Document dY5EOBO0N5DgNObXML8gjzaa5

i  Chairman*! Addrei* I 1 Medical Perspective, in! Atmospheric Hygiene rrUrt, MJ>,, a y s p r e s e n t c o n c e r n w*b the dtcn M of the environment on beakh fa norther new mot wwwul E*rry physician fa famflisr with the fact that fa Has been customary tad traditional for patients lo hluor (heir (oapUfab and physical 0iM(fa chemical and physical stimuli to which they haw been or may brhrv* they hot fam * posed. The rapfcfiy tocreailng faduitrialitatfaa of our society Km produced anr matcriafa aad t> poiurta. and ho accentuated old Icon. The t*m|* practfatonrr who ho boa trained to mvpiiir and treat dfaeais trim hraWjv upoo thr pitmii account of the development of lywpkm for ha ultimata diapnk When frank dorare oemn and physiological dysfunction fa pmrhihU, drtaUivr diagnosis and tnwtmnrf Ucnau pnssflde. Theo*ch training and esperirnev. the phyairiaa fa tanprteni to recognise ditram atatra and to fat* Srcpret thr significance of hn^opnly functioning phpkinpnl systems. During no period of hfa training, however, and certainly not to medical school fa hr Ukrly to have hao any ciposure to cooccpu of what constitutes good health. Yet. to the twentieth orotury, when the tocidenoe of to* factious dlooe baa been reduced dramatically, thoughtful practitioner* are noting aa Increase to the number of healthy patient* who are worried about thrfa health. Thk fa aa odd phenomenon at a time when the sge-adJuried mortality rate to the Catted State* fa almost two*third* lew than fa wm at the beginning of the twentieth century. The concern for health and the satiety that the discharge of warie* into the atmoephere will pro duce ftlarM and suffering and wiU ihorten life are natural results of our boric teoet that cleanliness and health are synonymous. Thk concept vu tra dition*! even prior to the time that there waa any knowledge of the effect* of bacteria] agent*. It fa entirely natural t)*at Individual* will become both Mowt a Mmm* mna--. Dewar .......... a flu lint m U Q 111 i n`t Manx Uha. * *am* mm umtmtm m a* III* -->i w mu * a* a--mm lewml w*aa (Muc tor fta, nn dfatremed and concerned for thrfr nrP-brtog and ttfrty when etauunheric poQutant* produce re duced visibility, soiling of building* and clothing and even physical dfanafort such aa eye Irritation nr coughing The mere fact diet any material to the wtmnmnfa fa cUmed aa a conenoa nukance or fa capable of becoming a safety hazard ahould furtifv fa* reduction or efamtooHon without Imply ing the development of chronic crippling dkraae or rffrefa on future grnrratton*. ualrM euch coosequence* can be foreseen reasonably and not im plied dramatically and absent hysterically. Such phrme* aa 'aerial garbage,* 'atmospheric filth." and *alr pollution Inked to the cooanon cold* may law great dramatic appeal to thr daily newtpapen, hut they have no place to mtdkal prriodicah wbrrr. ur^tuiutrly, they all too often appear. Such statements only annoy the name*! restarch arientfat and confuse the private practi tioner whose immediate problem fa the under standing and manajp-mral of the Individual pa tient and hfa symptoms. For these reasons, fa fa imperative that the medi cal proffusion devote fas attention to a calm ap praisal of the correct facts of hrekh. dfartia, and the environment. It fa true that there fa a great deficiency to the information tooceretog the electa of various atmospheric pollutants, hut fa fa equally rive that a great body of Information tmen nine tbs causa of disease and the effects of themicah on biologic*! system* fa available. The bapbretkm that no backpound of information rtkta and that all biologic phenomena produced by the absorption of various substance* must be drvrloprd as a new science fa both mbleading and erroneons, ft fa alarming to see vast sums of mooey being ospended to rediscover the obvious or to obtain certain fundamental Information that fa already avsilebk and could be trail evaluated tor a few hour* of dkaimtoating study to a medical library, AsticU* la popular msgirtass and newspapers pethaps need dramatic ana auggaretad statements -stX?r *'' A . .. Z . " " N 188.01 f Vstim,*** ATMOcfticjuc tnocftt-iwa m in order to attract attention Mid make t problem i{ipMr vivid, but one Km the right to aspect the Itaroed scientist to wort temperately and carefully in iht nMlkd tttmhm, The render to Mela Information Km the right to expect the* a problem will be prerented to him objectively, thet the data villi he tabulated carefully, coherently, nod in tucb fuhkw that they coo be scrutiatad critically. so that other IsTwetigeton wid be able toany out similar cUwvittoM to confirm or dewy the croduiicM. Investigators mey arrtw at mo* tenable cpiflket by nlnly ippriidM nil data. This Km always been the scientific method. Recently, however, there hot bom a plethora t4 article la the mrdical ttternture teawntog the effects of air pollution. Rarefy k nay portion d this problem discussed wfchoi* Mention of Donor*, the Meuse VBcy, foea (Ura, and the London nog Although no direct statements art made la reUlr three incidents to the general air pollution problems of our Urge din, the tmpbeetion Is ape* die that the problems are sfanflar. The scientist has always been eiported to be un/eehag, dicin' terested. and a careful observer of physical or bio logical phenomena- U this bnag* is out cwphtely attainable because the scientist is also a rwnosdbli member of society, be should, at toast, be son political and noohystericaL Sdatilc reumrch boa abreyt been a slow. anrthadteni, and cwnlnUnq process. No amount of governmental foaming or legislative wisdom uiH ever resolve the probirtas of pfcystoiogkul imcthma. the snlutkws f wfoh heve eluded dedicated scientific ofnnm for tern furies. It has been stated thet Awstscy is the heat sod for science. This Is lodcnd correct, provided that neither science nor democracy Uowes ma nipulated. The data obtained and Interpreted by official groups are no more vabd than tbr universal acceptance of their interpretation by other com* priest investigator*. Let m not forgsg ths medical lesson (her was taught In 1911 At a time when them wsa adequate evidence to show that pellagra was a deficiency disease, the report of die Tbnmp* soo-McFaddm Gommfeaioo wa published is New Tod stating that the disease was transmitted by the stable fly. This report was based cm *an trim* elve epidemiologic study." and delayed treatment eod prevention of the dispose. Practicing phytkians who are intimately and dh mtly cnocrTrwd with the health and svtfsn (f iheir pstlmti must depend upon specialists in research le drsrrilie and define for them new bowl* edge concerning health aod disease. They *iU fail to understand bw research workers can disagree completely about matters of cause and effrcl In problems rd etimmihnlc hygiene aod will, of na cesslty, conclude that what Is bring discussed If neither science nor medicine and that tbair Own opinion*, even though based on prsjadioo, are probably equally as valid. The more voluminous the barrage of opinion in the mrdical literature, the more certain is the reader that prejudice *od emotion have supplanted the scientific method. For this reason, the physician must employ guide* Uoea of his own. Some of thru are well nuUahrd la experience, aod the thoughtful pliysidan will learn to rely on them. The Ant of these guideline* tws been staled best by Comae/ who has written; *A reputable srteotWt speaking In bis own held, dcsems careful attention a scientist speaking out of bis Md should be glwo oon vou, fot a* anyone rise." Thera are indeed many reputable specialists con* csrntd with the effects of atmospheric contend* bants on the biological rystem Those who haw anecJaltoed in Industrial hygiene and occupational oMeases hew attaiord a Mgh degree of maturity and professional skill In the pest quarter century. Thru ability nod experience should be utdittd and appreciated to the fuQcct extent. The svsreft ph)*klaa does not rcaHac that cheat speciebats ntist. and even official agencies are tndlaad to overlook their rigntfiewtf contribution to smlron nsrntal ksshh (ho Increased understanding of the elects ef tsivWonmsutsI factors on health la a direct devel* opment of Mr highly iadutfrialiaed society. Con* aouou* studies of the Industrial environment and Rs workers have produced mrdkaJ and eogfnrwb^ principles baaed upon physiological and bsochrm* leal loncrpti of disense that have proved their value over many yean of observation These prim ciplc* are based fundamentally on the concept that before one can begin to uodmUod the influence 4 chemical and physical stimuli on brakh. one must hew a working definition of the healthy slate. The current favorite to dcfokkma of brakh ap* peart to he that developed by the World Health Organisation (KUO): "Health Is a state of con* plrie physical, mental aod social well-being, and not merely dir ahscnce of disease or tofientify." Thk definition hat coma to be synonymow urkh comfort, happiness, and material prosperity, and pwhapi Km certain social Justification. But a basic requirement for assisting. In the quest for Information concerning the effects of the environ* maot on todMduah or populations, M la confusing and almost Irrelevant. Basically, It produces 00 point of departure foe understanding whether or not an environmental stimulus Imu produced 111* ness, disability, or reduction to We span-and this Is the physician's problem. Medically, health Is fundamentally a htoV*gk*k- and. therefore, a phystotogkwi-p'nblem. There h no doubt that social, psychological, and even pm btical factors will Influence plrytiologlcaj reactivity. U a medical appraisal of cause and effect, how* ever, these cannot and must not be eotffused with chemistry aod physic*. Therefore, future advance* mmm mppmim ifaq^j^apwEg^ X?' A' ' * ... t` .r. ^ -V .fu:Vi::'. Ml ATVOinuriUC HTCIZVt-iTUWa JAMA. Hi ]. IMS ia miI to the bmlrdfe of atmospheric hygiene BKOt U b*wd on usable cooccpti of health la tmm of physiologic*} rwrtMty, ud ocft on Uto* pUi (OotffU of kcUl wrtftr*. ntyriologlcwlly, man li rvctive organism. Any stimuli* wtU produce a physiological reaction. This mdtoa nwry bo (ompcouimy or adaptive, It nuy be iDMWauJt^ Md Ud to offer Adequate protoctioa to samii tissue functioning, or It may be over* protective, And this very ovrrreactlvtty my to and rf lurU produce Uh m lUnup And pliytlolofic borewk)'. These 9 pmid^bijn are the ffeilt of any type of cowoomroul letmikM on tbe orpfr Imb, whether it be donlnl, physic*!, or bacterial. Concept* of tbe bndth iWc oust, tbu loit, take Into amkUretb* Co mb i * concept of bonxoO*. Ia and Dubos** concept of adaptshfltty. to adde tko to the rfeU produced by our changes lo social aOKudrt, and uiui{ habit*, dmp, food, aod taduiMil onkonmoK, d rf which lo* turner, to one way or another, both duoiise pal* term and personal attitudes. Any one of the** changr* la ddficvh lo aoana, both lo terms of Its drprr of importance aod Ms influence oa the popular** Cotiecthvly. tLrtr bo* pact cannot he determined by tmjrctun and crash research propeta to l*rt. ft h mtitdy potfUr that the only reasonable definition of health would be one that would vary from individual to todfi vtdual or from group to pmup. Store health atti tudes are an pmoul In nature, ft fc unlikely thft ooy drhftMi will ever be acceptahjr to all Noon* thrlro, Socrates* ddattko, "Ifouhli exists when tie organism h In harmony wfth Its rorvimewnewt,*' satis* 4c* physkstopLai entasis and nUltlulin a pntnt of departure from which one coo determine whm a disease state exists. Since harmony denotes a late of equilibrium, this definition may be it * worded to trad a state uf 'f)iuak pbpioluckd iquiUrtaa* Regardless of the tack of specificity of tills driotius, it Is useful hi the understanding of normal physiological process** aod lo oo so demanding of those degree* of abnormality known at disease, ft abo defines the fort that tlirte la a variability lo the health state ood that health Is not a static phenomenon. Continuous aod Intensive research Is required lo the study of afmtnpheric pollutants and (heir rU* tkmshlp to health aod disease. The confirmation of a point of view or a speculation Is neither re* search tvr In the interest cf the public. Advance* lo medioil unrlmtsoiling depend, ultimately, oo general advance* ft* physiology and IftnchrmtstTy, and In the development at new knowledge coo* earning (he metabolism of a variety of sulwtanc**, both totrinste and ostrituic. lo the body. This re* search Is laborious, ttone-conaumtog, and naps* sardy reprtlttvo, Th* currrwt madlnsl literature on air pollution has besom# overwhelming and penwastve. By implication, the nrsetictof physician Is advised that cnppling and deslb-aealtog disease is being products!, on all aide*, by both known aod b o know* cltemlcols to the atmosphere. These ar ticles all sccta to share Certain common charactrriitici: they are wrtrien as reviews of rtiuing diseases {mssy of them nonspecific and of otocure etiology), they are vigorous and eve* pak**te In suture, they frUto c u m and effect statistically (or epkhmtologicsBy. depending upon the author! aod they are written by persons whose intont semns to be relatively new. Statements (mu one * of tlaie most meat artirW are typical: "One of tii* most Important problems to medicine today Is the low4ml but chronic poisoning of our si* mnsphere by dotes* of chemical pmoesme char* actrristic of as advertng cMlttation. a poisoning which has Its effect om tbe course of many years, but which soArtMm inexorably cripple* and ViBs. .. . Although a nmrclMi between air pods* tkm and nnrunahgn mt respiratory duesset cme only be propmed SrwUtively, the connection blwwB air pollution and cam* of tbe respiratory mtra Is aa sure aa statistical studies c m make ft/ Tbh may be interesting reading, but it Is direct ly opposed to the opmtoo of one of (be best known and mat outstanding keikk ugtotu of (he pet*eat century. Or. Abel Wnlrnsn has stated:' Th* intuitrvp assumptions that a polluted atmosphere b not cemdurtve to (be hot health atiB lack either strong statistical a* epidemedugipd support Tbe me of suggestion. as a mask for scientific ignar* mrr, and of faaplkatkm, aa a substitute for opl* demtologle widitirr, are great temptadorn for bolstering budgri, for focusing public attention, and prwtding action even It UhdHtoed. To the acton* IK this mute to highly suspect. To the politician ft to a rich mrthod of raising popular Intercat and hence 'getting somrthtog done.1 To the cob umntot oo the prowl for lie dramatic and plaus ible, if no* tbe accurate, the route to fruitful. Another highly respected engineer* who boa devoted his Id* to the study of (be iniliwsnml and fts rrUtlooahip to health has quoted one of bis contemporaries os follow*; *] have discussed these problems many (ton with Dr. Morris W. Goldbutt of Britain, n totkafogbl of world-wide reputation and no aotliority on cntctoogenlrity. By fiisl hand iewOgatioos he knows a lot about air poNutkm trouble*. lie (old me that he believed there to no evidence that chmofe disrate of tbe rye, or In the chr< or shewhr** has been on* gmdeffd by Lo* Angela* nrvog. lie even went further and seld that there to no evidence that pltutorttenoral swing (* ft Lo* Antafos) has been responsible for the toddrate of Utog canoer to Caufrents.* Dr. Drinker* conclude*! "Thee* to M convincing evidence (bet air potVitkto It presently endangering the public health to iho United State*/ i Val >, j*4 4 ATMOIJItElUC HYC1EXK-JWKCI U tt msy be argued, historically, (bat Semmel* erie and Putrur were rl^St when the erprrtj were wrong. JJut either the pro)4erm nor the situations are analog****. la fact, almost the vmc k true, la a recent loc of Tit* Jo v w iaI* the problem has been hrouglit weO into focus by a sronrht amudr>& l*ft eitmnely accurals^ edi torial' concerning fallout: "When the cw* media and the bufraucntic hubbirheads atatc that you msy dcwkip abnormalities ta tl<e E/th groeration or the tilth or nen the arvroth. thk k true. It mey alao ocxur fa tlic ngk/i poifatua, but nr* the fi/hle ptr% only unto the seventh. You can't argue with thk hind of logic- You my fall of a truck (omorrvw and kiQ yourself, but yoo may not. You mey die of heart dkeaaa while yom are read* tag thk editorial, but you may not Abo, you may ert cancer from driminf cranberry fulco. Tbk kind of political rlogawy--"you ewy develop ... "yon msy be aficctid by ... * * you mey become . * resemble* the advmtklof tWfanry: *11 you have leprosy and need salicylic acid, take aspirin.* Tbk k the worst bod of deception beewuse tt tdlf the truth. So better example of thk type of deception eakts In the current literature than statements* based on Pavimlaa concepts that haply that any measurable physiological reaction Is drlrirrfcju*. The fact k that these Investigatioaa demonstrate merely that a stimulus will provoke a reaction. Thk k indeed a physiological fact and k not sm assardy evidence of Injury. Aside from these basic physiologic mkhra Hum, it k ioi(kiUiii to consider, ako, what we rcaOy know about the materials in (he atmosphere. The term "air pollution* may be descriptive, but it has no rtiolocic significance. Without adequate definition> of the airborne materials that era thought to produce disease, and without adequate definition qf the disease that k produced. It k fata* ous to attempt ritlier to diagnose or prevent dk> use the primary purpose of aO health worker*. An outstanding example of thk situation Is the error** confusion concerning chronic buaktk The disease k pot only poorly defimd, there k also cunfution concerning Its cause. For yean, to* baettt wmllAg tinutitk, poatnasal drip, alcohol* km. infection, organic and Inorganic Irvttanta, and so forth have been regarded as causative agents la Its production. It k said to be characterised by chances la the epithelial reuema of lie tra^heo* bnwKhUl tree, and by the expectoration of la* creasing amounts of sputum of vukUr crowkIrory. Yet, even thk common definition k talar* pMed diflcemriy by different observers. Urgardins of the differ***** of opinion com corning the diagnosis or severity of brunch* k, the applicetion of known scientific principle* to the study of thk disease wiU clarify d* problem and lesuk la Improvement Tho implication, however. that all dusts, fume*, and gases produce bronchitis will further confuse, frighten, and fail to reduce ti> Incldcoce of tlte disorder, it may. ta fact, while attempting to reduce one evd, real or Imagined, result in more serious health problem*. "Without adequate inrun* of comparing behavioral and physical dborders quantitatively. It b Impossible to say. In the sum total of human ailments, which ceusro the more actual Incapacity, psychic or or* ganic Influence*." While considering the effects of atmospheric contaminants cm health. It might be wrfl to consider the effects of air pollution propa ganda oa health. To suggest merely that the incidence of a die* ease or disease condition k rrUtrd mathematical* ly Id the Increme In soot-fall or lower visibility It not helpful to either patients pbyvSdeaa. The substance in the air that k under sui(4ckm most be examined critically from the point of view cf both chemical and physical characteristic*. \Vk* the component has Wn Identified and classified. Its effects must then be measured both In the at* tnosphere and In the laboratory. If the findings In one do not confirm throe in the other, one should pause and reflect on ocher influencing factor*. Thrrc are time* when laborstroy results are not confirmed in environmental exposerra, and vice versa. A remarkable example of thk type of oc* mrrrace k that aczolcia and formaldehyde do not account for aS row irritations ta smog, although they appear to do to in simple laboratory sya* At thr Opposite pots ef unidentified causative ' agent aa:nd undefined ducur entity are those alloca pUcte Ihazards where (he agent h known and un derstood precisely, and ft* effect ha* bren studied for many yean. Lend Is such a case. There k a grw* oral knprrosion that little Is known about the ib* sorption of lewd nod Its phytioloclatl consequence* In the organism. Per`hapus nI o other ei Substance has recxind more detailed investigation and study. The tins and symptoms of intoxication bv thk material have undergone long study and observation, and are rrported accurately In most textbooks of industrial hygiene, toxicology. Or cupattonal dkcross. Despite thk fact, medicaIl JfourOak continue to publish articles stating that leaded gasoline Is responsible for headache, dry noae, colitis, kidney akturbsnce*. riruMlic signs, trem or, Itching of the skin, resmu, temporary vtsuef Impairment, backache, vegHativ* dystonia, and Inffsfnmatiun of the nose with abscess formation." With thk appalling array of lymptoms and die ease* to orokkr. k It any wunder that (hero It concern about (lie levels uf lead k urbea atmoa* pherm wl*en the amount of vehicular traffic com tinuca to increase? Yet, detailed studies " of at least cue urban in* (Onrimuti) over a period of 10 yean havt shown that ths tm*d of concentration of lead In the oh .w h S A n .. i AmosrticAic itrcioc-ffttNCi JAMA, Nre lA IMS motphcrc has >wcr> steadily downward, de*pfte tl*e increase In n*tr* vehicles aod gasoline cocounipttoa ]( is obooui, tltfrefore, that oe cxoruA inply that tliere arc greater levels at lead in the air merely hrettivr ot Increased use at the compound, since other unmeasured factors may tcod to reduce what might be considered reasons for Increases In cooter.fr#rion. In estimating the dept* ot aay emlronmcntal hounl direct {uiuiurmcot at the environment U essential. In industry, the allowable tooccotTstica at lead b) tie atmosphere tlui is cootklrrod sale for work er* is 200 mkrogranw nrr cubic meter. It might be postulated that since ne working week leytwaU almost 90% at the total week, a safe concentration in the ambient sbnofplxrs would be 60 niao> prr cubic meter. This might be true tf the were simply a oonroartKe receptacle, and caute and effect were a straight!*nr function. But. since this is not true, and since rates of absorption, mtiboiua, and excretion ara important, such a figure might be either too hlgk or too low. la fad, the subpet cf lead nctibolha baa been discussed extensively." " and the evidence is dear that the of lead in the ttaemfere (taking into consideration concentration, particle site, absorp tion, and metabolism) are not hazardous. Perhaps it to significant tint lend la the atmosphere at Los Aagrlre has been reported at Inrli as high os 42 microgrami per cube meter without evidence at tocirasad Wad absorption or i&area. Perhaps the most rational attitude toward the problems of atmospheric hygiene we brat aw' peered by Prtndle.'* in lftfll *At present we do not have enough facts to make completely retime) decisions in the area of health and air pollution-- not enough facts to know when to act, what pro* Cbdy lo take action agshnt. and to what definite purpose. Until we do, we can recommend only that the public take herd of the otortcenth cen tury's progress in droning up fikb through prag* sutic experience.* These are wise words. Indeed, and when drsslinru or comfort are die factors that are heiog affected, Vi us by aS msana ret rid of the offending agents, but 1st w not tonpry that tlre is a three! to hfe whare there to only an offeree to our comfort and pleasure. la addition, a would be weU to discuss the true (acts when reporting economic loss from air pollu tion. When M is reported that the beahh efforts of air pollution hare resulted is bilboes of dollar* In health and economic costs, let us he prepared to show the data that demonstrate these conclusions, or be prepared f4 satire* ** tliat fnnoutisir (fiat only a lew of the tslwirv}fic cmkuiuM will add up to ude-Uu*J of ilw grvsa national product. Equally important to the fart that in legislating cer tain materials out of nU*M, we rua ths risk at peudortag wfa reenter measurable loan Finally, the ability tn control the environmeat must be weighed carefully against ti* fruits of such cootrol Though the gmirral problem is of great importante, them to no auddra emergrccy. and the prohlrms that do exist can await clear thinking and thoughtful In vestigation. It it truly anomalous that, although it has been noted * that dental entire, one almost uni versal disease rotated to environmental factors, is susceptible to the manipulation of die environment by adding fluoride to water, a large body of pubiio opinion is opposed to this prophy Lactic measure. About one year ago the steps essential to deci sive statesmanship la die field of atmospheric hygiene were luted as follow*/* (a) A precis* state ment of the essential characteristics of the miiroo mental problem; (b) Aa appr. val by competent profcation*] group* of the real and apparent health aspects of roe various factoei tonktd; (c) The development of suitable standardued methods for the analysis of exotic chemicals, (d) The design and fMosilptiM of crUrrU of health, safety, mad coe/orl la the environment; and (e) The tmicnlogj- cal effects of the substance* finding their way taH the RAvonorot must be assessed on a continuing basts by professional groups, preferably rooted to voluntary health agrtxst* rather than government. The practicing physician roust be concerned with the immediate complaint* of hk rubroL He know* that some persons base greater degrees of naui^ toy than others, not only to the environment, bat to food, brvrTajjr*, and so forth. In die ptreto period at coofussoo and disagreement. he must rwklt that there are specific criteria for the diagnosis of the cfnto at lauw* rebalance*. || Wl2 unJi three out Hi the proper medical tradition, srvl he cannot afford to assume that some hitherto m> lam* disease entity has been produced by csposurc lo and absorption of scene unknown com pound or combtosatioo at compounds. When he dnre smprrt tlie influence of cnvtouoracntol eth logic factors, he will consult with his connsgues who are recognized specialist* in the appraisal of the environment mod in the study of rentounuseotally-produced diseases. Above *Q ehe, the history of hiolugy tad mrdfcto* point out the necessity for beating dearly to mind our own ignorance at the Optimum. Although R ha# been possible to cootrel many factors to the environment, and It tnay he assumed that to wffl be possible to modify many then, Dubaa M has ob served dial: There are other factors that Mart he controlled so readily, and perhaps not at alb namely. (1) Tboss that are budi into Ihe hereditary (laic of man, his biological cycle* and perhaps to fwtwLmreMeJ emotional response*. (2) Certain on* MedKlshle natural furies and. m* Important psvLts. lie unpeedntaU# effauts of technological civilisation/ These are the farts of life as we have ftbwtya known lharm. This to not a phtiosoplnr of dsvpair. but, rather, an awareness of our owe Itonftationa of  fi* ^ i O V4 IM. * ATVOfetlfERtC >lTCl*E~ftU*CI both knowledge and cspcrimer. Hut H U thi* very snarmrM iku ia aIc i U possible to prot frura u* nenerxe, and ik 4 to bmurae cocdmed by the inskooun or the unciperted. One of AmcricVi emt distinguished plrysiciana ** Has iittourfml the imrtwy centltMloM to word* tlat cannot br txojxmrd upon; ^V>ni mot we doF We mwt accept ihto fantastic mid, study wbot tl known ond u*r our greet Injprmdry to develop tbs best possible pUn f<* prutrrtam. Thli pUa must be flcsihle. and u far a* posrihle must not inter* fere with the good likings of o>r lend, such M (doration. tlie arts and trerrL Tbcre is no eucb thing aa (>Un to provide complete pmtectluo or to climb nate all rink, and a little thought auggnta that frt doa from aJl danger would be a mistake.* t. Cl . C L. MirJ at NuW WMfoa L mew (J--v) lull 1 Ciuw. W. 11 WmU 4 tlU Awi*. No twk Ctyi w w s^ui a c*. itn 1 DvKos IL; Utmar * H*+k. WwU FMTKtM, vet tiXr. 11 C*y. Hwjv aa |USi 4. FuU. fc. U, an* WAnm. R H Li An rumav tun. a E^emry Waned. tAXtA IIRW <Uay SI (Ml 1 WfhA A i Ua* awl Ha O ><W U*ImmIi Oiaew rv*wnl awl Mhn*l CawafK W Ua*. Aw j A-*- 1W'J> <!W ) ltol. A rw.n. I*.: lull Aw^ W A* NIWkM, Ad Cw mm w~*i <c Wj a-ui-ira <Kesh) imi 7. Am. Gant rdUe Cut at. MUA IT*** <)-.> lOl a. Siuiwi. V. A.' AW CrCerta ft* Eduu ef Ok u at Ar--isb.ru MVawi a Lew CenUfiiuaa aa Oipii u. C% Lu Md Owe) ItoL I Let IL JU W Mu m u IWwkk mg Oww. A/H CwAw Hr-*A S3S-TJ |W) IbOL 1& KaV W. Li EW bre. Aa faflu--w fanada (Im, Li Marin* Cald., Tto -->teina. 1ML It. Tuaw. to.; AM*iL -a Haft.wrf (Tin* d Lead Pr.nHM kW Mato Wek 41^31-H. 1(X U. OwLL kUa. LJ. wl fc#W T. a. U4 CoWr* d Aiawfkw, Aa Mrfw Cued Aa / 114*1taa (jwi iwt. 13. Mm. R A-i H*4*a Utun, 1*00. / Aa* 1*4 fnbbr M~*A ft4**l<?. 10MJQ. IttvUA, 177-*00 ML 14. KAm, |L A.i IlffWae A<(wt> W FubiOn and Uw erf Lrarf AdW Cnmyrnm*.. AACA /. %a W pah* kU IS- hWk, R A-i Imaay d TM fdmai aa M-whh to facials Am JU La >u M04 (Ua*i) tML i'isriTUTio* or atnnnAS s c iex c t TTtrjmirvrs ron mc zh * S OM AND U'SCUr.-Tki ndr that CbWka Srtracr twrtwrts ewanot br labrrwd ( awtkd and aurgioal rare la aerUni cnaptaaitioa oaa ka (m upMd br afi the arhnrtin oa wiam'i menpruaatkia lew who are la accrd w*h the bw that wrlaw'l uieiaWiei Uudtl will not be paid tor the dweUbty ar death d aa 'lapUw* under (be mml woriara trmfaaraHoa acta* afcra evtber 0 ceased. nUtoufd or aggravated by aa Murawublt nfiail to alad te pruto^e and irtrwey awdaal and Mapial UrasenL Lakewue, thia strict raW he Ippbi to aorwpetMd Huaae etafaaa tht are brought by CTeimaa SrtmUatt la prnaui kfei <Us whah are brought by Cbrfadaa ScWe<laU. the law baa been dearty ad iauNl> npaard aa follow*: *Tt is s nrW id general apphortlea that ae wh be# been Ufueed by the arglignace <d another aKNt me ieaitil> I'tdrr the rule the mewed perwar | under a duty to secure promptly the annaa? awdaal ml Wprai trsutowM. I the netwe ei the kpry to auch M reamawUy to ;4 rwtmr* to. se aa to prevent e redwa the aggravetwa of the physical tofury md aarmal aufeemg U the mjwed person | iwgbgent and alhnr* a* miawnUr towgth d tune to aLpw bwweea the date cd the injury and the ttoae the am eatery medical and rap'd tee to meesad to, then aurfi negtignue to rrgaiWd a aa wmemg mar that amy rtlat lw W whoie ar seletantuby redme the awat d dtn.pl that tan la mwl tiure the party ef fault. Thus under the lew m pisad nwr nan. Oeawi UsantMa tw reomee htUe ar aa damagm shea the evhlente atom* ihm became rd thne Ulu4 they ba* refwed to efttoato swtmssry nltcd and rwfd a/e far their tofury, *d Irwtaad have lebed aelefy tgw ChfWiw Vues meetwent,-llubmuaeto. L Hi Qitoa Ctoa by Ovwtw ItauMa, |nfn< Um4 Snag Septamber. IMA.