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U. S. DEPARTMENT OF AGRICULTURE,

BUREAU OF ENTOMOLOGY -BULLETIN No. 73 (Rftj*$)B f^

L.O HOWARD. Enlomobgwl and Chief of Bureau * E

?' S' *V tun*

toONOMIC LOSS TO Till-] t>E0PLE OF THE

imtld status tiikokjii insists
that carry disease;

L. O. HOWARD, Pn. I).
Entomologist ami Chief of JZureau.

Issued May 27, 1909.

WASHINGTON:

GOVERNMENT PRINTING OFFICE
1909.

IT. S. DEPARTMENT OF AGRICULTURE,

BUREAU OF ENTOMOLOGY— BULLETIN No. 78 (Revised).

L. O. HOWARD. Entomoloaist and Chief of Bureau.

ECONOMIC LOSS TO THE PEOPLE OF THE

UNITED STATES THROUGH INSECTS

THAT CARRY DISEASE.

BY

L. O. HOWARD, Ph. D.
Entomologist and Chief of Bureau.

Issued May 27. 1000.

WASHINGTON:

GOVERNMENT PRINTING OFFICE,
L909.

BUREAU OF ENTOMOLOGY.

L. O. Howard, Entomologist and Chief of Bureau.
C. L. Marlatt, Entomologist and Acting Chief in absence of Chief .

R. S. Clifton, Executive Assistant.
C. J. Gilliss, Chief Clerk.

F. H. Chittenden, in charge of truck crop and special insect investigations.
A. D. Hopkins, in charge afforest insect investigations.
W. D. Hunter, in charge of southern field crop insect and tick investigations
F. M. Webster, in charge of cereal and forage plant insect investigations.
A. L. Quaintance, in charge of deciduous fruit insect investigations.

E. F. Phillips, in charge of apiculture.

D. M. Rogers, in charge of gipsy moth and brown-tail moth field work.
A. W. Morrill, in charge of white fly investigations.
W. F. Fiske, in charge of gipsy moth laboratory.

F. C. Bishopp, in charge of cattle tick life history investigations.
A. C. Morgan, in charge of tobacco insect investigatiojis.

R. S. AVoglum, in cltarge of hydrocyanic-acid gas investigations.
R. P. Currie, in charge of editorial icork.
Mabel Colcord, librarian.
2

LETTER OF TRANSMITTAL.

I'. S. Department of Agricttlti re,

Bureau of Entomology,
Washington, !>. ('.. April 20, 1909.
Sir: I have the honor to recommend for publication as Bulletin 7s.
revised, of this Bureau the accompanying slightly revised copy of the
original edition of this bulletin, entitled "Economic Loss to the
People of the United States Through Insects that Carry Disease,"
the supply of which is now almost exhausted.

The United States is just awakening to a knowledge of the disas-
trous results following a lack of appreciation of the danger arising
from the unchecked development of mosquitoes and the typhoid fly,
and it is hoped that this bulletin will not only emphasize this danger,
but will also lend support to movements, both local and widespread,
toward the destruction (often so easy) of these carriers of disease.
Respectfully,

L. O. Howard,
Entomologist and Chief of Bureau.
Hon. James Wilson,

Secretary of Agriculture.

CONTENTS

Page.

Introduction 7

Mosquitoes 8

Malaria 8

Yellow {'ever IT

Work on the Isthmus of Panama 21

The typhoid fly. commonly known as the house fly 23

Endemic disease as affecting the progress of nations ^__ 36

Index 39

5

ECONOMIC LOSS TO THE PEOPLE OF THE DNITED STATES
THROUGH INSECTS THAT CARRY DISEASE.

INTRODUCTION.

It has been definitely proven and is now generally accepted thai
malaria in its different forms is disseminated among the individuals
of the human species by the mosquitoes of the genus Anopheles, and

that the malarial organism gains entrance to the human system, so
far a- known, only by the bite of mosquitoes of this genus. It has
been proven with equal definiteness and has also become generally

accepted that yellow fever is disseminated by the bite of a mosquito
known as Stegoxnyia <<il<>j>ns (possibly by the bites of other mos-
quitoes of the same genus), and. so far as has been discovered, this
disease is disseminated only in this way. Further, it has been sci-
entifically demonstrated that the common house fly is an active agent
in the dissemination of typhoid fever, Asiatic cholera, and other
intestinal diseases by carrying the causative organisms of these dis-
eases from the excreta of patients to the food supply of healthy indi-
viduals: and that certain species of fleas are the active agents in the
conveyance of bubonic plague. Moreover, the tropical disease known
as filariasis is transmitted by a species of mosquito. Furthermore, it
i- known that the so-called "spotted fever" of the northern Rocky
Mountain region is carried by a species of tick; and it has been dem-
onstrated that certain blood diseases may be carried by several species
of biting insects. The purulent ophthalmia of the Nile basin is
carried by the house fly. A similar disease on the Fiji Islands is
conveyed by the same insect. Pink eye in the southern United States
is carried by minute flies of the genus Hippelates. The house fly
has been shown to be a minor factor in the spread of tuberculosis.
The bedbug has been connected with the dissemination of several dis-
eases. Certain biting flic- carry the sleeping sickness in Africa. A
number of dangerous diseases of dome-tic animals are conveyed by
insects. The literature of the whole subject has grown enormously
during the past few years, and the economic loss to the human species
through these insects is tremendous. At the same time, this loss is
entirely unnecessary; the diseases in question can be controlled, and
the suppression of the conveying insects, so absolutely vital with
certain of these diseases and so important in the others, can be brought
about.

8 LOSS THROUGH INSECTS THAT CARRY DISEASE.

MOSQUITOES.

Entirely aside from the loss occasioned by mosquitoes as carriers
of specific diseases, their abundance brings about a great monetary
Loss in other ways.

Possibly the greatest of these losses is in the reduced value of real
estate in mosquito-infested regions, since these insects lender abso-
lutely uninhabitable large areas of land available for suburban homes,
for summer resorts, for manufacturing purposes, and for agricultural
pursuits. The money loss becomes most apparent in the vicinity of
large centers of population. The mosquito-breeding areas in the
vicinity of New York City, for example, have prevented the growth
of paying industries of various kinds and have hindered the proper
development of large regions to an amount which it is difficult to
estimate in dollars and cents and which is almost inconceivable. The
same may be said for other large cities near the seacoast. and even
of those inland in low-lying regions. The development of the whole
State of New Jersey lias been held back by the mosquito plague.

Agricultural regions have suffered from this cause. In portions of
the Northwestern States it has been necessanT to cover the work horses
in the field with sheets during the day. In the Gulf region of Texas
at times the market value of live stock is greatly reduced by the
abundance of these insects. In portions of southern Xew Jersey there
are lands eminently adapted to the dairying industry, and the markets
of New York, Philadelphia, and the large New Jersey cities are at
hand. In these localities herds of cattle have been repeatedly estab-
lished, but the attacks by swarms of mosquitoes have reduced tin1 yield
of milk to such an extent as to make the animals unprofitable, and
dairying has been abandoned for less remunerative occupations. The
condition of the thoroughbred race horses at the great racing center.
Sheepshead Bay, Long Island, was so impaired by the attacks of
mosquitoes as to induce those interested to spend many thousand- of
dollars a few years ago in an effort to abate the pest.

All over the United States, for these insects, and for the house fly
as well, it has become necessary at great expense to screen habitations.
The cost of screening alone must surely exceed ten millions of dol-
lars per annum.

MALARIA.

The west coast of Africa, portions of India, and many other tropi-
cal regions have always, at least down to the present period, been
practically uninhabitable by civilized man. owing to the presence
of pernicious malaria. The industrial and agricultural development
of Italy has been hindered to an incalculable degree by the prevalence
of malaria in the southern half of the Italian peninsula, as well as in

MOSQUITOES AND MALARIA. 9

the valley of the Po and elsewhere. The introduction and spread of
malaria in Greece is stated by Ronald Ross, and with strong reasons,
to have been largely responsible for the progressive physical degen-
eration of one of tin' strongest races of the earth.

In tin1 United States, malaria, if not endemic, was early introduced.
The probabilities arc that it was endemic, and it is supposed that the
cause of the failure of the early colonies in Virginia was due to this
disease. It is certain (hat malaria retarded in a marked degree the
advance of civilization over the North American Continent, and
particularly was this the case in the march of the pioneers through

out the Middle West and throughout the Gulf States west to the Mis-

sissippi and beyond. In many large regions once malarious the disease
has lessened greatly in frequency and virulence owing to the reclama-
tion of swamp areas and the lessening of the numher of the possible
breeding places of the malarial mosquitoes, hut the disease is still
enormously prevalent, particularly so in the southern United State-.
There are many communities and many regions in the North where
malaria is unknown, but in many of these localities and throughout
many of these regions Anopheles mosquitoes breed, and the absence
of malaria means simply that malarial patients have not entered these
regions at the proper time of the year to produce a spread of the
malady. It has happened again and again that in communities where
malaria was previously unknown it has suddenly made its appearance
and spread in a startling manner. These cases are to be explained,
as happened in Brookline, Mass., by the introduction of Italian labor-
ers some of whom were malarious, to work upon the reservoir; or,
as happened at a fashionable summer resort near New York City, by
the appearance of a coachman who had had malaria elsewhere and
had relapsed at this place. In such ways, with a rapidly increasing
population, malaria is still spreading in this country.

To attempt an estimate of the economic loss from the prevalence
of malaria in the United States is to attempt a most difficult task.
Prof. Irving Fisher, in one of his papers before the recent Inter-
national Tuberculosis Congress, declared that tuberculosis costs the
people of the United States more than a billion dollars each year.
In this estimate Professor Fisher considered the death rate for con-
sumption, the loss of the earning capacity of the patients, the period
of invalidism, and the amount of money expended in the care of the
sick, together with other factors. In making these estimates he had
a much more definite basis than can be gained for malaria. The
death rate from malaria (as malaria) is comparatively small and is
apparently decreasing. Exact figures for the whole country are not
available. From a table comprising 22 cities it appears that two-
thirds of the deaths from malaria in the United States occur in the
South — one-third only in the North. The death rate from malaria
83434— Bull. 78—09 2

10

LOSS THROUGH INSECTS THAT CARRY DISEASE.

by States is available only for the following registration State-:
California. Colorado. Connecticut, District of Columbia, Indiana.
Maine. Maryland, Massachusetts, Michigan. New Hampshire, New
Jersey, New York, Pennsylvania, Rhode Island. South Dakota, and
Vermont, all of which are Northern State-. For these States the
census reports from 1900 to 1907
rates:

inclusive, give the following death

Table I. -Deaths <hi< to mnbirin in tin registration States, 1900-1907,

Year.

Number
of deaths

from ma-
laria per
100.000
popula-
tion.

Total
deaths
from ma-
laria.

Year.

Number
of deaths

from ma-
laria p.-r
100.000
popula-
tion.

Total

deaths

from ma-
laria.

1900

7.9
6.3

5.4
4.3
4.2

2. 134
1,791
1,738
1,410
1,391

1905

3.9
2.8

1 3M

1901

1906

1 415

1902

1907

i lfirt

1903

1904

Estimating, from the preceding table, the average annual death
rate due to malaria at 4.8 per 100,000 population, and considering
that the registration area includes only 16 of the Northern States
(assuming fairly, however, that the death rate in the other Northern
States is the same) , it seems reasonably safe to conclude that the death
rate from malaria for ^he whole United States must surely amount
to 15 per 100.000. It is probably greater than this, since the statistics
from the South are city statistics, and malaria is really a country
disease. Thus it is undoubtedly safe to assume that the death rate
for the whole population of the United States is in the neighborhood
of 15 per 100.000. This would give an annual death rate from
malaria of nearly 12.000 and a total number of deaths for the 8-year
period 1900-1007 of approximately 06,000.

But with malaria perhaps as with no other disease does the death
rate fail to indicate the real loss from the economic point of view. A
man may >uffer from malaria throughout the greater part of his life,
and his productive capacity may be reduced from 50 to 75 per cent,
and yet ultimately he may die from some entirely different immediate
cause. In fact, the predisposition to death from other causes brought
about by malaria is so marked that if. in the collection of vital statis-
tics, it were possible to ascribe the real influence upon mortality that
malaria possesses tin- disease would have a very high rank in mor-
tality tables. Writing of tropical countries, Sir Patrick Manson
declares that malaria causes more death-, and more predisposition to
death by inducing cachectic states predisposing to other affections,
than all the other parasites affecting mankind together. Moreover,
it has been shown that the average life of the worker in malarious

WOflQUl rOBS AND .MA I. AIM \. 11

places is shorter and the infant mortality higher than in healthy
places.

Hut. aside from thi.^ vitally important aspect of the subject, the
effect of malaria in lessening or destroying the productive capacity
of the individual is obviously of the utmost importance, and upon the
population of a malarious region is enormous, even under modern
conditions and in the United Static. It has been suggested that the
depopulation of t ho once thickly settled Roman Campagna was due to
the sudden introduction of malaria by the mercenaries of Scylla and
Marius. Celli, in L900, states that owing to malaria ahout 5,000,000
acres of land in Italy remain — -not uncultivated, hut certainly very
imperfectly cultivated. Then also, in further example, in quite recent
years malaria entered and devastated the islands of Mauritius and
Reunion, practically destroying for a time the productiveness of these
rich colonies of Great Britain and France.

Creighton, in his article on malaria in the Encyclopedia Britanniea.
states that this disease " has been estimated to produce one-half of the
entire mortality of the human race; and inasmuch as it is the most
frequent cause of sickness and death in those parts of the globe that
are most densely populated, the estimate may be taken as at least
rhetorically correct.""

Is it possible to make any close estimate of the ratio between the
number of deaths from malaria and the number of cases of the same
malady? No perfectly sound basis for such an estimate is apparent.
In the Engli.-h translation of Celli's work on " Malaria According
to the New ^searches," published in London in 11)00, it is stated
that the mortality from malaria in Italy from 1887 to 1898 varied
from 21,033 in the first-named year to 11,378 in the last-named year,
and the mean mortality for the period is assumed to be about 15,000.
In 180G a count of the patients in the hospitals in Rome was made,
and the mortality rate of 7.75 per thousand of the actual patients was
established. Calculating then on this basis, and at this rate, the num-
ber of cases per year for Italy was placed at about 2,000,000. Accord-
ing to this estimate, and with the average mortality for the United
States of 12,000 as above indicated, the approximate number of
cases for the United States would be about 1,550,000. It seems obvi-
ous, however, that Celli, in using the basis of hospital patients only,
must have underestimated the number of cases for the Kingdom,
since of the people in the country suffering from malaria the propor-
tion entering the hospital must be relatively small. Therefore the
death rate from malaria of malarial patients in the hospital must be
greater than the death rate from malaria of the people who suffer
from this disease in the whole country. In fact, so great must this

• Stee "Darwinism and Malaria," by R. 6. Bccles, M. I)., Medical Record,
New York, January 16, 1!»<»:>, pp. 85-83.

12 LOSS THROUGH LN6BCTS THAT CARRY DISEASE.

discrepancy necessarily be thai it would not seem at all unlikely to
the writer if the number of persons suffering from malaria in Italy
were in reality nearer :>>.000.000 than 2,000,000.

The same argument will hold for the United State-, and more
especially so since as a rule malaria in this country i- of a lighter
type than in Italy: in fact an estimate of :>.000.000 cases of malaria
in the United States annually i> probably by no mean- too high. It
will not be an exaggeration to estimate that one-fourth of the produc-
tive capacity of an individual suffering with an average case of ma-
laria is lost. Accepting this as a basis, and including the loss through
death, the cost of medicines, the losses to enterprises in malarious
regions through the difficulty of securing competent labor, and other
factor-, it is safe to place the annual loss to the United State- from
malarial disease under present conditions at not less than one hundred
millions of dollars. Celli has shown that in Italy the great railway
industries, for example, feel the effect of malaria greatly. Accord-
ing to accurate calculations one company alone, for 1.400 kilometers
of railway and for 6,416 workmen in malarious zones, spends on ac-
count of malaria 1,050,000 francs a year. The same writer states that
the army in Italy from 1877 to 1897 had more than 300.000 cases of
malaria.

The loss to this country in the way of retardation of the develop-
ment of certain regions, owing to the presence of malaria, is extremely
great. Certain territory containing most fertile soil and capable of
the highest agricultural productiveness is practically abandoned.
With the introduction of proper drainage measures and antimosquito
work of other character, millions of acres of untold capacity could
be released from the scourge at a comparatively slight expenditure.
These regions in the absence of malaria would have added millions
upon millions to the wealth of the country. Drainage measures are
now being initiated by the United States. Parties of engineer- are
being sent by the Government to make preliminary drainage sur-
veys in the most prominent of these potentially productive region-.
The following statement concerning the effect of malaria on the
progress of this work has been made to the writer by Dr. George ( Mi-
Smith, director of the United States Geological Survey :

" In one of the Southern States 11 topographic parties have been at
Work during the past field season. The full quota for these parties
would be 55 men. but I believe that something over 100 men have
been employed at different times during the season. While I have
not exact figures before me, I feel warranted in the statement that at
Least "5 per cent of these employee- have been sick, for periods rang-
ing from a few days up to two weeks, in the hospital. Many of them
have been able later to return to work, bin at least 30 per cent had
to leave the field permanentlv. Bv reason of this sickness the effi-

MOSQUITOES AND M \l.\Kl \. 1 ;;

ciency of the parties was reduced, at ;i very conservative estimate, by
25 per « -t » 1 1 1 .

•■ In my recent visit in this field I found one man sick in cadi of
the parties I saw and one man who had just returned from the
hospital Leaving the field for good. A similar state of things was
reported from the other parties. I regard the sickness as practically
all of a malarial nature, as extreme care was taken in all the camp-
to use nothing hut boiled water except in a few Instances where arte-
sian water from great depths was available. In all the camps the
tent- have been screened, and in every case where the topographer has
lived for any time 'on the country' there has been infection. A-
illustrating the value of the precautions generally taken by our camp
parties, I might cite the fact that lasl year in West Virginia with 30
men living in camp, with typhoid fever prevalent in the neighborhood,
no cases developed, while with 6 men living on the country where
the same care could not he taken regarding the water supply, two
cases of typhoid developed."

In estimating the weight of Doctor Smith's statement, it must he
borne in mind that the men of his field parties are exceptionally in-
telligent and prepared to take all ordinary precautions.

Throughout the region in question malaria is practically universal.
The railroads suffer, and at the stations throughout the territory it is
practically impossible to keep operators steadily at work. This re-
duction in efficiency in the surveying parties and in the local railroad
officials is moreover probably very considerably less than the reduc-
tion in the earning capacity of the entire population, which, however,
i> necessarily scanty.

In an excellent paper entitled " The relation of malaria to agricul-
tural and other industries of the South," published in the Popular
Science Monthly for April. 1903, Prof. Glenn W. Herrick, then of
the College of Agriculture of Mississippi, after a consideration of
the whole held, concludes that malaria i> responsible for more sick-
ness among the white population of the South than any disease to
which it is now subject. The following forcible statement referring
to the States of Louisiana, Mississippi, Alabama, Georgia, and South
Carolina is in Professor Herrick's words:

" We must now consider briefly what G35,000 or a million cases of
chills and fevers in one year mean. It is a self-evident truth that it
mean- well for the physician. But for laboring men it means an
immense loss of their time together with the doctors' fees in many
instances. If members of their families other than themselves be
affected, it may also mean a loss of time together with the doctors'
fee.-. For the employer it mean- the Loss of labor at a time perhaps
when it would he of greatest value. If it does not mean the actual
loss of labor to the employer it will mean a loss in the efficiency of

14 LOSS THROUGH INSECTS THAT CARRY DISEASE.

his Labor. To the farmers it may mean the Lose of their crops by
want of cultivation. It will always mean the noneultivation or
imperfect cultivation of thousands of acres of valuable land. It
mean- a Listless activity in the world's work that count- mightily
against the wealth-producing power of the people. Finally it means
from two to five million or more days of sickness with all its attendant
distress, pain of body, and mental depression to some unfortunate
individual- of those live States."

Referring to the Delta region in Mississippi, which lies along the
Mississippi River in the western part of tin* State of Mississippi,
extending from the mouth of the Yazoo River north nearly to the
Tennessee line, Herrick says that it is the second best farming land
in the world, having- only one rival, and that i- the valley of the Nile.
" Still." says Herrick. " this land to-day. or at least much of it. can
be bought at ten to twenty dollars an acre. Thousands of acres in
this region are still covered with the primeval forest, and the bears
and deer still roaming there offer splendid opportunities for the
chase, as evidenced by the late visit of our Chief Executive to those
regions for the purpose of hunting. Why is not this land thickly
settled? And why is it not worth from two to five hundred dollars
an acre? If it produces from one to two or more bale- of cotton to
an acre, and it does, it ought to be worth the above named figures.
A bale of cotton to the acre can be produced for thirteen dollar-,
leaving a net profit of twenty to forty dollars for each bale, or forty
to eighty or more dollars for each acre of land cultivated. Moreover,
this land has been doing that for year-, and will do it for year- to
come, without the addition of one dollar's worth of fertilizer. Land
that will produce a net profit of forty to eighty dollars an acre is a
splendid investment at one, two, or even three hundred dollar- an
acre. Yet this land does not sell in the market for anything like so
much, because the demand is not sufficient, for white people positively
object to living in the Delta on account of malarial chills and fevers.
A man said to me not long ago that he would go to the Delta that day
if he were sure that his own life or the lives of the members of his
family would not be shortened thereby. There are thousands exactly
like him. and the only reason that these thousands do not go there to
buy lands and make homes is on account of chills and fevers. But
there is a time coming, and that not far distant, when malaria in the
Delta will not menace the would-be inhabitants. When that time
come- it will be the richest and most populous region in the United
States."

Malaria is a preventable disease. It is pos-il>le for the human
species to live and to thrive and to produce in malarious region-, but
at a very considerable inconvenience and expense. The Italian inves-
tigators, and especially Celli and his staff', have shown that by

MOSQUITOES \ND MAI. AIM \. If)

screening the huts of the peasants <>n the Roman Campagna and bj
furnishing field Laborers with veils and gloves when exposed i<» the
night air, it is possible even in thai famous hotbed of malaria to
conduct farming operations with a minimum of trouble from the
disease. Moreover, Koch and his assistants in German Mast Africa
have shown that it is possible, by stamping out the disease among

human beings by the free use of medicine, that a point can he gained
where there is small opportunity for the malarial mosquitoes to become
infected. Moreover, the work of the parties sent out by the Liverpool
School of Tropical Medicine and other English organizations to the
wesl coast of Africa has shown that by the treatment of malarial
mosquito breeding pools the pernicious coast fever may be greatly
reduced. Aijain. the work of Englishmen in the Federated Malay
States has shown that large areas may be practically i'vanl from
malaria. The most thorough and the most satisfactory of all meas-
ures consists in abolishing the breeding places of the malarial mos-
quitoes. In regions like the Delta of the Mississippi this involves
extensive and systematic drainage, but in very many localities where
the breeding places of the Anopheles mosquitoes can be easily eradi-
cated, where they are readily located and are so circumscribed as to
admit of easy treatment, it is possible to rid the section of malaria
at a comparatively slight expense.

With a general popular appreciation of the industrial losses caused
primarily by the malarial mosquito and secondarily by the forms
which do not carry malaria, as indicated in the opening paragraphs,
it i- inconceivable that the comparatively inexpensive measures neces-
sary should not be undertaken by the General Government^ by the
State governments, and by the boards of health of communities, just
as it is inconceivable that the individual should suffer from malaria
and from the attacks of other mosquitoes when he has individual
preventives and remedies at hand. Large-scale drainage measures
by the General Government involving large sections of valuable terri-
tory haVe been planned and are practically under way; certain States,
notably New Jersey and New York, are beginning to work; communi-
ties all over the country through boards of health are also beginning
to take notice, while popular education regarding the danger from
mosquitoes and in regard to remedial measures is rapidly spreading.
But all of this interest should be intensified, and the importance of
the work should be displayed in the most emphatic manner, and relied'
from malaria and other mosquito conditions should be brought about
as speedily as possible.

A few excellent examples of antimalarial work may be instanced.

The Latest reports on the measures taken to abolish malaria from
Klang and Port Swettenham in Selangor, Federated Malay State-,
indicate the most admirable restdts. These measures were under-

16 1-»'SS THROUGH INSECTS THAT CABBY DISEASE.

taken first in 1901 and L902, and have been reported upon from time
to time in the Journal of Tropical Medicine. The expenditure
undertaken by the Government with a view to improving the health

of the inhabitants of these towns has been fully justified by the
results, which promise to be of permanent value. The total expendi-
ture for the town of Klang down to the end of 1905 was £3.100
($15,086), and the annual permanent expenditure is about £60 (S292)

for clearing earth drains and £210 ($1,022) for town gardeners. For
Port Swettenham the total expenditure to the end of 1905 was t'7.000
($34,065), and the annual cost of keeping up the drains, etc., is ap-
proximately £40 ($195) for clearing earth drains, and £100 ($487)
for town gardeners.

The careful tabulation of cases and deaths and of the results of
the examination of blood of children in especially drained areas
indicates the following conclusions: (1) Measures taken systematically
to destroy breeding places of mosquitoes in these towns, the inhabit-
ant- of which suffered terribly from malaria, were followed almost
immediately by a general improvement in health and decrease in
death rate. (2) That this was due directly to the work carried out
and not to a general dying out of malaria in the district is clearly
shown by figures pointing out that while malaria has practically
ceased to exist in the areas treated it has actually increased to a
considerable extent in other parts of the district where antimalarial
measures have not been undertaken.

The statistics for 1905 are even more favorable than those for 1902.
which gives a very strong evidence in favor of the permanent nature
of the improvement carried out. In fact it seems as though malaria
has been permanently stamped out at Klang and Port Swettenham
by work undertaken in 1901. and this experience in the Malay States
should be of value to those responsible for the health of communities
similarly situated in many other parts of the world.

Another striking example of excellent work of this kind is found
in the recently published report on the suppression of malaria in
Ismailia, issued nnder the auspices of the Compagnie Universelle du
Canal Maritime de Suez. Ismailia is now a town of 8.000 inhabit-
ants. It was founded by De Lesseps in April. 1SG2. on the borders
of Lake Timsah. which the Suez Canal crosses at mid-distance be-
tween the Red Sea and the Mediterranean. Malarial fever made it-
appearance in very severe form in September. 1877. although the
city had up to that time been very healthy, and inn-eased so that
since 1886 almost all of the inhabitants have suffered from the fever.
In 1901 an attempt to control the disease was made on the mosquito
basis, and this attempt rapidly and completely succeeded, and after
two year- of work all trace- of malaria disappeared from the city.
The work was directed not only against Anopheles mosquitoes, but

MOSQUITOES \M> YKI.I.nw I I \ BR. 17

against other culicids, and comprised the drainage of a large swamp
and the other usual measures. The initial expense amounted to
50,000 francs ($9,650), and the annual expenses since have amounted
to a I .out 18,300 francs ($3,532).

The results may be summarized about as follow-: since the be-
ginning of L903 the ordinary mosquitoes have disappeared from
[smailia. since the autumn of L903 not a single larva of Anopheles
has been found in the protected zone, which extends to the west for
a distance of l.ooo meters from (he first houses in (he Arabian
quarter ami to the east for a distance of L,800 meters from the first
houses in the European quarter. After L902 malarial i'v\r\- obviously
began to decrease, and since L903 not a single new case of malaria
has been found in [smailia.

A very efficient piece of antimalarial work was accomplished in
Havana during the American occupation of 1901 to L902, incidental
in a way to the1 work against yellow fever. An Anopheles brigade
of workmen was organized under the sanitary officer, Doctor Gorgas,
for work along the small streams, irrigated gardens, and similar
places in the suburbs, and numbered from 50 to 300 men. No exten-
sive drainage, such as would require engineering skill, was attempted,
and the natural streams and gutters were simply cleared of obstruc-
tions and grass, while superficial ditches were made through the irri-
gated meadows. Among' the suburban truck gardens Anopheles bred
(very where, in the little puddles of water, cow track's, horse tracks,
and similar depressions in grassy ground. Little or no oil was used
by the Anopheles brigade, since it Avas found in practice a simple
matter to drain these places. At the end of the year it was very diffi-
cult to find water containing mosquito larvae anywhere in the suburbs,
and the effect upon malarial statistics was striking. In 1900, the
year before the beginning of the mosquito work, there were 325
deaths from malaria; in 1901, the first year of the mosquito work,
171 deaths; in 190*2, the second year of mosquito work, 77 deaths.
Since 1 '.>()•_> there has been a gradual though slower decrease, as fol-
low-: L903, :>1 : 1901. I I : L905, 32; 190G, 20; 1907, 2:^>. These results,
although Less striking than (hose from Ismailia, involved a smaller
expense in money and -how surely an annual saving of 800 lives, and
undoubtedly a corresponding decrease in the number of malarial
case-, which may be estimated upon our earlier basis at something
less than 40.000.

YELLOW FEVER.

Yellow fever ha- prevailed endemically throughout the AVest In-
dies and in certain regions on the Spanish Main virtually since the
discovery of America. Barbados, Jamaica, and Cuba suffered
epidemics before the middle of the seventeenth century. There were
B3434— BvlL 7S- -09 3

18 LOSS THROUGH [NSECTS THAT CABRY DISEASE.

outbreaks in Philadelphia, Charleston, and Boston as early as 1692,
and for a hundred years there were occasional outbreaks, culminat-
ing in the great Philadelphia epidemic of 175):}. Northern cities were
able, by rigid quarantine measures, to prevent great epidemics after

the early part of the nineteenth century, but from the West Indie-
the disease was occasionally introduced and prevailed from time to
time epidemically in the Southern States. In Is:).0, it raged through-
out this region, Xew Orleans alone having a mortality of 8.000. The
last widespread epidemic occurred in 1ST8. chiefly in Louisiana, Ala-
bama, and Mississippi, but spreading up the Mississippi Valley as far
a- Cairo, 111., and attacking with virulence the city of Memphis, Tenn.
In this year there were 12:>.000 cases and 12.000 death-. In L882
there were 192 deaths at Pensacola; in 1887, G2 deaths in the Southern
States; in 1893. 52 deaths; in 1897, 481; in 1898, 2,456 cases with
117 deaths; in 1903, 139 deaths were recorded, mostly at Laredo.
Tex., and in 1905 there was a serious outbreak at Xew Orleans and
in neighboring towns, including one locality in Mississippi, in which
911 deaths were recorded for the whole country.

The actual loss of life from yellow fever during all these year-.
when compared with the loss from other diseases, has been compara-
tively slight, but the death rate is perhaps the most insignificant fea-
ture of the devastation which yellow fever epidemics have produced,
and the disease itself has been but a small part of the affliction which
it has brought to the Southern States. The disease once discovered in
epidemic form, the whole country has become alarmed ; commerce
in the affected region has come virtually to a standstill; cities have
been practically deserted; people have died from exposure in camping-
out in the highlands ; rigid quarantines have been established ; inno-
cent persons have been shot while trying to pass these quarantine
lines; all industry for the time has ceased. The commerce of the
South during the epidemic of 1878. for example, fell off 90 per cent.
and the hardships of the population can not be estimated in monetary
terms. With such industrial and commercial condition- existing
from Texas to South Carolina, many industries at the Xorth have
suffered, and, in fact, the effect of a yellow fever summer in the South
has been felt not only all over the United States, but in many other
portions of the world.

All these conditions, as bad as they have been, do not sum up the
total loss to the national prosperity during past years. Cities like
Galveston. Xew Orleans, Mobile. Memphis. Jacksonville, and Charles-
ton, snbject to occasional epidemics, ;i- they have been in the past,
have not prospered as they should have done. Their progress has
been greatly impeded by this one cause, ami thus the industrial
development of the entire South ha- been greatly retarded.

MOSQUITOES and J ELLOW PI v i 1;. 19

Physicians have been theorizing about the cause of yellow fcwr
from ili«' time when they began to treat it. It was thought by many
iliai it was carried in the air: by others that it was conveyed l»\ tin1

clothing, bedding, or Other article- which had come in contact with a

yellow-fever patient. There were one or two early suggestions of the
agency of mosquitoes, hut practically no attention was paid to them,
and they have been resurrected and considered significant only since
the beginning of the present century. With the discovery of the
agency of micro-organisms in the causation of disease, a search soon
began for some causative germ. Many micro-organisms were found
in the course of the autopsies, and many claims were put forth by
investigators. All of these, however, were virtually set at pest by
Sternberg in his " Report on the Etiology and Prevention of Yellow
Fever," published in L890, hut a claim made by Sanarelli in June,
iv.>7. for a bacillus which hi' called Bacillus icteroides received con-
siderable credence, and in lst>(.> it was accepted in full by Wasden and
Geddings, of the United States Marine-Hospital Service, who re-
ported that they had found this bacillus in thirteen or fourteen cases
of yellow fever in the city of Havana. There is no evidence, how-
ever, that this bacillus has anything to do with yellow fever. In L881
Finlay, of Havana, proposed the theory that yellow fever, whatever
its cause may be. is conveyed by means of Culex (now Stegomyia)
fasciatus (now calopus). Subsequently he published several im-
portant papers, in which his views were modified from time to time,
and in the1 course of which he mentioned experiments with loo indi-
viduals, producing 3 cases of mild fever. None of the cases, however,
was under his full control, and the possibility of other method- of
contracting the disease was not excluded. Therefore, his theory,
while it was received with interest, was not considered to he proved.
In 11)00 came the beginning of the true demonstration. An army
board was appointed by Surgeon-General Sternberg for the purpose
of investigating the acute infectious diseases prevailing in the island
of Cuba. The result achieved by this hoard, consisting of Reed,
Carroll, Lazear, and Agramonte, was a demonstration that yellow
fever is carried ^y Stegomyia calopus, and their ultimate demonstra-
tion was so perfect a- to silence practically all expert opposition. The
Third International Sanitary Convention of the American Republics
unanimously accepted the conclusion that yellow fever is carried by
this mosquito, and that the Stegomyia constitutes the only known
mean- by which the disease is spread. To-day, after abundant addi-
tional demonstration, the original contention of Reed, Carroll, and
Aiiranionte ( Lazear having died in the course of the experiments) is
a part of the accepted knowledge of the medical world. I'he im-
portance of the discovery can not he overestimated, and it- first
demonstration was followed by antimosquito measures in the city

20 LOSS THROUGH INSECTS THAT CARRY DISEASE.

of Havana, undertaken under the direction of Gorgas, with startling

result.-.

Yellow fever had been endemic in Havana for more than one hun-
dred and fifty year-, and Havana was the principal source of infec-
tion for the rest of Cuba. Other towns in Cuba could have rid
themselves of the disease if they had not been constantly reinfected
from Havana. By ordinary sanitary measures of cleanliness, im-
proved drainage, and similar means the death rate of the city was
reduced, from 1898 to 1000, from 100 per thousand to 22 per thou-
sand: but these measures had no effect upon yellow fever, this disease
increasing as the nonimmune population following the Spanish war
increased, and in 1900 there was a severe epidemic.

Stegomyia calopus was established as the carrier of the fever
early in 1901, and then antimosquito measures were immediately
begun. Against adult mosquitoes no general measures were attemp-
ted, although screening and fumigation were carried out in quarters
occupied b}r yellow-fever patients or that had been occupied by
yellow-fever patients. It was found that the Stegomyia bred prin-
cipally in the rain-water collections in the city itself. The city was
divided into about 30 districts, and to each district an inspector and
two laborers were assigned, each district containing about a thousand
houses. An order was issued by the mayor of Havana requiring all
collections of water to be so covered that mosquitoes could not have
access, a fine being imposed in cases where the order was not obeyed.
The health department covered the rain-water barrels of poor fami-
lies at public expense. All cesspools were treated with petroleum.
All receptacles containing fresh water which did not comply with the
law were emptied and on the second offense destroyed. The result of
this work thoroughly done was to wipe out yellow fever in Havana,
and there has not been a certain endemic case since that time.

In the Xew Orleans epidemic of 1905, a striking illustration of the
valueof this recently acquired mosquito-transmission knowledge is seen.
The presence of yellow fever in the cit}< was first recognized about the
12th of July, and the plan of campaign adopted by the Board of Health
under Dr. Quitman Kohnke, from the beginning was based on the
mosquito conveyance of the disease. Available funds were rapidly
exhausted, however, and on the 12th of August the Public Health and
Marine-Hospital Service was put in charge of the situation and pro-
vided with ample means. ¥>y that time the increase in the new cases
and deaths rendered it practically certain that the disease was as wide-
spread as during the terrible epidemic of 1878. There had been up to
that time 1 12 deaths from a total of 913 cases, as against L52 deaths
from a total of 519 cases in 1878. The work for the rest of the sum-
mer was continued with great energy under Doctor White, and the
measures Avere based almost entirely upon a warfare against the yel-
low-fever mosquito. The disease began almost immediately to abate,
and the result at the close of the season indicated 400 deaths, as
against 4.04G in 1878, a virtual saving of over 3.500 lives. The

WORK AGAINST MOSQUITOE

IN PANAMA.

21

following table of deaths from yellow fever in New Orleans from
1847 to L905 points out most strikingly the value of this antimosquito

work :

Tabu ii. Comparative t<ii>i< of deaths from yellow fever in Veto Orleans dur-
ing various years.

Month.

year.

1878.

1M7.

1-:-.

L853,

L854.

L8 ..

1-.-.

L867.

Mnv

:;i

1,521

6, 188

982

117

28

1

1

88

200

467

126

20

"""22

2

29

682

1,284

190
LSI

1,286

B74

97

L9

7

182

1. 1 in

2,204

1,187

22 1

15

1 l

L03
26

Julv ....

71

966

1,100

L96

12

in
1 15

L,0 1

1,7-u

1.

117

107

October

'i

Months imknou n

Total

2, 80 1

872

7, 848

2, 4'_>5

4,854

3, 107

4,046

160

The epidemics of L848, L854, and L855 are least comparable with
that of L905 because they immediately succeeded severe epidemics to
which were due very many immunes.

The population of New Orleans by the United State- Census was
130,565 in L850; L68,675 in 18G0; 191,418 in 1870; 216,090 in 1880,
and 287,104 in li>00.

WORK ON THE ISTHMUS OF PANAMA.

The United States Government has very properly used the services
of Colonel Gorgas, who was in charge of the eminently successful
work at Havana, by appointing him chief sanitary officer of the
Canal Zone during the digging of the canal. In L904 active work was
begun, and Colonel Gorgas was fortunate in having the services of
Mr. Le Prince, who had been chief of his mosquito brigades in Havana,
and therefore was perfectly familiar with antimosquito method-. In
Panama, as in Havana, the population had depended principally
upon rain water for domestic purposes, so that every house had cis-
terns, water barrels, and such receptacles for catching and storing
rain water. The city was divided up into small districts with an in-
spector in charge of each district. This inspector was required to
cover hi- territory at least twice a week' and to make a report upon
each building with regard to its condition as to breeding places of
mosquitoes. All the cisterns, water barrels, and other water recepta-
cles in Panama were covered a- in Havana, and in the water barrels
spigots were inserted so that the covers would not have to be taken
off. Upon first inspection, in March, I.000 breeding place- were
reported. At the end of October less than Ion containing larvae
were recorded. This gives one a fair idea of the consequent rapid

22 LOSS THBOUGH INSECTS THAT CARRY DISEASE.

decrease in the number of mosquitoes in the city. These opera-
tion- were directed primarily against the yellow-fever mosquito, and

incidentally against the other common species that inhabit rain-water
barrels. Against the Anopheles in the suburbs the same kind of work

was done as was done in Havana, with exceptionally good results.

The same operation- were carried on in the villages between Pan-
ama and Colon. There are some twenty of these villages, running

from 500 to 3,000 inhabitant- each. Not a -ingle instance of failure
has occurred in the disinfection of these small town-, and the result
of the whole work has been the apparent elimination of yellow fever

and the very great reduction of malarial fever.

The remarkable character of these results can only be judged accu-
rately by comparative methods. It is well known that during the

French occupation there was an enormous mortality among the
European employee-, and this was a vital factor in the failure of the
^vork. Exact losses can not be estimated, since the work was done
under 17 different contractors. These contractors were charged $1
a day for every sick man to be taken care of in the hospital of the
company. Therefore it often happened that when a man became
sick his employer discharged him. so that he would not have to bear
the expense of hospital charges. There was no police patrol of the
territory and many of these men died along the line. Colonel
Gorgas has stated that the English consul, who was at the Isthmus
during the period of the French occupation, is inclined to think
that more deaths of employees occurred out of the hospital than in it.
A great many were found to have died along the roadside while en-
deavoring to find their way to the city of Panama. The old superin-
tendent of the French hospital states that one day 3 of the medical
staff died from yellow fever, and in the same month 0 of the medical
staff. Thirty-six Roman Catholic sister< were brought over as nurses,
and 2-t died of yellow fever. On one vessel 18 young French engi-
neers came over, and in a month after their arrival all but one died.

Xow that the relation of the mosquito to yellow fever is well under-
stood, it was found during the first two years under Doctor Gorgas
that, although there were constantly one or more yellow-fever cases
in the hospital, and although the nurses and physicians were all non-
immunes, not a -ingle case of yellow fever was contracted in that
way. The nurses never seemed to consider that they were running
any risk in attending yellow fever cases night and day in screened
wards, and the wives and families of officers connected with the hos-
pital lived about the grounds, knowing that yellow fever was con-
stantly being brought into the grounds and treated in near-by build-
ings. Americans, sick from any cause, had no fear when being
treated in beds immediately adjoining those of yellow-fever pa-
tients. Colonel Gorgas and Doctor Carter lived in the old ward

THE TYPHOID FLY, OB HOUSE FLY. 23

used by the French for their officers, and Colonel Gorgas think- it
Bafe to say that more men had died from yellow fever in thai build
ing under the French regime than in any other building of the same
capacity at present standing. He and Doctor Carter had their wives
ami children with them, which would formerly have been considered
the height of recklessness, but they looked upon themselves, under the
now recognized precaution-, as being as safe, almost, as they would
have been in Philadelphia or Boston.

No figures of the actual cost of the antimosquito work, either in
Havana or in the Panama ("anal Zone, are accessible to the writer,
but it is safe to say that it was not exorbitant, and that it was not
beyond the means of any well-to-do community in tropical regions.

THE TYPHOID FLY, COMMONLY KNOWN AS THE HOUSE FLY.

The name "typhoid fly" is here proposed as a substitute for the
name "house fly.** now in general use. People have altogether too
long considered the house fly as a harmless creature, or, at the most,
simply a nuisance. While scientific researches have shown that it is
a most dangerous creature from the standpoint of disease, and while
popular opinion is rapidly being educated to the same point, the
retention of the name house fly is considered inadvisable, as perpetu-
ating in some degree the old ideas. Strictly speaking, the term
"typhoid fly" is open to some objection, as conveying the erroneous
idea that this fly is solely responsible for the spread of typhoid, but
considering that the creature is dangerous from every point of view,
and that it is an important element in the spread of typhoid, it
seems advisable to give it a name which is almost wholly justified and
which conveys in itself the idea of serious disease. Another repul-
sive name that might be given to it is "manure fly," but recent
researches have shown that it is not confined to manure as a breeding
place, although perhaps the great majority of these flies are born
in horse manure. For the end in view7, " typhoid fly " is considered
the best name.

The true connection of the so-called house fly with typhoid fever
and the true scientific evidence regarding its role as a carrier of that
disease have only recently been worked out. Celli in L888 fed flies
with pure cultures of the typhoid bacillus, and examined their
content- and dejections microscopically and culturally. Inocu-
lation- of animals were also made, proving that the bacilli which
passed through flies were \ indent. Dr. George M. Koher. familiar
with Celli's researches, in his report on the prevalence of typhoid
fever in the District of Columbia, published in L895, called especial
attention to the danger of the contamination of food supplies by

24 LOSS THROUGH INSECTS THAT CAREY DISEASE.

flic- coming from the excreta of typhoid patients. Tlio prevalence of

typhoid fever in the concent rat ion camps of the United State- Army
in the summer of L898 brought about the appointment of an army
board of medical officers consisting of Drs. Walter Reed, V. S. Army,
Victor ( '. Vaughan, U. S. Volunteers, and E. O. Shakespeare. U. S.
Volunteers, to investigate the causes. The abstract of the report of
this board, published in L900, contains (p. l<\) the following conclu-
sions with regard to flies:

"Fins undoubtedly served as carriers of the infection.

" Flies swarmed over infected fecal matter in the pits and then
visited and fed upon the food prepared for the soldiers at the mess
tents. In some instances where lime had recently been sprinkled
over the content- of the pits, flies with their feet whitened with lime
were seen walking- over the food.

••It i- possible for the fly to carry the typhoid bacillus in two
ways. In the first place, fecal matter containing the typhoid germ
may adhere to the fly and be mechanically transported. In the
second place, it is possible that the typhoid bacillus may be carried
in the digestive organs of the fly and may be deposited with its
excrement."

Doctor Vaughan, of the board just mentioned, in a paper read be-
fore the annual meeting of the American Medical Association at
Atlantic City. X. J.. June 6, 1900. gives the following additional rea-
sons for believing that flies were active in the dessemination of
typhoid fever:

" Officers whose mess tents were protected by means of screens
suffered proportionately less from typhoid fever than did those
whose tents were not so protected.

'; T}'phoid fever gradually disappeared in the fall of 1S0S. with
the approach of cold weather, and the consequent disabling of the fly."

There were also many important conclusions which bear upon the
fly question. For example, it was shown that every regiment in the
United States service in 1898 developed typhoid fever, nearly all of
them within eight weeks after assembling in camps. It not only
appeared in every regiment in the service, but it became epidemic
both in small encampments of not more than one regiment and in the
larger ones consisting of one or more corps. All encampments
located in the Xorthern as well as in the Southern Stan- exhibited
typhoid in epidemic form. The niia-matic theory of the origin of
typhoid fever and the pythogenic theory" were not supported by
the investigations of the commission, but the doctrine of the specific

aTliis theory is founded upon the belief that the colon germ may undergo a
ripening process by means <>f which its virulence is so increased and altered

thai il may l>o converted into the typhoid bacillus or at least may become the
active agent in the causation of typhoid fever.

THE TYPHOID PLY, OB HOUSE PLY. 25

origin of the fever was confirmed. The conclusion was reached thai
the fever is disseminated by the transference of the excretions of an
infected individual to the alimentary canals of others, and that a
man infected with typhoid fever may scatter the infection in every
Latrine or regiment before the disease is recognized in himself, while

germs may he found in the excrement for a lone,- time after the
apparently complete recovery of the patient. Infected water was
not an important factor in the spread of typhoid in the national
encampments of 1898, hut aboul one-fifth of the soldiers in the
national encampments in the United States during that summer de-
veloped this disease, while more than SO per cent of the total deaths
were caused by typhoid.

In L899 the writer began the study of the1 typhoid or house fly
under both country and city conditions. lie made a rather thorough
investigation of the insect fauna of human excrement, and made a
further investigation of the species of insects that are attracted to
food supplies in houses. Tn a paper entitled "A Contribution to the
Study of the Insect Fauna of Human Excrement (with special refer-
ence to the spread of typhoid fever by flies)," published in the Pro-
ceedings of the Washington Academy of Sciences, Volume II, pages
r>41-c>04, December 28, 1900, he showed that 98.8 per cent of the whole
number of insects captured in houses throughout the whole country
under the conditions indicated above were Musca domestica, the
typhoid or house fly. He showed further that this fly, while breeding
most numerously in horse stables, is also attracted to human excre-
ment and will breed in this substance. It was shown that in towns
where the box privy was still in existence the house fly is attracted to
the excrement, and, further, that it is so attracted in the filthy regions
of a city where sanitary supervision is lax and where in low alleys
and corners and in vacant lots excrement is deposited by dirty people.
He stated that he had seen excrement which had been deposited over-
night in an alleyway in South Washington swarming with flies under
the bright sunlight of a June morning (temperature 92° F.), and that
within 30 feet of these deposits were the open windows and doors of
the kitchens of two houses kept by poor people, these two houses
being only elements in a long row. The following paragraph is
quoted from the paper just cited :

" Now. when we consider the prevalence of typhoid fever and that
virulent typhoid bacilli may occur in the excrement of an individual
for some time before the disease is recognized in him, and that the
same virulent germs may be found in the excrement for a long time
after the apparent recovery of a patient, the wonder is not that ty-
phoid is so prevalent but that it doe.-> not prevail to a much greater

26 LOSS THROUGH INSECTS THAT CARRY DISEASE.

extent. Box privies should be abolished in every community. The

depositing of excrement in the open within town or city limits should
be considered a punishable misdemeanor in communities which have

not already such regulations, and it should be enforced more.rigor-
ously in town- in which it is already a rule. Such offenses are gener-
ally committed after dark, and it is often difficult or even impossible
to trace the offender; therefore, the regulation should be carried even
further and require the first responsible person who notices the de-
posit to immediately inform the police, so that it may be removed or
covered up. Dead animals are SO reported; but human excrement Lfi
much more dangerous. Boards of health in all communities should
look after the proper treatment or disposal of horse manure, primarily
in order to reduce the number of house flies to a minimum, and all
regulations regarding the disposal of garbage and foul matter should
be made more stringent and should be more stringenth7 enforced."

In the opening sentence of the paragraph just quoted attention was
called to the activity of bacilli in excreta passed by individuals after
apparent recovery from typhoid. Since the paper in question was
published, more especial attention has been drawn by medical men
to this point, and it has been shown that individuals who are chronic
spreaders of the typhoid germs are much more abundant than was
formerly supposed. Dr. George A. Soper recently discovered a strik-
ing case of this kind in the person of a cook employed successively
by several families in the vicinity of Xew York City, with the result
that several cases of typhoid occurred in each of these families. In
a paper by Doctor Davids and Professor Walker, read before the
Royal Sanitary Institute of London during the present season, the
history was given of four personal carriers of typhoid who had com-
municated the disease to a number of people. These four carriers
were detected in one city within a few months, and from this fad
it can be argued with justice that such cases are comparatively numer-
ous. This being true, the presence of unguarded miscellaneous
human excreta deposited in city suburbs, in vacant lots, and in low
alleyways intensifies to a very marked degree the danger that the food
will become contaminated with typhoid bacilli by means of the ty-
phoid or house fly. It is known, too. that the urine of persons who
have suffered from typhoid fever often contains active typhoid bacilli
for several weeks after the patients have recovered ; consequently this
also is a source of danger.

The importance of the typhoid fly as a carrier of the disease in army
camps, as shown in the Spanish war and in the Boer war and in the
camps of great armies of laborers engaged in gigantic enterprises like
the digging of the Panama canal, i- obvious, but what has just been
stated indicates that even under city conditions the influence of this
fly in the spread of this disease has been greatly underestimated. It
is not claimed that under city conditions the house fly becomes by this
argument a prime factor in the transfer of the disease, but it must
obviously take a much higher relative rank among typhoid conveyers

Nil. TYPHOID PLY, OB HOUSE PLY. 27

than it has hitherto assumed. Perhaps even under city condition*

it mu>t assume third rank next to water and milk."

It Is not alone a- a carrier of typhoid thai this fly i- to be feared.
In the same way it may carry nearly all the intestinal diseases. It i-
a prime agent in the spreading of summer dysentery . and in this w ay
is unquestionably responsible for the death of many children in sum-
mer. One of the earliest accurate scientific studies of the agency of
insects in the transfer of human disease was in regard to Hie- as
spreaders of cholera. The belief in this agency long preceded its
actual proof. Dr. (I. E. Nicholas, in the London Lancet. Volume II.

L873, page 7-J-1-. is quoted by Xuttall as writing as follows regarding
the cholera prevailing at Malta in L849: "My first impression of the

possibility of the transfer of the disease by (lies was derived from the
observation of the manner in which these voracious creatures, present
in great numbers, and having equal access to the dejections and food
of patients, gorged themselves indiscriminately and then disgorged
themselves on the food and drinking utensils. In L850 the Superb^
in common with the rest of the Mediterranean squadron, was at sea
for nearly six months; during the greater part of the time she had
cholera on hoard. On putting to sea, the flies were in great force;
hut after a time the flies gradually disappeared, and the epidemic
slowly subsided. On going into Malta Harbor, but without com-
municating with the shore, the flies returned in greater force, and the
cholera also with increased violence. After more cruising at sea, the
flies disappeared gradually with the subsidence of the disease."

Accurate scientific bacteriological observations by Tizzoni and
Cattani in 1886 showed definitely active cholera organisms in the
dejecta of flies caught in the cholera wards in Bologna, Italy. These
observations were subsequently verified and extended by Simonds,
Olfelmann. Macrae, and others.

With tropical. dysentery and other enteric diseases practically the
same conditions exist. In a report by Daniel D. Jackson to the
committee on pollution, of the .Merchants' Association in New York,
published in December, 1907, the results of numerous observations
upon the relation of flies to intestinal diseases are published, and the
relation of death.- from intestinal diseases in New York City to the

"Dr. John It. Mohler, of the Bureau of Animal Industry, IT. S. Department
of Agriculture, informs the writer that investigations made in his office show-
that typhoid bacilli will live in butter under common market conditions for 151
days and still be able to grow when transferred to suitable conditions, in
milk under market conditions they retain active motility for 20 days, after
which time there is a gradual lessening in numbers until, on the forty-third day
of t he test, they <iis;i i ipea r from view. At certain seasons of the year large num-
bers of Hies collect upon the vats in which milk and cream are being stored
in dairies and creameries. Many of the Hies fall in. their bodies being strained
out when the cream is sent to the churn. If any of these Hies carry typhoid
bacilli these are washed off by the milk and remain in the butter or cheese
made from it. Thus the eating of butter contaminated in this way may account
for vi'ry many cases of typhoid fever the cause of which cau not be otherwise
traced.

28 LOSS THROUGH INSECTS THAT CARRY DISEASE.

activity and prevalence of the common house fly is shown not only
by repeated observations but also by an interesting plotting of the
curve of abundance of flies in comparison with the plotted curve of
abundance of death- from intestinal diseases, indicating that the
greatest number of flies occurred in the weeks ending duly 27 and
August 3; also, that the death- from intestinal diseases rose above
the normal at the same time at which Hies became prevalent, culmi-
nated at the same high point, and fell off with slight lag at the
time of the gradual falling off of the prevalence of the insect-.

Similar studies have been carried on during tin- summer of 1008
in the city of Washington, and the curve of typhoid-fly abundance
for the whole city, as well as that for a district comprising eight city
squares in which intensive studies have been made both of flies and
of disease, will be plotted at the close of the season. At the time
of present writing this work has not been completed.

The typhoid fly also possesses import a nee as a disseminator of the
bacilli of tuberculosis. In a paper by Dr. Frederick T. Lord, of
Boston, reprinted from the Boston Medical and Surgical Journal for
December 15, 1904, pages 651-654, the following conclusions are
reached :

" 1. Flies may ingest tubercular sputum and excrete tubercle ba-
cilli, the virulence of which may last for at least fifteen day-.

"2. The danger of human infection from tubercular flyspecks is
by the ingestion of the specks on food. Spontaneous liberation of
tubercle bacilli from flyspecks is unlikely. If mechanically dis-
turbed, infection of the surrounding air may occur.

"As a corollary to these conclusions, it is suggested that —

" 3. Tubercular material (sputum, pus from discharging sinuses,
fecal matter from patients with intestinal tuberculosis, etc.) should
be carefully protected from flies, lest the}7 act as disseminators of the
tubercle bacilli.

" 4. During the fly season greater attention should be paid to the
screening of rooms and hospital wards containing patients with
tuberculosis and laboratories where tubercular material i- examined.

" 5. As these precautions would not eliminate fly infection by
patients at large, foodstuffs should be protected from flies which may
already have ingested tubercular material."

From all these facts it appears that the most important part played
by the typhoid fly or house fly in the human economy is to carry
bacteria from one place to another. The following tabic and com-
ments are taken from Bulletin Xo. 51 (April. 1908), of the Storrs
Agricultural Experiment Station. Storrs, Conn., entitled " Sources of
Bacteria in Milk." bv W. M. Esten and C. J. Mason:

THE r\ PHOID PLY, OB BOUSE PLY.
Table 111. Sources of bacteria from ft

29

Source.

Total
number.

Total acid
bacteria,

Rapid
liquefy
Ingbac

lena.

Slow
llquefj
Ing bac-
teria.

BacU /in in

hirtis

aeidi.

Group A.

Class l.

( n/, :, TO

il' II' s.

i iroup A.

( !lan 2.

L907.
July 27

m) l fly, bacteriological

::, 150

550
7,980,000

420.0(H)

156,000,000

1,660,000

183,000,000

928,000

lis. 800, oi mi

6,600,000

1. 125,000

17,580

22,880,1

880,000

35.500,000

822,700

308, 700

2 .i 1

100

220,000

11,600

S,95O,O(i0

95,800

2, lio.oiio

IS, 700

lo. 180,000
•_', 182,000

125,000

l. 167

22.. v. 16, ooo

869,000

600
0

0
0

0
0

10(1,000

700
0
0
0
0
120,000
4.600

too

0

July 27

[b] i fly. bacteriological
laboratory

Aug. 6

e) 19 cow-stable fliea

Average per fly

(>i) 94 swill-barrel flies

Average per By

(e) in pigpen flics

Average per flv

(/) 18 swill-barrel flies....

\\ enme per flv

[g) SO dwelling-house Bies.

Average per By

(A i 26 dwelling-house flies.

Average per fly

/ 1 10 dwelling-house flies.

Average per fly

(j) l large bluebottle
blowfly

•jo. 000

1, Ml III

II
0

266, i

1. l-o

l 1,500,000

804,000

12,500

117

84,000

L,SO0

125. Ill II)
1. 100

Audi
Aug. 11

Bept i
Sept.21

1,820,00(1

16,000

933,000

6,500

10,480,000

582,000

1,630,000

19,800

1,176,000

12,200

30,000,000

1,600,000

Sept. 21

Bept.27

13,670,000 8,840,000

121.200

Aug. 20

(•)

Total average of 41 1 flies. .

Average per Cent of 114

flies

1,222,570

367,300 i 7.830 73.500

30

765,000

25

6

230

6

268, 700

8

Average per fly of 256
flies, experiments (d),
(e),and (/)

3,061,000

211,500

18

Average per cent of 256

flies, experiments (d),
- i and ( f)

" 2,200 mold spores.

" From the4 above table the bacterial population of 414 flies is pretty
well represented. The domestic fly is passing from a disgusting nui-
sance and troublesome pest to a reputation of being a dangerous
enemy to human health. A species of mosquito has been demon-
strated to be the cause of the spread of malaria. Another kind of
mosquito is the cause of yellow fever, and now the house fly is con-
sidered an agency in the distribution of typhoid fever, summer com-
plaint, cholera infantum, etc.

"The numbers of bacteria on a single fly may range all the way
from 550 to 6,600,000. Early in the fly season the numbers of bac-
teria on flies are comparatively small, while later the numbers are
comparatively very large. The place where flies live also determines
largely the numbers that they carry. The average for the 414 flies
was about one and one-fourth million bacteria on each. It hardly
seems possible for so small a bit of life to carry so large a number of
organisms. The method of the experiment was to catch the flies from
the several sources by means of a sterile fly net, introduce them into
a sterile bottle, and pour into the bottle a known quantity of steril-
ized water, then -hake the bottle to wash the bacteria from their
bodies, to simulate the number of organisms that would come from a
fly in falling into a lot of milk. In experiments ' df ' ef and '/'

30 LOSS THROUGH INSECTS THAT CARRY DISEASE.

the bacteria were analyzed into four groups. The objectionable class,
coli-cerogene8 type, was two and one-half times as abundant as the
favorable acid type. If these flies stayed in the pigpen vicinity there
would be less objection to the Hies and the kinds of organisms they
carry, but the fly is a migratory insect and it visits everything ' under
the sun/ It is almost impossible to keep it out of our kitchens, din-
ing rooms, cow stables, and milk rooms. The only remedy for this
rather serious condition of things is, remove the pigpen as far as pos-
sible from the dairy and dwelling house. Extreme care should be
taken in keeping flies out of the cow stable, milk rooms, and dwell-
ings. Flies walking over our food are the cause of one of the worst
contaminations that could occur from the standpoint of cleanliness
and the danger of distributing disease germs."

The danger of the typhoid or house fly in the carriage of disease
has thus been abundantly demonstrated. Further than this, it is an
intolerable nuisance. With mosquitoes it necessitates an annual out-
lay for window and door screens in the United States of not less than
ten millions of dollars. As a carrier of disease it causes a loss of
many millions of dollars annually. Dr. G. X. Kober. in a paper pre-
pared for the Governors' Conference on the Conservation of Natural
Kesources, held at the White House in May, 1908, entitled " The Con-
servation of Life and Health by Improved Water Supply." presented
figures showing that the decrease in the vital assets of the country
through typhoid fever in a single year is more than $350,000,000.
The house fly, as an important agent in the spread of this disease, is
responsible for a very considerable portion of this decrease in vital
assets. As an agency in the spread of other intestinal diseases, this
sum must be greatly increased, and yet it is allowed to breed unre-
stricted all over the United States; it is allowed to enter freely the
houses of the great majority of our people; it is allowed to spread
bacteria freely over our food supplies in the markets and in the
kitchens and dining rooms of private houses, and. to use the happy
phraseology of Dr. Theobald Smith, " when we go into public restau-
rants in midsummer we are compelled to fight for our food with the
myriads of house flies which we find there alert, persistent, and
invincible."

Even if the typhoid or house fly were a creature difficult to de-
stroy, the general failure on the part of communities to make any
efforts whatever to reduce its numbers could properly be termed
criminal neglect; but since, as will be shown, it is comparatively an
easy matter to do away with the plague of flies, this neglect becomes
an evidence of ignorance or of a carelessness in regard to disease-
producing filth which to the informed mind constitutes a serious blot
on civilized methods of life.

TIIK TYPHOID II. V, OB HOUSE FLY. 8 1

Strange as it may seem, an exhaustive study of the conditions
which produce house Hies in numbers lias never been made. The
lil\- history of fche insect in general was, down to L873, mentioned in
only three European works and few exact facts were given. In is;:;
Dr. A. s. Packard, then of Salem, Mass., studied the transformations
of the insect and gave descriptions of all stages, showing that the
growth of a generation from the cue;- state to the adult occupies from
ID to 1 1 days.

In L895 the writer traced the life history in question, Indicating
that L20 eggs are laid by a single female, and that in Washington,
in midsummer, a generation is produced every LO days. AJthough
numerous substances were experimented with, he was able to breed
the fly only in horse manure. Later investigations indicated that the
fly will breed in human excrement and in other fermenting vegetable
and animal material, hnt that the vast majority of the flies that
infest dwelling houses, both in cities and on farms, come from horse
manure.

In 1D07 careful investigations carried on in the city of Liverpool
by Robert Newstead, lecturer in economic entomology and para-
sitology in the School of Tropical Medicine of the University of
Liverpool, indicated that the chief breeding places of the house fly
in that city should be classified under the following heads:

(1) Middensteads (places where dung is stored) containing horse
manure only.

(-2) Middensteads containing spent hops.

(3) Ash pits containing fermenting materials.

lie found that the dung heaps of stables containing horse manure
only were the chief breeding places. Where horse and cow manures
were mixed the flies bred less numerously, and in barnyards where
fowls were kept and allowed freedom relatively few of the house
flies were found. Only one midden containing warm spent hops was
inspected, and this was found to be as badly infested as any of the
.-table middens. .V great deal of time was given to the inspection of
ash pits, and it was found that wherever fermentation had taken
place and artificial heat had been thus produced, such places were
infested with house-fly larva' and pupae, often to the same alarming
extent as in stable manure. Such ash pits as these almost invariably
contained large quantities of old bedding or straw and paper, paper
mixed with human excreta, or old rags, manure from rabbit hutches,
etc.. or a mixture of all these. About 25 per cent of the ash pits
examined were thus infested, and house (lies were found breeding
in smaller numbers in ash pits in which no heat had been engendered
by fermentation. The house fly was also found breeding by Mr.
Newstead in certain temporary breeding places, such as collections

32 LOSS THROUGH [NSBCTS THAI CARRY DISEASE.

of fermenting vegetable refuse, accumulations of manure at the

wharves, and in bedding in poultry pens.

Still more recent investigations were carried on during 1908 by
Prof. S. A. Forbes, State entomologist of Illinois, who has reared it
in large numbers from the contents of paunches of slaughtered cattle,
from refuse hog hairs, from tallow vats, from carcasses of various
animals, miscellaneous garbage, and so on.

All this means that if we allow the accumulation of filth we will
have house flies, and if Ave do not allow it to accumulate we will have
no house flies. With the careful collection of garbage in cans and
the removal of the contents at more frequent intervals than 10 days,
and with the proper regulation of abattoir-, and more particularly
with the proper regulation of stables in which horses are kept, the
typhoid fly will become a rare species. It will not be necessary to
treat horse manure with chlorid of lime or with kerosene or with a
solution of Paris green or arsenate of lead, if stable men are required
to place the manure daily in a properly covered receptacle and if it
is carried away once a week.

The orders of the health department of the District of Columbia,
published May 3, 1906, if carried out will be very effective. These
orders may be briefly condensed as follows:

All stalls in which animals are kept shall have the surface of the
ground covered with a water-tight floor. Every person occupying
a building where domestic animals are kept shall maintain, in con-
nection therewith, a bin or pit for the reception of manure, and pend-
ing the removal from the premises of the manure from the animal
or animals shall place such manure in said bin or pit. This bin -hall
be so constructed as to exclude rain water, and shall in all other re-
spects be water-tight, except as it may be connected with the public
sewer. It shall be provided with a suitable cover and constructed
so as to prevent the ingress and egress of flies. Xo person owning
a stable shall keep any manure or permit any manure to be kept in
or upon any portion of the premises other than the bin or pit de-
scribed, nor shall he allow any such bin or pit to be overfilled or
needlessly uncovered. Horse manure may be kept tightly rammed
into well-covered barrels for the purpose of removal in such barrels.
Every person keeping manure in any of the more densely populated
parts of the District shall cause all such manure to be removed from
the premises at least twice every week between June 1 and October 31.
and at least once every week between November 1 and May 31 of
the following year. Xo person shall remove or transport any manure
over any public highway in any of the more densely populated parts
of the District except in a tight vehicle, which, if not inclosed, must
be effectually covered with canvas, so as to prevent the manure from
being dropped. Xo person shall deposit manure removed from the

THE TYPHOID PLY, OB BOUSE PLY, 38

bins or pits within any of the more densely populated parts <>f the
District without a permit From the health officer. Any person

violating any of these provisions shall, upon conviction thereof, be
punished by a fine of not more than $40 for each offense.

In addition to this excellent ordinance, others have been lS8Ued

from the health department of the District of Columbia which provide

against the contamination of exposed food by Hies and by dust. The
ordinances are excellently worded so as to cover all possible cases.
They provide for the registration of all stores, markets. rales, lunch
room-, or of any other place where food or beverage is manufactured
or prepared for sale, stored for sale, offered for sale, or sold, in order
to facilitate inspection, and still more recent ordinances provide for

the registration of stables. An excellent campaign was begun during
the summer of 1008 against Insanitary lunch rooms and restaurants.

A number of cases were prosecuted, but conviction was found to be,

difficult

For one reason or another, the chief reason being the lack of a
sufficient force of inspectors under the control of the health officers,
the ordinance in regard to stables has not been carried out with that
perfection which the situation demands. In the summer of 1896, the
health officer of the District, Dr. W. C. Woodward, designated a
region in Washington bounded by Pennsylvania avenue. Sixth street,
Fifteenth street, and the Potomac River, which was to be watched
by assistants of the writer. Twenty-four stables were located in this
region and were visited weekly by two assistants chosen for the pur-
pose. The result was that on the whole the manure was well looked
after and the number of flies in the region in question was very con-
siderably reduced during the time of inspection.

Were simple inspection of stables all that is needed, a force of four
Inspectors, specially detailed for this work, could cover the District
of Columbia, examining every stable, after they were once located and
mapped, once a week. The average salary of an inspector is $1,147,
so that the total expense for the Qrst year would be something like
$4,500. But the inspectors1 service is complicated by the matter of
prosecution. Much of the time of inspectors would be taken in the
prosecution of the owner- of neglected premises. Moreover, the health
officer has found during the summer of 1908, in his prosecution of the
owners or managers of insanitary restaurants, that his inspectors were
practically sworn out of court by the multiplicity of opposing evi-
dence. This means that it will be necessary in such cases to send two
inspectors together in all case-, so that the testimony of one may be
supported by the testimony of the other. This, perhaps, would double
the number of necessary inspectors, making the expense of the service
something over $9,000. It is reasonably safe to state, however, that

34 LOSS THROUGH INSECTS THAT CARRY DISEASE.

with such an expense for competent service, or perhaps with a slightly

added expense, the typhoid fly could be largely eliminated as an ele-
ment in the transfer of disease in the District of Columbia, and the
difficulty which the authorities have had in locating the cause of a
very considerable proportion of the cases of typhoid in the District
for the past two or three years indicates plainly to the mind of the
writer that the typhoid fly is a much more important element than
has been supposed. It is a comforting although comparatively insig
nificant fact and a matter of common observation that in certain
sections of the city the typhoid fly has been much less numerous dur-
ing the past summer than in previous years. The writer is inclined
to attribute this to the gradual disappearance of horse stables in
such sections, brought about by the rapidly increasing use of motor
vehicles.

A significant paragraph in Mr. Xewstead's Liverpool report, re-
ferred to above, contains the following words: " The most strenuous
efforts should be made to prevent children defecating in the court >
and passages; or that the parents should be compelled to remove such
matter immediately; and that defecation in stable middens should be
strictly forbidden. The danger lies in the overwhelming attraction
which such fecal matter has for house flies, which later may come into
direct contact with man or his foodstuffs. They may. as Veeder puts
it. * In a very few minutes * * * load themselves with dejection-
from a typhoid or dysenteric patient, not as yet sick enough to be in
hospital or under observation, and carry the poison so taken up into
the very midst of the food and water ready for use at the next meal.
There is no long, roundabout process involved.' "

The writer has already referred to this general subject in his re-
marks on the depositing of excrement in the open within town or city
limits, but Xewstead's specific reference to children reminds one that
in the tenement districts of the older great cities of England and other
parts of Europe there occur opportunities for transfer of disease
which, while probably less numerous in the newer cities of the United
States, nevertheless must still exist and be a constant danger.

We have thus shown that the typhoid or house fly i- a general and
common carrier of pathogenic bacteria. It may carry typhoid fever,
Asiatic cholera, dysentery, cholera morbus, and other intestinal dis-
eases; it may cany the bacilli of tuberculosis and certain eve diseases;
it is everywhere present, and it is disposed of with comparative ease.
It is the duty of every individual to guard so far as possible against
the occurrence of flies upon his premises. It is the duty of every com-
munity, through its board of health, to spend money in the warfare
against this enemy of mankind. This duty i< as pronounced as though
the community were attacked by band- of ravenous wolves.

THE TYPHOID PLY, OB HOUS1 PL!

35

As a matter of fact, large sums of money arc spent annually in the
protection of property in the United States. Large sum- of money
aiv spent also in health matters; hut the expenditure for protection
from flies is very small and is misdirected. There is much justifies
tion for the following criticism published editorially in the Journal
of the American Medical Association for A.UgUSl 22, L908, under the
caption. "National Farm Commission and Rural Sanitation:"

"The President calls attention to the fact that all efforts to aid the
farmers have hitherto been directed to improving their material
welfare, while the man himself and his family have been neglected.
Nowhere is this more marked than in the attitude of the General
Government in matters relating to sanitation. It is a trite saying
that whereas the Government, through the Department of Agricul-
ture, aids the farmer generously in carina' for the health of his hogs,
sheep, etc.. it does nothing for his own health. The Government
issues notices to the farmer of the injury done to his crops by the
cotton-boll weevil and the potato bugs and how to combat them, hut
the injury the mosquito does in spreading malaria to the people who
pick the cotton and hoe the potatoes is not impressed on him. The
fact that horseflies may carry anthrax to his cattle is dealt with at
considerable length, but the diseases which the house fly spreads to
tin1 milk and to the farmer's family attract practically no attention.
How to build a hogpen or a sanitary barn is the subject of a number
of government publications, but how7 to build a sanitary privy which
will prevent the spread of typhoid, hook worm, and many other dis-
eases is regarded as of strictly local interest."

But this criticism is not entirely justified, since there was published
by the Bureau of Entomology of the United States Department of
Agriculture, in 1000, a Farmers' Bulletin, entitled " How Insects
Affect Health in Rural Districts,"0 in which all of these points men-
tioned by the editor of the Journal of the American Medical Asso-
ciation have been touched upon, and at the date of present writing
102.000 copies of this bulletin have been distributed among the
people. Moreover, a number of years ago a circular'' was published
on the subject of the house fly, calling attention to its dangers and
giving instructions such as are covered in a general way in this
article, and some 18.000 copies of this circular have also been dis-
tributed. This is an indication that the General Government is by
no means blind to the people's needs in such matters as we have
under consideration, but further work should be done. That the
English Government is awaking to the same need is shown by the
fad that, in the parliamentary vote of the present year in aid of

" Farmers' Bulletin No. 155.

6 Circular No. 35, Bureau of Entomology, L891, afterwards re
form a-; Circular No. 71.

sued in revised

36 LOSS THROUGH INSECTS THAT CARRY DISEASE.

scientific investigations concerning disease, one of the projects sup-
ported by the General Government was the investigation of Doctors
Copeman and Nuttall on files as carriers of diseas

A leading editorial iii an afternoon paper of the city of Washing-
ton, of October '20. 11)08. bears the heading. " Typhoid a National
Scourge. " arguing that it is to-day as great a scourge as tuberculosis.

The editorial writer might equally well have used the heading "Ty-
phoid a National Reproach," or perhaps even " Typhoid a National
Crime," since it is an absolutely preventable disea-e. And a- for the
typhoid fly, that a creature born in indescribable filth and absolutely
swarming with disease germs should practically be invited to mul-
tiply unchecked, even in great centers of population, is surely nothing
less than criminal.

ENDEMIC DISEASE AS AFFECTING THE PROGRESS OF NATIONS.

In referring to the spread of malaria in Greece, the relation of this
disease to the rise and fall of national power ha- been touched upon
in an earlier paragraph of this bulletin (p. 9). The subject is one of
the widest importance and deserves a more extended consideration.

The following paragraphs are quoted from Ronald Boss's address
on Malaria in Greece, delivered before the Oxford Medical Society.
November 29, 1906:

" Xow, what must be the effect of this ubiquitous and everlasting
incubus of disease on ihe people of modern Greece \ Remember that
the malady is essentially one of infancy among the native population.
Infecting the child one or two years after birth, it persecutes him
until puberty with a long succession of febrile attack-, accompanied
by much splenomegaly and anaemia. Imagine the effect it would
produce upon our own children here in Britain. It is true that our
children suffer from many complaints — scarlatina, measles, whoop-
ing cough — but these are of brief duration and transient. But now
add to these, in imagination, a malady which lasts for year-, and may
sometimes attack every child in a village. What would be the
effect upon our population — especially our rural population — upon
their numbers and upon the health and vigour of the survivors? It
must be enormous in Greece. People often seem to think that such a
plague strengthens a race by killing off the weaker individual-: but
this view rests upon the unproven assumption that it is really the
weaker children which can not survive. On the contrary, experience
seems to show that it is the stronger blood which suffers most— the
fair, northern blood which nature attempts constantly to pour into
the southern lands. If this be true, the effect of malaria will lie
constantly to resist the invigorating influx which nature has provided ;
and there are many fact- in the history of India. Italy, and Africa
which could be brought forward in support of this hypothesis.

ENDEMIC DISEASE AFFECTING PROGRESS OF NATIONS.

" We now come face to lace with that profoundly Interesting
subject, the political, economical, and historical significance of this
great disease. We know that malaria must have existed in Greece
ever since the time of Hippocrates, about 400 B. C. What effect
has it had on the life of the country? In prehistoric times Greece
w a- certainly peopled by successive wave- of Aryan Invaders from the
north -probably a fair-haired people — who made it what it became,
who conquered Persia and Egypt, and who created the sciences,
arts, and philosophies which we are only developing further to-
day. That race reached its climax of development at the time of
Pericles. Those great and beautiful valleys were thickly peopled

by a civilization which in some ways has not been excelled.
Everywhere there were cities, temples, oracles, arts, philosophies,

and a population vigorous and well trained in arms. Lake Kopais.
now almost deserted, was surrounded by towns whose massive work-
remain to this day. Suddenly, however, a blight fell over all. Was
it dne to internecine conflict or to foreign conquest? Scarcely; for
history shows that war burns and ravages, but does not annihilate.
Thebes was thrice destroyed, but thrice rebuilt. Or was it due to
some cause, entering furtively and gradually sapping away the
energies of the race by attacking the rural population, by slaying
the new-born infant, by seizing the rising generation, and especially
by killing out the fair-haired descendant of the original sett lei--.
Leaving behind chiefly the more immunised and darker children of
fcheir captives, won by tin1 sword from Asia and Africa? * * *

" T can not imagine Lake Kopais, in its present highly malarious
condition, to have been thickly peopled by a vigorous race; nor, on
looking at those wonderful figured tombstones at Athens, can I
imagine that the healthy and powerful people represented upon
them could have ever passed through the ansemic and splenomegalous
infancy (to coin a word) caused by widespread malaria. Well, I
venture only to suggest the hypothesis, and must leave it to scholars
for confirmation or rejection. Of one thing I am confident, that
causes Mich as malaria, dysentery, and intestinal entozoa must have
modified history to a much greater extent than we conceive. Our
historians and economists do not seem even to have considered the
matter. It is true that they speak of epidemic diseases, but the
endemic diseases are really those of the greatest importance. * * *

"The whole life of Greece must suffer from this weight, which
crushes its rural energies. Where the children suffer so much, how
can the country create that fresh blood which keeps a nation young?
Bui for a hamlet here and there, those famous valleys are deserted.
I saw from a spur of Ilelikon the sun setting upon Parnassus, Apollo
-inking, as he was wont to do. towards his own fane at Delphi, and
pouring a flood of light over the great Kopaik Plain. But it seemed

38 LOSS THBOUGB [HTSBCTS THAT CARRY DISEASE.

that he was die only inhabitant of it. There was nothing there.

• Who.' >aid a rich Greek to me, 'would think of going to live in
such a place a> that I * I doubt much whether it is the Turk who
has done all this. I think it is very largely the malaria.'*

In considering carefully this suggestive argument of Major Koss
docs it not appear to indicate the tremendous influence that the
prevalence of endemic disease must exert upon the progress of mod-
ern nations, and does it not bring the thought that those nations that
are most advanced in sanitary science and preventive medicine will,
other things being equal, assume the lead in the world's work I Who
can estimate the influence of the sanitary laws of the Hebrew scrip-
tures upon the extraordinary persistence of that race through cen-
turies of European oppression — centuries full of plague years and
of terrible mortality from preventable disease? And what more
striking example can be advanced of the effect of an enlightened
and scientifically careful attention to the most recent advances of
preventive medicine upon the progress of nations than the mortality
statistics of the Japanese armies in the recent Russo-Japanese war as
compared with the corresponding statistics for the British army
during the Boer war immediately preceding, or for the American
Army during the Spanish war at a somewhat earlier date?

The consideration of these elements of national progress has been
neglected by historians, but they are nevertheless of deep-reaching
importance and must attract immediate attention in this age of
advanced civilization. The world has entered the historical age
when national greatness and national decay will be based on physical
rather than moral conditions, and it is vitally incumbent upon na-
tions to use every possible effort and every possible means to check
physical deterioration.

INDEX.

Abattoirs, regulations to avoid bouse Hies 32
Anopheles mosquitoes {see also Mosquitoes, malaria).

disseminators of malaria 7

suppression in Panama 22

Ash pits containing fermenting material, breeding places of bouse By •".!

Bacilli, typhoid, longevity In milk, cream, butter, and cheese '_'"

Bacillus icteroides, nol proven to be causative germ of yellow fever 19

Bacteria from Hies, census 29 •".<»

In milk, soimes 28 30

Bedbug, ;i carrier of disease 7

Bedding, old, In ash pits, breeding place of bouse fly :'.!

Bubonic plague, conveyance by fleas 7

Cafe's, regulation to avoid house Hies

Carcasses of animals, breeding places of house Hy :;•_!

Cholera, Asiatic, carriage by house fly 7,27,34

infantum, carriage by house fly 29

morbus, carriage by house fly :;i

cnh.r fasciatus -Stegomyia calopus 19

Deaths from malaria in United States «.» to

typhoid fever in concentration camps, P. S. Army 24 25

yellow fever in United States 18,3]

Disease, endemic, as affecting progress of nations 36 38

Diseases, intestinal, dissemination by house fly 7

Dysentery, summer, carriage by house fly 27. .".I

tropical, carriage by house fly 27, 81

Endemic disease as affecting progress of nations 8<; 38

Excrement, human, breeding place of house fly .".1

Eye diseases, carriage by house fly 8 1

Fermenting animal and vegetable material, breeding places of house fly__ ."51 :;2

Filariasis. transmission by a mosquito 7

Fleas, conveyors of bubonic plague 7

Flies, luting, carriers of sleeping sickness 7

Fly. house, breeding places 31-82

disseminator of cholera, Asiatic 7,27. 34

infantum 20

morbus 34

dysentery, summer 27,34

tropical 27

eye diseases 81

intestinal diseases 7,27-28

purulent ophthalmia 7

typhoid fever 7

tuberculosis 7, 28, 34

legislation 32-3G

life history 31

relation to typhoid fever 23-27

suppression feasible and all-important 30

manure, name for house fly 23

typhoid, name for house fly 23

Garbage, breeding place of house fly .">2

collection to avoid house flies 32

Hippelates flies, carriers of pink eye 7

Hog hairs, refuse, breeding place of house fly 32

Hops, spent, breeding place of house fly 31

Insects affecting health, publications by Bureau of Entomology 35

Lunch rooms, regulation, to avoid house flies , 33

Malaria, deaths in United States 0-10

dissemination by mosquitoes r,8-n

eradication at Ismailia. Suez Canal 1«*> 17

in Greece 36-38

39

40 LOSS THROUGH INSECTS THAT CARRY DISEASE.

Page.

Malaria, in Italy, loss therefrom 11-12

Mauritius 11

Reunion 11

United States, history 0

loss iii United states . 0-14

Italy 11-12

mosquitoes. ( See Anopheles mosquitoes and .Mosquito, malaria, i

pro vent ion It 17

relation to agriculture and other Industries of the South 13 l l

suppression in Havana it

Panama 21 S',

Selangor, Federated Malay states 15 id

Manure, disposal, to avoid house hies 32 :'.:)

horse, breeding place of house fly .".1

rabbit, in ash pits, breeding place of house fly 31

Markets, regulation, to avoid house flies ■ 33

Milk, sources of bacteria therein 28-30

Mosquito, disseminator of filariasis 7

malaria 7

yellow fever 7

malaria (sec also Anopheles mosquitoes).

suppression measures 15 17

yellow fever, suppression measures 19 23

Mosquitoes, losses in general which they occasion 8

through malaria which they occasion 8 17

yellow fever which they occasion 17 l'l

suppression in Panama l'l J".

Nations, endemic disease as affecting progress ."»•', :;s

Ophthalmia, purulent, carriage by house fly 7

Paper, old. breeding place of house fly 31

Pink eye, carriage by Hippelates flies 7

Plague, bubonic. (See Bubonic plague.)

Poultry-house bedding, breeding place of house fly 32

Progress of nations as affected by endemic disease 36 -38

Rags, old, in ash pits, breeding place of house fly 31

Restaurants, regulation, to avoid house flies 33

Sanitation, rural, necessity for government support 35

Slaughtered cattle paunches, breeding places of house fly 32

Sleeping sickness, carriage by biting flies 7

" Spotted fever," carriage by tick 7

Stable inspection against house flies, probable cost 33-34

Stables, regulation, to avoid house flies 32-33

Stcgomyia calopus (see also Mosquito, yellow fever).

disseminator of yellow fever 7, 10. 20

Stores, regulation, to avoid house flies 33

Straw, old, in ash pits, breeding place of house fly 31

Tallow vats, breeding places of house fly :\-

Tick, carrier of "spotted fever" 7

Tuberculosis, dissemination by house fly 7,28,34

Typhoid fever, a "National Reproach" 36

dissemination by house fly 7. 23 27, 34

in concentration camps, U. S. Army 24 25

loss in United States 30

Vegetable refuse, fermenting, breeding place of house fly 32

Yellow fever, cause, history of investigation L9

deaths in New Orleans 21

United states 18

dissemination by mosquito 7

history in America 17-18

loss in United States IS

mosquito, (tfee Mosquito, yellow fever.)

suppression in Havana and New Orleans 10-21

Panama 21-23

O