long, their freedom of movement is for a long time unrestricted, the great majority of them are young adults, the number of susceptible individuals is very large, and the economic damage is very large and continuous. The accessory causes of tuberculosis are, for the present at least, as important as its essential cause, and these are found in nearly all the circumstances which mark social distinctions. Age, sex, race, occupation, housing, food, wages, habits-all these individual relations and as many more political relations complicate the tuberculosis problem. The State can do much to limit the infective energy of the consumptive, and the State can do something to strengthen the resistance of the citizens in mass, but more than on these things the safety of the State will always depend upon the number of individuals who know how and are able to defend themselves in the particulars of their environment. It is not in the power of an American State to supply this knowledge or to compensate imperfect self-defense. The details of such work are too intimate for the State to undertake, but they may be very properly undertaken by a voluntary association. As the purpose of organized charity is to restore the individual to economic selfsufficiency, so the purpose of a voluntary association for the control of tuberculosis is to develop as far as possible individual power of self-defense. When legislatures and councils have been taught their duty and have assumed it, the utility of such an association as that just formed in Maryland will be no less than it is at present, and its activities will as certainly continue as this generation will give place to another. We shall never have done with Koch's infinitesimal plant, but in the control of its harmful activity we shall have increasing profit, and shall enrich our children and our children's children. FLIES AND TUBERCULOSIS. IT has long been known that living tubercle bacilli are present in the excreta of flies fed upon tuberculous sputa, and that the bacilli in dried flyspecks may remain virulent for a short time. A study by Frederick Lord of the relations of the excreta of flies to the transmission of tuberculosis appears in the Boston Medical and Surgical Journal for December 15, 1904. He finds that flies fed exclusively on human sputa, whether tuberculous or not, die in a few days; when fed on tuberculous sputa the tubercle bacillus is found in the intestines within 18 hours. It appears that the bacillus multiplies in the intestinal canal of the fly, but its activity is restricted to the intestines. In the digestive tract of the fly the bacilli increase about 15 times (in sputum 10 organizations per field, in the excreta 150 per field). Guinea-pigs inoculated with tuberculous flyspecks one day, eight days, and fifteen days old became tuberculous. Excreta 28 and 55 days old were inoculated into guinea-pigs without result. Of the three tuberculous animals, only one had generalized tuberculosis-that inoculated with the freshest excreta. The doses employed were quite large-100 flyspecks, or about 500,000 bacilli. It has been a common mistake, as we think, to use too large doses in the experimental study of tuberculosis. A guinea-pig was imprisoned for eight days in a box supplied with a constant current of air entering the chamber through a glass cylinder in which 23 flies and a quantity of tuberculous sputum had been kept for three days. At the end of 12 weeks this animal showed at autopsy no trace of tubercu losis. The author concludes from this experiment that the tubercle bacilli in excreta are not likely to be distributed by currents of air. Dr. Lord believes that the danger of infection through agency of flies lies in the ingestion of food contaminated by the infected excreta of flies, though he did not in the present study consider it desirable to feed animals with such excreta. It seems to us that the feeding experiment should have been preferred to that of inhalation. If the inhalation experiment had produced a tuberculosis, the result would probably have been added to the already enormous, and perhaps misleading, mass of evidence, which suggests the idea that the deeper air passages offer the most favorable atria for tubercular infection. The ingestion experiments are less numerous, but have no vice of ambiguity. Dr. Lord's paper adds important data to the accumulated proof that flies are effective agents in the transmission of infectious diseases, and his suggestion that tuberculous patients and their infective excreta should be carefully screened against flies is but one of many reasons for the more general use of insect-barriers about the sick. THE ERA OF IMPROVEMENT IN BALTIMORE. IF the excellent and very elaborate plans of Mayor Timanus for the improvement of Baltimore include adequate provisions for the sanitary needs of the city, these most expensive of the necessary reforms are strangely neglected in public discussion. It is said that we shall soon have a municipal hospital for infectious diseases. Let us hope that it is true. No civic necessity of equal value can be had at as small a price. There is a committee on water, which we hope will consider the responsibility of a great city for the consequences of failure to provide reasonable defenses against water-borne disease. Judged by the easy standards of American cities, our delinquency in this respect is perhaps not very glaring, but American standards are advancing, while we are not even marking time. A few years ago the question of filtration was indefinitely postponed because we had a prospect of engaging the greater problem of a sewerage system. This was for the time being a wise disposition of the water question. But the drainage of the city is no better, nor is it certain that the extraordinary opportunity provided by the great fire will be turned to advantage in the immediate construction of a portion at least of that complete modern sewerage system which a year ago we recognized as Baltimore's paramount necessity. A few days ago on a trolley car the writer overheard a group of theatrical people commenting on the appearance of Centre street near Washington Square. It was characteristic of Baltimore, and reminded them strongly of New Orleans. Baltimoreans hearing their remarks must have felt flattered by the comparison of their city to the poorly-ditched town on the lower Mississippi. One cannot traverse the burnt district today without acknowledging the excellence of the work done by the Emergency Committee and the Burnt District Commission. The mayor's recent action has given a tremendous impetus to the forward movement, and his call for the services of distinguished citizens has met with splendid response. Perhaps their enthusiasm will carry their work beyond the lines blazed out last February and include the whole city with all its needs. Medical Items. SURGEON, PHYSICIAN, PHARMACIST, HOSPITAL INTERNE, TRAINED NURSE FOR PANAMA CANAL. The United States Civil Service Commission announces an examination on January 18, 1905, to secure eligibles from which to make certification to fill vacancies in the following-named positions under the Isthmian Canal Commission on the Isthmus of Panama: Surgeon, physician, pharmacist, hospital interne, trained nurse. The scope and character of these examinations are as indicated below. Each applicant for the Isthmian Canal Service will be required to submit to the examiner, on the day he is examined, a recent photograph, not more than three years old, of himself, which will be filed with his examination papers, as a means of identification in case he receives an appointment. An unmounted photograph is preferred. The date, place, and kind of examination, the examination number, the competitor's name, and the year in which the photograph was taken should be indicated on the photograph. For further information concerning transportation to the Isthmus, conditions of employment, etc., attention is called to Form No. 1417 inclosed herewith. Surgeon.-Age limit, 25 to 50 years; salary, $250 per month. The examination will consist of the subjects given below, with the relative weights indicated: Subjects. 1. Anatomy.. 2. Surgical bacteriology.. 4. Surgical practice.. 5. Surgical gynecology.. The elements of practical experience will be rated upon the statements made in the application and accompanying vouchers. Special attention will be given to the quality of the applicant's experience, and applicants who have had experience in hospitals, particularly in the treatment of tropical diseases, will receive special credit. Only those who have had extensive hospital experience and are familiar with the treatment of tropical diseases will be selected for appointment to the highest-salaried positions. Promotions may be made in the discretion of the Isthmian Canal Commission from the lower to the higher positions in this grade. Pharmacist.-Age limit, 20 to 40 years; salarises, $900, $1000, and $1200 per annum, with board and quarters. The examination will consist of the subjects given below, with the relative weights indicated: Subjects. Weights. 1. Letter-writing. Chemistry.. 2. Weights. 5. Materia Medica.. Practical experience.. 5 5 Total.... 5 15 40 15 25 100 3. Surgical pathology and diagnosis... 15 6. Practical experience. (This element will be rated upon the statements made in the application and accompanying vouchers. Special attention will be given to the quality of the applicant's experience, and applicants who have had extensive work in large hospitals will receive special credit)..... Total...... 40 5 30 100 It is the desire of the Isthmian Canal Commission to appoint in this position only surgeons of thorough training and wide professional experience. Physician.-Age limit, 25 to 50 years; salaries, $150, $200, and $250 per month. Graduates of pharmacy only will be eligible to this examination. Experience will be rated upon the time spent in the general work connected with pharmacy, the preparation and compounding of prescriptions, and the making of official preparations. Hospital Interne (Male).-Age limit, 20 to 30 years; salary, $50 per month, with board and quarters, provided that if appointees are retained in the position of interne after one year they will be paid $125 per month. Only graduates of reputable medical schools having a three-year course will be admitted to this examination. It is expected that within the next few months 12 or more vacancies in this position will be filled as a result of competitive examination. 1. Letter-writing (the subject-matter on a topic relative to the practice of medicine).. 2. Anatomy and physiology (general questions on anatomy and physiology, and histologic or minute anatomy)..... 5 15 3. Chemistry, materia medica, and therapeutics (elementary questions in inorganic and organic chemistry; the physiological action and therapeutic uses and doses of drugs). 10 4. Surgery and surgical pathology (gen eral surgery, surgical diagnosis; the pathology of surgocal diseases) 20 5. General pathology and practice (the symptomatology, etiology, diagnosis, pathology, and treatment of disease) .... 6. Bacteriology and hygiene (bacterio- Total..... 25 ΙΟ 15 100 of the United States who comply with the requirements. Applicants should at once apply either to the United States Civil Service Commission, Washington, D. C., or to the secretary of the board of examiners at the places mentioned in the accompanying list, for Application Form 1312. The medical certificate in Form 1312 must be filled in by a reputable practicing physician. No person will be appointed for service on the Isthmus who is not physically sound and in good health. No application will be accepted unless properly executed and filed with the Commission at Washington. The exact title of the examination desired should be used in the application. As examination papers are shipped direct from the Commission to the places of examination, it is necessary that applications be received in ample time to arrange for the examination desired at the place indicated by the applicant. The Commission will, therefore, arrange to examine any applicant whose application is received in time to permit the shipment of the necessary papers. The following information is furnished by the Commission as to length of service, opportunities, accommodations, and privileges allowed employes and officers: Length of Service.-Is estimated at eight years and over which will be required to complete the canal, it is expected. Opportunities.-Promotion is promised for merit under the civil-service laws. Medical Attendance. - Medical attendance, medicines, and care at hospitals when sick are furnished to the employes of the Isthmian Canal Commission without cost. Well-equipped hospitals will be maintained at Ancon, adjacent to Panama, and at Colon. In meritorious cases sick leave on pay may be allowed. Accommodations for Employes.-The Isthmian Canal Commission furnishes quarters to its American employes, or, at its option in lieu thereof, commutation. A commissary department will be maintained on the Isthmus, Transportation to the Isthmus.-The Isthmian Canal Commission furnishes its employes free transportation to the Isthmus from either New York, New Orleans, or San Francisco, and also free return transportation upon completion of satisfactory service. Leave of Absence.-The employes of the Isthmian Canal Commission are allowed six weeks leave of absence annually on full pay. This leave of absence is not granted until after eight months of satisfactory service. 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