be regular farm inspection by competent persons, who shall at the same time instruct those who handle and produce milk how to do this in order that it may reach the consumer not only free from contamination, but in but in a cleanly, wholesome condition. The work of farm inspection must be supplemented and controlled by a bacteriological examination of the milk on delivery.

In the general solution of the milk problem in large cities some help may come through legislation. Certainly the Health Department of the State and city should be given the right to inspect farms and demand those things which are necessary in order to produce a wholesome milk and to exclude contagious disease. The greatest improvements, however, are not to be brought about by compulsion of the dealers, but by educating them to the point of voluntarily doing better work. It is to the cooperation of the farmers and dealers that we must look for an absolutely pure milk supply, and behind all this must be a public

appreciation of good milk. Great improvements in transportation are possible, and here the railroads should be made to feel their responsibility to the public.

applies in Russia to all operations. In order to surround the patient with further safeguards, the hypnotizer must notify "the local administrative authorities"-in other words, the police-of his intention to hypnotize a patient, giving the date, hour, and the names of the medical witnesses. Pub

THE REGULATION OF THE PRACTICE OF HYPNOTISM.

We have not seen the consideration of the subject of hypnotism so aptly and sensibly handled, so thoroughly stripped of its glamour of mystery and quackery as in the following editorial from the Medical Record:

"Ever since hypnotism has been studied. from a scientific viewpoint and placed in the rank of a rational therapeutic means, the principle, 'Hypnotism for none but physicians,' has been established by the consensus of authority.

"In most European countries, where, as we well know, so much arrant quackery flourishes side by side with the strictest medical laws, it is unlawful for any person who is not a licensed physician to practise hypnotism as a means of treatment, or for any other purpose. In Russia-a country which we have long considered barbaric and semi-Oriental, but which in legislation against charlatanism probably leads the world-the regulations on this subject are most stringent. Not only must the hypnotizer be a physician, but a hypnotic séance cannot be held except in the presence of other physicians-a rule which, by the way,

lutely prohibited, except in clinics or hospitals where only physicians and students of medicine are admitted. Public medical institutions are also exempt from the requirements of notification, simply because their officers are always directly responsible to the government. A careful press censorship is, in addition, exercised in Russia over all works on hypnotism accessible to the lay public.

Of course, the Russian regulations are incompatible with our ideas of personal and professional liberty, but it must be admitted that they express nothing but the legitimate solicitude of the government for the victims. of ignorant and unscrupulous hypnotizers. In practice, we fancy that the enforcement of the requirements of notification reacts rather unpleasantly on the physicians themselves. Imagine a patient's thoughts, when he hears that, in order to obtain permission to treat him, the doctor must apply to the police! There is no doubt that the prejudice against hypnotism, which is unfortunately by no means confined to the uncultured classes, is immeasurably increased by such regulations.

We shall not attempt to discuss here the question as to whether hypnotization at the hands of physicians may produce injurious effects upon the patient. In general, it may be said, however, that restrictions placed upon physicians which set difficulties in the way of using any mode of treatment whatever are wrong in principle, and hurtful in practice, except, of course, laws that concern acts criminal in intent. Yet in so enlightened a country as France, we are told by Grossmann in the Zeitschrift für Hypnotismus, the use of hypnotism as a therapeutic measure is prohibited in the military and naval hospitals. The source of such legisla

tion is probably to be looked for in the prejuIdice of the authorities at the head of the medical departments of the French army. and navy. Speaking of prejudice against hypnotism among physicians, it may be remembered that Virchow himself, on one occasion, thundered against the "hypnotic leanings" of a certain class of German physicians. On the other hand, such authorities as Bernheim, Liébault, Forel, KrafftEbing, Schrenck-Notzing, Moll, Pierre Janet, and Danilevsky are unanimously in favor of unrestricted practice of hypnotism by physicians.

When it comes to the quack hypnotist, and to the amateur mesmerist of the drawing-room, we are entering upon quite a different phase of the subject. In addition to the medical or scientific aspect, there are several questions in connection with this theme that should receive attention from our legislators. The first of these is the opportunity which the hypnotic séance gives for criminal acts, the second the possibility of inducing the "medium" to commit crimes under the influence of post-hypnotic suggestion. The effects of public performances, lectures, and "popular" literature on hypnotism upon the community is accurately expressed in the words of the circular of the medical department of the Russian empire, as quoted in a recent article by Rosenbach in Vratch, 1901, 34, 1030: "Public performances of hynotism may give unscrupulous persons the opportunity of learning the method of hypnotizing, and may enable them to employ this knowledge for immoral or criminal purposes; and, in general, hypnotic performances, without the appropriate scientific explanations, may breed wrong conceptions and create prejudices in the public mind, while post-hypnotic suggestions may be the cause of violations of the public order and peace, or of criminal acts on the part of the hypnotized persons."

In this country, unfortunately, the quack hypnotist, mesmerist, magnetist, or whatever he may call himself, is free to practise his "art" almost everywhere. The truth is, we have not yet, as a people, come to the reali

zation that all freakish, sectarian, and mystic forms of quackery, whether profanely allied to religion or not, should be weeded root and branch out of our national existence. The lay mind is, and ever will be, so blinded by the brazen effrontery, the sleek and suave manner, and the irrational doctrine of the quack that it tolerates him, and, alas, in how many instances greets him as the last resort. The result is that "hynotists," who have been made in a few hours by paying the modest fee of five dollars to one of the numerous "institutes of hypnotism" that advertise broadcast in our best magazines, prey upon the public's credulity, endangering the health and the pocket-books of new victims day by day.

Let us hope that the time may come when physicians will assert their influence in the community in a less timid manner than they do now, and will secure the passage of laws against quackery in all its forms. In the meanwhile, the medical societies should take the regulation of the practice of hypnotism under consideration, and should begin a movement which will arouse the apathy of the public and of the profession to the abatement of the quack hypnotist.

A NEW SMALLPOX TREATMENT.

SOMEHOW the profession, the health and school boards, and the vaccine laboratories combined do not seem to stamp out this loathsome disease. It crops out now and again in every quarter of the country and claims a certain proportion of victims. Treatment of the disease is little talked. about, and has made little or no progress for many years.

Dr. J. A. Knight, of Eatonton, Ga., is enthusiastic over a new treatment he has been trying, with brilliant success. He has some very practical ideas as to the disease, and we reproduce portions of his paper in Practical Medicine, including his remarks concerning the new remedy.

"As to its treatment, the profession is