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Full text of "Proceedings of the second Pan American scientific congress, Washington, U. S. A., Monday, December 27, 1915 to Saturday, January 8, 1916"

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hi-L\^S. 3.i .1 



l^aibarD ColUge l.iiiran! 



UNITED STATES GOVERNMENT 



TRANSFERRED 



HARVARD COLLEGE 
LIBRARY 



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i 

If 



V 



'A 



Proceedings of 

The Second Pan American 

Scientific Congress 



WASHINGTON, U. S. A. 

Monday, December 27, 1915 
to Saturday, Jannary 8, 1916 



Gtea Lerfai flwIgggH, Aa^h^wt Secratery 



SECTION vm 

(IN TWO PARTS) 

PART 1 

PCBUC HEALTH AND MEDICINE 

WnXUM C. GOBGA8, SOBGBON QSNUUL U. & A^ CHAIBMAN 




VOL. K 



WASHINGTON 
GOTESNBfENT PBINTING OFFICE 

lfl7 



/ 



,' r 






Harvard CDllet«» Library 



Jan. 



I 



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states Uovemment 




CONTENTS. 



Lettns ot te&amittai ▼" 

Reg;i8ter by writen off papers ^™ 

Foreword *^ 

Executiye committee ^ 

Ozganization oflfeers - ^ 

Committees of Section VIII * 

Aims and purposes off the congresB ^ 

Program statement off Section VIII ^ 

Adopted resolutions and recommendations off Section VIII ^ 

Morning ioirion of Pecember 28, 1915 7 

Yellow fever and its eradication, by Gen. William C. Goigas f 

Enfermedades transmitidas por insectoe en Pan AmMca, by Juan Guiteras. . . . 9^ 

Immunity to yellow fever, by H. R. Carter ^ 

Filariasis in the Americas, by Allen J. Smith •.<... 40 

Afternoon auaiion of December 88, 1915 77 

The epidemic off typhus ezanthematicus in the Balkans and in the prison 

camps off Europe, by Bert W. Caldwell 77 

Present views in respect to modes and periods of infection in tuberculosis, by 

liasyck P. Ravenel 86 

The parasitic diseases in the American tropical countries and their effect upon the 

progress off civiHaatum among the Latin-American people, by DAmaso Bivas. 96 

A review off the present yellow-ffever situation, by Arlstides Agramonte 100 

Liceaga and yellow ffever, by Maj. T. C. Lyster 106 

Otflos Finlay on the house mosquitoes of Habana, by Frederick Enab 107 

Gonsidtetions sur la fiftvre dite "fi^vre de fruits,'' by G. Mathon and L.Audain. 110 
La piofilaxia de la fiebre tifoidea por medio de la vacunaci6n, by Justo F. 

Goozfles 115 

Labuba (Leishmanions americana), by Luis £. Migone 117 

Kota sobre a extinct completa da febre amarella no Estado de S. Paulo 

(Braol), by Emilio Ribas 125 

La fl^vre typhdfde en Bolivie, by NMor Morales Villaadn 125 

IffnmlTig ■o—ion of Deeember 29, 1915 146 

Hie alcohol and drug habit and its pcoi^ylaxifl, by Harvey W. Wiley 145 

Ob fumadoras de maconha; effeitos e males do vido, by JO06 Bodriguea da 

CoitaDoria 151 

Lacha contra el alcoholisme, by Bicaido Sanniento Laspiur 162: 

El problema del alccAoUsmo y su posible soluci<Sn, by Luis L6pea de Mesa. . • • 166 

An inquiry into the causes of crime, by R. B. von KleinSmid 181 

Pauperism: An analysis, by Edwaxd T. Devine 187 

Aftomoon ae— ion of Dee^mber 99, 1915 106- 

Mechanical appliances in the treatment off pyonhea alvedarla, by Felipe 

Gallegos 1W« 

Beb4— Higiene del embaiaso y de la primera infancia, by AtiUo Naiaado 196 > 

Pnericultuia, by P. Rueda 285* 

La novocalna g^oero-yodada, by Juan D. Susini 286- 



IT CONTENTS. 

w ,■ *■»«* 

Log diflpeiiBwuw pan lacbuites (gous de 1ech«), coeao medio pan disninuir la 

mortsJidad infantil, by Julio A. Bauzi 242 

"O «To eaencift] de pente u lei bncilein do cMunento civil, by Jca£ Rodrigues 

d* Coot* Doris 247 

Mitodoa modeniM p«n la prevencite de la mratalidad inlantil. by Artoro L. 

Guerr» 254 

Prophylaxis do oldudiMao na America, by Vital Brasil 258 

Nota aobie tntamiento de laiofecciAn puerp«r^ pw Io« bafioB tibioe prolongadoa, 

by Ariatide* Fialio Cahral 281 

Acdan re^tintoria del depreeaor coidi«. by Teodoro Uubm 262 

Lepra y aaloaaiigrotaiapia — Necewdad d« una liga panamericaiut antilepnwa, 

by Luia Zanotti CavaEEoui 271 

Joint mat omrf Bttbwectton C of B»otionViIl and the American Aaaocia- 

tion for Labor Leglal»tlon 27« 

CSuld laboi aod public health, by Owen R. Lovejoy 276 

Legal protection of female wage earners, by John B. Andrewi 280 

El tntbajo de la mujer embanzada, by Augusta Turenne 2S3 

Factory sanitation, by E. R. Hayhurst 288 

Koraliif aeadon of Dacamber 80, 1910 2M 

The etiology and fneventicHt of tuberculoaia (rom the aociologiciU points of view, 

by William CaiarlflB While 300 

Tratamiento de la tuberculoeia por el pneumo-tiiraz. artificial, by Joaquim de 

OUveira Botelho 306 

Hoosing of wage eamen, by I*wrence VeiUer 314 

Ia influencia de la habitaci6n en la lucha contra la tubeiculosia, by Juan 

Honteverde 322 

La inspecd^n m^dica en Us eacuelas pliblicas de Centro America— Neceridad y 

pooibilidad de estableceria en vista de las condiciones existentee en Costa 

Rica, by Louis Schapiro - 330 

Jednt ■iiaaliiii of Subaeetioii B of Bootlon THZ and thm Amariean Sta- 

tlstleal AMoeUttoD 335 

The nature and significance of the changes in the birth and death rates in recent 

yean, by Walter P. Willcox 336 

The potenttal influence of vital statistice on the conservation of human Ule, by 

W.S.Rankin 344 

nie relation of aickneas reporta to health administiatioii, by John W. Ttask. . . 347 
Informes refoentes a la moiboeidad infecto-contagiDsa— Dispoeicianes y pro- 

cedimientofl adoptados por la adniinistnddn sanitaria paia bd obtendtin, by 

Julio Etchepare 362 

Vital statistice in relation tn life inmrance, by Louis I. Dublin 366 

Infant mortality statistics, by Lewis Uaiam 365 

Ooopwation by the Bureau ot the Census with State aufltoritiea in securing the 

enactment of adequate lam for the regtstratton of births and deaths, by 

Ri<jurd C. Lappin 374 

Joint ■iiasinn of Snbaoetlat D of Seettoa vm and Ou Amvilean Oivle 

377 

planning, by P. L. Olmsted 377 

lof dty planning, by J. Horace UcFariand 3S5 

d BubdiviBion upon houeitig and public health, by John Nolen . 3S7 

>yj. N. Hurty 398 

kf Sabaeetfrn B of Section vui and tbe American Sta- 

Biation 400 

istration service of the United Stales; its development, prob- 

!ctB, by Ckeasy L. Wilbuf 400 



CONTENTS. V 

Page. 
The incidence of the different causee of mortality in Providence during 55 yean, 

1856 to 1910, by Charlee V. Chapin 403 

Vital statistics in cities, by \Villiain H. Guilloy 411 

DesarroUo dc la estadistica demogr&fica en la Isla de Cuba, by Jorge Le<Roy y 

Cassd t 415 

Cinco afioe de demograffa uruguaya, by Joaqufn de Salterain 456 

The accuracy and completeness of compiled vital statistics in the United 

States, by John S. Pulton 464 

Afternoon seflsion of December dOy 1916 477 

Prophylaxis of venereal diseases, by Edward L. Keyes, jr 477 

Edacaci6n sexual de los j^venes como medio profilictico de las enfermedades 

ven^reas, by Alfredo Ptoico 483 

Public health measures in relation to venereal diseases, by William F. Snow. . 486 
International agreements in relation to the suppression of vice, by James 

Bronson Reynolds , 490 

Proyecto de la ordenanza reglamentaria de la prostituci6n, by Silvestre Oliva. . 518 
Joint aeasion of Subsection O of Section Vm and the American Socio« 

logical AsBociatlon 526 

Ways and means of bringing matters of public health to social usefulness, by 

^niliam C. Woodward 526 

What can unofficial e£Fort do for public health? by Irving Fisher 529 

What can unofficial efifort do for public health? by Hoyt E. Dearholt 533 

La medicina social y los problemas del trabajo en la Repdblica Aigentina, by 

Enrique Feinmann 540 

La influencia de la ankylostomiasis sobre la prosperidad de la agricultura y 

sobre la mortalidad infenttl, by Louis Schapiro and Mauro Femilndez 587 

Afternoon Beaeion of December 81, 1015 590 

Medical preparedness for campaign, by Edward L. Munson 590 

A contributiom to the study of artificial illumination, by James D. Gatewood. 599 

Thesanitation of the Panama Canal, by D. F. Reeder 610 

El pabeI16n modelo de clfnica m^dica del Hospital Rawson, by Tomis S. Varela 612 

Climate and h3rgi^ne of Rio de Janeiro, by Joaquim de Oliveira Botelho 613 

Buildings for human occupancy, by Robert W. de Forest 615 

The means by which infectious diseases are transmitted and their extermina- 
tion, by Alvah H . Doty 623 

Joint seirion of Subsection C of Section viix and the American Paycho- 

logical Aaaodation 628 

The defective child and the prevention of feeble-mindedness, by Henry H. 

Goddaid 628 

The training of defectives, by E. R. Johnstone 631 

Youthful offenders — ^A comparative study of two groups each of 1,000 young 

recidivists, by William Healy and Augusta F. Bronner 636 

Mental hygiene — ^The etiology and prevention of insanity from the sociological 

point of view, by William A. White 645 

Educaci6n de los nifios nerviosos, by Bernardo Etchepare 651 

R^^imen de convalecencia en los alienadoe, by Santin Oarlos Rossi 667 

La equivalencia mental entre el hombre y la mujer, mirada del punto de viata 

psicoldgioo, by A. Motaga Ponas 674 

^£1 ejercicio muscular de la respiraci6n, sistema sueco, es fisiol6gico? by A. 

MaragaPoma 688 

Autofraatas mentales, by Fernando Gorriti 696 

Higiene mental en sus relaciones con el desanollo y conservacidn de la energfa 

psfquica y de la fiitiga producida por la ensefianaa escolar, by A. Moraga 

Potias 698 



Letters of TfaasmittaL 



Washinoton, D. C, Maif SI, 1917, 

Sot: PuzBuant to the recommendation ol tlie executive committee of the Second 
Fan American Scientific OongresB, which was held in Washington December 27, 1915- 
January 8, 1916, and by the cooperation ol the United States Gongren (ingent defi- 
ciency bill, Sept. 8, 1916), the papen and disciUBdons of that great international 
flcientific gathering have been compiled and edited for publication under the able 
direction of the Aaaistant Secretary General, Dr. Glen Levin Swiggett. In this 
volume IB contained the report of Section VIII, of which Geneial W. C. Gorgas, of 
the executive committee, was chairman. 

In my fcmnal report, iriiich has already been submitted, I enlaiged upon the 
importance of the Second Pan American Scientific Ooogress, its laige attendance, and 
the high quality of its papers and discussions. I will, therelore, in this letter, which^ 
in slightly varied form, inlioduces each volume, make only a few general r efe rences. 

All of the 21 Republics of the Western Hemisphere were represented by official 
delegates at the Ck>ngress. Unofficial delegates, moreover, from the leading scientific 
associations and educational instituti<ms of these Republics presented papen and 
took part in its deliberations. The papen and discussions may be considered, there- 
fore, as an expression of comprehensive Fan American scientific effort and possess, 
in consequence, inestimable value. 

The Congress was divided into nine main sections, which, with their chairmen, 
were as follows: 

I. Anthbofoloot. W. H. Hohnes. 

II. ASTBONOMT, MbTXOROLOOT, AND SsiBMOLOQT. RobOTt S. Woodwud. 

III. OoNSSBVAtioN or Natural Rbsouroeb, Agriculture, Irrigation, and Forestiy. 

George M. Rommel. 

IV. Education. P. P. Glaxton. 
V. Enoinbbbino. W. H. Bixby. 

VI. ImtbbnationalLaw, PublioLaw,andJubI8pbu]>bmob. James Brown Scott. 
VII. MiNiNo, Mbtallubot, Eoonomio Gboloot, AMD Aftubd GHBMisnntT. Hen- 

nen Jennings. 
YIII. PuBUo Hbamh and Mbdioai. Soibnob. William 0. Gorgas. 

IX. Tbanspobtation, Oommbbob, Finanob, and Taxation. L. S. Rowe. 

These sections, in turn, were further subdivided into 46 subsections. 

Gver 200 delegates were in attendance from the Latin American Republics, while 
over a thousand from the United States participated in its meetings. The discussions 
and proceedings of the Congress attracted world-wide attention, and it was undoubt- 
^ly the greatest international scientific meeting that has assembled anywhere in the 
history of the Western Hemisphere and possibly of the world. It was, therefore, a 
fitting successor to the first Pan American Scientific Congress, which assembled in 
Santiago, the capital of Chile, in 1908, and to its predecessors, confined to Latin 
American representation, which in former years met, respectively, in Rio de Janeire« 
Montevideo, and Buenos Aires. Its success was a logical result of these preceding 
gatherings in Latin America and of the hearty cooperation of the Latin American 
Governments and scientists. 

To those who may have their attention brought only to the individual volumes 
•oovering the paeptn and discussions and who wish to know more of the proceedingfi of 
ihe Congress and the results accomplished by it, it is recommended that th^y should 

vn 



Vin LETTEBS OF TBANSMITTAL. 

also read ''The Final Act— An Interpretative Commentary Thereon/' prepared under 
the direction of Dr. James Brown Scott, reporter general of the Congress, and the report 
of the secretary general, prepared by the latter and the assistant secretary general, 
Dr. Glen Levin Swiggett. In these will be found not only the final act and the 
illuminating comment thereon but lists of delegates, participating Governments, 
societies, educational institutions, and other oiganizationB, together with a careful 
story and history oi the CongresB. They can be obtained by addressing the Director 
General of the Pan American Union, Washington, D. C. 

In conclusion, I want to briefly repeat, as secretary general of the Congress, my 
appreciation, already expressed in my formal report, of the hearty cooperation in 
making the Congress a success given by everyone concerned from the President of 
the United States, yourself as Secretary of State, and the delegates of Latin America 
and the United States, down to the office employees. The great interest manifested 
by the permanent executive committee, headed by Mr. William Phillips, then Third 
Assistant Secretary of State, the Carnegie Endowment for Intematioiial Peace through 
its secretary, Dr. James Brown Scott, and the executive aid of Dr. Glen Levin Swig- 
gett, as assistant secretary general, were vitally instrumental in making the gathering 
memorable. The Pan American Union, the official international organization of all 
the American Republics, and whose governing board is made up of the Latin American 
diplomats in Washington and the Secretary of State of the United States, lent the 
favorable influence of that powerful organization to the success of the Congress and 
authorized me as the director general of the Union to also take up the duties of secretary 
general of the Congress. 

Yours, very truly, 

(Signed) John Barrett, 



The Honorable The Secrbtary of State, 

Washington, D. C. 



Secretary General. 



Washington, D. C, 31 de maio de 1917. 

ExMO. Snb.: Em cumprimento de uma recommendagfio emanada da Commiatfo 
Executiva do Segundo Congreeso Scientifico Pan Americano, que teve lugar em 
Washington, de 27 de dezembro de 1915 a 8 de Janeiro de 1916, e, devido ao auxilio do 
GongresBO dos Estados Unidos (Lei para Qr^amentos extraordinarios de 8 de setembro, 
1916) as memoriae e as discussdes desaa assemblda scientifica intemadonal, foram 
colligidas e preparadas para publica^So sob a proficiente direc^io do Secretario Geral 
Adjuncto, Dr. Glen Levin Swiggett. Este volume comprehende o relatorio da secySo 
VIII que foi presidida peio General W. C. Gorgas, da Conmussfto Executiva. 

No meu reUtorio official, que j4 tive a honra de apresentar, me detive sobre a impor- 
tanda do Segundo CottgreeBO Scientifico Pan Americano, da sua grande concoirencia 
e da alta importancia das theses e das discussdes. Na presente nota, portanto, de uma 
maneira muito ligeira, deetinada a apresentar cada um doe volumes, eu fiaiei apenas 
algumas referencias muito geraes. 

Todas as Republicas do Hemispherio Occidental, vinte e uma em numero, se 
achavam representadas por delegadoe officiaes ao Congresso. Del^ados sem nomea- 
$So dos Govemos, mas repreeentando as mais notaveis sociedades scientificas e 
institiii^GeB de ensino dessas republicas apresentaiam theses e tomaram parte nas 
delibera^Oes. As mem(»rias e discussdes devem ser conaLderadas portanto, como a 
expresBfio de um justificavel trabalho scientifico Pan Americaiio e poesue, por esse 
motive, um valor sem egual. 

O Congresso foi dividido em nove sec^Oes principaeB> que a seguir enum^ro, com 
08 nomes dos sens presidentes: 

I. Anthbopologia. W. H. Holmes. 
II. Astbonomia, Mbtbreoloqia b Sismolooia. Robert S. Woodward. 



IJSTTEB8 OF TBAKBlilTTAL. IX 

ill. CONSBBVApXO DA RlQUXZA NaCIONAL, AoBICULTUBA, iRBIOApIO B SiLVI- 

cui;tuba. Ctoorge M. Rommel. 
IV. iNSTBUOpIO. P. P. Claxtoii. 
V. Enobnhabia. W. H. Bixby. 
VI. DiBBiTo Intebnacional, DmsiTO PuBUCO B JuRisPRUDBNGiA. JameB 

Brown Scott. 
Vll. M1NA8, Metallukoia, Gbolooia Practica b Cbivica Industrial. Hennen 

Jennings. 
VIII. Saudb Publica b Scibncias Mbdicas. William C. Goigas. 

IX. VIA8 DB COMlTDNICApIO, GoifMBRaO, FiNANpAS B ImPOSTOB. L. S. Rowe. 

Estas secedes, i>or sea lado, eram sabdivididas em 45 subsec^des. 

Mais de 200 del^ados das Republicas da America Latina frequentaram as sessdes 
emquanto os Estados Unidos se achavam representadoe por mais de mil peesoas. As 
discussOes e oe relatorioe do Congresso atdahiram a atten^So de todo mundo e foi 
sem duvida a maior assemblea scientifica que se realisou no Hemispherio Occidental 
e talvez em todo o mundo. Foi sem duvida um idoneo continuador do Primeiro Con- 
gresso Scientifico Pan- Americano, que se celebrou em Santiago, capital da Republica 
Ghilena em 1908 e das anteriores aasembleas que previamente se tinham realizado, 
apenas com del^ados da America Latina e que se reuniram em annoe anteriores no 
Rio de Janeiro, Montevideu e Buenos Aires. seu successo foi um resultado logico 
das reuniSes previas na America Latina e do cordial concurso dos Qovemos da America 
latina e dos sens homens de sciencia. 

A aquelles que nSo quizerem limitar-se a consultar os volumes que cont^m as 
memorias e as diacussdes e que desejarem conhecer alguma cousa mais dos trabalhos 
do Congresso e dos resultados por eUe alcan^o se Uies recommenda a leitura da 
Acta Final— a ezposigSo geral concemente i mesma— publicada sob a direcyfio do 
Sr. Dr. James Brown Scott, Relator Geral do Congresso, e o relatorio do Secretario 
Geral, preparado pelo abaixo assignado e pelo Secretario Geral Adjuncto Sr. Dr. 
Glen Levin Swiggett. Nestes trabalhos encontrar-se-hSo nfto sdmente a acta final 
mas tambem um magnifico commentario, a llsta dos delegados dos Govemos que 
adheriiam, sodedadee, institui^Ces de ensino e outras corpom^Oes, seguidas de uma 
cuidadosa historia do Congresso. Estes volumes continuam & disposipSo dos que os 
pedirem ao Director Geral da Unifio Pan-Americana, Washington, D. 0. 

Em conclusfio, eu desejo repetir, em duas palavraB, como Secretario Geral do Con* 
gresBo, o meu apre^o e reconhedmento, que ]& tive occasifio de ezprimlr no men 
relatorio official, pela cordial coopera^fio que por todos me foi prestada paim levar 
a bom exito este congresso, desde Presidente dos Estados Unidos, V. Eza., coma 
Secretario d'Estado, os Senhores Delegados da America Latina e dos Estados Unidos 
at6 OS diversos funccionarios do Congresso. O grande interesse manifestado pela 
Conmiiss9o Permanente Executiva jvesidida pelo Sr. William Phillips, ao tempo 
terceiro Sub-secretario d'Estado, pelo Institute de Cftmegie paia a Pfeiz Intemacional 
na pessoa do Sr. Dr. James Brown Scott, assim como a collabora^ prestada pela Sr. Dr. 
Glen Levin Swiggett, como Secretario Geral Adjuncto, constituiram obras basilares 
para successo desta reunifio. 

A Uni£o Pan- Americana, institul^fio intemacional sustentada por todas as Repu- 
blicas Americanas e cujo Conselho de Administra^ 6 constituido pelos represen- 
tantes diplomaticos em Washington e pelo Secretario d'Estado dos Estados Unidos, 
contribuiu com a sua poderoaa influencia para o bom exito do Congresso e me aucto- 
rizou a sendr de Secretario Geral do Congreno. 

Com a maior considera^, subscrevo-me 

De V. Exa., 

Vor. Mto. Atto., 

John Barrbtt, 

Seeretario C^eral. 
Exmo. Snr. Sbcrbtabio db Ebtado, 

WatMngUm, D. C. 



X LETTEBS OF TKANSMITTAL. 

Washington, D. C, 31 deinayode 19X7. 
Sen'or: 

En cumplimiento de una recomendaci6n emanada de la Comisi6n Ejecutiva del 
Segundo Gongreso Cientifico Panamericano que se reuni6 en Waahington deede el 
27 de diciembre de 1915 hasta el 8 de enero de 1916 y gracias a la cooperaci6n al efecto 
preetada por el Gongreeo de loe Estados Unidos mediante su ley sobre rectificacidn del 
presupuesto dictada el 8 de setiembre de 1916, h&nae recopilado y preparado para 
8U publicaci6n, bajo la h&bil direcci6n del Sr. Dr. Glen Levin Swiggett, Subsecretario 
General, las memorias preeentadas a dicho Gongreeo y los debates a que dieron lugar. 
El presente volumen contiene el informe relative a la Secci6n YllI, de la cual fu^ 
preaidente el General W. G. Gorgaa, miembro de la Gomisidn Ejecutiva. 

En el informe general que ya tuve el honor de presentarle, me hi6 dable conaiderar 
•detenidamemte la importancia del Segundo Gongreao Gientffico Panamericano, la 
numerosa concurrencia que al mismo a8i8ti6 y el elevado m^rito de las memorias 
preeentadas y de los debates que en aquel se suscitaron. Por consiguiente, he de 
limitanne en la presente, destinada a servirle de mera introduccidn a cada uno de los 
voldmenes, a algunas considoradones de caricter general. 

En el Gongreeo eetuvieron repreeentadas por medio de delegaciones oficiales las 
veinte y una repdblicas del Hemisferio Occidental. Tambi^n asistieron al mismo, 
tomando participaci6n en bus debates y presentando trabajoe pereonalee, delegadoe 
particularee de loe prindpalee cuerpoe dentificoe y de los institutes docentee de eeas 
mismas rep6blicae. En tal virtud, las memorias y los debates mendonados deben ser 
considerados como la expresidn de un amplio esfuerzo dentffico panamericano, 
-encerrando, por lo tanto, un valor ineetimable. 

El Gongreeo estuvo dividido en nueve secdones piindpales que en seguida peso a 
^numerar junto con el nombre de sus presidentee. Fueron las siguientes: 

I. ANTROFOLOoiA. W. H. Holmes. 

II. AaTRONOidA, MsTBOBOLOOtA T SisMOGRAFfA. Robert S. Woodward. 

III. G0NSBBVAa6N DS LAB FUBNTBS NaTUBALBS DB RiQUBZA, AgBIOUITU&A, 

iBBiGACiiK T Sblyicultuba. GoQige M. Bonunel. 

IV. In8tbuogi6n. p. p. Glaxton. 

y. iNOBNiBBiA. W. H. Bixby. 

VT. Dbbbcho Intbbnagional, Dbbbgho PtrBUoo t Jubispbudbncia. James 
Brown Scott. 

VII. MjkbbIa, Mbtaluboia, GBOLoafA £oon6mica t QuImiga Apucada. Hen- 
nen Jennings. 

VIII. Salubbidad PteuoA T GiBNOiA MAdica. William G. Goigas. 

IX. Tbabpobtb, Gombbcio, Finanzas b Imfvbstos. L. S. Rowe. 

Estas secdones estuvieron dividas, a su vez, en cuarenta y dnco subsecdonee. 

De las repdblicas latino-americanas asistieron m^ de dosdentoe del^ados; en 
4anto que las seeionee del Gongreso concurrieron mis de mil personas de los E^stados 
Unidos. Los tiabajos y debates del cuerpo despertaron universal inters, pues indu- 
dablemente hi6 aquel la asamblea dentffica mis grande que registra la historia del 
Hemisferio Occidental y probablemente la del mundo. £l fu6, en consecuenda, digno 
continuador del Primer Gongreso GientilLco Panamericano que en 1910 se reuni6 en 
la capital de Ghile y de los que previamente y con una asistencia exclusivamente 
latino-americana se habfan congregado en Rio de Janeiro, Montevideo y Buenos 
Aires. Su ^to fu6 consecuencia Idgica de las asambleas que anteriormente se habfan 
ceunido en la America latina y del cordial concureo que redbi6 de los gobiemos y 
de loe hombres de dencia de esa misma parte de Am^ca. 

A cuantos no quisieren limitazse a consultar los voldmenes que contienen las 
memorias y los debates y deeearen conocer algo m^ de las labores del Gongreso y de 
los resultados por 61 alcanzados, se les recomienda la lectura del Acta Final y de la 
Exposiddn General concemiente a la misma que escribio el Dr. James Bron^'n Scott, 
Informante General del Gongreso, asf como el Informe del Secretario General, prepa- 



LBTTBB8 OF TBAKSHITTAL. ZI 

rado pcMT el susczito y por el Dr. Qlen Levin Swiggett, Subsecreterio General del 
miBmo. En eetoe documentoe podr&n hallar no 86I0 el Acta Final y laminoeu consi- 
deraciones acerca de la misma, sino tambi^n la n6mina de los delegadoe y de IO0 
gobiernoB, sociedadee e inatitiitoe docentes que tuvieion representaci6n en la Asaniblea, 
juntamente con una relacidn puntualizada de las labores de la misma. Lob que deseen 
obtaner estoe voldmenee pueden sollcitarloe del Director General de la Unidn Pan- 
americana en Wellington, D. 0. 

Como Seoretario General del Gongreso deeeo hacer conatar una ves mia, antes de 
concluir, el agradeciniiento que en mi infunne general express por el cordial concurao 
que de todos recibf para asegurar el 6zito del Gongreso, desde el Presidente de los 
Estados Unidoe y uated miamo como Secretario de Estado y desde los delegados de 
la AmMca Latina y de los Estados Unidos hasta los diversos funcionarios del Oongreso. 
El gran inter^ desplegado por la Gomifli6n Pennanente Ejecutiva, que pre8idi6 el 
Sr. William Phillips, a la sasdn Tercer Subaocretaiio de Estado; por la Fundaci6n 
Carnegie para la Paz Intomacional, por el (k^gano de su Secretario, Dr. James Brown 
Scott; asf como la colabozaci6n del Dr. Glen Levin Swiggett, Subsecretarlo General, 
contribuyeron poderosamente a hacer memorable la aaamblea. Ia Vm6n Pan- 
americana, inatituci6n intemacional sostenida por todas las repdblicas de AmMca y 
cuyo Oonsejo Directive estd fonnado por los representantes diplomdticos latino- 
americanoe residentes en Wishington y por el Secretario de Estado de los Estados 
Unidos, contribuyd con su poderoaa influenda al ^zito del Oongreso y me autoriz6 
para que desempefiara las funciones de Secretario General de aqu61. 

Con sentimientos de la m^s alta consideraci6n me subscribe 

De usted muy atento servidor, 

John Ba.rrictt, 

Secretario General. 
Al Honorable SBcnsTARio de Estado, 

WdskingUm, D. C. 



Washington, D. C, Le St mat 1917, 

Monsibub: Conlorm^ment k la recommandation du Comity Ex^cutif du Second 
Congrte Sdentifique Panamdricain qui a eu lieu k Washington du 27 d^cembre 1915 
au 8 Janvier 1916, et par la cooptetion du Congrte des Etats-Unis (loi du budget 
extraordinaire, 8 septembre 1916), les m^molres et discussions de cette grande reunion 
sdentifique intemationale ont 6t6 recueilUs et ^it^ pour 6tre publi^i sous Thabile 
direction du docteur Glen Levin Swiggett sous-secretaire g^ndral. Ce volume contient 
le rapport de la section VIII, dont M. le g^n^ral W. C. Gorgaa du Comity Ex^utif 
etait president. 

Dans mon rapport officlel qui a 6t6 d^jli soumis, je me suis ^tendu sur Timportance 
du Second Congr^ Sdentifique Panam^ricain, sur le grand nombre de personnes qui 
y ^talent pr^ntes et sur rexcellence de ses m^moires et de ses discuasionB. C'est 
pourquoi, dans cette lettre qui, apr^ avoir subi quelques changementasanB, impor- 
tance, sert d 'introduction k chaque volume, je n'en parlend que d'une mani6re 
gfo^rale. 

Toutes les r^publiques de rH^misph^re Occidental au nombre de vingt-et-une 
4taient repr^nt^es au Congr^. De pluB, des d^l^gu^ k titre officieux envoy^ 
par les aBSOciationB scientifiqueB et les institutions ^ucatives les plus en vue de ces 
r^publiques ont soumis des m^moires et ont pris part aux d^lib^rationB. On pent 
done consid^rer les m^moiree et les diBcussionB comme 1* expression d'un grand effort 
sdentifique panam^ricain, posB^ant en consequence une valour ineetimable. 

Le Congr^ etait divifl^ en neuf sections prindpales que nous enum^ronB ci-deeaous, 
en donnant le nom de leuiB pr^sidentB. 

I. Antbopoloqie. W. H. Holmes. 

II. AsTRONOMiB, M^tAobolooie bt Sismologie. Robert S. Woodward. 



XII . LETTEB6 OF TRANSMITTAL. 

III. GONSBRYATION DE8 BbSBOUBCBS NaTURBLLBS, AOBIOULTUBB, iBRIOAnOK 

BT FoBtTB. George M. Rommel. 

IV. iNSTRuonoN PuBUQUB. P. P. Claxton. 

V. GiNiB Civil. W. H. Bixby. 

VI. DBOir Intfrnatiokal, Droit Public bt JukisPRUDBNCB. Jamed Brown 
Scott. 

yjl. MiNKfl, M^ALLUROIE, GAOLOGIR PRATIQUB, ET ChIMIE AfPLIQUAB. 

Hennen JeiiningB. 
VIII. Santb Pubuqub et Scibncb Medicals. William G. Gotgas. 

IX. TRAN8POPT, COMMERCB, FiNAKCB BT iMPdT. L. 8. Rowe. 

A lour tour ccs sections ^taient subdivis^es en quarante cinq souft-sections. 

On y comptait plus de deux cents d^l^gu^s de^ r^publiques latino-am^ricaines, et 
plus de mille d^l6gu^ des Etats-Unis ont assists aux r6unioiiB. Les discussions et 
les pioc^B-verbaux du Congrds ont attir6 Inattention du monde entier, et il a 6t6 sana 
le moindre doute la plus grande assemble sdeniiiique interne tionale de I'histoire 
de 'Hemisphere Occidental et peut-^tre mdme du monde entier, qui se soit r^unie jus- 
qu'ici. Venant aprds lo Premier Oongr^s Scicntifique PanamMcain qui s'est r€uni k 
Santiago, capitale du Chili, en 1908, et apr^ ceux qni ont eu lieu pr^^emment, respec- 
tivement k Bio de Janeiro, k Montevideo et k Buenos- Ayres, ces demiejB n'ayant que 
des repr^sentants de 1' Am^rique Latine, il s'est montr^ leur digne successeur. Sa r6u8- 
site a 6t4t un logique r^sultat de ces pr^^dents conoura dans TAm^rique Latine et de 
la sinc^ et cordial e coop^tion des gouvemements et des hommes de science de 
l'Am6r]que latine. 

Pour ceux qui u'ont port^ leur attention que sur les volumes renfermant les m^moirea 
et les dlscustdons, et qui d^sireraient connattrs d*une mani^ plas approfondie les 
actes et proc^verbaux du Congr^, ainsi que les r^sultats qui s'en sont suivis, je leur 
conseiUerai de lire ''L'acte Final, Commentaire explicatif,'' r6dig6 sous la direction 
du docteur James Brown Scott, rapporteur g6n6ral du Congr^, et le rapport du Secre- 
taire Cr^ndral r^ig^ par ce dernier et le docteur Glen Levin Swijiigett. En les lisant 
on n*y tiouvera pas seidement TActe Final et le commentaire explicatif, mais encore 
lee listes des d^l^gu^, d&> gouvcmements qui ont particip6 au Oongr^, de^ snci^t^ 
des iastitutions ^ducatives et autres, en m^me temps qu'un compte rendu soign^ 
ainsi que I'histoire du Congr^. On peut se les procurer en faisant uno demande par 
toit au Directeur G^n^ral de rUnion Panam^ricaine k Washington, D C. 

En terminant, je vais en quality de Secretaire Greneral du Congr^ exprimer de 
nouveau en peu de mots mes remerctments, ce que j'ai d^jk fait dans mon rapport 
offidel pour la part que chacun a eue dans la r^ussite du Congr^ depuis le President 
des ^tata-Unis, vous comme Secretaire d'etat, les dei^gu^s de TAm^rique Latine et 
ceux des ^tats-Unis jusqu'aux employes de bureau. Le haut int^rfit manifesto par 
le Comite Executifpermanent preside par M. William Phillips, qui etait alors troiaieme 
Sous-Secretaire d'Etat, par la Fondation Carnegie pour la Paix Internationale, par 
Ventremise de son secretaire le docteur James Brown Scott, et I'aide pr^te dans I'exe- 
cution par le docteur Glen Levin Swiggett, comme sous-secretaire general, ont puissam- 
ment contribue k faire de ce Congr^ un evenement memorable. L' Union Panameri- 
cable, administration officielle intemationale de toutes les republiques americaines, 
et dont le Comite d' Administration est compose des diplomates latino-americains k 
Washington et du Secretaire d'£tat des £tats-Unis, a use de sa favorable influence pour 
assurer le succ^s du Congr^s et m'a autorise, en qualite de Directeur General de 
r Union, k prendre en mains les responsabilites de Secretaire General du Congr^. 

Veuillez agreer, M. le Secretaire d'etat, en m^me temps que mes respectueux 

hommages Passurance de mon entier devoClment, 

John Barrett, 

Secritmre GfrUral. 
Monsieur le Secretaire d'Etat, 

WashinfftoTty 7). C 



REGISTER OF WRITERS OF PAPERS. 



Agramonte, Ariistidee 100 

Andrews, John B 280 

Audain, L HO 

Bauzi, Julio A 242 

Brazil, Vital 268 

Bronner, Augusta F 636 

Caldwell, Bert W •. 77 

Carter, H.R 41 

Chapin, Charles V 403 

Dearhol t, Hoyt E 633 

Devine, Edwaiti T 187 

Doty, AlvahH 623 

Dublin, Louis 1 356 

Etchepare, Bernardo 651 

Etchepare, Julio 352 

Feinmann, Enrique 640 

FemioideK, Mauro 687 

Fiallo Cabral, Arfatides 261 

Fisher, Irving 629 

Forest, RobertW.de 616 

Fulton, John S 464 

Gall^gos, Felipe 196 

Gatewood, James D 699 

Goddard, Henry H 628 

Gonzilez, Justo F 115 

Goigas, Gen. William C 7 

Gorriti, Fernando 696 

Guerra, Arturo L 264 

Guilfoy, William H 411 

Guiteras, Juan 9 

Hayhurst, E. R 288 

Healy, ^iniliam 636 

Hurty, J. N 393 

Johnstone, E. R 631 

Keyee, Edward L., ]r 477 

EleinSmid, R.B.von 181 

Enab, Frederick 107 

Lappin, Richard 374 

Le-Roy y Cassd, Jorge 416 

L6pez de Mesa, Luis 166 

Lovqoy, Owen R 276 

Lyster, Major T. C 106 

Mathon, C 110 

McFarland, J. Horace 386 

zm 



XIV BEGISTBR OF WBITERS OF PAPEBS. 

Page. 

Meiiam, Lewis 365 

Migone, Luis E 117 

Monteverde, Juan 322 

Moraga, Porras, A 874, 688, 698 

Morales Villaz6n, N^tor 126 

Muhm, Teodoro 262 

MuuBon, Edward L 590 

Narancio, Atilio 196 

Nolen, John 387 

Oliva, Silvestre 518 

Oliveira Betelho, Joaquim de 305, 613 

Olmsted, P. L 377 

P^rsico, Alfredo 483 

Rankin, W.S ^ 344 

Ravenel, Mazyck P 85 

Reeder, D. F 610 

Reynolds, James Bronson 496 

Ribas, Emilio 123 

Rivas, D^onaso 95 

Rodrlgues da Costa Doria, Joe6 151, 247 

Rossi, Santin Carlos 667 

Rueda, P 233 

Salterain, Joaquin de 456 

Sarmiento Laspiur, Ricardo 162 

Schapiro, Louis 330,587 

Smith,AUenJ 49 

Snow, William F 486 

Susini, JuanD 236 

Tra8k,JohnW 347 

Turenne, Augusto 283 

Varela, TomAs S 612 

Veiller, Lawrence 314 

White, William A 645 

White, William Charles 300 

Wilbur, Creasy L 400 

Wilcox, Walter F 836 

Wiley, Harvey W 146 

Woodward, William C 526 

Zanotti Cavazzoni, Luis 274 



FOREWORD. 



The work of the hygienic section has been most valuable. It has 
already produced excellent results in causing the BockefeUer Foun* 
dation to undertake the work of exterminating yellow fever. All 
the South American countries affected by this disease have agreed 
to cooperate, and if it had not been for the European war the work 
would have now been well under way. 

(Signed) W. C. Goboas, 

Chaimum. 



XV 



SECOND PAN AMERICAN SCIENTinC CONGRESS. 



EXECUTITB COMMITTBB. 

WiLUAX Phillipb, ABHJBtant Secretaiy of State, Cludmum ex officio. 

James Brown Soott, Secretary, Cam^e Endowment for International Peace, Vice 

Ghainnan. 
William H. Wklch, President, National Academy of Sciences, Honorary Vice 

Chairman. 
John Barrbtt, Director General, Pan American Union. 
W. H. BiZBT, Brigadier General, TT. S. A., retired. 
Philander P. Glaxton, Commissioner of Education. 
WiLLLAM C. GoRGAs, Siugeon Crenend, U. S. A. 
WnjJAM H. Holmes, Head Curator, Smithsonian Institution. 
Hbnnen Jennings, former President, London Institution Milling and Metalluigy. 
George M. Rommel, Chief, Animal Husbandry Division, Bureau of Animal Industry, 

Department of Agriculture. 
L. S. Rows, President, American Academy of Political and Social Science. 
Robert S. Woodward, President, Carnegie Institution of Washington. 



ORGANIZATION OmCBBfl. 



John Barrett, Secretary General. 

Glen Leyin Swiggbtt, Assistant Secretary General. 

e84S»— 17— vol IX 2 



SECTION Vm.— PUBLIC HEALTH AND MEDICAL SCIENCE. 

WiLLiAH C. GoROAS, Surgeon General, United States Army, Chairman. 
John Van R. Hoff, colonel, United States Army, retired, Vice Chainnan. 
Eugene R. WHmiORE, major, Medical Ck>rp6, United States Army, Secretary. 

COMMITTEBB. 

Subsection A. — Public Health. 

Rupert Blue, Surgeon General Public Health Service, Chainnan. 

Subsection B. — Vital Statistics. 

Samuel L. Rogers, Director of the United States Census, Chainnan. 

Subsection C. — Sociological Medicine. 

George M. Kober, President National Association for the Study and Prevention of 
Tuberculosis, Chainnan. 

SuBSBcnoN D. — Sanitation. 

William C. Braisted, Suigeon General United States Navy, Chainnan. 

SuBSEcnoN E. — Laboratory Conferences. 

Eugene R. Whttmore, major, Medical Corps, United States Army, professor of 
pathology and tropical medicine, Army Medical School, Chairman. 



SECOND PAN AMERICAN SCIENTOTC CONGRESS. 



AIMS AND PURPOSES. 

The congress, in accordance witii its high aims and purposes, 
namely, to increase the knowledge of things American, to dissem- 
inate and to make the culture of each American country the heritage 
of all American Republics, to further the advancement of science by 
disinterested cooperation, to promote industry, inter-American trade 
and commerce, and to derise the ways and means of mutual help- 
fulness in these and in other respects considered the following general 
program of subjects, divided into appropriate sections and subsec- 
tions. 

SECTION ym.— PUBLIC HKALTH AND MEDICAL SCIENCB. 

PUBLIO HEALTH. 

Infectious diseases — the bearing of their modes of infection on 
methods of control; nutritional diseases — their public health bearing, 
with special reference to beriberi and pellagra; reduction of infant 
mortality. 

VTTAL STATISTICS. 

Sickness (morbidity) reports; birth and death registration. 

SOOIOLOOICAL MEDICINE. 

Relation of the individual to the community; ways and means of 
bringing matters of public health to social usefulness; public health 
measures — industrial hygiene and sanitation; venereal prophylaxis, 
alcohol and drug prophylaxis; tuberculosis; mental hygiene. 

SANITATION. 

Town and city planning; buildings for human occupancy; food 
and water supply; ventilation; disposal of refuse. 

LABORATORY CONFERENCES. 

Symposia on anaphylaxis, life histories of protozoa, and cancer 
research. 






6 PB0GBEDIKQ8 SECOND PAK AMERIGAK SGIEKTIFIO 0OKGBB88. 

RESOLUTIONS AND BECOMMENDATIONa 

The Second Pan American Scientific Congrees considered and dis- 
cussed the subjects set forth in its program in the light of an intel- 
lectual Pan Americanism in a series of meetings from December 27, 
1915; to January 8, 1916, and adopted resolutions and recommenda- 
tions pertinent to die work of the nine main sections of the congrees. 
The foUowing recommendations refer to Section VIII: 

Abtiole 39. 

The Second Pan American Scientific Congress, recogniadng that the 
education of the pubUc in the elementary facts of malaria is of the 
utmost importance, requests that the American RepubUcs inaugurate 
a well-considered plan of malaria eradication, based upon the recog- 
nition of the principle that the disease is preventable to a much 
larger degree than has thus far been achieved. 

Abtiole 40. 

The Second Pan American Scientific Congress urges that the Amer- 
ican Bepublics in which yellow fever prevails or is suspected of pre- 
vailing enact such laws for its eradication as wiU best accomplish that 
result; inasmuch as yellow fever exists in some of the Eiux>pean col- 
onies in America, they be invited to adopt measures for its elimina- 
tion. 

Abtiole 41. 

The Second Pan American Scientific Congress recommends that 
such of the American Republics as have not already done so should 
justify the international conventions concerning the white-slave 
trade. 



GENERAL SESSION OF SECTION Vm. 

Nbw Ebbitt Hotel, 
Tuesday morning, December 28, 1916. 

Chainnan, William C. Gorgas. 
The session was called to order at 9 o'clock by the chaiiman. 

YELLOW FEVER AND ITS ERADICATION. 

By WILLIAM C. GORGAS, 
Surgeon General, United SiaUs Army^ 

I ahoiild like to discuss before you to-day yellow fever, and more particularly io' 
discuss its sanitary side. Yellow fever is one of the diseases that America has inflicted 
ai>on the human race and I hope before many more years shall have passed that we 
shall be able to say that Americans have freed the human race from this fell destroyer. 
When the Europeans first came to America, in the latter part of the sixteenth century, 
they found yellow fever on the Mexican littoral of the Gulf of Mexico. Fevers at this 
time were not differentiated so that they did not recognize it as a distinct disease. 
The vastly increased travel caused by the coming of the whites gradually spread 
yellow fever far beyond its original bounds. About the beginning of the nineteenth 
century it had spread through all the American tropics, the American Temperate 
Zones, had ravaged Spain and had spread down the West Coast of Africa. At this 
time it looked very much as if yellow fever was about to become one of the great 
world-plagues, as had cholera and plague. It takes no very vivid imagination to pic- 
ture what the conditions would be when this disease had spread around the Mediter- 
ranean Sea, through India and into China. If the ravages in these regions were as 
great as had been the ravages in Spain, the gloom of the picture could hardly be over- 
drawn. In the year 1800 it looked as if yellow fever had entirely conquered America, 
was firmly established in Europe and Africa, and as if it were well on its way to an 
equally firm footing in Asia. About this time steam navigation was introduced and 
sailing vessels began to be displaced as a means of sea travel. The sailing vessel was 
peculiarly adapted for carrying yellow fever from one port to another. The sailing 
vessel has to carry a large supply of fresh water for the use of its crew. This tank of 
fresh water was well adapted to breeding the stegomyia mosquito, and the sailing ship 
in warm climates always had on board a plentiful supply of these mosquitos. The 
sailing ship upon coming into a port and tying up to a dock where stegomyia prevailed 
at once had stegomyia come aboard, lay eggs in the water tank and from that tune 
forward carried with her a plentiful supply of stegomyia. While in this condition 
whenever a human being came aboard in the early stage of yellow fever he was bitten 
by some of these mosquitos and the ship at once became infected. By means of these 
sailing ships yellow fever was transmitted and epidemics started far beyond the north- 
ern habitat of the stegomyia mosquito. In Boston, for instance, the epidemic would: 



8 PROCEEDINGS SECOND PAN AMERICAN SCIENTIPIC C0NGBE8S. 

be started in this way: A ship supplied with stegomyia would come into the harbor 
and tie up to the dock early in the summer. The stegomyia would escape from 
the ship and b^n to breed in the neighboring cisterns, wells, and other fresh- 
water deposits. Later in the summer an infected ship would come into the port. 
A man in the early stage of the disease would sleep ashore and infect the stegomyia 
ashore. This would start the epidemic which would continue until the cold weather 
came on and killed all the stegomyia. The introduction of steam vessels changed con- 
ditions so that they were very much less favorable to breeding stegomyia aboard 
ships. 

Steamships, when they carry fresh water, carry it in tanks located in parts of the 
ship not accessible to mosquitoe, and gradually steam vessels have ceased to carry 
any considerable supply of fresh water, but distil it from time to time as needed . With 
the introduction of steam vessels the area affected by yellow fever was slowly con- 
tracted till by 1900 the disease was confined to tropical and subtropical countries. In 
1901 Reed and his co-workers announced to the world their great discovery that yellow 
fever was conveyed from man to man by the bite of the female stegomyia mosquito 
and in natiu^ in no other way . The sanitary authorities of Havana with the knowledge 
of this means of transmission were enabled to entirely eradicate yellow fever from the 
city of Havana. For 150 years Havana had never been free from yellow fever and 
had been the endemic focus from which yeUow fever had spread to all the Northern 
Hemisphere which had been infected by yellow fever. Within 10 years after the 
eradication of yellow fever from Havana the disease had practically disappeared from 
the Northern Hemisphere. The yellow fever sanitary measures worked out at Havana 
have since been adopted at Panama, Rio de Janeiro, and other places in the tropics. 

Yellow fever since 1901 has been driven from stronghold after stronghold till it is now 
endemic in only three or four communities, and there is no reason why these com- 
munities, in which yellow fever is still endemic, if they adopted the sanitary meas- 
ures now well known as applicable to yellow fever, should not themselves become free. 
As we look back over the history of animal life as revealed to us by geology, for the 
past two or three million years we can see that thousands of different species of animals 
have been slowly brought to perfection through untold eons of time. For various 
causes many species have become extinct. Where the last animal of a species had 
died there is no possibility of again restoring this species. As far as we can tell from 
our geological record a species once extinct has never been redeveloped. The titano- 
saurus, for instance, which became extinct many thousand years ago, w^e know has 
never been redeveloped from any remaining animal, and we all of us know that it is 
impossible for the titanosaurus to be redeveloped from any animal at present on the 
earth during any length of future time. Now the same is true of the yellow fever 
parasite. 

While we do not know the yellow fever germ from its analogy to malaria, we know 
that it must be a parasite very similar to malaria. If we can once get rid of yellow 
fever in the two or three places in the world where it is at present endemic the yellow 
fever parasite will be in exactly the same condition that the titanosaurus now is. 
No environment or no length of time could ever redevelop this parasite, and man for 
the first time in his history would have completely conquered a disease. He will 
not only have conquered it, but he would have placed it in such condition that no 
faults or errors on his part would ever cause him to be again scouiged by this fell 
destroyer. 

There is no doubt in anybody's mind tliat if the buffalo were a hurtful animal and 
the United States wished to deliver the world from the buffalo they could issue orders 
today which would cause the buffalo to become entirely extinct by the first of next 
February. Now, the yellow-fever parasite is in a much more precarious condition 
than the buffalo. There are many more herds of buffalo in the United States than 
there are endemic foci of vellow fever left in the world, and the countries in which 



PUBLIC HEALTH A17D HEDIdKE. 9 

these foci exist could iasue sanitary orders which would cause the extinctioii of yellow 
fever by December 31, 1916, just as certainly as could the extinction of buffalo be 
brought about. 

The countries represented in this congress are the ones piincipally concerned with 
yellow fever. This section of the congress is the section concerned with hygiene and 
sanitation. I therefore urge upon the section that they appoint a committee who 
shall draft resolutions urging the countries concerned to adopt the measures, in the 
two or three places where yellow fever is still endemic, which have been so successful 
in driving yellow fever from the rest of the world. 

Dr. Juan Guiteras. Mr. Chairman, I would move you that a com- 
mittee be appointed by the chair to prepare a form of resolution to 
be presented to the general congress for action, tending to take up 
the question of the complete eradication of yellow fever from the 
Western Continent. 

The motion was seconded and imanimously approved. 

The Chairman. I will appoint on the committee Dr. Vital Brazil, 
of Brazil, Dr. Juan Guiteras, of Cuba, and Dr. Henry Carter, of the 
United States, the committee to elect their own chairman. It would 
be desirable, if possible, for the committee to bring in this resolution 
for the afternoon meeting. The sooner it is adopted, the sooner we 
can get it to the general meeting of the executive committee. 

I shall now call for the first paper on the program, 'Troblems of 
insect-borne diseases in Pan America," by Dr. Juan Guiteras, of 
Habana, Cuba. 



enfermedadss transmitidas por insectos en PAN-AMCRICA. 

Por JUAN GUITERAS, 

Profe$OT de Patologia General y de Enfenrudadu Tropieaks en la Univenidad de la 

Hahana, 

El Preaidente de la Seccidn m6dica del Gongreso ha tenido la bondad de seflalarme 
el tema de este trabajo para su desarroUo y, dentro de los Ifmites de tiempo que se me 
ha concedido para la preparaci6n, me eeforzar^ por llenar mi cometido de la mejor 
manera pocdble, atendiendo m&B especialmente a aquellos factoree del problema que 
puedan afectar o intereaar laa relaciones intemacionales de los pafses que est^ aquf 
repreeentados. 

En la doctrina de laa enfermedades transmitidas por insectos se revive de una 
manera singular y bajo los auspicios de la ciencia, el pensamiento sencillo y directo 
del pueblo desde tiemx>os muy remotos. La opini6n popular acogfa f&cilmente la 
idea de la penetraci6n de las enfermedades por la superficie externa del cuerpo, 
segdn se desprende del concepto expresado por la palabra contagio. Asf vemos a 
Apolo en la leyenda hom^rica, lanzando a lo lejos sus dardos sobre los griegoe para 
herlrles con terrible pestilencia, y asl tambi^n, m^ tardc, en la Edad Media, encon- 
tramoe la leyenda de los untos como causa efectiva de la propagaci6n de la Peste. 
Los recientes descubrimientos de diversas infecciones transmitidas per insectos, han 
confirmado eetas opiniones, estableciendo un grupo notabilfsimo de enfermedades 
introducidas por la niel: Filariasis. Fiobre Aniarilla, Paludisino, Peste, Tripanoso- 



10 PBOOEEDINGS SEOOND PAK AMEBIOAK SOIEKTEFIG G0KGBE86. 

miaais, EspiioquetoBu, Uncinariaais, Leuhmaoiaria, y otras. Induye el gnipo 
algonaa de las infecciones de m^ grave importanda |»ra la rasa humana. 

En la mente popular, la plel, la parte vais expuesta del cueipo, se presenta como 
la m^ vulnerable, y acept&base naturalmente esta via como la mis directa y sencilla 
para las infecdonee. Pero de tal mode estaba imbufda en loe hombrea de denda la 
idea de medics de tranamiflidn mis rec6ndito8 y complicados, que, aun despu^ de 
aeomar loe piimeroe aSbareB en eetos campos de investigad^n, el gran inidador misno, 
el Dr. Patrick Manaon no aupo llegar a la verdad completa de la inoculad6n directa 
de la filaria por el moaquito, sino que hubo de inventar la via tortuoea que auponia la 
muerte del moaquito filariialco en el agua, y la ingeetidn del pariaito con aquel liquido 
por la via g^trica. Y mia redentemente aun, cuando biacia ya afioa que Finlay 
predicaba la tranamiaibilidad de la Fiebre Amarilla de hombre a hombre por el 
moaquito, directamente a trav6a de la piel, Manaon todavia indicaba la miama via 
torcida, x>or el moaquito y el agua al eat6mago del hombre, para la propagaddn del 
Paludiamo. 

Ea de aentirBe que dicunstanciaa, entre laa cualea cuento el haber aido eacogido yo 
como ponente, impidan el deaarroUo de eate tema en forma que mejor ae ajuate con la 
ocaai6n preaente; porque en verdad que nunca hubiera podido eacogerae tema alguno 
que m&B digno fuera de un Gongreao de eata indole. El tema ea eminentemente un 
tema americano, del cual puede dedrae, que ha deiramado mia gloria aobre la denda 
americana que acaao loa temaa todoa juntoe que pudieran preaentarae ante un Gon- 
greao Pan-Americano. 

Americano fu6 el que, en el afLo 1881, de una manera preciaa y con acopio de datoa 
bien fundamentadoe, declar6 por primera ves que ae tranamitia de hombre a hombre, 
por la picada de un inaecto, una infecd6n de caHcten general. 

Que infecdonea de eata naturaleza ae relacionaban de algdn mode con laa picadaa 
de inaectoB, que parecian inocular s^gCai veneno, producto de deacompoeidonea de 
aubatandaa animalea o vegetalea en el ambiente, la tierra, loa pantanoa, el aire; era 
una noci6n entreviata deade tiempoe atr&i por puebloa aalvajea, o poco menoa, en 
diveraaa regionea y propueata como aolud6n dentifica por penaadorea originalea como 
Beauperthuy (3), Nott (38), y, ya deepu^ de la declarad6n terminante del Dr. Finlay, 
tambi^ por 'King (31). Extenaaa dtaa de eatoa trabajoa, con obaervadonea, ae 
encontrar&n en la Bibliografia que acompafia eate eacrito. 

Pero la dedarad6n preciaa de que el microbio de la fiebre amarilla ae tranamitia 
de hombre a hombre por la picada de un inaecto, y que eate inaecto no podia aer otro 
que el moaquito que hoy llamamoa Aedes caiaptUt eaa declarad6n la hizo el afio 1881 
el Dr. Garloe J. Finlay, como conaecuencia de genial razonamiento que se fundaba en 
una aerie de profundaa obaervadonea y originalea experiendaa aobre la bionomia de 
aquel diptero. De eata manera ae preaenta el Dr. Finlay como fundador de la doctrina 
de enfermedadea de tranflmiaidn inaectil. No a61otu6 el primero en mantener que ae 
tranamitia una enfermedad del enfermo al aano por mediad6n de un inaecto, aino 
que previ6 tambi^n que ae hacia mia virulenta la picada al tranacurrir algdn tiempo 
deapu6a de chupada por el inaecto la aangre del enfenno. 

Y f u^ tambi^n ^1 el primero en aplicar un inaecto hemat6&go a un enfermo y despuda 
a un hombre aano con el objeto de tranamitir un virus. Noa enaefi6 de eata manera el 
Dr. Finlay el m^todo de experimentaddn, con todoa aua procedimientoa de tunica, 
aobre el cual ae fundan los grandee adelantoa de la Medidna Tropical. Invent6 
tambidn y public6, con todoa loa detallea neceaarioa, el aiatema que debia aeguirae 
para la eztinci^n de la Fiebre Amarilla. 

El Dr. Finlay falled6 el 20 de agoato dd afio en curso. Propongo a la Aaamblea 
que ae ponga en pi6 en reverenda a la memoria de aqud grande hombre. 

81 no fueeen aufidentea loa anteriorea triunfoa para darle al Gontinente Americano 
la prioridad en eate campode inveedgadonea, podemoa preaentar la aerie magistral de 



PUBUO HBALTH AND MSDIGIKB. 



11 



experimentoe que condujo a la comprobaci6n por Smith y KUbome de la tiuuniiflidn 
de la fiebre tejana del ganado por la ganmpata, el Moargatrypui annulatiu. (50) 

Las inveetigacioneB de Smith y Kilbome y los reaultados que obtuvi^ron, coiuti- 
tuyen la primeia compiobaddn complete de la doctiina de Finlay, de la transmiBi^n 
de enfermedades par inflectoe sanguisugos; y coiutitttyen tambi^u la piimera apli- 
caci^n con 4xitx> de su m^todo, es a aaber: la prepantci6n de iiiBectofl, con conodmiento 
completo de bu bionomia, para la vida de laboratorio y para obtener, a voluntad, picadas 
sucesivas aobre animales enfeimoe y sanos, en condiciones que se aprozimaaen lo 
m&B poflible a las condicioneB naturales.^ 

Finalmente, si todo esto no fuese bastante a establecer sobre base firme la prioridad 
americana, podemos sefialar a la ctipula que corona el edifido, la obra de la Gomisidn 
del Ej^rcito de los Estados Unidos de Norte AmMca, con la demo8(zaci6n concluyente 
de la tranwniBJ^n por el mosquito de la Fiebre Amarilla, enfermedad epid^mica 
dotada de extraordinarias fuerzas de resistencia y de expansidn. (107), (106) 

Oomo resultado pr&ctico del sistema de profilaxis fundado en estas doctrinas, hemes 
eliminado del €!ontiente, caai totalmente y en el transcurso de pocos afios, una de las 
pestUencias m^ terribles que jam^ azotaron a la humanidad. 

y^ase BibUograffa de (1) a (63). 

Fasaremoe a estudiar sucesivamente las enfermedades transmitidas por insectos 
que m&B imi>ortancia tengan en Pan-AmMca. 

Paluduemo, — ^Entre estas enfermedades nos parece que el primer lugar le corres- 
ponde sin duda alguna al Paludismo. Es verdad fya» a primera vista la enfermedad 
no parece presentar ningtin grave problema intemacional, ni siquiera manifestacionee 
que pudi^ramos llamar de inters general. Quiero dedr que el problema no se 
presenta en forma alarmante a la opini6n pfiblica. Podemos dedr del Paludismo 
que ee una enfermedad local y que, si su irea de distribuci6n es grande, est& com- 
puesta de innumerablee focos de car^ter local. Son dstos, sin embargo, tan numerosos 
y persistentes, que su cariU;ter fracdonal no impide que, sumados los focos, constituyan 
la fuente mis poderoea de destrucddn de vidas y de eneigfas en la raza humana, 
exceptuando tan 861o la Tuberculosis. 

En dertas regiones de los trdpicos, tan extensas algiinas que llegan a f ormar nadones 
de importancia, la mortalidad por el Paludismo puede superar a la de cualquiera 
otza enfermedad. Tal era la situaddn en Cuba en el afio 1900, que fu6 el primero en 
que contamos con datos del territorio todo de la Isla. Tal ftt6 tambi^n la situaddn en 
Venezuela en el afio 1910 y probablemente tambi^n en los afios anterioree, contaodo 
deede el 1905. (1) 

NUmero de Dtfuncume» por PahuKimo en Venezuela^ en loi afU>$ que t e eepeeifiean. 





MnertM 


AfiOB. 


por 




PaludJsmo. 


1906.... 


0,015 


1006.... 


8,644 


1W7 


7,066 


1008.... 


8,441 


1000.... 


10,268 


1910.... 


8,438 



El Anuario de Venezuela que se dta, s61o da el ni&mero total de defundones por 
todas las causas para el afio 1910. Pero las cifras del Paludismo se mantienen a tan 
elevado nivel, que no cabe dudar que en todos los afios mencionados la Malaria debe 
de ocupar el primer lugar, oomo en el afio 1910. Los informes de la India, de Italia, 

i Los ▼eidaderos preoiusoras de Finlay y liaaaon se encuentran entn lot inTettlfidom del Cubnnetoy 
DavaliM, C. Btades eor la oontagkm dn chtrbon dfaet les aidmiiix dooiMtiqiies. Bulletin de I'Aoad. de 
M6d.d« Paris, 1870. VoL XXXV, pp. 216 y 471. 



12 



PROCEEDINGS SECOND PAN AMEBICAN SCIENTIFIC COKOBE8S. 



de Paaamd, del Braail, de la Isla Mauiicio y otros, nos muestran iguales resultados 
para regionee determinadas, con exacerbacionea notablee a veces. Puedea ^taa 
alcanzar proporcionee tales que llegue a producine un efecto visible sobre la mor- 
talidad general. En estas condiciones decimoe que existe un estado de Paludismo 
epid^mico. 

En afios recientes nos vamos acoetumbrando tambi^n a encontrar reduccionee 
iguaknente notables en la mortaUdad por el Paludismo, como resultado de en^rgicas 
medidas profil^ticas. 

Ejemplo muy notable de tales reducciones encontramos en las ciCras demogrificas 
de Cuba, segtin aparece en la gr6fica y cuadros adjuntos. 

Como antes dije, en el ai&o 1900, el Paludismo 11^;6 a ocupar el primer pueeto como 
mayor causante de las defunciones en Cuba. De entonces ac& ha descendido al 
vig^slmo lugar. E2s este un resultado muy satisfactorio y bien vale la pena de eetudiar 
las cifras en detalle. 

CuADRO I. — NUtmto de Defunciones por Paludismo y Mortalidad por la miama causa por 
10,000 habitantes en los afloa que se especifican. RepUhlica de Cuba. 



AA06. 


NOmero 
deDo- 


Mortali- 
dad. 




Auidones. 


1900 


4,107 


25.16 


1901 


3,286 


19.42 


1902 


1,546 


8.79 


1903 


1,204 


6.06 


1904 


1,079 


5.79 


1905 


1,100 


6.09 


1900 


1,147 


6.77 


, 1907 

1 


925 


4.61 



Aflos. 



1906 
1909 
1910 
1911 
1912 
1913 
1914 



Ntkmero 
de De- 
funciones. 


Mortali- 
dad. 

3.43 


730 


746 


3.38 


622 


2.80 


497 


2.25 


493 


2.16 


446 


1.87 


463 


1.83 



CuADRO II. — Defunciones por Paludismo y Mortalidad par la misma causa, por 10,000 

habitantes en la Habana en los anos que se espedfican. 



Aftos. 


N6mero 
de De- 


1 

Mortall-i 
dad. 

1 


! Afios. 


NAmero 
de De- 


Mortali- 
dad. 




funciones. 


1 
1 

1 


fiinciones. 


1871 


262 


13.01 


1893 


246 


11.21 


1872 


316 


16.72 


1894 


201 


9.00 


1873 


320 


16.41 


1896 


206 


9.00 


1874 


288 


14.39 


1896 


460 


10.60 


1876 


284 


14.22 


1897 


811 


34.68 


1876 


334 


16.77 


1806 


1,907 


80.08 


1877 


422 


21.23 


1899 


900 


37.36 


1878 


463 


22.77 


1900 


,325 


13.02 


1879 


343 


17.23 


1 1901 


161 


6.87 


1880 


384 


19.27 


1902 


77 


2.90 


1881 


251 


12.69 


1908 


61 


1.87 


1882 


223 


11.77 


1904 


44 


1.60 


1883 


183 


9.16 


1906 


82 


1.11 


1884 


196 


9.80 


1906 


26 


a88 


1886 


101 


6.05 


1907 


23 


0.76 


1886 


135 


6.71 


1906 


19 


0.60 


1887 


209 


12.43 


1909 


6 


0.18 


1888 


206 


10.37 1 


1910 


18 


0.46 


1889 


228 


11.16 


1911 


12 


aso 


1890 


256 


12.30 


1912 


4 


0.12 


1891 


292 


13.78 


1913 


5 


0.16 1 


1892 


286 


13.26 I 

1 


1 1914 


4 


0.11 



Como que el 6xito que exponen los auteriores ouadros se debe principalmente a 
obra emprendida contra la Fiebra Amarilla, dejaremos para cuando se trate de dicha 
enfermedad el explicar c6mo se ha hecho esto y lo que ha costado. 

Dudoso es en \ erdad que se pueda dupUcar este ejemplo si tenemos en cuenta que 
la Habana es una ciudad tropical de gran importancia comercial, centro de gran 
movimiento personal y centro, por consiguiente, de grandes hospitales ptiblicos y parti- 
culares; de los cuales estoe illtimos, por su organizaci6n especial, atraen un gran con- 






■ttwJJaiuJli .^ !«S)Wl'^.yJ«J^\f.*V=«.-,u,«l ^-.V WTtA«;«,\^\\j,. 



PUBLIC H£ALTH AND MEDICINE. 13 

tiagente del interior de la Repdbiica. Con respecto a las eetadiaticas de eata ultima, 
conviene tambiM recordar que en todo el territorio no existe lugar alguno donde ha 
condiciones de temperatura sean obstdculo a la e oluci6n de las anofelinas. 

Refiri^ndome brevemente al quebranto econdmico que para una comunidad aigni- 
Hca el Paludismo podemos decir, que el Director del Departamento de Entomologia 
ea Washington, L. O. Howard (24) estima que las p^rdidas que el Paludismo le ocasi- 
ona a los Estados Unidos pueden calcularse en 100 millones de pesos anuales; y Angelo 
Celli, despu^ de entrar en detalles sobre el mismo asunto con respecto a Italia, y sin 
^ilvidar la influencia que sobre la emigraci6n sin duda ejerce el paludismo, concluye 
<'on estas palabres: " Riassumendo, si pu6 dunque con certezza asse erare che la 
malaria costa annualmente alV Italia incalcolahili teaori.** (55) 

La campana contra el Paludismo debe naturalmente de participar del mismo 
canicter local que hemes sefialado con respecto a la distribuci6n y otras manifestaciones 
de la enfermedad. La obra, por cons^uieDte, deberd subdividirse grandemente con 
el fin de cubrir las nmneroeas y desemejantes secciones del pals afectado. I^as varias 
campanas que se proponen, y los numeroaos informes que se encuentran en la publi- 
caci6n que, })ajo el titulo de ''Paludismo " edita el Comity para el estudio del Paludismo 
en la India, son muy caracteristicos de esta clase de traV ajos, segtin se descubre por 
la di isi6n en comisiones y subcomisiones que con frecuencia difieren entre sf en 
cuanto a opiniones y m^todos. El Presidente del Comity Central se quejaba de estas 
dlvergenria*; y discusiones que no son sino reeultados de la naturaleza misma del 
problema. (64) 

Ross (65) en su excelente monografia, reconoce la importancia de las opiniones 
locales y da mayor realce a su lihro introduciendo en ^1 "contribuciones especiales" 
por autores que se han labrado renombre intemacional por su lahor en estos proble- 
mas, en di ersas partes del mundo. 

Como era de suponer las campanas antipalddicas han recibido mayor impulse, y 
han alcanzado sus mejores ^xitos en torno de grandes centres de poblaci6n, o aquellos 
que por alguna causa especial se distinguen. Tales son las campafias de los ferro- 
carriles de Italia, de la Habana, de Ismailia, de Panamd, de Mauricio, de Rio, Nueva 
Orleans, Bombay y otras. 

Encontradas son las opiniones con respecto a los m^todos profil&cticos mds prove - 
chosos en di ersas localidades. Los campos contendientes pueden reducirse a dos 
grupoe, a saber: los que ponen su esfuerzo principal en la campafia anticulicida, y 
los que se proponen U^ar a la inmunizaci6n del hombre por la adminiBtraci6n de la 
quinina en dosis profil&cticas. 

Tales discusionies me parece que pueden ser de inter^ en los paises donde no reina 
la Fiebre Amarilla; pero donde quiera que coexistan ambas infecciones, parece que 
debiera aceptarse como sistema fundamental de la profilaxis, la lucha contra el mos- 
quito que combate a la vez el Paludismo y la Fiebre Amarilla. 

Los 4xitos que antes vimos patentizados en las estadlsticas de Cuba, por obra anti- 
culicida exclusi, amente se obtu\ ieron. Con respecto a la quinina podri decirse que 
la droga se emplea hoy mds eficazmente que antes; por lo menos no se gasta intitilmente 
en el Iratuniento de estados que no son palddicos; pero el use profildctico de la qui- 
nina no se ha empleado en Cuba, sino es indi\ iduabnente. 

La inmunizaci6n estd muy claramente indicada en las enfermedades estrictamente 
humanas; pero, en aquellas infecciones que se mantienen en fonnas mis o menos 
lar adas en algdn animal intermediario, debemoe sefialar los peligros de la seguiidad 
tolsa que se produce, de la creaci6n de razas de par^toe resistentes a la quinina, y de 
favorecer formas persistentes de la infecci6n humana. 

Xo puede negarse, sin embargo, que en pafses donde no existe la Fiebre Amarilla, 
el uso profildctico de la quinina ha side tan efectivo, y probablemente m^ pr&ctico y 
econ6mico, que cualquier otro m6todo. V^nae, por ejemplo, las campafias anti- 
palddicas de Italia y de las coloniaa alemanas. 



14 PB0GEEDIKG8 8EG0KD PAK AMEBICAK BOIBirnFIO COHGBBBB. 

En loe paises de Fiebre Amarilla, naestia Beguridad depende de la eficacia de nuestra 
labor anticulicida. A este fin debemoe siempre mantener escuela de preparnddn 
para estas hinciones que combinan a la vez las del entom61ogo, el ingeniero y el aani- 
tario. Las naciones que no estdn preparadas por ensefSanzas pr^ticas en estas materias, 
debieran enviar hombres que se adiestren en centroe de reconocida experiencia como 
son, Kue . a Orleans, Habana, Panami o Rfo de Janeiro. 

Pues no debemos olvidar que hasta la existencia nacional entra en ju^go con la 
resoluci6n de estos problemas. El vigor, la vida misma de los pueblos se gastan y 
rebijase el car&cter a niveles inferiores bajo la influencia del Paludismo, quedando la 
defensa nacional reducida a la misma endemia inhoepitalaria que ahuyenta al extian- 
jero de las costas. Tal fu^ probablemente la decadencia de los imperios del Mediterri- 
neo que nos representa una de las estrotas finales del Childe Harold: 

Thy shores are empires, changed in all save thee 

their decay 

Has dried up realms to deserts. 

He dicho que el Paludismo no presentaba ningdn problema intemacional grave, 
y, sin embargo, hay un aspecto de esta cuestidn que no hemes discutido a6n, y que 
debe considerarBe desde el mismo punto de vista que los problemas sanitarios inter- 
nacionales, es decir, el de las cuarentenas. Desde luego que no voy a proponer que se 
incluya el Paludismo entre las enfermedades cuarentenables. Gomo procedimiento 
intemacional no serfa eso practicable. No debemos pasar por alto, sin embai^o, el 
hecho de que nuestros medicos de puertos detienen, en la inspeccidn de barcos pro- 
cedentes de paises sospechosos de peste o de fiebre amarilla, a muchos individuos 
febriles que son enviados al Hospital cuarentenario. Resulta con frecuencia que 
se establece el diagniSetico de Paludismo, y estos individuos son debidamente tratados 
antes de entrar en el pals. 

Pero era mi objeto referirme m^ particularmente a lo que pudi6ramos llamar 
cuarentena interior de una parte de la poblacidn contra otra; procedimiento que he 
recomendado en relaci6n con las grandes industrias azucareras y otras empresas que 
atraen gran nt&mero de jomaleros. 

Al hablar de cuarentena, en este case, me refiero al examen de individuos que 
acuden a buscar trabajo en grandes centros industriales y que debieran ser en^igi- 
camente tratados, si presentan infecciones paltidicas, haata que dejen de ser una 
amenaza para la comunidad. 

Olvfdase amenudo tener en cuenta la influencia de las congregaciones humanas y 
de las corrientes migratorias sobre el Paludismo; influencia que se manifiesta tan 
claramente como en otras enfennedades transmisibles. Tal parece que todavfa tro- 
pezamos con dificultades en la aplicaci6n pr&ctica de la doctrina de la tranwmisibilidad 
del Paludismo que fundaron Gerhardt, Laveran, Ross y Grassi. 

Las notables recrudescencias del Paludismo, particularmente alrededor de centros 
de desmonte y otras empresas ferroviaiias, hidr&ulicas o agrfcolas, no se explican gene- 
ralmente de manera satisfactoria. Estos brotes, que pudi^runos llamar de Paludismo 
epid^nico, obedecen principalmente a movimientos migratorios. Aquellas gvuxdes 
empresas pagan buenos jomales y acuden a ellos hombres de todas clases, amenudo con 
sus familias. Suelen ser estos hombres precisamente de aquellos que no han prospe- 
rado en otras partes donde son conocidos por trabajadores in6tiles, sujetos a los trastor- 
nos agudos y crdnicos que ocasiona el Paludismo; individuos que acaso por esa misma 
causa buscan tierras mis salubres. Jomaleros de esta clase, y aun mis probablemente 
sus familias, importan el Paludismo de la misma manera que pudiera importaise la 
Fiebre Amarilla. 

Resultarfa econdmico para las referidas empresas el establecer laboratorios y pagar 
la direcci6n de peritos para obras de saneamiento, y para deacubiir y tratar debida- 
mente los cases de Paludismo que se presenten. Todo trabajador, antes de ingresar 



PUBUC HRALTH AND MEDIOIVB. 15 

en el campamento, debieia aer examixiado pan detenninar el aumento del bazo o la 
presencia de parfaitOB en la aangre (60). 

Un estudio ciddadoeo de loe cuadros de la mortalidad en la Habana, que mis arriba 
insertamoB, nos har& ver la influencia de los movimientoe migratorios aobre el Pa- 
ludimno. £1 inciemento en Iob afioe 1877-78 se debe a la terminaci6n de la gueira de 
diez alios, y la vuelta de laa tiopas del campo a la Habana. En el afio 1895 empieza la 
aegunda guerra de independencia; iniciase en 1896 el asceneo de la mortalidad por Pa- 
ludifimo, la que llega a la espantoea cifia de 80 por 10,000 habitantee cuando la recon- 
centiBci6n de la poblaci6n campesina en las ciudades por la orden tristemente memo- 
lable del GenenJ Weyler. 

Hace a]g:uno6 afios que hlce un viaje de exploraci6n en la Oi^naga de Zapata que se 
extiende por la costa sur de las provlncias de la Habana, Matanzas y Santa Clara. 
Es la Ci^naga un enorme depdsito de aguas dulces que no encuentran suficiente salida 
al mar del Sur, y que conatituyen, como era de suponerse, un gran criadero de andfeles 
y otros mosquitos. En la parte sur de la Ci^naga la poblaci6n consiste principalmente 
de leiiadoree y carboneroe. En la ocasi6n de mi v isita la formaban antiguos residentes, 
alguna gente de mar y reci^n Uegados de Espafia. No habia Paludismo, y las condL 
ciones de salubridad eran excelentes aunque se estaba trabajando en canalizaciones 
para el desagtle y el tr&fico. 

En la onlla Norte de la Gi^naga se encuentran tenrenos de grandes centrales pan la 
plantaci6n de ca&a. Uno de ellos, el centnl "Constancia," se proponla darle nuevo 
impulso a SOS operaciones y habla importado de la provinda Occidental de la Ida, 
empobrecida par la decadenda del cultivo del tabaco, un nthnero considefable de 
tnbajadores con sus familias. Se les hablan construfdo casas higiAnicas en un lugar 
llamado ' * la Horquita, ' ' junto a la CL^naga. La region de donde venfan eetas famiHas 
en de ligen endemicidad paltidica. Pronto despu^ de su llegada estall6 entre ellot 
un brote epid6mico de tal intensidad que ameoas^ seriamente el ^to de aquella 
colonizaci^n, si no hubierasido por el en^rgico tntamiento qulnico establecidopor el 
I>r. J. M. Portuondo que afortunadamente estaba bien preparado pan esta dase de 
emeigencia. 

El loco mayor de Paludismo en Cuba se encuentn hoy en la regi6n Oriental donde 
se fomentan nuevos centrales de azdcar y a donde acude la corriente migntoria del" 
resto de la Reptiblica, de Espafia y de Jamaica. La mortalidad mia alta se presenta 
en Guant&namo, con 19.62 por 10,000 habitantes, y le sigue Palma Soriano con 15.29. 
Por otn parte, en muchos t6rminos munidpales ha deeapareddo el PtdudiflDio en 
estos tdtimos alios. 

Sigue una lista de las Anof elinas encontndas en este Continente, y se marcan con 
bastardilla aquellas que ban sido seflaladas como tnnsmisons del paludismo. 

Anopheles maeuHpennis, Estados Unidos y Canadi; Anophelee crueiane, Estados 
Unidos y Cuba; ArMphelee punctipennis, Estados Unidos, Jamaica; Anophelee peeudO' 
puneHpennie, Panami, Antillas, Mexico; Anophelee pimctimaculata, Panami; 
Anophelee apicmacula, Panami; Anophelee male^tor, Panami; Anophelee eiaemi, 
Panamil; Anophelee annuliventris^ Ctale; Anophelee annulipalpis, Argentina; Anoph^ 
lee Bigoti, Chile; AnopheUe Cnuei, Bnsil, Panami; AnopheUe Lutsi, Braail; Anophe* 
lee psevdcrmaeulipee, Brasil; Anophelee fnnciscamis, Estados Unidos, Panaind; 
Anophelee Goigasi, Panam4; Anophelee nigripes, Estados Unidos; AnopheUe tarnma- 
culaioL PaDam&. 

Chagaeia Fajardoif Brasil. 

Arribaleagma mactdipee, BmsU; Arribabagaia peeudomaculipee, BrasU. 

Manguinhosia Lutzi, Brasil. 

Steihomya nirnba, Brasil, Guayana. 

Myeomyia Lutai, Brasil, Guayana. 

Cydolepteron Grahhamif Jamaica, Cuba; Ch/clolepieron mediopunetatvm, Brasil; 
CydolepUnm intermedium, Brasil. 

Myzonhynchella Lutd, Brasil; Myzorriiynchella nigritame, Brasil; Myzorrhyn- 
chella pearva, Brasil; Myzorrhynchella tihiamaculataf Brasil; Myzonhynchella GUeei, 
Brasil. 



16 PROCEEDINGS SECOND PAN AMERICAN SCIENTIFIC CONGRESS^ 

NysBorrhyncus albimanus, Braail, Venezuela, Guayana, Antillas, Argentina. 

Cellia albimanaj Antillas, Panam&, Quay ana; Cellia argyroUxms Estados Unidos^ 
Guayana, Braedl, Argentina; Cellia Brazilensis, Braail. 

Kerteszia Boliviensis, Bolivia. 

y^ase Bibliografia de (45 a (67). 

Peste, — ^Le corresponde, sin duda, a la Peste el segundo lugar en el estudio que 
venimos haciendo. Es en la ^poca actual la enfermedad transmitida por insectoe que 
m&3 seriamente parece amenazamoe; enfermedad nueva en nueetro Continente, donde- 
fu6 introducida por primera vez en el tUtimo afio del siglo pasado. 

Existen varios focos end^icos de Peste en el Yiejo Continente. Con excepci6n 
del de Yunnan, todos loe dem^ permanecieron inactivos en el afio 1893. En este afio 
el mencionado f oco manif e8t6 una gran actividad . Es el Yunnan una de las provincias 
meridionales de la China, limf trofe con la Birmania y el Tonkin. En el curao del afia 
1894 se extendi^ la epidemia por las vfas de comunicaci6n, a trav^ de las provincias 
de Kwang-si y Kwang-tung hasta llegar a la costa por Cantdn y Hong-kong. Este- 
puerio fu^ el centro de distribuci6n para el mundo entero: Oporto en 1899, Brasil, la. 
Argentina, Paraguay y Hawaii en el mismo afio; California y Glasgow en 1900; Cons 
tantinopla, Ndpoles, Liverpool en 1901; Odessa en 1902; Chile y Perd en 1903;. 
Panamd en 1905; la Isla de Trinidad en 1907; Venezuela en 1908; Nueva Orleans y 
la Habana en 1912. 

En nuestro continente se dii^^osticaron los pruneros casos humanoe en Santos, en 
1899, y por el mismo tiempo, en la Asuncion, Paraguay. Es muy posible que haya 
existido la Peste murina con anterioridad a esta fecha. Se presentan dudas con 
respecto al origen de la infeccidn en las costas del Brasil y del Plata, y se discute sL 
fu6 importada de Mozambique o de Oporto. Sea cual fuere su punto de origen, la 
enfermedad nunca ha desaparecido de aquel litoral. 

La misma confusi6n existe con respecto a la importaci6n de la Peste en los Estados 
Unidos. La enfermedad apareci6 en Hawaii en diciembre de 1899. Prevaleci6 
desgraciadamente por aquel entonces la tendencia a la ocultaci6n. El cad&ver de un 
chino encontrado en San Francisco en marzo de 1900, y reconocido por las autoridades- 
federales como cadiver de Peste, fu^ la primera intimaci6n de la presenda del mal en 
los Estados del Pacffico. 

Extendidse la infecci6n por aquella costa, llegando a MazatUn en M^jico por el Sur 
y a Seattle por el Norte, estableci^ndose finalmente entre las maimotas (Citellufr 
beecheyi) de California y entre las ratas de dudades de importanda comercial, par- 
ticularmente en las que son centros de diBtribuct6n de granoe y de viveres. En centros 
de esta clase parece que no es posible, con los medios de que hoy disponemoe, lograr 
la extuici6n de la Peste entre los roedores. Testigos son: Londres, Liverpool, Rfo de 
la Plata, Rfo de Janeiro, California, y, m^ recientemente, acaso tambi^n, la Habana 
y Nueva Orleans. 

Dije antes que la Peste era una enfermedad nueva en America, y esto es precisa- 
mente lo que le da una potendalidad amenazadora para nosotros. En la India ha 
estado sujeta la enfermedad a flujos y reflujos tan inesperados como inexplicables. 
Gabe pensar que lo mismo pudiera suceder en este continente, aunque, por la expe- 
riencia hasta ahora adquiiida, tenemos alguna base para la esperanza de que la actitud 
de los pueblos americanos ante la enfermedad ha de aseguramos siempre el pronto 
dominio sobre ella. 

Por el contrario, se me figura que, entre los pueblos orientales, existe una actitud 
pasiva, algo semejante al fatalismo que en la America Tropical predominaba con 
respecto a la Fiebre Amarilla. En esa misma actitud pudiera quizis encontrarae una 
explicaci6n de la mortaUdad mis baja que en America parece presentar el mal . Quiero 
dedr que en Oriente hay m^ probabilidades de que pasen inadvertidos los casos ligeros 
y que la alta mortalidad represente luia espede de selecci6n de casos graves. 

Los factores del 6xito en las campalias antipestoeas son principalmente dos: el 
reconocimiento y pronta declaracidn de la existencia de casos de Peste, ya sean hu- 



PUBUC HEALTH AND MEDICINE. 17 

manoe o murinos, y el mantenimiento de una bien organizada penecuciiSn de ratafl, 
particulannente en loe lugares donde haya rasones para sospechar la exutencia de 
ratas infectadas. 

Lob resultadofl obtenidoB en la Habana ban eddo muy satisfactorioe. Es eata dudad 
un importante puerto de mar y un gran centre de diBtribuci6n de vfveres. Las paredes 
de lo6 edificios en la Habana vieja y barrio comercial son muy gniesas y estin cona- 
trufdaa de un mortero que excavan f4cilmente los roedoree, abriendo cuevas y galerfaa 
que ascienden en complicada red hasta doe metroe por encima del nivel del suelo. 
D^bese probablemente a estas condiciones que hayamoe tenido en la Habana predi- 
lecci6n por el sistema de fumigaciones como uno de loe medioe para la de8ratizaci6n. 

En breve remimen los reeultados obtenidos en la Habana son loe siguientes: en el 
primer afio (1912) hubo tree cases; en el segundo afio (1914) hubo 25 casos y 17 en el 
tercer afio ( 1915) . Durante el primer afio no hubo ningtin brote secund^o. Durante 
el segundo afio tu^rimoe un caso en cada uno de dos pueblos del interior en f^il comu- 
nicaci6n con la Habana por ferrocarril y carretera; una rata infectada en otro pueblo 
en las mismas condiciones y 16 casos en Santiago de Cuba. En el tercer afio tuvimoe 
doe casos en la capital de la Provincia Occidental que se comunica con la Habana por 
ferrocarril, y dos casos en un suburbio de la Habana al otro lado de la bahfa. Un total 
de 57 casos en cuatro temporadas de Peste. Nuestra estaci6n de Peste ocurre en la 
primera mitad del afio. 

Nuestro 6xito en la dominacidn de brotes de Peste es evidente; pero en la Habana 
lo mismo que en otras partes, existe la misma pendstente tendencia a la reaparici6n en 
afios Bucesivos. Nos parece comparativamente f^il extinguir los brotes de Peste 
humana, o reducirlos a pequefias proporciones; pero es muy diflcil extinguir por 
complete la Peste murina, por lo menos en grandes centres de distribuci^n de granos 
y de viveres. La causa se encuentra, sin duda, en las dificultadee con que se trepieza 
para poner la poblaci6n a prueba de ratas. 

En la Habana le dames mucha importancia al empleo del icido cianhidrico en 
fumigaciones extensas y en inyeccienee parciales del mismo gas en las cuevas y ttinelea 
de las ratas. Tiene la ventaja el gas cianhidrico de ser r&pide en su acci6n, y de no 
ahuyentar las ratas per el olor picante. Destruye ademia las pulgas al mismo tiempo 
que las ratas, e impide que se infecten nuevos roedores que acudan a ecupar las ma- 
drigueras abandonadas. A las fumigaciones muricidas se une una campafia activa de 
de8ratizaci6n por medio de trampas, la que se recencentra en los lugares donde se 
supone que pueda haber ratas infectadas. 

Deseo aprevechar esta oportunidad para inaistir, como en otras ocasiones, en que se 
compla estrictamente el Artfculo Primero de las Convenciones Sanitarias Intanoacio^ 
nales — ^la pronta declaraci6n de cases de enfermedades cuarentenables. Los primeros 
pases de la Peste en este Continente se caracterizaren a veces x>or deegraciadas vacila- 
ciones en la comprobaci6n y declaracidn de loe cases. Es bastante general la tendencia 
a condonar estas infracciones y aun se tiene a mal que de ellas se hable pdblicamente. 
No me conformo con este sistema. Preferirfa que se sefialasen los infrac tores y se 
encontrase el modo de castigarlos. 

Debemes insistir, no s61o en la declaraci6n inmedlata de los primeros casee de Peste 
humana o murina, sine en el envlo continuado de informes sebre las operaciones de la 
campafia antimurina. Si no se envlan informes de esta clase, me permito sugerir que 
estd justificado el mant<»nimiento de medidas defensivas, aunque se declare que la 
]nfecci6n ha ceeado. 

Presento adjunto la forma en que se rinde en la Habana informe decenal de las 
operaciones del servicio de de8ratizaci6n. 

Deseo tambi^n recomendar insistentemente el uso del ^do cianhidrico para la 
desratizacl6n de naves que procedan de puertos infectades. Los gases que se 
obtienen por la combustion del carbono, al matar un ndmero de ratas sin destruir 



18 raOOEBIHNCM BEOOMD PAN AICBBIOAIT B OIKH T IJI O COHOBBBB. 

Im pulgas"que ftlb«rgaa, dojtui en Ubertad pulgM infecUdM que pueden atacu ftl 
liombie o 4 nuevae lataa qua lleguen ft bordo. El mondxido de carbono parace eaUr 
indicado pan la deeiatiiacitin de iis\'efl que no procedan de puertoe infectadoe. 
Bott prar inveubur nn apaato generador 7 propuloor de icido ciaahfdrico pan 




inyectar d gas, bajo prau6n y i&pidamente, tax cloacaa, caSoa, cuevaa de nttaa y 
ofiftcioB mayorea. Acompafio U figuia que repreaenta el apanto generador, ideado 
p<v el Dr. Hugo Roberts, y que empleamos en la Babaiu paia la inyeccifin del gaa 
«uuihldiko en cuevM de lataa. 



PUBLIC HEALTH AKD MEDICINE. 



19 



No 8^ Bi hay en esta aaamblea algdn represeutante de la ''United Fruit Company" 
que ezponga el plan que ha ideado el Dr. Deeks, medico jefe del departamento de 
sanidad de dicha compaflla, para poner las naves a prueba de ratas. Di.ide el 
Dr. Deeks sus barcos en compartlmientoe o unidades, cada una de las cuales est4 
perfectamente aislada de las otras, de manera que se imposibillta el movimiento de 
una lata de una parte a otra. Conviene estudiar este plan por si fuese conveniente 
hacer obligatoria esta con8trucci6n, o, por lo menos, el conceder privilegios sanitarios 
a las compafilas que la adopten. 

Vdase la Bibliograffa de (68) a (94). 

Fiebre amarUla. — No hace mucho que hubiera llamado la atenci6n el ver poetponer 
a un segundo t^rmino la endemia de tan terrlbles manifestadones epid^micas. Fiebre 
americana, Pestilencia americana, Tifus americano, fueron tftulos con que se indi- 
caba el origen americano de la infecci6n. Ya la enfeimedad habla rendido sus 
banderas cuando se inidaron estas conferendas o acaso tambi^n hubiera recibido 
algdn tftulo pan-americano. 

RBFO BUCA Dg CUBA 

SECRETARU D E SANIDAD Y BENEnCENOA 

JVATORA lO CAL Pg LA HABANA DIRBC CION DB SANIDAD SBRVKJ O Pg Pg WtATlXAClOy 

PES TE BUBONI CA 

Reaumen de lo$ servidos prestados por esta Ofidna durante el tranacurso de la decena que 

termina eldiaS del mee de didembre de 2915, 



Tkabajos. 



liancanas recorridas . . . 
RatoiMras en uso dlario 
Postas Teneuosas 



Dlas. 



24 



Ratas muertas 

Ratas oon trampes . . . 

Total derates 



De las 868 i&ta9 exami- 
nadas en el Labora- 
torio de Inyestigar 
clones, se ha hecho la 
sigaienteclasiAcacidn: 

Mus Alexandiinus. 

Hus Deeumanns. . . 

Mas Musculos 

MnsRattus 

MusC. Poeii 



R«soltaron Pestosas: 
Mus Alexandrinus. 
Mns DeeumaQns . . 

Mas Musculos 

MusRftttus 

MusC. Poeii 



Servlcios espedales: 

InspecKioaos de peni- 
teociailBS,euaiteles, 
ASilos, casas de 
salad ▼ hospltalei . . 

Coevas fnyeotadas. . . 

Cuevas obturadas . . . . 

Coevas reportadas . . . 

lospeccidn noctuma 
de tecepttealos de 
basuras 

Inapeocidn noctuma 
de baldeos de imsos. 

Embareaclones mul- 
tadas por infirao- 
ciones de drdenes 
del servlcio de 
desratisacK^n 

Reinspecciones de 
6rdenes 



600 

1,612 



1 
157 



168 



113 



25 



600 

1,612 



5 
158 



163 



06 



26 



600 
1,612 



2 

126 



128 



81 



Ninguna. 



1 




90 


115 


90 


115 


90 


116 


36 


42 


15 


17 


50 


59 



1 

110 
110 
110 



23 
16 



27 



600 
1,612 



3 

179 



182 



113 



28 



1 

96 I 

98 

96 



22 
30 



30 I 62 I. 



29 



600 
1,612 



30 



600 

1,612 



12 
212 



224 



156 



69 
60 



33 
37 

2 
70 



5 
145 



150 



74 



72 
72 
72 



32 
43 



76 



!• 



600 
1,612 



6 
145 



150 



101 



68 
08 



41 
44 



86 



600 
1,612 



4 

125 



129 



60 



2 
56 
65 

66 



62 
63 



3 



600 
1,612 



4 
169 



163 



75 



1 

27 
27 
27 



37 
63 



n5 



JOO 



Total. 



6843^— 17— VOL IX- 



-8 



6,400 
1,613 




1,447 



668 



7 
699 
699 
699 



327 
318 

3 
646 



20 



PB00EEDIKG8 SECOND PAK AMBBICAK 8CIENTI7I0 00KGBB88. 



Reiumen de lot $ervieia8 vre$tadospor e$ta Ofieina dwranU d tramewno de la decena que 

termina udiaS ddmes de dxeiembre de i9i5— Oontinda. 



TBABAJOa. 



Record de Agentee 
Eapedalee en Oada 
J>iatrU»-Beaa9 Bn- 
ttefttdUm 



tiito. 



1. 
2. 
8. 
4. 

5. 
C. 

Regla. 



Nombiw. 



J. Roqne 

A. Ortega 

J. Llorea 

B.CMtel 

J. HsiTon..... 

R. Tnero 

P.d«VG«rafa. 











Dfai. 










24 


25 


26 


27 


28 


20 


80 


!• 


2 


8 


S 


4 








8 


6 


8 


6 


4 


2 




4 









4 


2 


2 


4 


8 


7 


8 









7 


10 


10 


8 








7 






17 


7 





8 


19 


17 


18 


1 






14 


2 


4 


9 


9 





4 


6 






1 


8 


2 


2 


2 


1 


2 


6 






11 


2 


8 


10 


8 



Total. 



81 
78 
88 
71 
80 
81 



Agonte que Iw tenido major raocrd, SmiUo Oantel, dol Distrito No. 4. 










£MBre* en fue/uffon 
kaMdaila»fM7rata», 
























Distrito D^kmoro 1 


10 


18 


4 


19 




19 


18 


8 


10 


8 


104 


Distrito nAmero 2 


81 


17 


9 


14 




16 


10 


15 


12 


16 


140 


Di8tritonAiiiero8 


27 


24 


25 


88 




48 


22 


47 


26 


29 


281 


Dlstrlto ntfmero 4 


41 


48 


42 


58 




62 


54 


86 


24 


00 


426 


Distrlto ndmero 5 


27 


88 


28 


87 




58 


29 


19 


86 


88 


800 


IfueUedeCaballtfla... 


1 


» 2 


8 


1 




2 


1 




1 


2 


U 


MneUo de San Fran- 
























oisoo 


1 


1 
1 


1 


8 
2 




1 
1 




8 


2 

1 


1 
2 


17 


MoeDe d« Panla. 


8 


HaoOflo Ha^aoa Onh 






trai 


2 
8 






1 
2 








1 
5 






8 


lfueUeB8aoJoa4 


2 


1 




2 


8 


2* 


24 


IfnoUef Tallapiedra.... 


4 


1 


8 


2 




1 




8 


2 


1 


20 


DittritodeCasa Blanoa. 


9 


4 


6 


1 




1 




2 


2 


2 


30 


IHstritodeRegla 


2 


17 


6 


9 




18 




11 


10 


7 


80 


Total derataa 


188 


163 


128 


182 




224 


150 


150 


129 


168 


1,447 



Rooord batldo por el Dtotrito No. 4 a cargo del Inepeotor Sr. Eogenlo Oarrallo. 

Renanen general de raJUu hahidoM detde dSde mono de 1914. 

thtlmadeoeiia 90,617 

Bstadeoena 1,447 

Total general 02,064 

AdvfiteiiciM.— fie eremaron 276 goajrabitos. y de las mil ooatitNslentoa cnaienta y atete rata* oaptoradaa 
261 ae atrapanm en loa registnM del aloantariuado. 

Bl ditlmo caso de peste hnmana oourridel dfa 4 de Jnllo, y el ftltimo case de peste mniinaooonldeldlm 
12 de mayo del afto aetnaL 

Habana, 3 de dioiembie de 1915. 

Vto.biio.: 

Dr. F. RoDBfavBi Alomso, 
Jtfe da Kegoeiado de Detntincitn. 
Abmakdo dbl Vallb, 

Segundo Jefe. 

Lleg6 la enfeimedad ft adquirir a vecee tal fuerza de expaoflidii que amenazaba 
tomar el cariU:ter de pandemia. Afortanadamente se le han cortado las alas y ya hoy 
muy remotas son las probabilidades de que se ciimpla la profecfa de la invasidn de la 
India por la Fiebre Amarilla Big:uiendo la abreviada rata del Canal de Panami. La 
Fiebre Amarilla ha desaparecido de Panami, de las Repdblicas de Gentro AmMca, 
de las Antillas y de Vera Graz. Caa puede dedrse que estd extinguida en las costaa 
del Atltotico de Sur Arnica. Si el gran loco de endemicidad amarilla en el Africa 
Occidental no eetayieBeenvlasdexecibirlaat;enci6nque reclama, (110), (111), (112), 



PUBUO HEALTH AKD MEDIdHB. 



21 



pQdioa anceder qne el aomento de las camunicadoneB tranflcontineiitalet y'muiihoam 
Uegase a ser mis amenasadoza pent la India que el Canal de Pftoami. £s de xecordar 
qne la Peste no lleg6 a nuestro Continente per la que jwrecla la via mis directa, el 
Facifico, aino que aml>6 primero a las costas del Atlintico. Desde luegoTque, escep- 
tnando acddentee, la rata seri slempre la del mayor Mfico. 

£1 aiguiente coadro ezpone el descenso de la Fiebre Amarilla en Cuba liasta^sa 
total eztinci6n: 



OUADBO III.-^Jf< 



per Fiebre AmariUa m Cuba, par 10,000 hahitanUi erC^ 
afU)9 que ee eepecyUan, 



AiU». 


Horteli- 

dad. 


1900 


XS6 


1901 


a21 


1902 


aoo6 


1908 





1904 





1906 


an 


1906 


0.16 


1907 


a27 


1908 


ao7 


1908 





mo 





1011 





1012 





1913 





1014 






No tenemos en foima utilisable los datos anteriores a la Intervend^n Americana, 
peio es probable que los que de la Habana poeeemos, representen'^astante aprazi- 
madamente el movimiento de Fiebre Amarilla en toda la ReptLblica,f pueeto^que la 
Habana ha side siempre eentro distributivo, no solo de mercancfas ylde|inmigiantes^ 
■no *«»»^^^ de enfecmedades. 

CiTADBO IV. — Fiebre Amaritta. Ciudad de la Habana. NUmero de d^uneionee y 
mortaUdad por 10,000 habHantee en loe afloe qtu ee eepeeifican. 



Aflof. 


NOmaro 
d« 


MortaU- 
dad. 


AfiM. 


NOmsro 
d« 


Mortatt- 
dad. 




Obltoi. 




Obitot. 


1864 


1,042 


40.18 


1886 


166 


8.26 


1866 


669 


81.72 


1886 


107 


a84 


1866 


1,808 


82.81 


1887 


682 


aa60 


1867 


2,068 


96.88 


1888 


468 


28.84 


1868 


1,306 


07.01 


1880 


808 


14.88 


1860 


1,108 


67.61 


1890 


808 


14.80 


1800 


430 


21.26 


1891 


866 


laoo 


1861 


1,080 


49.60 


1892 


867 


laoo 


1802 


1,830 


07.68 


1898 


496 


32.01 


1868 


660 


26.86 


1894 


882 


17.11 


1864 


6,666 


27.1fi 


1896 


668 


24.86 


1886 


288 


11.67 


1896 


1,282 


66.66 


1860 


61 


2.60 


1807 


868 


8a60 


1807 


601 


29.10 


1896 


136 


8.70 


1868 


290 


14.81 


1899 


108 


4.26 


1860 


1,000 


49.46 


1900 


810 


12.41 


1870 


672 


28.84 


1901 


18 


aoo 


1871 


991 


49.22 


1903 








1872 


616 


26.68 


1908 








187S 


1,244 


62.06 


1904 








1874 


1,426 


71.24 


1906 


22 


a78 


1876 


1,101 


6a 16 


1906 


12 


a40 


1876 


1,619 


81.20 


1907 


5 


a 10 


1877 


1,874 


60.14 


1906 


1 


ao8 


1878 


1650 


78.88 


1909 








1870 


1,444 


72.56 


1910 








1880 


646 


82.38 


1911 








1881 


486 


24.82 


1912 








1882 


729 


3a 64 


1918 








1888 


849 


42.62 


1914 








1884 


611 


26.67 









22 



PROCEEDINGS SECOND PAK AMEBICAJ7 8CIENTIFI0 GOKGBESS. 



Al tratar del Paludismo en otra parte de este trabajo hube de introducir un cuadro 
semejante a ^te, y dije entonces que el descenso de la mortalidad por el Paludiamo 
en la Habana y Cuba era resultado de medidas tomadas especialmente contra la 
Fiebre Amarilla; y que dichas medidas consistlan, prindpalmente, en operacionee 
contra el mosquito. Ofreci entonces que al Uegar a esta parte del trabajo, por ser 
donde corresponde, presentarla un resumen de dichas operaciones, con relaci6n de loe 
gastos. 

Empezar^ citando la f6nnula que debe servir de base en las campafias contra la 
Fiebre Amarilla. Las palabras fueion escritas por el Presidente de esta Secci6n, 
Dr. Gorgas, en el afio 1908: ''Me inclino a creer que para la propagaci6n de la Fiebre 
Amarilla es necesaria la presencia de cierto nthnero de mosquitos y que, generalmente^ 
en los paises de Fiebre Amarilla existe dicho ntimero con gran ezceso. La campafia 
contra el mosquito continiia pues por algtin tiempo reduciendo el n(imero sin obtener 
resultadoe apreciables sobre la enfermedad; pero que, ll^ado a cierto punto se reduce 
el nlimero por debajo del nivel necesario, y la Fiebre Amarilla cesa abruptamente. 
Mant^ngase, pues, la poblaci6n de estegomias por debajo de ^ nivel que llamar^mos el 
nivel de Fiebre Amarilla y , por grande que sea el n(!imero de no imnunes o el de casos de 
Fiebre Amarrilla que se introduzcan, la enfermedad no puede propagarse. " Send* 
llamente expuesto asf el problema es como un gran programa reducido a una simple 
cartilla. 

Exceptuando el uso de telas de alambre en los hospitales y en lugares improvisados 
de ablamiento, nuestros esfuerzos se ban diiigido caai exclusivamente contra las 
larvas de mosquitos. Me inclino a creer que los m^todos recientemente introducidos 
para atacar tambi^n la forma alada del insecto merecen tomarse en consideracidn. 
Naturalmente que en presencia de un brote de Fiebre Amarilla se impone la fumi- 
gaci6n culiclda de los lugares donde ocurren cases. 

La campafia contra las larvas incluye el chapeo y limpiesa de zaajas, drenaje, 
eliminaci6n de dep<3sitos de agua, introducci6n de peces larvffagos y el uso de larvi- 
cidas (petr61eo, preparaciones de fenol). Entre los peces larvicidas debemos mencio- 
nar los que en Cuba llamamos guajacones. Son camivoras y abundan m&a especial- 
mente en nuestros rfos las especies CrOTribusia punctata y G. puncticulata. Poey. 

El siguiente cuadro presenta el resumen del trabajo de un afio en la per8ecuci6n 
4e larvas. Para obtener el cuadro se ba sacado el promedio de varies afios de los 
informes decenales que envfan las Jefaturas de Sanidad de toda la Repdblica. 

OtTADBO V. — NUmero de Inspecdones por larvas y nUmero de eriaderos que u encuentran^ 

con el tanto por cierUo de estos. 



MesM. 



Enero.. 
Febrero. 
Mano.. 
Abril... 
Mayo... 
Junto... 
Julio... 
Agosto 



Septiembre. 
Octabre. 



Nlbnero 

deinspeo- 

ciones. 



NoWembre. 
Diciembre. . 



Total. 



246,846 
235,896 
2W,864 
248,006 
261,701 
248,602 
268,646 
244,063 
237,494 
248,212 
244,828 
231,442 



2,042,462 



Crladeros 
de larvas. 



283 
207 
253 
328 
380 
635 
678 
048 
628 
525 
373 
278 



5,108 



Tanto 
ciento. 



0.00 
0.10 
O.IS 
0.16 
0.22 
a26 
0.26 
0.26 
0.21 
0.16 
a 12 



0.17 



El presupuesto para este servicio en toda la Repdblica, en el afio de 1914, se com- 
pendia en la forma siguiente: 

Personal $225,720 

Peti61eo 44,732 



Total 270.452 



PUBUG HEALTH AND MEDICINE. 23 

Otro6 cap(tuioe del Preenipuesto Nacional de Sanidad que aaciende a $2,616,770, y 
no dedicadoB expreeamente a obras de petrolizaci6n y zanjeo, contribuyen tambi^n, 
de manera indirecta a la campafia contra el moequito. 

Mi col^a el Dr. Agramonte ha de tratar del estado actual del problema de la Fiebre 
Amarilla desde el punto de vista epidemiol6g:ico y etiol6gico. Siguiendo el programa 
que me he trazado tratar^ brevemente las cuestioneB cuarentenarias que se relacionan 
con Fiebre Amarilla. 

No ha de tardar mucho en reunirse en Montevideo la Conferencia Sanitaria de las 
Reptiblicas Americanas y parece el presente Congreeo lugar indicado para presentar 
propoedciones de enmiendas a la Convenci6n Sanitaria de Wdshington de 1905. 

Me propongo, pues, discutir dicha Convenci6n en lo que se relaciona con enferme- 
dades ti^nsmitidas por insectos, y asuntos generales que con ellas se relacionan. 

£1 Articulo I de la Convenci6n se refiere a la obligaci6n que contrae todo Gobiemo 
de notificar a los demds de la aparicl6n de un caso de Peste, C61era o Fiebre Amarilla 
en su territorio. 

En este Articulo debiera exigirse tambi^n la notificacidn de la presencia de Peste 
murina, y convendrfa agregar un p4rrafo por el cual se facultase a loe palses a mantener 
medidas especiales de defensa contra el que no cumpliese con el Artfculo Primero. 

El Articulo VIl dispone que la presencia de un solo caso de Peste, G61era o Fiebre 
Amarilla no impone necesariamente la aplicaci6n contra un pais de las medidas 
indicadas en el Capftulo II de la Convenci6n. 

Yo propondrla que se eliminase a la Fiebre Amarilla de esta exenci6n o privilegio. 
En la ^poca actual, con el aumento progresivo de la poblaci6n no inmune en los que 
fueron focos end^micos, la presencia de un solo caso aut6ctono de Fiebre Amarilla, 
descubierto probablemente despu^s del tercer dfa de la enfermedad, es asunto mds 
grave, a mi juicio, que la presencia de un caso de las otras dos enfermedades, pardcu- 
larmente si consideramos que pueden pasar 18 dfas antes que obtengamos pruebas de 
que se hayan infectado mosquitos. 

Articulo VIII. Dispone que las medidas restrictivas que contra un pais se impongan, 
deberdn limitarse al distrito que estd actualmente infectado. 

En este articulo propondrla yo que se agregase al primer pirrafo, lo siguiente: 

''Podrd hacerse excepci<5n, en el caso de pafses donde han existido, o se supone que 
existen, focos end^micos de Fiebre Amarilla en medio de una poblacidn escasa y 
diseminada, y donde la existencia de habitantes inmunes puede ser causa de que no 
se manifieste la presencia de mosquitos infectados.'^ 

En el tercer pdrrafo de este articulo se expresan las condiciones que deben cumplirse 
para que las restricciones se limiten al distrito infectado. Aqui agregarla yo otra 
condici6n en esta forma: "y con la condici6n, ademds, de que el Gobiemo afectado 
dicte las medidas conducentes a obtener informes y hacer declaraci6n de nuevos 
cases que en otros distritos se presenten. " 

Articulo IX. Expone las condiciones que deberdn cumplirse antes que se declare 
un distrito libre de una infecci6n, y expresa el perfodo de tiempo que deberd trans- 
currir sin que se presente caso alguno de la infeccidn. Con respecto a la Fiebre Ama- 
rilla el articulo autoriza a los Gobiemos para extender este periodo. Esta autorizacidn 
ha sido muy criticada, y, a mi juicio, debe mantenerse, por la misma raz6n que aduje 
al analizar el Articulo VIII, es decir: por el cardcter larvado o latente que puede 
asumir la Fiebre Amarilla en medio de una poblaci6n inmune. Los mejores esfuerzos 
de las autoridades sanitarias se estrellan ante la imposibilidad de seguir las huellas 
de casos diseminados, de cardcter benigno, y que ocurren principalmente entre nifios, 
pero que airven de eslabones ignorados que unen un brote epid^mico con otro. 

El tUtimo pdrrafo de este Articulo, que indica las medidas que deben dictarse para 
impedir la propagaci6n de la enfermedad, debiera redactarse en la forma siguiente: 
'^Segundo, que todas las medidas preventivas de la propagaci6n de la enfermedad 
han sido aplicadas, y han aido continuadas por un tiempo razonable, hasta que se 



24 PBOossnnrGB seoohd pak amebioak boibvtifio oovobbbs. 

asteblescft satubctoriamente qne no ha habido propagacidn faeca del diotrito 
infectado/' 

ArticttloXX. Oladflcacidq de navea. Elaegundoptealodice: "Seconsidencoiiio 
aotp«clkoia U luve a boido de la (mal 1m habMo <»flO0 de Peate o de G^era en el mo^ 
de la partida o duzante hi tzmveafa, pero en el cual no se ha dedaiado ningdn caao 
nuevo deede hace aete dfaa. Setin tambi^n aoapechoaiMy tiatindoae de Fiebre Amft- 
rilla, loe bnquea que hayan permanecido en tal prorimidad a las costaa infectada% 
que haya hecho podble la entrada de moequitos en elloe." 

He de proponer que el pfoafo quede redactado en la fonna siguiente: 

*'Se conaideraril como soapechoao el buque a bordo del cual h* ocunido un caao o 
caaoe de Peate o de G61era, en el memento de la partida o durante el viaje; pero en 
el cual no ha ocurrido ningdn caso en loa siete dias anteriorea al de hi aiiibaida. Con 
reapecto a la Fiebre Amarilla, el barco que, habiendo eatado expueato a la introduc- 
ddn del moaquito calopua de cualquier procedencia, embarca paaajeroa en puerto 
infectado y llega ain fiebre amarilla a bordo. Con reapecto a la Peate, tambi^n el 
barco en que ha ocurrido una mortandad ins61ita de rataa.'' 

El tercer pteafo dice: "Se conaidera como indemne, aun cuando llegue de puerlo 
contaminado, una nave que no ha tenido ni defuncionea, ni caaoa de Peate, de Gdleis 
o de Fiebre Amarilla a bordo, aea antes de la partida, aea durante la traveaia o en el 
memento de la Uegada, y que, en el caao de Fiebre Amarilla, no ae haya aprozimado 
a la coata inleatada a una diatancia aufidente, a juido de laa autoridadea aanitaiiaa^ 
para recibir moaquitoa." 

Phtpondrla que ae modificaae la dltima parte del pfoafo que ae refiere a Fiebre 
Amarilla, en la fonna aiguiente: "con la condici6n, ai ae trata de Fiebre Amarilla, 
de que la traveaia haya durado m&s de aeia dlaa, y que ae pueda excluir la preaenda 
de eategomiaa a bordo." 

Artfculo XXI. En el pernio 6, con referencia a la desatizad6n de barcoa infectadoa 
de Peste, propongo que ae introduzca una cliuaula que especifique que la operaddn 
debe hacerse con gaa aulfuroao o Acido cianhfdrico, para obtener al miamo tiempo la 
deatrucci6n de laa pulgaa y evitar la inf ecci6n de nuevaa rataa que puedan introdudrae, 
o de peraonaa. 

Artfculo XXIV. Se refiere al barco claaificado como indemne, en que aparecen rataa 
infectadaa, o en que ae preaenta una mortandad in861ita de roedorea. Aqui tambi^ 
debe inabturae en el uao de gaa aulfuroao o cianhfdrico para la de8rati2ad6n. 

Loa artfculoe referentea a la Fiebre Amarilla que en la Gonvend6n de W^iahington 
colocamos al final con el Ndm. XLVI, para conservar el miamo orden de articuloa que 
tenia la Gonvend6n de Paris de 1903, deben colocarse en au lugar y recibir el Ndm. 
XXIX. 

El Artfculo XLVII de la Gonyend6n de Washington que, aegfhi lo que acabamoa 
de dedr, debe Uevar el N(hn. XXX dice: "Loe barcos sospechoaos de Fiebre Amarilla 
deberto aometerse a las medidas indicadas en los ndmeros 1, 3 y 5 del Artfculo anterior; 
y, ai no ae fumigan, ae deecaigar&n segtin dispone el sub-pfoafo (a) 6 (b) del miamo 
Artfculo. "Yo agregaria, ademiia, "Con respecto al 'pimio 3 del Artfculo anterior, 
el periodo de observad6n deberi contarae deade el memento de la (Utima ezpoaici6n 
al contagio.** 

Otro asunto que habr& de diacutirse desde el punto de vista intemacional, ea la 
dlgnificad6n de la palabra "inmune " en relaci6n con la Fiebre Amarilla. Deade que 
empea6 a legialarse para impedir la propagaci6n de esta enfermedad, hubo que tomar 
en considerad6n la existencia de un grupo considerable de personas que eran inmunea. 
Primero ae consideraron como tales a loe negroe y a loe nativoa de pafses donde reinaba 
la Fiebre Amarilla. Despu^ ae acept6 como base, que la inmunidad dependia de 
un ataque previo de la enfermedad. En loa reglamentoa de cuarentenaa adlo ae con- 
aideraban como inmunea a aquelloa que preaentaban certificad6n aatisfactoria de 



FUBLIO HBALTH AKD MBDIOIKB, 26 

haber paaado la Fiebre Amarilla, o de haber redidido en un foco end6mioo el tdenipo 
neceeario {mia justificar la 8apo8ici6n de que ya hablan adquirido la inmonidad. 

El ntimero de inmunee a la Fiebre Amarilla diaminuye progreeiYameiite y parece 
ya Uogado el tiempo de que no ae tomen en condderacidn al redactar reglamentoe de 
enarentenaB, o, oL se conaidera demasiado radical este acaerdo, definase, por lo menoi^ 
lo que, en lengnaje cuarentenario, debemoe entender por "inmune." 

Gamo que el ndmero de focoe end^micoe'viene dioninuyendo deede bace afioa, 
creo que debonos aceptar actualmente como *'inmunee" aSio a aquellaa pereonaa que 
ban residido en un foco reconoddo como endtoico, durante dies alloe couBecutivoe 
anteriores al de 1902. 

V^ase la Bibliografia de (95) a (112). 

La» FQanoi. — ^Faaunoe ahora a la conaideracidn de las enfermedadee filariisicaa. 
Fueron ^etas las primeras que acept;6 definitivamente la denda como enfermedadea 
tranonitidas por inaectoa. En la conalderaci6n de eate aannto encontzamoe un nuevo 
apoyo para la opinion antea expreaada en favor de la campafia contra el moaquito 
como principal fsictat en la profilazia del Faludiamo; pueato que dicba campafia es 
efectiva a la vez contra el Faludiamo, la Fiebre Amarilla y la Filariaaia. 

Mucho aiento no poder preaentar datoa eatadiaticoa confirmativoa; pero ea general 
la opinion entre loa m^dicoa de la Habana que laa manifeatacionea filariiaicaa ban 
diflminuldo en eata capital con laa campafiaa anticulicidaa. 

Cuatro eapedea dejildridai ban aido reconoddaa en Amdrica como paraaitariaa del 
hombre, a aaber: FUaria Baneroflif FUana Demarquayi, Aeanthoeheilonema pentam j 
Dirojilaria Magaihaen. De dataa la MaffaUiaea% encontrada en Braail, ea muy poco 
conodda; la Demarquayi eetk limitada a algunaa de laa Antillaa Menorea y laa Guay- 
anaa, y la pentfou al Africa Tropical y la Guayana Ingleaa. La diatribud6n de eatM 
fflilridaw en Am^ca ea, por conaiguiente, muy reatringida. No aaf la FUaria Banr 
tro/ti que tiene una diatiibucidn mundial en laa tierraa bajaa y en laa cuencaa de loa 
ribs, en laa zonae tropicalea y aubtropicalea. En el Continente Americano au ^urea de 
diatribuci6n abaica deade SI"" de latitud Norte baata 23'' de latitud Sur. 

Laa aiguientea eapeciea de moaquitoa ban aido aefialadaa como transmiaoraa de la 
Bcmenfti en America: en primer lugar y aobre todaa laa denUb, la Culu fatigan$. 
M&a dudoeamente la Aedes (Stegomyia) eahpus y CeUia albimcma, Al Dr. Lebredo 
<117) debemoB una deacripd6n muy completa del mecaniamo de la inoculaddn de 
la filaria en el momento de picar el moaquito. 

Hay razonea para creer que la Banero/H y la pentam ban aido introduddaa en eate 
Continente en dpoca relativamente redente. La importad6n de eaclavoa de la coata 
Ocddental de Africa debe de baber aido el medio de introducddn de ambaa; aunque 
la Banero/H pudiera tambidn baber aido importada de Aaia pbr loa culfa. 

Ea intereaante obaervar que algunaa formaa de filiuridaa y el Draeunculuif que deben 
haber aido importadoa frecuentemente con loa negroa de Africa (del Dractinculua ae 
aabe poeitivamente) nunca logranm naturalizaiae en America, evidentemente porque 
no exiate el budaped intermediario. En Cuba a61o logr6 domiciliaiae la Bancroftiy 
aunque eate pafa recibi6, propordonalmente a au poblad6n, mia negroa que ninguno 
otro, y continu6 fedbidndoloe baata una fecba mia redente. 

Vdaae la BibUografla de (113) a (121). 

Tytu exantemdtico.^EstA enfermedad nunca ba llegado a tomar, en America, laa 
grandee propordonea que en el Viejo Continente. Exiaten aquf, ain embargo, focoe 
enddmicoa, de loa cualea el m^ importante por au peraiatencia, gravedad y extenaidn, 
ea el que deade bace mucboa afioa exiate en la meaeta central de M6jico donde ae le 
conoce con el nombre de "tabardiUo." Otro foco, deaconocido baata dpoca muy 
redente, exiate en laa dudadea importantea del Nordeate de loa Eatadoa Unidos 
donde ae preaenta la enfermedad en forma baatante atenuada y con poca tenden- 
da a la propagaddn. En eata forma fu6 deacrita como nueva entidad noaoldgica por 
Brill, y ae llam6 Brill'a Diaeaae. (124.) 



26 PBOGEEDINGS SECOND PAN AMEBICAN SCIENTIFIC GONOBESS. 

No se presenta el Tifus Exantemdtico en las Antillas. La clase de poblaci6n que 
padece el Tifus, que es la clase pobre, no emigra en America, por lo menoe, en grand es 
grupOs como en Europa. Desde el ano 1900 86I0 he visto en Cuba un caso de Tifus 
Exantem&tico, que fu6 importado de la capital de M6jico. Ni es probable que esta 
infecci6n se naturalice en las tierras calientes. El calor es poco favorable al desa- 
rrollo del Pediculus vestimenti, ya por la acci6n directa de la temperatura, como 
perecen indicar los experimentos de Anderson y Goldberger, o por la clase de ropa 
que el clima requiere. 

El descubrimiento de la transmisidn del Tifus Exantemdtico por el piojo de la ropa 
se hizo en 1909 por NicoUe, y en el mismo afio, independientemente, por Anderson 
y Goldberger (122) que estudiaban el Tifus en la meseta de M^jico. Todos estos 
observadores hicieron sus experiencias en monos que resultaron ser muy susceptibles. 
NicoUe experiment6 con el chinpanc^ y Anderson y Goldberger con el Macacus 
rhesus. 

La identidad de la enfennedad de Brill con el Tifus mejicano o Tabardillo, y con 
el Tifus europeo parece estar bien establecida. 

En mayo de 1914 Plotz (125) da cuenta de haber encontrado en la sangre de enfermos 
de Tifus un bacilo pequeiio que se obtiene en cultivos aner6bicos. 

V6ase la Bibliograffa de (122) a (126). 

Fiebre de las Montafias RocaUosas. — ^Es esta una enfennedad humana transmitida 
por garrapatas y que estd liinitada a los Estados de la Uni6n Americana en la secci6n 
de los Rocallosos, particularmente los Estados de Idaho y Montana. El foco m^ 
intenso se encuentra en el Valle de Bitter Root en este tiltimo Estado. 

Los Doctores Wilson y Chowning de la Universidad de Minnesota, el Dr. H. T. 
Rickets que muri6 martir de sus estudios de esta infecci6n, y oficiales medicos del 
Servicio de Salud Ptiblica y del Ej^rcito, han contribuldo a la elucidaci6n de este 
interesante problema. La Bibli(^;rafla se encuentra en un trabajo resumen de W. C. 
Rucker en "Public Health Reports" de septiembre 6 de 1912. 

Estos investigadores han demostrado que la Fiebre de los Rocallosos Fiebre de 
manchas (spotted fever) es una infecci6n transmitida por la garrapata Demuicentor 
venusttLS. Se han encontrado garrapatas de esta especie infectadas naturalmente y 
se sospecha que la cabra {Oreamnos montanos) y la marmota {dtellus columhianus) 
de los Rocallosos son los depositarios habituales de la inf ecci6n. El ^ea de distribu- 
ci6n de la cabra corresponde con la de la enfennedad en el valle de Bitter Root, y 
McClintic ehcontr6 una garrapata infectada sobre uno de estos animales. Son suscep- 
tibles a la infecci6n los siguientes mamiferos de aquel distrito: la marmota, el topo 
de aquella regi6n, la ardilla de rocas (Callospermophilus Zat^aZis), los chipmunks 
(EtUamias luteiventris y p. qwadrivitUitus) y la rata de montafias {Neotoma cinerea). 

No se ha descubierto el agente infeccioso de esta enfermedad . Los primeros trahajos 
de la')oratorio parecieron indicar la presencia de un piroplasma en la sangre, pero esta 
obser acion no ha sido conflrmada por Stiles. Lo mismo puede decirse del bacilo 
descrito per Rickets. 

V^ase la Bil)Hografia de (127) a (131). 

Existe tambi^n en los Andes una Fiebre de las Montafias que se presenta en algunos 
valles de la Cordillera. Se ha descrito la enfermedad con los nombres de Verruga 
peruana, Fiebre de Oroya, Enfermedad de Carri&n. El informe preliminar de la Comisi6n 
de la Escuela de Medicina Tropical de Har\ ard, bajo la direcci6n del Dr. Strong (140) 
mantiene que la Verruga y la Fiebre de Oroya son dos enfermedades distintas; una 
afecci6n local aquella, y una infecci6n general y graA e 6sta. En junio de 1913 el Dr. 
Townsend, entom61ogo del Gobiemo peruano, public6 (142) la relaci6n de un experi- 
mento de transmisi6n de la Verruga a un perro chino, por inoculacl6n en la piel, de 
unos insectos recogidos en la zona infectada. El insecto es un Phlehotomus y la especie 
ha sido designada Verrucarum por Townsend. Segtln se informa en esta experiencia 
la sangre del perro presentaba los cuerpos endoglobulares descubiertos x)or Barton, y 



PUBLIC HEALTH AND MEDIdNB. 27 

que ban recibido el nombre de Bartonia badlli/ormis. La Comiddn de Hanard 
con6iina la presencia de estos cuerpos en la sangre de Iob enfermos de Fiebre de Oroya. 

Vdaae la Bibliografla de (132) a (143). 

Las Espiroqiutoses, — De mucho menoe importancia que las eufennedades hasta ahora 
mencionadas tenemoe en America dreas de infecci6n por las espiroqu^tidas. El g^nero 
de esta familia que presenta especies parasitarias en el hombre, y causantes de Lehres 
del tipo recuirente, es el g^nero Spiroschaudinnia. 

Mucho se ha discutido sobre si las espiroqu6tidas deben clasificarBe entre las bacterias 
o entre loe protozoarios, ain que, hasta ahora, se haya resuelto definitivamente el 
problema. 

Se han descrito v arias especies de Spiroschaudinnia, cada una de las cuales produce 
una enfermedad especffica, distinta de las otras; pero todas bastante parecidas entre 
sf, aunque se presentan en regiones del globo muy apartadas unas de otras. 

Las especies son: Spiroschaudinnia reewrrentiSf descublerta por Obermeier en 1868, 
en casoe de Fiebre Recurrente europea. Fu6 ^te el primer microorganismo descu- 
bierto y comprobado como agente de una enfermedad en el hombie. Transmitese 
eeta eepecie por la chinche, Clinocoris UctuUrrius y por loe piojoe. 

S. DoUonif ee el microbio de la Fiebre Recurrente del Africa Occidental y de 
Colombia, infeccl6n transmitida por especies de la familia de las Argdsidas: el Omitho^ 
dorus maubata en el Africa Occidental y el Argas Americanus en Colombia. Algunoe 
autores no admiten la identidad de estas dos fonnas de Spiroschaudinnia. 

S. Novyi, agente infecti o de la Fiebre Recurrente de Xorte America; 8. Carteri de 
la Recurrente de la India y S. Berbere de la del Africa Septentrional. Estas doe 
iiltimas son transmitidas por piojoe. 

V^flse Bibliografla de (144) a (149). 

La Tnpanosomiasis kumana de Amhica.'-Como era de esperarse, la gian ciudad 
tropical de Rio de Janeiro ha llegado a ser centro importante de investigaciones en 
Medicina Tropical. En tomo del ''Institute Oswaldo Cruz" y de la distinguida 
personalidad cuyo nombre lle^ a, se ha formado una escuela notable a la vez por loe 
brillantes resultados practices obtenidos en la Medicina preventi\ a, y por las contri- 
buciones a las ciencias m^icas. 

La entomologfa, la helmintologla, la protozoologla de aquella regi6n son hoy objetoe 
de investigaciones y publicaciones admirables; de manera que no es posible hacer 
eetudioe de car^ter general sobre aquellas ramas de la ciencia sin referirse uno a la 
Utemtura brasilefia. 

En la segunda parte del Vol. 1 de las ''Memoriae do Instituto Oswaldo Cruz " aparece 
un trabajo (150) en que el Dr. Carlos Chagas da cuenta de una nueva Tripanosomiasis 
por ^1 descubierta en la Pro^incia de Minas Geraes. Encargado de una campaf^a 
antipaltidica en la linea de constnicci6n del Ferrocarril Central, llam6 su atenci6n 
un hemfptero, de considerable tamaflo, chupador de sangre que con el nombre de 
Barbeiro era conocido en aquella comarca e infestaba las chozas de los pobres, donde 
se ocultaba de dla en grietas y rendijas de techos y paredes, para caer de noche solire 
los habitantes dormidos. El insecto es igualmente \ordz en los tres period os de su 
e*\ oluci6n, larv a, ninfa y adulto. 

Un estudio cuidadoso del hemfptero revel6 al Dr. Chagas la presencia de formas 
critideas en el intestine posterior. La inoculaci6n de animalee de laboratorio y de 
monoe demostr6 que las critideas eran formas evolutivas de un tripanosoma de mami- 
feroe, para el cual el insecto era un hu^sped intermediario perfecto. Pudo seguir 
Chagas el ciclo complete de la eYoluci6n. El descubrimiento de peculiares procesos 
endocelulares de esquizogonia di6 lugar a que se creyese necesaria la creaci6n de un 
nueA o g^nero de Trypanosomidas, al que se di6 el nombre de Schizotrypanum. M4b 
tarde, Chagas y sus colegas, al encontiar procesos eequizogdnicos semejantes en otras 
Tripanosomidas, han propuesto que se abandone el nuevo g^nero. 

Deefgnase, puee, el par&aito, Trypanosoma crtm, y el insecto transmisor. Lamas 
megistuSf de la familia Reduviidaej serie GymnoeenUay suborden Heterdpiera, oiden 



28 PB0GEEDINQ8 SBCOKD PAK AMEBIOAN SGIBirTIFIO 00KGBE8S. 

Hemiptera. Ptoece que el g^nero Conarrhintu, pr6ximo al Lamus, y algunas dino- 
c6rida8 (Uetularku) pueden tambi^n hacer el papel de hu^sped intennediario. 

Es evidente que el par&uto se adapta ^Umente a variadas condidones natuialee 
7 ezperimeatalee (coltivos, etc.)- Recientemeate sugiere Ohagas que el annadillo, 
Datjfput novemeinetus, puede ser el depositario natural del par&aito. 

Dada la adaptabilidad del oiganiomo no debe mara illamoa que la infeccidn se haya 
geneializado en la c<nnarca y que constituya un gra -faimo hctor de de0tn]cci6n y 
degeneiaci6n en las claaes pobree. En los perfodos de su deaanollo adiptaee tambi^n 
el par&aito a variadas localisaciones endocelulares que producen, en la esquizogonia, 
multiples ledones de di ersos drganos, como el tiroides, el sistema ner /iooo y el muscu- 
lar, incluyendo el coraz^n. La gametogonia se produce en las cdlulas endoteliales 
de los capilares del pulm6n. Tftmbi^n los eritrocitos albergan por alg6n tiempo a 
los merosoitos en su crecimiento. Esta mtUtiple exubeiancia da lugar a la mis 
extiaordinaria c(Hnbinaci6n de sfntomas, desde el case agudo de 10 a 30 dlas de dum- 
ci6n, hasta las variadas manifestaciones ci6nicas que constituyen diveraas fformas de 
la enfennedad: la peeudomixedeznatosa, la mixedematosa, la cardiaca, la nerviosa y 
la forma cr6nica con exacerbaciones agudas. 

Las formas agudas ocurnn generalmente en la primera infancia, de manera que las 
formas cr6nicas que se presentan en nifios que sobreviven al ataque agudo, tienen la 
duiBcl6n toda de la vida paza extender su miserable carrera de infortunios. 

La enfennedad se caiacteriza siempre por una hiperplaaia del tiroides con dismlnu- 
cl6n de su acti idad fundonal, por lo que se le ha dado el nombre de tyrtnditU para- 
iUaria. Presenta, mis o menoe intensamente, los fen6menos del hipotiroidismo, asf 
como tambi^n los de la insuficlencia suprarenal. Si consideramos por un momento 
los efectos de estas insuficiencias glandulares y los que ban de producir mdltiples 
lesiones del sistema ner ioeo, formas difusas de meningo-encefalitia, lesiones miocardf- 
ticas mia o menos extensas, no deber&n de sorprendemos las siguientes palabras del 
Dr. Chagas: "Melhor fdra, no ponto de \ista social, viesse sempre a morte ellmlnar 
da comunhfto humana esses especlmes de degenera^fto esquizotripanosica, evitando 
asaim a continual de umavidaimproducente." Mejor fuera, dice, desde el punto 
de ' Ista social, que viniese siempre la muerte a eliminar de la comunidn humana esas 
muestras de degeneraci6n esquizotripanosica, evitando de este modo la continuaci6n 
de vidas improducti\ as. 

La naturaleza de este trabajo no me permite entrar en descripciones m^ completas 
de tan singular enfennedad y debo ahora poner tOrmlno a esta serie de ligeros bosquejos. 
Permftaseme, sin embargo, que al concluir insista por un momento sobre el punto 
m^ saliente de esta nue. a doctrina de enfermedades transmitidas por insectos, punto 
que no - acilo en declarar, es el beneficio inmenso que le ha reportado a la humanidad. 

Podemos predecir con satis&icci6n los resultados del descubrimiento del Dr. Chagas 
sobre aquella poblaci6n degenerada, cretina, paralitica, de las comarcas del ^'orte de 
Minas Greraes. Podemos predecir c6mo se eliminar& allf otra de las rdmoras que 
impediian la marcha de los pueblos tropicales. La mayor parte de las enfermedades 
que hemos bosquejado en este trabajo afectan especialmente al hombre de los tr6picoe, 
y algunas han despoblado extensas regionee de aquella zona. 

Desde el comienzo de estos estudios he crefdo, y asf ha pensado tambi^n nuestro 
Presidente, que la nue\ a luz ser& punto de atracci6n para los fundadores de imperios, 
y que un gran por\ enir le espera a las razas que han venido luchando contra inniune- 
rables obst4culos para reno\ar las grandes civilizaciones del pasado en las tierras 
del Sol. 

Y pensar, Sefiores, que un hombre clamaba por largos afios en el desierto, clamaba 
en \ ano para que el mundo viese la nueva luz. A €1 dedicamos las palabras de Oarlyle : 
''Cuintas \ eces hemos \ isto algdn explorador aventurero que, entre las censuras de la 
mdltitud, penetra por regi6n ohidada y distante, pero de importancia vital, cuyos 
tesoros eecondidos fu6 H el primero en descubrir y proclamar persistentemente, hasta 



P0BLIO HBALTH AND ICBDIOUIB. 29 

<]iie la atenci6n uni eisal y el Offueno allf m fijaron, y el triunfo fu^ completo. De 
tU modo, en aquellas sus excuniones, al parecer sin rumbo, abre nuevas orientacionee 
y fonda coloniae habitables en la vasta exteiui6n ambiente de la Sombia y de la 
Ifada/' (Sartor ResartuB. Chapter I.) 

BIBUOOftAliA. 

1. Annarlo eatadiiBtico de Yeneaaela y docmnentoa de 1011 y 1912. Caracas, 1913. 

2. Arribilaaga, Fdllx Lynch. Dipterologia Argentina. Revi$ia del Miueo d§ la 
Plata, 1891. 

3. Beanperthuy, Loola-Daniel, Travaux adentifiquesde, docteur en m^dedne des 
i^olt^ de Paria et de Caracas. Naturaliste Cian^ais et mirrographe. Bordeaux, 
1891. 

Xn atto alk) pobUotf lot maoiMBrltOi im taennaiio del Dootor. Aste Miedtf en •! afio 1871. Sedlotqiw 
«Df Ideas mUin InoorponMSai eo oMDanleadouM dirisldai a la Academlm de Peril eiitie loc efloe de 18SS 
7 ISO. Kl eapflolo eobie flebie emerine del llbro i|iie eDtee m dte, ie pablied en "La Oaceta Ofldal da 
Onaana'^deBuyoSSdelSM. Dedletioee|)ftiiloliaaolMeiteegiieaoontliiiieflidDaparaeeB. 

Deipiilsde deeir que habfa lido nombndo mMloo nnmldpal de Comena durante laepldemia de flebia 
amerille de 1868, oontlnda: 

*'Dans la mission que j'arais k remplir, j'apportais le fruit de quatcNrse ann^ea 
'd'obsen ations faitee au micioacope sur les alt^tions da sang et dea antrea fluidea 
•de r^onmnie animale dans les fi^^res de tons les tsrpes." 

Despu^ de algiinas declaracionea muy tetminantes con respecto al tratamiento^ 
•borda el tema de la etiologfa en los siguientes t^iminos: 

L'affectioa connue sous le nom de typhus amaril, de vomissement noir, etc., est 
inoduite par la mdme cause qui produit les fi^vres r^mittentes et intennittentea. 
Cest par suite d'une distraction bien grande qu'on a fait de la fi^vre jaune une maladie 
inflanunatoire. L'ezamen microscopique des mati^res noires lejet^es par les indi« 
\idus atteints de la fi^vre jaune montre qu'elles sont de la mtoie nature que celles 
obser ^es dans les fi^vres intennittentes, r^ittentes et pemicieusee. L'analogie est 
complete ; c'est la m6me substance, k la couleur prte qui est jaune, verd&tre ou ohscure 
4]ans les autres iidfvres. II n'y a de difif^nce que dans le degr6 d 'intensity de la 
maladie. Sans la preoccupation de vouloir Caire de la ft^vre jaune une affection dis- 
tincte des autres fibres, on eut tenu compte da- antage que ce mal reconnatt pour 
cause lea mtees foyers de putrefaction produite par la decomposition des suV stances 
animales et veg^taies qui occaaionnent les fi^ res que Ton nomme miasmatiques de 
tons lea types; et que ces fibres coexistent constamment a ec les epidemies de typhus 
amaril. Sou^ ent, du reste, la fi^ re jaune re*, ^t une fonne normale qui n'eet paa 
one complication (comme on Ta donne k entendre) et preaente les types remittent et 
intennittent, et dans ce cas tons les auteurs sont d'accord sur Tefficacite des anti- 
periodiques pour enrayer la marche de cette affection. Nous ne pou ons partager 
I'oplnion dea auteura qui attiibuent lea symptdmes obser. es dans la premiere periode 
de la fi^re jaune k une gastrite. L'autopsie ne confinne paa cette mani^re de - oir, 
puiaque dans le plus grand nombre de caa la muqueuse intestinale est intacte, et lea 
ecchymosea qu'on obaer^ e quelquefois k sa surbce ne doi ent pas 6tre plus attrilueea 
k nn etat inflammatoire que lea petechiea et eechym<)8es de la peau ne procMent de 
^inflammation de cette memhrane. Ces epanchements sont dus k la grande lique- 
faction du sang qui suinte en quelque sorte k la surface dea muqueuses, comme cela 
ani e dana le scorbut, la fi^ie typhdde, dans les cas de mort due k la morsure dea 
serpents -* enimeux, etc. 

Le frisson, la cephalalgie, lea naiis6es, les etourdissements, la courbature, etc., qui 
s'observent an debut du typhus amaril, aontlea mteies symptdmes qu'on observe, k 
un moindie degre, il est vrai, dans I'invadon des fidrvres rfoiittentes et intennittentes; 
et personne ne s'est avise, dans ces demi^res maladies, de les attribuer k Tinflammatum 
de la membrane gastro-intestinale; et jamaia cea symptAmes n'ont ete regaidea comme 
une contre-indication k Temploi dee antiperiodiquea. 



30 PB0GEEDIN6S SECOND PAN AMEBICAlir SCIENTIFIC CONGRESS. 

Le typhus amaiil est une fi^vre de type anormal, qu'on doit attaquer sans attendre 
la remission des symptdmeSy et il faut administrer les neutraUsants des influences 
r^put^es miasmatiques, dans le fort m§me de la fi^vre, conime cela se pratique dans les 
premiers acc^ des fi^vres pemicieuses: m^thode qui est constamment suivie des plus 
heiireux succ^s. 

Qu'il me soit permis, en tenninant ce court expoe^, de dire quelques mots des 
traitements pr^onis^ dans le but de ranger la fi^vre jaune sous Tempire de certaines 
doctrines. 

La saign^e est constamment nuisible. Elle a deux graves inconv^nients: celul 
d'activer I'absorption de la mati^re alt^r^e et qui constitue k un degr^ avanc6 la 
substance noire des dejections, et de preparer une convalescence tr^ longue. Les 
saign^es locales sont ^galement nuisibles pour les m^mes raisons, bien qu'& un moindre 
d^r6. 

Les vomitifs sont, pour le moins, inutiles. lis fatiguent les malades, et n'ont pas 
la puissance de d^truire Tagent morbide. 

Les purgatifs ne sont indiqu^s que lorsque les antip^riodiques ont neutralist raction 
d^l^t^re de Tagent r^put^ miasmatique. 

On ne pent consLd^rer la fi^vre jaune comme une affection contagieuse. Les causes 
de cette maladie se d^veloppent dans des conditions climat^riques leur permettant 
de s'6tendre k la fois ou successivement sur plusieurs localit^s. Oes conditions sont: 
rei^vation de la temperature, I'humidite, le voisinage des cours d'eau, les lagunes, 
le peu d'ei^vation du sol au-dessus du niveau de la mer. Ces conditions sont celles 
qui favonsent le d^veloppement des insectes tipulaires. 

La fi^vre jaune n'^tend jamais ses ravages dans les terrains marecageux de Tint^rieur 
de la province de Cumand. Elle est inconnue dans les belles et fertiles valines de 
Cumanacoa, de San Antonio, de San Francisco, Guanaguana et de Caripe, valines 
destinies k devenir avec le temps de grands centres de population, et dont Paltitude 
varie de 200 k 800 metres. 

La fi^vre jaune ne diff^re des fi^vres putrides, r^mittentes et intermittentee, que 
par I'intenaite des symptdmes. Comme ces maladies, elle se d^veloppe apr^ une 
p^riode plus ou moins longue d 'incubation, p^riode pendant laquelle les fiuides 
lymphatiques et sanguine sont alt^r^s profond^ment, avant m^me qu'aucun symp- 
tdme fasse entendre son cri d'alarme. 

Les tipules introduisent dans la peau leur 8U9oir, compost d'un aiguillon canalis6 
piquant et de deux scies lat^rales; ils instillent dans la plaie une liqueur venimeuse 
qui a des propri^t^s identiques k celles du venin des serpents k crochets. II ramoUit 
les globules du sang, determine la rupture de leurs membranes t^gumentaires, dissout 
la partie parenchymateuse, facilite le melange de la mati^re colorante avec le s6rum. 
Cette action est en quelque sorte instantan^e, comme le d^montre Texamen micros- 
copique, puisque le sang absorb^ par ces insectes, au moment m^me de la succion, 
ne pr6sente pas de globules. Cette action dissolvante paraft faciliter le passage du 
fluide sanguin dans le conduit capillaire du 8U9oir. Si Tinsecte est interrompu dans 
reparation de la succion, tout le venin reste dans la plaie et produit une plus vive 
d^mangeaison que lorsqu'une grande partie du fluide venimeux est repomp6e avec 
le sang. On attribue sans motif le prurit k la rupture de Taiguillon; cet aiguillon est 
une substance conime eiastique, dont je n'ai jamais observ6 la rupture dans mes 
Bombreuses observations. 

Les agents de cette infection pr^sentent un grand nombre de vari^t^s qui ne sont 
pas toutes nuisibles au m§me degr6. La variety zancudo bobo^ k pattes ray6es de blanc» 
est en quelque sorte Tesp^e domestique. Elle est la plus commune et sa piqiire est 
inoffensive comparativement k celle des autres esp^ces. Le puyon est le plus gro6 
et le plus venimeux; il produit une gale; son aiguillon est bifurqu^ k son extr^mit^; 
sa piq(hre, dans les cas plus favorables, oik le venin n'est pas absorb^ dans I'economie, 
determine une irritation locale qui presente la forme d'un bouton pruzigineux sem- 



PXTBLIC HEALTH AND MEDICINE. 31 

blable an scabies purulent, mais nuUement contagieux. C'est surtout les enfants 
qn'il attaque. L'6teiidue du foyer de suppuration rend difficiles les recherches qui 
tendent k d^couvrir Texistence du sarcopte dans ces v^sicules. 

L'acide carbonique sulfur^ et Thydrog^ne phosphor^, gaz d^gag^s dans la decompo- 
sition des mati^es animales et v^g^tales en putrefaction, peuvent bien, k un certain 
degr^ de concentration, determiner Tasphyxie; mais jamais produire un malaise 
comparable aux symptdmes des typhus ou des fi^vres d'acc^. 

Les plages des regions ^quatoriales et intertropicales sont couvertes de debris de 
plantes marines, de poissons, de crustaces, de moUusques, etc., dont I'accumulation 
produit une fermentation tr^ active, surtout k repoque de Fhivemage, quand les 
pluies et Thumidite de la saison forment de nouveaux elements ajout^s k la putrefac- 
tion. Les racines et les troncs des paietuviers (rhizophora) et autres arbree peiagiques 
«e couvrent k maree haute de couches de mati^res animales, de mucosites et de myria- 
des de zoophytes geiatineux, dont les vastes bancs, s'etendant pendant certaines 
saisons de Tannee k plusieurs milles de longueur sur la surface des floto, sont generale- 
ment connus sous le nom de agua mala. A la maree basse, toutes ces substances 
glutineuses appliquees contre recorce des arbres se dess^hcnt et forment un enduit 
qui ne tarde pas k se corrompre. Les insectes tipulaires que frequentent les sombres 
retraites formees par les mangliers, maintiennent leur existence en absorbant ces 
fluides decomposes. C'est accidentellement, on pent le dire, qu'ils font servir le sang 
de Phomme k leur nourriture, et dans ce cas, la puissance dissolvante des sues contenus 
dans le tube intestinal de ces insectes est telle, que les globules du sang sont ramollis 
et liquefies d'une mani^re presque instantanee, comme j'ai eu occasion d'en faire I'ob- 
servation au moyen du microscope. Que sont ces mati^res peiagiques dont les tripu- 
laires se nourrissent, ainon des substances animales phosphorescentes comme la chair 
des poisBons? Qu'y a-t-il d'etrange que I'instillation dans le corps de Thomme de 
ces substances k retat putride produise des desordres tr^ graves? M. Magendie 
n'a-t-il pas prouve que quelques gouttes d'eau de'po^^Bon pourri, introduites dans le 
sang des animaux, determinaient en pen dlieures des symptdmes analogues k ceux 
du typhus et de la fi^vre jaune? N'est-ce pas, en effet, une instillation de poisson 
en putrefaction que versent ces insectes sous la peau et dans le tissu cellulaire de 
Fhomme 7 

II n'est plus necessaire de chercher poorquoi le typhus icterode, si commun au 
voisinage de la mer, est si rare dans Tinterienr des terres et sur les lieux pen frequentes 
par les insectes tipulaires. On a observe k la Basse-Terre, capitale de Tune de nos 
Antilles, que les epidemies de fi^vre jaune n'etendent pas leur influence pemicieuse 
jusqu'au quartier du Matouba, localite situee k une distance k peine d'une lieue de 
cette ville. II faut convenir que cette distance est bien rapprochee pour preserver 
le Matouba des effluves pretendus nuiaibles exhales sur le littoral, et que les courants 
aeriens qui leur servent de vehicules peuvent y transporter en peu de minutes quand 
le vent souffle dans la direction de Touest; tandis que cet eioignement du livage de 
la mer, c'est-2i-dire des localites habitees par les insectes tipulaires, est plus que 
soffisant pour preserver de leur action et des graves inconvenients qu'elle produit. 
D'ailleurs la chimie n'a-t-elle pas examine les gaz des marecages et des mati^es 
animales en putre&tction? Ses moyens parfaits d'analyse lui ont permis de recon- 
nattre que les produits volatUs de ces decompositions ne sont que des acides carb- 
onique, hydrog^ne sulfure et hydrog^ne phosphore. II est parfeitement reconnu que 
ces gaz peuvent k un certain degre de concentration determiner Tasphyxie, mais 
jamais produire auciine maladie comparable aux symptdmes des fi^vres d'acc^. 

Non seulement le virus des insectes tipulaires varie selon leurs espies et les localites 
qu'ils habitent, mais aussi selon les saisons de I'annee. 

O'est aprte les grandes inondations et k repoque de Tabaissement des eaux qui les 
aiTosent que les alluvions deposees sur les bords des fleuves sont reputees malsaines. 
La retndte des eaux abandonne les mati^res animales et veg^tales emp&tees dans ces 



82 PBOCEEDINGS 8EC0KD PAST AlffEBIOAK 80IEHTIFI0 OONOBBSa. 

teminfl fangeux aux aideun da soleil qui active puiflBamme&t lour piitr6&ctioii. C'eat 
alon que lee piq(U^ des insectes tipulaiieB qui a'alimentent de ces sabstaxicea d^com- 
poB^ cauaent plus d'iiritation et aont plus dangereuBes. G'est une vMt6 reconnue 
8ur les bords de tous les giandB fleuvea des pays chauds, que les fi^vres essentielles 
diminuent et sont plus b^nignes pendant la croe des eauz. Gee faits s'appliqnent 
k TAmazone aussL bien qu'au Magdalena. On sait que la peste dieparatt en Egypte 
k r^poque du d^bordement du Nil. 

On a dit que les effluves d^ag^ des mar^cages exeicent sur r^conomie animale 
une influence plus nuisible pendant la nuit que pendant le jour. Pour queUe raison 
en serait-il ainsi? Oes effluves ne sont-ils pas au contraire beaucoup plus abondants 
pendant le s^jour du soleil sur llioiizon? La chaleur n'est pas I'agent le plus actif 
de la decomposition des mati^res v4g6tales et animales, et de la fonnation des gaz qui 
s'en ^chappent? C'est une explication peu satisfaisante que la supposition de Tinno- 
cuite des effluves, pr6cis^ent dans le moment de la joum6e ot ils sont plus abondants. 
On a admis que ces effluves, apr^ avoir mont^ dans Patmosph^ durant le jour, 
retombaient pendant la nuit comme une ros^e malfaisante an voisinage des mai^cagee. 
Pour que cette explication tat exacte, il faudrait admettre rinunobilit6 de Pair au- 
desBus des endroitB mai^cageux. L'ateiosph^ de ces locality n'est-elle done pas 
■oumise k ces grands courants a^ena qui bailaient avec une vitesse de plusieurs lieues 
par heure la superficie de la tone? Que deviennent les effluves au milieu de ces 
grands mouvements de ventilation? Bans les r^ons 6quatoriales et tropicales, c'est 
pr^ds^ment pendant le jour que le soleil, ce puissant ventilateur, donne impulsicm 
aux courants a^ens, et c'est au contraire pendant la nuit que Tatmoflph^ reste en 
calme. 

AnimaleuUs de la fih)re jaune; Vermiueaux Jympkatiquu, — Ces animalcules se meu- 
vent dans toutes les directions, remontant le courant, et sont dou^ d'un mouvement 
de giration de droite k gauche et de gauche k drdte. 

Une trte petite quantity de sulikte de quinine mdlang^ avec le liquide, paralyse 
instantandment Taction des animalcules. Ils sont entzatn6i par le cours du liquide 
sans manifester aucun mouvement. 

Nota. — Get article a et6 public dans la Gazette offidelle de Gumani, le 23 mai 1854, 
num. 57. 

AlgniiM han cnldo ver en la dta intBrior donde dice: "mrntntto te6o, a pattet laytfw de blaae" qoa 
Beanperthuj seflalaba eete moiqiilto de patas rayadas de blaooo como el eaiuante de la flebn amaiiHa, 
La verdad es <iae el menelonado aator dice praebamente to oontrario. 81 ie lee ouldadoeamoiite todo at 
IMuaJe en que ooone la ftase antes dtada, le obaerrarA que Beaapertbay evldenteniente oonfdnde doe 
elases oonmnes de moeqoitos rayados, a aaber, el Aeiet {Stefomifia) eUoput, j el Ouiex toUeUa^M. Eete 
iUtlmo mereoe Terdaderamente el nombre de bobo. Es may fidl mater este mooqolto eoaodo se posa 
sobie la pieL Loeontrario sooede eon el ediopiu que esimo de los mosqaitos mis tItos, todo loeoDtraiiode 
bobo. El toiieitant Invade las babitadones bumanas en grandes ndmeros y, stn la piedsldn de nnestroa 
eonoolmlentos aotaales, se le tomaila por ana espeete dom^stka. El beobo de oonslderar Beaaperfbny 
este Maneuio bobo oomo espede domtetlea le indaoe a seikalaro eomo el menos pellgroso de los mosqaitos 
porqoe tiene, sapone H, menos oportonldad de aUmentane de las sobstandas animates y TesBtales en 
dssoomposlddn, las ooales, segdn laereenoia de Beauperlbuy oontlenen los anlmAkaJos de la flebie *"*m*"h 

4. Berkely, William E. Laboratory work with mosquitoes. New York, 1902. 

5. Boyce, Robert W. Mosquito or man? The conquest of the tropical world. 
London, 1909. 

6. Britiah Museum. How to collect mosquitoes, 1899. 

7. Garter, H. R. Notes on the sanitation of yellow fever and malaria from isthmian 
experience. Reprint from New York Med. Record, July 10, 1909. 

8. Oastellani and Ghalmers. Manual of Tropical Medicine, 1913. 

9. Ghantemesse et Mosny. Traits d'Higi^ne, Vol. XVII, Etidogie et prophylaxie. 
Maladies transmissibles par la peau, 1911. 

10. Gldment, A. L. Destruction des insects et autres animaux nuisibles. 

11. Doty, A. H. On the extermination of the mosquito. Am. Journal of the Med. 
Sdencei, February, 1906. 



FUBUO HBALIH ASD MXDIGOrS. 88 

12. Doty, A. H. The Moflquito: Its relation to dueaae and its extennination. 
New York State Journal of Med., May, 1906. 

13. Finlay, Oarlos J. Trabajos selectos. Selected papers. Pablicacl<Sn del 
Gobiemo de Cuba, Habana, 1912. The first publications of Finlay on the trans- 
mission of disease by mosquitoes may be found also in ''Transactions of the Interna- 
tional Sanitary Conference of Washington." Protocol Nt&m. 7, session of Feb., 1881, 
p. 34, and in the An. de la Real Acad, de Sciencias M6d. Fis. y Natur. de la Habana^ 
y<A. XVIII, p. 147, session of Aug. 14, 1881. 

See also, " Method of Stamping out Yellow Fever suggested since 1899 " in " Selected 
Pi4[)ei8" above mentioned, or Transactions of the Conference of State and Provincial 
Boards of Health of North America, Oct., 1902, or New York Med. Record, May 27, 
1S99. 

14. Galli-Valerio, B., y Rochaz, J. Manuel pour la lutte contreles moustiques, 1906. 

15. Geihardt, C. Ueber Intermittensimpfungen. Zeitschr. f. klin. Med., VII, 
8. 373, 1884. 

16. Giles, G. M. A. Handbook of the gnats or mosquitoes. London, 1902. 

17. Gdldi, Emil A. Die sanit&risch-patholpgische Bedeutung der Insekten. 
Berlin, 1913. 

18. Goigas, W. C. Sanitary Work on the Isthmus of Panama during the last three 
years. Reprint from the New York Med. Rec., May 19, 1907. 

19. G<»gas, W. C. Sanitation of the Tropics with special reference to malaria and 
yellow fever. Reprint from the Journal of the* Am. Med. Asso., April 3, 1909. 

20. G<ngas, W. C. Sanitation of the Canal Zone. Address delivered at the Com- 
mencement Exercises of Johns Hopkins Univ., June 11, 1912. 

21. Grail, Ch, et Clarsc, T. Traits de pathologie exotique. Vols. I and III, 1910 
and 1912. 

22. Grubbs, S. B. Vessels as carriers of mosquitoes. Yellow Fever Institute, 
XT. S. Mar. Hosp. Serv., 1903. 

23. Grunbeig, Earl. Die blutsaugenden Dipteren. Jena, 1907. 

24. Howard, L. O. Economic loss to the people of the United States throu^ 
insects that carry disease. U. S. Dept. of Agric, Bureau of Entomology, Bui. Ntim. 
78. 

25. Howard, L. O., Dyar, H. G., and Enab, F. The Mosquitoes of North and 
Central America and the West Indies, 3 vols., published 1912, 1915. 

26. Howard, L. O. Mosquitoes. How they live, etc.. New York, 1901. 

27. Howard, L. O., and Mailat, C. L. llie principal household insects of the 
United States. U. S. Dept. of Agric, 1902. 

28. Howard, L. O. Remedies and preventives against mosquitoes. U. S. Dept. 
of Agric, Fanners' Bui., 1911. 

29. Howard, L. O. The mosquitoes of the United States. Dept. of Agric, 1900. 

30. Kendall, A. I. Experiments in practical culicidal fumigation. Bui. Ndm. 2, 
Board of Health, Isthmian Canal Com. 

31. King, A. F. A. ''Insects and disease, mosquitoes and malaria." Abstract of 
a paper on "The prevention of malarial disease, illustmting, inter alia, the consen a- 
tive function of i^e," read before the Philosophical Society of Washington, Feb. 10, 
1882. Popular Science Monthly, New York, Sept., 1883, pp. 644-658. 

Annqne haofa m§a de un afio que Levenm hablft deeooblerto el Plasmodinoi enando el Dr. King eeeilMd 
sa trebi^lo, no le refleie fete a aqnel deaeabrimieiito. Bl Dr. King diee: "Bs mi principal objeto presentar 
en este tnbalo kaheoluM que pnedaen defenM del orifen eoliddo de las flebns maUrieas." Pareoe pennr 
el Dr. King, lo mlnno que el Dr. Nott eon leepeoto a la ilebre amarilla, qne el moeqnlto ee en elerto modo 
el aemte morbllloo. For eio emfrfen m trabajo de la stgatente manera: "El origen «i^««»r^ifti' o inaectil 
de las enfermedades no es una nueva idea." Como quionque sea, el Dr. King, qne eserfbid nn aHo despote 
qne el Dr. Finlay habfa hecbo sns deetaradones con rsspedo a la transmisldn de la flebre amarilla por el 
mosquito, no se lefleie en manera algnna a la tiansmisibiUdad del pahidlsmo de hombie a hombie, ni por 



34 PROCEEDINGS SECOND PAN AMERICAN SCIENTIFIC CONOBESS. 

el mosquito ni por ningitai otro medio. Contleiie, sin embargo, su trabiOo una serie de inisenlosos argn- 
mentos que praeban que la preeencia del pahidismo se reladona de algto modo oon la presencia de miieqiii« 
tos. Brevemento ezpreaados los argumentos son: Coinddencia de oondidones Ultricaa y cUnUlticas qu« 
favorecen a los mosquitos y a la enfennedad; semejanza de oondidones que protejen al hombre contra Is 
flebre y contra insectos; la aglomeracidn de casas se opone al desarrollo de mosquitos y de la malaria. De 
la mlsma manera estudia la aocidn de la interposiddn de bosques, del cnltivo del terreno, de la inundaeite 
de las tlerras, de la ezposiddn durante la noebe, del uso de fuegos, de la Influenda de las oenpadonefly da 
la elevaddn sobre el nival del mar j, flnalmente, la odnddenda del paludismo y de los mosquitos. 

Es este, sin dud a, un ingenioso rasonamiento; pero no alcanso a descubrir que dlflera esendalmente del 
que, en forma mis orada, llevd a pueblos ign<Mantes en dlversos palses a las mlsmas conchislones que ex- 
ponen Beauperthuy, Nott y King, es deolr, que los mosquitos tenfan algo que ret con la producddn del 
paludismo. 

32. Knab, Frederick. Unconsidered factors in disease transmission by blood- 
sucking insects. Journal of Economic Entomology, Vol. V, No. 2, 1912. 

33. La.eran, A. Note sur un nouveau parasite trouv^ dans le sang de plusieuis 
malades atteints de fi^re palustre. Acad, de MM., Paris, 23 Nov., 1880. 

34. Manson, Patrick. Tropical medicine. London, 1903. 

35. Mense, Karl. Handbuch der Tropenkrankheiten. Zweite Aufl., 1913. 

36. Mitchell, E\ elyn G. Mosquito life. New York, 1907. 

37. Mosquitoes or GuUcidae of New York State. New York State Museum, 1914. 

3S. Ke propongo reprodudr fragmentos del trabalo del Dr. Nott, porque entiendo que no se le ha com- 
prendido y hasta se oita err6neamente el tftulo de su publieaddn, que es como signe: 

Nott, Josiah C, IC. D., Mobile, Alabama. "Yellow Fever contrasted with Bilious Fever. Reasons 
for believing it a disease su<(P0n«ri«. Its mode of propagation. Remote oanse. Probable insect or aolmal- 
colar origin, eto." New Orleans Medical and Siirgiisal Journal, VoL IV, No. fi, Mardi, 1848. 

Rs el trabajo del Dr. Nott, considerando la 6poca en que se esoribid, un hAbil argumento en pro de la 
teoila mierobiana de las enfennedades. La freouenda con que emplea la palabra "insecto " como slndnlmo 
de <'anlmiUoulo" o germen o mlcroblo, como dirfamoe ahora, y el uso que frecoentemente haoe de serss 
mito elevados en la eocala animal, verdaderos insectos, para sus expUcadones, ban conduddo al error da 
ereer que 61 defendfa la idea de la transmisidn de la flebre amarllla por el mosquito. 

Siguen los fragmentos del trabalo dtado: 

I now propose to give the results of my observations on the peculiar hahits, or what 
may be called the natural history of this disease, and my reasons for supposing its 
specific cause to exist in some form of insect life. 

I propose now to show, from fatcts presented during the various epidemics in Mobile, 
that the morbific cause of yellow fe. er is not amenable to any of the laws of gases, 
vapors, emanations, etc., but has an inherent power of propagation, independent of 
the motions of the atmosphere, and which accords in many respects with the peculiar 
habits and instincts of insects.^ 

Before entering on the ''Insect HypotheaLs" in detail, it ma^ be* well to give a 
familiar illustration of it, based on fiacts well known to all classes m the cotton region. 
The perfect analogy between the habits of certain insects and yellow fever will thus 
be made apparent at once. 

It is a law of nature that every plant affords sustenance to several parasitic insects. 
The cotton plant, like others, is attacked by its parasites, ha ^ ing their peculiar habits 
and instincts. One or se eral of these insects may appear the same season, and, true 
to their instincts, each attack, different jparts or organs of the plant, as the leaves, 
bark, woody fiber, roots, pods or bolls, nowers, etc. Some years there may be an 
entire exemption m>m one of these insects, or, to use a medical phrase, there may be 
a few spoiaaic cases. At another time a worm may appear at a single point, and 
from this focus will spread slowly over a portion of a fiela (as did the yellow fever in 
1842 and 43), leaving the other portion almost untouched. In another year a worm 
comes like a great epidemic, appearing at many points in rapid succession or simul- 
taneously, and ravaging not only a single plantation but laying waste the cotton 
region for several hundrad miles. 

All the attempts heretofore made to account for the greater activity of the morbific 
cause of yellow fever at ni^t have failed, and in my humble opinion the ^t may be 
much better explained by a reference to habits of insect life. Many of the Infusoria, 
as well as insects proper, are rendered inactive by too much light, heat, or dryness. 
They remain quiet through the day^ and do their work at night. 

It was not my plan to argue the insect origin of periodic fe \ ers in this paper, but 
the morbific causes of fevers have been so long and so inseparably united in the 
minds of the profession that it is almost impossible to tear them asunder now. 



PTTBLIO HEALTH AKD lODIOINB. 85 

All writers are a^;reed on the fact that a very imperfect barrier will obstnict the 
prpgren of marsh miasmata — ^row of houses or of trees, etc., will often effectually 
protect dwellings from the access of this hXal poison. It is moreover asserted that 
these miawmw are not only impeded but attiacted by trees. 

I ha e been a^ le in my researches, to disco er no facts of this kind in connection 
with yellow fever, and my personal obser ation repudiates them in toto. We ne^ er 
find yellow fe er as the sportsmen say *'up a tree" but on the contrary, the materies 
morbi, whate er it may be, creeps along the ground, regardless of winds, passing 
finder and through houses, trees, etc., and knowing no impediment but a sneet m 
water.' 

^ Contagion. If by this term we understand that a morbid poison generated in one 
li ing body may by contact, either mediate or immediate, reproduce an identical 
disease in another, then are we justified in denying that yellow fe^ er is a contagious 
disease. But while without hesitation I take this position, I am equally strong in 
the con iction that there exists no conclusi e e iaence that the germ or materies 
mofbi may not be transported from one locality to another. There are many curious 
facts connected with this question which require a pa«ing notice. 

The insect theory here awn comes to our aid, and mav explain diflfeulties which 
ha e much perplexed writers on contagion. The early history of yellow fe er 
is in ol ed in great obscurity, and many of the highest European authorities belie e 
that this disease was imported originally into the Old World, and that it may still 
be transported from one country into another. There is no time here for discussing 
this point, and I will only say that the mass of authority in fa or of this opinion u 
fluch as to challenge our full respect; no reasonable man, in the present state of ^ts, 
oin assert positi ely that yeUow fe- er may not, under peculiar circumstancee, be 
transported. 

I have shown that yellow fever often commences in a point from which it gradually 
extends from house to house for several weeks. Now it is clear that in this case there 
must be a local, though in iedble. cause; it can not exist in the atmosphere, as it could 
not, if thus diffused, be confined to a point. Suppose the infected point and a few 
flurrounding acres of ground were taken up in August and put down m the center of 
New York or Philadelphia, is it not probable that the disease would spread from that 
point as in Mobile? If so, why may not the morbific cause be carried and thrown out 
of a vessel with a cargo of damaged coSee, potatoes, grain, sugar, meat, etc.? The 
germ might here find a niding place, though I na e no idea that the gaseous emanations 
from these * egetable or animal substances could produce yellow fe er. We ha e 
no reason to belie e that such emanations, differing so widely in themsel es, can 
produce one specific disease. 

We ha e e idence around us almost constantlv that the germs of inserts lie dormant 
for indefinite periods and are then suddenly called into acti ity and propagated with 
inconcei a^ le rapidity. By what ph3nsical causes these sleeping and waking states 
are go erned, human sagacity can not yet di ine. 

It is prol^aMe that yellow fe er ia caused by an insect or aninudcule bred on the 
ground, and in what manner it makes its impression on the system, is but surmise — 
unless the animalcule is, like that of psora, bred in the system, we could no more ex- 
pect it to be contagious than the bite of a serpent. We'may therefore easily under- 
stand that it can at the same time be transportable in the form of germ ana yet not 
contagious. 

As according to the theory we are discussing, the natural history of yellow f e- er 
is closely allied to the natiual history of insects, it ia proper that I should say a few 
words more on the latter. The infusoria or microscopic animalctdes particularly 
demand a passing notice, as few of our readers ha e access to original sources on this 
curious subject. It has, I think, been pretty clearly shown that the propagation of 

Sellow fe er can not be explained by tne malarial theory, and it must remain with 
ie reader to determine whether the chain of analogies offered render the insect theory 
more provable. 

The habits and instincts of larger Insects are obscured by numerous impediments, 
but how much more perplexing must be the natural history of those whicn can only 
be reached by powerful microscopes? We ha e learned much about the infusoria 
proper, but myriads of minute beings might inhabit the air uid e- en congregate in 
eucn numbers as to dim the light of the sun without our being able to seize and observe 
them. Denyiujj; animalcules the power of flight, which would be absurd, there are 
etill ample pro isions of their transportation long distances, whether in the form of egg 
or perfect animal. 

> It is ft curloua fact tbat from 1829 to 1837 there was no epldMiiio of yellow fever in MobOe, and during 
this thne the streets were beaiitiftiUy shelled; slnoe 1837 we have had it five times, and the shelling was 
not ooQtinued. If the insect theory be correct, could the lime be an impediment to their progress acroas 
streets? 



68436— 17— VOL ix- 



86 PBOOEEDINGB 8EC0ND PAH AMEBIOAXT SOIBXrilFIO OOKOBBSCI. 

The narcotic pouonfl, for example, though deri^ ed frmn different plants and diffeiing^ 
in their analysiB, will often produce Bvmptonui so alike as to render it impossible for 
us to decide under which a patient is laboring. The same confusion will be found in 
the poisonous effects of different snakes, spiders, etc. In like manner fevers, if 
arising from insects of the same genus, might present some general characteristics in 
common and yet preser e specific differences. 

The history of tnose great epidemics which sweep over the surface of the globe affords 
very strong support to the insect theoiy . 

' * Whatever is true as to the habits of insects obvious to our senses is likely to be more 
especially so in those whose minuteness removes them further from observation. 
Their generation may be presumed to be more dependent on casualties of season and 
place; their movements determined by causes of which we have less cognizance; 
and their power of affecting the human body to be in some ratio to their multitude 
and minuteness." This last paragraph is quoted from Sir Henry Holland. 

39. Nuttall, George H. F. On the rdle of insects arachnids and myriapods, as 
carriers in the spread of bacterial and parasitic diseases of man and animals. Re* 
print from the Johns Hopkins Hospital reports, Vol. VIII, 1899. 

40. Osbom, Herbert. Insects affecting domestic animals. U. S. Dept. of Agri- 
culture, 1896. 

41. Pasoe, Jos6 H. Gontribuci6n al estudio de los mosquitos de Cuba. Boletin de 
Sanidad y beneficencia, julio-diciembre, 1909. 

42. Peryassd, Antonio Gon^alves. Os culicideos do Brazil. Trabalho do Insti- 
tute de Manguinhos. Rio de Janeiro, 1908. 

43. Proceedings of the Medical Aaso. of the Isthmian Canal Zone. Half-yearly, 
1910-1913. 

44. Rosenau, M. J. Disinfection against mosquitos. Bulletin No. 6. Hygienic 
laboratory, U. S. Marine Hosp. Service. 

45. Revista de Modicina Tropical, Vob. I-VII, 1900-1905. 

46. Rubner, Gruber u. Ficker. Handbuch der hygiene, Vol. Ill, 1913. 

47. Scheube, B. Die krankheiten der warmen l&nder. Jena, 1910. 

48. Sergent, Edmond. Determination des insects piqueuis et suceurs de sang. 
Paris, 1909. 

49. Sergent, Ed. et Er. Moustiques et maladies infectieuses. 

60. Smith, Theobald, and Eilbome, F. L. Investigations into the nature, causa- 
tion, and prevention of Texas southern cattle fever. Bulletin No. 1, Bureau of Animal 
Industry, U. S. Department of Agriculture, Washington, 1893. 

51. Surcouf, J. M. R., et (xonzalez Rincones, R. Essai sur les dipt^res vuln^rants 
du Venezuela. Paris, 1911. 

52. Theobald, Fred. V. A. Monograph of the culicidae or mosquitos. 4 vols, and 
Atlas, 1901-1907. 

53. Vermoret, V. Les pli^ges lumineux et la destruction des insects, 1902. 

Malaria. 

54. Bertrand et Klynens. La malaria, 1903. 

55. Celli, Angelo. La malaria secondo le nuove ricerche. Roma, 1899. 

56. Darling, S. T. Transmission of malarial fever in the Canal Zione by anopheles 
mosquitos. Journal of the Am. Med. Asso., Dec. 18, 1909. 

57. Same. Factors in the transmission and prevention of malaria in the Panama 
Oanal Zone. Annals of Tropical Med. and Parasitology, July, 1910. 

58. Gorgas, W. 0. The sanitary organization of the Isthmian Oanal Zone as it bears 
upon antimalarial work. 

59. Grassi, Battista. Studi di uno zoologo sulla malaria. Roma, 1900. 

60. Guiteras, Juan. Malaria, in Manual de Pr&ctica Sanitaria. Issued by the 
Health Department of Cuba, 1905. 

61. La^ eran, A. Du paludisme et de son h^matozoaire. Paris, 1891. 

62. Mannaberg, J. Die malaiia-krankheiten in Nothnagers Specialle Pathologie 
a. Therapie. Vol. II, 1899. 



PUBLIO HEALTH AISTD MEDIGINB. 87 

63. OreoBtein, A. J. Moequito catching in dwellings in the prophylaxis of malaria. 
American Jour, of Pub. Health, February, 1913. 

64. ''Fklludism " being the Transactions of the Committee for the Study of Malaria 
in India. SimU, Nos. l-^S, 1910-12. Also Proceedings of the Third Meeting of the 
General Maboia Committee, 1913. 

65. Ross, Ronald. The prevention of malaria. London, 1910. 

66. Stephens and Christophers. The practical study of malaria, 1908. 

67. Stembeig, G. M. MaUiria and malarial diseases, 1884. 

Plague. 

68. Agramonte, A. The Ute outbreak of plague in Havana. Reprint from Amer- 
ican Journal of Trop. Diseases, July, 1914. 

69. Agramonte, A. Plan de campafia sanitaria contra la peste bub6nica. Secre- 
tarfa de Sanidad y Beneficencia, 1915. 

70. Agramonte, L6pez del Valle, Guiteras. Discusidn sobre peste bub6nica. 
Acad, de Ciendas Med. Fisicas Natur, febrero 26, 1915. 

71. Baker, Carl F. The classification of American Siphonaptera. U. S. National 
Museum, 1905. 

72. Bamet, E. B. La peste bub6nica. Junta Sup. de Sanidad, Cuba, 1903. 

73. Boelter, W. R. The rat problem. London, 1909. 

74. Clemow, A. G. Plague in Siberia and Mongolia and the Tarbagan. The Jour- 
nal of Tropical Med., Feb., 1900. 

75. The same. The endemic centers of plague. Journal of Tropical Med., March, 
April, May, 1900. 

76. Creel, R. H. Epidemiology of plague in New Orleans. Am. Journal of Trop. 
Dis. and Prev. Med., Sept., 1915. 

77. Cruz, Oswaldo Gonyalvez. Peste. Institute de Mangguinhos, 1906. 

78. Bager, J. M. The present pandemic of plague. U. S. Pub. Health and Mar. 
Hoep. Service, 1908. 

79. Giemsa, G. Ueber die vemichtung von ratten, etc. durch kohlenoxid. 
Arch, f . Schiffs-u. Tropen-Hygiene. Band XV, 1911. 

80. Guiteras, Juan. La pulex cheopis, transmlsora de la peste bub6nica entre las 
latas de la India es la pulga corriente en las ratas de la Habana. Comunlcaci6n verbal 
con pre8entaci6n de specimens. Anales de la Acad . de Ciencias Med . Fis. y Nat. , 1908. 

81. Guiteras, Juan. Three cases of bubonic plague in Habana. Journal of the 
Am. Med. Asso., Nov. 16, 1912. 

82. Guiteras, Juan, and Recio, A. Bubonic plague in Cuba. Reprint from Boletin 
de Sanidad y Beneficencia, 1915. 

83. Hart, Merriam C. California ground squirrels. U. 8. Pub, Health ReporU, 
Dec. 25, 1908. 

84. Journal of Hygiene. Plague numbers and papers. Vol. VI, No. 4, Sept., 1906; 
Vol. VII, No. 3, July, 1907; Vol VII, No. 6, Dec., 1907; Vol. VIII, No. 2, May, 1908; 
Vol. X, No. 2, Aug., 1910; Vol. X, No. 3, Nov., 1910; Vol. XII, No. 1, May, 1912; 
Vol. XII, No. 3, Oct., 1913; Vol. XIV, No. 3, Nov., 1914; Plague supplements I and 
II, 1912; III, 1914; IV, 1913. 

85. Eolle, W., u. Wassermann, A. Handbuch der pathogenen Mikrooiganismen. 
Pest. IV, Bd., p. 165, 1912. 

86. Lebredo, Mario G. Plan de campafia contra la peste bub6nica. Secretarfa de 
Sanidad y Beneficencia, 1915. 

87. liston, W. Glen. The cause and prevention of the spread of plague in India. 
Dec. 11, 1907. 

88. The rat and its relation to public health. Publication of the U. S. Pub. Health 
and Mar. Hosp. Service, 1910. 



38 PBOGEEDIKQS SECOND PAK AMEBICAK SCIENTIFIC CONOEBSS. 

89. Bosenaa, M. J. An inTestigation of a pathogenic microbe applied to the 
destruction of rats. Hygienic Laboratory Report No. 5, U. S. Mar. Hosp. Service, 
1901. 

90. Arthivf. Schiffg- u. Tropa^Hygiene, The fint volumea from 1B97 follow vevj 
cloeely the march of the plague pandemic. See also the Weekly Reports of liie 
U. S. Public Health Service. 

91. Simpson, W. J. Recrudesc^ice of plague in the East and its relations to 
Europe. The Journal of Tropical Med., Sept., 1899. 

92. Simpson, W. J. The Groonian lectures on plague. Journal of Trop. Med. and 
Hyg., July-Sept., 1907. 

93. Swellengrebel, N. H., u. Otten, L. Ueber "mitigierte" Pest Infektion bei 
Ratten, etc. Arch,f Schiffi- u. TroppenrHyg., Bd. XVIII, No. 6, 1914. 

94. Wyman, Walter. The bubonic plague. Publication of the U. S. Mar. Hoep. 
Service, 1900. 

YeUowfever. 

95. Agustin, Geoige. History of yellow fever, New Orleans, 1909. 

96. Boyce, Rubert. Yellow fever and its prevention, 1911. 

97. Carter, H. R. The period of incubation of yellow fever. New York Med, Ree., 
March 9, 1901. 

98. Same. The methods of the conveyance of yellow fever infection. Yellow 
Fever Institute, Bui. No. 10, U. S. Pub. Health and Mar. Hosp. Service, July, 1908. 

99. Same. A note on the spread of yellow fever in houses. 

100. Finlay, Carlos J. Trabajos selectos. Selected papers. Publicaci6n del 
Gobiemo de Cuba. Habana, 1912. The first publications of Dr. Finlay on the 
transmission of disease by mosquitoes may be found also in ''Transactions of the 
International Sanitary Conference of Washington," Protocol No. 7, Session of Febru- 
ary 18, 1881, p. 34, and in the Anales de la Real Academia de Ciencias M^dicaa, 
Ffsicas y Naturales de la Habana, Vol. XVIII, p. 147, Session of August 14, 1881. 

See also Method of Stamping out Yellow Fever suggested since 1899, in Selected 
Papers above mentioned, or Transactions of the Conference of State and Provincial 
Boards of Health of North America, October, 1902, or New York Medical Record, May 
27, 1899. 

101. Guiteras, Juan. Experimental yellow fever at the inoculation station, with 
a view to producing immunization. Amer, Medicine, Phila., Nov. 23, 1901. Pub- 
lished in Spanish in Revista de Medwina Tropical, Habana, Oct., 1901. 

102. Guiteras, Juan. The natural history of epidemics of yellow fever. Annual 
Report pf the Supervising Surgeon General of the U. S. Mar. Hosp. Service, 1888. 
Republished with notes on endemicity and infantile yellow fever, in Soletin d* 
Sanidad y Benejicencia, Dec., 1912. 

103. The same. La fiebre amanilla infantil. Revista de Med, Trop., Habana, 
abril, 1902. 

104. Marchoux, Salimbeni et Simond. Raport de la Mission Frangaise. Ann. 
de VlnsHtut Pasteur, Nov., 1903, p. 665. 

105. Otto, M., Neumann, E. 0. Studien ttber das Gelbe Fieber in Brasilien. 
Leipzig, 1906. 

106. Parker, H. B., Beyer, G. E., Pothier, O. L. A study of the etiology of yellow 
fever. Yellow Fever Institute Bui. No. 13, March, 1903. 

107. Reed, Walter, Carrol, James, Agramonte, A., Lazear, J. W. The etiology of 
yellow fever. A preliminary note. Read at the meeting of the American Public 
Health Asso., held in Indianapolis, Ind., Oct. 22-26, 1900. Reprint from the Pkila. 
Med. Journal, Oct. 27, 1900. 

108. Reed, Walter, Carrol, James, Agramonte, A. The etiology of yellow fevor. 
An additional note. Read at the Pan Am. Med. Cong, held in Habana, Feb. 4-7, 
1901. Published in Spanish in Revista de Medieina Tropical, Habana, Feb., 1901. 



PUBUO HEALTH AND HBDIOINB. 39 

109. Ribaa, Emilio, Lutz, A., Pereiia, Baneto, Bamw, A., Silva, Rodrfgues. Ex- 
periendas realizadas no Hospital de Isolamento de S. Paulo por iniciativa da Direc- 
toria do Servicio Sanitario do Eatado. Feb., 1903. 

110. West Africa, Duciusion on the distribution and prevalence of yellow fever 
in W. A. at the Society of Tropical Med. and Hygiene. Journal qf Trop. Med. and 
Bjfg,, Jan. 2, Jan. 16, Feb. 1, March 1, 1911. 

111. West Africa, Report of certain outbreaks of yellow fever. 

112. West Africa, Reports of the Yellow Fever Commission in 1912 and 1913. 

FUaria. 

113. Finlay, Carlos J. Conedderaciones sobre algunoe casos de Filaria obaervadoa 
en la Habana. An. delaR. Acad, de Cienciaa Mid. Fis. y Nat. de la Habana, 1882-83. 

114. FQllebom, Uebertragung von Filarienkrankheiten durch MQcken. Arch. /, 
8th. u Trop. Hyg., Band 11, No. 20, 1907. 

115. FOllebom, Beihefte. Vol. XII, 1908. 

116. Guiteras, John. The Filaria sanguinis hominis in the United States. Chy- 
luria. Medical News, Apr. 10, 1886, p. 399. 

117. Lebredo, Mario G. Metamdrfosb de la filaria sanguinis hominis noctuma en 
el mosquito y causas que acceleran o retardan su evolucidn. Punto por donde salen. 
Modo experimental de hacerlas salir bajo el microscopio. Revieta de Medieina Tropiealf 
julio-agosto, 1905. 

118. Manson, Patrick. The filaria sanguinis hominis. London, 1883. 

119. Mastin, W. M. History of filaria sanguinis hominis, 1888. 

120. KtUlez, Enrique. La drugla de las manifestaciones filari6sicas. Ptemio de 
la Academia, 1905. 

121. Wucherer. GauUa Med. da Bahia, Dec., 1868. 

TyjAue/ever. 

122. Anderson, John F., and Goldbeiger, Joseph. A note on the etiology of "Tabar- 
dillo," the typhus fever of Mexico. Public Health ReporU, Dec. 24, 1909. 

123. Anderson, J. F. Typhus fever, its etiology and methods of its prevention. 
XT. 8. Publ. Health ReporU, Apr. 30, 1915. 

124. Brill, Nathan £. An acute infectious disease of unknown origin. A clinical 
study based on 221 cases. Am. Journal of the Med. Sdencee^ -^P'-t 1^10. 

125. Plotz, Henry. The etlcdogy of typhus fever (and of Brill's disease). Prelim- 
inary conununication. Journal of the Am. Med. Aeeo., May 16, 1914. 

126. Niccolle, Gh. Reproduction exp6rimaitale de typhus exanthtaathique ches 
le nnge. Compt. Bend. Acad, de Sdencee, juillet 12, 1909. 

Rocky Mountain fever. 

127. Anderson, J. F. Spotted fever (tick fever) of the Rocky Mountains. A new 
disease. Hygienic Lab. Bulletin No. 14, U. S. Pub. Health and Mar. Hoep. Service^ 
1903. 

128. Ashbum, P. M., and Craig, Ghas. F. A comparative study of tsutsugamushi 
disease and spotted fever or tick fever of Montana. Manila, 1908. 

129. McCtintic, T. B. Rocky Mountain ifpotted fever, being the last season's notes 
(1912) before he died of the disease he was studying. Public Health Reports, Apr. 

24. 1914. 

130. Reed, R. Harvey. A contribution to the study of mountain fever. Journal 
Am. Med. Asso., April 20, 1908. 

131. StOes, Gh. Waidell. A zoological investigation into the cause, transmission^ 
and source of Rocky Mountain "spotted fever." Hygienic Laboiatory Bulletin, No 

20.1915. Public Health and Mar. Hoep. Service. 



40 PBOOEEDINOS 8E00in> PAK AMEBIGASr 80IBKTIFI0 OOKOBlSBa. 

Oroifafever. 

132. BaaselrSmitli, P. W. The pathology of the blood in Voniga. Bril. Med. 
Joum,, 1909, Sept. 15, p. 783. 

133. Biffi, Ugo. Sobre las hemoaglutmas de la aangre humana y hematologia de 
la ''enfeimedad de Cam6n." Bol. de la Acad. NacUm. de med. de Lma^ III, 1903, 
No. 2. 

134. Biffi y Garbajal, G. Sobie un caso de ''enfermedad de Gam6ii" con verruco- 
mas supuiados. Cr6nUsa midiea, XXI, 15 de Oct. de 1914. 

135. Hirach. Handb. d. hist-geogr. Path.- 2. Aufl. II, 1383, p. 78. 

136. Odiiozola, Ernesto. Estado actual de nuestios conocimientos acerca de la 
enfennedad de (^mi6n o verruga peruazia. lima-Perd, 1908. 

137. Odiiozola. Gae. med, de Lima, 1858, abril; Med. Tim. andCfax., 1858, Sept., 
p. 280. 

138. Ruge, R. Zur geographischen Pathologie der WestkOste Sadamerikas. Berl. 
Uin, Woeh., 1897, No. 46, p. 1005. 

139. Salazar. Gae, med, de Lima, 1860. 

140. Strong, Richard P., Tyzzer, E. E., Brues, Charles T., Sellards, A. W., Gasti*- 
buni, J. G. Verruga Peruviana, Oroya Fever and Uta. Preliminary report of the 
first expedition to South America from the department of tropical medicine of 
Harvard University. Jour, of the Am, Med, Aeso., Nov. 8, 1913, Vol. LXI, p. 1713. 

141. Tamayo, M. O. Apuntes sobre la bacteiiologla de la enfermedad de Gani6n. 
Cr6n, Mid, Lima, junio, 1913. 

142. Townsend, 0. H. T. La Zitira es trasmisora de la Verruga Peruana. Cr&niea 
Med., junio, 1913. 

143. Townsend, Charles H. T. The Transmission of Verruga by Phlebotomus. 
Jour, of the Am, Med, Aseo., Nov. 8, 1913, Vol. LXI, p. 1717. 

Sjnrodiaetoeii. ^ 

144. Balfour, Andrew. The spirochaetae of Egyptian relapcdng fever. FoiurA 
Heport of the Wellcome Trojrieal Research Ldboratories, 1911. 

145. Breinl, A., Kinghom, A. Observations on the animal reactions of the spixo- 
'chaetae of the African tick fever. Lancet, March, 1906. 

146. Same. Studies on spirillum Obermeieri and related organisms. Jour, ef 
Inf. Die,, Chicago, May, 1906. 

147. MtUilens, P. RuckfalMeber. Spirochftten. Handbuch der path, mikrooig. 
Kolle u. Wassermann, Bd. VII, p. 864, 1913. 

148. Novy, F. G., Xnapp, R. E. Spirochaetae Obermeieri. Jour. Am. Med. 
Aeeo., Jan. 13, 1906. 

149. Seigent, Edm., Foley, H. Recherches sur la fi^vre recurrente. Arm. de 
rinetitut Faeteur, May, 1910. 

TVyponofomtom. 

150. Chagas, Carlos. Nova tripanozomiaze humana. Estudios sobre a morfolojta 
e o ciclo evolutive do Schizotarypanum cruzi n. gen. n. sp. ajente etiolojico de nova 
entidade morbida do homem. Memoriae do Inetiiuto Oewaido Crue, agosto, 1909. 

151. Chagas, Carlos. Nova entidade morbida do homem (Rezumo geral de estodos 
etiolojicoe e clinicos). Memoriae do InetUuto Oewaido Crue, Tomo III, Faciculo 
II, 1911. 

152. Diaz, Ezequiel. MolesUa de Carlos Chagas. Estudios hematologioos. Memo- 
riae do InetUuto OsunUdo Cruz, T(nno IV, Faciculo 1, 1912. 

153. Guerreiro, Cezar. Observa$oes urolojicas na molestia de Carlos Chagas. 
Memoriae do InetUuto Oewaido Cruz, Tomo IV, Faciculo 1, 1912. 

154. Hartmann. Notiz Hber eine weitere Art der ScMzogonie von Schizotrypanum 
cruzi. Arch,/, ProOetenhunde, 1910, Vol. 10, p. 361. 



FUBUO HEALTH AKD MBDIOlSJft. 41 

166. ICayer, Martm, it. da Bodia-Iima, H. Zvm Veilialteii von SdiiaotrjriMiram 
enisi in Wannbltttem und ArUiropodeii. Arddv/. SMft u. Trop.-Hyg.^ Beihefte, 
Vol. XVIII, 1914. 

166. VlamiA, Qmpar, Oontxibu^ao pm o eatado de MiatomiA patolojica de "Mo- 
leetia de Carloe Ghagas" (Esquisotripaiioie humaiia on tbreoidite pansitaria). if«mo- 
Km do Inttttuto OnoaXdo Cnu, Tamo III, FlMdculo II, 1911. 

Dr. AfifsTiDES AoBAMONTE. Before beginning the discussion of 
tliis interesting paper of Dr. Guiterasi I beg to move you, sir, tliat 
ihe su^estions which Dr. Guiteras has made toward modifying the 
articles adopted by the last Pan American conference be referred to 
a committee for action, report, and recommendation; and, further- 
more, that the chairman be authorized to appoint this committee. 

The motion was seconded and unanimously approved. 

The Chaibman. Since this subject is somewhat allied, I will refer 
it to the committee just appointed, consisting of Dr. Guiteras, Dr, 
Carter, and Dr. Vital Brasil. 

Col. John Van R. Hoff. It has been suggested that Section Vlll 
of this congress consider most praiseworthy the work done in Cuba by 
the various organizers of the health organization there, and pass a 
resolution of thanks and applause to said organizers. I wish to 
make this motion. 

The motion was seconded and unanimously approved. 

The Chairman. As Dr. Carter's paper will be upon much the same 
subject as that of Dr. Guiteras, the chair will rule that further 
cussion be postponed until the conclusion of Dr. Carter's paper. 

Hereupon, Dr. Agramonte, of Habana, Cuba, took the chair. 



immunitt to yellow fever. 

bt h. r. carter, 

AitisUnU Surgeofi General, UniUd Statu PvMic EedUh Service. 

Whether the immunity produced hy an attack of yellow fever is permanent or 
temporary is a disputed point among modem epidenuologiBts. Naturally, a diaeaee 
produced by microorganiflme and which recoven spontaneously must produce im* 
munity, local or general, temporary or permanent, else one would not recover. That 
it is permanent has been, and is now, the opinion of American epidemiologists and 
of the older generation of the French and English writers, who added so much to our 
knowledge of this disease by their observations in the West Indies and in Africa. 

There was, however, a very common belief among the laity of localities in which 
yellow fever was endemic that leaving such focus of endemidty for a sufficient time 
would restore the susceptibility to the disease. This belief is alluded to by many 
writers. It was, I think, universally regarded as erroneous by those not living in 
endemic areas, but given more consideration and sometimes, I think not generally, 
tSSameA by writers who live in such endemic areas. 

On the other hand, a commission of the Pasteur Institute (Marcbouz, Salimbeni, 
and Simond), working at Rio Janeiro in 1903 to 1905 sUte categorically that the im- 



42 PBOGEEDINQS 8E00KD PAN AMEBIGAN 8GIBNTIPIC C0NQB£8£k 

immunity produced by an attack of yellow iever gives temporary immunity only 
and that the infection ia kept up in endemic centers by recurrent attacks among 
the indigines. This view is reiterated by other recent French observers and, so 
far as recurrent attacks being common, is accepted by Seidelin, Bubert Boyce, and 
others. Indeed, it is fair to say that this view, that recurrent attacks of yellow fever 
are common, is held by nearly all of the writers recently engaged in investigating 
the epidemiology of yellow fever. Seidelin seems to base his belief mainly on the 
occurrence of sickness in men who have had yellow fever before, which attacks he 
pronounces to be also yellow fever on account of finding in the blood of these patienta 
the organism, Paraplaama flavigenum, he believes to be the cause of yellow fever. 

When the statement above quoted was first made by Marchoux «Dd Simond no 
evidence therefor was, I think, given. A large amount is given, however, by Simond 
and his collaborators in the report on the epidemic at Martuiique in 1908 and 1909. 
This report is far stronger in its implication of recurrent attacks than it is in asser- 
tions of definite recurrences in individual cases and it is a strong report Without 
criticising it — ^this would require a greater knowledge of the nosology and epidemi- 
ology of Martinique than I possess— it is so at variance with what I have seen in the 
United States, in Cuba, and in Panama that it seems advisable to give such reasons 
as I have for the opposite view. Especially as one would suppose that in the United 
States where greater intervals occur between epidemics of yellow fever, which have 
also been apparently both more extensive and more severe than those in Martinique^ 
one would be more apt to find recurrent attacks than in that island. 

In speaking of the immunity given by an attack of yellow fever beLog permanent — 
generally permanent only is meant. Absolute immunity given by one attack is 
not predicated of any disease. 

Obviously, the natural method of testing this question is by observation of the 
exposure of men who have had yellow fever to the infection of that disease and deter- 
mining if they contract it again. The existence of the infection and degree of ex- 
posure would be judged of by the proportion of cases contracted by those who had not 
had yellow fever similarly exposed to infection as controls. If a negative result ia 
reported the observation would be convincing in proportion to the number of sup- 
posedly immune men thus exposed, the intervals from their last attacks, the degree 
of exposure, and the certainty that secondary attacks did not occur among them. 

Such observations are not rare. For instance, at the end of 1879, there must have 
been a very small proportion of the population of New Orleans, Mobile, and the coast 
towns between them who had not suffered an attack of yellow fever in that or in 
previous years. They were free from yellow fever until 1897. In that year and 1898 
there were widespread epidemics. Yet recurrent attacks were reported in extremely 
few cases in these towns in 1897 and 1898, 18 years later. Certainly no considerable 
number of well-marked cases could have occurred in those years. The same is true 
of many other epidemics and many other towns in the United States. We can readily 
present then a large number of people having had one attack of yellow fever exposed 
alter sufficiently long intervals to infections very prevalent among those who had 
not had yellow fever with report of no, or extremely few, cases of yellow fever among 
them. 

Ought not this to be convincing of the permanency — the general permanency— of 
the immunity? Put yourself on the other side. The first three factors in the evi- 
dence: The number of people exposed, the lengths of the intervals and the prev- 
alence of the inf ection^-you will readily grant us; but I fear that a question will be 
raised on the last condition — the certainty that secondary cases did not occur. The 
question will be asked: Is it certain that yellow fever did not occur, and quite gen- 
erally, among these people? It would be held that on accoxmt of bdieving that one 
attack gives permanent protection we would not recognize yellow fever occurring 
among them. 



PX7BLI0 HBALTH AND MBDIOIHB. 43 

There is truth in this contention. We of my generation have accepted previous 
opinion on this matter and, not having found it contnulicted by obvious facts, have 
not examined into the matter criticaUy. We assumed that one attack gave perma- 
nent protection. We would then have been little apt to consider an attack of sick- 
ness occurring in one who had previously had yeUow fever as yellow fever unless it 
was either (1) well marked or (2) gave rise to yellow fever in others. The first might 
not be the case with lig^t — certainly not witii ephemeral — attacks, the kind which 
would naturally occur as second attacks. The second we will consider presently. 

Even if a second attack were clearly yellow fever one with our belief would, in the 
absence of good evidence to the contrary, question the diagnosis of the previoudy 
reported attack. This it is natural to do because we know how many cases of other 
diseases are diagnosticated as yeUow fever during an epidemic. I did this in the 
case of an officer in my service, who died of yellow fever under my care at Ghande- 
leur in 1890. He was reported to have had yellow fever in 1878. For the acceptance 
of a second attack then it might require that a well marked case of yellow fever 
occur twice in the same person. Now, even under the doctrine of temporary immu- 
nity, this would be rare, as those who hold it also hold that there would be a lowered 
susceptibility from the first attack and that if the attacks were not very far apart 
the second one would be mild — or very mild — and that is reasonable. You can see 
then that we have not been in a proper state of mind to examine this part of the ques- 
tion critically, and indeed I at least have not done so. Even allowing for this, the 
number of second attacks reported in places in which yellow fever occurs only in 
epidemics — the places in which we would be most apt to expect them — are exceed- 
ingly rare. They ore reported, however, and the recognition of such cases is proof 
that our eyes are not so blinded by our belief that we can not recognize second attacks 
of yellow fever, if they be plain enough. I have seen three cases of yellow fever in 
people who were said to have had a previous attack. In two of them the evidence 
for the first attack seemed to me to be slight; the third I could not inquire into. 

When we come to individual cases, the men we knew who had yellow fever at one 
epidemic and were exx)osed to it a second time alter a considerable interval — and I 
Ittve eeen many suchr— the most I can say is that in my acquaintance I have not 
known a second attack to be reported. Drs. P. and W. had yellow fever in Memphis, 
Tenn., in 1878 and 1870, respectively, and were not exposed again until 1897 at Ed- 
wards, Miss., after intervals of 18 and 19 years. P. was not reported to have yellow 
fever at Edwards, but he was sick there with a diagnosis of malarial fever, which was 
also prevalent and to which he was subject. W. was not sick at all. Lieut. G. had 
yellow fever in Brownsville, Tex., in 1882. No exi>osure until 1898 at Siboney, 16 
years later. He was sick at, or after leaving, Siboney with a diagnosis of malarial 
fever, which was extremely prevalent. He did have malaria; plasmodia demon- 
strated and recurrent attacks for about a year; but that by no means excludes the pos- 
sibility of yellow fever. Dr. P., of my service, had yellow fever at Chattanooga, Tenn. , 
in 1878. Next exposure was at Panama in 1903 — ^26 years interval. He was, after 
nearly a year's residence in good health at Panama City, sick at Ancon Hospital in 
October, 1904, with what I myself thought was going to develop into a severe attack 
of yellow fever until the second day, when the case showed itself to be clearly dengue— 
I am satisfied that this case was dengue— ^thoug^ it was before we knew the diag- 
nostic value of the blood-picture — ^for it was a severe case, and such are well marked. 
The terminal eruption, too, was typical. Yet you see that one believing that secondary 
cases are common might find fault with the di^tgnoses of all (rf the above. I could add 
of my own knowledge I think from 25 to 50 cases to the above, but they would be 
more or less similar. Some did not get sick on the second or subsequent exposurei 
yet that is not convincing. Some people who have never had yellow fever go through 
an epidemic unscathed. Also, light attacks might well escape any notice. 



44 PBOGEEDINQS SECOND PAN AMEEIOAN 80IBNTIFIG 00N0BB88. 

The difficulty is that we recognize no sign as pathognomonic for all cases of yellow 
fever, the mild and ephemeral as well as the severe. It is trae that Seidelin claims 
to have such a sign in his Paraplasma flavigenum, and also to have demonstrated it 
in a secondary (ephemeral) case of yellow fever in himself and in others, some of 
whom showed no signs of illness— i. e. were "canieiB." Without in any way pro- 
nouncing on the validity of his claims, yet until his primary contention is con- 
firmed—the tranaferrence to guinea pigs is certainly discredited— we can not accept 
the existence of his bodies as pathognomonic of yellow fever and hence as proving 
a second attack. 

The second test, that yellow fever was communicated to others from cases of sick- 
ness of men who had previously had yellow fever, is again hard for us to apply. 

When you consider how freely men ''protected by a previous attack of yellow 
fever'' have been allowed to move from places virulently affected with that disease 
into susceptible communities in the United States, and how many hundreds of timea 
this has occurred during epidemics, you would think we should have satisfactory 
data on this subject, positive or negative. If not immune to yellow fever, some of 
these men should have contracted it and developed it in an infectable but not 
infected place, and even if not diagnosticated it should have infected mosquitoes 
and spread to others in whom the diagnosis would be easy. An epidemic can not 
be hidden. 

I know of no evidence that this has occurred, yet the evidence to the contrary 
has not been scrutinized critically. Since we did not believe that secondary cases 
of yellow fever occurred— or occurred very rarely — it an outbreak occurred we would 
be little apt to impute conveyance of yellow fever to any sickness of indeterminate 
nature occurring among people who were ''protected by a previous attack of yellow 
fever." Almost any other hypothesis would be accepted to explain it, or it would 
be left unexplained. Indeed, in times of epidemics there are so many ways in which 
infection can be introduced that an outbreak of which we are not able to explain 
the introduction is not to be wondered at. 

To use this test, then, we must depend upon the scrutiny of exposures of susceptible 
communities to cases of sickness of such "protected " men who had themselves been 
exposed to yellow fever and under such conditions that other sources of exposure of 
the community are excluded. Opportunity for this would rarely occur during an 
epidemic. 

As evidence that attacks of yellow fever do not recur among such "protected" 
people, these observations to be convincing must be on a large scale; there must be 
many failures of susceptible communities thus to receive infection. This would 
be negative testimony and convincing only in proportion to its mass. I know of 
no positive observations on this subject. It seems useless to relate the twenty-five 
or thirty— maybe fifty-^Qgative observations I could give you. They are not 
enough to be convincing. 

Possibly, however, we have in the passenger traffic of the Plant Steamship Line 
data of sufficient mass to be worth considering. From 1889 to 1890, inclusive (9 years) 
there was no bar to the transit on these vessels from Habana to Key West and Tampa 
of passengers "protected against yellow fever by a previous attack or 10' years resi- 
dence in an endemic focus," and a great many of them came— Cubans on their 10 
years' residence and Americans on certificates of a previous attack. There were 
dgar factories in Key West, Tampa, and Jacksonville, all manned by Cuban em- 
ployees. There were generally two vessels per week; part of the time three vessels. 
Habana was about 6 hours from Key West and 24 from Tampa. I am unable to get 
the exact numbers of these passengers on account of the destruction of the records 
of the State Board of Health of Florida by fire. Such reports of this board as are 
available to me give the number of such passengers as follows: 



FUBUC HEALTH AND MEDICINE. 45 



Tampa Bay quarantiiM 

1801, May 1 to October 31 2,620 

1802, May 1 to October 31 2,684 

1803, May 1 to October 31 2,440 

1804, May 1 to October 31 3,681 

Four years 11, 434 

Key Wert— 

1808, August, September, and October 3,134 

1804, May 1 to October 31 7,656 

One and a half years 10, 600 

In addition we have a Habana record showing that about 3,420 passengers were 
certified for Tampa in 1805 (2,850 from May to October 1). At the above rate the 
entries at Tampa would, for years, be 25,726. Gall them 20,000, to be conserva- 
tive. For the 8h<»t time of which we have record. Key Wert had double as many 
entries as Tampa, and this is in accord with my observation at the time in 1800. It 
will be very conservative, then, to put the number of these so-called "immune pas- 
sengers" at 30,000 for the yean— it was more likely 50,000 or 60,000. Many entries 
naturally were of the same people going backward and forward between Habana and 
Florida ports. Now, remember that this very considerable number of people— and I 
have given you minimal figures — came from a city where yellow fever was epidemic; 
that they came in hot weather; to towns where A9de$ eahpui (Stegomyia) were abun* 
dant and active and where people susceptible to yellow fever were also abundant. 
If, then, any considerable proportion of them after arrival had been infective to 
Aides calopuB (Stegamyia) 1 can not but think that there would have been at least 
<me outbreak of yellow fever in Florida during these years. There was none. 

Were these people so exposed in Habana that any considerable number of them 
would certainly have contracted yellow fever if they were susceptible to that disease? 
Let us see. That those who had not had yellow fever were liable, and very liable, to 
contract that disease firom exposure in Habana at this time was evidenced by the hia- 
tory of vessels from that port whose personnel had not had yellow fever. They fre- 
quently brought cases of yellow fever to our quarantine stations. In 1805 at the Dry 
Tortngaa I had 13 cases of yellow fever on Habana vessels out of a ciew lirt of less than 
450 men. Indeed the crew lirt of men exposed to infection in Habana was not over 
half of 450 as the steamers lay in a sale part of the harbor— Triacofia— and allowed only 
a very few men ashore and were practically free from fever. It occurred (with one 
exception) on vessels which had lain on the Habana side of the harbor. Unquestion- 
ably then, those susceptible to yellow fever could contract it in Habana during this 
time. 

Compare these observations: 

(1) Four-hundred and fifty people who had not had yellow fever, from Habana, 
gave 13 cases of yellow fever, every one of which should have been infective to Adde$ 
edapu$ (SUgomgia). 

(2) Thirty thousand people from the same place during a period covering the same 
time give no evidence of infecting JStfet eahjnu (Sleqomyia): certainly gave rise to no 
outbreak in the susceptible communities to which they moved. 

You may not consider this proof. There may not be enou^ of it to satisfy you; 
but the mass of this evidence, negative as it is, is sufficient, until the contrary is proven, 
to confirm me in my belief that for sanitary purposes the immunity conf ened by one 
attack of yellow fever is permanent: that lecunrent attacks, infective to Aides edhpu$ 
(SUgcmijia), do not occur and that we are justified in basing our sanitary measures 
thereon. It should at leart prevent your acceptance of the doctrine that the immunity 
confened by an attack of yellow fever ia quite temporary and that subsequent attacks 



46 PB0CBEDIXQ8 SECOND PAN AMBBICAN SCIENTIFIC CONQBE8S. 

infective to AMet ealopui {SUgomyxM) are common and that Banitary measuies hmiA 
on the contrary opiiiioQ era notjustifiabloand uunfe. TIub observation — thepasaen- 
ger traffic of the Plant Line — is also inconsistentwiththeexiatenceof "Canien"aBB 
common phenomenon capable of infecting £dt$ tadopK* {Sttgamgia) with yelloT 

I »ud "until the conliBry is i»nven," became if it be ever shovQ that an oi{^nism 
coueative ol yellow fever occurs in men who have had previous attacki of this diaeaae, 
and ia conveyable from them by Xda ealopui {SUgomyia) mosquitoes to othet tnao, 
producing yellow fever in them, I will count the contrary proven. I well know how 
much more determinative are the reeulta of experimental than of epidemioli^cat 
inveetigationB. Yet in this diaeaae it was, I believu, the latter that gave the key to 
the problem; whichdetermined the direction of the experimental inveetigatioii which 
demonatrated the method of coDveyanc«. I do not mean that tbia ia the only means 
of demonstration. Even if the cansBtive microorganism is not demonstrated, the 
frequent reciurence of clinical yellow fevtr in thove who have had one attack, as 
indicated in the Martinique epidemic sufficiently verified, would be proof. 

There are other epidemiological investigationa which an at least conaiHtent with a 
doctrine of permanent immunity such as the spontaneous disappearance of yellow fe vet 
from small and modiratflly sized towns in the Tropica which received few susceptible 
immigrants. I do not mean that thia always occura, but it ia by no meana rare ia 
America. The great decrease of infection in Habana in 1899, due to the falling off of 
immigration in the previous years, ia alao consistent with it. This was shown in thA 
small number of cases of yellow lever in the spring and summer of that year aa com* 
p«i«d with normal years, althou^ the town was full of Americans who went everywhere 
and of ^U* eaioput {Stegotmfidj. 



Is the immunity conferred by an attack of yellow fever permanent, or are subsequent 
attacks common? The fiiat is the view held by obaervera in countnea where yellow 
fever prevails epidemically. The second has bmn the beliti of many, especially of 
the laity, in endemic foci. It js now held by many eminent investigators who have 
worked in endemic fod of yellow fever; by the majority of rec«nt writen, I think. 

The evidence for the permanence of this immunity ou^t to be most abundant in 
places where yellow fever occurs in epidemics and much is brou^t forward, negative 
hom the nature of the case. This evidence would rarely be ntiEfactory to those hold- 
ing a contrary view, because the belief of the physicians in such places that thia 
immunity is permanent would render them little apt to recogniae secondary attacks 
unless they were well marked, and they would rarely be well marked. 
There are, however, some epidemiological data which, as far as they go, are evidence 
itdary cases infective to Aldei eatoput {StegoToyia). 
888 and 189S there entered Florida porta over 30,000 
d from yellow fever by previous attack, or 10 years' 
I. " They came during the summer, May 1 to October 
w fever prevailed during thia time— to Key Weet and 
ilopus {SUgomyia) and of people susceptible to yellow 
aa about 8 hours to Key West and 24 to Tampa. Aa no 
trida during this period there should have been no con- 
f attacks infective to Aida caiopu* (SUgovu/ia) among 

readily contracted from Habana by people susceptible 
during this time 450 people from Habana not certified 
tided 13 cases of yellow fever at a quarantine station, 
any one of which should have been infective to JJUs* 
among 4S0 men who had not suffwed from tme attack 



FUBUO HBALXH AKD MSDIOZNE. 47 

it would aeem that, if recurrent attacks were common, enough cases should have 
occurred among the 30,000 to have produced an outbreak in Florida. There was 
none. 

The above is also evidence that yellow fever carriers are not as common as alleged 
hy some modem observers. 

BEBLIOORAPHT. 

Maidioux et Simcmd. Annales de rinstitute, 1905 

iiarchoux et Simond. Etudes sur la Fi^vze Jaune. Ann. de Tlnstitute Pasteur. 

1906. 
Simond, Aubert et Noc. Epidemieologue Amarile. Ann. de I'lnstitute Pasteur. 

1909 
Oarac et Simond. La Fi^vre Jaune. Pathologie Exotique. Vol. 111. 
Seidelin Handd. Report of yellow fever expedition to Yucatan. 1911-12. 
Seidelin Harald. Nature and Control of Yellow Fever. 1912. 
Seidelin Harald. On the Existence of ''Pseudo-Carriers" of the Infection of Yellow 

Fever. 1914. 
British Yellow Fever Commission. Reports 1913 and 1914. 
Reports State Board of Health of Florida. 1891 to 1896. 

The chairman called for a discussion of the papers of Dr. Guiteras 
and Dr. Carter. The discussions in Portuguese and Spanish of Dr. 
Vital Brazil of Brazil, Dr. Elias Sag&maga of Bolivia, and Dr. Luis 
Migone of Paraguay were unfortunately not reported. 

Dr. Dahaso Riyas. This subject of tropical diseases is of great 
interest, and it has been so wonderfully illuminated by our teacher, 
Dr. Guiteras, that there is really nothing to add. Still, there are 
some other observations from the standpoint of my own experience 
that I would like to speak of. 

Emetin, since the subject has been mentioned, is not in my judg- 
ment a specific. I have treated cases of ameba dysenteriee with 
emetin, and I have been able to remove the ameba from the intestines 
if I searched long enough, but I never was able to find the occult blood. 
Z refer to that, because the occult blood is a test more delicate than 
the microscopical finding of the ameba. The ameba may not be 
foimd in sufficient numbers so as to be seen under the microscope, 
but the occult blood test I have found more reUable. Emetin has 
also been used a great deal in pyorrhea alveolaris. So far as my 
experience is concerned, it has no especial value. Of course, I woidd 
not say that emetin in dysentery has no tonic value. 

The discussion by Dr. Rafael Gonzalez-Rincones, of Venezuela, in 
Spanish was not reported. 

Dr. GuTTEBAS. Dr. Carter did not use, I think, an argument which 
certainly should have some weight, though it is of negative charac- 
ter also: It does not seem to me that it would have been possible to 
eradicate yellow fever from Habana, the neighboring cities and the 
country in Cuba in general, if the recurrence of yellow fever were the 
rule as these gentlemen seem to imply. To me that appeals very 
strongly. I do not see how yellow fever could have disappeared under 
these circumstances ; for instance, if it was being kept up in the interior 



48 PB0CEEDING8 SECOND PAN AMBBICAN SCDSKTIFIO CK>N0BES8. 

by repeated attacks among the Cuban population. We never should 
have seen the end of it, it seems to me. 

Dr. Casteb. When I spoke of the immunity from yellow fever as 
being permanent, I meant that it was generally permanent, as per^ 
manent as that of smallpox, of measles, and bf the other zymotic 
diseases. Secondary attacks unquestionably occur, but the teaching 
at present of certain schools is that secondary attacks are common, 
that immunity is not only transitory but very transitory, that it 
lasts but a short while. I was led to write this paper because recently 
I have been investigating the nature of a disease, trying to determine 
whether it was yellow fever or not. I found that it occurred habitu- 
ally among people who had been long resident in endemic centers; 
and in one case at least had occurred in one who certainly had had 
yellow fever. Three gentlemen whom I know, one who had worked 
with SeideUn in Africa, one who had worked with Simond in Mar- 
tinique, and a third, firmly beheve that there was no immimity beyond 
six months or a year or two years, that secondary attacks of yeUow 
fever were not only common but the rule. Therefore the conclusion 
that I tried to draw from the occurrence of this disease among those 
who had had yellow fever fell to the ground. I saw at once that 
they were properly unwilling to accept my statement of not having 
seen secondary attacks, of not knowing of secondary attacks, at a less 
value than I placed on it. It was perfectly true, as they stated, that I 
had not been in the proper mental state to fairly evaluate the symp- 
toms of obscure diseases or little ailments, ephemeral diseases occur- 
ring in those who had had yellow fever; that I did not expect them to 
be yeUow fever and therefore might overlook them. Therefore I made 
my argument and rested my case upon the broad epidemiological 
fact of the immune traffic from Habana to Florida, 30,000 (there 
are reaUy about 50,000) people who had had yellow fever coming 
from Habana in the summer time into a coxmtry where yellow fever 
was not prevalent, where stegomyia were present, and that was 
full of people who had never had yeUow fever. The time of passage 
was from 6 to 24 hours. If they had been subject to secondary 
attacks or if carriers had been at all common among them, it seemed 
to me that they would unquestionably have infected stegomyia in 
Florida. Out of this nimiber of people, from 30,000 to 50,000, 
some of them would have infected stegomyia and would have pro- 
duced an epidemic. Now an epidemic can not be hid. It is upon 
that broad epidemiological fact that I rest my thesis that secondary 
attacks in yellow fever are rare and from the sanitary standpoint 
need not be regarded. 

The CHAmMAN. If there is no further discussion I shall announce 
that the next paper will be read by title, as the author. Dr. Allen J. 
Smith, has just sent a telegram, stating that it will be impossible for 
him to be present this morning and read his paper in person. 



FUBLIO HBALTH AJSHD MEDIdlfB. 49 

nLABIASIS IN THE AMERICAa 

By ALLEN J. SMITH. 

McManu Laborator%e» of Pathology of the School of Medkinef Univenity of Penn' 

tylvarvia. 

In broad significance the terms filariasis, filariosis, and filarial disease have an 
inclusive application necessarily beyond the scope of an article intended for current 
presentation; although the writer in the course of literature consultation required 
for the preparation of the present paper has been fully persuaded of the desirability 
of an inclusive monograph upon the major title, embracing the filarial parasites both 
of man and of the lower animals, with appropriate presentation of their morphology, 
life histories, modes of acquirement, and of the pathological consequences of para- 
sitism by them, as well as their geographical distribution and histories. 

The full subject being of unwieldy proportions the present discussion will be 
limited to the geographical distribution and history in the Americas of those species 
of the filaridse which parasitize man, with further restriction, too, to those particular 
epeciee alone whose larval or microfilaria! stages ^ are met in the blood (for conven- 
ience, therefore, to the exclusion of Dracunculus medineruis (Linn., 1758), the ques- 
tionable species FiUxna oris Jiominis Leidy, 1860, and AgamofUaria georgiana Stiles, 
1906), and to a few points of particular interest to the writer in the clinical study of 
filariaais. Recently Padilla' published his discovery of the presence of a small 
aperiodic, actively motile microfilaria in the blood of persons presenting no symptoms 
referable to the parasites, in the Province of Tucuman in Argentina (in over 25 per 
cent of individuals examined in the Galera district, in over 16 per cent of those exam- 
ined in Arcadia). This he regards as a new sx>ecies (F, tucumant), in which view he 
is not, however, sustained by Neiva, of the Cruz Institute of Rio de Janeiro. The 
writer believes he would be acting prematurely in at once accepting the verity of 
Fadilla's new species, as in a number of respects (exclusive of its ensheathment, which 
Padilla asserts, but which might be a mistake when we remember that Manson himself 
at first thought the microfilarise of perstans were ensheathed) it closely resembles the 
larval FUaria demarqwayi. He may perhaps therefore at the present time be pardoned 
if no systematic discussion of the proposed species is included in the current paper. 
Unquestionably fuller knowledge with confirmation or with correction will shortly 
follow. 

AmEBIOAK FlLARIABIfl. 
1. FILABIA BANGROFTI (OOBBOLD, 1877). 

Synonyms: F. sanguinis hominis Lewis, 1872; F. sanguinis i^gyptica Sonsino, 1875; 
F. dermaihemiea da Silva Araujo, 1875; F. wUchereri da Silva Lima, 1877; F, noctuma 
Manson, 1891. 

Historical. — ^This, the pathologically most important and the most widely distrib- 
uted of the restricted group of filarial worms here under consideration, was discovered 

1 Tbe name mlcrofllarla, scu^gestod by Le Dantec in 1904 (Mslad. des Pays Chauds, Paris, 1910, p. 1000) 
as a oonvenlent term for the Termicatar brood met In the blood of the definitive host of whatever species, is 
varioosly employed as synonymous with the words embryo and larva. The writer believes that a differ- 
entiation of terms to be applied to the different early stages of the parasite is desirable; and he would sug- 
gest that the term fllarial embryo be applied only to the vermicule within the egg membrane within the 
uterus of the mother; that the term microfilaria or filarial larva be restricted to the vermicule, whether 
sheathed or free, after its birth and during its presence in the blood or other fluids of the definitive host and 
before its access to the intermediate insect host; that for the stage represented by the further developed 
wmicule in the mosquito or other intermediate host the term prefllaria be employed; and that these 
terms be understood as general to all species, to be employed in oomieetion with the spedflc name of th* 
adult fliaria when reference to particular stages of the early life of the parasites is desirable. 

> Bemana medloa, Buenos Aires, 1915, Sept 2S, anno 2^ p. S71. 



50 PBOCEEDIN08 SECOND PAN AMBBICAK 80IBKTIFI0 GONGBESB. 

in its larval or microfilarial form in 1863 by Demaiquay, in PftriSy in the fluid with- 
drawn from a hydrocele of a patient from Habana.' Demarquay's part in the history 
of the parasite attracted little attention and was practically overlooked until recalled 
in 1881 by Dr. Bemhaus de Lima.' Three years after Demarqnay's discovery, the 
parasite was independently found, again in its microfilarial stage, in the bloody and 
chylous urine of a number of individuals in Bahia, Brazil, by O. Wdcherer,* the hosts 
being for the most part natives of Brazil. By these first two demonstrations of this, 
the first known humau hematic microfilaria, America became definitely fixed in the 
history of our knowledge of this panunte. 

In 1870, Timothy R. Lewis* met the same larval filarise in Calcutta, in the chylous 
urine and later in the blood ' both of chylurics and of persons apparently in health. 
Lewis gave the first description of the ndcrofilarial sheath, and applied t^ these 
hematozoa the name Filaria mxnguiniM hominu (dropped by rule along with others in 
favor of the name first assigned to the later described adult worm of the species). 

In 1876, Bancroft, at Brisbane, Australia, after having encountered the larval form 
in chylous urine and in the blood, first met with an adult female parasite in a lym* 
phatic abscess; and the following year Cobbold, to whom the specimen was sent for 
study, described it and gave it the specific name FUaria hanarofti^ Shortly after 
Lewis ^ and Garter ', in India, also obtained adult specimens, the former contributing 
the fint description of the male. Da Silva Araujo* in October, 1877, in Bahia, aiMl 
about a month later doe Santos,'^ in Rio de Janeiro, first met with the adult parasite 
in the Western Hemisphere. 

From the time ot their first recognition until 1891 all microfilaria found in human 
blood were regarded in casual manner as identical and as belonging to the species 
here under consideration. Manson," to whom we owe so much of our knowledge of 
filariasis in general, in this latter year called attention to the fact that more than one 
species, represented by hematic microfilaria, infest man; and separated primarily 
those with microfilariae in the peripheral blood stream at night from those whose 
larvse are present in the peripheral circulation during the day, and those, the micro- 
filaria of which may be found in the peripheral blood both day and night. His 
names for these species, FUaria noctuma, Filaria diuma, and FUaria perstans are of 
commendable descriptive value; but in accordance with the rules of zoolc^cal nomen- 
clature the first and second are properly but synonyms for Filaria bancro/H Cobbold, 
1877, and Loa loa Guyot, 1807. 

The rdle of mosquitoes as intermediate hosts of Filaria bancrofti was first urged by 
Manson,^' his study being taken up from purely theoretical reasoning as to the need 
of some bloodsucking agent to free the microfilarifle from the original host. The 
experimental work was prosecuted in 1877, Manson feeding a number of bloodsucking 

> Oas. mM. de Paris, Oct. 11, 1863, p. 665. 

' These inaag., Rio de Janeiro, 1881. 

'Oas. iBQ^ ^ Bahia, Deo. 15, 1868, p. 97; Ibid., Sept. 30, 1860, p. 38; cf. Uxnspersw, Zeitschr. t Fire- 

flftenk, 1800, y. 1. p. 370; Leackart, Parasiten, 1876, Lelpsig and Heiddberg, t. 2, p. 040, et ante. 

^Sl^th Ann. Rep. Sanit. Comm., Qovt. India, Appendix A ,p. 130-178, 1870; Brit. Med. Jour., Not. 19, 
iWO. 

^-^Ishth Ann. Rep. 8anJt. Gomm., OoTt. India, Appendix E, p. 341, 1873; see also Quain's Diet. o(Med.i 
*' ^^yltniSy Filaria sanffuinia honUnit. 
T j**^n Lazuset, Joly U, 1877, v. 2, p. 70; iWd., Oct. 0, 1877, ▼, 2, p. 496. 
a ^"^don LMcat, Sept. », 1877, t. 2, p. 4S3. 
^ fl^v^*^^ ondoabtedly early pco p oeed explanation for the chylnric symptoms; hat the writer liss failed 
<>^,w^^ reference to the present connection of his name except in Bancroft, and Includes his name here 
^^^^l*^ o/the authority of Brumpt, Prteis de Parasitologie, 2d ed., 1913, p. 504. 
a% 3^^^ m^. da BablB, Ko'v. 1877; ahst. in Arch, de mM. naT., Paris, March, 1878. 
*^ ^^^^^KtmnmM., lUo da Janeiro, Dec. 16, 1877. 
^ J^Hdon Lancet, 1»1, ▼• *» P- *; Brit. Med. Jour. 1897, v. 2, p. 1837. 
^l^^J^-t^^^l^ London Laneet, 1878, t. 49, p. 09; Manson in Davidson's Hygiene and Diseases of Wsrm 
^'V^^^^^esL 1803 Edinhnrglt And London, p. 771; Jour. Linn. Soc. London, Aug. 1878, y. 14, ZooloKXi P* ^i 
^ UmL Soc., London, 1884, see. ser., r. 2, Zoology, p. 307. 




PT7BLIG HEALTH AND UEDlOtKB, 51 

insects upon a filariated individual and examining them at intervals therealter. In 
most of the insects the larval filarue were digested or else at least failed to develop; 
but in a certain mosquito they grew in size and underwent a developmental differen- 
tiation. His observations were early and fully corroborated by Lewis,^ Sonsino,' 
Silva Aran jo,' Bancroft/ and others. At first, while it was appreciated that the 
prefilarix underwent a probably necessary development in the mosquito, it was be- 
lieved that the latter, dying when ovipositing on water, was responsible in the greatest 
sense only for affording access of the parasites to water ; that they became free for a time 
in water; and were transferred to the definitive human host when water containing the 
vermicules was swallowed. The real part taken by the mosquito as the direct trans- 
mitter as well as an intermediate host came to be accepted only after the studies of 
Grassi and No^, and subsequently of FtUlebom, proving the direct transmission of 
Dirofilaria immitig Leidy, of the dog, by mosquitoes, and after further studies of Bian- 
son and Bancroft, and of Low,* James, and ^others, about 1900; but for a considerably 
later period the idea of water convection continued to attract adherents (as Audain 
and Ricot, in Haiti). ^ 

From the earliest observations the association of filarial parasitism with hematuria 
and chyluria was recognized, although not explained. An influence on the part of 
FHuTva bancro/H in the etiology of lymphvarices and elephantiasis was likewise sug- 
gested at an early date, as in the experience of Lewis ' and others; but perhaps to 
Manson's studies more than to any preceding influence should be credited our pre- 
vailing views as to the explanation of the relation between the parasite and these 
filarial manifestations, with the addendum of the further influence of bacteria (the 
dermococcus of Le Dantec) in inducing tbe recurrent and eventually chronic in- 
flamations which lead to the great fibrous overgrowth in the skin in elephantiasis. 

Geographical distrUnuion in America. — Precise information of the existence of this 
type of filariasiB is best afforded by examination of blood Withdrawn at nighttime by 
puncture of the peripheral circulation of the individual under suspicion; and from a 
reasonable number of such investigations of different life-residents of a given locality 
an acceptable idea of the endemic presence or absence of the affection and of its rate 
of incidence in the locality is attained. (It la true that if one will withdraw a larger 
amount of blood, hemolyse it and centrifugate, microfilariae of the species may be 
found at almost any time in the 24 hours; but during the day there is a chance that 
even by this method the parasites will be missed.) Data based upon such ideal 
methods of study are unfortunately obtainable in published form for only a com- 
paratively small part of the general American distribution. Hematochyluria, lym- 
phedema and elephantiasis are, it is true, comparatively common clinical complica- 
tions of filariasis of this type; but it must be kept in mind that other causes of 
lymph obstruction than filarial parasites are possible. The endemic prevalence of 
such conditions, however, is not likely to be due to such other influences; and in the 
absence of better evidence these complications are very commonly accepted as 
indicating the presence of this parasite in an area concerned. 

Based upon evidence of varying exactness, but in the main quite credible, it is safe 
to say, as most writers declare, that Bancroft's filaria is known to-day to be the most 
widely distributed species of filaria parasitizing human beings, extending unevenly 
throughout the whole tropical belt, and north and south in diminishing rate beyond 
the thirtieth degree of latitude. 

1 Proc Asiatic Boc., Bengal, Harch, 1878, p. 80. 
1 Med. Tlznes and Oac, Hay 27, 1882, p. 664. 

* Referred to by MagalhJUw in Bevieta doe Canoe theoricae • prat, da Facnlt. da MM.de Rio de Janeiro, 
1886, ann. 3, no. 3. 

* Scientific Lectures, Brisbane, 1879. 
> Brit. Med. Jour., 1900, ▼. 1, p. 1466. 

* Brit. Med. Joor., v. 2> P- ^« 

^ Fievres Intertropicales, Audain, 1900, Porto an Prinoe, pp. 79O-802. 
Eighth Ann. Rep. Sanit. Conun., Govt. India, App. B, p. 241, 1872. 

68436— 17— VOL IX 6 



52 PBOCEEDINGS SECOND PAN AMEBICAN SCIENTIFIC CONGRESS. 

As far u America is concerned, it is very improbable that the worm w indigenous, 
although no less acute and erudite clinical reasoner than Carlos Finlay * has raised the 
question of its pre-Columbian existence in the Western Hemisphere; suggesting that 
])ossibly the idol Tetzahuitl (meaning "a horror'') may have been intended to repre- 
sent filarial disease, being made in the image of a man with a necklace of 10 human 
hearts and with a great serpent about his body intertwined among a variety of animal 
figures. On the contrary, there is a prevalent belief, expressed as early as 1750 for 
elephantiasis by Hillary ' and repeated by many others, as in recent years by 
Daniels, ' that the species was introduced into America from Africa with the importa- 
tion of negro slaves. 

There are reasons, suggestive if no more, partly based on the history of human com- 
merce and travel in comparison with the grades of infestment of known districts and 
the history of ancient prevalence of such manifestations of filariasis as elephantiasis 
and chyluria, that would support the conjecture that the original location of the species 
was along the southern coast of Asia, and that the parasite spread thence east and west 
into Indo-China and Oceania on the one hand and into Africa on the other. In the 
latter continent it would appear to have taken a hold first in lower Egypt and the 
nearer shores, and to have followed thence along the east coast and to Madagascar, to 
have penetrated Africa along the Nile, and to have proceeded along the Mediterranean 
coast to and along the west coast of Africa, penetrating thence into the interior along 
the Kongo Basin. 

The known severity of infestment of some of the Antilles, the fact noted both by 
Hillary ^ and by Hendy ^ that elephantiasiB is said to have been rare at the beginning 
of the eighteenth century in Barbados (although later become so common as to have 
acquired the name ''Barbados leg"), and the absence of notice of such a striking 
phenomenon as elephantiasis in the detailed records of the discoverers and the con. 
querors (as the ''Decades" of Peter Martyr, Eden's Translation, 1565) give food for 
belief that with the transportation of negroes from the west coast of Africa the parasite 
found its first fixed hold in the Western "World in the West Indian Islands. From the 
frequent infestment of and high grade of prevalence in the Leeward and Windward 
Islands one may at least tentatively believe that the parasite found early lodgment 
here; although the relative importance of Cuba, Haiti, and Porto Rico make it im- 
probable that these large islands failed to be invaded as well. 

The widespread occurrence of filariasis in the West Indies was doubtless largely a 
sequence of interinsular communication, with perhaps repeated renewal from Africa. 
That the parasite spread from the island foci to the mainland is probable and is 
somewhat supported by the popular belief in Dutch Guiana' that elephantiasis 
was brought into that country in 1799 by negro slaves from Barbados. The marked 
grade of infestment in Brazil about Bahia and Rio de Janeiro, and the early employ- 
ment of negroes in the development of these districts, make it probable that here, 
too, direct importation from AMca determined special foci of parasites. The com- 
parative freedom of the Pacific coast, even in tropical America, in contrast with the 
long range of Atlantic coastal infestment, gives further weight to the general view here 
expressed of the origin of American filariasis of the Bancroft type from trans- Atlantic 
(presumably African) importation. 

As known to-day in America the species has been met in cases indigenous to the 
districts for which they were reported as far north as Philadelphia and in South 
America as far south as Buenos Aires. 

1 Ann. de la real. Acad, de Ciencias, etc., de la Habana, 1882, ▼. 19, p. 40; also Trabajos select. , 1912, p. 611. 
> Diseases, acute and chronic, peculiar to the island of Barbados, I<ondon, 1750; referred to by Castellani 
and Chalmers, Manual of Tropical Medicine, 2 ed., 1913, p. 1125. 
s Brit. Med. Jour., Sept. 24, 1898, v. 2, p. 879. 
« Sup. dt. 

• Glandular Disease in Barbadoes, London, 1784; referred to by Castellani and Chalman, Man. Trop. 
Diseases, 2 ed., 1913, p. 1125. 

• Dayidson'8 Qeographical Pathology, New York, 1S92, ▼. 2, p. WI, 



PUBLIC HEALTH AND MEDICINE. 53 

UniUd Stales.-r-ln 1897 Dunn > published the occurrence of Bancroft's i^ariasis in 
a young woman 19 years of age, a native of Philadelphia and resident of this city con- 
tinuously, with the exception of a visit in Altoona, Pa. ; somewhat earlier Wynn ' 
had published a case occurring in a woman of Indiana who, while having vidted in 
''the West" and in New York City, ''had never resided in nor visited tropical or 
subtropical regions''; and still earlier Weiss * had reported a case on about the same 
level of latitude in a child who had never been outside of the State of Illinois, John- 
stone in 1903 reporting a second case from the same State.^ In 1891 Slaughter * 
announced his discovery of two indigenous cases of hematochyluria with micro- 
filacise in the urine from the northern part of Virginia, one of his patients residing 
within 6 miles of Washington, D. C. 

In 1913 Barnes reported a third case of Bancroft's filariasis from the same district 
in a Washington negro bom in Maryland and never farther south than Culpeper, Va.* 
Northingham ^ reports a case of elephantiasis of questionable type, which he regardc 
as of filarial origin, in a mulatto native of North Carolina, living near Wilmington. 
Microfilaria were not demonstrated in the case. He quotes Dr. Boyster, of the same 
State, to the effect that filariasis is rare in North Carolina, and Dr. E. J. Wood as 
regarding it comparatively common. The first demonstrated cases of indigenous 
filariasis of tlus type in the United States were reported by John Guit^ras * from Charlee- 
ton, S. C, along with four other cases from Key West, Fla. These Florida subjects 
were natives of Cuba and had probably brought their parasites from their home island; 
but Guit^ras expressly stated his belief that the worm existed at the time of his obser- 
vations either as '*a permanent resident or a successful colonist in the island of Key 
West." His belief has since been confirmed for the State of Florida;* and in South 
Carolina, in addition to sporadic cases in the general littoral, Charleston has proved 
to be by far the most severely infested focus of filariasis in the United States if not in 
the whole world,'® Johnson " reporting 19.25 per cent of positive findings in 400 hospital 
inmates within the past year. A case studied in Philadelphia by F. P. Henry '^ is 
referable either to South Carolina or Florida, the subject having lived from birth in 
Columbia, S. C, and in Palatka, Fla., untO shortiy before coming under observation 
in Philadelphia, and the writer recalls two South Carolina nergoes infested by FUaria 
bancrofti, studied in Philadelphia by William Pepper, jr., but not published. 

If one may infer from the scattered instances of chyluria and elephantiasis along 
the South Atlantic and Gulf coast regions, the affection prevails in sporadic grade 
throughout this general district. Mastin " in a comprehensive and analytical article 
upon filariafiis reported an indigenous case from Mobile, Ala., and in a lecture by 
Matas,^^ based upon an imported case of filarial chylocele of the tunica vaginalis, rec- 
ognition was expressed of the sporadic occurrence of such filarial manifestations as 
chylocole, chyluria, and elephantiasis in the Louisiana district. The writer, while 
static aed at Galveston, on several occasions met with what he believed to be clinical 

I Tr. Coll. Physicians, Phila., 1896, v. 20, 3 ser., p. 80. 

• Indiana Med. Jour., 1805-96, y. 14, p. 400. 
> North American Praot., Oct., 1800. 

< Chicago Med. Recorder, 1903, v. 25, pp. 34, 82; Women's Med. Jour., 1004, r. 14, pp. 1, SS. 

• Med. News, Sept. 5, 1801. 

• Monthly Cyclopedia and Med. Ball., Jan., 1013. 
7 Charlotte Med. Jour., 1914, v. 70, p. 100. 

• Med. News, Apr. 10, 1886. 

• Cr. Smith, Ann. Univ. Med. Sd., 1802, r. 1, p. L 131; Andrade, Amer. Jour. Med. ScL, 1005, t. ISO, 
p. 126; Knox, Milit. Surgeon, 1011, v. 28, p. 650. 

i« De Saussare, Med. NewB, June 28, 1800; Thompson, Trans, So. Carolina Med. Assoc., 1888, p. 141; 
Andrade, Ga. Practitioner, v. 3, p. 10. 

II South. Mod. Jour., July, 1915, y. 8, p. 630. 
u Med. News, May 2, 1806. 

1* Ann. of Surgery, 1888, y. 8, p. 320. 

M New Orleans Med. and Soif. Jour., June, 1891, y. 18, p. 601. 



54 PROCEEDINGS SECOND PAN AMERICAN SCIENTIPIO CONGRESS. 

expreasions of filariasiB, a case of chronic lymph fistula and a case of elephantiasis; 
but in these, as well as in several series of night-blood preparations from medical 
students and hospital inmates, failed to find microfilariae. More systematic studies 
would undoubtedly reveal scattered cases through a large part of the southeastern 
section of the United States, as suggested by instances of similar clinical manifesta- 
tions of filariasis reported from time to time for more than a generation past (as Brigg's 
case of elephantiasis at Nashville, TennJ), and corroborated by the occasional demon- 
strated cases above mentioned (as those of Weiss and Johnstone in Illinois, and of 
Wynn in Indiana). 

Cases of imported filariasiB have been recorded from different parts of the United 
States, mainly from the West Indian Islands,' and recently on the Pacific coast, from 
the Philippine Islands, the Pacific Islands, or from Asia. But as far as the writer is 
able to leam at this time, no indigenous cases have been recorded from the Pacific 
coast of the United States. Wellman and v. Adelung ' state that filariasis is con- 
stantly present in the cities upon San Francisco Bay, but believe there is no danger 
of distribution among the citizens because of the lack of suitable mosquito carriers. 
They have studied CuUx coruobrinus and Culex tantdis, the two most important 
mosquitoes of the locality, from this point, and have determined their incapacity to 
serve as transmitting agents. 

West Indian Islands. — Collectively the West Indian Islands are all open to suspicion 
as infested localities. The parasite has been actually demonstrated in most of the 
larger islands and in many of the smaller ones; and various clinical features of filari- 
asis have been recorded for others, lending support to the belief in their infestment as 

weU. 

Discovered first in a Habanese, the parasite to-day constitutes one of the persiBtent^ 
if not serious, pathogenic agencies in Cuba, apparently beginning to yield in frequency 
of occurrence in response to the vigorous antimosquito campaigns of the past decade 
and a half;* and doubtless if one may judge from the early records of filarial clinical 
manifestations, the island has been infested in at least a moderate degree for a long 

time.' 

In reference to the prevalence of the disease the data compiled by Nufiez are of 
significance. Out of a total hospital population of Hospital Mercedes, from the estab- 
lishment of the institution in March, 1886, to January, 1906, of 62,548 patients, 356 
were recorded as proved filarial cases or as exhibiting one or another form of the clini- 
cal expressions of filariasis; and in Hospital No. 1, founded in 1900, up to July, 1904. 
there had been received 19,586 patients, among whom similar ^evidences of filariasu 
were recorded in 70 — somewhat less than 0.5 per cent incidence in each institution. 



> Noted in Qnes's System of Surgery, 1882, v. 1, 507. 

s Oult^ras, sup. dt.; others mentioiied below in assignment to places of origin; add here the ease of Dela- 
fleld in New York, said to have come "from the West Indies," Med. Oa«., 1883, v. 10, p. 210, and case of 
Ealiski, Amer. Joor. of Urology, 1911, v. 7, p. 429, in a negro " from the West Indies." Kallski states that 
he has met five oases of Bancroft's lUarlasls in New York City in the last five years. 

> Jour. Amer. Med. Assoc., July 11, 1910, ▼. 65, p. 217. 

« Ouit^ras, Insect Borne Diseases, Tr. of H Pan American Congress, Washington, D.C., 1915-16, Scien- 
tific section. 

• Literature upon Cuban Infestment: Flnlay, Ann. real. Acad, ciencias med.etc, de la Habana, ▼. 19, 
pp. 40-61, June 15, 1882, and Trabajos Select., 1912, p. 611; GultABs, Med. News, Ajw. 10, 1886, referring 
from Key West 4 cases to Cuba; Matas, New Orleans Med. and Surg. Jour., Jan. 1891, v. 18, p. 501, a case of 
ohylooele imported into New Orleans from Cuba; Lebtedo, Rev. de M6d. trop. Habana, 1904, v. 6, p. 171 ; 
Ibid., 1905, V. 6, pp. 117, 141; Jour, of Infect. Dis., 1905, v. 1, supp. 1, p. 832, dealing with mosquito transmb* 
Slon; Garcia R«o, Cr6u. mM.-quir. de la Habana, 1904, v. 30, p. 119; Garcia Mon y Carballo, Revista de 
mdd. y clrurg. de la Habana, 1904, v. 9, p. 622; Nuflei, Escuela de Medicine, Mexico, 1906, v. 21, p. 129, and 
continuations, dealing with filariasis and its surgical complications; L. Gutleirea Lee, Crdn. mM.-quir. de 
la Habana, 1911, v. 87, p. 550, and Rev. de mM. y clrurg. de la Habana, 1911, v. 16, p. 405; reference to casas 
of elephantiasis in Med. Report of United Fruit Co., New York, 1913, p. 85; Brault, Ga«. des Hopit., 1907, 
▼. 80, p. 155, general article on geographical distribution of fllarfasis; etc 



PUBUC HEALTH AND MEDICINE. 55 

The Island of Haiti, where the work of Leon Audain and his aasociatee,^ has been 
notable, is known to be infested and has probably been infested for many years, per- 
haps in no higher ratio than Cuba. 

Porto Rico at the present time is heavily infested. Ashford ^ after examining a 
series of civilian and enlisted Porto Ricans, states that in his belief about 10 per cent 
of the general population of the island harbor filariae, about 12 per cent of the soldiers 
examined and nearly the same proportion of cL\dlians having been found parasitized. 
Of somewhat more than a dozen students from Porto Rico examined in the pathological 
laboratories of the Univendty of Pennsylvania within the last few years 4 were found 
to be hosts of Filaria hancrofti* Funk ^ has reported a similar finding in Philadelphia, 
and Harden * in Baltimore, in Porto Ricans. Recently Martinez,' writing from San 
Juan, P. R., has discussed a case of filarial lymphangitis simulating bubonic plague. 

Young in 1897 ^ reported a case from Jamaica; and more recently Wanhill * after 
meeting with but a single case in several troops of native soldiers and after inquiring 
among local medical officers of experience, states that while occasionally encountered 
in Jamaica, filariasis is almost unknown on that island. He mentions the fact that 
Mott failed to find any microfilaria in a series of 400 slides of blood collected by Dr. 
Grabham from natives of Jamaica. 

Among the Danish West Indies, the islands of St. Thomas ' and St. Croix ^^ are 
recorded as infested localities. 

It is improbable that the Bahamas are entirely free, but that these islands can have 
no more than rare sporadic instances of filariasis is surely indicated by the fact that in 
the long list of publications consulted by the writer he has failed to encounter any 
record of the affection in these more northern islands. 

Of the lesser Antilles, in the groups of the Leeward and Windward Islands, stretching 
oat below Porto Rico toward the South American coast, there is reason to believe 
there has been an early and heavy implantation of the parasite, and there is evidence 
that it persists in some of these islands in high grade up to the present.'^ 

I Andain, Formes ehir. de la fibiiose genit., 1894; RIoot in Andain, Fievres Intertropicales, 1910, p. 777; 
«f. also Monoorvo, In OnndMr and Gomby, Tiait^ de lial. de I'Enfuioe, Paris, 1904, v. 2, p. 802. 

* Med. Reoord, No7. 7, 190B, t. 64, p. 734; Report of Smgeon Oen. U. 8. Anny, 1903-04, p. 98. 
I Smith and Rlvas, Amer. Jour. Tnip. Med., I>eo., 1914, v. 2, p. 861; 8 oaaes; 1 unreported. 

« Proe. Phfla. Path. Boo., 1914, y. 16, n. s., p. 62. 

* Bdep. Bull., UniT. of Maryland, 1913-14, v. 9, p. 60. 

* Joar. Amer. Med. Aaoc., May 28, 1014, y. 62, p. 1622. 
' Bilt. Med. Jour., 1897, y. 1, p. 1037. 

* Jour. Roy. Army Med. Corps, London, 1906, p. 561. 

* Pontopldan, qaoted by Blanohard, Traits de Zoologle MM., Paris 1800, y. 2, p. 527; Opie, Amer. Joar. 
of Med. Sd., September, 1901, y. 122, p. 251; and probable esse of filariasis, intermittent chylurla. Soils- 
Cohen, Times and Register, May 18, 1888, Jour. Amer. Med. Assoo., July 2, 1892. 

>• Abbe, N. Y. Med. Joar., February, 1880; v. 21, p. 130; Lambert, N. Y. Med. Jour., Apr. 80, 1802. 

u Llteratare opon Leeward and Windward Islands: Biaolt, sap. cit.; Creyaox, L'Ematarie chylense oa 
Kiaissease des Pays chauds, 1872, reyiewed in L'Unlon med., 1872, y. 12, p. 795; Lenckart, Parasiten, Leipslg 
snd Heldelbarg, 1876, y. 2, p. 628; Hint, N. Y. Med. Jour., Jane 15, 1805, p. 737, a oase in New York from 
Barbados; Manson, Brit. Med. Joar., 1897, y. 2, p. 1887; Lothrop and Pratt, Amer. Joar. Med. ScL, 1900, 
y. 120, p. 525, 2 eases In Boston tram Barbados; Galgey, Select. Colon. Med. Rep., London, 1904, p. 196, St. 
Lacia; Monooryo, in Orancher and Comby, Traits les Mai. de PEnlanoe, Paris, 1904, y. 2, p. 802; Low, 
Joar. Trop. Med. and Hygiene, Feb. 15, 1908, y. 11, p. 50; Orindon, Missouri Med. Jour., 1908-09, y. 5, p. 
129, case from Ooadaloape; Simond, Noc and Aubert, Bull. Soc. Path. Exotique, Paris, 1909, y. 2, p. 319; 
Ctanc, Leboeaf and RlgoOet, Traits de Path. Exotlqne par Qiall et Clarac, y. 6; Mai. Parasit., Paste, 
Psris, 1913, p. 813; HfUary, Dfaeases peculiar to the Island of Barbados, 1750 and Hendy, Glandular Dis- 
ease in Barbados, 1784, both quoted by Oastellani and Chahners, Man. of Trop. Med., 2 Ed., 1913, p. 1125; 
Lyle, Ann. of Surgery, 1912, y. 56, p. 942, case in New York from St. Eitts; O'Nell, Bost. Med. and Surg. 
Jour., 1908, y. 158, p. 117, a case in Boston from Barbados; Armstrong and Mullally, Surgery, Gynecol, 
sad Obstet., 1914, y. 19, p. 690, a case In Montreal firom Antigua; Leger «t Le Gallon, Bull. See. Path. Exo- 
tiqae, Paris, 1914, v. 7, p. 125, Ouadaioape; Steyenel, Ibid., 1913, y. 6, p. 357, Goadaloupe; Noc et Steyenel, 
ibid., 1913, y. 6, p. 668, Martinique; for old unedited refd^noes see Houllier, De la fllariose, etc, des Pay 
diaads, Thes6, Montpeller, 1913. 



56 PBOGEEDINQB 8EG0ND PAN AMEBIGAN SCIENTIFIC C0NGBE8B 

In Low's admirable travel study, he found evidence of heavy infestment (47 cases 
out of 143 examinations at night) in St. Kitts. Manson found microfilariae in 6 
films of blood out of 28 sent him from St. Kitts and Montserrat. In Dominica, Ixnr 
examined 144 individuals at night and found that 11 harbored microfilarue in their 
blood. In Guadaloupe I^eger and Le Gallen, in an examination of 150 Guadaloupian 
enlisted men in 1914, found 23 infested (15.33 per cent); in 1913 Stevenel found 4 
out of 12 individuals examined to harbor FUaria hancrofti in Giiadaloupe. That 
Antigua is at least in some measure infested may be inferred from a case reported 
from Montreal, Canada, by Armstrong and Mullally in 1914, as originating in Antigua. 
Guadaloupe is said by Olarac, Leboeuf , and BigoUet to be seriously involved by filari- 
asb,> and Martinique is likewise characterized by these authors. Simond, Noc, 
and Aubert state that clinical manifestations of filariasis are common in Martinique; 
and Noc and Stevenel in 1913 published data showing that of 4,000 individuals com- 
ing to the dispensary of the hygienic institute in Martinique between 1909 and 1913, 
88 showed different forms of Ijrmphatic affections (77 endemic lymphangitis, 15 
elephantiasis, 25 without microfilarise). 

In St. Lucia, Low examined the blood of 356 persons at night, finding microfilariae 
in 27.' In St. Vincent he examined the blood of 100 individuals at night, 6 of these 
showing the presence of microfilariae; and Manson found the same number, out of 
152 blood preparations sent him from this island, to contain microfilariae. In Bar- 
bados, the manifestations of filariasis (as the "Barbados leg") have been known from 
the early part of the eighteenth century; and a serious endemic focus is centered in 
this island. Of GOO individuals examined at night by Low, microfilariae were found 
in the blood of 76 (12.66 per cent), a proportion comparable to that indicated for 
Porto Rico by Ashford. The island is particularly named by most writers in sys- 
tematic treatises ui)on parasites and tropical diseases; and a number of Barbadian cases 
have been recognized and published from other parts of the world to which they have 
gone (as the cases of I/Othrop and Pratt, in Boston). 

In Grenada, Low found no examples of Infestment among 174 individuals examined 
at night; and in Carriacon, a small island of the Grenadine group, out of 28 individuals 
he found 1 case of filariasis (but this individual had been bom and lived in St. Kitts 
until within a year of the time of Low's examination, and should under the circum- 
stances be regarded as belonging rather to the more northern island) . 

Trinidad was found by Low to be a decidedly infested island, 43 individuals out 
of 400 examined at night by him showing microfilariae in their blood; Vincent * in 
examining 500 individuals in hospital, asylum and private practice found 25 in- 
fested (5 per cent) and 33 showing elephantoid complications (6.6 per cent). 

While in this hasty review of the West Indian infestment, the writer has doubt- 
le« missed many important items, the serious grade of involvement of certain islands 
and the widespread diffusion of the parasite is surely shown sufiliciently to substan- 
tiate the statement that collectively these islands are all to be regarded as open to 
the suspicion of being infested . And yet the Bahamas, Jamaica, and I^ow's experience 
in the Grenadines are evidence that such a sweeping statement must not be too seri- 
ously accepted for any individual location. There are places in the West Indies 
(perhaps, too, limited localities on infested islands), where known and unknown 
circumstances have operated to prevent the invasion or the permanent fixation of 
the parasite; but whether such circumstances are to be regarded as constant for these 
places is quite another matter. 

Mexico and Central America, — Returning to the mainland of the American Conti- 
nent, in Mexico definite records of the discovery of the parasite are singularly lacking 
in the literature which the writer has had opportunity to examine, although general 
statements of the occuirence of filariaaas are now and again to be met in systematic 

^ISee also Leackirt, Cnnxxr, Grtndon, llbiioorTO • Brit. Med. Joor., 1903, ▼. 1, p. Ifl9. 

\Cf. also Oalgey. 



PUBLIC HSALTH AND HEDIGmL 67 

articles upon the affection. Glarac, Leboeuf , and Rigollet > state tliat elephantiasis 
is "compaiatively frequent on the coasts of Mexico, beooming more rare as one 
proceeds to the north." Newman and Mayer,' in their cursory statement as to the 
distribution of JUaria boTiarofti, also include Mexico as infested. The writer recalls 
to have personally observed several cases of elephantiasis in Mexico in the course 
of visits in the Republic some years ago. 

Nor is the recorded evidence of the prevalence of the parasite in the Central Ameri- 
can Republics more satisfactory in the literature available to the writer. Creneral 
references to its occurrence in Central America,* in Nicaragua,^ and a few specific 
records of its clinical manifestations ^ in Costa Rica in the medical reports of the 
United Fruit Co. constitute the only items met. The writer's colleague, Dr. Damaso 
Rivas, a native of Nicaragua, has personally informed the writer that cases of ele- 
phantiasts are not very uncommon in Nicaragua. 

In Panama, elephantiasis is noted as "relatively common" by Clarac, Leboeuf, 
and Rigollet,* and examination of the reports of the department of sanitation of the 
Isthmian Canal Commission may be regarded as verifying this statement. Occasional 
cases of elephantiasis, lymphscrotum, and chyluria occur in these monthly reports, 
and there are a number of demonstrated cases of filariasis distributed in the various 
hospital records. It is to be recalled that these reports do not deal directiy with 
the fixed population of the Republic of Panama, but rather with the heterogeneous 
group of canal employees who congregated in the Canal Zone during the period of 
active canal construction, and that among them many of the laborers came from 
known localities of infestment, as from various West Indian islands. Some of these 
people, however, doubtiess have remained on the Isthmus, and one can not dis- 
regard them as having been and even now in some degree being potential factors of 
maintenance and dissemination of the affection in the district. 

The figures collected by the writer from the reports of the department of sanitation 
are undoubtedly too low, as they are based upon the hospital records of blood exam- 
inations, and for the most part these examinations were made for other diseases than 
Bancroft's filariasis, the vast bulk of the blood specimens having been unquestionably 
prepared in the daytime. Uncomplicated cases of filariasis, too, are not likely to 
have been included in the hospital population; and the tediousness of blood exami- 
nations with high objectives, as for malaria, is probably reason to suppose that in 
most instances as little as possible of any given blood film would be actually scruti- 
nized. The reports for nine years, from 1905 to 1913, inclusive, are best adapted for 
analysis, because of the uniformity of the plan of reports of blood examinations and 
of report of positive, findings of microfilariae. In this period they aggregate a total 
of 144,423 microscopic blood examinations in the various hospitals of the Canal Zone; 
among which 111 positive instances of demonstration of microfilariae are recorded, 
considerably less than 0.1 per cent. By years the distribution of recorded instances is 
as follows: 1905, 2; 1906, 1; 1907, 3; 1908,3; 1909, 9; 1910, 29; 1911,44; 1912, 13; 1913, 
7. The annual report for 1914, which is not included, states that two cases of filariasis 
were admitted to the hospitals of the Zone, but does not give the number of bloo^ 
examinations made in the hospital. laboratories. The cases were distributed over the 
entire length of the Zone, being recorded at Ancon, Colon, Miraflores, and Santo 
Tomas, indicating, therefore, infestment on the Pacific as well as on the Atlantic 
side. Specific differentiation is not indicated in the reports; but there is one case 
(1906, at Colon) reported as ''filaria diuma."^ 

* Bop. dt,. Leeward and Wiadward Islands, p. 874. 

> Atlas and Lebrb. wichtiger tierJseh. Paraslt. a. ihrer Uebertrftg., M (taicben, 19M, p. 366. 

> CasteUani and Cfaalmers, sup. dt. Leeward and Windward Island Literatnre. 

* Newman and ICayer, sap. dt. 

» As of diyhirla and elephantiasis; Ked. Reports CJnlted Fruit Co., New York, 1912, p. S7; 1M3, p. 87. 

* Snp. dt. I.»eeward and Windward Ldands, p. 374. 

' For abore data d. reports of deportment of sanitation of Istbmiao Canal Commtasioii, Washlngtoii, 
D. C, for years indicated, condensed in the Annnal Report of the Director, or embodied In the mcnthly 
laboratory reports of the Tarloos hospitals for the different months of eadi year. 



58 PBOGEEDINGS SECOND PAN AMEBIC AN SCIENTIFIC CONGBESS. 

Sotith America. — In Colombia Marquez > refers to cases of elephantiaaLs and chyluiia 
occuning not infrequently in the Santa Marta district (on the Atlantic side). A case 
originating in Colombia, apparently near Cartagena, is reported by Cunningham ' 
in Boston, whither he had come for surgical treatment; and casual mention of Colombia 
as infested may be noted in the works of Moncorvo ' and of Castellan! and Chalmers ^. 
Moncorvo alone, of the writers consulted, lists Ek;uador among the countries infested; 
although it is unlikely to be any more exempt than its neighbors Colombia and Peru, 
the latter being incriminated by a number of writers.' Crevaux and Moncorvo place 
Chile also among the countries infested by Filaria hancrofti. 

The parasite is undoubtedly more conmion and has been better traced in the Atlan- 
tic coastal countries of South America. J. Surcouf and R. Gonzales Rincones, in 
their paper on the bloodsucking diptera of Venezuela,* state that chyluria and ele- 
phantiasis, evincing the presence of Bancroft's filariasis, are very common in Venez- 
uela about its important western harbor, Porto Cabello; and the proximity of the 
island of Trinidad ^ is strong suggestive evidence that the eastern coasts of Venez- 
uela have not failed of infestment. Important texts such as Castellani and Chalmers, 
Clarac, Leboeuf , and Bigollet, and Moncorvo,* and Newman and Mayer * mention 
Venezuela in their lists of infested countries. 

The three Guianas are probably equally and seriously invaded.' Speaking of 
British Guiana, Daniels ^° calls attention to the coastal coincidence of FUaria ban- 
erofti and elephantiasis in contrast to the absence of elephantiasis in the interior and 
to the replacement in the latter district of Filaria hancrofti by another species, F. 
demarquayi. Low ^' found over 16 per cent (25 out of 150) of a series of blood films 
collected at night to contain microfilariae in studying the incidence in British Gui- 
ana." 

In Brazil, Otto Wucherer," at Bahia, was the first in America to observe the larval 
stage of the parasite, in 1886, in the prevalent hematochyluria of this district; but 
this, as well as other filarial manifestations had been a matter of interest and anxiety 
for years earUer in Brazil. As early as 1835, a conference was held upon the subject 
of hematochyluria at Bio de Janeiro, following and probably stimulated by the paper 
of Saleee upon this condition. ^^ Rego ^' in 1843 recorded elephantiasis as being com- 
mon in Rio de Janeiro, and quoted Souts-Ammarel, of the latter dty, as having dealt 
surgically with certain examples of huge elephantiasic growths of the nude and female 
genitals. WQcherer's' discovery, not published for several years, was followed in 

I Geognpbf a M^dlca y Patolqgfa de (Colombia, Bogota y Nneva York, 1916, pp. 140, 219. 
I Ann. of Surgery, 1906, v. 44, p. 481. 

• Snp.cit., Leeward and Windward Islands, p. 802. 

• Sap. dt. Leeward and Windward Idands, p. 1125. 

• Castellani and CSialmers, sap. dt.; CrBvaox, sop. dt.; Newman and Mayer, sap. dt.; Monoorvo^ sup. 
dt.; et al. 

• Arch, de ParadtdoKie, 1911-12, y. 15, p. 248. 

Y Vide sapra. Leeward and Windward Islands, Low. 

• Sup dt.. Leeward and Windward Islands. 

• Sup. dt. 

1« Brit. Med. Jour., Sept. 24, 1898, y. 2, p. 878. 

u Sup. dt., Leeward and Windward Islands. 

It Goosolt also Lodcwood, Maryland Med. Joar., Oct., 1907, y. 46, p. 867, case in Baltimore; Lefeyra, 
Tr. N. Y. Path. Soc., 18B3 (Nor. 23, 18B2), p. 114, case in New York; PHcher and Pildier, New York Med. 
Beoord, 1911, y. 79, p. 434, a case in New York; all from British Guiana. Armstrong and Mullally, Sur- 
gery, Oyneed. and Obstel., 1914, y. 19, p. 609, a case in Montreal firom British Goiana; Kingsbury, Joor. 
Cut. Med., 1911, y. 29, p. 357, case bom in Venesueia, living from age of 6 to 22 in British Guiana, one year 
later obsenred In New York; HHUs, London Lancet, 1882, y. 2, p. 069; Manson, Brit. Med. Jonr., 1807, 
y. 2, p. 1838; Oizard, Brit. Guiana Med. Ann., 1897, y. 9, p. 24; Winekd, Arch. f. klin. Med., Feb. 25, 1870, 
y. 17, p. 308; and as noted under Leeward and Windward Idands, Castellani, and Chalmers, Clarac, Leboeuf 
and RigoOet, Moncorvo, Crevaux. 

u Sup. dt., note 5. 

>« Dissertation sur Thomaturie ou pissement du sang, These, Paris, 1884. 

» Gac. des Hopltaux, Aug. 31, 1843, p. 412, from Revista mid, flumenense. 



PUBLIC HEALTH AND MEDICINE. 59 

Brazil by a group of investigators, including at Bahia, J. F. da Silva lima,* who is 
credited with applying the name Filaria wUdiereri to the parasite, A. J. da Silva 
linia,' da Silva Araujo,* who, in 1875, met microfilariae in the exudate from lesions 
of craw-craw and in this connection applied the name FUaria dermathemiea, and who, 
in October, 1877, encountered the adult worm in elephantiasis of the scrotum, Pe- 
reira,^ d' Almeida Oouto,^ and Paterson,* and, at Bio de Janeiro, F. doe Santos,^ 
who was one of the early observers of the microfilaria in the blood in elephantiasis 
and who obtained the adult worm in a lymphatic abscess only about a month after 
de Silva Araujo in Bahia, de Moura,'^ who obtained the microfilaria in the exudate 
from craw-craw lesions, and de Magalhaes.* 

Ab some indication of the incidence of the parasite Paterson at Bahia in 1878 found 
26 cases of filariaaifl among 309 individuals examined at random. Moncorvo *® in 1904 
stated that the affection was less frequent in Brazil at that date than it once bad been. 
Ollveira " in 1909 in his thesis presented to the medical facidty of Bahia indicated an 
endemic index of 10.5 per cent of fiUriftiria in Brazil.*' 

In 1882 Wernicke " published a case observed by him in Buenos Aires, the most 
southern recorded case on the American continent, the solitary case, as &r as the 
writer knows, referred to in various systematic articles which list Argentine as an 
Infested district (save the recentiy reported cases of Padilla in Tucuman). 

2. FILARIA DEMABQUAYI (mANSON, 1897). 

Synonyms: Filaria ozzardi Manson, 1897, pro parte; F, juncea Railliet, 1908. 

In 1893 and in 1895, in blood films sent him from St. Vincent by Dr. Newsam, Man- 
son '^ met with a microfilaria which he had not previously encountered, smaller than 
the larval Filaria bancro/H, without a sheath, with a finely effilate tail end, and aperi- 
odic. Tentatively, at Blanchard's suggestion, he named the i)arasite in honor of De- 
marquay, the original observer of the larva of Filaria bancro/ti. And in 1896 and 
1897, in a series of blood slides sent him by Dr. Ozzard from Indians of the interior of 
British Guiana, Manson again met with a microfilaria of the same morphology (which 
he believed might be identical with the St. Vincent specimens) but in association 
with it another small aperiodic, nonsheathed microfilaria with a bluntiy pointed tail 
(which he believed Identical with the African peratans). Uncertain of his ground, he 
for a time hesitated to distinguish between the two, giving them joiiflly the name 
FiUma ozzardi, Ozzard and Daniels >^ shortiy afterwards confirmed Manson's discov- 
ery, but at the time made no distinction between the two confused larvsB. 

*■ Oas. mM. da Bahia, Sept., 1877, v. 2, 3 ser., p. 387, translated in Arch, da mM. nav., Paris, Dec., 1877, 
▼. IS, p. 439. 

* Rev. in6d. Rio de Janeiro, July 15, 1876, ▼. 1, p. 107. 

* Mem. sohre a ffllarase on a moleatia per nma nova eapecfo de paraatta cntanea, Bahia, 1876; Gas. mM . 
de Bahia, Nov., 1877, ▼. 2,2 ser., p. 402, translated in Arch.de mM. nav., Paris, March, 1878, v. 20, pp. 200, 
470; Caz. mAd. da Bahia, 1878, v. 3, 2 ser., p. 40; Oas. mM. da Bahia, Oct., 1879, v. 4, 2 ser., p. 465. 

* Mai. parasit. les plus frequentes dans les climates intertropicales, 1876, Dissert., Bahia. 

* nemahiria endemica dos palsce quentes, Bahia, 1872. 

* Gas. mM. da Bahia, Dec., 1878, v. 3, 2 ser., p. 620; trandated in Londiin Veterinarian, June 20, 1870, 
and in Galveston Med. Joor., Jan., 1880, v. 1, p. 14. 

f Gas. m6d. da Bahia, March, 1877, ▼. 2, 2 ser., p. 137; Progresso m6d., Rio de Janeiro, 1877-78, v. 2, 
p. 06, 106. 

* Revista mM. de Rio de Janeiro, Aug. 81, 1875, y. 2, p. 216 and oontinniitiaDB; Da Ghylnria, These, 
Rio de Janeiro, 1877. 

* Gas. mdd. da Bahia, Dec., 1877, v. 2, 2 ser., p. 538; Progresso vaM. Rio de Janeiro, Nov. 16, 1877, v. 
2, p. 20. ibid.. May 16, 1878. 

^*Sup. cit.. Leeward and Windward Islands. 

u inaug. Thesis, BahJa, 1909; quoted by Padilla, Semana mM., Buenos Aires, 1016, anno 22, p. 371. 

1* For more recent studies hi Brazil cf. Froes, Brazil m6d., Rio de Janeiro, 1006, v. 20, p. 63, 76; Monteiro^ 
Tribuna mM., Rio de Janeiro, 1006, v. 14, p. 00; Ferrari, ibid., v. 14, p. 07. 

i> CoDsideracioncs a proposito de un casode quiluria observado en lapoliclinica del circulo niM., Argen- 
thic, Buenos Aires, 1882. 

" Brit. Med. Jour., 1807, v. 2, p. 1837. 

u Quoted by Manson, ibid.; see also Oszard, Br. Guiana Med. Ann., 1897, v. 9, p. 24; and Daniels, Br. 
Guiana Med. Ann., 1807, v. 0, p. 28; Ibid., 180S, v. 10, p. 1; Jour. Trop. Med. and Hyg., 180S, v. 1, p. 13; and 
Brit. Med. Jour., 1808, v. 2, p. 878. 



60 PBOCEEDINOB SECOND PAN AMEBICAN 8CIENTIFI0 OONOBE88. 

In the same year Daniels ' at a post-mortem examination of two Indians, who diw> 
ing life had shown both fine-tailed and blunt-tailed larvse in their blood, met with a 
number of adult filans which were identified later with adults of AeanthocheiUmema 
pentans ' by Manson. As the blunt-tailed larvxe were from the fint suspected of 
being identical with the African pentans larvae, and as such larvse were obtained by 
Daniels from the adult females, the one group confused under the name Fiiaria ot- 
zardi was thus definitely eliminated. Meanwhile Galgey in St. Luda ' had recog- 
nized the presence of tiie Microfilaria demarquayi in St. Luda and in 1899 had ob- 
tained a number of adult females from the upper part of the mesentery at autopsy. 
One of these he sent to Ozzard for determination and description, but, owing to its 
poor state of preservation, little definite could be made out. ^ In the same year, how- 
ever, Daniels ' had opportunity to perform a post-mortem section of the body of a 
third Indian from the interior of British Guiana and found beneath the peritoneum 
of the anterior abdominal wall an entire adult female fiiaria and the broken caudal 
end of a male. The Indian in life had shown both fine-tailed and blunt-tailed larvae 
in his blood, the former predominating toward the end of life. These adult filaiiae 
differing from the previously separated perttans adults, Daniels published them as 
the probable parental forms of the fine-tailed larvae. In form they resembled Fiiaria 
bancro/ti rather than AoanthocheUonema perstanSy were characterized by a smaller head 
and thicker body than the latter, and lacked the caudal cuticular processes of the 
latter, the tail of the male being more tightly enrolled, terminating abruptly, and 
showing no protruded spicules (there are, however, two spicules which were not at 
the time recognized). The fine-tailed larvro from St. Vincent, St. Luda, and from 
British Guiana having been identified, these worms (the adult females agreeing with 
Galgey's spedmens from St. Luda) have been accepted as FUaria demarquayi (the 
tentative spedes Fiiaria ozzardi thus falling out entirely). 

As &r as its distribution in America is concerned the study by Low * is the most 
complete thus far at hand. In St. Lucia, in an examination of 472 individuals, he 
met with the larval demarquayi in 23, and notes the fact that it tends to segregate 
itself in special fod, the heaviest infestment of St. Lucia being met in the part known 
as Gros Islet. In Dominica he examined 160 persons and found Microfilaria demar- 
quayi in but 2. In Barbados he found no instances of the parasite in question in 
600 individuals examined (in contrast to the heavy infestment of Barbados by Fiiaria 
bancro/ti). In St. Vincent he met it in scattered fod in the country districts, as in 
the village of Galliaqua, where 8 out of 30 persons were found to be hosts of the 
parasite. 

In British Guiana Low examined 183 full-blooded Indians from various parts of the 
interior, finding 49 to be hosts of Fiiaria demarquayi (alone in 11; in association with 
AoanthocheUonema perstam in 38). 

Vincent,^ in his study of filariasis among the asylum and hospital populations in 
Trinidad, notes the finding of a single instance of parasitism by demarqwxyi. 

It is quite possible t^t the geographical distribution in America is more extensive 
than is here indicated and that Low's suspidon is correct that it and perstam are 
probably scattered all through the deeper forests of not only British Guiana, but of 
the other Guianas as well, and perhaps of Venezuela. One may not improperly 
think of it in connection with the diurnal microfilaria recorded in the Colon Hospital 
Report for 1906 in the Reports of the Isthmian Canal Commission. And the writer 

1 Brit. Med. Jour., 1896, y. 1, p. 1011; Br. Outana Med. Ann., Iffif*, v. 10, p. 1. '* 

s See note to Danieb's paper in Brit. Med. Jour., 1888, r. 1, p. 1011. 

> St. Lucia, Colon. Reports, 1899; Brit. Med. Jour., 1899, v. 1, p. 146; see also Low, Brit. Med. Jour., 1902, 
V. 1, p. 196. 
« See Ozzard, Jour. Trop. Med. and Hyg., 1902, v. 5, p. 250. 
» Brit. Med. Jour., 1899, v. 1, p. 1459. 
• Brit. Med. Jour., 1902, y. 1, p. 190. 
T Brit. Med. Jour., 1902, y. 1, p. 180. 



PUBLIC HEALTH AND MEDIOIKB. 61 

om not but raise the question whether Fikarta tueumani, recently reported from the 
district of Tucuman in Aigentina, will not be found to be Filaria dmarquayi. This 
last is a small and active microfilaria, without periodicity (but with predilection for 
ni^t as shown by the fact that night blood is apt to contain upward of double the 
proportion of microfilariae seen in day specimens), showing marked variation in size 
<but with an average of 0.17 mm. long and 0.006 mm. thick and some as long as 0.252 
mm., some not more than 0.087 mm. in length), and provided with a sheath. Varia- 
bility in size is well known in case of the microfilarice of demarquayi} If Padilla's 
specimens are really ensheathed he is correct in differentiating them from denuxrquayi^ 
but the determination of ttus point is not always easy. For example, Manson ' at 
first believed that the demarqwxyi larva was ensheathed, but recognized later that the 
sppeaiance was due to artefact from the shrinkage of the microfilariae in stained blood 
films. Should this surmise be correct the American limits of distribution will be 
materially widened; and there should then be expected more or less infestment in 
the deeper Brazilian forests to link up the Guianas with Aigentina. 

The general impression at first was that FUaria demarquayi is native to America, 
the very isolation of its foci of endemicity suggesting this. But the certainty of 
«ach belief is disturbed by the fact that Manson some yean ago found a microfilaria 
of apparent identity in the blood of a native of New Guinea, according to Seligman,' 
who likewise has met tke same microfilaria in the same distant locality. 

The importance of the worm is doubtful from a positive standpoint; its presence 
being without recognized pathological effects upon the host. But in a negative way 
it is of importance that medical men distinguish it and its microfilaria from Filaria 
hanax/H, lest from confusion we fail to appreciate in full the serious pathogenic effects 
<rf the latter worm. 

Iti intermediate host is unknown. Low, hrom this standpoint, tested Cutezfatigantf 
SUgomgia faKxata^ CSdex taetMafta, AnopheUi allnpes^ Pulez penetrans^ and Pulex 
tmfoiu without meeting with development of the microfilarise into prefilarial fonns.^ 

3. ACANTHOOHKILONEMA PEB8TANB (mANBON, 1891). 

Synonyms: Filaria sanffuinis homini8 var. minor Manson 1891; F. ionguinis hominis 
pentana Manson 1891; F. pentans Manson 1891; F, ozsardi var. trunoata Manson 1897. 

Manson, in 1891,* from the study of blood from negroes from Western and Central 
Africa, distinguished microfilariae of essential difference from those of Filaria ban' 
croJH, which previously were the only known filarial hematozoa of man. Two new 
types were met, one of a size comparable to the Bancroft type, ensheathed, but 
occurring in the peripheral blood in day rather than at night, this being subsequently 
identified as the larval form of Loa loa (named at this time by Manson Filaria sanguinis 
hommis var. major)] and a second, smaller, not sheathed, with active progressive 
movement, and without either diurnal or nocturnal periodicity in the peripheral blood 
but found therein at all hours, to which he gave the name Filaria sanguinis hominis 
var. minor (subsequently changing the name to Filaria perstans). In an article pub- 
lished in 1897,* inter alia he announced that in blood preparations collected and for- 
warded to him by Dr. Ozzard from aborigines living in the interior of British Guiana 
he had baled to find microfilariee of the type of Filaria hancrofti, but had encountered, 
sometimes in the same perparation together, sometimes separately, two small non- 
sheathed microfilariae, one with a finely drawn point of the tail, resembling the micro- 

1 Cf. Galgey, Brit. Med. Jour., ISM, v. 1, p. 14A. 
*Brit. Med. Jour., 1897, v. 2, p. 1837. 

• Joar. of Pathol, and Bact., 1901, v. 7, p. 308. 

• Brit. Med. Jour., 1902, v. 1, p. 190. 

• Load. Laooet, 1891, v. 1, p. 4, abstracted in Ceatralbl. f. allg. Pathol., 1891, t. 2, p. 298; Tnaas. Seventh 
Interoat. Congress Hyg. and Demography, 1891, t. 1, aeot. 1, p. 79. 

• Brit. Med. Joor., 1897, v. 2, p. 1887. 



62 PBOCEEDINGS SECOND PAN AMEBICAN SOIENTIFIO CONQKBS8. 

filaiia of Fxlaria demarquayi (which he announced in the aame paper from the island 
of St. Vincent), and the other with a blunter tail, which resembled the AMcan per- 
sistent microfilaria. In spite of the recoginized morphological differences he for the 
time applied to both the name Filaria ozzardi. This finding was shortly afterwards 
corroborated by Ozzard and Daniels. ^ 

In December, 1897,' the latter investigator announced that he had met adtdt 
filarise in the retroperitoneal tissue at the base of the mesentery, about the pancreas 
and beneath the pericardium in two autopsies upon Indians from the interior of 
British Guiana, who in lifetime had shown in their blood both forms of the so-called 
Fikaria 02zardi. The females ranged from 70 to 80 mm. in length; the males were 45 
mm. long; and in both sexes a small triangular cuticular process was noted on each 
side of the caudal tip. The male tail was curved, and there was noted a single spicule. 
Larvas obtained from these adult females corresponded with the blunt-tailed type of 
Microfilaria ozzardi. From subsequent comparison with adults obtained from African 
hosts of Microfilaria perstans, come to autopsy in London, Manson ' identified Daniels's 
specimens with the African adult parasites; and subsequently, based upon the cuti- 
cular processes at the caudal end they were referred to the genus AoanthocheHotuma 
Cobbold by Railliet and Henry.* 

In its American distribution Acanthocheihnema perstaru (Manson), it is to be noted, 
as in Africa, occurs in the hot, heavy and moist climate of trop^al forests, rather than 
in open districts. In the coast districts of British Guiana neither this nor Fdara 
demarqujayi (the two originally confused under the name Filaria ozzardi) were met in 
blood examinations by Daniels and by Ozzard at Georgetown and New Amsterdam. 
Filaria bancrofti had been found in 52 out of 348 individuals of the settlements (whites, 
negroes, and civiUzed Indians) by Daniels; and Ozzard had in a like population met 
with 24 cases of Bancroft 's parasite out of 83 individuals examined. Manson in blood 
specimens from 61 natives of Demerara had found 9 instances of FUaria bancrofti^ but 
none of the small unsheathed larval worms. But among the aborigines of the interior 
Daniels ^ found 134 individuals out of 231 examined to harbor the small forms (both 
perstaru and demarquayi, confused) which he was at first disposed to accept as varia- 
tions of a single species. Low * examined 163 full-blooded Indians of different parts 
of the interior of British Guiana and found 105 of them to be hosts of the small un- 
sheathed microfilariae, with double infestment by Filaria demarquayi and Aeaniho- 
dieilonema perttans in 38, perstaru alone in 56 and demarquayi in 11 alone (a total of 94 
of the 163 infested with Acanihoi^ieiUyMma perstaru). Apparently this is the only 
focus of American endemic occurrence of this parsite, but one which is firmly fixed 
among the Indians of the deeper forests of British Guiana, extending, if Low's sus- 
picions be correct, into similar parts of both French and Dutch Guianas and into the 
confines of Venezuela. In the upper part of the British Guiana cosst it is known to 
approach the sea. 

The carrier is unknown, investigations thus far made being without positive results; 
but it is usually believed to be a bloodsucker of habits requiring the protection of 
shade and a constant tropical heat, with moisture. Various mosquitoes have failed 
to show development of the larvee ingested from a filariated subject; or at best have 
shown only uncertain and partially developed prefilarise. In Africa Brumpt noted 
the fact that in spite of high incidence in communities the naked negroes were by 
no means selected; rather those who wore some amount of clothing (but fleas and lice 

1 Brit. Guiana Med. Ann., 1897, v. 9, pp. 34-28. 

* Brit. Med. Jour., 1S98, v. 1, p. 1011. 

s Tropical Diseases, ed. 1910, p. 6i8; see also annotation to Daniels, Brit. Med. Jour., 1899, v. 1, p. 1459; 
and Low, Brit. Med. Jour., 1902, v. 1, p. 196. 

* Bull, de la Soc. Pathol. Exotique, 1912, y. 6, p. 895. 
» Brit. Med. Jour., 1898, y. 1, p. 1011. 

* Brit. Med. Jour.; Jan., 1902, y. 1, p. 196; Ibid. 1903, y. 1, p. 722. 



PUBLIC HEALTH AND MEDI0IN1&. 63 

were not found capable transmittera). The writer would reserve until later commente 
upon this problem, the solution of which need not necessarily follow absolutely the 
proved methods of insect transmission obtaining in case of Filaria bancro/ti and Loa 
loa. 

The pathogenic influences of the parasite are equally unknown, and apparently 
of no great moment. There are apt to be heavy infestments in a single host, the adult 
worms ranging from a small number to many. Brumpt,* in an African subject, met 
at autopsy with several hundreds of these parasites. 

The species is undoubtedly African, the widespread distribution in western and 
central Africa assuring us upon this point. Its American appearance can best be 
accounted for by convection through the African slave trade, its definite and limited 
distribution here being determined by the conditions of life for its unknown trans- 
mitter, clearly favored in districts of little civilization, and therefore determining 
its marked restriction to the Carib Indians of the dense forests of upper South America, 
to whom the improvements of civilization have not yet reached. It seems not impos- 
sible that when fuller medical knowledge of the deeper Amazonian forests is attained 
the XMuasite will be encountered in this area as well. The writer would urge for this 
parasite not only the chance of an as yet unknown pathogenicity but also the negative 
importance, mentioned above in connection with FHaria demarquayi, of avoiding 
confusion with the microfilaria of Bancroft's parasite. 

4. DIROFILARIA MAOALHJSSI (bLANCHABD, ISftS). 

Synonyms: F. bancro/ti Magalhaes 1892, nee Cobbold 1877; J^. viagalhxsi Blanchard 
1895. 

The intracorporeal habitat of the microfilariae of this species is unknown, and the 
writer is justified in including the parasite in the present article only because of the 
probability that, when opportunity is afforded for their obser\'ation, they will be 
found in the circulating blood (in analogy not only with the other filarise here described, 
but more particularly with its closer relative, Dirofilaria immitis Leidy, of the dpg). 
The parasite has been encountered but a single time. In 1886, J. P. Figueura de 
Saboia, at Rio de Janeiro, found at autopsy of a child, in the left ventricle of the heart, 
a male and a female adult filaria, which he referred to P. S. de Magalhses for study 
and description.^ No statement as to the nature of the fatal illness of the child b 
given; and the blood is not known to have been examined for larvae. The path- 
ological role of the parasite is therefore unknown; and thu solitary occurrence in a 
human being is often held as accidental, with expression that probably it will be found 
in more fixed parasitic occurrence in some lower animal. Occasional suspicions of 
the possibility of aberrant occurrence of Filaria lancrofti Cobbold in the blood cir- 
culatory system in adult stage have been suggested; but even were this true the ana- 
tomical characters serve to distinguish these two species and also to distinguish the 
specimens of Magalhaes from Dirofilaria immitis Leidy, of the dog (the latter having its 
proper habitat in the right cardiac ventricle) . Magalhses, at the time of his description, 
regarded his specimens as the adults of Filaria banerofii Cobbold; and this was accepted 
until 1894, when Manson pointed out the mistake and in 1895 Blanchard gave it the 
name of its discoverer.* It is distinguished by its size (the female measuring 155 mm. 
in length and 0.715 nmi. in thickness, the male 83 mm. long and 0.407 mm. thick); the 
female cephalic end is club-shaped, that of the male not swollen; the cuticle is finely 
striated circularly; the mouth simple, circular, unarmed, terminal; the tail of the male 
has four pairs of preanal and four pairs of post anal papillie of slender shape and villous 
surface, two equal spicules, and is slightly incurved. The embryos as obtained from 
the adult female measured 0.300 to 0.350 nun. long and 0.006 mm. in thickness. 

IC. R. Boo. UoL, 19M, ▼. 51, p. 758. 

t MagaDues, Gaz. Med. da Bahia, 1887-88, 3 ser., y. 40, pp. 100, 152, 200; Ibid., 1801-02, 4 aer. ▼. 2, p. 
438; Centralbl. f. Bakt. a. Parasttenk., 1802, y. 12, p. fill. 
> Lay«fan and Btanfihard, Lee hematoioaires de Vhomme et das anlmauz, Paris, 1805. 



64 PBOCEEDINGS SECOND PAN AMEBICAN SOIENTIFIO CONGRESS. 

The deairability of recognitioii of furthor instances of this pansite, whether in 
man or a lower animal, especially in the Brazilian district where it has been found 
in the solitary known case, is of course obvious. 

6. LOA LOA (OUTOT, 1806). 

Synonyms: FHaria loa (Guyot, 1805); F. oculx Gervais and Van Beneden, 1850; 
Draeuncuhu oculi Diesing, 1860; D. loa Cobbold, 1864; F, suboonjunctivalii Guyon, 
1864; F. diuma Manson, 1891; F, 9anguvn%$ homini$ var. major Manson, 1891. 

In tracing the American relations connected with this parasite the writer must 
primarily express his indebtedness to Ward,' who in his admirable inclusive and 
analytical study of 1906 has followed the history of this parasite and has, in addition 
to a clear discussion of its morphology and life history, arranged a full list of its pub- 
lished occurrences with bibliography. From this the writer has culled the cases 
assigned to the Western Hemisphere, adding thereto the instances which are recorded 
in literature since 1906 for America. 

It is to be recalled that Loa loa is within very strict limits a habitant of west Africa, 
where doubtless it has existed from time immemorial. Its specific name loa was 
the name applied to it by the negroes of Angola, where Guyot, a French naval suigeon, 
observed it in 1777, his account not being published until 1805.' Yet before Guyot*a 
observation of loa reference appeared to certain worms of the human eye encountered 
in the West Indies, which to all appearances must be referred to the parasite here 
considered. Thus as early as 1770 Mongin * recorded the extraction of a worm from 
beneath the conjunctiva of a negress at Maribarou in the island of Santo Domingo. 
Two cases in negroes at Cayenne in French Guiana were reported in 1777 by Bajon,^ 
in the one case the worm being removed in 1768 from beneath the conjunctiva of a 
negro girl of eight years of age, in the second the worm not extracted but seen to 
move across the eye between the conjunctiva and cornea of an older negress (in 1771). 
Arrachart published two cases on the authority of Mercier, who in 1771 extracted a 
worm from beneath the conjunctiva of a negress in the island of Santo Domingo, and 
in 1774 extracted the second from the eye of a negro above the cornea. 

Arrachart also states that in 1795 a Creole woman, Mile. Fraise, bom in Santo Domin- 
go, assured him that her brother when from three to five years old had had several 
worms extracted from his eyes and that young negroes of the island were often attack od. 
In Arrachart's publication, appearing in 1805, the accounts of Guyot's observation of 
these worms on the coast of Angola and his reasons for differentiation of tli. m fr^m 
Dracunculua m^dinensis, with which doubtless the earlier American cases were con- 
futed, were given. Thereafter the American list, following Ward, includes a case in 
whl'h Do Lassus, an army officer in Santo Domingo, removed a worm from the eye 
of a negro; ^ a case of a worm observed by Clot-Bey ' crossing the cornea of an African 
slave girl at Monpox, Colombia, in 1828; the removal of two filarise in 1837 from the 
e>'e of a y )aii^ iiuinea negress in Martinique by Blot.^ Two instances of eye filarite 
folio .V from Brazil, in each of which the question of Guinea worm arises, one a case 
of ex^tractlon of a worm from the eye of a negro in Rio de Janeiro by Lallemont,^ the 



IJ ir. ( r Infect. DIs., 1906, v. 3, p. 37. 

• 1 n A rr\c lart, Memolres, diaser tattoos et obaervatloos de ehlmigiey PtriB, ISOS: Mdmoire sur les vers des; 
> eii : .11 •• <* rp the Academy of Surgery in 1778, p. 217. 

» J de .Sf 'd., Paris, 1770, v. 32, p. 338. 

• ^' m i-e ) >i]r %rvlr a Thistoire de Cayenne et de la Guyane fTanoobe, 2 yob., Pari<, 1777, \c\l, p. 325 
hhiir .ic -' i in Jour de Med., 1778, v. 40, pp. 386, 481; quoted in Arracbart, sop. clt. 

• t{ .1 hy T arrey, Xftoioires de chimrgie mHitaire et camp., Paris, 1812, 4 yoN., viA 1 , r. 223. 

• 1 V. n. Acad. roy. des sciences, stance da Dec. 10, 1832. Ardi. gen. de MM., Paris, lo • ani.f'e., vol.. 
3fl I . 6 ^ I lis by some authors referred rather to RouUn. 

7 Fee rde 1 by Guyon. C. R. Acad. Sd., Paris, 1838, v. 7, p. 756. 

• C IS. er'.s Wochenschr. f. d. ges. UeOkunde, 1844, p. 842. 



PT7BLIG HEALTH AND MEDIGINB. 65 

otbar the report of a case observed by Siguad ^ of the removal by C. J. doe Santos 
of a wcffm from the orbit of a negreas of the Mina tribe in Brazil » at Rio de Janeiro, in 
1833. In 1845 Mitchell ^ saw a worm, estimated at about 2 inches in length, in the 
sabconjunctiva of a negress in Trinidad who had come from the west coast of Africa 
in 1834. The wonn was first noted in 1837, again in 1841 and 1845, and was said to 
have grown in the eleven years. (Ward properly questions whether each time the 
same parasite was seen.) By Mitchell's account there was a tradition that a similar 
worm had been seen in a family in Antigua 60 years before (1799). 

With these the published American cases close until the latter end of the past cen- 
tury, the usual and probably the correct interpretation of the cessation being that 
with the end of slave importation from Africa the source of the parasite was diverted 
from the Western Hemisphere. It is to be presumed that the parasite failed of find- 
ing a proper insect conveyer in America and that each case therefore died out without 
dissemination. The only strong suggestion of endemic fixation concerns Santo 
Domingo, where if the statement of Mile Fraise to Arrachart was correct, the worm may 
have been locally propagated for a time. It is not stated, but is to be presumed, that 
her brother, a child of between three and five years, was bom on the island, as she 
was, and that he there acquired the inf estment she related. The further statement of 
the common affection of young negroes on the island and the several recurrences ol 
case reports from this island bear as evidence in the same Line. Whether there was 
also some local dissemination in Brazil is also a matter of some possibility, the Mina 
negress from whom Dos Santos removed a specimen being presumably a native. It 
is to be remembered, however, that there is some uncertainty as to the identification 
of all these early American cases; that they were regarded at the time as Guinea 
worms (which it is well known acquired at least partial endemic fixation in South 
America and the Lower Antilles). 

Since the date of Mitchell's observation (1845), after a lapse of half a century, occa- 
sional cases have reappeared in America, but with a change of location to the north, 
in the United States and in Canada, and with a change from the uniform infestment 
of negroes (except the Creole child related by Mile. Fraise to Arrachart) to infestment 
of whites who invariably present the history of sojourn in west Africa (for the most 
part in missionaries returned from the latter district). 

Ward UstB, of the modem American cases, the following: (1) Mn. M., a missionary 
living prior to 1897 for several years at Batanga, 70 miles inland on the Gaboon River, 
in west Africa. In 1898, at Toronto, Canada, Dr. Frederick Fenton removed two 
specimens from her lids, and in 1899 found a third , but failed in extraction .* (2) About 
1896, Dr. F. N. G. Starr, of Toronto, Canada, removed a filaria from the skin of the 
chest of a woman who had been a missionary on the west coast of Africa, but had 
returned on account of ill health; and demonstrated it before the Toronto Patho- 
logical Society.^ (3) In 1902, Milroy, of Omaha, Nebr., removed a loa specimen 
from the upper right eyelid of Mr. K., an American who had been living in 
Batanga, in German West Africa.' (4) Ward also records a series of cases detailed 
to him by Dr. B. C. Loveland, of Clifton Springs, N. Y., later of Syracuse, N. Y. 
In 1890, Loveland removed a loa from the skin of the left scapular region of Mrs. 
R, who had been a missionary stationed near Batanga; and in 1898 he extracted 
a loa from the eye of Mrs. J., also a missionary invalided home from Batanga. Love- 
land stated that Mrs. J. informed him that her husband and children have all had 

• 

> SJgand, Du Cllmat ct des malad . da Br^sfi oo ststistiqae m4d. de cet Empire, Paris, 1844, p. 135. 

* London Lancet, 18fl9, ▼. 3, p. fi33. 

* Case detailed in Ward's paper, sup. cit. 

* Detailed In Ward's artlde, sup. cit.; and both this and the previous case recorded by Primrose, Brit. 
M^d. Jour., 1903, v. 2, p. 1282. 

* Detailed in Ward's paper, sup. dt. 



66 PROCEEDINGS SECOND PAN AMERICAN SCIBNTIFIO CONGRESS. 

theee parasites. (5) Dr. G. F. Friend, of Chicago, is also quoted by Ward in relation 
to a previously' unreported case, Mrs. X., formerly a missionary in west Africa, from 
whose eye he removed a specimen about four years after her return to America. (6) 
Vail, of Cincinnati *■ presented before the American Academy of Ophthalmology and 
Oto-Laryngology in 1905 several spedmens of loa he had removed from the eyes of 
Mrs. L., the returned wife of a medical missionary at Elat, Ebolowa in central Africa. 
To theee cases, all from Ward's paper, may be added : (1) McDonald in 1908 ' reported 
a case of extraction of a specimen of Ion from the eye of i£n American who for nine 
years previously had resided in the Old Calabar region of west Africa. (2) In 1911 , 
Huffman and Wherry ' reported a second case from Cincinnati, Ohio, with description 
of the parasites removed from the eyes of Mrs. B., after return from missionary service 
at Batanga in the Kameroon district in West Africa. 

Smith and Rivas ^ in 1911 presented before the Philadelphia Pathological Society 
specimens from two white American missionaries invalided home from the same dis- 
trict in west Africa. One of the specimens, from Mr. K., of Philadelphia, was imper- 
fect, only the caudal half of the worm, a male, having been obtained. The anatomical 
features presented by this led the writers to the queory whether it does not represent a 
new species of the genus loa. No other species of loa or of other genera of filaridae with 
habits like those of {oa is known; but the question of a possible American species is 
raised by Ward to account for the suggestion of endemicity in South America and in 
Haiti, as an alternative to acceptance in these localities of a fit insect transmitter. 
And such a posaibility is by no means to be lightly brushed aside. Can this be the 
meaning of tiie case reported in the Canal Zone at Colon Hospital in 1906. as fikaria 
diumat Or if that case be hunted down, will it turn out to have been an imported 
case of Loa loa from Africa (which does not seem probable) or a mistaken diagnosis 
of an aberrant day specimen of Bancroft's microfilaria, or the microfilaria of pentans 
ix demarqwn/it * 

There is no occasion in this article for narration of the identification of loa with 
MicrofiUxria diwma by Manson and others, or of the development of our present views 
as to its morphological peculiarities or its pathogenic effects, nor yet to more than 
mention that the suspicion held in Africa that the parasite is carried by ''mangrove 
flies" {Chrysops and tabanus species) has been sustained by the success of Leiper * 
in obtaining development of the microfilaria into prefilariae in Chrysops dimidiatus 
and Chrysops sUacea. Flies of the same genus and with the same unpleasant habit of 
energetically sweeping about the heads of human beings and trying to alight to draw 
blood are biown in America, as Chrysops viUatus Wiedemann and Chrysops niger 
Macquart. Leiper failed to obtain prefilarial development in stomoxys, in various 
mosquitoes, and in fleas and bedbugs. It is questionable whether in actual truth the 
parasite will be found consistently nontransmisaible in America; and there may welj 
be a suspicion as to whether the imcertain endemicity temporarily apparent in Haiti, 
and possibly in South America, was not real, and whether firm fixation was not escaped 
more by chance than by necessity. 

Comments. 

Of the main purpose of the current article, that of presentation of the history and 
geographical distribution of the group of filarial parasites above considered, the pro- 
ceeding pages doubtless cover the principal features; but the writer realizes that much 

1 See Lippert and also Vail, Cincinxiati Lanoet-CUnic, 1905, v. 55, p. 733. 

> So. California Practitioner, 1908, v. 23, p. 325. 

> Parasitology, 1911-12, ▼. 4, p. 7; see also Haffman on the loa larva, ibid., p. 75. 

* Proc. Phila. Path. 8oe. 1911, n. 8., ▼. 14, p. 2; and Amer. Jour. Trap. Diseases and Prevent. Med., 
1914, V. 2, p. 361. 

6 See Report of Dept. of Sanitation, Isthmian Canal Commission, laboratory report of Colon Hospital for 
June, 1906. 

* Proc. Zoolog. Soc. London, 1910. 



PXTBLIO HEALTH AlO) MBDIOnrB. 67 

ha0 probftbly been miaBed which should have found place therein. SysteinatlcaUy 
complete knowledge of the geography of the different filaridm is very desirable as a 
baais for any sound plan for prophylaxis, and for dealing with the larger problems of 
eradication of these pests. When we consider that surely three of these five parasites 
have been brought into the Western Henusphere, and that of the other two, only one, 
the single occurrence of DirofUaria moffaihsuif is surely indigenous, and when we recall 
how restricted in distribution are Aeanthodieilonema perstana and JUaria demarguayi, 
how Loa loa after seeming to take hold in Haiti and Brazil promptly diaappeared when 
its importation ceased, and how apparently the mosquito campaign in Cuba gives some 
promise of the abatement otfilana banerofti, it seems well worth while that we should 
look forward to the possibility of eradicating all these parasites from among us. The 
problem is surely not greater than that of dealing with the hookworm; for some of the 
group probably no more than that of handling yellow fever. 

But to establish the fundamental knowledge to be utilized for so laudable a purpose, 
we require more definite information as to the precise geographical location and area 
of infested districts for each species of filaria. This means concerted work, a combina- 
tion of individual and central effort. Where health statistics are maintained by local 
or general governments, filariasis (with differentiation of the species for obvioua 
easons) should be made reportable. Where such plan is impracticable, local medical 
oiganizations should act instead, and ask for voluntary reports from members and other 
physicians of the district concerned. A central agency for reception, coordination 
and publication of such reports could undoubtedly be found in the health deiMutment 
of some one or other of the American countries, or in such an organization as the Inter- 
national Health Commission, which is doing such admirable work toward reducing 
the ravages of the hookworm. With the field well mapped out, not only will the 
extent of the problem be before us, but at the same time there are sure to be sugges- 
tions from that knowledge as to advantageous mode of dealing with the question in its 
specific stages. 

The pioneer work of Low and others who have been mapping out the infested 
areas of the West Indies and of British Guiana is even in its incomplete form suggestive. 
The peculiar limitation of demarqiuiyi to country districts and imoiganized villages 
in St. Vincent, and the restriction of demarquayi and perstans to the forest depths of 
inland Guiana, with tendency toward heavy infestment in these areas, will unques- 
tionably be found significant in the. matter of the mode of their transmission. And 
the promise of effectiveness of mass handling of these affections is to-day in closest 
line with prevention of transmission. 

1. Problems offilccnal transmMon. — It is probably a general law that transmission 
of filarial worms must include opportunity for development of the iarval filaria, or 
microfilaria, in some intermediate host into an infesting or prefilarial stage. We 
know, thanks to the studies of Manson, Bancroft, Lewis, Dutton, Low, James, Lebredo, 
Daniels, Leiper, and others that Culex/atigans in the West Indies, Myzomyia rossii in 
India, Pyretophorus costalis in Nigeria, Myzorkynchus sinenna and barbirostris in 
India and China, Manaonia unifarmis in Africa, India, the Philippines, and Australia, 
Stegomyia pseudoacuteUaris in Fiji (7), and other mosquitoes serve as intermediate 
hosts adapted to such development for the larval Filaria banarofli; that for Loa loa 
development of the microfilaria takes place in certain mangrove flies, Chryaopa dimi- 
diatus and ailacea, and that these are apparently efficient transmitters of the prefilaria; 
that Aeanihocheilonema perstans seems to reach at most only partial development in 
several types of mosquitoes and possibly, too, in the African tick, OmUhodortu mou- 
bata, which are therefore only tentatively held as transmitters; and that Filaria 
demarquayi may likewise undergo at best only partial development in certain mos- 
quitoes, and that these can not be held certainly as transmitting agents. On the 
negative side, too, for each of these parasites a list of bloodsucking arthropods have 
been tested and found for the individual species incapable of acting as efficient hosts 
and transmitting agents. 

e843&— 17— VOL rx 6 



68 PBOGEEDINGS 8EC0KD PAK AMERICAN 8GISNTIFI0 G0NQBES8. 

In the early views of mosquito transmissioii, it was not contemplated that the infested 
mosquito directly transmitted the prefilaria along the sheath of the proboscis of the 
insect to the woimd made by the mosquito stiletto in the skin of its victim. Rather 
it was thought that the insect merely provided accommodation for development into a 
phase capable of independent life ; that after oviposition on the surface of the water, with 
the death of the mosquito, the prefilaria escaped into the water and later gained access to 
the human host by being swallowed with the water. The proof of direct transmisfdon 
of Dirofilaria immitis by Anopheles maculipennis by Grassi and N6e was applied at 
once to the conception of the part played by mosquitoes in transmission of human 
filariasis; and Manson's theory of partial water convection was abandoned byManson 
himself in favor of the theory of direct insect convection. The experience of time 
and study have confirmed this latter belief for the mosquito and Filmia bancrofti. 
But, on tJie one hand, does this necessarily disprove the older idea or some possible 
adaptation thereof for all species, and on the other hand is the list of insect conveyors 
for this one species complete? Are mangrove flies the only transmitters of Loa loaf 
Are we to accept for perstans and for demarquayi the uncertain sausage-shaped forms 
which have developed in the thoracic muscles of certain mosquitoes as sufficient proof 
that these insects are efficient intermediate hosts and capable transmitters of these 
parasites in nature? 

The relative infrequence with which Filaria bancro/H and Loa loa occur in associa- 
tion with other filarise (more marked for the first than the second) is in consonance 
with the mode of transmission by bloodsucking insects specific for each; the frequent 
coincidence of Filaria denwrquayi and Acanthocheilonema perstans in British Guiana 
is suggestive of a common mode of transmission (which may be by some totally differ- 
ent type of transmitter, or which may differ itself intrinsically in method). Whatever 
the agent or the mode it seems rather fixed in limited areas, not apt to persist in organ- 
ized communities, and to be of such a nature as to favor heavy infestments in the local- 
ity where it exists. It is quite conceivable that such characters may apply to some 
bloodsucking insect; but the writer can not easily rid himself of the thought that the 
modus operandi may be quite different and perhaps follow the lines of Manson's 
original conception with certain modifications. 

For these latter species may there not be some mode of transmission possible which 
will not necessitate the supposition of peculiar bloodsuckers living only in restricted 
and undeveloped districts and in the depths ol forests? Is it not possible that their 
lack of ensheathment in the blood of the host endows these small microfilarise with a 
mode of e'^cape other than through abstraction by a hematophagoiis insect? Manson 
in early conmients upon lack of microfilarial sheaths in these blood worms suggested 
that perhaps, because of their freedom of movement, these might be able to penetrate 
through the walls of the blood vessels and escape into the tissue spaces. May they 
not, if they possess such ability, succeed by their own efforts in escaping from the 
body of the host to a temporary free existence? Would it be impossible for them, 
without inducing notable symptoms, to escape via the kidneys, the intestine, or the 
lungs to such freedom? ^ The writer would suggest especially the desirabi ity of 
examining the expectoration and the mouth moisture for microfilariae, recalling here 
the fact that escape through the walls of the pulmonary capillaries is not an unknown 
step in the life cycle of certain worms (as in case of larval hookworms and larval 
strongyloides). And as by accident, the larger ensheathed larva of FUaria hancrofU 
is sometimes expectorated with a bit of blood. . Dutcher ' reports a case of Bancroft's 
filariasis in a Porto Rican soldier, who in a paroxysm of coughing in whooping cough 
expectorated a small amount of blood between the hours of 9 and 10 in the morning, 

1 Low (Brit. Med. Jour., 1903, ▼. h p. 723; Joor. of Trop. Med., 1908, v. 6, p. 180) in Uganda notes the 
flrequenre of large numbers of perstant microfilarto In tlie lungs. 
' Jour. Trop. Med. and Hyg., June 1, 1914, y. 17, p. 163. 



PUBLIO HEALTH AKD MEDICINE. 69 

a number of microfilarifle being afterwards found therein. Beukuma, ' at Nagasaki; 
likewise found microfilarue in the hemoptysis of a case of Bancroft filariaeis; a third 
case is reported by Yamane,' and Garcia Mon and N. Garballo,' in Habana, met with 
a case of repeated hemoptysis at night with microfilarias in the expectorated blood . 
(In this last case, because of the time of finding the larvse in the pulmonary area, and 
because the blood taken from skin puncture at 9 p. m. failed to exhibit microfilariae, 
the query naturally must arise whetiier possibly there existed here an infeetment with 
a diurnal filaria.) 

We are well aware that the embryonal forms of a related genus, Dracunculus medi- 
nensU, escape, as the mother worm perforates the skin of the host, from the maternal 
body into the water; live independently therein for a number of days, and then 
develop into an infesting prefilarial form in some species of cyelops; and that when 
swallowed with the water drunk by a human being they escape into the stomach and 
infest the man by penetrating from the alimentary canal into the tissues. This last 
is brought out by Leiper's experimental infestment of monkeys by giving them to 
drink water containing infested eydopsy and by the fact that in water acidulated with 
hydrochloric acid the body of the cyelops is disintegrated, and the contained pre 
filarial parasites are set free, apparently not only unharmed by the acid but stimulated 
by it into activity of movement. 

May it nut be possible that some such route of escape is also followed by the small 
unenaheathed microfilariae of the perstan$ and demarquayi species (perhaps to find 
their intermediate host in qf clops or an analogous water animalcule)? And is it not 
possible that the restriction of locality characterizing these parasites in America (away 
from the centers of population, in country villages and in forests), and the high ratio 
of incidence in the inhabitants of such places, may be as well explicable on the basis of 
contaminated drinking water as upon the local occurrence of a very particular type of 
mosquito or other bloodsuckers? 

One who is far from districts where actual investigation is possible on such lines 
naturally hesitates to annoy the field worker with such queries; but the points of 
analogy seem sufficient to make the thought possible that truth may be near (esx>ecially 
while we are not assured of success in the mosquito trials thus far made for either 
penUmi or for demarquayi). 

2. Problenu of microfilarial periodicity. — Clinical diagnosis of tilariasis should not 
be absolute save after detection of microfilariae in the blood or other fluids of the sub- 
ject. Differentiation of the type of filariasis, while possible from gross manifestations 
in case of Filaria banarofti and Loa loa, should rest mainly upon differentiation of 
the microfilarial species. This depends principally upon morphological features of 
the larval worms; but it is desirable to know whether the subject manifests periodicity 
(X aperiodicity of microfilarial presence in his peripheral blood, and whether an 
actual periodicity is diurnal or nocturnal, before coming to final conclusion as to the 
species with which he is dealing. 

The nocturnal periodicity of the Bancroft type of microfilaria was early a matter 
of mnch speculation and theorization, becoming only the more attractive when a 
diurnal and a persistent species came to be known. Of the older theories in explan- 
ation of this phenomenon in case of Filana bancro/ti that of v. Linstow ^ rests upon 
a mechanical basis. Linstow believed that during the active working daylight 
houiB of the host the peripheral capillaries are narrowed, or in a state of tonicity, 
and that at such times the larvae of Filaria bancro/ti are too large to enter these con- 
stricted circulating passages, but that in the relaxation of sleep the peripheral capil- 
laries widen sufficiently to allow the vermicules to enter and traverse their lumina 



> Nedtrl. TUdsebrtft ▼. geneesk., Amsterdam, 1884, v. 30, p. 661. 

*CeatcBlbl. f. klia. Hed., Mar. 34, 1888, p. 331, oolidenaed from article by Kentaro Murata In Mit. aas d. 
Hed. Facalt. d. kaisarl. Japanlseb. Unlwnlt&t, Bd. 1, no. 1, Toklo, 1887. 
■BavlBtamed. y. dnux. da la Habana, 1304, ▼. 3, p. 833. 
* Oentnlbl. f. Bakt. u. Parasitenk., 1802, t. 12, p. go. 



70 PBOOEEDINOS SECOND PAN AMEBIOAN 8CIENTIFI0 C0N0BE88. 

and that therefore at nighttime alone (ordinarily, for Mackenzie ^ had shown that 
the phenomenon was connected with sleep rather than with darkness, and could be 
reversed by reyersal of the sleeping habit of the subject) these parasites are demon* 
strable in the blood withdrawn by skin puncture. While attaining for a time wide 
credence, this explanation rapidly declined in popularity when its inconsistency 
for the diurnal periodicity of Loa loa became appreciated. The suggestion of Myers * 
that each periodic appearance of the microfilariae represents a fresh quotidian brood, 
and that each interval is due to the death of the last brood, never attained any wide 
acceptance; and was thoroughly discredited by the proof that these filarial larvse are 
possessed of much greater duration of life than a single day, and that in reality the 
phenomenon of periodicity is rather bound up intimately with cyclic change of 
location of the vermicules in the blood circulatory area. Manson, who first established 
the last fact, conceived that these changes of position of the microfilariae en masse 
from the peripheral to the pulmonary area, and thence to the periphery again, can be 
explained as a chemotropic phenomenon .' No chemotropic agent, whether x>08itive or 
negative in its influence upon the microfilariae, has ever been demonstrated (although 
theoretically demonstrable); and we may seriously question the verity of the con- 
ception in that it has been shown that periodicity is not absolute for any periodic 
species, but that for any nocturnal or diurnal type it is possible at any and all hours 
to demonstrate microfilariae of the species in question in at least small numbers in 
the blood of the periphery. If chemotactically influenced, all microfilariae in every 
part of the circulation should be influenced equally and at the same time. It can not 
but appear singular, too, that if there be chemotactic influences regulatory in case of 
FiUxna hancrofti and Loa loa some evidence of like phenomena can not be witnessed 
in case of all hematic microfilariae. The adaptation theory of Bahr ^ may likewise 
be held in question. This conception would presuppose some unformulated natural 
law of adaptation of the habits of parasites to the habits of their necessary transmitting 
hosts (that, applied to Filaria hancrofHf its microfilariae appear noctumally in the 
peripheral blood of man to insure their acquirement by a night feeding mosquito; 
that, in cas^ of Loa loa^ its larvae are diurnal in order to facilitate their withdrawal 
by some day biting bloodsucker, as cfvpyiops). Why should adaptation demand an 
ingenious arrangement when mere persistence of the species in the peripheral blood 
for the whole 24 hours could not fail to accomplish the same end? Can it be 
consistently supposed that Bancroft's microfilaria would change its habit of peri- 
odicity to become a persistent parasite in the peripheral blood in order to adapt 
itself to the day-feeding Stegomyia pseudoseuteUaris in the Pacific islands when, 
among others, the efficient intermediary, Culex faHganSy prevails in the same lands 
as a dusk and night attacking pest? The writer would prefer to accept the indi- 
viduality of Filaria philippinenais Ashbum and Craig, rather than be compelled to 
the idea that it is a Filaria hancrofti changing its habits to accommodate itself to an 
unnecessary intermediate host. 

In a recent article the writer, with Dr. Bivas,' detailed a series of studies made upon 
several cases of loa and of hancrofti infestment, in which we felt that we found evidence 
against phototropic and thermotropic influences in relation to the phenomenon of 
periodicity, and, on the other hand, suggestions that mechanical foctors (such as 
increase of the circulatory flow from exercise and from alcoholic stimulation, and 
variation of compression of the tissues) are operative in determining the number of 
microfilariae to be found at a given time in measured specimens of the peripheral 

» London Lancet, 1881, v. 1, p. 707. 

* Mod. Report China Imp. Customs, Shanghai, 1886; abst. in Brit. Med. Jour., 1887, v. 1, p. 783, and edi- 
torial, ibid., p. 1394. 

* Drit. Med. Jour., 1899, Sept. 9, v. 2, p. 644. 

< Jour, of London School of Trop. Med., 1912, Supplement 1. 

* Smith and Rivas, Amer. Jour. Inf. Dls. and Rev. Med., 1914, v. 2, p. 361. 



FUBUO HEALTH AND MBDIGDrB. 71 

blood.* GompajAtive counts of the number of microfilariflB (in a Bancroft case) in 
measured amounts of blood from the peripheral capillaries (skin prick) and from a 
▼ein (by syringe directly from vein) at time of maximum showed a marked excess 
of microfilarisB in the former; which was taken to mean that the ndcrofilarie are 
accumulated in the peripheral capillaries at time of presence of the period, probably 
because they are too large to pass through at that time (not merely because they are 
too laige to get into the capillaries in the interval, as linstow supposed). We believe 
that the maximal presence thus represents a concentiation of the parasite by, as it 
were, the sievelike function which the capillary networks serve, a ideve fine enough 
to retard the progress of the vermicules, but not to completely prevent their passage. 
This alone can not, of couAe, explain the clinical peculiarities of periodicity, but we 
believe it to be basic. Oonsidering in illustration the microfilarue of FUaria ban' 
crofti and of Loa loa, this would not explain why the first are nocturnal and the second 
diurnal; the two species would present practical identity and probably aperiodicity 
were it otherwise. The writers would believe, with v. Linstow, that there does 
occur a diurnal tonus or constriction of the peripheral capillaries and at night (from 
the fotigue of the day and the relaxation of sleep) a slight widening. The proof ia 
perhaps not complete, but physiologists believe that such variations of caliber of the 
peripheral capillaries is compensated for in the splanchnic area, dilatation of the skin 
capillaries being accompanied by contraction of the splanchnic capillaries, and vice 
versa. However, a second capillary barrier to the free circulation of the microfilariae 
in the blood stream, that of the pulmonary capillaries, must be kept in mind, a series 
of capillaries the lumen of which is believed to be fairly constant and independent 
of at least ordinary variations of the peripheral circulation. 

From histologic studies one may be fairly assured that the caliber of the fine pul- 
monary capillary network is much the same as the average caliber of the fine peripheral 
capillaries, permitting a free progress of the red-blood cells "in Indian file," but not 
large enough to allow progression of more than a single cell side by side. This should 
mean no inconsiderable difficulty for an object of the size and shape of either bau" 
orofli or loa micTofilari» to pass through the pulmonary area (probably hours, if one 
may compare the time of presence of the parasites in the cutaneous capillaries). 
The intervention of these two capillary barriers in the circle, one at the cutaneous 
periphery of the general circulation (with an appreciated diurnal contraction and 
nocturnal dilatation) and one in the lesser circulatory area (this one relatively fixed at 
a caliber just permitting single red cells to move easily), may be believed to complete 
conditions making for an intermittent retardation of convection of any passive objects 
near the size of red cells and not quite as adaptable as are red cells, because of greater 
long meaeurements and unfavorable curves. Caught in the skin capillary network 
in the period of diurnal constriction, even those somewhat less than 0.007 millimeter 
in diameter would be enmeshed, only to escape in large number as the tonicity of day 
gives way to the widening of night (those which pass the pulmonary area at night 
and are swept to the skin would at once pass through and back to the lungs); 
passed to the lungs, they are again held until the force of the stream washes them 
through. Those which more closely approximate the red-cell measurements are 
held even better in the relatively unvarying lung plexus of capillaries and are there 
enmeshed even when the akin capillaries are dilated in sleep (this probably accounting 
for the perfect periodicity of Miero^ria banerofti in comparison with the greater 
tendency in case of Microfilaria ha to he found occasionally in the peripheral blood 
in the interval). Those that are materially smaller than red cells are retarded in 
neither set of capillaries and are persistently to be found in the peripheral blood as 
well as in the pulmonary blood. From the standpoint of sisse the microfilaria of 
Bancroft's species is the largest, measuring usually nearly or quite 0.300 millimeter 

^ Compare Granville's old theory of the influence of modification of rate of blood flow and blood pressun 
by sleep In explanation of migration of ndcrofllarise to snrface at night, London Lancet, 1882, Feb. 20, 



72 PBOCEEDIKGS SECOND PAN AMEBICAN 8CIENTIFIG CONGRESS. 

in length and 0.0075 to 0.008 miUimetera in tbickness; the larval Loa loa is from 0.200 
to 0.250 millimeter long and from 0.006 to 0.007 millimeter in thickness; the larval 
form found in the blood of the type described from Japan by Taniguchi is described 
as 0.164 millimeter in length and 0.008 millimeter in thickness; the larval demar- 
quayi measures 0.200 millimeter long and 0.005 millimeter thick; the perstoM larva 
is nearly of the same size, possibly a shade thinner. 

The hancrofti and taniguckii larvae are both periodic at night in the peripheral 
blood, and they are the thickest; loa microfilaria ranks less in thickness and is peri- 
odic in the diuroally constricted skin capillaries; perstaru and demarquayi both have 
materially smaller diameters and are not restricted at all, that is, are aperiodic. 
From the standpoint of size, therefore, there is a basis for belief that the two barriers 
of capillary network to be passed determine the fact of periodicity for microfilarise of 
approximately the thickness of the diameter of a red blood cell, and offer explana- 
tion of the aperiodidty of those of materially smaller diameter. In the diurnal con* 
traction and nocturnal dilatation of the skin capillaries (with the relative fixation of 
the pulmonary capillary mesh) there is basis for explaining the nocturnal entangle- 
ment of the larger forms at night, and of Loa loa by day. 

But size can not be the sole factor to be appealed to. In some sense any ensheathed 
microfilaria may be thought of as a relatively passive object, swept by the current of 
the blood and unable to accomplish much active progression of its own initiative; 
but unsheathed microfilariae can readily dart at will in the fluid in which they live. 
To observe the ineffectual wriggling of a larval hancrofti in the field of the microscope, 
and to note the swift darting movement of the same larva if in some way it escapes 
from its sheath, is to recognize at once the difference referred to. The writer is confi- 
dent that even were perstans and demarquayi larvae ensheathed, their small size would 
insure their passage through the capillary barriers and their aperiodicity; but their 
freedom of movement in the blood, because they lack the embryonic sheath, in addi- 
tion assures them ability to force their way along (and probably would, even were 
they larger than they are). With the ensheathed types this advantage does not ob- 
tain. The writer knows of no unsheathed periodic microfilariae. Only one aperiodic 
sheathed hematic microfilaria of man has been described, the contested Filaria philips 
pineruii of Ashbium and Craig, of the Pacific islands. Its microfilarial measurements 
are identical with those of the larva Filaria hancrofti, with which many would identify 
it. Its sheath is described as closely fitting, in contrast with the loose saccular en- 
sheathment one notes in case of Filaria hancrofti and Loa loa. This surely means as 
much in the matter of the effectiveness of its motor efforts, as to a human being it 
matters for his ability to run whether he be ensheathed in a closely fitting garment 
adapted to his limbs, or completely enveloped within a loose sac. The writer is dis- 
posed to regard the aperiodicity of this exceptional type as due to its ability to move 
in free progression in spite of its relative size, because its sheath does not hamper its 
movements. 

To carry this idea still further, one may well believe that between loa and hancrofti 
forms of larvae the more twisted appearance of the former in permanent microscopic 
preparations means that in life loa is the more vigorous. Some progression is possible 
for each, in spite of the sheath, little though it be for either; but it should be greater 
in case of loa, other things being equal, and this should mean for loa more facility in 
pasedng capillary networks (that is, avoiding concentration of numbers, save in the 
fullness of diurnal tonicity). 

One can readily apply the explanation to the fact of reversibility of hancrofti peri- 
odicity by changing l^e period of sleep from night to day, and to the loss of periodi- 
city in general disturbances of the circulation from fover, anesthesia, etc. (do Saus- 
sure reports a case at Charleston in which during labor a negress lost the periodicity 
of her microfilariae, although later the periodicity was regained).^ The writer must 

1 Med. News, 1890, June 28, y. M, p. 704. 



FUBUO HEALTH Ain> liEDIdlTB* 78 

confess that he can not see its applicability to the reported failure to cause change 
of periodicity in loa infestments by changing the hours of sleep to day, unless the 
observers failed to recognize that there really occurs aperiodidty (as might be ex- 
pected) rather than reversal of periodicity to night. Loa loa is naturally less definitely 
periodic than hanero/H (that is in the interval one is surer of finding a few microfilaiite 
in the peripheral blood) ; in reversal of sleep to-day a failure to get full capillary tonus 
would merely cause loss of the required accumulation, that is, would only make the 
periods less distinct. 

In capitulation of this attempt to explain the phenomenon of filarial periodicity, 
the writer would hold in theory: (a) That no microfilaria which is without a sheath 
in the circulating blood or is closely sheathed and which in size is materially less 
than the diameter of a red blood corpuscle or at least not distinctly thicker, can accu- 
mulate under ordinary conditions of circulation in any part of the circulatory cycle, 
and can not for that reason present the phenomenon of periodicity; (b) but that any 
microfilaria which, because of size or looseness ol ensheathment, along with no great 
vigor of motor activity, is likely to be caught in the meshwork of the peripheral and 
pulmonary systems, is sure to exhibit this phenomenon; (c) that of this latter group, 
the larger the parasite, the looser the sheath and the less vigorous the motor activity, 
the more likely is the periodicity to be nocturnal, and conversely the smaller and 
more active are likely to be diurnal in their peripheral periodic presences; (d) changes 
of marked d^^ree in the vascular tone of the host, whether from disease, drugs, or 
habit, may induce loss of periodicity. 

If Fiiaria phUippinenais really is FiUxria bancro/tiy the writer suspects its aperiodi- 
city is rather due to climatic influences upon the vascular tone of the host than to 
any change of habit of the parasite itself (aside from the peculiarity of its closely 
adapted sheath). Such an explanation should be open to verification or to disproof 
experimentally as well as clinically. In fact Rivas and the writer have sought in a 
dog infested by the aperiodic DvrofiUsna immitia, kindly sent us from New Orleans 
by Dr. C. G. Bass, to induce in mimicry of periodicity an accumulation of microfi- 
lariae in skin areas by constriction of capillaries in the areas in question from cold 
and by compression. Our results have been irregular, variations both in excess and 
in deficiency and sometimes no variations at all being recorded in comparison with 
the numbers taken from uninfluenced surfaces. That a disturbing influence was 
exerted can be said definitely; that the results were not uniform can only be attrib- 
uted to failure of uniformity of adjustment of conditions. The writer for the present 
can only express hop>e that further experimentation will lead to more uniform results 
so that reliable statements may be made pro and con in relation to the explanation 
we have proposed. 

3. Problem om to the Umgevity of filarial parantea, — No less to the general public 
than to the infested individual does the problem of prognosis of filariasis appeal. We 
have no reliable remedy for the destruction of the parasites; and we can not, save by 
extraction of the parent worms (as in loa and in occasional cases of Bancroft 's filariasis), 
put a stop to the infestment and to the chance of dissemination, or to the danger of 
untoward complications to the individual himself. In such a position, what do we 
know of the length of time during which adult fiiaria remain alive, and for what 
period of the lifetime of the female does she give birth to microfilarice? How long 
after entrance into man before they reach maturity? If fertilized, how long will that 
state of fertilization continue without renewal? Is infestment in any way preventive 
of reinfestment, or may hyperfilariasis occur if chance permit? How long are the 
microfilaiis visible in the blood and what comes of the millions which must surely 
escape abstraction by mosquitoes? If there be a free stage in any of these species, as 
suggested above, what is its length? How long may the prefilaria continue to live in 
the intermediate host? It is far more easy to propound such problems than to even 
suggest the mode of their solution; and yet there is need of exact information in this 
general connection on more points than here brought forward. 



74 PBOGEBDINGS SBOOKD PAK AMEBIOAN 80IENTIFI0 C0NQBB88. 

Adult filfliue sometimeB die within the lifetime of the hiiman host, and of neceBBity 
die at least shortly after the death of the human being who harbors them. They have 
been found calcified and encapsulated in the tissues. But why they die, whether 
from filarial senility or special and unknown cause, we are ignorant. 

To the clinical article by Matas,^ of New Orleans, McShane adds a section dealing 
with biological questions concerning Fikarid hancroftif wherein he refers to observa- 
tions by da Silva Araujo of individuals who had suffered with chyluria for 14 and 22 
years, in whose chylous urine he found microfilariae; of a like observation by Sonsino 
of a woman similarly affected for over 20 years, with microfilaria in her urine; and 
of a statement by Lanceraux of an old Creole woman of over 80 years of age who had 
had chyluria for more than 50 years, in whose urine he foimd microfilariae. These are 
ominous data, but there is no assurance that the last instance (or any of them for that 
matter) does not include reinfestment. The duration of complications such as ele- 
phantiasis or chyluria without the demonstration of coincidence of microfilazie in the 
blood or urine is not significant of the length of life of the original parasites, observa- 
tions of cases of such condition without microfilariasis being r^arded rather as evi- 
dence that the parent worms have died, leaving the complication as a sequel. The 
certain knowledge we possess of the life of FUaria bancrifti within the body is meager; 
but from the time of infestment to maturity surely several months must elapse and 
possibly more; and the duration of life in maturity probably ranges from 1 or 2 to 15 
or 20 years. Longer periods of microfilariasis are probably explicable on the basis of 
reinfestment. The small number of adult parasites usually found and the lack of 
clear evidence of reinfestment have opened the question whether an immunity is 
gained against ready reinfestment or whether, on the other hand, a condition of 
hyperfilariasis is possible. 

In case of Loa loa, the frequent finding of immature worms and the failure to find 
microfilarise in children, and the more common finding of mature specimens in adults 
have led some to believe the developmental period of the parasite in the host ib a pro- 
longed one, although,' judging from the appearance of its * * Calabar swellings, ' ' clinical 
effects may appear within one or two months. Its adult life is surely capable of 
extending over a number of years (one of the cases reported by Smith and Bivas * 
was of at least 10 to 11 years and possibly 18 years in duration); and in this species 
the large number of parasites which may be foimd in one individual (34 found by 
Fenel in one individual)* is probably significant of more frequent reinfestment than 
in case of Filaria bancroJH. 

EQlz,' who was himself parasited by AcanthocheiUmema peratant, first found larval 
filarise in his blood four years after the supposed time of infestment. Others reduce 
this period of development in the host to within one and a half years; its full life 
period doubtless may range up to a number of years, although little is definitely 
known of this point. There may be large numbers found in one individual. 

The period of development and duration of life of Filaria demarqiUEyi are probably 
similar to those of the already mentioned parasites, but certain information is lacking. 
The number infesting one individual is not apt to be large, but commonly more than 
a single pair. 

Known instances in Africa of the coincident infestment of one host by Loa loa and 
AcarUhocheUonema pentans, and in British Guiana of the coincidence of the latter and 
Filaria demarquayi are by no means infrequent. But thus far it is rare to find coinci- 
dence of Filaria hoTicrofti with other filarial parasites; whether from the special pecu- 
liarity of the transmitting agents, peculiarity of conditions of infestment, or any par- 
ticular resistance offered by Filaria banerofli to secondary infestments, is unknown. 



> NeTv Orleans Med. and Siirg. Jour., 1891, v. lit, p. 501. 

• Leber and Provaiek, Belheft t. Arch, t BcbllllB- u. Tropenhyg., 1902, v. 16, p. 441. 
t Sup. olt. 

• Arch, de Fanudtol., 1906, v. 9, p. 194. 

• Arch. f. Sohifl!»- a. TropenhyK., 19U; t. 16, p. 811. 



PUBUO HEALTH AKD MBDIGINB. 75 

Information npon the normal periods of development, duratioiLol the period of 
sexual reproduction during maturity, the time of senescence, and the full limit of Ufe 
of each of these parasites would be of decided interest, and useful from a standpoint 
of prognosis, if not for other points as well. 

How long is the life of the microfiliaria in the blood of the definitive host? Cer- 
tainly more than 24 hours, as Myers once suggested in attempting to explain the 
periodicity of FUaria bctnero/H. The writer has seen one out of a number of larval 
FilarUe hancrofti living in a thick blood film, isolated on a glass slide, after eight days 
had elapsed; other, writers have maintained them extracorporeally even longer. In 
cases where fortunate removal of parent filarise by operations has been accomplished 
(when chyloceles and similar surgical complications have been treated) the microfi- 
larisB disappeared hrom the blood in the course of a few weeks. But this need not 
of necessity follow in so short a time, if one may appeal to the analogy of experi- 
ments with other filarise. Gruby and Delafond injected microfilarifle of Dirofilaria 
immUis into other dogs than the host from which they obtained them, and could find 
them for as long a period as three years thereafter in the blood of the recipients; 
and in a rabbit they lived at least 89 days. 

We have little knowledge of the fate of the larvsB which fail to be taken out of the 
circulation by the intermediate host. Of course, where such condition as chyluria 
exists, many pass to the exterior of the body in the urine. Whether there is another 
easy path of loss has not been sufiiciently studied. As above indicated, the writer 
feels that time and effort should be applied to determine whether they are not fre- 
quently to be found in sputum and in the moisture of the mouth and respiratory 
passages. Occasional remnants, at times encapsulated and calcified, have been 
observed in the capillary areas of the lungs, liver, spleen, and kidneys; but no suffi- 
cient trace of the great numbers which presumably die in the host has ever been 
realized. 

4. Problem of dieTnotherapy of filariam. — ^The therapy of filaxiasis, aside from that of 
its complications and the surgical indications, involves two possible purposes, the 
destruction of the parent filaria (with the consequent destruction of their microfilari» 
as well) and the destruction of the microfilaria alone. Of these the former is of course 
the more desirable; but success in the second line may at least prevent serious com- 
plications for the individual host and will for the time set aside i>ossibility of dis- 
semination of the parasites to new hosts. Neither empirically nor from experimental 
studies are we in possession of an agent which can be relied upon to accomplish the 
destruction of either the parent worms or their broods of microfilariee; nor is it to be 
sorely expected that the precise remedy in the same dosage will, if ever discovered, 
necessarily be equally lethal for all species of filaria. Numerous drugs which might 
be found lethal to microfilarise can not with certainty be expected even in higher 
dosage or more persistent administration to kill the fully developed parental forms. 
It seems not improbable, too, that the ensheathed microfilaria would manifest a 
better protection against destructive agencies than the free microfilariae because of 
the ensheathment itself. 

But one who has access to fresh blood preparations from filariated human beings 
or for that matter anyone who can command similar material from cases of animal 
filariasis, as that of the dog, will do well to systematically study in such preparations 
(with and without citration of the blood) the possibility of destroying the microfilariae 
with certainty and promptness by such drugs and in such dosage as might be permis- 
sible in human medication. Accomplishment of even this limited purpose will mark 
a long step in advance; and possibly may suggest further method of eradication of 
the parent worms and thus definitely curing the affection. Perhaps adjustment of 
dosage or chemical variation of the basic remedy might succeed with the adults 
when once a reliable microfilarial lethal agent or method is realized. The writer is 
disposed to believe that investigations prosecuted along one or other of these theo- 
retical lines in careful systematic fashion with view of destroying microfilariee will 



76 PBOCEEDINGS SECOND PAN AMEBICAN 80IENTIPIC C0N0BE8S. 

eventually be found successful, in each case founding the crucial experiments in 
man upon preliminary observations upon living microfilarise on the microscopie 
slide and then upon those in circulation in some filariated animal, as a dog. The three 
lines of study in mind include the employment of (a) exogenous agents likely to be 
immediately toxic to the microiilarise, (h) of means of cutting down or off the food 
supply of microfilariae, and (c) of generating within the host of substances toxic to 
microfilariae (in each case within range of toleration of the host). Of these of course 
the first must appeal the most strongly. Four remecties, administered empirically, 
have seemed to have influence in case of Microfilaria hancrojti : thymol, methylene 
blue, quinine, and arsenic. Each, urged as curative at first by its advocates, has faUen 
into disrepute because of failures in the hands of most of those employii^ it. Occa- 
sional experimental study of such agents ^ may be met with, but little has been done 
toward a consistent and systematic trial in vitro and in vivo of the filariacidal influ- 
ences of all of the suggested remedies and others which might appropriately be 
considered. When one remembers the thorough and long-continued studies of 
Ehrlich in ferreting out salvarsan for the destruction or the syphilitic treponema, 
the insignificance of our searches for filariacides is obvious. 

As far as the second measure is concerned there Ib of course little actual fundamental 
knowledge. There is a slight increase in size of the microfilariae from the measure- 
ments of those in the maternal uterus and those of the microfilariae in the circulating 
blood (thought by some to be due merely to inhibition of fluid), but the variability 
noted in the size of Microfilaria demarquayi as seen in any blood preparation bespeaks 
some degree of growth in the microfilarial stage of the parasite. It seems unlikely 
that the nutrient material basic to such growth was derived solely from the maternal 
worm before the birth of the microfilaria. Much of the substance of these as of other 
parasitic worms is of carbohydrate nature, largely glycogen; and it is at least worth 
considering whether by restricting in the diet of the host elements which make readily 
for the formation of glucose and glycogen in metabolism (the application of Allen's 
diabetic regime, for example) may not influence both the parent and the microfilarial 
parasites in harmful fashion without injury to the host. Suggestions bearing on the 
line of the third idea, that of inducing harmful changes in the host with the purpose 
of interfering with the well being of the filariae naturally first are offered by the 
well-known fact that in acute infectious diseases the hosts of intestinal parasites are 
often spontaneously relieved of their parasites. The writer knows of no instance of 
the cure of filariasis by an intercurrent infectious fever, and has no data that the num- 
ber of microfilariae in the blood is influenced under the same circumstances. But 
there can be little doubt of the reality of the principle that the toxemias of acute 
infections are apt to work harmfully upon coinciding animal parasites. Bahr* 
studied the effect of a staphylococcus vaccine upon one of his filariasis subjects, 
with negative results. There may naturally be considered in this same connection 
the factor of increased body temperature of the host; and undoubtedly the possi- 
bility of thermotherapy presents a field open to research (as by the induction of 
febrile temperature by some such definite chemical as /3-tetrahydronaphthylamine). 
Reasoning by analogy it is possible, too, that exaggeration of substances identical 
or similar to excretory or waste material from the parasites within the host may 
be of harmful influence to the parasites. Most of these low animal parasites pro- 
duce among their waste products fatty acids, thought to include in important propor- 
tion valerianic acid. Is it possible in vitro to find that substances of such a type, 
valerianic acid, butyric, oleic, acetic, or lactic acid, in proportions tolerable to the 
host, can have lethal effect? 

The field is almost entirely unworked, and the writer has said more than enough 
to suggest lines of work, which are open at every point in fact. 

Hereupon the session adjourned at 12.15 o'clock. 

& Bahr, FUariasla in Fiji, Joor. of London School of Trop. Med., sapplement 1, 1913, p. 78. 
* Ibid., p. 79. 



SESSION OF SECTION VIIL 

New Ebbitt Hotel, 
Tuesday afternoon^ December 28 ^ 1916. 

Chairman, Col. John Van R. Hoff. 

The session was called to order at 2 o'clock by the chairman. 

The Chairman. The first paper on our program is by Dr. B. W. 
Caldwell, of the American Red Cross. 

THE EPIDEMIC OF TYPHUS EXANTHEMATICUS IN THE BALKANS AND 

IN THE PRISON CAMPS OF EUROPE. 

By BERT W. CALDWELL. 
Superintendent Allegheny Oeneral Hospital^ PitUhurgh^ Pa. 

The epidemic of typhus exanthematicus which spread over Serbia from December, 
1914, to the end of July of the present year, was in proportion to the territory involved 
and the population affected, the most severe that Europe has ever experienced. The 
spread of this epidemic from the Danube to the Grecian boundary, ilivolving every 
hoepita], prison camp, soldiers' barracks, and almost every home, was due entirely 
to preventable causes, to inexcusable indifference on the part of the Serbian civil 
and military authorities, and to carelessness which amounted to crime. 

It is impossible to tell how many were afflicted with this disease, as there are no 
reliable statistics available. The military reports do not include the civil populik 
tion and those who were ill and died of this disease unattended by physicians, where 
no diagnoses were made. Conservatively, one out of every five of the two and a 
half million population was attacked by typhus, and 135,000, including 30,000 Austrian 
prisoners, died of typhus during this epidemic. The hospital mortality ranged from 
19 per cent to 65 per cent. No part of the country escaped, and every city, town, 
and village in Serbia contributed to the morbidity and to the consequent mortality. 

The unreliability of the estimates in this epidemic is further increased by the fact 
that the Serbian physicians classified typhoid fever as typhus abdominalis, relapsing 
fever as typhus recurrens, and typhus fever as typhus exanthematicus, and they used 
the term "typhus" vicariously to indicate any one of these three diseases. Lack 
of physicians in hospitals and among the civil population caused the diagnosis of 
typhus to be made in almost any case running a temperature, and was given as the 
cause of death in many cases where it did not exist. 

The word "typhus" covered a multitude of sins in diagnoses, as well as a world of 
ignorance and carelessness. This does not apply, however, to the better hospitals 
under Serbian control, or to those managed by the American Red Cross units, or 
to Red Cross missions sent from other countries. 

Typhus is transmitted by the louse. The body louse is completely incriminated; 
the head louse probably so, and the crab louse not at all. While no human experi- 
ments were made in Serbia, still the observations made in those cases of typhus occur- 

77 



r 
t 



78 PBOGEEDINOS SECOND PAN AMEBIOAN 8GIENTIFI0 OONGBBSA. 

ring in hospitals and private homes, gave no evidence that the disease is transmitted 
in any other manner than through the bite of the infected louse. Measures looking 
to the eradication of lice from people and in their habitations, the improvement of 
personal and community cleanliness and hygiene, the isolation of people afficted 
with the disease, within a short time placed the epidemic under complete control. 
Like cholera, typhus is one of the easiest infections to prevent, and should it creep 
in, it is one of the easiest to eradicate when conditions favor, and when our present 
knowledge of the control of the disease is scientifically applied. It is essentially a 
disease of winter months, and no sanitary measures at present known are better or 
more efficacious than warm weather and sunshine, when the poor can leave their 
crowded quarters for the open air, and when bathing can be accomplished frequently, 
when clothing can be washed and changed frequently, and when lice leave because 
of the heat which they can not endure. As the colder months, with their congested 
conditions, immediate want and squalor, are ideal conditions favoring a typhus 
epidemic, so warm weather, accompanied by the sunshine, which permits the popu- 
lation of homes and communities to seek more hygienic living conditions, to take 
better care of their clothes and persons, and to destroy the lice with which they 
have been infested, are the conditions which favor the control and eradication of 
this disease. Want and the overcrowding of people, soldiers, and prisoners, where 
the facilities for bodily cleanliness and personal hygiene are denied, where filth 
and squalor exist, and is added to by each incoming guest, when the climate is so 
severe that heavy clothing with infrequent changing is imperative, afford conditions 
for the breeding of lice and the propagation of this dangerous infection which are 
ideal. 

Typhus has an incubation period of about 14 days; probably a little under 14 days 
than a longer period. Eruption follows the onset closely and reaches its maTimum 
intensity on the.fifth day. It is during this five-day eruptive period that the presence 
of the infected louse becomes dangerous to the non-immune; after this period of the 
disease and during the convalescence, there is little or no danger of the louse becoming 
infected after feeding upon the patient. The disease reaches its climax and if death 
does not ensue a long and difficult convalescence is experienced. The mental dis- 
tress and disturbance, often serious in character, invariably follows. Gangrene of 
the extremities at times necessitating amputation complicates convalescence. Severe 
emaciation attends the convalescent stage and a general neuritis is often noticed . The 
disease seems to be a general septicemia, but nothing has been discovered at autopsy 
to throw any light upon the patholpgy of this disease, with the exception of the recovery 
from cultures taken from the spleen of an organism resembling the Plotz organism. 

Sex influences the incidence of typhus. Adult males are particularly susceptible; 
adult females form a very small percentage of those infected and a still smaller per- 
centage of those who die of the disease. Usually the disease when attacking females 
is mild in type and the severe sequelae which follow the disease in males is not noticed 
among the females who have suffered from this infection. Children of both sexes 
are seldom attacked. The greater opportunity which women and children have 
and which they exercise for the cleanliness of their clothes and persons and which 
men, especially soldiers on campaign and prisoners in barracks are usually deprived 
of, undoubtedly affords protection to the weaker sex; so also those who live in sanitary 
surroundings and who have an opportimity to live in comparatively good hygiencie 
conditions are equally protected. 

With proper precautions large numbers of nonimmunes can live in the midst of a 
typhus epidemic and escape the disease. In Monastir during the period of the epi- 
demic our American missionaries maintained a school and orphanage having an 
attendance of 140 pupils. Their school is located in the center of the city and within 
a stone's throw of four of the largest hospitals, accommodating at one time 3,000 typhus 
patients. In addition typhus was incident in the homes of many of the immediate 



FtTBLIO HEALTH AKD MEDIdKE. 79 

neigfabon and the teachers in this school and the senior pupils visited the hospitals 
r^golarly two or three times a week to minister to the stck and yet there was not a 
single case of typhus among the pupils or faculty of this school. In Belgrade a found- 
lings' home, containing 40 children, is located just across the street from the dvil 
hospitals and Dr. Ryan's Red Cross Hospital, where thousands of cases were treated 
in the course of the epidemic and no case of typhus occurred in this orphanage. The 
insane asylum in Belgrade, containing 180 males and 150 females, is located adjacent 
to the dvil hospital and is separated from it only by a high stone wall. The inmates 
irf the asylum performed manual hbot in and about the hospital grounds, yet during 
the entire epidemic only four cases of typhus occurred in the asylum and the progress 
of the epidemic was immediately checked. 

But caJy where the conditions for hygienic living were provided did the Serbian 
people escape. AU classes and professions were affected. The medical profession 
in Serbia suffered more tram the disease and consequent mortality than any other 
profession in proportion to its number. Overworked and exhausted by the endless 
labor of caring for their sick, these civil heroes lost 160 of their number out of a total 
ai 340 at the beginning of the war. To theee self-sacrificing men and women a glory as 
great as any gained on the battle field or in fire-shelled trench is due. They spared 
not themselves, they spared no effort and no labor, but worked until exhausted and 
the disease attacked them. Among our own American physicians who went to the 
aid of the stricken people of Serbia five died, two of whom, Drs. Donnelly and Mac- 
Cruder, were members of the American Red Cross units. The nurses did not escape; 
they too performed heroic deeds, and in one of our Red Cross units 11 out of 14 were 
stricken with typhus; happily none of them died. The physidans and nurses which 
other countries sent to Serbia suffered as heavily. 

The conditions for the spread of the epidemic in Serbia were ideal. During the 
Balkan War typhus had invaded Serbia and had never been completely eradicated. 
Here and there scattered through the country, especially in the northern districts, 
were sporadic cases and from these lod of infection the epidemic had its origin. The 
pec^ie were exhausted from previous wars; they had been invaded by a large army 
and the dvil population had retreated as the army fell back. Belgrade in normal 
times has 100,000 people — during the war only 30,000 remained. The smaller dties 
and villages in central and southern Serbia soon became congested and overcrowded. 
The lack of bathing fodlides in the homes of the better class of Serbians, their entire 
absence in the homes of the middle and poorer classes, the crowded conditions in 
which they were forced to live, the cold months of the winter, all favored the intense 
spread of the epidemic which had started. Then came their military success. The 
Austrian army was thrown back through the invaded territory and across the Save 
River and 70,000 Austrian prisoners were taken captive. These prisoners, starved, 
exhausted, and vermin infested, were distributed in the little dties and villages of 
central and southern Serbia, thus further increasing the already overcrowded con- 
ditions. 

In December, 1914, a sick soldier was sent to his home in Belgrade and was confined 
to his bed for three days before a physician was called and a diagnosiB of his case made. 
His home was in one of the thickly populated quarters of Belgrade and many of the 
members of his family and his ctuious but well-meaning neighbors visited him during 
this period of illness. When a physidan was called the patient was found to be in 
the fourth or fifth day of th^eruptive period of typhus. No effort was made to isolate 
or quarantine this case and people were permitted to visit the patient as before until 
he died. Within two weeks in this particular section of the dty dosens of cases of 
typhus developed and the epidemic spread through all quarters of the city. In 
six months it was estimated 7,000 cases of typhus occurred in the dty of Belgrade 
alone, the dvil hospital caring for l,8d0 of them, with a mortality of 19 per cent, which 
was the lowest hospital mortality of which the writer knows in any hospital in Serbia. 



80 PEOCEEDINGS SECOND PAN AMEBIGAN SOIENTIPIC CONGRESS. 

At the nme time in other cities of Serbia, among soldiers, prisoners, and civil popula- 
tion, the epidemic was increudng at a fearful rate, and by the middle of January 
practically the whole of Serbia was involved. 

The overcrowded conditions in the hospitals in northern Serbia led the Serbian 
authorities to distribute the surplus sick suffering from typhus among the hospitals 
in the cities and villages of central Serbia and Macedonia, in many instances infecting 
cities where the disease had not existed up to that time. Due to lack of room in ho^ 
pitals, soldiers and others connected with the army, becoming infected with typhus, 
were sent to their homes in whatever part of Serbia they might live, in this manner 
carrying the disease broadcast with them. From this time there was no possibility of 
controlling the epidemic with such means as the Serbian authorities had at their com- 
mand. Such efforts as were made by the medical authorities were feeble and unavail- 
ing; indeed , the epidemic had grown to such proportions that the entire time and labor 
of the few ph3rsicians in Belgrade and throughout Serbia were devoted to waiting upon 
those already infected with the disease. The Serbian authorities lacked organization, 
capacity, and direction, and the most inexcusable and unexpiainable things were per- 
mitted to be done by them. Trainloads of typhus patients were sent from northern 
Serbia to all parts of the country, even to the extreme southern boundary, in thb man- 
ner invading many localities with the infection which were comparatively free from 
the disease. The cities in which the few cases of typhus had already made their 
appearance might have been protected by prompt isolation, disinfection, and efficient 
quarantine. All these measures were entirely neglected. Their hospitalization was 
miserable. The regular hospital establifibments were too few in number and of too 
small capacity to accommodate those who had been wounded or taken ill during the 
military campaign; and schools, colleges, and public buildings of all kinds were hur- 
riedly converted into emergency hospitals to accommodate those who were becoming 
infected with typhus. Two beds were placed side by side together and a single mat- 
trees placed over them, in this manner affording accommodation for three patients 
where only two could have been accommodated before. No wards were segregated 
for the especial use of treating typhus patients, but the incoming patients were scat- 
tered indiscriminately throughout the hospitals in whatever section or ward an empty 
place could be found. Often a patient suffering from typhus in the active stage of 
the disease was placed between two patients on the same bed who were not saffmng 
from the disease, and in the due course of time all became infected. Every hospital 
became a hotbed of infection. Few of them had anything like sanitary arrangements, 
and in them only military patients were accommodated. The civil population was 
almost entirely n^lected; only such attention in a professional way was given to 
patients in their homes as could be given by physicians already overworked by their 
duties in the military hospitals. In one section of Macedonia, containing a popula- 
tion of 250,000 people, there were only 8 physicians, all of whom were attadied to the 
military service, and not a single one was left to give any attention to the civil popula- 
tion. Hundreds of new cases were reported daily, and the deaths reached an alarming 
total. The people, long inured to hardship and misfortune, became didieartened 
and discouraged at the fearful danger that was threatening them with extermination. 
Starvation and squalor added their terrors to the frightful picture, and the people were 
without hope. It was amidst such surroundings and at such a time that the AJnerican 
Red Cross Sanitary Commission and the commissions sent by the Governments of 
England, France, and Russia, airived in Serbia, during the month of April, and began 
their enexgetic campaign to combat and control the disease. There were never more 
favorable conditions for the spread of an epidemic than those esiBting in Serbia at thie 
time. With these commissions came what was far more valuable to the suffering 
people and far more effective in the control of the disease — ^the wanner weather and 
the sunshine. With every wann day the disease lessened. The people left their 
crowded homes, the prisoners were permitted to leave their congested banrncks, and 



PUBLIC HEALTH AND MEDIdNB. 81 

the Boldiere had greater and more oppertanitieB and time for the promotion of peiBonal 
and community cleanlineeB. Theee new oonditiona, aided effectively by the activi- 
ties of the American Red Oosb Sanitary Commiamon, under the eneigetic, experi- 
enced and veraatile director, Dr. R. P. Strong, soon placed the infection in that por- 
tion of Serbia which was assigned to the American Red Gross Sanitary Commission 
■ for the field of its labors under good control, and a few weeks later the disease was com- 
pletely eradicated. Serbia, for the purposes of controlling the epidemic, was divided 
into four sections; the northern and eastern sections, respectively, were assigned to 
the French and Russians, the central section was assigned to the English, and the 
southern, comprising practically one-half the area of Serbia and many of its larger and 
more important cities, was assigned to the American Red Chrass Sanitary Commission. 
Immediately after arrival the Americans began their campaign in Uskub, Veles, 
Prizien, Pristina, and Monastir, and, while on the 1st day of May there were 3,000 
cases in Uskub, 1,500 in Veles, 1,000 in Prizien, 1,000 in Pristina, and 2,000 in Mon- 
astir, three months later, on August 1, there were not a dozen active cases in all of 
these cities, or in the remaining parts of Macedonia. 

The measures taken by the American commiwion consisted in fumigating all hos- 
pitals, barracks, schools, and other loci of infection. The patients in the hospitals 
were bathed with soap and water and kerosene, and their clothes were disinfected 
by steam at a temperature of 115° Gel. for 30 minutes.. After this process the patient 
was returned to a clean and vermin-free ward. This process was repeated as necessary. 
Soldiers and prisoners in barracks were bathed and their clothing disinfected in a like 
manner. Houses in which typhus was present were fumigated, and the patients were 
quarantined and isolated, or removed to the typhus lazarettos connected with local 
hospitals. A general sanitation of towns and cities was instituted, bathhouses were 
built, sewers were constructed, and proper disposal of sewage and garbage was insisted 
upon. Emergency hospitals were abandoned as rapidly as possible, and patients 
suffering from typhus were segregated and sent to hospitals or wards especially dedi- 
cated to the treatment of these cases, (reneral sanitation and hygiene was insisted 
upon throi^out the territory, and conditions rapidly improved. With the coming 
of the warm months of summer the disease disappeared, and it is worthy of note that 
it disappeared coordinately in all parts of Serbia, in those districts in which the mis- 
sions from other countries were laboring, to the same gratifying degree as in the district 
to which the American Sanitary Commission was assigned. Only in the thickly 
populated districts of northern Serbia was an isolated case here and there reported, and 
it does not seem to have been completely eradicated in this territory. In the event 
that conditions such as existed during' the past winter repeat themselves during the 
coming winter, Serbia will again experience, or at least this northern part of Serbia, 
an epidemic of typhus. 

As magnificent as were the results which attended the labors of the American Red 
Cross Sanitary Commission, not less worthy of credit, and certainly more marvelous, 
were the accomplishments of the countries bordering on Serbia, in keeping the disease 
from getting a foothold within their borders. A number of cases, probably a thousand 
or two, were reported in those parts of Austria-Hungary adjacent to Serbia, but the 
epidendc was not permitted to spread, and after a time was eliminated entirely in 
many localities in which it had made its appearance. In Roumania, which is the 
highway of travel between Serbia and the southern part of Europe and Russia, the 
energetic measures taken in the quarantine station at the Roumania-Serbo border 
completely prevented the entrance of the disease into this country. 

Bulgaria, with its highly developed corps of physicians and sanitarians, which 
bounds Serbia for almost its entire length on the east, and which is another highway of 
communication between southern and western Europe, succeeded in preventing any 
typhus from crossing its boundary Une. But the most creditable of all was that of the 



82 PBOCEEDINGS 8B00KD PAN AMEBICAN 8GISNTIFI0 C0N6BB8& 

Greek phyeiciaiu and quaraatme ofllcen and sanitariaoB. Greece bounds Seibia on 
the south, and since the beginning of the war the only communication which Serbia 
had with the rest of western Europe and America, was through the port of Saloni ki , a 
city of 200,000 people, with an additional 40,000 refugees of all classes, located within 
buildings and barracks within and about the city. Saloniki is connected with Serbia 
by two lines of railroads, and the old Via Romana highway affords another means of 
conmiunication between Monastir and Saloniki. Hundreds of thousands of people 
traveled in and out of Serbia through this port, and were exposed constantly to the 
diaeaee while in Serbia during the lifetime of this epidemic, yet such were the care- 
fully executed measures established by the Greek quarantine officers and sanitarians 
that less than 200 cases were reported in Saloniki and in the remaining cities of Greece 
while the epidemic in Serbia existed. At each point of entrance into Greece, the 
Greek authorities had instituted quarantine stations equipped with disinfecting plants 
and isolation wards, and every passenger on every train, and everyone crossing the 
boundary line on foot or by conveyance of any kind, was stopped at these stations, 
examined by competent quarantine physicians, their clothing and baggage disin- 
fected, and all suspicious cases running a temperature of any sort, or due to any cause, 
were held for an incubation period of 14 days before being peimitted to continue their 
journey into Greece. Upon arrival of any passenger from Serbia to Saloniki, or any 
other city in Greece, the traveler was again examined by a physician, who issued him 
a card upon whidi were blanks for the recording of temperature for the five succeeding 
days, and under heavy penalty for failure to carry out the instructions, the traveler 
was ordered to report daily to the local physicians for the recording of his temperatures 

In the city of Saloniki, where a majority of the cases reported made their appear- 
ance, the authorities handled the situation in a correct and scientific manner. Every 
case which ran a temperature from any cause, in the dty, was reported to the health 
officer, who held the attending physician to a strict account for the faithful reporting 
of progress and diagnosis in the case. In any case of doubtful diagnosis, expert pro- 
fessional advice from the health office was tendered without charge to the patient, 
and in case a diagnosis of typhus was made, the patient was called for by an ambulance, 
taken to a central disinfecting plant, where his clothes were taken from him and disin- 
fected in an autoclave, the patient given a hot-water, soap, and kerosene bath, his 
hair cut, and new hospital clothes given to him, and in a different ambulance from 
that which conveyed him to the disinfecting station, he was removed to a typhus laza- 
rett located at the edge of the city, and there remained until his recovery. He was 
not permitted to receive any visitor at any article sent from the outside, and was 
waited upon during his illness by a competent force of physicians and hospital attend- 
ants. The feat which these efficient sanitarians accomplished in preventing the 
epidemic from gaining a foothold in their city, which was at that time the greatest and 
busiest port in the Levant, is a wonderful demonstration of what proper hygiene and 
sanitation will do. 

The problems which confront all the countries engaged in this war are the care, 
treatment, and preservation of the health of the prisoners which they take captive. 
These men, brought together from all parts of the world and suffering all the hardships 
of long and arduous campaigns, under the most unfavorable living conditions, espe- 
daUy when engaged in trench warfare, are, when they are taken prisoners, usually in 
a state bordering on starvation, exhausted in mind and body, and almost without 
exception vermin infested. To the country which takes these men captive comes the 
great problem of preventing the bringing in of contagious and infectious diseases, 
whidi not only threaten the health and lives of other prisoners, but their own soldiers 
and civil population as well. So far as typhus is concerned, these countries h^wdlftd 
the situation with wonderful success. 

In one of the countries having upward of 2,000,000 prisoners, and in which prison 
camps accommodating forty or fifty thousand prisoners are not unusual, with the 



FUBUO HEALTH AVD MEDICIH Ji, 88 

exception of one ot two camps, they hare succeeded in keeping typhus from coming 
in. In these camps in which the epidemic has occuned it has been controlled with 
a minimnm degree of sickness and loss of life. Their methods for controlling this 
disease are simple, but very effective when consistently carried out. Upon the 
entrance of a number of new prisoners into any prison camp they are immediately 
isolated in a section of the camp separate from the remaining barracks for a period of 
14 dajrs. Upon admission to these, isolation barracks each prisoner has his hair cut, 
is taken to a central bathhouse, disinfecting plant, and laundry, located in the center 
of the isolation compound, where he is bathed with cresolized soap and water and 
afterwards with kerosene, during which process his clothes are disinfected with live 
steam at'a temperature of 135° Cel. for 20 minutes. After his bath his clothes are 
returned to him and he departs from the building through an exit in the rear of the! 
bathhouse. This process is repeated during the 14-day period every 4 or 5 days. 
At the end of that time the prisoners are mustered for personal ii&pection by the 
pnaan physicians, and if they are in condition they are sent to their permanent bar- 
racks in the other compounds. In the event that any case of infectious disease occurs 
in any part of the prison camp, the case is at once removed to a well-equipped hospital 
attached to the priscm and is there isolated and quarantined until he is free from 
danger to the other prisoners. The American Red Cross Commission, sent to Ger- 
many for sanitary work in the prison camps in that coimtry, personally inspected 
camps in which there were 125,000 priscmers. They mustered for penonal inspection 
of clothing and persons, hundreds of prisoners of different nationalities in the different 
camps; they personally inspected hundreds of barracks in which prisoners were 
quartered, and thousands of beds and bunks on which the prisoners slept, and not a 
single louse or bedbug was discovered. This demonstrates the wonderful care and 
application which the authorities of this Government use in preventing the incidence 
of contagious diseases of any Bcri among its prisoners and illustrates most forcibly 
what energetic and correct measures will accomplish when scientifically applied in 
the prevention of infection. 

The greatest hotbed of typhus and other infections existing in Europe before the 
outbreak of the epidemic in Serbia was in Gralicia and Poland, along the Russian 
battle front. WitJi the overrunning of these two immense Provinces by the con- 
tending armies the danger from the spread of the disease to the remaining parts of 
Europe became greater and more apparent each day. Wlien finally the Russians 
were driven back beyond the borders of Galicia and Poland, and the current of travel 
between important points of these two Provinces a?ain b^;an to flow, it became 
necessary for the German and Austrian Grovemments to make great preparations 
and take the most effective measures to prevent the ingress of infection. On this 
front is built what the Germans call a louserin, which was completed at a cost of 
5,000,000 marks, and was paid for out of the private fortune of the German Emperor. 
To this great establishment ail persons, of whatever age, naticmality, or rank in life, 
going from Germany into Poland or Galicia and from those Provinces returning into 
Germany or Austria, arc sent and are detained for 5 days, during which period they 
are bathed daily and their clothes disinfected in their large autoclaves with each 
bath. At the end of the five-day period each traveler is given a personal examination, 
autl upon being found to be free from disease or vermin is given a certificate which 
permits him to continue hii journey across the frontier. No exception is made in 
the case of any traveler, no matter what his rank or station in life may be, the imperial 
family being just as amenable to the rules of this great establishm^t as the poorest 
subject of Poland or Gennany . 

In Serbia, in addition to typhus, relapsing fever, which is transmitted by the bed- 
bug, was prevalent in large numbere. The sanitary methods applied by the American 
Red Cross Sanitary Commission in combating the typhus epidemic went very far 
toward the elimination of relapsing fever, especially the fumigation and disinfection 

68436— 17— VOL IX 7 



84 FB0CEEDING8 SBGOND PAN AMERIOAK 80IBVTIFI0 C0K0BB88. 

ci bamcks, hospitals, beds, and doChing. It did not disappear with the approach of 
fliunmer, but decreased to a very great degree. Tyi>hoid fever was constantly present, 
not in epidemic form but in sufficient numbers and covering a sufficiently wide range 
of territory to become a serious problem. The cities and villages of Serbia, without 
exception, are built on rapid-running streams, usually on both banks of tiie river, 
which serves the common purpose of sewer and bath, laundry and drinking-water 
supply. Only the bet that the water which supplies these streams comes from the 
mountains and that generally the streams are rapidly running over gravelly beds, 
and the water has a tendency to purify itself quickly, ii a greater incidence of water- 
borne di wwww prevented. 

The fly problem is always serious, and the natural habits of the peasants and their 
living conditions all tend to the increase of fly Iweeding. Kanuro of all sorts is care- 
fully saved for the fertilization of the fields and other purposes. Human and animal 
feces is carefully conserved, mixed with straw enough to hold it together, made into 
large circular cakes, and pasted against the outside walls of the habitations of the 
people, there to remain until dry and hard, and in this condition to be carefully saved 
for fuel purposes during the succeeding winter. Every house, every alley, every 
street, every place, was a breeding place for flies, and typhoid fever has probably 
been one of the curren t disenses in Serbia and Macedonia for generations. 

The country ii farmed by irrigation. Every valley has its mains and laterals run- 
ning through it, all the ditdies grass-grown and shaded to prevent evaporation, afford- 
iqg ideal places for the breeding of mosquitoes. Malaria, during the months of July, 
August, September, and October, is provalent to an unusual degree. It is peculiarly 
pernicious in its forms, and the writer knows of more deaths resulting bcm malaria 
infection in Serbia during the six months he was pre s en t there than occurred in 
Panama during any one of the nine years of the American oocupatian. 

In addition to all these d i s ea s e s , Uskub and other cities of Serbia experienced epi- 
demics of papatacci fever— a three or four day fever, not fatal in character, communi- 
cated by the papatacci gnat, iHiich is prevalent along the Adriatic shores and in 
this section of the Balkans. The patient suffers severely from headaches, back and 
body pains, congestion of the conjunctiva, throat and nasal passsges, and runs a tem- 
perature of 104^ F. for two or three days, id&ich then subsides and a rapid convalescence 
ensues. The treatment for this fever is purely symptomatic; no measures have been 
discovered other than general sanitation and hygiene to combat tlus disease. 

The treatment of tsrphus fever is unsatisfactory. It ii supportive and symptomatic 
in character. The use of the serum prepared by NicoUe, or that prepared from the 
Plots organism seems to have a tendency to abort the disease, and seems to have 
value in its theraputics. Plenty of water should be given to the patient, and a 
saline infusion should be constantiy at hand for use at any period succeed^ the 
eruptive stage and the climax of the disease. The severe emaciation which attends 
aU these cases should be carefuUy managed. The diet should be carefully selected 
and carefully administered, and every precaution to support and stimulate the patient 
judiciously should be taken. The nervous and mental systems, which are very much 
disturbed, should be carefuUy cared for, and this disturbance, often continuing for 
six months following convalescence, should never be neglected. 

The prophylactic measures which were employed in Serbia by the American Red 
Groes Sanitary Commission, and those wludi are used in the prison camps in Europe 
and in the quarantine stations of the countries bordering on Serbia, afford an effective 
prophybuds in this direase. The value of the Plots serum in imnmni«;t>g tgunst 
typhus infection ii problematical. It probably has a value which will be fully dem- 
onstrated before ty])hus ia eliminated from the Balkans. It was very interesting to 

ote that out of some two or three hundred people nonimmune to typhus, who found 
it necessary to go to this part of Europe during the epidemic, all of whom were inocn* 
lated with the Plots vaccine, among which number were all of the members of the 



PXJBUO HEALTH AND MEPICINB. 86 

American Red Cross Sanitary Commission, with but one exception, and the memben 
ef the miasion which Columbia University sent to Serbia, and many othen who were 
exposed at some time or another to a greater or less degree to the infection, not one 
case developed. 

The lesson which this epidemic teaches is particularly valuable to the sanitary 
wmidy especially to those localities which are from time to time subject to an epi- 
demic of typhus fever. It demonstrates beyond any question of a doubt that Uie 
disease can be kept out of a country by instituting proper quarantine and sanitary 
measures, and by the proper observance of personal and community cleanliness and 
hygioie. It has demonstrated with equal certainty that if it should at any time 
secure a foothold in any locality, it can be easily limited and eradicated in a short 
time. With our present knowledge of the measures which control this disease, we 
can take a very optimistic view of the future, and assert with confidence that the 
epidemic of tyj^us which Serbia has so recently experienced is probably the last 
one which will occur in Europe, unless conditions favoring epidemic are worse than 
ever before existed in the history of the continent. 

The Chairman. We ahall now listen to a paper on ''Present views 
in respect to modes and periods of infection in tuberculosis," by 
Dr. M. P. Bavenel, of the Uniyersity of Missouri. 



FRESENT YIBWS tS RESPECT TO MODES AND PERIODS OF INFECTION 

IN TUBERCULOSIS. 

By MAZYOK P. RAVENEL, 



Pro/e89or of PreverUive Meditine and BaderiolofiPf DvmAor of P^itiUc Heeiitk Labotm 

iotyy UvivenUff of Miuouri, Columbia, Mo, 



In considering the various modes in which infection with the tubercle bacillus can 
occur, we may, for the purposes of thia paper, leave out of discussion all except inha- 
lation and ingestion, because there is practically no difference of opinion concerning 
the others. They play a small part in the epidemiology of the disease, and the total 
number of cases due to them is insignificant compared to those in which infection 
lakes place through the respiratory and the digestive tracts. Both routes of infec- 
tion are now univenally recognized, and there remains to be determined now only 
their relative importance as portals of entry. 

Tuberculosis is a disease, the lesions of which are found so preeminently in the lung, 
that it is easy to understand how the older physicians considered the respiratory 
tiact the route of invasion. The classic work of Arnold gave scientific standing to 
this idea, since it proved that the lung could be invaded even by particles of inert 
matter, such as lamp-black, introduced by the respiratory tract, and the ex])eriment 
of Comet, who exposed guinea pigs to the dust produced by breaking up dried tuber- 
culoufl sputum with a broom, resulting in the infection of most of the animals, seemed 
to settle the question in favor of this method from a practical point of view. 

The older observations were apparently lost sight of, and did not receive due con- 
sideration until after the memorable British Congress on Tuberculosis in 1901, when 
the attitude of Koch in regard to the danger of bovine tuberculosis and the alleged 
ruity of primary intestinal tuberculosis brought them to the front once more. 

BXaraiATOBT DfFBCnON. 

The work of Arnold and the experiment^ of Comet have been mentioned as fur- 
nishing the basis for the belief that tuberculous infection took place mainly through 



86 PROCEEDINGS 8EC0in> PAN AMERICAN SCIENTIFIC CONGRESS. 

the reepiratory tract. Further evidence seemed to be at hand in the greater number 
of casus in which the supposedly primary lesion was found in the lung and bronchial 
lymph nodes as compared with the intestme and mesenteric glands. The value of 
this evidence has been weakened during recent years by the discovery of the fact 
chat in children particularly the bronchial lymph nodes are often tuberculous when 
uo change can be found in the lung, and the belief is growing that the bronchial 
glands and small lymph nodes are first infected, and the lung tissue becomes in- 
volved later. Schroeder and Cotton have demonstrated that infection of the lung 
and bronchial glands can result from inoculation into the most distant parts of the 
body. A calf inoculated under the skin at the end of the tail died affected with 
tuberculosis of the liuigs. The bronchial, mediastinal and mesenteric glands were 
edematous and contained tubercle bacilli, though not having the histological changes 
of tuberculotds. 

Three hogs inoculated in the same way developed progressive tuberculosis of the 
lungs, liver, and inguinal glands, and in one the gastrohepatic and bronchial glands 
were involved. 

It is evident that infection of the lung is not the simple process of inhaling bacilli 
directly into the alveoli, as was formerly believed, but involves a more complicated 
mechanism. 

The fixing of the portal of entry by the so-called oldest lesion is also open to serious 
question. I have produced &tal pulmonary tuberculosis in monkeys by feeding, 
with very insignificant intestinal lesions. All the oldest lesions were located in the 
lungs and bronchial glands, yet the method of feeding largely precluded the possi- 
bility of the tubercle bacilli reaching the lung except througfi the digestive tract. 
Practically all observers agree that in children there is a marked tendency to rapid 
and general dissemination of the disease, and many note that it is frequently im- 
possible to determine the oldest lesion. As our conclusions have been drawn largely 
from post-mortem observationa on children these facts are significant. 

DU8T AND SPRAY. 

In regard to the form in which tubercle bacilli are inhaled, all are agreed that dust 
from dried and pulverized sputum, and mouth spray produced in coughing, talking, 
eneezing, etc., both play their part. The relative danger of the two methods has not 
been determined, some belie\dng that dust is the chief menace, while others follow 
FlQgge in holding that the mouth spray produces infection more readily. The bacilli 
in the spray are certainly more apt to be alive and virulent. Both must be recog- 
nized as capable of producing infection, and droplet infection is probably the more 
dAngerouB. 

INFECTION THBOUGH THE DIOEflTTVB TRACT. 

The first recorded cases of infection through the digestive tract are those of Klenke, 
who in 1846 gave the histories of 16 children who have been fed on cow's milk, and 
all of whom showed tuberculosis of the intestines, glands, skin, or bones. 

Previous to this, however, CanuichasJ, in 1810, recorded as his observation that 
he had frequently seen the mesenteric glands ttrumoiu without involvement of the 
external glands, and this led him to believe that in scrofula the mesenteric glands 
were first involved. He referred to the frequency of a disease similar to scrofula 
seen in pigs fed on sour milk, and called attention to the common occurrence of 
bowel trouble in children at the time of weaning '*too often followed by disease of 
mesenteric and lymphatic glands." 

Casper, 1882, refers to the extent of tuberculosis ("nodular consumption") among 
the milch cows of Paris, and says: ''It ip possible that there is a connection between 
this phenomenon and the many tuberculous diseases among the children of Paris." 

Experimental evidence of tuberculous infection in cattle by feeding was given as 
early as 1868 by Chauveau, who extended his work with corroborative results in 1872 



FUBUO HEALTH AKD MEDIdKE. 8? 

and 1873, and Villemiii in 1869 obtained positive reoults by feeding in rabbits and 
guinea pigs. He was the first to employ a tube for the introduction of tuberculous 
material into the stomach. Experiments by scientists of every nation have given 
positive support to the work of these early observers. It is also a well-known and 
widely observed fact that in the spread of tuberculosis of cattle and swine the digestive 
tract plays a most important rdle. Swine particularly are infected through the diges- 
tive tract in the great majority of cases, and the ingestion of milk from tuberculous 
cattle is universally recognized as one of the chief factors in the spread of the disease 
among these animals. The first examination made by the ofiicers of the Federal meat 
inspection service is based on this fact. In 93.3 per cent of cases tuberculous hogs 
ahow infection of the cervical glands. 

As the disease is essentially produced by ingestion the glands and tissues associated 
with the digestive tract are llie most frequent seats of infection. Indeed, the superior 
cervical gkmds (in almost all cases the submaxillary gland) are nearly always affected, 
as 'at the post-mortem examinations held by bureau inspectors over a consecutive 
period on 120,000 tuberculous hog carcasses, 93.3 per cent were found to contain lesions 
in these glands. The large tonsils and the large number of lymph sinuses in the lymj^ 
glands probably account for this great frequency. 

From some records relative to the locations of tuberculous lesions in cattle that were 
made at the same time that the figures pertaining to hogs were collected, it appears 
that in tuberculous cattle the lesions of tuberculosis were located in the cervical glands 
in 66f per cent of the animals, in the bronchial glands in 54} per cent, and in the medi- 
astinal glands in 63.6 per cent. 

In 1901, in his London address, while discussing the relation of bovine tuberculosis 
to human health, Koch took the groimd that infection through food could be assumed 
to have taken place with certainty only when the primary tuberculous lesion Was 
located in the intestines. He claimed that this was rarely found to be the case, and 
argued that the danger of infecticm through food was slight. The stand taken by Koch 
assumed that the tubercle bacillus was unable to gain entrance to the system through 
the intestinal wall without the production of a lesion at the point of entrance. 

The question raised by Koch has been thoroughly investigated, and it can be said 
with certainty that the tubercle bacillus can penetrate the mucous membrane of the 
upper digestive tract as well as that of the intestine readily and quickly, without 
producing a tuberculous lesion at the point of entry. It is, however, held by Baum- 
garten that there is always a focus of infection at the point of entrance sooner or later, 
even though it may be microscopic. Against this is the demonstration by von Behr- 
ing and Roemer of the ready permeability of the intestinal mucosa of young animals 
by various bacteria, even the large anthrax bacillus. In 1,000 swine, infected through 
food, Ostertag found the glands of the throat, neck, and mesentery tuberculous, while 
the mucous membrane of the intestine was dAw&yn free from disease. Orth, in 1879, 
and Comet, in 1880, observed bacilli pass step by step through the fully developed 
mucous membrane of the uninjured intestine and reach the lymph channels and mes- 
enteric glands, leaving no recognizable trace behind (Furst). Dobroklondd, in 1890^ 
working under Comil, showed that the tubercle bacdllus would quickly penetrate 
the healthy wall of the intestine in guinea pigs. Desoubry and Porcher, students 
of Nocard, showed in dogs that during the digestion of fats large numbers of bacteria 
were carried through the intestinal wall and could be detected in the chyle within a 
few hours after the meal was given. If food free from fat was given few or even no 
bacteria could be found. Nicolas and Descos, in 1902, found that tubercle bacilli 
given to dogs in fatty food reached the chyle within three hours. During feeding 
experiments conducted at the laboratory of the State Live Stock Sanitary Board of 
Pennsylvania, we frequently observed extensive tuberculosis of the lungs and thoracic 
glands in animals which showed slight or even no involvement of the intestine. In 
1902-3 I introduced into the stomachs of a number of dogs tubercle bacilli suspended 
in an emulsion of melted butter and warm water, using a tube in order to prevent pos- 
ftble infection through the trachea. The dogs were killed after three and one-hall to 



88 PROCEEDINGS SECOND PAN AMEBICAK 8CIBNTIFIC 00KGBE8& 

four hours, during active digestion, as much chyle as possible was collected, and the 
mesenteric glands were removed. Guinea pigs were inoculated with this material. 
Tubercle bacilli were demonstrated in abundance in 8 of 10 experiments. The dogs 
were kept on soft food for some days before the experiments, and were purged with 
castor oil, in order to rid the intestine of all foreign matter which might injure the 
mucous membrane. Numerous sections of the gut were examined also, but no injury 
could be detected. 

It is possible here only to mention the work of Calmette and his students, as a result 
of which he reached the conclusion that pulmonary tuberculosis acquired at any age 
may be due to recent intestinal infection. 

The rapidity with which tubercle bacilli penetrate the intestine and reach the lung 
through the thoracic duct is remarkable. Besanti and Panisset found that when fed 
to dogs in soup they reached the heart blood within four to five hours. Bartel'found 
that after a single dose they penetrated the uninjured intestine and reached the 
inesenteric glands during the following digestive period. Schlossman and Engel, by 
inoculating tubercle bacilli suspended in cream into the stomachs of young guinea 
pigs through an indsion in the abdominal wall, demonstrated that they reached the 
lung within six hours. Their work has been confirmed by Ravenel and Reichei. 
Rabinowitsch and Oberwarth established nourishment through a gastric fistula in 
swine, and then resected the aesophagus, after which tubercle baciUi were introduced 
into the stomach. Within 24 hours they were shown to have penetimted to many 
organs of the body. 

IliFECnON BY THE BOVINE TUBERCLE BACILLV8. 

The statement of Koch in 1901 that bovine tuberculosis was not a menace to public 
health has also led to a vast amount of study which throws light on the portal of eatty 
of the tubercle bacillus. It is conceded by ever3rone that bovine tuberculosis is 
found almost exclusively in children under the age of 16 yean, and that the suscep- 
tibility to this type of infection is greater during the fint ^ve yean of life than it is 
afterwards. It is perfectly evident that the only exposure that children of this age 
can have to the bovine germ is through the food whidi they eat, and infection there- 
fore is invariably through the digestive tract. 

The results of the English Royal Commission, the Gennan Imperial Commission, 
and numerous private workers have been frequently quoted, and I give here a sum- 
mary of cases collected by Dr. Park which indicates fairly the amount of infection 
due to the bovine tubercle bacillus, especially in fatal cases. 

Adults, 16 yean and over, 955 cases, 940 human, 15 bovine. Children, 5 to 16 
yean, 177 cases, 131 human, 46 bovine. Children up to 5 yean, 368 cases, 292 human, 
76 bovine. 

Many nonfatal cases of tuberculosis are also caused by the bovine germ. These 
are found almost exclusively in children and the infection is throu^ the digestive 
tract. 

Eraser, in 67 cases of bone and joint tuberculosis in children under 12 yean of age, 
found the bovine germ 41 times, the human 26 times, and both 3 tunes. 

Mitchell examined 72 children under 12 yean of age with cervical adenitia and 
found the bovine germ in 65, the human in only 7. 

It should be remembered that the human tubercle bacillus is capable also cl pro- 
ducing infection through the digestive tract and the nustake must not be made of 
considering only those cases in which the bovine germ ia found as due to ingestion. 

INFECTION THBOUOH THE TONSILS. 

The frequency of infection through the tonsils has been recently called in question 
by von Pirquet, who quotes Albrecht and Ghon to support his view. The former in 
1,060 cases found only three instances of primary tonsillar infection and the latter 



FUBUO HEALTH AHD MBDIOXKB. 89 

in 189 cases found only one. It is hard to reconcile these findings with those of odiefs 
or with experimental work. 

Wood has coUected from the literature f,671 cases, 88 (5.2 per cent) of which showed 
primnry tuberculosis. These examinations were made by various methods and 
piobAbly fall short of the truth. Lartigau and Qoodale have shown that systematic 
inoculation of animals gives a higher percentage of tuberculosis. In 75 cases Lartigau 
found 12 (or 16 per cent) tuberculous. Dieulafoy by the inoculation of guinea pigs 
found tuberculosis of the tonsils in 15 of 96 cases. His work has been criticised on 
the ground that he made no histological examinations and was not careful to exclude 
cryptBf which may lodge tubercle bacilli. However, Latham, who avoided theee 
sources of error, in 25 consecutive autopsies on childrmi from 3 months to 13 years 
of age, found seven which were tuberculous— results practically identical with those 
of Dieulafoy. Confirmatory reports have been made by a large number of observen^ 
many of which are included in the figures quoted from Wood. The susceptibility 
of the tonsils to tuberculous infection ia shown by the examination of person dead of 
phthisis. 

Experimentally the tonsils are readily infected by direct application as well as 
by feeding tuberculous material. In a series of experiments which I carried out 
at the laboratory of the State Live Stock Sanitary Board of Pennsylvania swine fed 
with tubercle bacilli from man and from cattle developed generalized tuberculosis 
with marked involvement of the tonsils, apparently primary, with necrosiB and ulcer- 
ation. 

The experiments on these lines are too numerous to review here. Practically all 
experimental observers have noted the susceptibility of the tonsils to tuberculous 
infection. Wood, of Philadelphia, has carried out a most instructive series of experi- 
ments on swine. He found that the application of tubercle bacilli to the back of the 
mouth rapidly produced primary tuberculosiB of the tonsils, soon followed by involve- 
ment of the submaxillary and cervical glands and extensive disease of the lungs. 
The mesenteric and bronchial glands were always diseased in about an equal degree. 

I have referred above to experiments carried out on monkeys by feeding, in which 
the lungs showed extensive and destructive tuberculosis. In these animals, while 
no lesion of the tonsil could be found, caseous lymphatic glands were found in the 
neck in the region draining from the throat and there could be no doubt that a part 
of the infection at least occurred by penetration of the mucous membrane in this 
r^on. 

Grober believes that infection through the tonsil is the most frequent origin of 
apical tuberculosiB. His experiments have demonstrated that from the cervical 
glands there is a direct route to the pleursB and lungs, and that this leads especially 
to that portion of the lung most frequently the primary seat of tuberculosis— the apex. 

The evidence that the tonsils are frequently the portal of entry for the tuberclis 
bacillus appears to me very conclusive and it seems equally certain that food is the 
bearer of the infection in a large proportion of cases. 

PSRIOD or INFBOrnON IN TUBSBOUUHBIS. 

Few problems o£fer more inherent difficulties in their solution than the determina- 
tion of the age at which tuberculous infection cecum. It is easy to construct tables 
showing the age at which the disease becomes manifest clinically, but, except in the 
early years of life, these give little clue to the exact time of infection. 

There is no doubt of the existence of a widespread opinion that infection takes 
pkce chiefly in infancy and childhood and this opinion appears to be growing. It 
seems to have a Intimate basis even if not wholly true. In 1900 Nageli showed by 
Autopsies in Zurich that by the age of 30, 98 per cent oi persons showed tuberculous 
ksunis or scars, results which have been in a measure confirmed in other cities, but 
irtiich can not be accepted as correct for the general population. 



00 



PBOCEEDnrOS SECOND PAH AMEBIGAK SCifiHTUflO C0NQBE88. 



The uae of tuberculin by the method of Vod Pirquet or some of its modifications is 
even more directly responsible for the belief in early infection. Von Pirquet himself 
obtained positive reactions among children of the poorer class in Vienna in a surpris- 
ing number of cases — ^70 per cent if clinical cases of tuberculosis are excluded and 
80 per cent if included, as shown by the following table: 



AceCyesn). 


Indnding eases oltabercn- 
losis. 


Exdudlng oases of tuberco- 
losis. 


Total 
number. 


Positive 
reactions. 


Percent 
positive. 


Total 
number. 


Poslttve 
rasctions. 


Peroenl 
positive. 


Under 1 


410 
110 
206 
M4 
216 
188 


21 

24 

74 

127 

138 

165 


6 
20 
85 
48 
64 
80 


888 

80 
102 
180 
154 
147 






lto2 






9 to 4 


22 

53 

74 

106 


IS 


4 to 7 


80 


7 to 10 


48 


10 to 14 


70 







More surprising even are the results of Hamburger and Monti, also on diildren of 
the poorer class in Vienna: 



Age (years). 


Nnmber 
of 

children. 


Poritive 
reaction. 


Percent 

positive. 


Under 1 


28 
40 
50 
75 
50 
08 
46 
80 
86 
26 
28 
10 
17 
17 






lto2 


4 
11 
24 
26 
82 
28 
22 
2S 
22 
27 
18 
16 
16 





2 to 3 


20 


8 to 4 


82 


4 to 5 


62 


6 to 6 


61 


6 to 7 


61 


7 to 8 


73 


8 too 


71 


OtolO 


86 


10 to 11 


08 


11 to 12 


06 


12 to 13 


01 


13 to 14 


01 







Basod on such findings the belief is widflly held that over 90 per cent of children 
are infected with tuberculosis by the 14th year, and statements have been made 
that tuberculosis in adult life is only the recrudescence of infection acquired in 
early life. 

A further study of reports from diffesvnt parts of the world reveals marked varia- 
tions in the percentage of positive reactions, but all diow that tuberculous infection 
in diildhood is extremely common, as seen by the following table: 



Name. 



Overland, Bergen 

Amenta, Palermo 

MQller. Vienna 

Oalmette, Orvaes and Letulle, Ltlle. 
Stawsky, Odessa 



Number 
tested. 



843 

800 

040 

1,226 



A8e. 



1^14 
8-12 

10-14 
5-12 

12-10 



Positive. 



50.0 
83.0 
61.0 
81.4 

00.0 



Post-mortem reports by von Pirquet, MQUer, and othen show that the positive 
reactions ^1 short of showing the full number of those infected. 

Turning to recent work in the United States, we find a somewhat different picture. 
Yeeder and Johnston tested 1,321 hospital children in 8t Louis, and obtained a maxi- 
mum of positive reactions at the 10 to 14 age period of 48 per cent, includiDg cases of 
clinical tuberculosis, and 38 per cent exclusive of these. 



FUBLIO HBALTH AND 



• MiHttl. 



91 






AfB (y«tti). 


Namber 

ehfldren 
teeted. 


positive 
reMtians. 


Percent 
podUYO. 


Under 1 


224 
137 
188 
300 
182 
157 
115 
112 


25 
84 
67 
68 
74 
09 
45 
54 


11 


lto2 


31 


ato4 


30 


4 to 6 


3S 


6 to 8 


40 


8 to 10 


44 


10 to 13 


40 


13 to 14 * 


48 








1.821 


436 









ReadionM in dkUdren wiOunU tUnieal mam/iftslaHofni of tuhereulom. 



Age (years). 


Number 

of 
children 
tested. 


Positive 
reactions. 


Percent 
positive. 


Under 1 


302 
100 
163 
172 
163 
126 
107 
04 


3 
6 
33 
40 
44 
38 
87 
86 


1.5 


lto3 


5.5 


3 to 4 


19. a 


4 to 6 


38.0 


•to8 


39. a 


8 to 10 


30.0 


10 to 13 


84.a 


13 to 14 


88.0 








1,135 













Cattermole, of Colorado, in a oerieo of 66 cases from 1 to 14 years of age, found 26 
or 38 per cent of positive reactions. Taking the 10 to 14 year age period his positive 
reactions reached 63 per cent. 

Gattermole quotes Manning, of Seattle, as having obtained 58.1 per cent of positive 
reactions, at the 10 to 16 a^re period, in a series of 228 children. 

He also quotes Fishbeig, of New York, who among 692 children living with tober« 
cnlous parents in the tenements obtained 67.26 of positive reactions, while among 
688 of the same class, but living with nontuberculous parents, 62.72 per cent gave 
positive reactions. 

It is impossible to escape the conviction that childhood is preeminentiy the time 
of life when the tubercle bacillus gains a foothold in the body. 

Theee findings are corroborated by post-mortem examinations done on diildren who 
have died from various diseases. 

The studies of Harbits throw much ligfit on this question. I give his results, a* 
well as those of others, most of which are quoted from his monograph. 

Harbits, in 276 autopsies on children under 16 years of age, found 117 (42.6 per 
cent) of tuberculosis. 

Babes, in 902 autopsies on children under 16, found tuberculosis in 288 (81.9 per 
cent). 

In 1887, in 93 autopsies, tuberculosis of the bronchial and mesenteric glands wae 
found 65 times. In only 18 was death caused by tuberculosis. 

Geill, in 902 autopsies on children under 16, found tuberculosis in 288 (81.9 per 
eent). The maximum was reached at the 6 to 9 year period, 46.9 per cent. 

MQUer, in 500 autopsies on children, found 150 (30 per cent) cases in whidi death 
was due to tuberculosis, and 59 (11.8 per cent) of latent tuberculosis. 

Hecker, in 700 autopsies on children, found active or latent tuberculosis in 147 
(21 per cent). 

Monnid, in 654 autopsies on children, found tuberculosis in 167 (24 per cent). 



92 PB0CEEDINQ8 SECOND PAH AMEBIOAK 80IBNTIFI0 CONOBB88. 

At the Pathological Institate of Kiel, in 2,572 antopiiai on diildren under 15, ta- 
berculosiB was found in 16.7 per cent. 

Bolts, in 2,601 autopoiee on children under 15, found tuberculosis in 428 (16.1 per 
cent). Exclusive of those under 1 year of age, we have 1,171 autopsies wiUi tuber- 
culosis in 364 (31 per cent). 

Heller found latent tuberculosis in 140 (19.6 per cent) among 714 children dead 
«f diphtheria. 

Ooundlman, Mallory and Pearce, in 220 autopsies on children dead of diphtheria, 
found latent tuberculosis in 35 (16 per cent). 

Hand, in 332 autopsies on children, found tuberculosis in 115 (34.6 per cent). 

Still, in 769 autopsies on children under 12, found tuberculosis in 269 (35 per cent). 
In 43 it was latent, and in 117 (43.4 per cent) before the second year. 

Many other similar reports could be given, but these have been selected as covering 
a laige part of the world, and representing fairly the occurrence of tuberculosiB as 
found poet-mortem in children. 

The difficulty, especially marked in adult life, of connecting the clinical manifes- 
tations of tuberculosis witli the date of infection, has already been mentioned, but 
fairly accurate ioformaticm on aduk infection can be obtained by the careful study of 
groups of individuals of good family history especially exposed to infection for con- 
siderable periods, such as physicians and attendants at hospitals and sanatoria for 
tuberculosis, and those who marry consumptives. A number of collective investiga- 
tions are quoted by C6met and other writers. Many of these, owing to incomplete 
data and other defects, are of little or no value. From the material at hand I have tried 
to select those which seem to throw some light on the question. 

Saugman states that of 174 sanatorium physicians, whose average term of service 
was three years and whose subsequent history was followed for three and one-half 
years, only two became tuberculous. Among 64 laryngologists from 8 different 
clinics, none contracted tuberculosis. 

Williams has, in two papers, given most interesting facts concerning infection of 
physicians and attendants at Brompton Hospital, founded before the discovery of 
the tubercle bacillus, and before the contagiousness of tuberculosis was recognized. 
His first paper gave the statistics of the hospital staff from its foundation in 1846 to 
1882, 36 years. Among four resident medical officers, one of whom held office 25 
years, no case of consumption hfis developed. Among 150 house physicians, none of 
whom held office for less than six months, and many much longer, only eight cases 
of consumption occurred. 

The second pai>er gives the results from 1882 to 1909. It includes resident and assist- 
ant resident medical officers, house physicians, resident and nonresident porters, 
pathological assistants and dispensers, in all 369 persons, of whom 12, or 3.2 per cent, 
developed i^thisu later, two of them through inoculation wounds. 

The comments of Goring on this report are most interesting. He compares these 
results with those obtained by himself in a study of 3,090 individuals of nontubercu- 
lous parentage, assuming that a person coming of tainted stock would not be likely to 
take service in a consumption hospital. Among his 3,090 persons 79, or 2.6 per cent, 
developed tuberculosis. Thus two groups, one exposed to special risks and one not, 
showed an amount of infection varying only 0.6 per cent. If the two hospital cases 
associated with inoculation wounds are left out of consideration, we have practically 
the same percentage of infection, 2.6 per cent and 2.7 per cent. 

At the Adirondack Cottage Sanitarium there has been no case of infection since its 
foundation more than 28 years ago among the employees, including waitresses, cham- 
bermaids, and laundresses. 

Infection through marriage may give some clue to the susceptibility of adults. 
Comet says: ''The number of cases of marriage infection, often of classical simplicity, 
runs up into the hundreds." His own study of 594 couples showed that in 23 per 



FUBIJO HXALXH AND MSDIGIKS. 98 

cent both pwrtnen were tubefculous. He admits that the findings do not necessarily 
imply an etiological relation between the cases. Comet believes the actual cases 
ran higher than the figures given indicate. Other observefs place marital infection 
at from 3 to 12 per cent. Recent studies made according to modem statistical methods 
tend to throw doubt on the earlier work. 

The late £. G. Pope's study of this question failed to show definite proof of infection 
between married persons. His work has been reviewed by Karl Pearson, who says: 

I may conclude in the slightly modified words of Mr. Pope: 

It would seem probable, then, (1) that there is some sensible but slight infection 
between married couples, (2) that this is laigelv obscured or forestalled by the fact of 
infection from outside sources, (3) that the liability to the infection depends on the 
presence of the necessary diathesis, (4) that assortative mating probably accounts for 
at least two-thirds and infective action for not more than one-third of the whole cor- 
relation observed in these cases. But the demonstration of this result depends on 
the acceptance of the Inherited diathesis to be effective, and the existence oi assorta- 
tive mating of equal intensitv in the case of want of mental balance must prevent 
dogmatism. In all future collection of statistics with regard both to marital infection 
and parental infection, it is most important that the age of husband and wife at mar- 
riage and the age at onset and death in both should be recorded. Age at onset and 
death of the parent, age of parent at birth of child and age at onset and death of child 
should also be records, u is only by such complete records that we shall ultimately 
be able to accurately apportion the ac^on of infection, assortative mating, and 
inheritance. 

For real light on the problem of assortative mating of the tuberculous, we must wait 
till we have definite knowledge in each case of the family history of botn husband and 
wife. If we find (i) that the marriage of two ultimately tul>erculous persons took 
place before either were suspected of the disease, and (ii) that there is in such cases 
a larger percentage of family histories of tuberculosis than in the case of nonmarried 
tub^ulous individuals, we should have definite evidence of the assortative matinff 
which seems probable. If, on the other hand, the percentage were smaller, we shoula 
have definite evidence for the infection theory. 

The difliculty of determining the date of infection by the appearance of clinical 
symptoms has already been mentioned. As our ideas have been in the past largely 
^rawn from clinical data it is evident that there is need of some revision. How such 
data may mislead is evidenced by the statement of Goring (Studies in National Det^ 
rioration, V): "The mean age of onset for both sexes taken together is about 27 — ^the 
standard deviation is about 9 years. It follows from this that between the ages of 14 
and 45 may be looked uix)n roughly as a danger zone for tuberculous infection. The 
modal value of age of onset is about 23, and this is the age when danger of infection 
is most intense; the danger diminishing fairly rapidly to the age of 14, and more grad* 
ually to the age of 45.'' 

It seems certain that the early years of life are those in which tuberculous infec- 
tion takes place in the great majority of cases, and primary infection of adults is much 
less frequent than formerly bdieved. Clinical histories can not be relied upon to 
determine period of infection. It seems equally certain that infection of adults does 
occur, and that no age is exempt. 

0ONCLU8ION8. 

1. The evidence at hand indicates that in the majority of cases the respiratory tract 
is the route of infection. 

2. The alimentary tract is a frequent portal of entry for the tubercle bacillus. 

3. The tubercle bacillus is able to pass through the intact mucous membrane of 
the alimentary tract without producing a lesion at the point of entrance. This takes 
place most readily during the digestion of fats. 

4. The bacilli pass with the chyle through the lacteals and thoracic duct into the 
blood, which conveys them to the lungs, where they are retained largely by the fil- 
tering action of the tissues. 

5. Infection through the alimentary tract is especially frequent in children. 



04 PBOGEEDIKGS 8EC0KD PAN AMSBICAK 8CIEKTI7I0 C0NOBB88. 

6. Infancy and childhood are preeminently the periods of life when the individ* 
ual is susceptible to tiiberculous infection, and the majority of cases of infection 
occur during these early years. 

7. Any campaign against tuberculosis which leaves out oi consideration the proteo- 
tion of children against infection will fail of success. 

8. Tuberculous infection in adult life occurs, but not so frequently or readily as 
generally believed. 

9. Tuberculous infection may occur at any age. 

Dr. Carter. I am reminded of some data that Dr. Ravenel may 
not have seen. I left Habaua after the influence of the reconstruc- 
tion period had passed. I found that the death rate for four or five 
years from tuberculosis was four and one-half times that of the aver- 
age large American city. I took, for comparison, New York, Chi- | 
cagO; and Philadelphia. It is difficult to state that there should 
be as much infant infection from food in Habana as there should ' 
be in American cities. In the first place, the Cuban mothers in the 
beginning nurse their own childreg; it is rare that the child starts 
there bottle fed. 

Milk is always boiled before being sold. The people are accus- 
tomed only to boiled milk and won't drink raw milk. Their raw 
milk will not keep, and so it is boiled from a commercial stand- 
point. When I say **raw milk," I mean raw cow's milk. They do 
drink the raw milk from the goat or ass. The little troop of goats 
or asses is driven around from door to door and the animal is milked 
into the cup or bowl that is brought out from the house. Now, I 
think neither goats nor asses are especially liable to tuberculosis, 
so one would think that there was little infection from milk in child- 
hood in Habana. The foods they got later, it seemed to me, would 
be singularly free from conveying tuberculosis. The principal source 
of meat was the dried hed from the Argentine cattle, which in 
their half-wild state then should have been measurably free from 
tuberculosis; the next was probably codfish; and the third were Amer- 
ican hog products. Such beef as they had been getting had come 
mainly from the Province of Porto Principe, where the cattle were 
wild cattle on the plains. It would seem that the Cuban either in 
childhood or in adult life should have been singularly free from in- 
gested tubercle bacilli as compared with those in America; and yet, 
for the four years I took — ^I forget what they were now, but it was 
well after the reconstruction period — ^there were about four and one- 
half times as many deaths reported in Habana as from the three 
cities I took — Chicago, Philadelphia, and New York. I mention 
that not as opposing your view, but because I believe it will give 
additional data. 

Dr. Ravenel. Not as a reply, but in explanation, I will say that 
that same line of argument has been brought up in regard to Japan 
and a number of other places. Now, I do not pretend to be able 



PUBUO HEALTH AKD ICEDICXKl. 95 

to explain everything about tuberculoets, but the actual incidence 
of tuberculosis does not prove the mode of infection one way or the 
other. I can only answer by simply saying how much worse it 
would have been if exposure through food had been added to exposure 
through the respiratory tract, how many cases may have been 
saved in Habana in spite of there being four times as much as in 
this country, and how much worse it would have been if in addi- 
tion to that infection there had been added bovine infection also and 
ingestive infection. 

The Chairman. The next paper on the program, 'Tarasitic dis- 
eases in the American tropical countries," is by Dr. D&maao' Rivas, 
formerly of Nicaragua, and now of the University of Pennsrylvania. 
Dr. Guiteras, will you be kind enough to take the chair! 

Thereupon Dr. Juan Guiteras, of Habana, Cuba, took the chair. 



THE PARASmC DISEASES IN THE AMERICAN TROPICAL COUNTRIES 
AND THEIR EFFECT UPON THE PROGRESS OF CIVIUZATION AMONG 
THE LATIN-AMERICAN PEOPLE. 

By DAMASO RIVAS, 

Profenor Univernfy of Penmylvania Medical Stkool, 

I. Introduction. 

The term ^'diaea^" (dis-ease) implies lack or absence of ease, uneasiness, pain, 
etc. Pathology defines the word ''disease" as a morbid 9tate of the body; a deviation 
from the health or normal condition of any of the functions of the organism or 
tissue of the body, due either to physical, chemical, or biological agencies. By 
"biological agencies" is commonly undervtood that collective group of phenomena 
produced by the metabolic activity of certain lower forms of life, either plants or 
animals, on the tissues or organ? of a higher organsini upon which they live. Since 
these lower forms of life depend for their existence upon the food derived from 
the organism, the name of parasite? is given them in contradistinction to the other 
organifim upon which they live commonly known as hort. Biologically, therefore, 
disease is a symbiotic phenomenon between the parasite and the host on which the 
action of the former is detrimental to the latter. 

That these lower forms of life were the cause of diseases in man was suspected since 
the time of the Egyptian and Greek civilization. Not one can fail to recognize the 
impertance of the hygienic regulations in the Mosaic period. The writing of Hippo- 
crates, Oelws (25 B. C), AreUeus (32-00 A. D.), and Galen (131-210 A. D.) are full 
of suggestions, and Paulus in 1700 gave an accurate description of the diseaeee due to 
flat and round worms. 

Modem medicine began after the Crusades when western Europe was confronted 
with new diseases imported from the Orient, and when Fracastori (1483-1553) formu- 
lated the theory of contagious and diseniination of diseases during his study of syphilis, 
but the foundation of parasitology and tropical medicine dates from 1547 when Brie 
discovered the liver-fluke, and Dubini in 1338 found the hookworm. Demarquay 
in 1803 discovered the microfilaria; Bancroft the adult worm; and Manson demon- 
strated the life cycle of the parasite in the moequito. 



96 PBOCEBDINOS SEOOKD PAN AM2BICAN SCIEKTOIO G0NQBE88. 

Protoso0B w€re recognised by Lewenhoak siiice 1675. Obermeyor discovered the 
panudte of relapsing fever, and Loesh the amoeba djrse.iteriae. Of great importance 
has been the discovery of the malaria parasites by Lavaian in 1880, and those of Ross 
and Grassi upon the life cycle of this protoeoa in the mosquito. Dutton in 1902 dis- 
covered the organism of the sleeping sickness; Schauddinn that of syphilis, and Ghagas 
in the last years the parasite of American trypanosomiasis. 

A great factor in the develop of tropical medicine and parasitology in general has 
been the wonderful progress made in bacteriology and the name of Pasteur, Koch, 
Hansen, Eberth, Nicolaier, Yerson, Kitasato, and others stand preeminently as 
pioneers in this modem science. 

II. Parasrio Disbasbs. 

Among the parasites in general are included bacteria, protoaoa, and metasoa and 
they produce bacteria, protoaoan, and metaaoan diseases, respectively, but by common 
consent the name of parasitic diseases is commonly applied to those diseases known 
to be produced by protocoa and metasoa parasites in man. Bacterial diseases, as a 
rule, are acute, of short duration, and end either in death or complete recovery » 
The protoaoan and metazoan diseases on the other hand are commonly chronic, of long 
duration and of uncertain termination. They are seldom pet m the cause of death, 
but they produce in the host a constant impairment of health and a predisposition 
to permanent organic disturbances and secondary complications. The parasitic 
diaftBaw of man known at the present are numerous and their number are constantly 
increasing as the biological cause of these diseases are discovered, but of those only 
those due to protoaoa and metazoa of a special importance to the tropical countries^ 
will be here considered. 

III. Disbasbs dub to Pabasihc Protozoa: Malaria, Dtsbntbrt, Trtpano* 

80MIA8I8 AmBRICANA. 

Of the several protozoan diseases of the Tropics, three particularly deserve special 
consideration, namely malaria, dysentery, and American Trypanosomiasis. 

MALARIA. 

This disease is especially common on the west coast of Africa from the Senegal to 
Congo, and the whole of Africa except Cape Colony. It is also common in India, 
Asia, Southern Europe, and all the tropical and subtropical regions of America. Of 
all the diseases of man, malaria may be said to be the most cosmopolitan disease. 
In America it is especially found in the tropical regions along the Atlantic coast of 
Mexico, Central, and South America. 

The disease is produced by malaria parasite. This protozoon lives in the red 
blood cells of man and feeds on the hemoglobin of the cell. In a marked infection 
the destruction of red4>lood cells may be such that a rapid manifestation of anemia 
may follow. The parasite is also the source of irritation to such internal organs as 
the spleen and liver, which in time gives rise to passive congestion, fibrosis, pigmen- 
tation, and other disturbances. The parasite is transmitted by the mosquito — 
onophelei maeuJtpen^t— which lives in swampy places and bites especially at nig^t. 
The malaria parasite on entering the body of the mosquito undergoes sexual devel- 
opment and metamorphosis leading to the production of several hundred of minute 
sporelike bodies called tponoida from a single pair of the malaria parasites. The 
mosquito infects man by introducing these sporzoides during the bite of the insect. 

The disease produced by the parasite is known as malarial fever and is manifested 
by intermittent attacks of fever, accompanied with chills and sweating. At the 
beginning the disease is characterized by having an acute course lasting from some 
weeks to one or two months, which, if untreated or improperly treated, becomes chronic 
and incurable. During the chronic stage the malarial parasites may have disappeared 



PUBUO HEALTH AHD MSDIGIVB. 97 

from the blood, but it has left in man a permanent leaion in the internal organs^ 
eipecially the liver and spleen, characterized by torper ol these oigans, permanent 
lenone in the blood and blood-making organs, manifested by a certain degree ol 
secondary anemia, more or less intense. The impairment of function of internal 
organs, together with this anemia, is the source of general physical and mental lethargy 
commonly seen among the people of the tropical countries. 

DTSBNTBBT. 

By the term ''dysentery" is generally understood a disturbance of the intestines 
manifested by diarrhea and accompanied with bloody stools. Several may be the 
causes for this morbid condition, such as bacterial infection, protozoan, metazoan 
infestation, etc. We know at present more than 12 biological agencies as the cause 
of dysentery, among which one, Entamo^ kUtolytiea, is of special interest to the 
American tropical countries. These protozott belong to the rhuopodei. It lives in 
the large intestine of man, imbedded in the ulcers of the mucosa and submucosa. As 
the organism is the cause of the ulceration, one of the characteristic symptoms of this 
disease is hemorrhage from the bowels and the presence of blood in the passage, which 
in time may gradually give rise to a pernicious type of secondary anemia. In pros* 
trated cases the parasite is apt to be carried either by the lymph channels or the 
blood stream to the liver, where it produces amoebic abcesses of the liver, commonly 
seen in the Tropics. The involvement of the liver ii accompanied with torpor of this 
ofgan, which is the cause of icterus, gastrointesdnal disturbances, and a general 
impairment of health. The patient at this stage of the disease commonly presents 
a greenish tint of the skin and conjunctiva, his mental and physical power are im- 
paired, a general lethargy is common, and a constant desire to sleep prevails. This 
condition may be aggravated by a secondary bacterial infection, which not uncom* 
monly may cause death. 

The parasite is transmitted by contaminated water, food, etc., and probably also 
an unhygienic condition of the mouth and teeth are important predisposing facUm. 
It has been shown lately by Barrett and Smith that in cases of pyorrhea alveolaris 
amoebae are present in acertain percentage of the cases in the pus collected from the 
teeth. Whether these organisms are the same as those of dysentery has not been 
determined as yet, but it is not improbable that the same predisposing factors of 
pyorrhea are those of dysentery. Six cases of dysentery which have come under the 
writer's observation, all have shown to be accompanied with pyorrhea alveolaris or 
to have had the disease for some time previously. Of course pyorrhea alveolaris is a 
very common disease in man and the above observations may merely be a coincidence, 
but the saprozoitic habit of the amoebes of the mouth leaving, as it does, in the pockets 
ol the gums, and that of B. hitiolytioa, leaving similar pockets in the submucosa of 
the intestine, may possibly point to the iBct that both organisms, if they are not the 
same, at least require the same environments for their existence and that the pre« 
disposing causes in both instances are the same, and that pyorrhea alveolaris, if it does 
not represent the primary manifestation of dysentery, at least may be regarded as a 
predisposing condition. 

TRTPANOSOMIASIS AMBRICANA. 

In 1910 Ghagas, in Brazil, discovered a flagellate in the blood of children suffering 
with remittent and intermittent fever accompanied with a certain degree of anemia, 
edema, enlargement of the lymphatic glands of the neck, axilla, and the spleen. 
This flagellate is known as the trypanoioma cruzi and is transmitted by conorkintu 
megittus, commonly known as ''kissing bug." This form of disease is of special 
importance to the American tropical countries in general, because though it has been 
found only in South America, it is not improbable that in the future the disease will 



98 PB0GEEDIN08 8&00ND PAK AMEBICAK 8CIEKTIFI0 C0KGBE88. 

be found to be alao prevalent in Gentrai America and in the south ol Mexico. The 
studies made up to the present time on this disease may be said to be incomplete. 
They show, however, the interesting fact that the affection is more common among 
children; that it produces certain morbid changes chronic in nature which are apt 
to leave a permanent impairment of the body, and that, like other chronic parasitic 
diseases, it predisposes to secondary infection and complications which not uncom* 
monly are fatal, thus bearing an important relation to the infant mortality in the 
American tropical countries. In some respects this disease may be compared to the 
sleeping sickness of Africa, and probably it represents a mild character of that disease. 

IV. Diseases due to PAHAsmc Metazoa: Filabiasis, Anctlostomiasis, 

ASCARIASIS. 

k 

METAZOA. 

Among the metazoa parasites are included trematodes, cestodes, and nematodes. 
The trematodes as a rule are unimportant parasites of man here in America, and with 
the exception of schistosoma and a few other trematodes common in Asia and Africa, 
this group of parasites has only a few parasitic species of man. Among the cestodes, 
taenia solium^ taenia aaginataf taenia eckinoooccus, and dxbothrocephahn la£a» are the most 
common parasites of man, and though they are indeed of great importance in human 
parasitology, they per se are not restricted to tropical countries. 

The group of nematodes, however, comprise numerous parasitic species of man, 
among which three especially, namely T^Zonas, ancyloHomun, and tucaris are of special 
interest to the American tropical countries. 

PTLARIASIS. 

This disease is caused here in America by filaria bancrofti, commonly known ai 
F. noctuma. The adult parasite lives in the lymphatic of the pelvis and abdomen of 
man, where it deposits its embryos or microfilaria, which, carried by the lymphatic 
channels and thoracic duct, reach the heart, the blood stream, and are found in the 
peripheral blood. The parasite is transmitted to man by several species of mosquito, 
and probably by bedbugs %pd ticks. The microfilariie enter the body of these 
insects with the blood. It undergoes development, and after a certain time, about 
12 days, it becomes a larva, in which stage it passes to the probosis of the mosquito 
and is introduced into man during the bite of the insect. 

The presence of the parasite in man may not be accompanied with any appreciable 
symptoms, but not uncommonly it mipht give rise to a moderate degree of anemia, a 
cortain degree of eosinophil ia and other constitutional disturbances. In marked infec- 
tion of long standing, the disease not uncommonly may give rise to a chronic derma- 
titis and cellulitis in the dependent parts of the body such as the legs, arms, etc., 
charaf'terized by filx>rosis of the sucutaneous tissue, hyperplasia of the skin, and 
edema of the parts commonly known as elephantiasis. 

The fact that ancient Indian writers were acquainted with elephantiasis, while 
Celsus does not appear to have known the disease, and according to the writings of 
Hillary and Hendy that this disease was rare in Barbadoes at the beginning of the 16th 
century, and furthermore Hillary's view that elephantiasis was Introduced by the 
Negro slaves from Afrira, gives rise to the belief that the endemic home of filariasisls 
Asia and that it so spread from hence to Africa and from Africa to America. In 
America, filariasis is especially common in the West Indies and it is believed that in 
Porto Rico, in certain districts, about 20 to 30 per cent of the population is affected 
with the disease. Filiarasis is also common along the Gulf of Mexico and all alon^ 
the Atlantic coast in the tropical regions of Central and South America. 



FUBUO HEALTH AKD HEDIOIKE. 99 

ANCTIiOBTOiaABIB. 

The AncylostomuMif or hook wonn diseMe is produced by a pAntitic nemfttodei 
which inhabit the small intestine of man. The parasite lives attached to the mucus- 
membrane of the intestines by means of special <»gan8 of attachment in the form of 
hooks or plates, which produce laceration and ulceration at the point of attachment. 
The parasite in general is the source of gastro intestinal and constitutional disturb- 
ances. It has been shown by Smith and Loeb that the parasite is provided with a 
pair of glands at the cephalic end which empty into the mouth and that the secretion 
of this gland has an anticoagulating action on the blood which predispose to a constant 
oodng of blood from the ulcerations at the point of attachment of the parasite. Occult 
blood in the stools is a constant symptom of the disease and this slow but constant loss 
of blood in the patient gradually gives rise to a secondary anemia pernicious in type. 
The abdomen is usually distended, and the internal oigans such as the spleen, Uver 
and kidney are the seat of organic lesions. The physical and mental faculties gen- 
erally diminish and it is not uncommon to see among these unfortunate patients such 
a degenerated stage of the mind which almost reaches imbecility. The parasite is 
transmitted by the mouth with infected food or polluted water or through the skin 
in the larva stage of the parasite. The eggs of the worm are dischaiged with the feces, 
and in soil there hatches a larva which infects man. 

ASCARIASIS. 

By Ascariasis is meant that group of morbid conditions produced by the presence 
of aseanu Ivmbriooidei in the intestine of man. This parasite is conunonly found in 
children and only occasionally in adults. The disease is of importance in the Ameri- 
can tropical countries in so far as it is responsible for a variety of morbid changes in 
children in those regions which not uncommonly cause death. The presence of the 
parasite also is the source of gastro intestinal disturbances, distension of the abdomen, 
emaciation and a certain degree of anemia. If the infection is persistent it may lead 
to a retardation of growth in the child and is apt to leave permanent organic lesions. 
The parasite is transmitted in the larva stage by contaminated water, food, etc., or 
directly introduced with the fingers. It is a common habit among the poor and the 
lower class in the American tropical countries to lay the child on the ground, where 
naturally he soils his fingers and introduces the larva into his mouth with the dirt. 
The eggs are discharged with the feces, then undergo development in the soil and 
water into larvas which are transmitted directly as above stated, by the contaminated 
food or water. 

V. General Considbration and Conclusions. 

The above brief description of the most common parasitic diseases in the American 
tropical countries clearly shows that these diseases per se are not as a rule the causes 
of death, but they predispose to secondary complications and more especially give 
rise to permanent organic disturbance in man, leading to a physical and mental 
impairment. These diseases, as may be seen, are especially conunon in those places 
where the hygiene have been neglected, thus countries like Cuba, Panama, and 
Costa Rico, in which special stress has been placed by their respective govenuQents 
for the eradication of these diseases, clearly show the beneficial result of these prophy^ 
lictic measures, and also may be taken as an example that if such a r^;ulation was in 
force in other tropical countries in America, equally as good results would be obtained. 

The importance of sanitation of American tropical countries can not be too highly 
Emphasized. It is almost superfluous to say that for the normal performance of our 
mental faculties a normal condition of the body is essential. The human race, of 
course, is constituted by the aggregation of those units of which man is the representar 
tive, and it is only when those units work in harmony and with sound body that they 

68436— IT— VOL IX- 



100 PBOCBBDINGS SECOKD PAN AMEBIOAK BOIBHTIFIO OOHOIUBM. 

can produce sound and efficient results. It is almost useless to expect that a man 
afflicted with these chronic diseases can perform his duty in the same way as a normal 
man will do it. In vain will be all the effort toward the progress of civilization among 
the Latin- American people, if the most essential part, the hygiene of those countries 
and the health of the community, is neglected. How can it be expected that a man, 
with an enlarged liver or enlarged spleen and in which other organs at the same time 
are not performing their normal function in the elimination of the poison from the 
system, would perform the same tasks as another person with a normal body? The 
blood we know is our vital liquid and supplies us with food, and it is eacy to under- 
stand that our phyucal and mental faculties will be greatly impaired by any degree 
of disturbance in the circulatcMy syrtem. We know that sleeping sickness in Africa 
produces a complete lethargy in the patient who usually dies in the comatose condi- 
tion. We know that similar symptoms are common, thougb in a mild degree, in 
chronic malaria, ancylostomiasis and other parasitic diseases, the lethargy character- 
istic of the people of the tropical countries and the well known "maflana" symbol- 
ized the character of the people. This '* mafiana," of course, could be made today 
any time if efforts are directed to the sanitation of the tropics. 

The Chairman. The next paper is called ''A leview of the present 
yellow ferer situation/' and is by Dr. ArisUdes Agramonte, of the 
University of Habana, Cuba. 



a review of the present TELLOW-rETER SITUATION. 

By ARlSTIDES AGRAMONTE, 
Proffeuor of BaeUriology and Expaimenial Pathotogy, in tk$ CTfimrn^ o/Habana, Cute. 

At a moment when the most enlightened and dviliaed nations of the world are 
engaged in a merdless and devastating war, the like of which has never taken place 
in history, ancient or modem, at least with reference to its magnitude and the means 
employed for the destruction of man and all that man holds dearest, it is well to con- 
template this gathering of representatives from other nations no lens enlightened 
or civilized, this side the Atlantic, intent upon the cultivation of the sciences, upon 
the quest for truth, and thus directly upon the conservation and the moral and physical 
bettennent of man. It is such a spectacle ss the one here made evident, that serves 
to support the tottering faith in the ultimato emancipation of mankind from the evil 
passions of the primitive inhabitantB of our world, and yet congresses of the greatest 
import, scientific and religious, have been held repeatedly in the very lands that 
to-day are steeped in the blood of their men, throughout their confines raging unutter- 
able misery and woe, ruin and desolation. 

We can only hope that the present conflict may stand ss an awful example to the 
future generations, and that our respective countries may never see the like among 
themselves. In this connection, regardless of enervating pessimism, very much can 
be accomplished by the frequent inteccouise of our representatives and their meeting 
upon a higher plane than mere politics or commercialism. And what plane may be 
considered higher, of greater moral worth, than the earnest endeavor to suppress 
disease and human suffering? 

It may be pointed, I may say with pride, by every one hero, to the almost extinction 
ol yellow fever, for so long considered a Pan-American disease, as the result of that 
concerted international action in a good cause, intelligently and penistently main- 
tained. Because of its gradual disappearance (aside from my personal shortcomings) » 
the subject that I was invited to treat upon has been particularly difficult to handle. 



FUBUO HEALTH AHD MSDIGIKB. 101 

Yellow lever has been eradicated from its farmer haunti, if not entirely, at leavt to 
each an extent that the common diaeaaes of infancy, not to say other infections like 
malaria, dysentery, or typhoid fever, have become more worthy of the sanitarian's 
oonaideratian. This, notwithstanding, we can not lose sight of the grave problem 
which its appearance would imply to those countries that never had it, or that have 
managed to stamp it out in their territory, and so, the maintenance of a condition of 
preparedness, is no less important in connection with this contingency than with any 
other of a political or financial character. 

This is the only excuse I can offer for having accepted the honor of contributiog 
this paper. 

In view of the present status <A yellow fever, which I shall endeavor to make evi- 
dent, what should be our attitude towards the peril it involves? How stringent 
flhould our quarantine regulations be? What may be allowed now, formerly prohibi- 
tive, that will make commerce and intematlGnal relations less cumbersome? 

If we determine these points in any degree to our common satisfaction I shall fee 
that my efforts have not been entirely in vain. 

HIBTOBIGAL BKBTOH. 

Barely to outline the history of yellow fever one must delve into the musty annals 
dating back centuries, perhaps to the period of the discovery of America. We know 
now that the records were kept then in a manner far from accurate; how "fancy" 
took a prominent part in the description of common, everday occurrences; how the 
most trivial event was exaggerated and distorted by repetition, for the sake of 
notoriety if not for fame and profit; how iniquity, misery, and discontent were made 
light of, or silenced, if silence was conducive to the attainment of a desired purpose. 
Hence we can not wonder at the difficulties encountered by our contemporaries in 
their efforts to remove the veil that enshrouds the origin of this dreadful scourge. 
One thing seems definitely shown by the investigations made in that direction, 
namely, that whatever may have been the extent of its dissemination, the cradle of 
yellow fever was either Mexico or Central America on this side of the Atlantic, or the 
western coast of Africa upon the other side. 

Some historians, our immortal Finlay was one of them, believe that yellow fever 
existed among the Indian tribes of the Mexican and Central American coasts, even 
before the coming of Columbus, and that the discoverers carried the infection back 
with them to the Canary Islands, from where its propagation to the African Coast 
seems feasable. Others, in view of recent findings as to the endemidty of yellow 
fever in west Africa, where it may have existed through centuries unknown, are 
inclined to believe tiiat the slave trade may have been the means of infecting our 
western hemisphere. 

Be that as it may, the fact remains that the best authenticated record of epidemics 
of yellow fever in America corresponds in time to early slavery days, and to the clearest 
description of the disease on hoard a vessel plying the west African waters; I refer 
to the epidemics in Habana during the years 1762-1769 and to *' the fever which raged 
on board the Weasel sloop of war during the rainy season at Gambia in 1769." 

Since then the great disproportion between the increase of the white population in 
America and that' of west Africa has undoubtedly been the reason why our attention 
was ever turned toward home in the desire to solve the problem of etiology and prophy- 
laxis, and how seldom we seriously considered, until very recently, Sierra Leone and 
the Guinea coast as endemic f od of yellow fever. And so Mexico, the West Indies, and 
South America have borne the stigma of being the home of pestilence and a danger 
to all other civilized countries during a period of more than two centuries. 

Definitely established as an endemic disease in cities of the Gulf of Mexico, the 
West Indies, and Brazil, yellow fever made incursions, causing terrible ravage into 
the United States and across the Atlantic, invading European ports of France, Por- 
tugal, and Spain. 



102 PROCEEDINGS SECOKD PAN AMEBIOAN SGIEKTIFIC CONQBSSS. 

In 1693 the expedition intended to capture the Island of Martinique brought yellow 
fever to Boston, losing 1,300 Bailors and 1,800 soldiers, at the same time infecting the 
town. In 1689 Philadelphia, only 17 years established, suffered the first epidemic; 
in subsequent years many outbreaks occurred, the severest being in 1797 (with 1,300 
deaths), 1798 (3,500 deaths), and 1799 (with a mortality of 1,000). 

New Orleans was the American city most attacked by yellow fever; its commercial 
relations with the West Indies and the Mexican Gulf ports, kept infection, if not 
permanently, with yearly exacerbations from 1817 to 1858; after this the worst epi- 
demics took place in 1867 (mortality of 3,093), 1878 (mwtolity 4,600). In 1905, we 
hope the last epidemic that will be seen in America, New Orleans lost about 460 lives. 

All the Southern States were destined to be overrun by this disease whenever it 
gained entrance through any of its ports, and so the epidemic of 1878 invaded 132 
towns and caused a mortality of 15,934 out of a total number of cases exceeding 74,000. 

In South America importations from the West Indies and Mexico established 
endemic foci after causing severe epidemics in various cities of Brazil as early as 1686, 
in Pemambuco, having also developed in epidemic form in Montevideo, Buenos 
Aires, and other cities on the east coast from where it has disappeared. 

The last epidemic invasion of yellow fever at all important occurred at Tocopilla, 
Chile, where the disease; spread with wonderful rapidity, but was as quickly stamped 
out by the local sanitary authorities. And so, wherever it may have been bom, I feel 
that we are coming surely to its death; it no longer holds for us that nameless dread 
which follows all mysterious things. 

aSOORAPHICAL DISTRIBUTION. 

We find that yellow fever has vanished from some of its former homes, probably 
forever, now constituting endemic areas of comparatively slight importance in other 
localities; for instance, Cuba and the Mexican Gulf ports have been free for many 
years, as well as the Isthmus of Panama and the West Indies, where no cases at all 
have been recorded for two years. 

During the first half of the present year (1915), yellow fever in America has been 
confined to a part of the Mexican Republic, probably kept alive by the movement of 
troops, that is, by the renewal of nonimmime element in the endemic areas, mainly 
in the peninsular of Yucatan. Sporadic cases, or cases at long intervals, without a 
clear history as to their source, have appeared from time to time at the places shown 
in the following table: 

Yellow fever cases reported in 1915 (U. S. Public Health Service): Brazil, Bahia, 
February to July, 5 cases; Ecuador, Guayaquil, February to April, 6 cases; Mexico, 
M6rida, up to April 10, 4 cases; total, 15 cases. 

The very complete reports of the English Yellow Fever Commission, first ami second, 
though not giving us an exact idea as to the present conditions in West Africa, point 
very directly to the fact that fever is endemic there. The commission says: 

We have therefore to recognize the occurrence amongst the natives of the West 
Coast of Africa of two types of yellow fever, the one a mild type accompanied by such 
slight symptoms that its diagnosis is often very difficult, and another, tne hemorrhagic 
type, presenting all the grave and fatal characters of the disease as it commonly affects 
Europeans and newcomers into any area in which it is more or less constantly present, 
(maladie habituelle). 

If we accept, as we should, that yellow fever is an endemic disease in that part of 
the world, equally affecting blacks and whites, though not in the same d^ee of inten- 
sity, then we know where it shall make its last stand, when we drive it, as 1 am sure 
we will, forever, from America, because the implanting of prophylactic measures in 
an uncivilized community is well nigh impossible, so that it may render a sense of 
security at all in proportion to the expense and trouble it entails. 



PUBUO HEALTH AKD MEDICINB. 103 

DlfiSKHINATION OP YELLOW FEVER. 

It has often been said, in fact, a paper was read upon the sabject at the last Inter- 
national Medical Congress held in London (1918), that the opening of the Panama 
Canal, facilitating as it does the more active commercial intercourse between the 
Americas and theur opposite seacoasts, as well as the more rapid and therefore more 
frequent relations between eastern America and Asia, was sure to be the means by 
which the disease would travel across the Pacific Ocean, thus endangering a tropical 
region of the Earth, until now, as far as we know, free from that plague. 

I took occasion to point out then, as it has been proven by the time elapsed, how, 
instead of a danger, the Canal Zone, was in fact a sanitary bulwark, or at least a veri- 
table filter through which, neither yellow fever nor any quarantinable disease could 
pass, for I was convinced that the United States Government would necessarily main- 
tain there, the wonderful sanitary control established during the period of its con- 
struction. 

Of course the danger of its spreading from one of the above-mentioned foci to any 
other part of the country or to any other country is just at present to-day as ever, except 
that the scarcity of cases where they occur now, and the better knowledge of its etiology 
and prevention, render this danger less acute than formerly, when great epidemics 
n^ed in one or several ports of the Atlantic and Pacific coasts. 

In this regard it is proper to consider for a moment, the present knowledge and prac- 
tice, respectively, of the 

ETIOLOGY AND PROFHTLAXIS OF THE DISEASE. 

No organism has been discovered that may be accepted upon good scientific grounds 
as the causal i^nt of yellow fever. Needless to say, many claims have been made by 
enthusiastic investigators, but all of them, from Domingo Freire, of Brazil, to Harald 
SeideUn of the Liverpool School, have been shown definitely as in grave error. The 
exact nature of the germ is therefore still unknown, though we have learned that it is 
found in the blood during the first three days of the disease, that it passes through the 
pores of a filter which holds back bacteria, that mosquitoes, who take it into them- 
selves by stinging a patient can transmit it to other persons after twelve days and that, 
if these persons are not immune to the disease they will develop an attack within six 
days. These facts were first demonstrated by the United States Army yellow-fever 
board, thus confirming and converting into a doctrine, the theory advanced 20 yean 
before by Dr. Carlos J. Finlay, the theory of the man to man transmission of the dis- 
ease by mosquitoes. 

It was the establishment of these facts (the period of infectivity in man, the period 
of incubation in the mosquito and that in man), as well as the knowledge of the kind 
of mosquito, its habits, that led to the fiist rational campaign against yellow fever, sue* 
cessfuUy carried out by the then Maj. W. C. Gotgas in Habana, during 1901. As 
though by the wave of a magician's wand, the epidemic there and then subsided; 
immediately after, the same thing in Mexico; then in rapid succession, Laredo, Tex., 
Rio de Janeiro, Bahia, and Sao Paulo in Brazil, were subjected to the same methods 
of mosquito destruction and protection of the sick from their bites, with the results 
that yellow fever soon disappeared from all those cities. 

Another fact of the greatest interest to the welfare of commerce and international 
relations, also demonstrated by the Army board, was the innocuousness of ** fomites," 
tiius doing away with disinfection as practised until then, of the person, baggage, 
clothing, etc., suspected of being infected or considered as tainted. 

Sanitarians when dealing with yellow fever became interested only in the mosquito; 
the problems which they then had to solve were principally (a) to obtain knowledge 
of the relative proportion of the species Stegomyia in the locality, (b) breeding places 
of same, (e) possibility of their transportation at a distance, (d) their extermination by 
all means possible. The cases of yellow fever themselves occupied a secondary plane 



104 PB0CEEDINQ8 SECOND PAK AMEBIGAH 80IBKTIFI0 OOHOBBSa. 

in the order of importance inasmuch as it was presumed, when a case was discovered, 
thai it had aheady infected every mosquito in the immediate nei^b<»hood; once 
the patient was put into protected wards it ceased to be of interest from epidemiologic 
standpoint. 

No mosquitoes naturally means no yellow fever; but such a consummation, much as 
it is devoutly to be wished, seems at all events impracticable and so the countries, 
which we may term most threatened, have been compelled to be satisfied with keeping 
down the number of insects in their towns and cities, " below the yellow fever level" 
as expressed, I believe originally, by Gen. Goigas, and trust upon their power of watch- 
fulness to ward off the introduction of the infection, in the hope that if by any unf orseen 
circumstance such a misfortune should occur the scarcity of mosquitoes, since their 
absence is impossible, will make the chances of propagation comparatively less. 

INTEBNATIONAL PROFHTLAZIS. 

This depends, as in the case of every infectious disease, upon the knowledge of the 
facts concerned in its etiology and epidemiology. As regards yellow fever they are 
mainly such as I have outlined above. Of no less importance in this connection, de- 
pendent upon the period of incubation in the mosquito, is the fact first pointed out by 
Surg. H. G. Garter, of the United States Public Health Service, to the effect that 
secondary cases never occur before two weeks or 18 days after the primary or initial 
case; needless to say, the greatest difilculty has been, and no doubt always shall be, 
to discover the primary case in any emergency. 

The question of international defense was considered of suflSdent importance by the 
Qovemments on this side of the Atlantic so that it was taken up at the sanitary con- 
ference which met in this city in 1905, making such additions to the articles adopted 
by the International Sanitary Gonference held in Paris in 1903, as to make them ex- 
tensive to yellow fever as well as to cholera and plague. And now that the means of 
propagation became well known, it seemed more within our power to prevent its 
entrance into new fields; this could only occur by the introduction of infected mos- 
quitoes in ships, railroad cars, or in any other way transported, or by the introduction 
of cases during the period of incubation, or both ways. 

The question of quarantine as it was imposed against yellow fever, before 1901, is 
now entirely obsolete. All effort has been naturally directed to prevent the convey- 
ance of mosquitoes in vessels, cars, stages, or whatever are the means of communication 
between the countries concerned and to guard against the introduction of an infected 
individual. When this is said, one is tempted to dismiss the subject as sufficientiy 
expounded, but tiiere are certain details such as must necessarily interest more i>ar- 
ticularly a gathering of international character, which, at the risk of "going beyond 
my depth " I beg to at least place before you for deliberation. 

We must not lose si|^t of tiie fact that the great epidemic foci have disappeared and 
we would not be justified in thinking of any dty to-day wiih the dread that inspired 
Habana, Vera Gms, or Rio de Janeiro in former times; for that reason we can not hold 
the same quarantine measures against localities whidi are known to develop now and 
then a few cases of yellow fever, that we formerly did when the disease raged there in 
epidemic fonn, in foct, other quarantinable diseases are to-day more prevalent and 
should demand greater attention on the part of the sanitarian if we hope to ever accom- 
plish in regard to them what has been attained with reference to yellow fever. I do 
not mean by this that we should ftdl to watch and look with some degree of suspicion 
upon certain ports, for an evil reputation justly acquired throughout a lifetime, in 
spite of all that may be said for it, can not be suddenly and favorably changed. 

There are fundamental opinions that must be modified to accord with the progress 
of international sanitation, not the least important being, what constitutes a person 
immune to yellow fever to-day? Formerly, aside from having suffered an attack of 



FUBLIO HEALTH AND MEDlUUfl. 105 

the diaeMe, Uie hid of baling lived for 10 ooneecative ymn in » well knofwn yellow 
fsver focus, was considered sufficient evidence of immunity. These foci heving 
IRicticaUy dissppeered the incieese in the poimklkm since the disease WAS endica 
from there, means a nonimmune element th«t is growing with the yean of indenmity 
idiidi the locality may enjoy, at the same time tiiat it makes so much keener and 
more dreadful the danger of a reintroduction of the infection and thus demands that 
it be more carefully guarded against. 

We can no longer look upon ships coming from ports where yellow fever may be 
ptesent only, with the same suspicion that in epidemic times they formerly inspired, 
since the decrease in the chances of their infection should in justice be considered 
favorable to them and permit less restraint in the quarantine measures, that are now 
applicable if compliance with the letter of the law must prevail over good judgment 
and a sound sanitary policy. 

Althoufi^ there is no room for discussion as to what constitutes an infected vessel, 
inasmuch as only one having the disease on board or within seven days after leaving 
port can be so considered, the question as to what circumstances should warrant the 
term "suspected vessel" when applied with reference to yellow fever is one that must 
be further elucidated. I think the definition as made by the last International Sani- 
tary Conference in Paris (1911), in acceptable then, ought to satify the majority of 
my hearers now, more so, in face of the present status of yellow fever in America. 
"A veswl is considered suspected (or suspicious), when it has had cases of * * * 
yellow fover on board at the time of departure, or during the vo>iige, but no new cases 
for seven days." 

In connection with the whole subject of international prophylaxis, it becomes urgent 
that exact and early diagnosis and prompt notification of cases be made. Only thus 
can a feeling of confidence be maintained that will be conducive to a better under- 
standing between the various governments interested. 

I firmly believe that within a short period of time, as time is measured in the history 
of the world, yellow fever, if it was not so originally, wUl be relegated to the condition 
of an African disease; that it shaU be endemic only in the semidvilized states of the 
Central 2«one, which, regardless of what we may hope or strive for, shall continue to 
be for many decades, if not the white man's "grave" at least a peril to the white 
man's final settlement there. 

Having taken a small part in its undoing, I find it the source of greatest satisfaction 
to witness the final passing away of this terrible scourge. 



1. Conference Sanitaire Internationale de Paris. Proces verbaux, 1912. 

2. Apuntes sobre la Historia Primitiva de la Fiebre amarilla, Dr. Carlos Finlay, 
mbana,1884. 

3. Dicdonario de la Isla de Cuba. Introducci6n. Pezuela. 

4. Report on the Etiology and Prevention of Yellow Fever. 6. M.Stembeig, Wash- 
ington, 1890. 

5. Reports, first and second, of the Yellow Fever Commission, (West Africa), Lon- 
don, 1914. 

6. Public Health Reports, United States Public Health Service, Washington, 1915. 

7. YeUow Fever Bureau Bulletin, Vol. Ill, No. 4, Aug. 1915. 

The Chairman. A brief paper under the title of ''Liceaga and 
yellow fever'' has been prepared by Maj. T. C. Lyster, of the United 
States Army, and will now be presented as a discussion of the paper 
by Dr. Agramonte. 



106 PROCEEDINGS SECOND PAN AMERICAN SCIENTIFIC CONGRESS. 

LICEAGA AND YELLOW FEVER. 

By Ifaj. T. 0. LY8TER, 

Offiiot of ih€ Surgeon General, War Department. 

We have seen in the last 12 yean the yellow fever endemic centen shifting farther 
south, and cities, such as Habuia, Panama, and Vera Cruz, have lost their unenviable 
reputation. There is now remaining but one endemic center (Yucatan) in the North 
American Continent. We know the work that has been done by Americans, but 
it may not be known to all of us here the noble part played by one of the great men 
of Mexico, Dr. Liceaga. There is a country which needed and still needs men of 
his high character, to bring up a greater Mexico, after all these years of strife and deso- 
lation. 

It was my good fortune to have access to records and official letters bearing on sani- 
tary matters concerning Vera Cruz for the last 15 years. Had T the talent for biogra- 
phy, the literature showing the reasons for the widespresd knowledge of yellow fever 
would surely be enriched by a detailed history of the relations of liceaga to the excel- 
lent sanitary work whif*h has been done in Mexico. A man can not be really great 
unless he is sincerely modest and wins his countr3nnen through their love and affec- 
tion, as well as by their faith in his ability. liceaga had, and still has, the active 
support of those who were working disinterestedly for Mexico, and is idolized by 
those who serve under him. 

As early as 1903 Liceaga had submitted a comprehensive plan for the elimination of 
yellow fever from Mexico. Native lethargy in endemic centers, such as Vera Cruz, 
together with an acquired immunity to yellow fever, and indifference in the City of 
Mexico, on account of geographical immunity, were the must difficult of sanitary 
obstacles to overcome. 

Liceaga- believed that the immunity of those in Vera Cruz was acquired in an 
unrecognized form of yellow fever in chOdhood. His letters to the health authorities 
of Vera Cruz put emphasis on the control of sll doubtful and ill -defined forms of fever. 
Funds were provided both by Vera Cruz and the Mexican Federal Government to 
eliminate yellow fever. As a result, we found Vera Cruz in May, 1914, after three 
years ot internal warfore, not only free from yellow fever since 1909, but also provided 
with an annual appropriation of nearly 52,000 pesos for preventive yellow fever 
measiues. 

We found evidence of how other money was spent, and wisely spent. We found a 
city well paved and lighted, good sewerage, and an excellent water supply for a normal 
population of 35,000 to 40,000. These were the results of sani tary ed u(*ation , and made 
possible by such men as Ticeaga as the heads of Mexican national affairs. We also 
found a network of outlying drainage ditches which only ne<.-esBitated clearing out 
and extension to make them thoroughly effective. 

By enforcing his plans for the destruction of breeding places both within and with- 
out the city, Vera Cruz became practically free from mosquitoes and thus insured 
against the spread of yellow fever. 

While the elimination of yellow fever from Vera Cms was but one of Liceaga's 
many sanitary achievements, it was a most worthy one and all America should be 
proud to claim him as one of the brilliant products of the Western Hemisphere. 

The Chairman. I shall now call for the next paper, ''Carlos Finlaj 
on the house mosquitoes of Habana/' by Mr. F. Enab, of the Bureau 
of Entomology, United States Department of Agriculture. 



PTTBUG HEALTH AND MEDICIKE. 107 

CABLOS FINLAY ON THE HOUSE MOSQUITOES OF HABANA. 

By FREDERICK KNAB, 

United States Bureau of Entomology. 

Historical accounts of the discovery of the agency of the mosquito in the trans- 
mission of yellow fever usually minimize Dr. Finlay's share in the work. This is 
largely attributable to the tendency of more recent writers to content themselves 
with statements obtained at second hand. In consequence it is not generally appre- 
ciated that Finlay's theory resulted from deductions based upon the closest observa- 
tion. We frequently find the earlier suggestion of Beauperthuy mentioned together 
with the theory of Finlay, whereas their ideas were totally different. The former 
thought that mosquitoes caused yellow fever by inoculating man with poisonou- 
flubetances extracted from swamps and foul places. It is not even clear that Beaur 
perthuy distinguished between the yellow-fever mosquito {Aides oalopus) and othes 
similarly marked species occurring abundantly along the coast, such as Aidee txnior- 
hjfndms. 

Finlay, from a close study of yellow fever, had become convinced that it is not trans^ 
mitted in the manner of ordinary contagious or infectious diseases. He was '^ con- 
vinced that any theory which attributes the origin and the propagation of yellow 
fever to atmospheric influences, to miasmatic or meteorological conditions, to filth 
or to the neglect of general hygienic precautions, must be considered as utterly inde- 
fensible." In his conception there was concerned some virus or micro6iganiem in 
the blood and that this was transmissible from man to man solely through the agency 
of some blood-sucking insect. This naturally led to mosquitoes. He found two species 
of house mosquitoes at Habana, known to him under the Latin binomials respect- 
ively of CuUx mosquito and CvUx cvbensis. The former is the species now generally 
know under the names Aides calopus or Stegomyia fasdata; the latter is the species 
better known under t]ie names CuUx quinquefasciatus and CvJex/aiigans. Finlay in 
studying these two species found such marked differences in habits that he was able 
to eliminate Cidez cubensis (quinquefasciatus) and incriminate the species which was 
afterward proved to be the transmitter of yellow fever. He pointed out the character- 
istics of CtUex mosquito {^ Aides calopus) which are essential to its rdle of transmitter. 
In his paper read before the Royal Academy at Habana in 1881, '* £1 mosquito hipot^ti- 
camente considerado como agente de transmisi6n de la fiebre amarilla,"^ are to be 
found recorded all the important details in the life history of the yellow fever mos- 
quito which were afterward brought forward in more elaborate form by the French 
commission to Rio de Janeiro, by Goeldi, and by other workers. 

Finlay clearly understood the domentic character of the two ppecies of house mosqui- 
toes. He contracts their habits, pointing out the bearing of the differences on the 
question of transmission. Cidex cubensis is strictly nocturnal, and according to his 
observations, if not interrupted during feeding takes but a single blood meal.^ He 
was never able with captive females '*to obtain a second bite, whether it had or had 
not laid its ova." As in the European Culex pipiens the eggs are all laid at one time 
in a mass directly upon the suriace of the water and the death of the female follows 
shortly. "After having launched their little boat of eggs, they often stretch them- 
selves out to die upon the water, and I have wondered whether the dead insects 
which R6aumtir attributes to new-bom ones which have been wrecked and drowned 
at the moment of leaving their pupa shell might not be the cadavers of mothers who 
had died in order that their bodies should remain close to the ova so as to contribute 
to the feeding of their progeny." 

> AnalM R. Acad. Qendas med., fls. y nst., Habana, vol. 18, pp. 147-100 (Aug. 14, 1881). 
* This 8tat«ment is not altogether correct. This species {eeds at less frequent intervals and, for the rea- 
Indicated by Finlay, is shorter lived under normal conditions of activity. 



108 PB0CEEDINQ8 SECOND PAN AMERICAN 8CIBNTIFI0 CONGSESS. 

Finlay iiiBista that Ctdex tnotquiUo is a strictly diunud mosquito. The female 
must have blood for the development of her ova and begins to suck blood after having 
been fertilized. The eggs are not all developed at once and are deposited at intervals 
in groups of from 9 to 15. They are sometimes placed upon the water and at others 
"upon solid bodies not too far removed from the level of the water, so that a moderate 
elevation of that level will allow the water to cover them. ' ' Accordingly this mosquito 
is longer lived and requires and takes repeated blood meals at intervals. A female 
kept alive for 31 days fed 12 times during that period. Finlay points out that these 
repeated blood meals are an important postulate for disease transmission: 

Evidently from the point of view which I am considering the Culex mosquito is 
admirably adapted to convey from one person to another a disea^ which nappens 
to be transmissible through the blood; since it has repeated opportunities of sucsing 
blood from different sources and also of infecting different persons, so that the proba- 
bilities that its bite may unite all the conditions required for the transmission will 
thereby be greatly increased. 

The sluggishness of this mosquito after a blood meal and its unwillingness to under- 
take long flights are discussed at some length and their significance in relation to the 
peculiar manner of spread of yellow fever pointed out. The often noted failure of the 
disease to spread beyond narrow limits when no appreciable barrier api>eared to exist 
found a ready explanation in the reluctance of the mosquito to leave the house where 
it had fed . On the other hand the outbreaks of yellow fever at distant points could be 
explained by this same sluggish habit of the mosquito, its tendency to hide causing 
it to be carried long distances in baggage and clothing. 

The importance of all these points has since been fully recognized and discussed 
at length by many workers in the field of yellow fever investigation. However, but 
few even of the best informed authors have realized that Finlay clearly understood 
and discussed them about 20 years before the question of the mosquito transmission of 
yellow fever was definitely settled by the immortal work of the United States Army 
conunission. 

Dr. AoRAMONTB. I do not wish to decry the great glory that is due 
to Dr. Finlay. At the same time I believe we should not forget the 
work of a man who was a pioneer in the same line of investigation, 
since his conception of the transmission or the propagation, as he 
called it, of yeDow fever deserves consideration. Beauperthuy was 
traveling around as early as 1840 with a microscope examining his 
patients — the skin, the excreta, the urine, etc. — things that at that 
time were only undertaken by a man who really had great scientific 
enthusiasm and devotion to his medical practice. While he did not 
point to the transmission of yellow fever by the mosquito, he very 
directly mentions in his works that if there were no mosquitoes there 
would be no yellow fever; and he mentions, for example, the town 
and the island of Guadeloupe, in which there were great numbers of 
mosquitoes and in which yellow fever prevailed, whereas only a league 
away in an inland town where there were no mosquitoes yellow fever 
was not usually developed. Now a great many points in the history 
of this man Beauperthuy, I believe, are worthy and we should treat him 
with greater respect. I must take exception to the attitude taken 
by Dr. Eoiab and express my belief that his remarks were unjust in 
trying to show that his work was valueless. It was so only so far 
that it was published and buried, as usually has been the case with 
the work of our tropical investigators. In this manner Dr. Finlay's 



PUBUO HBALZH AHD MKDIGHni. 109 

work was buried. For 20 years he defended a theory that he could 
not demonstrate, and I am sure that if he had lived in a different 
-country, where such work was better appreciated, his worth and the 
value of his work would have been sooner apparent. 

Dr. Carteb. I certainly agree with Dr. Agramonte in hoping that 
we shall soon see the end of yellow fever. I also agree with him in 
saying that the endemic foci are becoming fewer and fewer. The 
greater ones have already disappeared. But along with the safety that 
that gives us it introduces a certain element of danger. There are a 
great many places that used to be endemic foci of yellow fever, or 
partially endemic foci, into which the introduction of yellow fever in 
days gone by made practically no difference, the population being 
wholly or laigely immune to yeUow fever. As time has gone by, the 
proportion of susceptible people is becoming greater and greater. 
Take the town of Habana. In 15 or 20 years the introduction of 
yellow fever there, if there were any reasonable number of stegomyia, 
would spread as it used to do in New Orleans. We have to look at 
the thing then from two points. I wrote a memorandum to the 
health officer of Porto Rico and to the governor, stating that the town 
of San Juan was in a dangerous condition; that there had been no 
yellow fever there for about sixteen years and they were raising up 
a susceptible population; that it was not possible for any maritime 
quarantine, comparable with any reasonable commercial advantages, 
to keep out yellow fever eventually from such a place; that it was in 
a worse condition than New Orleans, where yellow fever will spread 
only six months in the year, whereas in San Juan it will spread 12; 
and that it was necessary for them to do antistegomyia work. 

Instead of being too hopeful we should be, not by fear but by 
hope, stirred up to introduce into the Tropics antistegomyia work 
now. The fact of a disease being on the run is to my mind rather 
a reason for attacking it. Twenty or 25 years ago plague was con* 
fined to a small section in south China and I believe that four or 
five millions would have stamped it out; I do not believe a thousand 
millions would now do so. We have yellow fever now in but a few 
places and it seems to me that we should not belittle its threat. Its 
threat is greater because it is in a few places. Its threat is greater 
because many places are becoming filled with susceptible people that 
were not susceptible then. 

One word in regard to quarantine. That is a big subject. It 
should be madC; as Dr. Agramonte says, without any consideration 
of the rules that were in force prior to 1901. That is true; that is 
correct. It is absolutely right that our war is against the mosquito, 
not against fomites. Many of our rules, however, were founded on 
experience and, though empirical, hold good still; and I can not 
think that the rules of the Paris convention have any foundation in 
reason or experience or correct theory. I can not think that a ship 



110 PBOCEEDINGS 8ECOKD PAK AHBRIOAN BOIEHTIFIC C0KGBE88. 

that has had no case of yellow fever aboard for seven days is simply^ 
suspicious. Why the ship may be loaded with stegomyia that have 
had no opportunity of showing their infectivity after, say, 17 days — 
12 plus 5. The time element does come in, but the time element 
scarcely enters in in counting a ship immune against yellow fever^ 
Unless I am mistaken, one has recently come to your port, Dr. 
Ouiteras, that had been out many more than seven dajrs, and when 
commencing to load developed yellow fever. 

Dr. GurrEBAS. Many more than seven days. 

Dr. Cabteb. I know well that in 1911 one went from Acapulco 
to Honolulu and that, when commencing to unload, yellow fever 
developed and a case developed later on in the interior. They had 
carried yellow fever as much as four weeks. To my mind time can not 
be counted as freeing a ship from stegomyia unless you count a very 
long time. 

I also think, and I have preached it all my life, that quarantine 
must be used only for protection; and yet I remember Dr. Liceaga 
saying that he was able to get sanitary measures down in Vera Cruz 
partly by showing the effect that the brutal quarantine of Carlos 
Finlay had upon their commerce; that if they rid themselves 
of stegomyia and of yellow fever it would greatly diminish their 
conmiercial obstacles. I think, then, to be easy on the places that 
will not free themselves from yellow fever may be an injury to them 
as well as a risk to ourselves. 

■ 

There were further discussions in Spanish of this paper by Dr. 
M. G. Lebredo, of Habana, Cuba, and Dr. Rafael Gonzalez-Rin- 
cones, of Caracas, Venezuela. The discussion in Spanish was not 
reported. 

The Chaibman. If there is no further discussion, I shall now call 
for the reading of the following papers: 

Consid6ration sur la fiftvre dite "Fidvre de fruits," by Dr.C.Mathoh 
and Dr. L. Audain. 

La profilaxia de la fiebre tifoidea por medio de la vacunaci6n, 
by Dr. Justo F. Gonz&lez. 

Lia Buba (Leishmaniosis Americana), by Dr. L. E. Migone. 



CONSmSRATIONS SUR LA FifiVRE DITE '*nfiVRE DE FRUITS." > 

Par C. MATHON, 

pTofeBseuT h la FaculU de MSdecine de Port-au-PHruXf Haiti, 

et L. AUDAIN, 

Directeur du Lahoratoire de BacUriologie de Port-au-Prince, Haiti. 

L€e aliments et les boisBons que nous ing^rons sont suscepti^ lee d'introduire dans 
notre organiame dee maladiee plus ou moins gra\ es. L'appareil qui est le plus expoe^ 

1 Cett« fldm qiM 1«8 Indlgtees attribaent anz fruits est bien eertatmm^nt d'origine Intestinale oomme 
en fait fol I'^tude cUnlque que nous allons «iitrepi«ndre. 



FUBUO HBAUXH ANP HRDICtKB. Ill 

:^ ces maladies est, sans contredit, k cause mtaae de tos fonctions phyiiolo^queB, 
I'appareil digestif. Ausd, Phygi^niste a-t-il pour de- oir de d^truire, par tous moyens 
«iL eon pou oir, ces gennes, avant leur penetration dans le tul.e digestif et de maintenir 
I'oiganisme en bon ^tat de defense, afin que par see seuls moyens il arri . e k iutter 
victorieusement contre les germes qui peu^ ent Ten ahir. 

Mais, a- ant d'entreprendre un tel ou mge le medecin hygieniste doit connattie, 
dans ses moindres details, I'histoire clinique de ces maladies. 

II existe en Hsuti, tant6t k retat endemique, tant6t k T^tat epid^mique une maladie 
infectieuse d'origine intestinale dont je ^ais faire ici une courte etude clinique, 
d'atlleurs indispensable pour la direction intelligente d'une V.onne prophylaxie« 

S'il est A Ru que les enterites pro . oquees par une hygiene alimentaire defectucuse 
ont ete etudiees de temps immemorial, 11 est un telt incontestable, c'est la grende 
•confusion qui existe encore dans la classification et mdme dans la terminologie de ces 
affections. Quand on dit d'un malade qu'il est atteint de meningo encephalite 
x^hxomque diffuse, chacun comprend et il n'est plus rien k dire; mais, quand on dit 
<l'un malade qu'il est atteint d'enterite, de dysenterie, de diarrhee -^ erte, de dlarrhee 
-de Cochinchine, etc., on n'en.isage qu'un cdte de la question que Thabitude seule 
nous permet de comprendre, sans qu'il soit donne en aucune mani^re de voir la cause 
premiere de la maladie, Tinflammation, ni le siege de TinAammation. 

Des considerations d'ordre anatomo-pathologique, symptomatique et pathngeni- 
•que nous ont permis en HaSti, sous I'impulsion de notre Mattre Audain, de comddem 
et de denommer les affections gastro-intestinales des pays chauds, comme on fait 
pour toutes les autres maladies. La nou. elle classification d 'Audain est tr^s simple, 
comme chacun pent s'en convaincre. 

II faut considerer avant tout qu'il existe du cdte du tube intestinal deux appareils 
bien diatincts: Tappareil glandulaire et Tappareil lymphatique (~ aisseaux et tissus 
adenoidiens) qui, pathologiquement, reagiasent d'une fayon spedale, et, clinique- 
ment, d'une fagon absolument differente. La cause pathologique porte-t^lle ses 
effets sur le systems glandulaire? Vous avez une inflammation des glandes intesti- 
nales et les symptdmes d'une enterite glandulaire. 

Agitrelle sur la partie lymphatique de Tintestin? Vous a- es, sui ant que cette 
action reste localisee aux lymphatiques, une lymphangite intestinale compara' le k 
la lymphai^fite simple des membres, sans retentissement gai^lionnaire important. 

Cette action s'etend-elle au tissu lympho'ide de I'intestin? Vous vous trou ez en 
presence encore d'une inflammation: la lymphango adenoTdite intestinale ou enterite 
lymphatico-adenoldien, comparable a la lymphangite des membres a.ec adenite 
secondaire. 

A. II existe, au point de vue anatomique, une grande analogie entre la peau et 
I'intestin. Les differences de structure que nous obser ons entre le derme interne 
et Texteme ne tiennent qu'i leur rdle physiologique different. Du cdte de la peau, 
couche epidennique plus ou moins epaisse, plus ou moins dure sui ant le si^. Du 
cdte de rintestin, couche de cellules cylindriques, epitheiiaies, cellules calciformes, 
leucocytes. Au-dessous de la couche epidennique sous-cutanee se trou e la couche 
papillaire riche en vaisseaux sanguins et lymphatiques et surtout en filets ner eux. 
Pour rintestin, au-dessous de la couche epitheiiale, couche des \ illositee, sorle de 
papilles saillantes. Giacune des villosites possede: une arteriole, une \ einule et, de 
I'une k Tautre, un reeeau capillaire tres riche. Le centre de la a illosite est occupe 
par un lymphatique sp^ial, dit chylifere. La villosite est compietee par une char* 
pente de tissu conjonctif et des faisceaux musculaires horizontalement places et 
relies par des fibres anastomotiques obliques. 

Pour la peau, les lymphatiques naissent au tiers de la hauteur des papilles par un 
cul de sac ou une extremite aflUee. lis aboutiasent k un reseau sous papillaire dont 
les mailles sont mdiees k celles des r^seaux ^ asculaires sanguins de la r^ion. De 
celui-ci partent des tioiics plus volumineux qui se rendent au reseau de tissu cellulo* 
adipeux sous-cutane. 



112 PB0CEEDIK08 SEGOHD PAN AMSBIOAN SODSKTIFIO 00KGBB88* 

Pour rintestin, lee lymphatiques naiaBent de deux Bouicea diff^rentes: des villoait^ff 
(v&iBseaux chylif^ree) et de la tunique musculaire. ' ' Lea canauz chylif^ree ae rendent 
directement dans la muqueuae en paasant entre lea glandea de lieberkun, on biea 
ila fonnent d'abord un i^aeau hoxisontal auperficiel aitu^ k la baae dea villoait^ et 
autour dea orlficea glandulairea. Dana la tunique aoua-muqueuae, lea chylif^rea 
conatituent, en ae r^uniaaant. un r^eeau txanaveiaai foim^ de conduita, tantdt ^tralta, 
tantdt largea; cea conduita accompag^nent lea vaiaaeaux de r^aeau aanguin autour 
duquel ila fonnent m6me dea gainea." Juaqu'ici Panalogie eat trte giande entre lea 
lymphatiquea de la peau et ceux de I'inteatin. Lea diff^ncea qui exiatent pnr. ien- 
nent aurtout, d'une part dea modificationa qu'a dd aubir Tinteatin pour aaaurer la 
progreeaion du chyle (fonctionmotrice) et d'autre part pour pr^aer. er Torganiaine tout 
entier dea dangera qui I'euasent & tout moment menace du fait m&ne de la fonction 
ap^dale de I'inteatin: Tinteatin eat un puiaaant laboratoire de poiaona, il eat auaat 
un formidable r^aervoir de dangereux microbea. 

Du c6t6 de la peau, le ayat^me lymphatique eat d'une grande aimplicit^, paice que 
I'^pidenne offre une rMstance infranchiaaable aux gennea pathog^nea moina nom- 
breux et aurtout en contact moina intlme avec lee tiasua. 

Pour lea inteatina, lea dangera 6tant plua nombreux et conatanta parce que I'^pil 
thelium inteatinal eat beaucoup plua d^cat et plua fragile que T^pidenne aoua- 
cutan^y la nature dana aa aage pr6. oyance a multiplid lea ouvragea de d^fenaea: 
gangliona mtentMquea, richeaae de tiaau lymphoide duchoridh, foUiculea cloa isol^ 
folliculea agmin^, toua oiganea dont la atructure eat analogue k celle dea gangliona; 
kur rdle eat le mAme. 

Au point de vue de la phyaiologie g^ndrale de I'inteatin, qu'un genne p^n^tre, aoit 
k trK\ era T^pith^um aain, aoit par effraction de cet ^pith^lium k tra\ era lea eapacee 
lymphatiquea que voyona-noua: lea leucocytea migrateura ae portent k aa rencontre et 
la bataUle a'engage; qu'il p^n^tre dana le rteau lymphatique, le voili cheminant ^ era 
lea folliculea cloa et lea plaquea de Peyer oik la lutte eat encore plua violente. Ge 
pioceaaua de d^fenae toume parfoia au detriment du follicule ou de la plaque de Peyer. 
Pour mieux faire face k I'ennemi, la nature redouble d'efforta, lea vaiaaeaux aa n gu ina 
■e congeationnent, lea leucocytea ae taaaent, lea titaua ae compriment, dea abc^ ae 
fonnent qui a'ouvrent g6ndnJement dana I'inteatin, d^tenninent dea ulc^rationa 
plua ou moina ^tenduea ou bien dea eacharea ae produiaent, a'^liminent, occaflionnant 
dea pertea de aubatancea fort grandea. 

En r^aum^ cette courte ^tude noua permet d'avancer que (en mettant de cdt6 lea 
inflammationa ganglionnairea pzimiti~\ ea qui doi\ ent dtre plac^ea dana un cadre ap^ial) 
la plupart dea maladiea b6\ ^rea microbiennea a3rant pour ai^ Tinteatin debute par 
une lymphangite. L'analogie ae pourauit done m6me au point de vue pathologique 
avec ce qui ae paaae du cdt6 de la peau: lymphangite localia^, lymphangite plua 6ten- 
due determinant la tmn^faction dea folliculea et plaquea de Peyer, comme on voit 
une lymphangite de la jambe, par exemple, prtxluire la tumefaction dea gangliona 
de I'aine; auppuration de cea oiganea comme pour cea gangliona; eacharea k cauae de 
leur atructure ap^dale. 

En r^aume, le premier acte de toute attaque microbienne de I'inteatin eat done 
une lymphangite. Loraque celle-ci n'eet que de moyenne intenaite, qu'elle n'en- 
tratne paa I'ulceration dee folliculea, la aituation eat claire; la maladie ^volue comme 
une lymphangite ordinaire. 

Si, au contraire, la lymphangite eat d'intenaite plua grande que lea gennea franchia- 
aant le ayattoe lymphatique intestinal, que lea gangliona m^aenteriquea aoient im* 
puiaaanta k lea arrdter, la fi^vre toxh^mique inteatinale devient une infection veritable 
qui pent dtre eberthienne, chol6rique, tuberculeuae, etc. 

G'eat ae baaant aur cea conaiderationa qui viennent d'etre expoe6ee et a'appuyant 
■ur dea obaervationa cliniquea, hdmatologiquea et bacteriologiquea que le Docteur 
Audain a propoe^ la claaaification auivante des maladiea inteatinalea; claaaificatioa 
qui eat gen^ralement admise en Haiti: 



PUBUO HEALTH AHD ICXDIOnrB. 118 

1. LymphAngite inteotinale ou entente lymphatlque, canct6rifl6e cliniquemeiit 
par un acc^ de fi^vre unique ^lev^ durant une p^riode de 24 li 36 heures; apr^ quai 
toat rentre dans I'ordre. 

Cet acc^ de fi^vie peut faire penser k du paludiflme; maia il n'existe jamais de 
paraoitefl dans le sang. Cette maladie jMurrait 6tre identifi^ avec la fi^vre dite 
4i^6mhre des auteuis. 

2. Lymphango-ad6noIdite intestinale ou entente lymphatico-ad^oldienne, carac- 
t4sna6e par une fi^vre tantOt intennittente, tantdt r^mittante ou continue, d'oi^ la 
acNis-diviflion en forme 1^^, moyenne et grave. Cette demi^re ayant toutes les 
alluree de la grande typhotde dee pays temp^r^; mais la 86ro-r6action de Widal, de 
mdme que la diaso-r^tion, reste negative dans tout le cours de la maladie, dont la 
dur^e est de 12 2t 90 jours. Notons ^;alement Tabsence totale de parasites de Laveran. 
Haisy ce qui est int^ressant de noter dans ces cas, c'est la reaction sanguine. 

A. Dans la premi^ forme, elle est caract6ris^ par de la leucocytose pol3muclMre 
decourte dur6e (122^24 heures)et suivie d'une mononucl^ose tr^ fort6(60 k 90 pour 
cent). 

B. Dans la forme I6^te ou moyenne, il y a toujours une dissociation entre les deux 
facteurs: facteur leucocytaire faible et facteur mononucl6aire fort ou inversement. 
En tout 6tat de cause, la mononucl^ose est toujours moins ^lev^ que dans le caa 
pr6c6dent. 

C. Dans la forme grave, les deux facteurs sont faibles: hypoleucocytose et hypo> 
JDononucldose ou formule leucocytaire normale. Ce n'est qu^k Tapproche de la 
gu^rison que les deux facteurs se reinvent ou m^me un seul, ordinairement la mono- 
nucl^oee. 

8i je ne craignais d'outrepasser le cadre assign^ par le Congr^ je m'^tendrais davan- 
tage sur les conditions biologiques qui r^gissent ces diverses vari6t^ d'ent^te. Mais, 
c'est r^tude ^tiologique surtout qui doit nous arrdter un instant, car c'est elle qui con- 
dxtionne les indications que doit remplir Thygi^niste. 

Abstraction faite de Pent^te glandulaire, dont Pune des principales causes rMde 
dans la d^fectuosit^ de Thygi^e alimentaire, et qu'on ^vitera en recommandant une 
alimentation saine; les ent^tes lymphatiques, elles, reconnaissent pour cause la 
p^^tration dans les lymphatiques intestinaux et le d^veloppement intensif de cer- 
tains microbes, soit par suite de leur grande virulence, soit par suite d'une defense 
oiganique faible, nidle ou tardive. 

Cette p^6tration est favoriade par les ^raillures, si petites soient-elles que peuvent 
inoduire les corps Strangers fins, pointus ou trancbants: aretes de poissons, • • • 
larves de vers qu'on rencontre dans certains fruits. Ces larves en p^n^trant dans 
I'intestin produisent des ^ndllures ouvrant par ainsi des portes d'entr^e aux divers 
agents microbiens qui stationnent dans cet oigane. Mais ce que font ces larves d'autrea 
helmintes qui ont pour habitat I'lntesdn peuvent aussi le faire. Les ascaris lombri- 
coldes si puissanunent arm6s, les trichoc^phales qui s'enfoncent par leurs extr6> 
mit^ c^phaliques dans la muqueuse intestinale; le strongylus, Puncinaria duod^ 
nalis qui vit en grande quantity dans Tintestin gr§le de Thomme, implant^ sur la 
muqueuse od il pnxiuit de petites h^morrhagies, les vers du fromage (larves de Piophila 
casei) pourvus de crochets ac^r^ peuvent, k n'en pas douter, produire la porte d'entr^ 
nfcesaaire k Pinvasion microbienne. 

En Haiti la croyance populaire est que certains fruits (cirouelles, mangues, sapo- 
tilles) sont susceptibles de provoquer une fi^vre que Pon d^signe pour cette raison 
sous le nom de "fi^vre de fruits." Cherchant si quelque part de y6nt6 pouvait se 
cacfaer sous cette croyance populaire, j'ai constat^ que, r^Hement k P^poque des 
fruits, il existait dans les selles des enfants surtout un certain nombre de vers vivants» 
Btudi^ au point de vue de leur armature, ces vets, ainsi qu'en fait foi la description 
suivante, sont puisaamment arm^s. 



114 PBOGEEDINOB SBOOKP PAK AMBBICAH 8CIEKTIFI0 COITOBBSS^ 

La lanre d'une long:aeur d'un coatim^tie, de couleur blaache, poasMe, au nivean 
de Torifice buccal, une pake de crochets ac^rda dont void lea caract^ristiquea: de 
la baae k la pointe 384/i. L'annature eat form^ de deux parties, Tune rectangulaiie 
a une longueur de 204^ sur une laigeur de 60m. Les deux angles sup^iieurs de ce 
rectangle sont surmont^ de deux pointes ayant Tune 48m 6t Tautre 60m- A cette 
partie rectangulaire s'ajoute le crochet proprement dit, incurv^ sur lui-m6me de fa^on 
ik former un bord interne tr^ concave. La longueur de ce crochet est de 180m. 

Je ne crols pas qu'll soit possible de mettre en doute le rdle dee vers intestinaux dans 
la production de la lymphangite intestinale: il faut seulement se dire que les vers 
n'agissent pas par eux-m6mes, mais par les IMons qu'ils d^tenninent et Tinfection 
•qui en pent rteilter. La prince de ces vers est grande en Haiti. La statistique du 
Laboratoire de Bact^riologie de Port-au-Prince accuse 50 pour cent. G'est bien cer- 
tainement U Tune des causes les plus sinenses des diverses vari^t^ d'ent^rite lym- 
phatique qui font tant de ravages dans notre pays. 

Le rOle des vers intestinaux, bien que secondaire, n'en est pas moins important. 
Aussi, Taigument qu'on oppose parfois d'individus ayant des vers et ne faisant pas de 
pounde d'ent^te lymphatique n'en est pas un. Que d'draiUures de la peau non 
aulvies de lymphangite 1 L'oiganisme qui se defend a vite fait de d^truire les microbes 
et, par une infranchissable bani^ de leucocytes, d'ext^ioriser une plaie jusqu'ik 
•cicatrisation complete. 

C'est 4 la faveur de Teau de boisson, des legumes non cuits que les oeub d'helminthes 
et les larves de fruits p^n^trent dans Tintestin et s'y d^veloppent. Leur seule presence 
ne suffit certes pas pour provoquer la maladie; d'autres conditions sont requises. II 
faut qu'ils aient produit des 6raillures d'une part, et d'autre part que Pindividu soit 
en 6tat de receptivity. C'est pour cette demi^re raison surtout que tous les porteurs 
de vers ne sont pas atteints de fi^vre. Les conditions de receptivity ou de non-r6cei>- 
tivite morbide dans les infections intestinales d'ordre lymphatique peuvent 6tre 
determin6e8 h^matologiquement, comme le d^montre Texamen d'un grand nombre de 
malades que nous avons suivis k ce point de vue. 

Voici les conclusions auxquelles nous out conduit dix anndes d'observations 
cliniques, h^matologiques et coprologiques: 

1. Dans rheLminthiase intestinale, sont k I'abri des infections de causes bact6rio- 
logiques diverses qu'occaaionnent les vers aim^s, tous ceux dont la defense intestinale 
est caracterisee par la grande activity des elements lymphoides de Tintdstin, c'est-k- 
dire par une forte mononucl^ose en mdme temps qu'une fortd leucocytose (associa- 
tion de deux elements de la defense). 

2. lis sont k Tabri, tant que dure cette condition favorable, condition qui pent 
persister des ann^es enti^res, touts la vie m^me; mais il faut savoir qu'elle peut dis- 
parattre momentan^ment et pour un temps plus ou moins long. Ix>rsque le fait se 
produit, las individus qui ^taient en etat de non-r6ceptivite perdent cet etat et sont 
susceptibles d'dtre infect^e. 

3. Lorsque Tun des elements de cette bonne defense faiblit, par exemple, qu'au 
lieu de rhyperleucocytoee, il se fait de la leucop^nie avec mononucieose ou inverse- 
ment, Tindividu est susceptible d'etre infect^. 

Point n'est besoin d'etemiser cette lutte entre hygi^nistes et parasitologues. Le 
Professeur Ghantemesse a bien raison de vouloir que Ton ne boive pas d'eau conta- 
min^e, parce que s'il n'existe pas d'Eberth dans Tintestin. la typhoids ne pourra pas 
se produire, m^me en presence d'une eraillure intestinale. Mais les professeurs 
Blanchard et Guiart ont raison de recommander la destruction des vers intestinaux, 
parce que m6me si TEberth exists dans la cavity intestinale, la fi^vre typholde ne se 
•declarera pas en Tabsence d'eraillures produites par les vers Intestinaux. Ces der- 
iiiers surtout sont une des causes les plus puissantes de la maladie. 

En resume il faut se mettre k Tabri des causes vuln4rantes capitales puisque sans 
•el les la penetration microbienne est, sinon impossible, du moins trte difficile, et se 



PUBLIC HEiJ/EB ANB ICBDIOIKS. 115 

aoaveair que ai on peut k la rigoeur emp^her la typfaotde de se d^velopper par lea 
pr^autions hygidniques, on eat dterm6 en presence du coUbacille, hOto normal de 
I'inteetin, cause probable de la plupart dee ent^rites lymphatiques ou lymphatico* 
adenoid lennee dont nous venona de faire T^tude. — ^Audain: Fid^rroi Intertropicalea. 

Dans de telles occurrences, quel devra 6tre le rdle de Thygi^niste? Quelles mesures 
prophylactiques doit-on recommander pour arriver k un r^sultat satisfaisant? 

Deux indications sont k remplir: 

(a) Chez les indivldus d^j^ atteints, suppximer tout apport nouveau de poison 
dans Toiganisme, ce que Ton obtiandra par un regime di^t^que a6vhte; augmenter 
par touB les moyens en notre pouvoir la d^ense oiganique (MMication leucog^e), 
travaiUer par consequent k fortifier la puissance phagocytaire des globules sanguins. 

(b) Chez les non-infect^, empdcher T ingestion des eaux polluto, des l^^umes non 
cuits, de certains fruits arrive k une maturity trop avanc6e, autant d'^l^ments qui 
constituent les principaux vecteurs d'oeuls de vers; maintanir Toiganisme en bon 
^tat de d^ense, afin que, par ses setds efforts, il puisse arriver k d^truire les gennes 
qui, malgr^ tout, auraiant pu Tenvahir. Surveillez par consequent que sa r^sultante 
leucocytaire soit normale. 



LA PROFELAXU DE LA FIEBRE TIFOIDEA FOR MEDIO DE LA 

VACUNACION. 

Por JUSTO F. GONZALEZ, 
Pro/esor Agregado de Bacteriologia e Hiffievie de MorUevideOf Urugrwy, 

La fiebre tifoidea tiene car^ter end^mico en la Repdblica del Uruguay, y ademis 
empujes marcados durante el verano y el otofLo. Declina en los restantes meses del 
ano. 

Obs^rvanse en nuestro pais los preceptos generaies de profilaxia, para evitax el 
desarroUo de la enfermedad de la cual vamos a ocupamos y que incluimos en el gnipo 
de las infecciones de origen hldrico, no obstante la dificultad que presenta, la compro- 
baci6n del bacillus de Eberth en las aguas destinadas a la alimentacidn. 

La dotienenterfa sigue en nuestro pais una marcha casi invariable a pesar de los 
eafuerzos higienicos que se realizan, con el fin de evitar la propagaci6n de la enfer- 
medad y su desarrollo epidemico. 

Hace unos meses, en el Hospital Vilardeb6 de Montevideo, se produjeron varies 
cases de fiebre tifoidea entre los enfermos alll asUados y entre el personal de enfermeros. 
Gomprobamos la enfermedad clinic a y bacteriol6gicamente y procedimos a investigar 
el foco inicial del mal Eberthiano. 

La invest igaci6n en el agua de bebida, del bacillus de Eberth, resultd negativa. 
Se Bospecha entonces que el suelo de este estableclmiento hospitalario, en la zona 
destinada a la plantaci6n de legumbres alimenticias, podrla estar contaminado, porque 
el agua empleada para el riego de las hortalizas provenia de un pozo, es decir, de la 
nappa subterr&nea. Las veiduras podrlan muy bien vehiculizar el agente patdgeno 
y producir la enfermedad entre los asilados y entre el personal de servicio, que se 
alimentaban con esa clase de legumbres sospechosas de contaminacidn. 

El aniJlifliB bacteriol<5gico del agua del pozo, no di6 el baciUus de EberUi, en cam- 
bio, se encontrd una cifra elevadlsima de bacterias por c. c, con predominio del coli- 
bacillus. 

Entre tanto se piensa esterilizar ese foco de contaminaci6n haciendo un estudio m4s 
riguroso y prolijo de la nappa subterr&nea. Pero la tarea no siempre ficil, no fu^ 
X>osible llevarla a cabo por tratarse de una localidad urbana. Por otra parte el 

68436— 17— VOL ix 9 



116 FR00REDIKQ8 SBOOVD PAH AMSBIGAV SGDfiVTIFIO C0KGBE88. 

■neMniqnto del saelo no Iqgift infliur a veces adbre U nuachft de U fiebre tafoadea en 
alguiiM localidadeB, y mheaum \o diffdl que leeolte en dertas ocaooaee llevarlo a la 
priicttca. 

Lnego, pues, deade el ponto de viata higi^nioo las nijtam de profilaxia general obeer* 
madaa leeoltan inaufidentee paia luchar con eficacia contra la infecci6n Eberthiana. 

Ee natural y Itfgico que en el momento actual, qne diflponemos de una anna pre- 
doea de profilaxia, baaada en la etiologia de la enfeimedad, penaemoa en aacar de ella 
el mayor paitido deade el punto de viata higi^nico. 

For razonea ttdlea de comprender que entnn en reladdn con la natnnleza de eate 
oertamen no podemoa aer extenaoa y dar toda la amplitud que eata cueati6n modecna 



EH agente patdgeno de la fiebre tifoldea perf ectamoite individualizado a peaar de la 
afinidad con otraa eapedea microbianaa patdgenaa, airve para prevenir el deaanollo 
de eata enfennedad en laa colectividadea ainfifnay4idaa. £1 reaultado obtenido en las 
agrupadonea humanaa, no puede aer mia augeativo deade el punto de viata de la 
profilaxia verdadera y radonal de la fiebre tifoldea. 

En nueatro pafe preparamoa un material vacclnico aegdn la tunica del Profeaor 
Vincent. £1 procedimiento aeguido por el Profeaor Gamelli, jefe del Laboratorio 
Bacterioldgico M unidpal, conaiate en la deatrucd6n y e8terili£ad6n por el 6ter aulf 6- 
rico de loa badllua de Eberth procedentea de culturaa de 24 hoiaa en agar y en la 
emulai^n de ^toa en una aoluddn fiaioldgica clorurada. 

£8ie procedimiento repreaenta aobre loa anteriorea un verdadero adelanto en la 
elaboraddn de la vacuna. 

La acddn bioldgica de la vacuna antitifica aobre el oiganiamo humane, ea auaceptible 
iodavfo de mayor eadaredmiento y ea de eaperarae que nuevaa manipuladonea e 
inveatigacionea biol6gicaa tniigan ajMurejada una aimplicaddn mayor en la t^cnica. 

La vacuna que he tenido ocaai6n de emplear en el Hospital Vilardeb6 con motive de 
loa caaoa de fiebre tifoidea mendonadoa, ea preparada con 10 espedea procedentea de 
A\tAiniA» localidadea de la Reptiblica. Ea inoculada por via subcut&nea cada 8 dfaa 
haata llegar al ntbnero de 4 inyecdonee. £1 primer centfmetro c^bico inyectado 
contiene 100 millonea de badllua, que aumentan haata llegar a 300 millonea de g^ 
menea muertoa en la fUtima inyecd6n. 

Ahora bien, tenlendo en cuenta que en el momento actual ae tiende a admitir que 
en el protoplaama microbiano, eatd el prindpio albuminoideo que deapierta en el 
oiganiamo la acddn biol6gica defenaiva, cabe eaperar que laa inveatigacionea encau- 
sadaa en eaa nueva via hagan inneceearia la numerad6n de laa bacteriaa en la vacuna 
y que derta doaia de protoplaama microbiana que contiene el prindpio albuminddeo 
AtU aea aufidente para produdr en el organiono la miama inmunidad antitifica haata 
hoy conaeguida. 

En eata inveatigad6n eatamoa ocupadoa actnalmente pero nada concreto podemoa 
comunicar por ahora a eata diatinguida aaamblea. 

El nnevo criterio con que encaramoa la cueati6n de laa albdminaa eapecfficaa micro- 
bianaa, tiene derta reladdn con un nuevo producto preparado y enaayado contra la toa 
convulsa por el Profeaor Enuiaa, director del Inatituto Bacterioldgico de Buenoa Airea 
y conocido en el mnndo dentifico por aua numeroaaa producdonea. 

El Profeaor Erauaa ha dado a conocer la tunica aobre que repoaa la vacuna, contra 

^ " coqueluche " por A obtenida. Se trata de un procedimiento anilogo al del 

J^feBor Vincent. 

. eeputo de nn enfermo atacado de toa convulaa, previa inveatigaddn bacterio- 

J^c« referente al badlo de Koch, ea tntado por el 6ter aulftirico puro y agitado 

"'^^^te Urgo ttempo y emuJaionado con una aolud6n fiaiol6gica clorurada. Tal ea la 

'^^^^Oai de la llamada impropiamente vacuna contra la coqueluche, aiendo en realidad 

^^'^ I>r<oducto albdmino ter&pico obtenido por el m^todo de Vincent, el cual tiende a 

^f^'^^ra-lizaree df a a dfa para la obtend6n de la vacuna antitffica. No ea en vano eaperar 



FUBUO HBALXH ASD XSDIGDrS. 117 

qam hm ftlbdmiBia aspoclficM del badlhii de Bbertfa not Itoven % aceptw el criterio 
•baervado pan la albteino-teimpia. 

Ssia o Mmi nO'Ebtr A^p foJUaxia pnede condiicir a one nneve via de inveatigaddn 
paiA el tntamiento bacteriotev&pioo de la fiebie tifoidea. 

Tsnieiido, pnea, ana aima poderoaa pan oombalir el doaurrollo de U infecci6n 
in)ertliiana, la idea de uitt piofilaxtt lacioiial y dtil tiene qn^ 
MgieniataB y laa laaonea expuertaa aobie piofiliia mp^ML de la fiebie tif oidea, debe 
ante todo tener por baae Is vacnnacMn. 

El aaneamientb del aoelo, le pioteod^n de oidea hfdrico, 1* deainfeccidn, etc., 
deben aer lelegadaa al aq[;undo nmgo, como aiudliaiesocoadyuvantea de Ua acunad^n 
pieventi\a. 

Por lo taato debemoa difondir el valor de eata vacima en todoa lot pafses de AmMca 
deode la fiebie tifoidea ea una pieocnpaci6n de la autoridad aanitaria; y 11^^ a la 
Tacunacidn facnhativa n obligatoria aegil&n loa caaoa, para defender a laa colecti idadea. 
La vacunaci6n en laa eacuelaa, en loa cnartelea, cirrelea, eatablecimientos bbriles y 
luMfpitalea, debe hacerae con el fin de Uegar al dominio del mal si ee poail le, o por lo 
menoa a loa beneficioaoa reaultadoa que pan laa cdlectividadea ha alcansado la a acuna- 
ci6n anti . aii61ica frente al \irua varioloao. 

En dertaa profeaionea la fiebie tifoidea bace mtkym ndmero de vfcttmas, debemoa 
tenerlo pieaente pan condudr la lucba 16gica y ncional centre el baciUua de Eherth a 
biien t^imino, aconaejando en eaoa caaoa, que loa aujetoa comprendidoe dentro de eae 
gmpo de profeaionea, deben aer inmuniaadoa por medio de la vacunacidn, contn la 
fiebie dotienent^rica. 

Finalizamoa aconaejando la enaefianza de dertaa nodonea de profilaxla entre laa 
colecti\ idadea, deade el punto de vista de la higiene aocial, con el fin, en nueatro caao, 
de difundir loa deberes y derechoa que tiene el indl iduo aialadamente y frente a la 
colectividad ante la aoluci6n del problema profiUU:tico modemo de la fiebre tifoidea. 

nsauMBN. 

En reaumen llegamoa a laa conduaionea aiguientea: 

1. Declanmoa que la vacunad6n antitffica ea un excelente recuiao piofiUctico, pan 
pievenir el deaanoUo de la fiebie tifoidea. 

2. Que la profilaxla de la fiebre tifddea por medio de la vacunacl6n debe aer difun- 
dida en todoa loa paiaea donde la infecd6n Ebertluana ea una preocupaci6n de laa 
autoiidadea aanitariaa. 

3. Que debe aconaejane la inmunidad antitffica pan dertaa profeaionea. 

4. Que la vacunaci6n, indirectamente, fak^-orece el aaneamiento del auelo. 

5. Que deben eaperarae reaultadoa anilogoa a loa obtenidoa por la vacunaci6n anti- 
varidlica, por medio de la vacunad6n antitffica. 

6. Que aeii con^ eniente difundir entre la maaa popular, nocionea aobre loa deberea 
7 derechoa del indi\ iduo aislado y de la colectividad frente al problema profilictico 
modemo de la fiebre tifoidea. 

7. Que la vacunaci6n antitffica debe aer facultativa u obligatoria aegtin loa caaoa. 



LA BUBA (LEISHMANIOSIS AMEBIGANAV 

. Por LUIS E. MIGONE, 
Pro/tBor de la Faadtad de liedieina de AMunddnf Paraguay. 

Deade hace tiempo ae deearrolla en el norte del Panguay, entre loa obreroe de loa 
grandea eatabledmientoa industrialea de eaaa regionea, que tnbajan en la preparad6n 



8<aAn el alitor biMllcAo, A ustw geiUa, U palabn "babft" proTtciw d« ]a africana "booba. 



w 



118 PBOGEEDING0 6EG0KD PAN AlCBBICAN ^IBlfTIFIG G0N6BESS. 

de la yerbarmate y entre los obreros que labranmaderas, ima enfeimedad llftmada 
"buba/' enfennedad ulcerosa, de car&cter cr6iuco, de desenvolvimiento lento, que 
ataca las partes descubiertas del cuerpo, pies, piemas, brasos, cuello y car% y mia 
tarde invade las mucosas nasales, tolngea, laringea, paladar y labios. 

Muy a menudo esta enfeimedad detennina la imposibilidad, pasajera o cooipleta, 
para el trabajo. 

Esta enfennedad ha penetrado, seguiamente, en eete pckfs por contaminacioneB 
sucesivas de loe Estados brasilefios limltrofes al Paxaguay, donde existia ya esta 
enfennedad con el mismo nombre desde hace muchos alKos, segt&n loe autwes braaileftoe 
y europeos que de ella se ban ocupado. Hoy dfa, eetaa llagas se deeenvuelven en eataa 
r^ones de tal manera que, aegta los enf ermos que vienen de esos lugares, no hay caaa 
en la que no se encuentren uno o varios atacados del nud. 

Hemes observado esta enfermed^i en los nacionales y en loe extranjeroe» en loe 
hombres y en las mujeres, en los viejos y en los niflos de pecho. 

La enfeimedad se hace sentir tan teniblemente que a voces en ciertos lugaies de 
100 obreios que entran en los bosques para el trabajo, doe meses despu^ salen 70 u 80 
enfermos a k ves, con una o dos llagas, con 10 o 20, con 30 o 40 llagas repartidasenel 
cueipo. Esto obliga a suspender la empresa. 

Varios insectos son acusados como inoculadores del virus: Ixodes, t^banos, mosquitos, 
gimulinidos, pero los m^ son los primeios. 

En el Paraguay, como en todos los paises donde existe esta enfennedad, se consideia 
a la buba como id6ntica a la sifilis, pero una slfilis rebelde al tratamiento especifico: 
de alii resulta que su estudio etiol6gico peimaneci6 abandonado; su tratamiento, 
siempre mal diiigido, era infructuoso y el mal progresaba. 

Los medicos, que por primera vez examinan estos casos, sin tener en el esplritu la 
patologfa propia de estos palsee, pueden confundir con mucha frecuencia esta enfeime- 
dad con la sifilis, con el lupus, con la esporotricosis, el cancer, etc., sobre todo a. ella 
se encuentra en un estado avans^o, atacando la mucosa de la nariz o del fondo de la 
boca. 

Hoy en dla ya hay muchos trabajos publicados sobre esta enfennedad. 

Ella paxece ser descrita ya en el a£Lo de 1759 por Sauvage y Charluis con los nombres 
defranhoemi tropical y papiloma tropicum, respectivamente. 

Los doctores J. Moreiia y A. Austregesilo de Rio y B. Sommer, de Buenos Aires, ban 
presentado en el Gougreso Latino Americano de 1904, que tuvo lugar en Buenos Aires, 
trabajos muy importantes sobre esta enfermedad.' El doctor L. Zanotti Gavazzoni, 
de Asuncidn, ha publicado unas observaciones importantfsimas en los anales de 
nuestra Universidad sobre el mismo tema.' Se puede dear que sea ^1 el primero que 
se ocup6 en este pais de la buba y de su diferencia con la sifilis. 

En los primeros trabajos de Gharluis y de Austregesilo se encuentra la historia de la 
enfennedad en America y un notable cuadro diagn^stlco de la buba. 

Los trabajos del Profesor Aquile Breda, de Padua, los de Majochi, y Bosellini, de 
Bolofia,* los de Fiocco y Verrotti * tambi^n nos son conocidos. En todos ellos se 
encuentra la buba diferenciada de la sifilis. 

Por otra parte, en todas las obras cl4sicas de enfermedades tropicales y de derma- 
tologla se encuentra la buba confundida o como id^ntica al pian o framhoesia o al 
yawo9y o en confufli6n con (ilceras d6 los paises tropicales. Hoy d^, giacias a loe 
estudios modemoe, se puede diferenciar estas enfermedades, antes confundidas, y 
unificar los diferentes nombres que se han dado a la misma enfeimedad en los diferen- 
tes paises. 



> S«gundo Congreso Latino Anittfcaiio, 1904, Ba«no8 Airw, T. m. 

I Lois Zanotti Cayaxzoni. Anales de la Universidad del Paraguay, 1904. 

• Soil 'Etlologla del Bubas, Bolofia, 1900. 

« Undeelma rinnlone de la Sooleta Italiana dl l>«rmatologla. Roma, 20 de abril de 1906* 



TTJBUO HEALTH AJXD MUDIGDnL 119 

EnelPangi]ay,Beledaeliiombiede"buba''akqiieenelB]»BU8eUaiiui''bouba;'' 
JBspundia en Bo]i^ia y Ferd y iUoeta TorrnJba en Golambu; yo creo que la HAoera d» 
Bcurd de Fuanhos, Lei^muardoni rino-buco'farinffea de Splendaie y Oarini, etc., 
etc., eon todas una mimna enlemedad, con manifestacionee olceioaas del cutis y de 
las mucosas naso-buco-faringea. £s una sola enfennedad produdda par una sola 
eqMcie de Leitkinama. 

Escomel,^ de Arequipa, ha dado una bnena desciipcidn clfnica de la Eipundia del 
PMi; Laveian y N. Lanier* han desoito la Leitkmanioj agente de la lnfecci6n, bajo 
el nombre de Leishmania tr&pioa, variedad americana. Laveian ha propueeto el 
nombfe de LeMnumions amerioana, 

£n el F^oaguay hemes tenido la oportunidad de estudiar esta enfennedad en toda 
sn ervoluci^n. Hemes visto que en la primeia Cas (fax aUdnea) cuando las llagas se 
encuentran en la snperficie cutanea de las extiemidades, sobre el cuello o cara, ellas 
tienen mucha semejanza con el Botdn de Biskia o de Alepo, con la iiJUii, etc. 

Gtennalmente la enfennedad comienza pcv uno o vaiios eritemas papuloses, muy 
pioriginosos, como si fuesen producidos per las picaduxas de insectos, tan abundantes 
en esas regiones. Dos o ties diss despu^ se fonna sobre uno o varios de estos eritemas 
un punto pustuloso, grueso como la cabeza de un alRler que no tarda en vaciaise. 
Al yaciane queda una pequefKa cavidad profunda, de donde sale un Ifquido sero- 
gomoso que al endurecerse fonna una costrita negnuca. 

£n las regiones donde abundan estas llagas existe la creenda que ellas son produci- 
das por picaduias de garrapata$ o ixodeB* (oToblyommai), 

En efecto casi todos enfexmos que hemes examinado acuaan a estas ffarrapatas como 
origen de sub males. 

Guando el doaro ha logrado hacer penetmr su rostro en la piel, es dificil desprenderlo 
sin que esa parte no quede incrustada en la piel. Esta picaduia causa un prurito 
intense que obliga al enfenno a rasparse continuada y.fuertemente con las ufias hasta 
escoriaise. Los obreros que conocen esta consecuencia, no arrancan violentamente 
el dcarOy lo calientan ligeramente con un dganro encendido hasta que de por sf se 
despienda; en este case la picas^n no es fuerte. 

Sin embargo he visto enfermos cuyas llagas iniciales est&n en la can, en las orejas, 
consecutiTas a picaduias de mosquitos o tibanos (criaapt) u otros inacetos. Otias 
voces he visto desanollarse sobre picaduias o nugufios con espinas en las plantas de 
loe pies. Jamis he visto desanoUaise sobre el cuero cabelludo, como si una 8oluci6n 
de continuidad de la piel fuese necesaria para queel virus penetre y origLne la llaga o 

Ik^^BS. 

Una vez la dlcera foimada, crece, secubre de su costra negruzca espesa y dura, la 
piel drcunvecina se pone tuigescente y un poco edematosa; de muy pruriginosa que 
em al iniciarse, ahora se pone o poco dolorosa, o dolorosa. Si se aprieta la costra, deja 
aparecer a los lados un llquido aero-punderUo de olor f^tido. 

Estas ^eras son orfgenes de linfangitis, verdaderoe cordones dtiros, de color rojo, 
subcut^Lneo que a la presi6n deja aparecer sobre su extremidad en la tilcera un liquido 
9era-^purulmU>. En el trayecto de esos cordones linf&ticos se notan unos ndduloa 
bastante gruesos que se abren y fonnan nuevas llagas. 

Cuando se eleva la costra de una llaga, se ve un fondo rojo, camoeo, botonado, que 
sangia con la mayor bcilidad; el borde est4 cortado a pique y no hay descolamiento. 
Este borde tiene todos los caracteres de una herida at6nLca: maigen Ifvido, hipertro- 

■ " II ■ I ,««!— .. 1. Ill I I I .im^m^,^ I .11 ■ I III I 111 1 

^ X Bulletin d« Fatbologie EzoUque, T. IV-jiiUo 1911. 

•BoIlfltindaPathologleBzDtiqiieT. y-1913. 

* SI Piofesor Neamaim, dela Eacoelade Vgterlnaria de Toloia, ha clMJfletdo log fxoda into (nnrimlnadoB 
4i» MD Im Amiiit^mmM (ydftM Baeajd o |f«ttM oorfoto oi AmUifamma fCraHMn XbA (yoteM Aoeopi 
teyo) AmlOifomfiia fognm Keumann (yottM pjftami o yoteM) poropi en nln/of de Awbliamwtafoaiu^ 
lyiwc.) Nnaatns fampatoi de moptes ofrecen aSn variedades deeoonoddas segdn el Profeeor Nattall 
de la UniTenldad de Cambridge. 



u I 



120 PBOCEEDINGS SBOOKD PAN AMBBIOAK 80IBKTIFI0 OONGBE80. 

fiado, im poco dirigido hada hiera. EstM dIceiM »1 cabo de oiete u ocho meses, 
cunn espont^neamente, sea en su totalidad o en parte. Las Uagaa que ae cuimn dejaa 
una dcatriz Indeleble, de borde mil o menoa eatiellado o inegnlar, de oentio apeiga- 
minado, acr6micOy tnaldddo, d^jando ver las peqnefiaa aiteriolaa neo-fonnadas. 
Eata cicatrix es caiacteriatica. 

Los ganglioB lintttdcoa ragionalea aon doloRMoa al principio, deapn^ el dolor deaapa- 
leoe; elloa no toman nunca au tamafio natiual. 

Oomo afntomaa generalea, ea notado nna fiebre veopenl, dolores articulacea, cela- 
lalgia, curvadura pero en el perfodo de infeccidn cntiiDea. 

Las dlcenui que quedan ae deaenvudven lentamente, algonas ae elevan aobie el 
nivel de la piel, ae hacen papnloaaa, o camoaM y hdmedaa, d^jando coner on Uqnido 
aeroeo ain tener tiempo de fonnaxae la coatra: Ma ea la hfiba lankieea h^an§ia; o Mem 
la llaga ae hace aeca, ae cubxe de coatra y ae llama a ^Bbk la 61160 aeoa. 

Hay iilceraa del tamafio de una moneda de 20 centavoa, otraa aon mis gsandea y 
otzaa son tan gnndea que cubie todo el dono del pi6 o toda la parte antsrior y poaterior 
de la piema o del bimao o antebraso. Al cabo de doa o tree mesas, o mis tarda, que 
las llagaa descritas aean o no dcatriaadas, empiesa su manilestacidn sobre laa mucosas 
nasales o laringeas, esta ea la fas segunda que comiensa: la/of mueosa. 

Guando la llaga Inidal eat& en la cara, entoncea la mucosa nasal suire muy pronto. 
Hay casos tan de^graciadoa que doa tree measa de curarw unas iradgnificantea llagaa 
ya que est! o no completamente dcatrizada la piel, ya empiezan en laa mucoaaa nasalea 
las ulceradones. 

El enf ermo experimenta una dificultad en la respiracidn nasal, la pranunciacidn ae 
hace nasal, un eatam iero-puruUnto, mis o menos tefiido en ssngre, aparece. 8i ae 
examina la mucosa, se la ve infiltrada, roja, cubierta en parte de una coatra amariUenta 
aobre el septum nasal. 

Sobre uno de estos puntos se profundiza la lealdn y perforacon frecuencia el aaptnm 
pero sin epistazis. 

La infiltiaddn progresa, el enfermo no tarda en aentir una aspereaa y aequedai 
de la garganta o del velo del paladar. Poco a poco se eqMsan y se ponen gtannlooaa 
eatas mucosas; se espesan loa pilarea, las amigdalas, la campanilla. El enfermo aufre 
unpocoaltmgarlosalimentoasecos. ICIs tarda el enfermo toaey la vosse hace ranc»: 
1a huringe ae infiltn, laa cuerdas vocalea se cubren tambiln de gianulacionea. 

Cuando ae obaenra un caso y% un i>oeo aTaocado ae ve una infiltracidn general de la 
mucosa del f ondo de la gaiganta con neoformadonea granukmatosaa caracterlsticaa. 

Del septum nasal destruido, d cueipo miamode lanaria esatacado, dlase hace roja, 
espesa, aumentada de volumen y edematosa. El labio superior prdximo a ella, 
tambiln suire la misma infiltractdn, loa pdoa caen, loa pteuloa ae infiltian y ae ponea 
tuigescentes. La ulceraddn invade de la mucoaa nasal, la pid de loa bordea de laa 
naricea, de los pdmuloa y labioa. La pid destruida ea reemplaaada par una gra- 
nulad^ ya aeca o ya hlfaneda que de d aspecto de un verdadero lupua ulceroao y 
con d cual muy a menudo se confunde. 

A medida que la ulceraddn ae eztiende en d eztsrior, en d interior laa mucoaaa 
tambiln se espesan, se hacen granulosaa a tal eztremo que d velo dd paladar, la 
Avula, los pilarea, las amigdalas lorman una masa comte enri^ecida, gianuloaa, 
sangrando con la mayor fadlidad. El itmo de laa fancea ae encuentra ad reduddo, 
esbrecho; la fuinge y laringe sufren lo mismo. 

El enf enno, en esta drcunstancia ea Ifono y se nutre diffdlmente, mlarime cuaado 
todos los dientes estan atacados de una infiltrad6n periMica de una dveolitia 
secundaria. 

Jamis he visto, aun en loa casos muy avaaaadoa, leaionea wohn la leogna y lesunea 
oseas verdaderas. 

Como fldlmente se comprenderl, un midieo que no luya obaervado enfennos de 
eeta naturdeza^ ecnrfundird ttdlmente con la i^Uu, d lupm, d odneir, etc. 



PUBUC HBALTH AND MBDIGIinL 121 

ESota aegunda £az del mal podii formar an capf talo espedftl de rinolaringologUi. 

Cujuido el enfenno lleva eete mal dunnte 10, 15 o 20 afiot, se ve que la infiltraciiSii 

prqgreaa hasta U^ar a loe gmeeos bronqmoa, provocando fiebre, hectLqnea, denutxici6n 

• conoiiiicidn haste la muerte. 
Jamia hemoa obaervado lesionea de loe drgaooa digeativoe^ o leaJonee 6waa pfoda« 

cidas oomo 0(mtini]aci6ii del mal. 

Asf mueren loa bubitioos que no baa tenido la precaud^n o la oportunidad de 
hacer curar su llaga inicial. 

Todos lo0 enfennoa avansadoa, con leaionea en la muooaa naso-laiingea, predaa- 
mente moatniAn la dcatria de una llaga inicial que date de 2 o 3 afioa atnte. 

Etiologia. — ^En el cuxao de eate expoaici6n, noaotroa hemoa dicho, aegdn afiimaci^n 
de loe enfermoa» aer un ixodet el que inocula el vinia. Pefo hemoa tenido la oportu- 
nidad de atender otroa enUagadoa cuyaa Uagaa no ptovienen de picaduraa de inaectoa 
pero que af ae han deaaixoUado aobie una pequefia excoriaci6n de la piel, hecha oon 
la ufia o con laa eaptnaa en eaaa r^gionea, como ai el virua eaperaia una aolud^n de 
eontinuidad de la piel para penetrar y deeanollar el maL 

Examinando el pua que aale al lado de laa coatiaa laa mia nuevaa, y odkveando 
con el Aaul de Marino o con la aoluci^n Giemaa, ea muy ttcil comprobar la pnaencia 
de numeroaoa oorp4aculo$ de LHahmamn, Laa grueaaa cHulaa epiteliodea aon laa que 
contienen mia. 

Eate paHbito ae parece mucho al oorptbeufe dd Bot6n de Bi$tn o de AUpo, ezpli- 
cindoae aa( la identidad atribuida por Ulyaae Fttranhoa entie el bot&n de Biekra y 
ikera de BautH eatudlada por fl,^ la cual aeria un caao de buba en au primeia laa de 
deaaiTollo. 

En loa caaoa avansadoa ea dificO comprobar lapr o a on cia deXaidbumma, peio ae lo 
encuentra aiempre. En el caao de C. A. del4afioa»oonaapiiarconla jenngaunpoco 
de linfa del tejido granuloao, ae pudo encontiar ttdlmente. 

Aaf ae ha llegado a encontrar loa miamoa oorpdacuka, enoontradoa por Paianhoa, 
Cwini y Splendore, etc., en loa caaoa aemejantea a loa mloa. 

Loqueyonohepodidoconaeguirealainoculacidnenloaanimalea. Laheenaayado 
aobre peno, gate, nueatio mono {Sdme <mdmofut) ain obtener ningnna leaidn impor- 
tante. 

He examinado leaionea cut^bieaa de loa perroa de caaa de loa obieroa que tiabajan 
en laa r^gionea inf ectadaa ain encontrar LeiAmanmii, Tampooo nada he encontiado 
enlaaangre. 

Digno tambi^ de notane ea que el bubdtioo no preaente LeiAmaMiiai en au aangre. 

He pretendido enaayar laa culturaa de loa medioa de Novy y MacNeal y en aangre 
eitra t ada pero ain obtener ^ito. Eato aer& por falte de una buena ttoiica. 

Eidoloiia paloidgiea. — ^La biopda piacticada de algunoa tumorea en au primer 
eatedo de deaazroUo y en au complete deaaiiollo, ofrece algunoa caracterea en el tejido 
aubcut&neo y en el cutia propiamente dicho. Si ae compaia un poco de piel aana 
al lado de una plena llaga, ae ve quo el dermia ea edematoao; laa papilaa de Malpighi 
eatdn como aplaatadaa algunaa o prdoogadaa otraa pero aeparadaa do entre ai» a cauaa 
del edema 

Laa papilaa a medida que ae van acercando a la parte del dermia infiltrado, ae ven 
oxtenderae en profundidad, haate que llegan al pleno tea infiltrado en que ellaa 
ae deehacen. La fluxi6n inflamatoria eat4 caracterizada por el cllmulo de c^ulaa de 
pequefia dimenai6n, linfoaitoa y por c^lulaa pdlinudeadaa que ae efectda en la extremi- 
dad de una papila de Malpi^ como ai alll eatuviera el virua quimiot^lxico. 

Poco a poco la infiltzaci6n celular ae hace e ep o aa, ella forma un verdadero n6dulo 
inflamatorio, laa papilaa deaaparecen obaervindoae reatoa epiteUalea entre laa cflulaa 
invaaoraa. Lo miamo paaa con la c^lula de laa gUndulaa audorf paraa y cehiceme, Una 

^ I |-r -II ■ !■ I l-IIIWIBI I ■ ■■ IIIIWB [■IIIBIWIIB ■!■!■ 

^ Uantldad &blm 4lun$ ie BmiiHifBei6mi$ AUpooU Siden^orVlywee T^ Instltnto Fa»- 

<«iirde San Fablo« 1909. 



122 PBOOEEDINQS SEOOim PAN AMEBIOAN SGIEKTIFIC G0NGBES8. 

vez destniida la capa baaal de la epidennis, ella no tarda en deBtruirae por complete 
y la dlcera se forma. Lob vaeos capUaies linttticoB ee hinchan, disttnguUndoBe blen 
las c61ula8 endoteliales y algunaa con panfisitos. 

No hemos notado la formaci6n de c^ulas giganteB^ en las lesioneB bub&ticafl, aun 
en loe casoB muy antigaos. 

LoB m^todoB empleadoB para la coloraci6n y fijaci6n son: Soluci6n Giemsa y Schau- 
dinn, sirvi^ndonoB del xilol acetona en diversas proporcioneB para decolorar. 

Para el diagn6itico de Leishmannia se neceBita raspar nn poco Iob ''granulomas/' 
o tomar Iob IfqtddoB que salen por Iob bwdoB de la coBtra o blen aBpiiar con una jeringa 
y colocarlo despties con Giemsa. 

Resumen dd tratamiento. — Cuando el mal eetd en su origen el tratamiento cb f&cil: 
cadstico, termocauterio y un poco de yoduro de potasio y de ars^nico por boca, son 
BufidenteB. 

Cuando el caso es avanzado, es dif fell de sanar. Las cauterizacioneB igneas y el 606 
dan bastante buen resultado, pero es necesaiio aplicario tres o cuataro veces consecu- 
tLvas. 

Ouando el mal ha penetrado en la mucosa bucal o nasal, ee muy tenaz. El mal se 
tnodifica notablemente con la hectina con el 606 o con el orsudan o la Boamina, pero 
la curaci6n se hace lentamente y ayudado con los catlurticos locales. Las granula- 
clones de las mucosas ofrecen poca resistencia al termocauterio como si fueeen de 
manteca. 

Los trabajos recientes de Caspar Viana ^ nos ban llamado la atenci6n y podemos 
asegurar que el em^tico produce efectivamente, en inyecciones intravenosas y en la 
proporcuSn al 1 por ciento, muy buen resultado. Solo que la sal es muy irritante en 
caso de tratarae de em^tico no muy puro. 

Oonviene hacer notar que todavfa despu^ de tres o cuatro aplicaciones del 606, atin 
se encuentran los par^sitos, y a veces hasta despu^ de tree meses de tratamiento por 
medio de la soamina, como si estas sustancias aiseniales no tuviesen acduSn alguna 
Bobre eetos protozoarios especfficos. 

La LeUhmmtiosis Americana existe en el Paraguay, probablemente introducida por 
contaminaciones sucesivas de los Estados limftrofes brasileflos. Ataca a la especie 
humana sin distinci6n de edad ni de sexo. Esta enfermedad es producida por una 
Leishmaniay la Leishmania trdpica. 

Los mMicos que no conocen esta enfermedad, la pueden confimdir con el lupus, 
can la lepra, con el edneer o con la sifilia. 

Los patologistas ameiicanos o europeos que de ella se ban ocupado le ban dado 
diferentes nombrea, o bien la ban confundido con otras enfermedades tropicales, 
cuyos agentes pat^genos son distintos. 

En los pafses ameiicanos tambi^n recibe nombre distinto. Asf en el Paraguay y 
en la Aigentina la llamamos Buba; en el Brasil, Buoba; en el Perti, JEspundia o tfta; 
en Colombia, lilciTa de Torrealba, etc. Es necesaiio pues una designaci6n cientffica 
y tbiica de esta enfermedad en los diferentes pafses en donde eUa existe. 

La enfermedad se manifieBta por una o por mtHtiples Ilagas cut^eas en su primer 
perfodo, y por tilceras de las mucosas nasales, faringea y palatina en su s^gundo 
perfodo. Las tilceras pueden ser secas o bdmedas. Son jmr lo general redondas y 
de bordes cortados a bisel. Aparecen de preferencia en la partes descubiertas del 
cuerpo, brazos, piemas y cara. Las manifestaciones mucosas, o sea las del s^gundo 
perfodo, pueden faltar si la cura de las Ilagas iniciales ha side r&pida u oportuna. 

Esta enfermedad no es aguda sine eminentemente cr6nica. 

— ' — 

oon flsta indioaoitfn naestia. 6l en on oaso de tfJeera dute del BroMf eocontndo on Roma, pndooompro-. 
bar la presencia de odlulas gigantes, elementos no enoontrados por ooaotros. No habiA habido elementos 
bacUares en aqueUa maniliBstaoidii estodiada por 6IT La buba no ezclnye el kipos. " Bnlletin de Patho- 
logie Exotiqae, marxo, 1918." 
s Archi. braallero de medicina, afio 11, ndmerol . 



PUBLIC HEALTH AND MmnOtSE. 12^ 

Su anatomfa patol^gica es distiiita de la de la slfilu, del lupus y del epitelioma. 
Su agente pat^geno es ya bien conocido y merece pues que sea una enfennedad 
distinta. 

En cuanto a su manera de infeccidn hay mucho que estudiar. Lo m&a verosfmil 
es que algtin insecto la facilite, aunque a veces basta una 8oluci6n de continuidad 
superficial para que se desarrolle. 

El tratamiento preventivo es adn nulo; el curativo se reduce a los ciusticos, anti- 
s^pticos o estirpacidn de la tilcera inicial una vez bien diagnosticada. £1 606 da 
bastantes resultados favorablee, pero ayudado siempre con los antis^ptieoe extemos, 
para combatir la infecci6n mixta. El em6tico tambito da buenos resultados. 

The Chairman. The following papers will be preeented before this 
session of Section VIII as read by title : 

Nota sobre a extinc^fto completa da febre amarella no estado de 
S. Paulo (Brasil), by Dr. Emilio Ribas. 

La fiftvre typhoide en Bolivie, by Dr. Nestor Morales V. 



NOTA SOBRE A EXTINCCAO COMPLETA DA FEBRE AMARELLA NO 

ESTADO DE S. PAULO (BRASIL). 

For EMILIO RIBAS. 

S. Paulo come^ou a combater com succeeso esta molestia antes mesmo que os 
estudofl realizadoe em Cuba indicaasem a applica^ daa medidas especificaB para sua 
extinc^lU). 

E isto verificou-ee, porque nSo se conhecendo os meios scientificos para combatel-a, 
todas as amuis foram empr^gadas e, entre as medldas de excellente efficacia 
prophylactica, destacou-se a remo^fio das aguas estagnadas, providencia indispensavel 
e de exito sQg:uro na guerra de exterminio do unico agente provado na transmiaafto da 
febre amaiella. Este resultado foi de mode evidente notado em Campmas e no 
imix>rtante porto de Santos, cidades flagelladas intensamente por esta molestia 
durante longos annos. 

Desde que foram conhecidas, porem, as experiencias da commis^U) norte-americana, 
chefiada pelo Dr. Walter Reed, e depois de repetidas em S. Paulo com o fim de 
arredar objec^des menoe justas contra as conclusdes tiradas em Havana, o combate & 
febre amarella foi entSo firmemente dirigido e com exito s^guro em todos oe f6cos da 
molestia. 

Embora convencido dos resultados brilhantes das experiencias da commisHfto 
amerlcana, n&o a6 pelos detalhados relatorios recebidos, como por cartas e tel^grammas 
que me foram dirigidos pelos Drs. Carlos Finlay e James CanoU, pedi ao Govemo de 
S. Paulo a repetl^fto doe estudos sobre a transmissSo da molestia, porque suigiram no 
nosso paiz objecgCes que pareciam fundadas, por parte de profissionaes honeetos e com- 
petentes, alguns at^ professores das nossas faculdades de medicina, que, partindo 
do facto de ser Havana um f6co intense e secular da molestia, admittiam a hyx>othese 
de ter side a febre amarella propagada por outro mecbanlsmo que nSo o mosquito nos 
cases dos estudos exi)eiimentaes. 

As experiencias sobre a propaga9&o da febre amarella, realizadas no Hospital de 
laolamento de S. Paulo, e as provas epidemiologicas obtidas em diverB08'f6cos d^te 
morbus muito impressionaram e concorreram para a acceita$fto immediata da pro- 
phylaxia eflpecifica no Brasil. Foiam seis as peesoas que ezpcmtaneamente se deixa- 
ram picar pelos mosquitos que haviam sugado saogue de doentes graves de tyi^o. 
icteroide antes do quarto dia de molestia. 



134 PBOGBUOKOS SBOOHD PAK AMXBIOAS SCIBHTIIIC CONQBESa 

O resnltado foi o nuis coDvincenta paaav«l: tiea p«cient«a que, cotu gniule tn- 
qnracu, peniuuieciam new fdcoa iatensoe d» doenfK, n&o ^kieaenUma ■ymptomk 
algum do mal de Si&o e oa oulioa trea, readentes em loc»Iidsdee inununei, leveiaiam 
evidentanokta o qnadro clinico do vmiuto preto. 



^ 



■^',^*""'^"^-*" -^,-^-/*-- -^ir r 



"^y'*"^-"*^-*^"*- ^^-y<-->g^- -^^- 



No primeira gnipo noa achkvamM o mntto conhecido e ealinuMlo adentute Dr. 
AdcrfjAo Lata, o 8r. Oocai Ucnin e eu. 

Fftnam parte do aegniido gnipo oa 8ia. Andrfi RKmos, Domingon Penan Vas e J»- 
niuuio Fieri, que fci nm caao clinico muito clan, como ae verifies no aegninte diagnun- 
ma, qoe inaeln algnna deUlbee intofeoaantea aobre propagaf&o do nxHbaa. 



FUBLIO HEALTH ABD KBDIOIITS. 



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126 PBOGEEDINGS SEGOin> PAN AMEBICAK SCIENTIFIC CONGRESS. 

Como 86 sabe o typho americano, originario do Novo Mundo, teve oe seus principaes 
f6co6, desde de epoca mui remota, no golpho do Mexico, nas Antillias e na America Cen- 
tral, irradiando-se deetes pontoe, geographicamente eetrategicos, para flagellar os outros 
paizes das duas Americas. Em consequencia das enormea devasta^des deste flagello, 
contam os liistoriadores que na terceira expedi9&o de Colombo, & qual n&o adheriratn 
OS homens livres, pelo terror que inspirava a despovoadora peste, teve o govemo 
hespanhol necessidade, para o fim de fundar as primeiras colonias, de lanpar m&o dos 
condemnados, promettendo-lhes a liberdade. 

Este isucto e muitos outros, posteriormente conbecidos, demonstiaiam claramente 
que a febre amarella foi, atravez dos seculos, o maior estorvo ao progresso das 
nagdes americanas. 

O nosso Brasil victimado por diversas vezes em remotos tempos, foi ultimamente 
flagellado durante nais de meio seculo. 

Agora, gragas, porem, & propbylaxia especiflca, a sua transforma^fto sanitaria fot 
completa, vencemos o inimigo capital do nosso progresso. A nota que apresento, 
al^ de documentar os resultados ob tides com a excluaiva applicagHo das medidas 
para o ezterminio do unico agente provado da transmiafiodo mal — a SUgomyia 
/(ucicUa — 6 tambem uma justa homenagem aos scientistas norte-americanos que, com 
o seu saber, directamente concorreram para a solugSo do humanitaiio pioblema. 
De facto, nada 6 mais significativo para provar que os ensinamentos de Havapa 
tiveram decisiva influencia nas campanhas contra a febre amarella em S. Paulo, do 
que 06 dlagrammas seguintes: 

Estes diagranunas demonstram claramente que ha 11 annos completes cesaaram em 
todo o tenitorio do Estado de S. Paulo as aasoladoras explos5es do typho icteroide, 
gramas & guerra de exterminio aos mosquitos. 

Em Sorocaba, depois de uma enorme epidemia definida por 2.322 doentes e 877 
obitos, nem um s6 case de febre amarella se verificou no decoirer dos 14 annos 
s^^uintes. 

Nesta cidade foi obtida nitidamente a prova epidemiologica, antes de se conhecerem 
detalhadamente em nosso meio os brilhantes resultados a que chegou em primeiiD 
logar o General Wood, govemador da ilha de Cuba e medico do exercito americano, 
que empregou para o saneamento daquella ilha os mesmos preceitos postos em acgSo em 
Sorocaba e finalmente o mesmo resultado favoravel foi alcan^ado em Ribeir&o Preto, 
onde a observa^ epidemiologica 6 por certo muito interessante, pela circumstanda 
de nfto se terem feito ahi desinfec^Oes ou obras de saneamento. 



LA FlfiVRE TYPHOlDE EN BOUVIE. 

Par NfiSTOR MORALES VILLAZON, 

Directeur de VlnsUtut National de Bacttriologie, ex-Doyen de la FactUti de MMecine de 

La Paz, Bolivie, 

LA YACUNOTH^BAFIB DB LA Fli:yRB TYFHOIDE EN BOLIVIB. 

Parmi toutes les entitds morbides connues en Bolivie, la fi^vre typholde a toujours 
6t^ une de celles qui ont fait le plus de victimes dans toutes les classes de la soci6t6. 

Cette maladie existe k r6tat end^mique dans presque toutes les villes populeuses, 
at tout particuli^ment k Cochabamba, Sucre et La Paz. 

La forme end^mique est ordinairement b^nigne, et sa courte Evolution ae termine par 
ia gu^rison. II n'en est pas ainsi des cas ^pid^iques qui, d'habitude, fauchent des 
villages entiers et laissent des zones immenses de territoire sans bras pour les cultiver. 

Les ^pid6mies apparaissent rarement dans les villes ou dans les villages considdra- 
bles; elles attaquent de pr^f^nce les cantonnements des indiens et y produisent. 



PT7BU0 HEALTH AND MEDIOIKS. 127 

quand dies s'y 8ont enradnto, juaqu'ji 90 pour cent dee d^te. Pour bien com- 
prendie ces effete tembles de la fi^vze typhoXde, il est n^cessaire d'avoir pctentes k 
resprit les circonstances qui d6terminent la vie de Tindien, soit dans la plaine, soit 
dans les hauteuis des Andes. 

Sa maison, a neuf metres carr6i au maximum; les mura et le toit sont tidta de teire 
m^lang^e avec de la paille; Tentr^e, tr^ 6troite, n'a qu'un m^tre cinquante de haut, 
sur 50 4 GO centimetres de large. Ce n'est que par cette petite ouverture, dose la 
nuit par un groesier tissu de laine ou par quelque porte rudimentaire, que Fair peut 
p^n^trer k Tint^eur. G'est dans ce nus^rable r^uit que vit toute la famille, qui 
compte tr^ souvent de huit & dix personnes, sans compter qu'avec les maltres du 
logis vivent les animaux domestiques, tels que poules, canards, dindons, codions 
d'Inde, etc. 

Les agglom^tions comportent un nombre variable de ces pauvres chaumi^res, 
extrdmement froides en hiver; il y en a des groupes de huit, de cinquante, cent et 
quelquefois davantage, abritto centre la violence du vent, au pied d'un monticule, et 
pr^ de quelque couiant d'eau. 

L 'alimentation de Tindien qui vit dans la plaine est tout k fait diff^rente de celle 
de rindien qui habite dans les regions froides. L'indien de la plaine se nourrit 
surtout avec le male cuit ou en forme de soupe; il ne mange preeque jamais de viande; 
quelques pommes de terre cuites et quelques 16gumes font son bonheur; il faut ajouter 
la feuille de coca qu'il a dans la bouche du matin au soir; cette coca et le male grille 
forment, dans les 6poques peu productives, son unique alimentation. 

La boisBon ordinaire de Tindien est Teau, que tons les habitants puisent k la mdme 
source. Les jours de f6te ou de r^jouiasaaces publiques, tons boivent la "chicha, *' 
qui s'^labore de la fa^on suivante: Les femmes moulent le mals et forment avec la 
farine de petites boules qu'elles introduisent dans leur bouche; elles les mastiquent 
avec ardeur, p^n^tren t de leur salive cette farine et Texposent ensuite au soleil . Gette 
substance, que les indiens appellent ^'mucku, '' est T^l^ment principal de la chicha 
(tdiictcha) . On melange le mucku avec une quantity plus ou moins grande d'eau que 
Ton fait bouillir, puis on la met fermenter dans de grands vases de terre qui peuvent 
contenir jusqu'^ cent litres et quelquefois davantage. On a soin de boire cette 
preparation aussitdt que la fermentation tumultueuse a cess^; sans cette precaution 
la chicha se convertirait bientdt en vinaigre. 

L'examen microscopique montre que le ferment de la ** chicha" est un saccharo- 
myces tr^ reesemblant k celui du vin. 

Avec une augmentation de 800 diam^tres on peut distinguer des cellules ovales et 
arrondies, les unes plus grandes que les autres. On y voit aussi dee cellules qui se 
divisent directement par ''mamelonnemenf 

Au contact de rh^matoxyline, le corps protoplasmique se colore et laiese aperce- 
voir des granulations diverses et aussi de petites vacuoles qui ne se colorent pas. 

Si Ton m61e ce sacchaiomyces avec du moiit de vin, la fermentation est visible 
apr^ 24 heures et se manifesto par la production de grosses buUes de gaz. A la 
superficie du moQt, le ferment depose une pellicule de couleur blanch&tre. II est 
remarquable que dans ce milieu, en plus des cellules que nous avons d6}k signal^ee, 
11 se forme de longs filaments semblables aux elements cellulaires que nous avons 
d^crits plus haut. 

En resume, le ferment de la chicha n'est qu'une variety du microderme du vin. 

L'indien du haut plateau se nourrit de mais moulu et de "chuilo'' (tchugno). Le 
chufio est la pomme de terre que Ton a soumise k Taction combinde du froid de la 
Gordill^re et du dess^hement; operation qui a pour effet de lar^duire d'un cinqui^e 
ou d'un sixi^me de son volume primitif et de lui donner la propriety de se conserver 
indefiniment. Get indien ne mange presque jamais de legumes, mais il consomme la 
coca en plus grande quantity g^ndralement que Tindien de la plaine. 

Ge n'est qu'exceptionnellement qu'il mange de la viande fratehe; il use de viande 
dess^chee de brebis, connue ici, sous le nom de chalona (tchalona). 



128 PBOCEEDINGS SECOND PAN AHEBIOAN 80IENTD10 C0KGBB8S. 

Sa boiflscm est ^galement I'eau; il ne boit Talcool que dans lee grandee fdtea, en 
lui ajoatant deux ou troia pardea d'eau; danaceaoccaaioiiail en abaorbe ime grande 
quantity. 

Je £ai8 noter ce fait afin de iaire mieux comprendre le pooiquoi de la mortality 
exceflcdve de cette race caua^ par la fi^vre typholde, aind que lea grandea difScult^ 
qui B'oppoaent k son traitement efficace. De tr^ nombreux et tr^ diatlngu^ mMe- 
dna boliviena attribuent unanimement ik la doth^nient^e de la race indig^e, det 
caract^reB sp^aux, qui en font un type particulier. 

Un m6decin tr^ competent et qui a fadt see 6tudea en Europe, le Dr. Hermog^ne 
Sejaa, fut charge de combattre la fi^vre typholde dans la province d'Arque et publie 
lea remarques Buivantes sur lee caract^res de cette fi^vre: 

'' II y a deux cauaea pour leequelleB la fi^vre tsrpholde qui attaque lee indiens du 
haut plateau soit ixhs maligna et d'une gu6riaon difficile: 

"1. L'extraordinaire malpropret6 dana laquelle ila vivent. Jamaia ila ne ae bai- 
gnent ni ne se lavent la bouche; jamaia ila ne nettoient leurs habitationa qui ne sent 
que de miadrablee huttes de 3 metres de haut, avec une seule porte d'un m^tre de 
pur n'a huttes pleinea de fum6e oil n'a jamaia p6n6tr6 la lumi^re du Boleil, oik I'air 
hauteur; jamais circuit. Dana ces troua obacura et ^troits, au milieu d'un amaa inde- 
scriptible, lea indiens pr6parent leuia repaa, mangent et dorment; ila 8*y entaasent au 
nombre de cinq, six ou davantage, hommes, femmee et enfants, sains et malades 
fi^vreux 2t cdt6 lee una des autrea, m&chant la coca nuit et jour. 

'' 2. L'lndi£f6rence, I'^tat de 16thargie dans lequel est plough I'indien Femptehent 
d'obaerver les pr^autions hygi^ques les plus ^l^mentaires ou de prendre les remMea 
lea plus salutaires. Si on lui reconmiande, par exemple, durant une forte maladie, 
de laiflser sa coca ou de ne prendre aucun aliment solide qui augmentera sa fi^vre, 
il feint nc pas comprendre et il mange le chufio et lea pommee de terre comma 
d'habitude. A cauae de ces imprudences, la fi^vre augmente tr^ rapidement et 
la mort s'ensuit g^^ralement vers le huiti^me jour, c'est-li-dire dans la premi^ 
p^riode, quand, au contraire, dana lea villes, la fi^vre typholde n'atteint ses victimes 
qu'apr^ quinze ou vingt jouia, c'eat-i^dire entre le premier et second sept^aire. 

** II faut encore ajouter k ces causes la terrible coutume qu*a Pindien de boire 
I'alcool pur, ce qui le predispose k cette maladie. 

'* J'ai remarqu^ que cette rapidity des progr^ de la fi^vre est due k la coutume 
fatale qu'a I'indien, de ne jamais observer de di^te pendant sa maladie; il continue k 
mastiquer des substances solides et aussi la coca. La mort survient, comme je I'ai 
d6]k dit, presque k la fin du premier sept^naire." 

La conaciencieuse obaervation du docteur Sejaa montre I'extraordinaire malignity 
de la fi^vre dans la race indienne; il eat facile de comprendre par la description faite 
plua haut, combien est difficile I'aasiBtance k des malades qiii se trouvent k de 
grandea distances des centres peupl^, manquent de m^ecin, de remMes et desquela 
il est impossible d'obtenir aucun changement ou modification du cours de leur vie 
ordinaire, et qui n'acceptent paa lea mesures ordonn6e8 par Thygi^e. 

BA8S DB LA VAOaNATION ANTTUFHIQUB. 

Nona connaisBona que leB vaccina produisent Timmunit^, en determinant la forma- 
tion dana I'organiame animal, d'diements de defense connus sous le nom g^ndral de 
"anticorps. " 

Les essaia preiiminaires de vaccination remontent k une ^poque tr^ lointaine, et 
Ton pent dire que see premiers principes furent etablis en 1798, d'apr^ lea etudes 
faites par Tillustre inveatigateur Jenner. 

Plus tard, en 1881, le Profeeseur Pasteur fit entrevoir par ses deiicats travaux sur le 
bacille antracis, les avantagee que la th6rapeutique peut obtenir des vaccines micro- 
biennes. En cc qui conceme particuli^rement la vaccination antitiphique, c'est le 
Profc3SPur '"hantemc^RH^ qui, en 1887, osfla>'U le premier de donner Timmunite aux 



PUBUO HEALTH AND 1CBDI0I9S. 129 

Miinmix de labaratoire contre rinfectioa EbcrUrienne, grftce k I'mjectioii tons 
cutan^ de produitB 8t6ri]is6i ptr la cbaleiir. Puis lei travaux de Widal, Kliockwics, 
Snarelli, Bruchettim, qui fireot auni dee owmiw but lee animaux pour 6tudier ractioD 
preventive dee vacdnea badllatree, firent aonp^onner Pavenir r^eerv^ k la vacuno- 
th^rapie. 

En 1896, Pfeiffer et KoUe en Allemagne, et Wright en Ang^eterre, apf^qu^rent 
cee m^thodes prophylactiquee k Teepee humaine. Quelque temps apr^ en 1899, 
GhantemeoM vaccina tout le penonnel de son service d'hdpitaux, employant des 
cultures chauff^ i 100^. 

Lesr^sultatsde la vaccination antitiphique, eont aujourd'huiparbitementvMfi^» 
et il nous suffira de dire que pendant la gueiTB du Transvaal, dans I'lnde et pendant 
la guerre contre les Henreros, la vaccine pr^serva compl^tement lea soldati qui y 
furentsoumis, tandis que les non-vacdn^ avaient une morbit^ plus ou nunns Aev^ 
et une mortality qui n'^tait pas k d^daigner. 

Post^eurement on put observer un fait semblable, pendant les ^pid^mies d'Avignon 
(juin et ao(it 1912), de Paimpol et de Puy-rEv^ue (octobre et novembre 1912) dans 
lesquelles la vaccine eut une double action: limiter I'^pid^mie et gaiantir toutes les 
pereonnes susceptibles de contagion. 

On commenoa la vaccination dans la flotte de guerre fran^aise en 1912 et les r^sultats 
furent parfaitement appr^ables. Sur 67.947 personnes nonvacdn^, dans le terme 
de sept mois, on put observer 649 cas de fidvre typholde et 118 d'embarras gastriques- 
f^briles; tandis qu'en ^alit6 de drconstances et conditions, 3.660 personnes vac- 
cin6ee, faisant vie commune avec les pr^^dentes, ne pr4sent^nt pas un seul cas 
de fi^vre typholde. 

Le Professeur Vincent, qui, avec Ghantemesse, fut le grand propagandiste de la 
vaccination antit3rphique en France, rendant compte devant le Gongr^ International 
de M6decine de Londres de I'ann^ demi^, de ses investigations, fait remaiquer les 
biillants r^sultats obtenus dans rarm^e fran^ise du Maroc, Alg^rie et Tunisie, lieux 
oh la dothi^nent^e qui atteignait jusqu'li 168,48 cas, avec une mortality de 21,13 pour 
cent, descendlt rapidement k une proportion pas plus grande que 0,18 cas et 0,09 pour 
mille de d^^. 

VAOCHfS BMFLOTia OONTRB LA niVRB TTFHOiDS. 

On pent les grouper en quatre vari^t^: 

1. Geuz qui contiennent des bacilles vivants, chauff^ ou non. A ce groupe appar- 
tiennent les vaccins employ^ par Castellani, NicoUe, Connor et Gonsey. 

2. Ceux qui contiennent des bact^rlee mortes; ceux Bont les plus nombreux et les 
plus connus. Nous poes^ons le vaccin Wright, qui est compost de bacilles peu 
virulents de 10 k 12 jours, st^rilis^ k GO^ et m^langds k une petite quantity d'une 
substance antiseptique; le vaccin Leishman, qui diff^re de Tant^rieur uniquement par 
sa culture qui dure seulement 48 heures, et la sterilisation qui se fait k 63^; le vaccin 
Bassange-Mayer; cultures tr^ virulentes stMlisdes k 90^; le vaccin Wasserm 
Kitassato; cultures sur g^l^ose, st^rilis^ k 90® ^vapor^ au dixikne, pr^pitto par 
Talcool; le vaccin Snarelli; cultures en g^l^ose de cinq k six jours, st^rilisdes k 120®; 
le vaccin Shiga; cultures sur g^l^ose, st^rilis^ & 60® ; le vaccin Pfeififer-KoUe; cultures 
sur g^l^ose chauff^es k 60® et m61ang^ avec trois pour cent d'acide ph^nique; 
le vaccin Fierbert-Moreschi; cultures sur gdldose, st^tlis^ k 120®; le vaccin Chante- 
messe; cultures sur g^l^ose Bt^rillBto k 66®, dmulsionn^dansde Teau physiologique; 
le vaccin Ferrdn. En ce qui conceme ce vaccin, je dois falre remarquer que le 
c^l^bre bact^riologue barcelonais, docteur Jaime Ferrftn, me prie, dans une lettre que 
j'ai re^ue de lui le 17 Janvier de Tann^ en coun, de faire remarquer qu'il y a 26 ans 
il a commence Templol de son vaccin, ayant fait les premiers essais de vaccination 
en 1887. Le Dr. Ferrdn signale que sa m^thode est tr^ ressemblante ft la m^thode 



130 PBOCEEDIKGjB SEOOND PAN AMEBIOAN BOIBXTTIFIC G0NQBB88. 

claamque de Wrig}it, et qu'elle a beauGoup de details tecfaniques, qui la font semblable 
au produit ^labor6 k La Paz; vaccin am^icain de RusBell; pondde grande reeeem- 
blance avec celui de Leishman; les cultureB ee chauffent de 55° Ik 56^ ; on lee imuLsionne 
dans du s^rum phyBiologique, puis on y ajoute 1 pour cent de tricTesol, que BuBsell 
d'apr^ BOB etudes d^uit 6tre le meilleurantiseptique, ayant la propri^t^ tr^ impor- 
tante de faire conserver plus longtempe k la vaccine son activity; vaccin Morales; 
61abor6 k I'lnstitut National de Bact6riologie de La Paz. 

En ce qui conceme ce vaccin je dois entrer dans quelques details car, quoique 
dans sa preparation on suive un proc^d^ semblable a ccdui couramment employ^ dans 
les produits similaires; il a, cependant, quelques points techniques qui le diffdren- 
cient des autres vaccins. 

D'abord, pour faire les cultures, au lieu d'employer la g^l^ose qui aujouxd'hui est le 
moyen d'^lection, pour la plupart des bact^riolog^istes; j'emploie le bouillon qui, 
d'apr^ mon opinion, a I'avantage de profiter, int^gralement, des produits grace 
auxquels le bacille d'Eberth provoque la formation d'anticorps d^fensifs. 

Afin d'^viter de multiples details de technique bact^rlologique. je mentionnerai 
seulement que les oiganismes bact^riens d^terminent Paction defensive, soit par les 
endolisines, soit par les exolislneB, dont la production est plus abondante dans le 
liquide. Pour ne citer qu'un seul exemple il suffit de signaler ce qui se passe avec le 
bacille de Elebs-Loeffler. dont les cultures en B^rum, de m^mequ'en g^l^ose, donnent, 
une quantity m^prisable de toxine, tandis qu'il y a une abondante production dans un 
milieu liquide, conune le bouillon Martin. 

Ce principe g6n6ral de bact^riologie s'efFectue avec le bacille d'Eberth, cette 
affirmation peut §tre v^rifi^ en filtrant les cultures k travers une bougie Kitassato. 
Le liquide clair, qui reste dans la partie filtr^ et qui ne contient pas d'oigamsmce 
bacillaires, est dot^ de propriety immunisantesqu'on peut facilement verifier par des 
inoculations dans la s^rie animale. Partant de ce principe, il est facile de comprendre 
que, quand il s'agit de preparer un vaccin actif, il est indispensable d 'employer 
des cultures liquides qui, forc^ment, doivent contenir une quantity plus grande 
d'antig^ne. 
Je prepare ]e bouillon de la mani^re suivante: 

Je fab mac6rer pendant deux heuris dans de Teau bouillie et froide, les parties 
les plus puepeuses de la viande aprte les avoir depouill6es deleurs parties grasses 
et les avoir d^coup^es en petite morceAux. Ces temps 6couie, je jette le liquide de 
maceration, le rempla9ant par un nouveau dans la proportion de 500 grammes de 
viande k litre d'eau distiliee. Je laisse de nou\eau cette maceration en repos pen- 
dant deux heures et je prepare ensuite le bouillon peptonise selon le proc^de ordi- 
naire. Moyennant la l^g^re modification apport^e dans la preparation du bouillon, 
j'obtiens que celui-ci soit beaucoup plus limpide et clair que celui qu'on emploie 
generalement; j'evite en plus qu'un exc^ de substances solides, specialement 
d'hemoglobine dissoute et de peptones, se precipitent pendant la culture, donnant 
lieu ^ la formation de grumeaux. 

Le bouillon est distribue en ballons Pasteur, d'une contenance de 250 granunee> 
ayant soin de ne mettre dans chacim d'eux que 100 granmies, afin qu'il y ait une 
abondante oxygenation qui favorise le vigoureux developpement des bacteries. 

Pour les semis j'emploie sept espies de bacteries de differentes pro enances, et 
dans la forme suivante: Allemagne, Paris, Vienne, Etats-Unis du Nord-Amerique, 
A^^ntine, Chili et La Paz. 

La purete des cultures se verifie, grace k des semis en gelatine. De la gelatine je 
s^me k nou\eau k la geieose, laquelle se maintient k la chaleur d'une etuve k une 
temperature de 37° pendant 48 heures. Ce temps ecouie, je prends les cultures en 
geieose, pour les resemer dans du bouillon. Dans les aemis je n'emploie pas le fil de 
platans, parce que je crois qu'il est difficile de prendre la mdme quantite cbaque fois 
d'oti, conune consequence logique, un developpement plus abondant dans les ballons 
qui ont re^u plus giande quantite de semis. 



PUBLIC HEALTH AND MEDICINE. 131 



Dana mon proc4d^, je fais les aemu moyennant un jise de pktine, de deux mili- 
giammes de capacity, ce qui me donne la cotitude d'avoir sem^ mes ballonB, avec 
une quantity plua ou moins ^gale de bacilles. 

Selon la quantity de vaccin que Ton desire preparer, j'enBemeoce avec chaque 
lace baciUaire, soit deux, tiois ou quatre baUoiui, ayant eoiii que cbaque race aoit 
reprdsentte toujoun par un nombre ^gal de baUons. 

La culture se fait dans Tetuve r^l^ k 37®, la letirant au bout de 42 heuie ezaetei; 
on num^rote ensuite par centimetre cube, auivant le piocM^ ordinaire de oompami- 
flon avec les globules rouges. 

Si la proportion nous donne le chifire d^sM, qui est de 1,000,000,000 de baclMee 
par centimetre cube, on continue Toptetion jusqu'i la fin; en cas contiaire, on 
r^jette les bailoos quiont un d6\eloppement exceaif ou InsnfBsant. 

Lee cultures sent soumises & T^hauffement au bain-marie k 53® pendant deux 
beures. On melange eqmte le ccmtenu des diff^nts flacons dans un ballon d'une 
contenance de 2 & 3 litres et Ton ajoute au teut une solution de lysol, dans la proportion 
de 0,25 grumne pour cent. 

II ne reste plus qu'4 distiibuer le vaccin dans des ampoules stMUsto en verre, de 
.1 k 2 centimetres cubes, que i'on st^iHse de nouveau k la tempteture de 53® pendant 
deux hemes. 

^our r^pondre k cerUdnes indications, je prepare aussi un vaccin d^y6 que je 
distingue moyennant la formule sui ante: V. M. 2 V. Ce produitcontient 500,000,000 
bact^es par centimetre cube, et il est form^ de parties ^gales de bouillon, de culture 
et d'eau physiologique. 

3. Vaccins sensihilis^: Le type en est constitue par celui de Desredka, qui de- 
puis 1902 pr^coniaa sa m^thode d 'immunisation moyennant les vaccins sensibilis^. 
Elle coufliste en r^um6 k mettre les bacilles d'Ebertb en contact avec le s^rum 
antityphique et k filtrer le s^rum apres les 24 heures, k laver les bacilles, et finale- 
ment k les mettre dans ime solution d'eau sal^. Les bacilles, ainsl pr^ar^s, con- 
tinuant 4 vivre, ce qui permet, d'apres Topinion de leur auteur, une plusgrande 
^nergie d 'action. 

La premiere application de ce vaccin k I'eepece humaine se fit par Broughton 
Alcock et les r^sultats obtenus permirent leur grande g^^ralisation. 

Nous pouvons, dans ce mdme chapitre, inclure le vaccin Ranault, qui consiste en 
cultures de bacilles typhiques qui ont perdu toute virulence, gr&ce k une exposition 
prolong^ aux rayons ultra-violets. 

4. Vaccins qui emploient des agents chimiques: Le plus connu et qui, pendant 
ces demiers temps, a acquis une juste renomm^ est celui du Professeur Vincent. 

L'auteur emploie des bacilles typhiques de diff^ntes provenances (10 races) ; il les 
cultive pendant 24 heures sur g^lose en bottes de Koux k 38®. Ensuite le contenu 
des bottes est ^mukionn^ dans 200 cc. d'eau physiologique st^le, puis on y ajoute 
de rather. Le melange est fortement agit^ pluaieurs fois et maintenu pendant 24 
heures k la mdme temperature que celle du laboratoire. On recueHle la partie de 
1 'Emulsion qui sumage sous la couche graisseuse et on la soumet k Taction du vide, 
moyennant la trompe d'eau. Par ce proc^^ on obtient 1' Evaporation de Father. 

La preparation est repartie dans des ampoules de 5,10 et 20 cc. ferm^es k la lampe. 
Chaque centimetre cube de cette Emulsion contient 400.000.000 k 420.000.000 
bactEries. 

Le laboratoire de Val-de-Grftce prepare aussi un vaccin par autolisie. 

MANlteB DB P&AnQUBB IiB VAOCtN. 

Les voies qu'on emploie pour introduire le vaccin dans I'oiganisme humain sent 
<}uatre: 4:1a rectale, la buccale, la sous-cutanEe et I'intrarveineuse. 

Voie buccale: On emploie des vaccins morts & 53®, faisant IngErer 10 lit 20 centi* 
metres cubes par jour, avec des rEsultats, paratt-il, favorables. Le docteur Abraham 
PEre^ liir6 de Cuba est un des premiers qui ait employ^ cette mEthode. 
0843^— 17— VOL IX 10 



182 PBOCEBDINQS 8BCOND PAN AMEBIOAN 8CIRHTIVI0 OONaBBSS. 

Voie rectale: O'est ^Counnont 3t Rochais, que revient le m^nted'avoir, topremieny 
pr6eoiU86 la voie rectale, moyennant dea ^dmea compoa^s de 10 ^ 100 cc. de 
vaccin st^rilia^ par la chaleur. La reaction estpresque toujoun nolle, et to lavements 
s'appliquent k cinq joins d'int«rvaUe. Le Dr. Darier croit que cette m^thode est 
sikre et eflicace. 

Voie sons-cutan^e: Est celle qu'on emploie de pr6f6rence et elle s'l^plique moyen- 
nant nne petite seringae de Pravaa, par injectioDs sous-cntan^. 

Les precautions 1^ prendre pour appliquer I'injection ne different en rien de celles 
couiamment employ to pour les inoculations hypodermiques. 

Les points d'^lection varient quelque pen salon les auteurs, chacun d'eux ayant 
des regions auxquelles ik donnent la pr^^rance. Ainsi quelques-uns indiquent la 
partie post^eure du thoiax, dans le point inteiscapulaire; d'autres, la paioi de 
I'abdomen et quelques-uns encore la partie post^rieure du bras. 

Pour moi je conseille la partie ext^eure du bras, au niveau de Tinsertion deltolde. 
Les TSisons pburlesqu^esj'ai cette pr^^renca sont: la sensibility qui,ii cet endroit, 
est insignifiante, et la ^ilit^ pour d^couviir cet endroit du corps sans d^shabiller 
I'individu, comma il arrive quand on choisit la r^on interecapulaire. 

L'lnjection doit se &ire de pr^^^ence Tapr^midi, ayant soin qu'elle sent 
ngoureosement sous-cutan6e, car j'ai vu que les rations doulouieuses et violenteti^ 
aont toujours pr^sent^es dans les cas oh TaiguiHd d'tooculation avait p^etr6 ou tiop 
sapeiflcieUement ou trop profond^ment. 

RiAcnoN pbovoquAb pab lb vaocin. 

Les diff^rentes formules de vaccines donnent aussi lieu k des reactions difif^rantes. 
Ainsi la primitive de Wright donne lieu k des ph^omtoes assea douloureux, avec 
augmentation de volume sur le point injects, hausse de temperature souvent con* 
siderable, vomissements, dlairhees et cephalalgia. Avec d'autres types de vaccina, 
les reactions sont moins importantes, de mdme que la douleur est presque insignifiante. 

Je ne discuterai pas ai le vaccin qui prodult une inaction ou celui qui ne la produit 
pas est meilleur; je crois que les deux extremes sont nuisibles et que I'ideal d'un 
ban vaccin devrait toe, et serait, celui qui, avec une molndre reaction, donnendt an 
maTJmum d'immunite. 

Quant au produit eiabor6 k Pinstitut, nous pouvons grouper les phenomtoes aux- 
quels il donna lieu, en trois categories: peu importants, moyens et violents. 

Au premier groupe appartiennent lea cas dans lesqueb la temperature est monteet 
jusqu'i 38^.5; an deuxi^me de 38^.5 k 39** .5 et an troisi^me it 40^ et m^me davanti^. 

II resulte de mes observations que le premier type se lealiBe sur 10 ii 15 pour cen 
descas, ledeuxitoe sur 30 pour cent etletroisi^e sur 5 pour cent. Done la reaction 
moyenne est presque constante. 

Le type de la courbe thermique, est le suivant: Au bout de 4 heures la temperature 
attaint son wi^^'rimMfn, pafi eQe commence k dediner pendant 24 heures jusqu*it 
levenir k son etat normal. 

n se produit dans certains cas, dans Tapr^midi du deuxitene jour, une legtea 
hausse de la temperature de 2uelques dixitoes, toujours peu imporUnte. 

Quant aux manifestations locales dies n'ont aucune importance, se bomant k un 
durdsMment peu douloureux k la pression, de la grosseur d'une pidce de monnaie de 
5 francs. Paifois se presentent ausri des inftoctus gangikmnaires sous-axillaires, qui 
diqMtfainent rapidement. 

Bur un nombre de 5.000 k 6.000 inoculations preventives que j'ai faites, et 
suivies de jwds, pas une fois je n'ai ranaique les naus6es et vomiseements signaiee par 
la plupart des auteurs. 

En fait d'acddents rares, I'lmique signaie jusqu'it present par im des aides du 
laboratoire, est une violente epitaxie, survenue i'apr^midi mdme do la vaccination. 



FUBUO HXALXH AlTD MlDTCnyE, 138 

NouB avons effecta^ dum la pnitiqiid deux inoculations flucceeaiveB a^parto par 
nn intarvalle de 10 joiin. 

Oidinairement, la deudteie injection prodnit one inaction moinB intense que la 
premie. La temperature ne monte qu'^ 38** et descend compl^tement au bout 
de 10 on 12 heures, de manite que le cycle dvolutif s'effectue dans un temps plus 
court qu'i la premite. 

Pour mesurer rimmunit^ donn^ par le titre du steun en aghxtinines, au tioisttoe 
ou quatridme jour aprte la seconde inoculation, j'extraas de Textrtoit^ d^tale de Tin- 
dlvidu quelqueegouttes de sang et je fais ensuite la reaction d'aglutinatkm midlangeant 
i une goutte de s^rum jusqu'i 100 et 150 pour cent de bouillon de culture. Dans 
la grande majority des cas, la reaction a 6t6 absolument positive, mtoie k la dose 
de 1 pour 250, ce qui prouve sans discussion la bont6 de mon produit. 

Je ne pretends pas que la quantity d'aglutinines dans le s6rum sanguin soit suffi- 
sante pour juger en dernier r^sultat d'un i»oduit de cette nature. G'est un 
chapitre trte pen ^tudi^ de la science bact^riolqgique et trte probablement destine k 
Bubir des modifications sdiieuses; mais il est certain que n'ayant pas un autre moyen 
de contrfile, T^eigie de la reaction aglutinante est digne d'etre prise en compte 
et sous ce point de vue mon vaccin a prcMiuit la fonnation d'aglutinines en proportion 
]dua grande sur les autrss produits similaires. 

PHASE NBGAnYB. 

Wri^t le premier, et d'autres auteurs ensuite, d^rivirent sous ce nom une tend- 
ance plus grande, de la part de ceux qui avaient 4t6 vaccina, & contractor la fi^vre 
pendant les 8 It 10 jouis suivants celui de Tinoculation. Plus tard des dbserva- 
teurs d'un minte incontestable mirent en doute Tezistence de cette p^iiode native, 
se basant sur le fait de ne I'avoir pu verifier. 

Pour ce qui conceme mes etudes, je dois dtelarer que je me suis trouv6 dans des 
conditions particuli^rement favorables pour constater ce phtoomtee, car comma je 
Tai prte^emment dit, dans la race indienne Tisolement n'est pas possible et les 
individus malades vivent ensemble avec les sains, dans de mis6rables huttes d'un 
espace ezcesstvement r6duit. 

n est Evident, que si la p^riode negative existait rMlement, la contagion devait 6tre 
beaucoup plus facile et fr^quente, ce qui n'eut pas lieu une seule fois. 

Lesdiff^rentes commissions qui vaccin^rent dans les peuplades d'indiens de Arque, 
GhangoUa, Isladel Sol, Carangas, Punata, Jesds de Macbaca, Mocomoco, Comarapa, Pul- 
quina, Umala et autres endroits situ^ k des bauteurs de 500 k 4.100 metres au-dessus 
du niveau de la mer, d^larent parmi les individus vaccina et vivant dans les 
mAmes habitations oil se tnnivait la fi^vre en pleine i)6riode, n'avoir pas observe 
on seul cas de contagion, ce qui prouve le pouvoir pr^ventif de la vaccine, la non-ex- 
istence de la p^riode native et ce qui est tr^ probable encore, que dans un indl- 
vidu d6]^ avec des prodromes, on pent, giftce k la vaccine ^ter le d^veloppement 
de la maladie. 

DOSB PBiVBNnVB. 

Quant k la quantity de bacilles qui est n^cessaire pour produire I'immunit^ 
effective, I'avis des auteurs varie dans des limites trop amples, en soite qu'on pent 
aflSrmer, qu'il n'existe pas une dose unique et d^termin^ avec caract^ g^^ral. 

Ghantemesse indique le nombre de trois mille millions de bact^ries, distributes en 
4 injections, s6par6es les unes des autres par un intervalle de sept jours minimum et 
14 maximum. 

Ardin, Delteil, N^igre emploient le vaccin sensibilis6 de Besredka et effectuent 
4 injections k intervalles de trois jours. 

Jaime Feir&n fait ime premie inoculation de 2 centimetres cubes, moiti^ dans le 
bras droit, moiti^ dans le gauche. Sept k huit jours apr^ il refait une application de 
la m6me quantity. 



134 PB0CEEDIN.6S SECOND PAN ASCEBICAXT 8CIBNTIFIG G0N6BESS. 

Pour Vincent, le mieux serait pratiquer 4 injections, k doses cioisBUiles de 0,50» 
0,75, 1 et 2 centimetres cubes distributes de huit en huit jours. II est it remarquer 
que ce vacdn contient seulement 400.000.000 de badges par centuntee cube. 

Dans nui pratique je kne b<»ne k faire deux injections d'un dend centimetre cube: 
la premi^, avec une teneur de 500.000.000 de bact6nes, et huit jouzs aprte une 
autre d'un centimetre cube. 

Pour la race indienne il est n^cessaire de cheicher un pioc6d6 d'immunisation 
qui ne n6cesBite pas b^aucoup d'inoculatiooB sucoessives, et ceci pour plusieun 
raisons. D'abord k cause des formes distances auxqudles se trouvent les villages et 
hameaux; dans des endioits d^pourvus de toute ressource avec des chemias d^tes- 
tables pour les mulets les voyages font beaucoup soufErir les envoy^ et leur causent 
d'innombrables fatigues. Le caractere supentitieux et appr^henail des naturels est 
ensuite la cause que, si Ton a pu obtenir qu'une loss ils se soumettont k rimmunisa- 
tion, la l^^re fettigue qu'ils ^prouvent les tetvorise et il est A pen prds impossible 
de leur faire accepter une deuxi^me, et, comme il est natural, bien moins une troisieme 
ou quatri^me vaccination. 

On doit pr^tendre en Bolivie, plutdt que des immunisations de longue dur6e, une 
immunisation qui, rendant retractaiies, quand mdme ce ne serait que pour pen de 
temps, tons les individus d'un endroit d^tennin^, empMieiait la propagation de 1'^- 
d^mie et P^pouvantable mortality qu'elle cause. 

R^ULTATS DE LA VACCINE PR^VENTIVB. 

J'ai signal^ en passant dans un des chapitres.de la pr^nte ^tude les avantages 
obtenus par la vaccine employee comme agent pr^ventif . Je vais maintenaat ctfeer 
quelques statistiques en plus, pour ^tablir une cwnparaison entre ce qui s'est pass^ 
dans d'autres pays et ce que j'ai pu observer en Bolivie. 

J'ai d^ik fiiit remarquer que c'est k Wright que I'on doit les premiers essais de 
vaccination antityphique; en cons^uence c'est rAngleterre qui la premiero 
b^n^fida de cet agent th^peutique. 

Tout le monde sait que Tarm^e anglaiae au Transvaal eut k subir dans une proportion 
alarmante, la prince, parmi les troupes, de la fi^vre typholde, qui causa de nombreux 
d^^s. C'est Ik que les meilleures 6tudes statistiques furent £utes en m6me temps 
que comparatives et dont les chifCres sont les suivants: 

Ladysmith, guetre du Transvaal, 1906, vacdn^ 1.705; cas, 35—2,05 pour cent; 
morts, 8 — 0,47 pour cent. Non-vaccin^ 10.529; cas, 1.489 — ^14 pour cent; morts, 
329—3,13 pour cent. 

Dans d'autres colonies anglaises les r^sultats furent: Inde, 1900, vaccin^ 5.999; 
cas, 52—0,87 pour cent; morts, 8—0,13 pour cent. Non-vaccin^ 54.554; caa, 731 — 
1,69 pour cent; morts, 24-0,48 pour cent. Inde, 1901, vaccin^ 4.833; cas, 32—0,66 
pour cent; morte, 3—0,06 pour cent. Non-vacdn^ 55.955; cas, 744 — ^1,33 pour 
cent; morts, 9—0,36 pour cent Inde, 1907, vacant, 2.207; cas, 0,68 pour cent; 
mortB, 0,13 pour cent. Non-vaccin^, 8.113; cas, 2,13 pour cent; morts, 0,52 pour 
cent. Malta-Gibraltar et Gr^te, 1910, vacant, cas, 0,53 pour cent; morts, 0,89 pour 
cent. Non-vaccin66, cas, 30—0,04 pour cent; morts, 1,69 pour cent. 

Amiriqu£ du Nord. — Dans ce pays gr&ce k la generalisation de la vacdneet aux lois 
qui Pa dfclar6e obligatoire dans rarm6e, la typhoSde a diminue dans une proportion 
telle qu'elle &dt penser que sous peu les statistiques n*enr^;istreront pas un seul cas. 

Etats-Unis, 1909, cas, 175; morts, 16. 1910, cas, 142; morts, 10. 1911, cas, 44; 
morts, 6. 1912, cas, 9; morts, 1. 

AUemagne, 1904-1907, vaccinas, 7.287; morts, 24—0,35 pour cent; non-vaccines, 
9.204; morts, 116—1,26 pour cent. 

France, epidemie d'Avignon, 1912, vaccinas, 1.366; cas, 0; morts, 0; non-vaccines, 
687; cas, 156; morts, 22. 



PUBLIC HEALTH AND MEDICINE. 



135 



Alg^e et Timisie, vacdn^, 10.7M; cm, Q; morts, 0; non vaccina, 6.293; cu, 
168 — 44 pour cent; mortfl, 21. 

Bolivie, 192S. — ^Ma statistique ne peut 6tre concluante sur ce point; j'ai d6}k 
indiqu^ lee laiaons %ui m'emp^ch^rent de faire une 6tude plus comply. 

.La vaccination s^ant 6t6 6ffectu^ dans une region d^termin^, la commksion 
aanitaire attend aeulement 8 & 10 joun, et, si dans oe tenne aucun nouveau malade ne 
se prtente, elle quitte Fendroit infect^, laiasant 4 Tautoritd locale le soin d'avertir 
imm^dialement si de nouveauz cas de typholde se prtentaient. 

Par consequent Topinion sur laquelle je me base pour juger de reflScacit^ de la vac- 
c^ie, repose sur le fait saiyaat: Dans les villages soumis & la vaccine, T^pid^mie a dis- 
paru compl^temeat; de nouveaux cas ne s'^tant pas pr6sent6 dans un tenne qui, 
jtisqu'Ji present, atteint huit mois comme maximum et un mois comme fnimmnin 

TJniquement dans deux endroits la fi^vre fit un retour offensif , ce qui me permit 
de iaire une ^tude importante sur Tefficacxt^ preventive de ma vaccine; ces deux 
epdroits iurent Arque et Punata, dans lesquels repidemie, apr^ avoir disparu, 
revint au bout d'un certain temps avec nouvelle vigueur, ce qui motiva Tonvoi de 
nottvelles commissioiis, chaig^es d'annoter soigneusement les cas dans lesquels une 
personne vaccinae aumit contract^ la fi^vre. 

A Arque, tant par la declaration des autorit^s qui par ordre du Gouvemement 
firent une soigneuae investigation, comme par le rapport du commisaionne, Ton sait 
que pas une seule fois on ne vit que les individus vaccinas eussent pris la maladie; 
quoiqu'ils v^cussent dans des huttes infectes et malsaines avec leurs parents malades. 

A Punata le Dr. Villarroel declare avoir vu deux cas uniques d' individus qui 
apr^ avoir 6t6 vaccinas prirent la fi^vre. Gee deux cas sont les seuls oCl des indi- 
vidus vslfcines aient subi la typho'ide. Dans les autres endroits, comme on peut le 
voir d'apr^ les tableaux que je tranacris ci-dessous, les epidemies ont disparu dans 
un terme de huit li quinze jours. 

Vaccination. 



Dates. 



1913. 

ComnUssloD Dr. Hendoaa,da24 de Jafllet 
au 28 d'aoat. 

Commission Navarro, mtoie date 

Commission R6A|ely septembre 14 It sep- 
t«mbre30. 

Commission Baloasar, septembre 26 au 
15 octobre. 

Commission Orlhoela, ootobre 3 k octo- 
bre 14. 

Commission Navarro, ootobre 21 an 16 
novembre. 

Commission liTarlJa, ootobre 29 

Conunlssion Dr. Fefiaranda, ootobre 14 . . . 

Commission Antonio lioraleB,noTembre20 

Commission Dr. Villairoel, deoembre 9. . . 

Commission Dr. Aiamayo, dteembre 80... 
Divraes commissions 



1914. 

Commission Dr. Mercado, Janvier. 
Commission Dr. Saens, feviier 13. 

Tribonal de m^decine, mars 4 

Commission Rocabado, man 28. . . 

Commission Vargas, mars 16 

Di verses oommiasions 



Endroits. 



Arque, Colcha, Berenguela 
y Tucsoma. 

Changolla e^ Tarata 

IsladelSol. 

ArqiM, Golcha, Berengue- 
la, Tucsoma. 
Province de Carangas 

Mocomoco 

Tarila-vilieet villages 

Jesds de Machaca 

Umala 

Punata 

Potosf, vllle et villages ... . 
Polaoayo. Hos^tales, 
Aobacachl, etc. 



Comarapa et TambiUo 

Vallagrande 

Tarija 

Quecfaisla 

Sicasica 

Oruro, Fotosi, etc 



Nombre 
devao- 
dnte. 



360 

250 
300 

427 

350 

500 

850 
300 
220 
500 

150 
730 



4,427 



800 
200 
100 
100 
500 
1,000 



R^nltats. 



L'^ptd^mio se pr^senta 

de nouveau. 
Ne se prfeenta plus. 
Ne se pr^nta plus. 

Ne se pr^senta plus. 

Ne se prteenta plus. 

Ne se prteenta plus. 

Ne se pr^senta plus. 
Ne se pr^senta plus. 
Ne se iir^nta plus. 
L'dpioemie se pr^senta 

de nouveau. 
Ne se pr<$senta plus. 
Ne se pnSsenta plus. 



Ne se prteenta plus. 
Ne se prteenta plus. 
Ne se prteenta plus. 
Ne se prteenta plus. 
Ne se prteenta plus. 
Ne se prteenta plus. 



186 PBOOEEDIHGS SECOND PAN AMEBIOAK 80IBVXIFI0 C0K0BE8& 

VAOOnr OUBATIF. 
PBBMlisSB taTDBB. 

La presqne totality des Batefan qui se sont occupy de bBrt^rioth^impie Bccoid«nt 
^ Eug^e Fraflnkel d'Hambouig le mMte d'avoir ^t^ 1e premier k appliqaer le vac- 
cin comme agent, non pas piophylactique inais curatif . C'eet en 1892 et 1893 que 
cet autenr mena k bonne fin see Etudes, ayant compriB dans see expMences 57 maladeSy 
8ur lesquelfl le nouveau traitement donna des r^sultats ai hivorables qu'tb fadflatant 
d6}k pr^volr lea avantagea qu'avec le tempa on poturait retiier de aon emploi. 

Weugeberber, dana aon excellente th^ aur "L'^tat actuel de la vaccination contra 
la fidvre typhoTde/' croit qne ce fat Eichhola, qtd dana TAfrique Allemande du Sad, 
aur 68 nuiladea fit avant FVaenkel dea ezpdriencea avec la vaccine comme agent 
curatif. 

Ferr&n affirme que c'eat k lui qu'on doit I'emploi du vaccin comme agent curatif; 
ayant depuia 1887 fait diveiaea inveatigationa, qui revendiqueraient pour lui le 
m^te de droit de primaut^. 

De aon cdt6 Cfaantemeaae fait remaiquer que c'eat k aea ^tudea et k cellea du Pio- 
leaaeur Widal que le triomphe de la vaccinot^npie antityphique eat dA. 

PluB taid une vMtable phalange d'inveatigatoura ont effer-tu6 dea eaaaia plua cm 
moina favorablea; lea mdmea que je tranacria d*une communication faite par le 
Profeaaeur Arnold Netter, k la 8oci^t6 MMicale d'Hdpitauz. 



PUBUO HBAT.TH A3SD MEDICIBB. 



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FUBUC HBALIH AND MBDICIKE. 189 

Lt le tableau pr^Ment, on voit que juflqu'aujourd'hui lee etatistiquen 
plus nombreuees eont celles de Petrowitch avec 460 malades et la mieiuie avec 844. 

Je doia hue noter que je ne marque paa plus de deux cents cas qui de diff^nts 
points de la R6publique m'ont ^t^ communique (Dr. Gershi d'Oruro, Dr. Aremayu 
de Potosf, etc.), parce que je ne posaMe pas les observations cliniques completes ei 
que je dteire que ma statistique soit s6v^ autent que possible. 

Ajoutant aux 344 cas les deux cents pr^it^, j'aurais une statistique globale de 544 
malades soign^ avec un r^ultat toujours favorable, ce qui me placerait k la t6te de 
tons les auteurs d'aprds le nombre de malades traits. 

Pour 6purer ma statistique, je vais supprimer les cas sans 6tude clinique complete, 
et lee 100 de 1914, dont la documentation ne m'est encore pas parvenue totalement; 
de mani^ que ma statisique sera rMuite k 234 malades, avec deux d^te. 

D'apr^ les tableaux trac^ par le Dr. ViUanoel, on peut classer les 234 malad€*fi> 
en 6 groupes distnbu^ de la ia^on suivante: 

Premier tableau. — ^Nous prendrons comme type Dionisio GondUee, 7 4 13 jours de 
maladie, commence le traitement: Premier jour, temperature 40^, injection vaccin 
Morales d'un demi centimetre cube; deuxi^e jour, temp^ature 36^.5, injection, 
6tat g^n^ral, bon; troisi^me jour, temp^ture 36^.5, injection vaccin national, 
quatri^me jour, convalescence. Dans ce tableau sont compris 126 malades. 

DeuxQme tableau. — Francisco Delgadillo, 4^8 jours de maladie, temp^ture 39'' 
le premier jourdu traitement, injection vaccin; deuxi^me jour, temperature 38°. 9, 
reaction locale intense, injection I'apr^ midi; troisi^me jour, temperature 38", 
reaction locale intense, injection; quatri^e jour, temperature 37°, langue et etat 
general normaux; convalescence; comprend 43 malades environ. 

TroisOme tableau. — Juan Ml. Garcia H., quatre jours de maladie, avant traitement, 
temperature 39^.8, injection; deuxi^me jour, temperature 38°; troisi^me jour, tem- 
perature 39°, une heure apr^s T injection, friaaons, hallucinations, deiire violent,, 
quatrieme jour, injection, etatle m^me; sixi^me jour, mdme etat, injection; douzi^mt^ 
jour, temperature 39°; vingti^me jour, convalescence. Comprend 42 malades. 

Quatrihne tableau. — ^Antonio Ugarte, quatre k huit jours de maladie. Premier 
jour, temperature 40°, injection vaccin Morales, deuxi^me jour, temperature 
38°, injection d'un quart de centimetre cube; troisieme jour, temperature 37°.8, 
traitement voie interieure; cinqui^me jour, hypothermie, appetit demesure, con 
valescence. C!omprend 9 cas. 

Cinquihne tableau. — EscoUstica Quinteros, ftge avance, 60 1^ 80 ans, 7 & 10 jours 
de maladie, temperature 39° le premier jour du traitement, injection matin, et soir 
hausse de temperature pendant deux heures plus on moins. Deuxi^me jour, hypo 
thermic, traitement voie interieure; troisi^me jour rhsrpothermie s'accentue; 
necessite caieine et autres tonicardiaques; quatri^me jour, suit rhypothermie, 
man vais etat general; cinquieme jour, dec^s. Comprend deux cas. 

Sixihne tableau. — ^Type: Mariano Condori. Temperature au moment de T injec- 
tion 40°. 5. Inoculation matin et soir d'un demi centimetre cube le premier jour; 
un centimetre cube le deuxieme et le troisieme jour; demi-centimetre cube le 
quatrieme et le cinquieme jour. Dans ce tableau on remarque la chute brusque 
de la temperature apres la septieme injection. 

Je dois k titre de document d'etude ajouter un dernier tableau, ainsi caracterise.* 
Non jeune, du service des hdpitaux, k son arrivee en Italie prit la fievre typholde 
par contagion. Traitee par un coUegue, elle presenta comme caractere special 
I'hyperthermie excessive, avec des temperatures de 41 et 42 degres qui ne cedaient 
k aucun traitement. Au bout de 15 jours et en plein etat de toxhemie, le coeur 
defaillant et pouls filiforme; on fit plut6t par acquiescence que parce qu'on attendait 
une action efficace du vaccin, des injections d'un demi-centimetre cube pendant 
deux jours. La temperature ceda k la premiere inoculation, tombant de 40 & 38, 
et retat general de la malade fit concevoir quelque espoir. Au bout de deux jours 



140 PB0GBBDINQ8 SECOKD PAN AMEBICAK 80IEKTIFI0 OOKGBBSg. 

1a tozh^mie avait continuiS sea progrte et une h^optysis abondante sorvint, dont 
la cause m'est inconnue, et la mort se produisit imm^diatement. 

Je ne mentionne pas ce cas daos ma statistique, de mdme qu'un autre dans lequel 
au bout de dix-huit jours et en pleine pMode d'agonie, on fit, & titre de tentative 
d^sesp^r^, Tapplication du vaccin. 

Dans les deux cas T^tat des patients 6tait tr^ grave, et on eat xecoun k la vaccine 
comme une demi^ ressource. 

R^duisant les tableaux qui {n^^cMent k une expmrion plus concrete et abaolue, 
qui facilite leur Interpr^tion, nous avons les chl&es suivants: 

234 malades traits. 

190 (tableaux 1, 2, 4, et 6), dans lesquels la dur6e maximum de la maladie fdt 
sept jours. 

42 avec une longue Evolution, sans complication et sans d^^. 

Deux malades qui mouruient au dnquitoe jour, mais de typholde dee vieillaids 
qui est trte mauvaiae. 

La proportion de mortality des statistiques plus nombreuses est la suivante: Fraen- 
kel, 8,77; Petrovitch, 3,04; Sadler, 10,22; Morales, 0,85. 

D08S8 THiRAPBDTIQirBS. 

L'avia des diff^rents auteurs qui se sont occupy de cette question vane beaucoup 
en ce qui conceme la quantity la plus conveDable de vaccin qu'il est n^essaire 
d'employer et au moment le plus favorable pour faire les injections. 

Cette diversity d*avis se doit autant au different crlt^rium des exp^rimentateurs, 
comme k ce que chacun d'eux employa dee produits di£F^rents, avec un index bext6- 
rien divers; de sorte que les r^sultats ne peuvent, dans aucun cas, 6tre comparables. 

Josu^ et Belloir injectent trois fois 200.000.000 de bacilles, avec douze heures d*in- 
tervalle; la culture est prise du mdme malade. 

Netter applique 500.000.000 de badUes (st^rilis^s) sensibilis^ k chaque fois, pendant 
tiois jours suivis. 

Meakins emploie la dose de 1.000.000.000 de bact6rie6 chaque hult joura; Ardin- 
Delteil, la mtoe quantity mais chaque trois jours. Boinet, ^gale quantity durant 
quatre joura suivis. 

On voit done, avec quelle difference la valeur th^rapeutique de la vaccine est 
appr^cide. Pour les uns les doses massives doivent, de preference, ^tre employees; 
tandis que d'autres croient que les doses moderees, frequemment repetees ont plus 
d'efficacite. 

Quant k moi, void mon procede: Matin et soir pendant deux joura consecutifo, 
j'injecte des doses de 500.000.000 de bacteries. Si apr^ ce traitement la temperature 
baisse k 38, je suspends les inoculations; mais, si la temperature se maintient eievee, 
alon je fais une cinqui^me, sixi^me et exceptionnellement une septi^me injection. 

Seulement dans un cas on employa des doses plus fortes; ce fut avec le malade du 
Dr. Luis Martfnez Lara, auquel on fit trois applications de 1.000.000.000 de bacteries. 
Je crols qu'il n'y pas de raison pour employer des doses aussi eievees. 

ACTION DU VACCIN. 

Pour donner une idee complete de la mani^re dont le vaccin agit, je vaia raconter 
le premier cas oil il fut applique. 

Vera la fin du mois de mai de Tannee deml^re, au numero 41 de la section de Mede- 
cine de THdpital Landaeta se trouvait Tindien N. N., Age de 20 H 25 ans. L*examen 
dinique reveia une typholde dans le quatri^me ou clnqui^me jour de son evolution, 
avec tons les caract^res clasdques. La reaction de Widal et la diazo-ieaction de 
Ehrlich, confirm^rent pleinement le diagnostic. Nous pouvons classer cette typholde 
entre cellos de moyenne intenaite, avec une certaine tendance k Phyperthermie qui 
<»'Rvait pas cede aux fortes doses de quinine. Dedde k easayer la vertu curative 



PUBLIO HEALTH AND MBDIGIKB. 141 



da vaccin et aprte une loogue et Uborieuae ^tude mir la s^rie animale, coura- 
geuaement coUabor6 par lee Dn. Juan Medina Vaca at Luis Martfues Lara, je fie la 
pwaakn injection d'un demi-centimdtre cube le matin du 27 mai. 

Deux heuiee apr^ la temperature, qui au moment de TinoculatiMi 6tait de 39^, 
mcmta 8A0, tombant le lendemain k 37,8. On r6p6ta lea inoculations, la tempera- 
ture se maintenant k 88, et baiflsant le quatri^e jour d'une fa^on definitive k la 
nonnale. 

L'obeervation qui prickle est, avec peu de vaiiantes, la mtaie qui se r^peta dans 
tous les cas, exceptkm faite de ceuz remaiquee par le Dr. YiUanoel dans le D^parte- 
ment de Cocfaabamba, et dont revolution fut plus longue. 

Je dois {aire remarquer que les reactions douloureuses avec deiire furent frequentes 
jurtout dans les individus alcooUques; tel qu'il aniva durant repidemie de Punata. 

Je dois de mtoe appeler Tattention sur le but particulier que, hors tiois ou quatre, 
peut4tie cinq, malades qui furent soumis au regime lacte, 11 fut impossible avec les 
Autres de regler leur nouiriture, ni m6me d'obtenir leur isolement et de leur foire 
boiie de Teau cuite. 

Les indiens out constamment refuse tout changement dans leur coutumes ordi- 
naiies. 

COMPUCATION8. 



Je ne puis sur ce chapitre Mze tr^ affinnatif , car comme je I'ai deji dit plus haut, 
les diCferentes commissions chaigees de combattre la typholde, rest^rent seulement 
huit k dix jours dans les lieux infectes; de sorte qu'eUes ne purent appreder les 
•complications qui ont pu survenir aprte la maladie. 

Quant k celles qui pendant le cours«de la maladie se presentent, je pens unique- 
ment affirmer que les frequentes hemoiragies, signaiees par quelques auteurs comme 
un fait habituel du traitement vaccinotherapique, ne figurent pas dans mes observa- 
tioos ni comme plus graves ni plus frequentes que dans des autres foimes de traite- 
ment. 

CONVALX8CBN0B . 

Un fait signaie par les Dtb. Villanoel, Mendoza et Sejas, est que les malades traites 
par le vacdn ont une convalescence beaucoup plus rapide que quand le patient est 
soumis k d'autres moyens therapeutiques. 

Les forces re iennent rapidement, Tappetit est exagere, et au bout de six k huit jours 
maximum, le malade a repris ses energies; de sorte qu*il ne conser. e aucune conse- 
quence de son infection. L'exemple le plus surprenant que j'aie remarque dans cet 
ordre est celui de Mile. Maria Teresa Olagui' el, ftgee de 14 ans, qui attaquee de 
dothienenterie exceptbnnellement gra^ e le 19 fer rier, put le 28 du mdme mois aller 
jusque cbez moi pour m'exprimer sa gratitude, ne donnant aucun signe que seulement 
une semaine aupara\ant elle avait ete sur le seuil de la tombe. 

LA TTPHOIDS KM BOUVIX. 

. La tsrpholde fut en Bolivie une entite morbide, d'une vaste etendue geographique 
et ses degats se faisaient sentir dans tous les coins de la Republique. 

Les epidemies etaient parfois tellement gra^ es qu'en 1912 les proprietes voisines du 
lac Titicaca perdirent presque 70 pour cent de leurs laboureurs, et demi^rement k 
Hauillamarca d'apr^ le teiegnunme que je transcris ci-dessous et qui fut remis par 
la premiere autorite politique de cette pro^. ince, on remarque qu'avant I'emploi du 
vaccin il y eut dans un seul village 200 dec^. L'aide Nestor Orihuela, emoye 
quelques jours apr^ cette veritable hecatombe, guerit, grftce k une acti. e campagne, 
40 malades et eteignit compl^tement repidemie. 

Voici le teiegnunme: ''Eucalyptus, le 14 Octobre.— Directeur de Tlnstitut de 
Bacteriologie, La Paz.— Vaccine k Carangas succte complet.— Nous parcourdmes les 
tillages de C!orque, Ouiaguara, Turco, et Huaillamarca, c'est-4rdire, une etendue 



142 PROGEEDINOS SECOND PAN AMBBICAN SCIENTIFIC C0N0BES8. 

d'environ 80 lieues. Ttoia cent cmquante vaccinatioiM prdventives furent iaitBB 
et 40 maladoB gudrls. Avant de pratiqaer la vaccination, deux cents indiena moimi- 
rent k Huaillamarca, d'apr^ lea renaeignementB dea indiena. Details par counier. 
A. nUnes, Sou8-Pr6fet de la Province." 

De ce moment-ci k Tinstant o5 j'^ria cee lignes, il n'y a pas dana toute la B6pu- 
blique trn eeul cas de fi^vie typholde; de aorte que beaucoup d'exiatencea eont con- 
serve pour le commerce et la richesse publique. 

LB YAGCIN A L'lfcTBANOER. 

Sur demande faite par diff^ntes autorlt^ sanitaires ou politiques et par per- 
Bonnes particuli^res, nous avons remis du vaccin aux endroits sui^ anta: Chili 
(Santiago, Arica, Tacna), Argentine (Salta), Cuba (Sagua la Grande), P^u (Lima), 
Mexique (Yucatan), Etats-Unis (New- York). 

DUR^B DU VAOCIN. 

II n'est pas encore possible d'assurer pour combien de temps le vaccin conser. e 
son acti . it6 complete. Les premieres Missions ^labor^ Pan dernier vers la fin de 
mai, se sont conserv-^ sans alteration dans tous les climats, depuis le climat presque 
glacial du plateau andin, sous des temperatures de 10 et 12 degree au-dessous de a^ro, 
jusqu*au climat ardent des plaines de Santa Cruz, avec 30 et 35 degr^a au-desaas 
de z^ro. 

£n date du 20 avril, afin de verifier TactiAite du vaccin, on fit dea experiences 
BUT la s^rie animale dont les resultats, qui feront Pobjet d'une seconde communi- 
cation ik TAcademie de Medecine, sont les suivants: un lapin des Indes de 460 
grammes, qui hit injects de 1 cc. de vaccin antityphique, de la premiere emission, 
qui fut eia1)oree vers la fin du mois de mai 1913, eut une eie^ ation de temperature 
deux heures aprte Pinoculation de 40,6 degres. Le lendemain cette temperature 
tomba & 38,2, chifTre normal. 

Injecte, un autre lapin pesant 490 grammes, d'une dose egale de Aaccin anti- 
typhique mais de treizi^e emission, eiaboree pendant le mois de mars de Pannee 
en cours, donna comme elevation de temperature 40,5 deux heures apr^, reA enant 
le lendemain k 38,2, ou ce qui est la mdme chose k la normale. 

Cette seule observation dans laquelle les temperatures s'eieverent d'une £A9on 
tellement ressemblante dans les deux cas, ne sendt pas sufifisante pour en tirer des 
conclusions definitives et deduire que le premier vaccin avait conser. e toute sa 
force, et pour avoir un renseignement de plus k ajouter II cette interessante question, 
j'ai precede k Texperience sui\ante: Deux lapins de mdme poids furent respecti.e- 
ment injectes avec du vaccin antityphique de la premiere et demiere emission; 
huit jouis aprte on injecta aux deux par la voie intraperitonienne 1 cc. de culture 
virulente de bacille typhique. Chez le lapin traite par le vaccin de la premie 
emission, la temperature s'eieva rapidement k 41 degree, baissant deux heures apr^ 
k la normale. Celui injecte avec le vaccin de la demi^re emission, eut une eleva- 
tion de temperature qui arriva k peine k 39,8, tombant au bout de 24 heures au type 
egalement normal. 

D^ ce moment ils ne subirent aucun malaise; leur appetit etait excellent et ils 
paraissaient n'avoir aucunement souffert de Pinoculation de cultures virulentes. 

Deux lapins injectes en m^me temps avec des cultures typhiques, mais qui n'avaient 
pas subi Taction du vaccin, eurent des temperatures iiba variables, qui se main- 
tenaient encore au bout de dix jours k 39,8 et seulement aprte vint une longue con- 
valescence avec une perte considerable de poids. 

Les observations precitees sont convainquantes d'apr^ mon opinion et prouvent 
deux choees: 1^ que le vaccin eiabore k Tlnstitut National de Bacteriologie de La Faz, 
au bout de 11 mois a conserve toute son activite; 2*, que son action efficace de defense 
s'est montree egalement moyennant Pinoculation de cultures de bacille typhique , 



PUBUC HEALTH AND MEDICINE. 148 

c'est k petne si una l^g^ et ioBigiiifiaiite fi^vre se ppoduisit (^l^vation de temp^iu- 
tiire), tandu que lea i^mouiB aoufiErirent gravement. 

CONCLUSION. 

Pour tenniner, je crois de men devoir de manif ester que, d'aprte mon opinion, la 
vaccinothtepie de la fi^vre typholde est destin^e ^ substituer toutes les autres formes 
de txaitement cofmues jusqu'aujourd'hui, et sur lesquelles elle a les avantages suivants: 
facility d'application, mortality minime et le manque jusqu*& ce jour de contre- 
IndicationB qui pounaient ftdre craindre son application. 

Mofuiewr le Diredeur de VInstittU National de BacUriologie Dr. Nhtor Morales V,, 

PrherU. 

Gomme membre de la Commision Sanitaire, charg^ de combattxe I'^pid^mie de 
fi^vre typhoide qui se d^veloppa dans les Provinces de Arque et Tarata du D6- 
partement de Gochabamba, j'ai eu Toccasion d'exp^rimenter I'application de votre 
vaccin antityphique dont j'ai Thonneur, me r6f^rant k I'ordre de rinterrogatoire ' 
formula par vous, de certifier les r^sultats sur les points suivants: 

Premier. — Dans les multiples foyers ^pid^miques qui existent k Arque, comprenant 
neuf regions dans les hauteurs de la section de Golcha, deux dans la section de Ghan- 
goUa, Tacopay'a, et trois regions de la Province de Tarata, le personnel de la commis- 
sion ex^uta d'aprds les tableaux nominaux remis k cette Direction, 700 vaccinations 
preventives et 40 inoculations curatives, obtenant un, r^sultat plus que satisfaisant, 
tel que la gu^rison de tous les malades et I'extinction de I'^pid^mie en moins d'un 
mois; d'oiH Ton d^uit que le vaccin fut employee non seulement comme agent 
pr6ventif mais comme agent cuiatif . 

Deuxihne. — Dans les reactions autant locales que g^n^rales des vaccin^ pr^ven- 
tivement, jamais aucun accident malbeureux ne s'est pr^nt^. Dans les typhiques 
les reactions thermiques auxquelles la vaccination a donn^ lieu, se sont montr^ee du 
cdt6 de la defervescence, apr^ la troisi^me inoculation dans la plupart des cas et 
dans quelques-uns apr^ la deuxi^me, comme le font voir les graphiquee port^sik 
votre connaissance; avec la baisse de la temperature ont coincide Tattenuation et 
Parrfit des autres symptdmes morbides, obtenant au bout de quelques jours la gueri^n 
du malade. Base sur ces faits de contrdle personnel et sur les resultats ob tonus avec 
un succ^ semblable par les Drs. Sejas et Villairoel, qui eux aussi, ont combattu 
repidemie precitee, je consid^re que la vaccine antityphique constitue un puissant 
remdde capable par lui-m§me de faire disparattre et de prevenir I'infection typhique. 

TroieiiTne, — Dans le cours de repidemie des provinces citees plus haut de Cocha- 
bamba, on employa seulement le proc^de vaccinotherapique excluant tout autre 
traitement. 

QtuUrihne. — ^Avant I'intervention de la vaccination antityphique, la mortalite etait 
considerable, d'apr^ les renseignements foumis par les autorites et les doutes. Lassi- 
tude, manque d'appetit, epitaxis (presque tous les malades presentaient ce symptdme) 
mal de tdte violent, insomnie, enfin le tableau initial de Tinfection typhique; puis 
la fievre, le deiire, le caractere de la langue, les perturbations intestinales les roulades 
de la fosse iliaque, quelques manifestations bron^hiales et pulmonaires, si frequentes 
dans cette maladie et autres symptdmes que je ne mentionne pas poiu: etre plus bref, 
guid^nt mon jugement pour faire le diagnostic que j'ai signaie. Les sept malades 
etaient dissemines en different hameaux voisins du SaladiUo de la fa^on suivante: 
2 a Agua Blanca, 3 k JagUe, 1 k TEstanque; 1 k San Pedro; la plupart etaient dans le 
second septenaire, k San Pedro c' etait une jeune fille de 14 ans, plongee dans la plus 
grande mis^ et qui presentait la forme typique de la fi^vre ataxe adinamique. II 
est inutile de dire qu'aucun d'eux n'avait ete traite si peu que ce soit, ni qu'ils ne 
pratiquaient mdme pas les regies d 'hygiene les plus eiementaires, vivant en repugnant 
p41e-mMe avec les individus sains, mangeant et buvant ce dont ils avaient envie, et 
se levant pour faiie leurs necessites. Tout ceci explique I'extraordinaire gravite de 
revolution du proc^ morbide. 



144 PBOOEBDIKQS SECOND PAK AMBBIOAN 80IBKTIFI0 00VQBB88. 



En prtence de la sftiet^ que les renBeignemeiiti diniques me donnaient, je n'] 
pas k appliquer imm^diatement lea injectioDa de B^ram antityphique, pr6par6 & 
I'lnatitut de Bact^ologie, par le Dr. N^etor Morales Villaz6]i, et que le Fr^fet avait 
eu la gentUlease de me procurer. 

Matin et aoir je pratiquai k chaque malade une injection d'un demi-centun^tre 
cube et j'eua la satiahiction de conatater un r^aultat splendide i partir du deuzi^e 
jour du traitement. Chez un malade il suffit d'un jour de tndtement pour que la 
temperature revtnt k son 6tat noimal et les symptAmes qu'il prtentait disparussent; 
chez les autres une franche amelioration se produisit k la quatri^me injection, et chez 
la malade de San Pedro k la cinqui^me injection je pus la cousiderer hors de danger. 

Aprte la demito injection je restai deux jours de plus observant les r^sultats d6fi- 
nitifi et attendant de nouveaux cas qui ratifinssont les tiiomphes obtenus sur les an- 
terieuTB. Aucun ne se prtentant j'entrepris mon voyage de retour, regrettant de ne 
pas pouvoir repasser k Capillas par manque de temps et k cause du r6tablisBement non- 
d^finitif de ma 8ant6. 

Je dois faire un acte de justice envers le jeune homme Manuel Montafio qui fut 
mon collaborateur d^vou^ et qui m'accompagna dans toutes les excursions que matin 
et soir j'avais k faire pour visiter les malades. C'est k lui que je recommandais de 
continuer k me foumir tei^graphiquement des renseignements sur les malades; ces 
renseignements ont confirm^ pleinement la complete guerison de ces derniets. 

Je traitai aussi la convalescence de tons ceux qui, avant mon arrivee, etaient tomb^a 
malades, employant pour cela le regime tonique et reconstituant coiiseill6 pour 
ces cas. 

Avant mon anivee k Saladillo il y ent les malades suivants: Agua Blanca, 25; 5 
d^c^; li San Pedro, 12; 2 dMe; k Saladillo, 3; pas de d^cte; k JagQe, 14; 3 morta; k 
I'Estanque 9; 1 ddcte, qui ajout^s aux sept cas tndtes par moi donnent un total de 
70 malades et 11 d^cte. 

ReflecbisBant sur les causes qui ont pu determiner ce proc^ infectieux, j'en ren- 
contre Texplication dans la mauvaise quaUte de I'eau. Ce sont des lieuz depourvua 
d*eau courante et leurs habitants doivent employer Peau qu'ils retiennent daoa 
des excavations faites dans ce but. Pendant la saison des pluies ces d6p6ts-li se 
xenouvellent constamment, nuus dans la saison s^che, I'eau qui n'est pas renouvdee 
prend mauvaise odeur et subit des decompositions de tout genre, et Ton sait que 
le microbe d*Eberth, agent producteur de la typholde trouve dans Teau un excellent 
milieu de developpement; I'lngestion de ces eaux produiairent les premiers cas, 
la malproprete, le manque de precautions hygieniques se chaigdrent de propager la 
maladie sous forme epidemique. 

Je dois faire remarquer une drconstance: le village de Comarapa est k nu-chemin 
entre Capillas et Saladillo et cependant repidteie sauta, on pent le dire du premier 
au deuxitoe point sans attaquer un seul individu du village; ceUk est dO 2i un ruisseaa 
que ce dernier possMe et qui lui foumit de Peau propre et pas contaminee, qui le 
■mvegarde des infections intestinales du genre de celle dont nous nous occupons. 

Je terminefai. Monsieur le Aref et, ce point de mon rapport avec les concludona 
suivantes: 

1. L'epidemie qui se developpa aux envizoDB du village de Comarapa fut la fi^vre 
typhtilde. 

2. Les sept typhiques tiaites avec le vacdn prdparee k PInstitut NatUmal de 
Bacteriologie par le Dr. Nestor Morales Yillaz^n ont gueri compl^tement. 

8. Hors le tndtement hygienique general, aucun autre que le serum n' a ete employe 
pour les 7 malades predtea. 

4. Je crois que dans la mauvaise qualite de Teau reside I'origine de l'epidemie. 

Je profite de la presente occasion pour exprimer an Gonvemement, par I'interme- 
diaire de Monsieur le P^et, la necesslte d'etablir d'nrgence un service reguHer 
sanitaire dans cette region. 



FUBUO HEALTH AKD MBDIGIKB. 145 

Toute cette r^<m oe pr6te k ragricultare et mtaie k Tflevage da Mtoil, car il existe 
en effet sur lea collineB et danB lee vallto det laboungee plua ou moins ^tendus, et 
dans leequelfl lee pioduits de la contrde viennent adminiblement; mais un obetacle 
eodste qui s'oppoee k son progrte puiaqu'i) d^dme lea biae ou lee inutiliee pour a 
labeor actif, c'est le paludisme. G'eet la maladie doounante daoa toute la contr^ 
ety enracin^ et prqpagde de telle ia^on, qu'il n'y a pas dans toute Tann^ una aaiaon 
danfl laquelle elle ne se prtente, et il eot trte rare qu'un mMedn ne rencontre dans 
toos les habitants de cette r<^on quelque vestige lointain ou r^ent de rinfection 
malarique. 

II est certain que le paludisme des r^ons tempMes ne revdt pas la forme aigufi et 
maligne des climats tropicaux que nous avons eu Toccasion d'obeerver au Beni, mais 
U n'en est pas moins vrai que, malgr^ sa b^nignit^, il finit par causer de s^rieuz boule- 
versements, affaiblissant les pereonnes auxquelles il s'attaque, minant Toiganiame 
le reodant pr6t k contractor les infections secondaires. D'autre part c'est li Tunique 
obstacle qui empMie la population d'augmenter/car il s'abat surtout sur lesenfants 
du premier ftge, et ceux qui en ^chappent se d^veloppent alors dans une pauvret^ 
Qifganique extreme, soutenue souvent pendant leur existence par la t6nacit6 de la 
maladie. ^ 

L'histoire de la dtouience de la valine de Miaque, florisMuite auparavaat, est 
un t6moignage frappant du labeur destructif du paludisme. Pampagrande qui ^tait, 
il n'y a pas longtemps, un centre de commerce asses important, se trouve aujourd'hui 
c<mverti en un triste hameau depuis que le iwludisme y fit son apparition et je ne 
m'avance pas trop en disant que cette maladie est T unique entrave au piogc^ de ces 
regions. 

ICaintenant que les pouvoiis publics s'int^ressent k encourager notre commerce k 
renforcer nos 6neigies productrices, k aider Paugmentation de notre population, qui 
est la base de ragrandiasement national, ils sont oblig^ d'entreprendre I'oeuvre 
humanitaire de combattre la maladie qui flagelle ces malheureux villages, en employ- 
ant pour cela les ressouroes dont dispose la science. 

Tout d'abord, et comme oeuvre initiale, s'impose la n^cessit^ de la creation d'un 
poste pour un mMedn titulaire, dont la rMdence serait fix^ k Gomarapa, et qui 
eendt charge de surveiller les environs et de faire surtout une guerre sans merd au 
paludisme. Cette base 6tablie, on poumdt ensuite accorder un vaste plan sanitaire 
qui en peu d'annto donnendt les plus beaux r^sultats. 

^opi^taizes des lieux infect^, ayant atteint dans quelques endroits le tiers de la 
totality des habitants. Avec le traitement par vaccinothtepie il y eut seulement 
un d^c^ sur les quarante malades traits. 

Cinqwhne. — Quant k la dur6e de la maladie par le traitement vacdno-Antityphiquet 
on a observe que la baiase thennique s'efTectuait du troisi^me au quatritoe jour, 
cMant graduellement les joun successifB les autres manifestations symptomatiquesy 
jusqu'au sixi^me ou huiti^me jour oii la gu6rison du malade s'accentuait. 

Ges r^ultats mettent en Evidence la bont^ et I'efficadt^ de ce nouveau traitement 

qui non seulement attaque la cause mteie de la maladie, mais rMuit considteble- 

ment le temps de son Evolution. 

Db. JbAus F. Mbndosa. 
La. Paz, le 13 novembre, 1913. 

The Chatrman. Through the courtesy of the author, the following- 
named printed volume is presented to the congress through Section 
Vni: La blastomicosis humana en el PerA j Bolivia, by Edmundo 
EscomeL Arequipa, Perd, 1914. 

The session adjourned at 6 o'clock. 



GENERAL SESSION OF SECTION VOL 

New Ebbitt Hotel, 
Wedne9day morning, December £9, 1916. 

Chairman, William C. Goboas. 

The session was called to order at 9.30 o'clock by the chairman. 

Dr. Cabteb. Mr. Chairman, we were unable to avail ourselves of 
the assistance of Dr. Vital Brasil, as he found it impossible to be 
witti U8. The foUowing report prepared by the majority of your 
oommittee on the amendments suggested by Dr. Ouiteras is now 
.submitted: 

Referring to the matter of amendmentB to the International Sanitary Convention 
submitted to us, this committee ia of the opinion that all changes in said convention 
ought to be considered and acted upon by the Sanitary Conference of the American 
Republics, which meets at Montevideo for that purpose, and therefore the amendments 
proposed should be matter for such conference to consider, together with such opinions 
as may have been expressed by other members of this section. No report on this 
subject, then, from yoiur committee seems called for. 

Dr. KoBEB. I move the adoption of the report. 

Seconded and approved. 

Dr. George M. Kober took the chair. 

The CHAmMAN. The following papers will be presented at this 
session: 

The alcohol and drug habits and its prophylaxis, by Dr. Harvey 
W. Wiley. 

Os fumadores de maconha: efFeitos e males do vicio, by Dr. 
Rodrigues Dona. 

El problema del alcohoUsmo y su posible soluci6n, by Luis L6pez 
de Mesa. 

Lucha contra el alcoholismo, by Dr. Ricardo Sarmiento Laspiur. 

THE ALCOHOL AND DRUG HABIT AND rrS PROPHYLAXIS. 

By HARVEY W. WILEY, 
Contributing Editor^ Good Househwping Magazine. 



What is a drug habit? The taking of any stimulating, exciting drug which has no 
food value, and which produces directly excitation of any of the organs of the body 
or nerves controlling them in such a way as to suggest or compel a repetition of the 
dose, is a drug habit. The drugs which are commonly used for this purpose are alco- 
hol, tobacco, opium and its derivatives, chloral, cocaine, acetanilid, phenacetin, 

146 



PUBLIO HEALTH AND MSDIdKB. 147 

andcaffein. There are many other drugs which tend to produce a habit without 
appealing to the sense of artificial relief, as, for instance, those which are used habitu- 
ally to correct constipation. These drugs, however, are not so commonly employed, 
nor is thd habit which they induce difficult to overcome. A very distinguished friend 
of mine told me recently that he had been taking for years sodium phosphate, regu- 
larly, as he would his meals. He had grown into the conviction that his physical 
well-being would be so disturbed by the omission of this dose that he did not dare to 
leave it off. 

The habit-forming drugs which are most extensively used are alcohol, nicotin, and 
caffein. If we class as drug addicts those who have acquired the habit for one or more 
of these drugs the number of them in the United States would be very close to half 
or two-thirds of the population. When we speak of drug addicts, however, we usually 
have a more restricted sense and refer rather to those who are slaves to opium or the 
coca leaf and their dmvatives. I, however, for the purpose of this paper include all 
drugs of the class mentioned above. 

The methods of acquiring these habits are so well known that I need not dwell 
long upon them here. Unfortunately for the reputation of the medical profession, it 
is certain that a very large percentage of the cases of opium addiction is due to the 
use of this remedy in some form in regular medical practice. The same is true, 
though to a less extent, of cocaine. In regard to alcohol the case is quite different. 
A half or a third of a century ago alcohol in some form was very commonly adminis- 
tered as a remedy, and doubtless in these cases the alcohol habit was often acquired 
in this way. At the present time the use of alcohol in any form in medicine, except 
as an external application, is becoming extremely rare, and no notable percentage of 
alcohol addicts to-day can justly claim that they have become so through the minis- 
trations of the medical profession. In so far as the use of tobacco is concerned, the 
medical profession is entirely innocent, as tobacco is rarely, if ever, used as a medicine. 

The drug habit is usually the result of imitation — ^in other words, of example. If 
parents use a drug at home the children fall into the same habit. It is rather embar- 
rassiog to explain to the child that father or mother may use wine, or whisky, or 
brandy, but the child must not. It is equally difficult to explain why the grown per- 
sons of the family may use tea and coffee and the children are denied this privilege. 
The child learns from his parents. He imitates his parents. He wants to act as they 
do. He makes the same motions with his body as itxey make. He learns to walk as 
they do and to talk as they do, and naturally he learns (o eat and drink as they do. 
But every child who has been properly taught to avoid tobacco, when he grows to be 
a schoolboy or a freshnum is very likely to think it more or less manly to use tobacco. 
How many boys have been led astray by this false idea of what manliness consists of. 
If a classmate uses tobacco his chum is likely to indulge in the same practice. 

Fortunately in many States the use of tobacco, especially cigarettes, by minors is 
an offense against the law. In many colleges and imiversities, idso, the use of tobacco 
is discouraged. But nevertheless the use of tobacco is not in any way regarded as a 
social crime. In fact, it is looked upon as an indispensable adjimct of social affairs. 
When the dinner is over the men retire to the smoking room. In so far as equal rights 
are concerned there is no reason why the women should not do the same inst^wd of 
going to the gossip room. That men should segregate themselves when they smoke is 
a silent tribute to the other sex. Otherwise there would be no reasonable excuse for 
segregation. Often young women encourage their admirers to smoke. In all these 
ways the tobacco habit is encouraged. 

In this country, at least, the use of alcohol is, as a rule, discouraged by all persons, 
except at dinners. The youth of the country are not by any means so obnoxious to 
the acquirement of the alcohol habit as they were in former years. More and more 
restrictions of a legal nature against the use of alcoholic beverages are coming into 

68486— 17— VOL ix 1 1 



148 PBOCEEDINGS SECOND PAN AMEBIOAN SCDENTIPIO C0NGBE6S. 

vogue. The area of prohibition is constantly expanding. The social protest against 
the use of alcoholic beverages is growing stronger. The propaganda for prohibition is 
becoming more widely spread, and all of these forces are tending to repress the 
communication and spread of the habit. 

In regard to the more })otent drugs, such as opium and coca and their derivatives, 
the restrictive legislation is more effective. Not only is there State and municipal 
regulation of the traffic, but now we have a national law which, while far from per- 
fect, is doing much to curb the possibilities of the acquirement of the habit of using 
these two drugs. One of the chief faults of these restrictive laws is the concession 
which is made to almost all of them of the use of certain minimum quantities without 
restriction. There is no question of the fact that the insertion of such proviso in 
National and State laws is a mere concession to Mammon, which was secured by a 
desire to placate the dealers in these drugs. If one can secure with impunity a pre- 
scription containing a small amount of opium or coca or their derivatives, he has only 
to make arrangements to get a sufficient number of doses to secure the effect which 
he is seeking. The regulatory laws applying to commerce in these articles should 
extend to even the minimum quantities which are employed in ordinary medi- 
cation. In point of fact, the administration of any of the derivatives of opium or of 
coca should be surrounded by the strictest safeguards. There are so many other ways 
of relieving pain which are not likely to form the habit that the physician should 
hesitate a long while before either morphine or cocaine is employed. It is a re- 
sponsibility which should affect the conscience of the physician keenly, and which 
in no way should be subjected to evasion. 

It is difficult to make a census of the number of drug addicts in the United States. 
In most cases the victims of the drug habit are thoroughly ashamed of their pitiable 
condition. No one, as far as I know, is proud of the fact that he is a drunkard. No 
one that I know boasts of the fact that he takes morphine or cocaine daily. No one is 
proud of the fact that he uses tobacco. No one boasts of the fact that he could not 
live without coffee, tea, or coca cola. The progress in ethical culture and in manli- 
ness and womanliness of conduct have driven drug addicts to cover and made it more 
or lees a stigma to be known as such. Thus, any attempted census of the number of 
addicts must be more or less difficult to make. 

Commissioner of Health Lucius P. Brown, of Teimessee, made a very extensive 
study of the probable number of drug addicts in that State, and he found that there 
were registered in Tennessee in harmony with the provisions of the antinarcotic law 
of that State 2,370 persons of all ages and colors, of whom 33.1 per cent were males and 
66.9 per cent females. This was a census of those persons only who used opium or 
cocaine or their derivatives. 

Dr. Martin I. Wilbert, of the Public Health Service, has contributed an interesting 
and valuable document on this point. In a pamphlet entitled ' ' The number and kind 
of drug addicts, '' basing his computation on the data obtained by Dr. Brown, he esti- 
mates that in the United States there are 118,000 drug habitu^ of opium and cocaine, 
consuming approximately 1,416,000,000 doses per year. Including the illegitimate, 
that is, illegal, use of narcotics, at a certain estimated ratio over those declared, Wilbert 
finds that there are not more than 187,000 users of opium and its derivatives in all 
parts of the United States, and he adds that there are probably 150,000 cocaine addicts 
in the United States, making a total of something over 300,000 of both kinds of victims 
in this country. The committee of the American Pharmaceutical Association esti- 
mates that in this country the total number of victims of opium and cocaine are not 
much in excess of 200,000, and Wilbert is of the opinion that this is a figure that is more 
nearly correct than that based upon the data gathered in Tennessee. 

One of the principal objections to the enforcement of the Federal antinarcotic law, 
known as the Harrison law, was an appeal to sympathy for addicts suddenly deprived 
of their daily dope. While it is true that there may be some intense suffering, as with 
the delirium tremens after a debauch of alcohol, it is better, in my opinion, to let a few 



PX7BU0 HEALTH AJSTD MEDICINE. 149 

victims suffer acutely rather than to threaten the whole mass of the people with dis- 
aster. Wilbert quotes from the coroner's chemist of Cook County, as reported in the 
journal of the American Medical Association, that during the month of March, 1915, 
seven deaths occurred in Cook County that were indirectly due to the sudden cessation 
of the use of morphine. Four died from taking an overdose of morphine. One of 
them died from a dose of Dr. Wetherby's Remedy, a morphine cure containing over 
17 grains of morphine sulphate per ounce. 

Wilbert has collected data, also, relating to the origin of drug addition, particularly 
that drug addiction of opium and cocaine, and quotes from Dr. Teny, the health officer 
of JacksonviUe, Fla., in the Journal of Public Health for 1914, that 54.6 per cent of 
morphine victims came from the use of physicians' prescriptions or similar prescrip- 
tions administered personally; that 21.6 per cent acquired the habit through the 
advice of acquaintances who were, for the most part, themselves drug addicts; through 
dissipation and evil companions, 21.2 per cent; through chronic and incurable disease,. 
2.4 per cent. These conclusions of Terry agree very well with those found by Dr. 
Brown, of Tennessee, who is of the opinion that from 90 to 95 per cent of the persons 
habitually using narcotics never have had and never would have any necessity for 
their use. 

It is of interest to inquire how long it is necessary to use a drug of this kind, especially 
opium or morphine, in order to acquire the habit. There is no possible way of defi- 
nitely answering this question, because it is more a personal factor than it is a factor 
of the drug itself. Some persons would acquire the habit after a few days of use, while 
others mig^t use the drug for a month, two months, or three months, without acquiring 
the habit. It is of little utility, therefore, to discuss this point, as the only safety liea 
in abstention. 

From what has been said above the means of preventing the drug habit are apparent. 
First of all, education. Education, not of the drug addict but of the people at large, 
and this education must begin at the bottom and not at the top. Children must be 
instructed from the very beginning of their career in regard to the dangers of drugs 
of this kind. Parents are under obligations to protect their children, by a proper 
instruction and example, from these dangers. The school is the next place where 
this instruction should be continued. The school teachers of the country should be 
thoroughly acquainted with the facts relating to the acquirement of these habits and 
the dangers of acquiring them. Regular instruction should be given in our schools 
respecting the desirability of refraining from the use of alcohol in any of its forms, 
tobacco, opium, cocaine, tea, coffee, and synthetic drinks, such as coca cola, con- 
taining caffein. 

I believe more in education than I do in legal restriction. I must confess, however, 
that l^;al restriction seems necessary in respect of some of the more dangerous drugs. 
In other words, I would fiivor rigid control of traffic in alcoholic beveragCNs, in opium 
and its derivatives, and in coca leaves and their derivatives. I would not be in &vor 
of any restrictive legLslation respecting tobacco and tea and coffee, except in so far 
as children are concerned. I would, however, apply very restrictive legislation to 
all synthetic drinks or preparations containing any of these habit-forming drugs. 
The natural articles might go, as fiur as grown people are concerned, without regula- 
tion, but the synthetic articles should be rigidly forbidden. What advantage is it 
to the parent, for instance, who teaches his children at home not to drink tea or cof- 
fee, while they go to the drug store and buy a synthetic beverage, which contains 
the very element, caffein, which the parents are guarding their children against? 

Drs. Fisher and Fiak say in their new book ''How to Live, ** page 65: 

Among the poisons which must be kept out of the body should be mentioned habit- 
forming drugs, such as opium, morphine, cocain, heroin, chloral, acetanilid, alcohol, 
caffein, and nicotin. The best rule for those who wish to attain the highest physical 
and mental efficiency ia total abstinence from all substances which contain poisons 
including spirits, wine, beer, tobacco, many much-advertised patent drinks served 



150 PBOGEEDINGS SECOND PAN AMBBICAN SCIENTIFIC CONQBBSSw 

9Li Boda-water fountaiBs, most patent medicines, and even coffee and tea. Many eo- 
called patent or proprietary medicines contain habit-forming drugs, especiall^r mor- 
phine, coal-tar preparations, caffein, and alcohol, and depend lately for their sale 
upon the effects of these harmful substances. 

In a recent article in Good Housekeeping Magazine on the dangers of the use of 
tobacco I say: 

While tobacco, next to alcohol, is the most generally used narcotic or sedative, it 
stands on an entirely different jplane from that occupied by alcohol, opium, cocain, 
and other dangerous and seductive drugs. As has been indicated in the preceding 
sections, the use of tobacco is popular and does not yet generally offend tne public 
taste. To be sure, its use is surrounded with restrictions which ought at least to call 
the attention of the people to the fact that there is something wrong with it. From 
the ethical point of view this condition is, of course, restrictive, but from a moral 
point of view the use of tobacco is practicall>r unhindered. The man who indulges 
to excess in alcoholic beverages loses, to a certain extent, his standing in a community, 
but from a moral point of view the character of the smoker still stands untouched. 
As long as ministers of the Gospel, school UAchen, business men, captains of industry, 
women leaders of high society, and young girls, continue to promote and encourage 
the use of tobacco, tne habit will not be regarded as a moral obliquity. The readers 
of Good Housekeeping ought to consider tne promiety of consistently discouraging 
such an expensive, useless, and dangerous habit. Their boys and girls should be tola 
the truth about tooacco and the havoc it works. They should be taught by precept 
and example that it is not manly or womanly to use it. If it were manly to use 
tobacco it certainly would be womanly, and yet 90 per cent of the readers of Good 
Housekeeping would be horrified to think of the use of tobacco becoming as general 
among girls and women as it is among boys and men. Let us take care that no such 
condition arises. Let us, by precept and example, discourage the tobacco habit. 
Let us encourage our formers to plant a less acreage of tobacco and a greater acreage 
of potatoes. 

Many pathetic letters are received from wives and mothers asking for a *' tobacco 
cure,'' that the habit may be vanquished merely by dosing, without any effort or 
self-denial or duffering on the part of the habitu^. There is no such cure known, 
though tonics, restraint, and certain drugs mav be used under observation to assist 
the patient if he is ready to cooperate. But the patent medicine man who sends a 
secret preparation, and at long distance guarantees a "cure" is only indulging 
false promises of his kind. Strength of will can not be supplied from a bottle or a piU 
box. The football player lays aside his cigar, pipe, or cigarette, aided only by a 
nourishing diet, fresn air, exercise, and an overwiielming desire to throw aside every 
handicap that he may ''make good " and win the game. Surely any sensible boy or 
man, when once convinced of the dangers of the habit and the physical and mental 
handicap that it represents, would and could make an equal effort to ''make good" 
in the race of life. 

I appeal to the mothers of the country. Consider the following facta concerning 
the boy who uses tobacco: 

1. He will acquire a habit which will bring him into sympathetic associations 
with the boys who are going to the bad. 

2. He wi^l be a dave to a habit which s^egates him bom the decent crowd of 
travelers and spectators. 

3. He will join the procession that is made up of maichers with hesitating stepa, 
shaky hands, and palpitating hearts. 

4. He will unfit himself for athletic sports and high attainments in his studies. 

5. He will weaken his resistance to disease and fall an easy victim to infection. 

6. He will exclude himself from many activities leading to higher pay and 
preferment. 

7. He will waste large sums of money while doing himself lasting and even fatal 
injury. 

8. He will more readily become a victim of alcohol, cocain, opium, and other 
narcotic drugs. 

9. He will mar the efficiency of his work. 
10^ He will shorten his life. 

11. His presence will disclose itself to the nostrils of the next. 

12. He will finally become a slave to tobacco and other kindred masters of misery. 



PUBLIO HEALTH AUD MEDICINE. 151 

OS FUMADORES DE MACONHA: EFFETTOS E MALES DO VICIO. 

Por RODRIGUES DORLA, 

Pn^titor de Medkma Publica da Faeuldade de Direito e ecUhedratico, em dUponUnlidade, 

da Faeuldadt d$ Medicina da BaJaa. 

Actnelkment dans la plupait a«i pays da monde, l1iomm«, & qaelqa* rang de la 8ocl6t6 qa'll appartf- 

% ime, lalt usage poor sa sstisfliotlon penoaelle deoartaliMs substances tozlqnee, particolttrement excitant es 

poor son systime nsTYeox. Get osaca remomte aax #poqoss les plus recnlto, se perp^tue de cto^ratton 

•D gfodcation en se transfonnant parfois soiTSiLt les caprices de la mode, et va soavent jasqo' k Tabos 

occasionnant abfs les troables les plos vari^ oomme ftinnes et oomme intensity.— Dr. Roger Dapoay, 

08 Ghlnezes, venddos em 1842 peloe Inglezea, tiveram de se submetter & ganancia 
commercial doe brancoe civiliaados, que oe obrigaram a abiir de novo oe seus portoB 
e conaentir na importa9^ do opio, que tanto tern estragado e deteriorado a milhOee 
de filhoB do Celeste Imperio. O vicio de fumar a dnSga n&o ficou, porem, limitado 
Aquelles povoe oiientaes; acompanhou oe uBurarios deese commercio nefasto, e hoje 
faz as suas devastagOes em varios paizes da Europa, eepedalmente na Inglaterra e na 
Franga, onde se encontram em maior profusfto as casas de fumar o chandoo ou o dro$s. 
"£ o vencido que se vinga do seu vencedor/' diz o professor E. Rdgis, no Prefacio 
do Les Opiomanu do Dr. Roger Dupouy, ''inoculando-lbe sua perigosa paiz&o atavica, 
o que Brunei soube com propiiedade chamar uma avaria Extreme Oriented' 

Outrotanto podemoe tambem dizer: os nossoe antepassados, avidos de lucre, fizeram 
o baizo trafico da came humana, no comego da noesa formal, at6 1851, quando foi 
decretada a prohibiyfto de importar oe pretos afrlcanos, airebatados i, fruig&o selvagem 
das suas terras, paia serem aqui vendidoe, como escravos, que as leis assim os recon- 
hedam. Em 13 de Maio de 1888, por entre alegrias e festas, foi promulgada a lei 
que aboliu a escravid&o no Brazil e integrada a nacionaUdade com oe libertados, tor- 
nados ddadftoe; mas no paiz ]& estavam inoculados varios prejuizos e males da exe- 
cravel instituig&o, difficeis de extenninar. Dentre esses males que acompanharam 
a laga subjugada, e como um castigo pela usurpa^So do que mais precioso tem o ho- 
mem — a sua liberdade — ^noe ficou o vido pemidoso e degeneiativo de fumar as sum- 
midades floiidas da planta aqui denominada ^uTno d'Angolaj maconha e dianiba, e 
ainda, per comipgfio, Itamba^ ou riamba, 

A palavra/uTito, que quer dizer propriamente os gazes mais ou menos densos que 
se desprendem dos corpos em combustfto, substituiu no Brazil, quer no commerdo, 
qu^ em outras rela^des, o vocabulo tabaco para designar a nicotiana tabacum, seja 
a planta viva, sejam as folhas prepaiadas para serem fumadas, como quando sfto 
enxoladas em corda, ou dispostas em mandcas — expressiLo brazileira dada aos m<Slhos 
(manojos) de folhas propiias para a confec$&o dos charutos. A analogia do uso das 
folhas da diamba e da nicoclana certamente determinou a denominagSo de fumo 
d' Angola, derivada ainda dessa parte da Africa occidental, poesessfto portugueza, 
donde naturalmente nos vdo a planta. Por este nome ouvi muita vez cluuaaar o 
vegetal em Sezgipe e Alagoas, nas margens do no S. Francisco. 

Nos dicdonaiios da lingua portugueza de Adolpho Coelho, Aulete, Silva Bastos e 
outros, 16-se que a palavra ''liamba," o mesmo que pangoy indica herva do Brazil, 
da familia das myrtaceas {cannahie eativa indica), "de cujas folhas, diz Moraes, os 
nogios usam como tabaco, que fumam em cachimbos, e Ihes produz o effeito pemidoso 
do opio; por isso foi em tempo a sua venda prohibida por posturas municipaes da 
Camara da Cidade do Rio de Janeiro; tambem Ihe chamam liamba e riamba." ^ 

1 Postnrss da Camara Mtmtcfpal do Rio de Janeiro, Seccfto Prlmeln. Sande Pnblica, Tit. 2*. Sobre 
▼SDdad«geDfnMer«medto0,esobrebotloarlo«.|7*. Hepn»bibidaaTendaeonsodoPtodoFango,bem 
oomo a aonserraoio della em oasas pohUoas: os oontraventorcs sario maltadot, a saber, o Tendedor em 
donoo, e OS csof»Tos, e mais pessoas qne delle nsarem, em 8 dias de Cadte. Paco da Camara Manicipal do 
Rio ds Janeiro em sessfto de 4 de OntnbrodelSSO. O Presldente, Bento d§ Olivtira BroifatJoatiUm Jwk 
SOm, Antonio JoU Bibeiro ia Cunka, Jotto J99I ia Cunha, flenri^iM Joti dt Anmfo. 



152 PBOCEEDINGS SECOND PAN AMEBIC AN SCIENTIFIC CONGBESS. 

A planta nSo 6 entretanto brazileira, como penaam os primeiios lexicographos 
citados, e informam alguns fumadores, que dizem fdra priinitivamente usada peloa 
indioB. Minha atten^&o foi chamada para a maconha, e seu uao no Brazil, depois 
da leitura de um trecho da obra de Bentley — A manual of botany — ^ao quflJ, tratando 
da familia das Caimabinaceas, e referindo-ee d Cannabis saHva, e a sua vaiiedade 
indica, diz o autor: '^Esta planta i iguaknente conhecida sob o nome de liamba, 
na Africa occidental, onde ^ empregada para fins intoxicantes sob oe nomes de inacofniia^ 
ou maJdah.^* Conseguintemente, o facto de ser o vegetal laigamente usado pelos 
pretoe africanos, nas antigas provincias, hoje Estados, onde elles abundavam, a 
parldade doe nomes que aqui soffreu ligelra modifica^&o, mudanga apenas de uma 
letra — ^maconha, llamba ou riamba — e o appellido de fumo d' Angola, indicam bem 
a sua importapSU) africana. Em 1910, quando estive na presidencia do Estado de 
Seigipe, pude fazer a identifica^ da maconha com o canhamo, cultivando alii a 
planta com sementes adquiridas nas margens do no S. Francisco. 

£ principalmente no norte do Brazil onde sei achar-se o vlcio de fumar a maconha 
mais espalhado, produzindo estragos individuaes, e dando por vezes lugar a graves 
consequencias criminosas. Nessa parte do palz, primeiramente se desenvolveu a 
lavoura da canna de assucar, e foi grande a importacSo de escravos, que mais tarde, com 
o augmento grandemente remunerador do plantio do caf6, nas provincias de S. 
Paulo e Rio de Janeiro, eram vendidos para o sul. Os Indies amansados aprenderam a 
usar da maconha, vlcio a que se entregam com paix&o, como fazem a outros vicios, 
como do alcool, tomando-se habito inveterado. Fumam tambem os mestizos, e 6 
nas camadas mais baixas que predomina o seu uso, pouco ou quasi n9o conhecido 
na parte mais educada e civilisada da sociedade brazileira. ''Na Africa, diz Charles 
Eloy (Diccionaire encyclop^dique des sciences m^cales, artigo Haschich)^ das 
maigens do Mediterraneo at^ o Cabo da Bda Esperan^a, 6 vulgar o emprego da cannabis 
indica, e nas diversas partes da Asia mais de duzentos milh5es de homens s&o escravos 
deste habito.'' A esse numero pode-se accrescentar o de centenas, ou antes, de 
milhares de brazileiros. 

A Africa j& havia recebido a planta da Asia, onde nasce espontaneamente ao p^ daa 
montanhas al^m do lago Baikal, e em outros si ties, e com a qual preparam o hasckieh. 
Taes sao os sens effeitos pemiciosos, que delle deriva a palavra assassinOy vinda do 
arabe hachich, ou p6 das folhas do canhamo, com que elle 6 preparado (Adolpho 
Coelho) . O Dlccionario da lingua ingleza de Webster consigna esta mesma etymologla. 
Conta-se que na idade media, entre 1090 e 1260, oe principes do libano, especialmente 
Hassam-ben-Sabak Homairi, appellidado o VeUio da Montanha, fazia os seus soldados 
usarem a planta, para fanatizal-os, e, com furor, assassinarem os inimigos, e a legenda 
chamou-o principe dos haschischinos. 

O cultivo da maconha, ou do canhamo, entre n6s, n§,o 6 largamente espalhado, por 
n&o ser aqui utilisada a liamba na industria das fibras textis, e somente empregada 
como planta da/eliddade, causando as delicias dos que a fumam pelo extasis em que 
entram. Esse cultivo ^ acompanhado de praticas fetichistas, que bem fazem lembrar 
a celebrada mandragora da antiguidade. Os mysteries que cercam os cuidados com 
a planta concorrem para Ihe dsir mais valor, exalgar as suas virtudes, excitando a 
imagina^&o dos ignorantes, suggestionando-os. Os mens collegas e amigos Drs. 
Aristides Fontes, clinico em Aracajd, e Xavier do Monte, em Proprid, attendendo 
bondosamente as minhas solicita^Oes, fizeram em Sergipe, nas suas respectivas cidades 
inqueritos, que muito me v&o auxiliar na confec^o deste ligeiro e despretendoso 
trabalho. 

A planta, da familia das cannabinaceaSj 6 herbacea, annual, attingindo em Sergipe, 
como verifiquei, um metro e meio mais ou menos de altura, dioica, com folhas inferi- 
ores oppoetas, e altemas as superiores, estipuladas, de limbo profundamente fendido, 
com 5 e 7 lobulos, de bordas serrilhadas. A inflorescencia feminina ^ em espigas 
compoetas; as flores bSlo r^^ulares, na axilla de uma bractea persistente, que envolve 



PUBLIC HEALTH AND MEDICINE. 153 

o fructo, qual 4 um ftchenio, amarello escuro, com venula^des claras. As infloreso 
cencias masculinas a&o em cacho6 de cymoe. As inflorescenclas occupan 06 verticee 
dashaates. 

Dizem oe cultivador^s que o vegetal macho n&o attiDge o creecimento, nem tem a 
abundaDcia de ramificag&o da planta f emea, e s&o mais delgados os seus ramos. Isto 
talvez devido aoe culdadoe maloree que teem com a femea, empr^gada de preferencia 
em todoe os mysteres, excepto, na medicina popular, quando dfto em infus&o contra 
as colicas uterinas. Somente neste caso recommendam as mfloresceucias e folhas da 
planta TnaKulirM. 

E* sem a menor duvida o vegetal cultivado e usado no Brazil sob a denomina^fto de 
maconha, fumo d' Angola e diamba, nada mais do que o canhamo — Canndbii aativa, ou 
a sua vaiiedade indica, que nos paizes quentes adquire propriedadee mais activas e 
eneigicas, e com a qual os asiaticos preparam o haschich e outras misturas, e cujas 
folhas, colhldas na ^pocha da florag^, e deseccadas, s&o por elles fumadas, sob a de- 
nominagao de gunjah. 

Quando a planta attinge certo desenvolvimento, e tende a seramificar, procedem ao 
procesBo da capagaOf que consiste emcortar o olho ou o rebento terminal, para provocar 
o desenvolvimento de olhos lateraes, e, portanto, produzir maior ramifica^o, i, semel- 
han^a do que fazem os cultivadores da nicociana. 

Essa operayfto, effectuada no segundo mez da v^eta^fio, nfto deve ser feita em 
preeenga de mulheres, que n&o podem tocar o vegetal, principalmente em occaaifio 
das regras, pois faz machear a planta, isto 6, esta produziri inflorencias masculinas 
que 8&0 as menos apreciadas. Essa lenda a reapeito da mulher menstniada 6 bem 
velha, e j^ Plinio, o Antigo, dizia que t&o violenta era a toxicidade do sangue menstrual 
que o seu contacto, ou mesmo o seu vapor, podia azedar o vinho, tornar estereis as 
sementes, queimar as plantas novas, matar os enxertos, seccar os fructos, e diversas 
coisas mais. Durante a opera^ feita sobre o fumo d' Angola, o operador deve ter 
o cuidado de n&o dizer obscenidades, nem assoviar,* o que commumente fazem os 
lavradores durante o trabalho do campo, porque dar-se-iam os meamos resultados que 
a ^pproximap&o ou o contacto de uma mulher durante o catamenio. 

A colheita se faz na matuiidade da planta, e sfto usadas de preferencia, ou quasi 
excluaivamente, as inflorencencias femininas, com os envolucros floraes e brae teas. 
Essas partes s&o deseccadas & sombra, expostas a correntes de ar, e depois algumas noites 
ao rdento para receberem o serdno e ficarem curtidaa, ou sofErerem fermenta^So, 
o que as toma, dizem, mais agradaveis ao fumar, modificando esse processo a acridez 
da planta e abolindo as suas propriedadee nauseabundas. 

A maconha 6 ordinariamente fumada pura, ou mlsturada is vezes ao fumo — nicoc- 
iana — em cigarros, cujo envolucro ^ feito de bracteas de milho (Zea mats) das mais 
centraes, por serem mais delgadas e macias, ou em cachimbos, depois de separadoe 
08 fructos, o que fazem coUocando as inflorescencias na palma de uma mfto e com a 
outra imprimindo um movimento rotatorio sobre a massa. fomilho do cachimbo 6 
na maioria dos casos de barro, grosseiramente confeccionado, e ennegrecido, depois 
de cosido, com a fuma^ de certos vegetaes resinosos, que os toma luzidios exterior- 
mente. Nas maigens do rio de S. Francisco fazem tambem o cachimbo de pedra. 
A capacidade do fomilho 6 igual a dos cachimbos communs de gdflso, ou de espuma, 
ao qual 6 adaptado um tubo de desprendimento da fumaga, feito de madeira. Esco- 
Ihem para isto ramos de um vegetal a que donominam canwdeiro^ pan de cacMrnbo ou 
cantido d* pita, Carpotroche braziliensis Endl, Bixaceoi, em virtude de ter o caule 
fistuloeo e do mesmo diametro em grande extensSk). Com um fui&o aquecido ao rubro 
removem os restos da medulla, e ds vezes enfeitam-nos toscamente com anneis e 
riscos, extedormente, feitos a fdgo (pyrogravura). Alguns servem-se tambem dos 
ramos da coirana, Cestrum laevigatumj Schlecht, da familia das solanaceas. Para 
mitigar a ac9Sko irritante da fumada que provoca tosse, e ds vezes faz espirrar, adaptam 
o cachimbo a um dispositive, em imita/^ ao cachimbo turco, e pelo qual a fumada 6 



154 PBOCEEDINGS SECOND PAN AMEKICAN SCIENTIPIO CONGRESS. 

lavada, deixando n'^ua, segundo dizem os fximantefl, o sairo, e ficando mais fresca, 
agradavel, aromatica (?) e activa. Esse dispoeitivo conBist<e em uma ^arrala com- 
mum, ou em ama cabala, que 6 o fructo de uma cucurbitacea, Lagenaria vulgaris, do 
qual extrahem as sementes e a pdlpa por um furo no ponto da insert do pedunculo. 
Esse fructo tem a perspectiva de 8, sendo o bdjo inferior muito maior do que o superior. 
Chamam-n*o tambem grogold, nome proveniente de grogoHy que quer dizor "vaso 
cheio d'agua em que se immerge o tubo doe cachimbos para resfriar o fumo" (SOva 
Bastos, Dice, portugriez). Oomo se vd dos desenhos, introduzem o tubo do cachimbo, 
que tem uns 30 centimetros, mais ou menos, pela boccadagarrafa, at^ mergulbar na 
agua, que em certa por^fto 08t& no interior. Este 6 o dispositivo mais rudimentar, e 
fumam applicando os labios directamente sobre a bocca da garraf a que nSo fica de todo 
obturada, e onde chupam, precisando um certo exercicio para conmguirem appirar 
bem a fumaga. Uma dapla tubuladura, sendo um dos tubes curves para embocadura, 
}& 6 um aporfei^oamento. No dispositivo da caba^fazem um orificio no bdjo menor, 
onde collocam um x)equeno tubo de taquary, meroMtachys eUnusenif gramineas, onde 
chupam, puxam a fuma^, como se exprimem os praticantes. As vezes a^piram 
directamente, pondo os labios sobre a cabala. Esses cachimbos constituem um 
arremMo do narghileh ou cachimbo turco, usado nas casas de fumar o opio, ou nos 
bazares arabes onde se fuma o has(^ich. Ao cachimbo com o dispositivo da garraf a 
ou da cabala dSo, na giria dos fumantes (Aracajti), o nome de Marieas. Os mais 
refinados no vicio, fazem no tubo do caohimbo, na parte que fica fora da garrafa ou da 
cabala, um pequeno furo para se desprender um pouco da fumaga, que nfto foi lavada, e 
provocar espirros, irritando a pituitaria, e const«tumdo isto um epiphenomeno pootico 
do viclo. O Marieas 6 companheiro inseparavel dos canouiros e barcaceiros. E' 
tambem aproctado entre elles o borborinho que ao atravessar a agua produz a fiunaga 
sorvida em profundos e esfor^ados tragos. 

O uso do canhamo 6 muito antigo. Herodoto falla da embriaguez dos Scythas que 
respiravam e bebiam a decoc^fto dos giiU)s verdee do canhamo. No livro de Botanica 
do Dr. J. M. Caminhod, que foi professor desta materia na Faculdade de Medicina do 
Rio de Janeiro, Id-se qie o famoso revnedio das mulheres de DiospoUs, bem como o 
nepenthes de que falla Homcsro, e que Helena recebera de Polymnesio, era a cannabis 
indica. Os Cruzados viram os effeitos nos Musulmanos. Marco Polo observou nas 
cdrtes orientaes entre os emirs e os sultGes. E' muito usado no valle do Tigre e Enph- 
ratos, nas Indias, na Persia, no Tukerstan, na Asia Menor, no Egypto e em todo o 
litoral africano. Com o canhamo se prepara o haschich, como }& foi dito, e ainda 
pouco conhecido na sua manipula^; o povo do Oriente fuma o p6 das folhas e flores 
no narghileh. 

Entre as differentee mifftiiras em que entra a planta f ormando a sua base, e que tem 
nomee diversos, os mais usados ^k> o dawamec (da Arabia), o mapouehari (do Cairo), 
e o maoou (de Calcutd). Naquellas partes os hachahs, comedores, bebedores o fuma- 
dores, consomem o haschich em estabelecimentoe especiaes ou maseheehels, semel- 
hantes ia casas de fumar o opio. 

Entre n6s a planta ^ usada, como fomo, ou em infus&o, e entra na composi^fio de 
certas beberagens, empregadas peloe feiticeiros, em geral pretos africanos ou vdhos 
caboclos. Nos eandonibUs—feiBtaiS religiosas dos africanos, ou dos pretos creouloe, 
delles descendentes, e que Ihes herdaram os costumes e a f6, ^ empregada para pro- 
duzir hallucina;5es, e excitar os movimentos nas dansas selvagens dessas reunides 
barulhentas. Em Pemambuco a herva 6 fumada nos catimhds — ^lugares onde se fazem 
OS feiti^os, e sfto frequentados pelos que vfio alii procarar a sorte e a felicidade. Em 
Alagdas, nos sambas e batuques, que sfto dansas aprendidas dos pretos africanos, 
usam a planta, e tambem entre os que porfiam na eoleheia, o que entre o povo mstico 
consiste em dialogo rimado e cantado em que cada replica, quasi sempre em quadras, 
come^a pela deixa ou pelas ultimas palavras do contender. 



PUBUO HEALTH Ain> MSDIOINE. 155 

Disem que a maconha 00 toma mau espertos, e de inteUigencia mais prompta e 
feciinda para encontrar a ideia e achar a conaonancia. Vi algiimaw veses, quando 
aian^, naa feiras semanaet de PiopriA, minha tena natal, & noite, ao ceasar a veDdagem, 
individuos ee entreKarem & pratlcade fumar a herva nosdispoeitivMnisticoe j& deecrip- 
toe, do6 quaes muitoe ae aervem promiacuamente, aorvendo em hauatoa piofundoa a 
fumaiada apetedda, depoia do que entmva o deei^o ou o duello poedco; alguma ves 
a contenda tomava fei^&o diffeiente, e ezigia a interven^So da policia para apaziguar 
OS contendorea exaltadoa. £' fumada noa quarteia, naa i»iaOea, onde penetra is 
escondidaa; 6 fumada em agrupamentoe occasionaes ou em reunifles apropiiadaa e noa 
bofdeia. Muitos fumam iaoladamente 4 aemelhan^ do uao do tabaco. 

Oa aymptomaa apreaentadoa pela embiiaguez da nuux>nha aBo vaziaveia com a dose 
fumada, com a pioveniencia da planta, que pode conter maior quantidade doa prin- 
cipios activQs, com as anggeslCes, e prindpalmente com o temperamento individual. 
Um estado de bem eatar, de aatiafacgSo, de feliddade, de alegria ruidoaa tfo oa effeitoa 
nervoaoa predominaatea. £' ease eatado agradavel de euphoria que leva a maior 
parte doa habituadoa a procurar a planta, a cujo uao ae entregam com maia ou menoe 
afeno. Aa ideiaa ae tomam maia claraa e paoam com rapides deante do espiiito; 
OS embiiagadoB fallam demamadamente, dilo eatrepitoaaa gargalhadaa; agitamrae, 
danaam, pulam, caminham; mostram-ae amaveia, com expanaCea fhitemaea; v6em 
objectoa phantaatkoa, ou de accordo com aa ideiaa predominantea no individuo, ou 
com aa auggeatOea do memento. Dizem que a embriaguea da maconha mostra o 
inatincto do individuo, como ae attribue ao vinho--tn vino Veritas. Algumaa vesea 
dfto em beberagem para obterem a revela^ de aegtedoa. A eaae eatado aegue-ee ia 
veeea acunno calmo, viaitado por aonhoa delicioaoa. Ha na embriaguea da maconha 
o facto inteieaaante de, np6B a diaaipa^fto doa phemomenoa, lembrar-ae o padente de 
tudo o que ae paaaou durante a phaae do delirio. 

O Dr. Aiiatidea Fontea, que converaou com peacadorea habituadoa a uaar da maconh a, 
ouviu que, quando ae encontram no mar em cantea ou jangadaa, fumam em grupoa 
para ae aentxrem maia alegrea, diapoatoa ao trabalho, e menoa penoaamente vencerem o 
frio e aa agruraada vida domar. Den<Hninam auembUia a eaaa reuniSo, e come^am 
a aeoBo, fumando no cadiimbo Maneoi, no qua! cada um puxa a nta tragada^ 
na phraae por elles empregada, para ezprimir o eafor^o que exige o cachimbo toaco e 
a quantidade maior da fuma^ que procuram abacHver. Depoia de algumaa fumaradaa, 
tocadoa pelo effeito da maconha, tomam-ae alegrea, converaadorea, intimoa e amaveia 
na paleatra; una contam hiatoriaa; taea fasem veiaoa; outroa teem halludna^Oes 
agradav^ja, ouvem aona melodioaoa, como o canto da aereia, entidade muito em v6ga 
entre ellea. Um deana, cabodo, lobuato, de 43 annoe de idade, fumando a herva ha 
maia de vintie annoa, aem apreaentar perturba^fto da aaude, informou que a uaava, 
quando ae aentia triate, com telta de appetite e poucadiapoeiySo parao trabalho, prind- 
palmente & ndte, quando ia para a peacaria, ficando aatiafeito, diapoeto e podendo 
comer copioaamente. Dizem que fas ceaaaf aa caimbraa que ezperimentam ao entrar 
n'agua, & ndte. Ao Dr. Xaviw do Monte referiu L. 8., a quem conhe^o, homem de 
45 annoa de idade maia ou menoa, lobuato, que fumou a maconha, como experiencia, 
aentindo-ae alegre, achando gra^ em tudo, dando eatridentea gargalhadaa a todo 
propoaito, como um louco e tinha muita feme. Comeu deameauradamente, e ap6a 
ceeaou o delirio, entrando em aomno profundo e calmo. Dizem que o aanicar de canna 
faz ceaaarem oa phenomenoa da embriaguez. Alguna misturam-no com aa fdhaa no 
cachimbo. 

Xi Merat e de Lena aconaelhavam o uao do canhamo na hypocondria, na moroaidade 
e no apleen. 

B' tambemnotado portoda a parte eaae augmento de appetite, que faz empr^gar a 
planta como aperltivo, excepto noa iniciantea, que ia vezea teem nauaeaa e vomitoa. 
Kaempfen menciona a fome axmna como aymptoma do Juuekiekumo, appetite, 
porem, ae i>6rde e embota naa intoxica^Oea intenaaa e na forma chronica. 



156 PB00EEDIN6S SECOND PAK AMEBIOAK SOIENTIFIO 00NGKE88. 

yillazd, citado por Charlee Eloy, observou no Cairo, entre os fumadores do haschich 
easa erupgSo de al^gria retumbante, paliice, comgrandevolubilidade, gestoe rapidos e 
gaigalhadas. Notou que as hallucina^^Ses se relacionam, nas casas de himar a herva, 
com as figuras pintadas nas paredes, e que muita ves reflectem as ideias dominantes 
na pessda e d'ahi o estado de beatitude, de sena^Ges indiziveis de felicidade, de 
languidez, com crea^des imaginativas bizarras dos orientaes. 

Em uma nota do livro Les Ojnomanes, j& citado, se Id a seguiute desciipySo de Sachs: 

*'0 hcu^ich produz os effeitos seguintes: O ar se adelgaga e pazece center suaves 
perfumes. Tudo 6 bello e radioeo. Sente-se prazer em viver. Sob sua influencia 
fiz passeios soberbos; meu arrebatamento loi alem de toda expresB3k>. Sua influencia 
depende do temperamento de quem o usa. Faz alegiia; produz gaigalhadas pelo 
motive o mais futil. Exagera o appetite, toma eloqueAte, gracioeo, encantador. 
Sob sua influencia durante duas horas me exprimi em versos livres; as limas eram 
ricas e as ideias perfe&tamente sensatas e seguidas. Sens inconvenientes sao a sansag&o 
de um estrangulamento mais forte do que no opio, uma tinta livida, esverdinhada, uma 
fome que nada aplaca, algumas vezes deeejos sensuaes loucos, com requintes impos- 
siveis de sensualidade * * * a produ^fto de ataques epilepticos e p^urbagdes 
ataxicas." 

Nas experiencias de Villard, as ideias se succedem com rapidez, se contradizem, se 
entrechocam, as palavras se comprimem para exprimil-as, e toman-se incoherentes. 
O intoxicado ouve o murmurio de uma fonte, julga-se no meio do mar, transportado, 
embalado em um barco, ao lado de bellas mulheres; ora assiste a um f^ de artificio, 
tendo a cabe^ cercada de uma aureola brilhante, a brincar com os anjoe. Wood diz 
que para o haschichado a dura^o de um minuto representa um seculo, um estreito 
aposento alaigarse at^ a immensidade; transpde mares, continentee, atravessa os axes, 
seu espirito perde o sentimento da extensfto. 

O quadro symptomatico pode ser diverso. E' conheddo nos lugaies, onde abusam 
da maconha, o delirio, a loucura transitoria, e mesmo definitiva, causadas pela planta, 
e com phidionomia peiigosa. Os embriagadoe tomam-se rixosos, aggressivos, e vSo at^ 
& pratica de violencias e crimes, se nfto s&o contidos. Um trabalhador, paido, de 30 
annos, robusto, referiu ao Dr. Xavier do Monte ter fumado a maconha, como remedio 
para ddresde dentes, elogo sobrevieram-lhe suores fries e abundantes, lingua pesada, 
pegajosa, e delirio. Tudo o amedrontava, via-se perseguido pelo povo, sentia fome 
de voradora, e depois de ter comido uma por^fto de batatas doces e f arinha de mandioca, 
foi melhorando, at^ voltar ao estado normal. 

Do inquerito feito pelo Dr. Aristides Pontes, que 6 medico da Escola de ^rendizes 
Marinheiros de Aracajti, ouviu a um saigento da mesma escdla, c(»itando 28 annos 
de idade, que, quando aprendia na Escola de Macei6, aos 16 annos, vendo frequente- 
mente um preto velho airicano fumar a maconha no Marietu, experimentou a herva em 
cigano, sentindo-se logo tonto e vendo tudo gyrar ao redor de si. Por nuiis baixo que 
Ihe fallassem, ouvia as vozes em alta Itonalidade; tinha halludnagdes auditivas e 
visuaes, ouvia cantos de passaros, e via vagalumes no ar. Tinha a impressfio de que 
tudo ia cahir sobre elle e estendia os brakes para se amparar. Sentia as pemas pesadas, 
fatigadas, e a impressfto de que estava a subir uma ladeira; as ideias eram confusas. 
Adormeceu, e quatio horas depois despertou, sentindo apenas fome intensa, chegando a 
comer 6 paes de 200 granmias cada um. 

Um preto carregador, de 39 annos, de disposigSo alegre e risonha, fumou a maconha, 
e sentiu forte excitagSo, deu para pular, coner; depois dormiu, e sonhou coisas mara- 
vilhosas, paasando mais ou menos neste ultimo estado por dois dias. Diz ter melhorado 
de caimbras e ddres rheumaticas de que sofiEria. 

Easa incessante necesaidade de locomopfto 6 referida por Henri Cazin que diz tel-a 
visto seguida de prostra^ e sjmcope. 

Um magistrado de Seigipe referiu o facto de um seu estribeiro, rapaz de 16 annos, 
mais ou menos de modes humildes, o qual teve delirio furioso, aggressivo, tendo sido 



PUBLIC HEALTH AND MEDI0II91B. 157 

trancado em um quarto onde entrou em somno piofundo, do qual despertou, sentindo 
canaa^o e languidez. 

Relenu-me o pharmaceutico militar Gandido Coneia que, em Obidoe, no Estado 
do Paxd, onde estacionava o 40 batalh&o de artilharia, um aoldado, aliis de boa con- 
ducta, foi Bubmettido a concelho de gueixa, e sofEreu penas, por haver fumado a 
diamba, pela primeim vez, e entrado em deliiio furioeo, tentando matar um capit&o 
em cuja caaa entrou, armado de faca, tendo ferido uma outra peasoa. Tambem 
leferiu-me o pbaimaceutico Maffei, que funccionou na GommiaBfto nuHtar, a qual, 
nestes ultimoe tres annoe, tra^u ob limites entre Brazil e Venezuela, ter visto metter 
em camiaa de for^ doia soldados, em delirio fmioso, por haverem fumado a herva. 

Ob commandantes dos batalhOes, noB EatadoB do Norte, eSio for^adoa a terem uma 
grande vigilancia, para evitar que a maconha entre noa quarteia, pelaa conaequendaa 
deBaatroaaa, como br^aa, aggreasOea e Crimea. 

Em Penddo (Alagdaa) para evitar perturba^Oea que ae davam naa feiraa, aa autori- 
dadea policiaea, rigoroaamente, prohibiam a venda da nmconha. 

A loucura pode aer a conaequencia do uao da herva. Officiaea do 33 batalh&o de 
infantaria, que j^ eatacionou em Aracajti, releriiam que o aoldado Jo&o Baptiata, de 
30 annoa, moreno, entregavarae ao vicio de fumar a hamba, e tinha exalta^Oea megalo- 
maniacaa, dizendo-ae genial, Deua, etc.; deaenhava no paaseio do quartel navioa, 
noa quaea, em marea tempeatuoaoa, fazia longaa viagena. Uma vez tentou agredir 
um official, acabando na loucura que o fez ezduir do ezercito, aendo mettido em 
custodia. 

Utiliaam-ae is vezea da dioga oa aoldadoa que querem dar baiza, para aimular a 
loucura e illudir a inapec^ medica. 

"A aliena^ mental, eBcreve Charlea Eloy, & um doB phenomenoa terminaea do 
vicio. No Egypto, o numero de alienadoB augmentou paraUelamemente ao uao do 
Juuehich, e a loucura tem a f 6rma monomaniaca com hallucinates. 

No livro Le8 Opiomanea, j& citado, 16-ae que, ao contrario do que ae obaerva na 
intoxica^ pelo opio, em certaa fdnnaa do haachichiamo agudo, a embtiaguez 6 muito 
mala povoada de hallucinapdea, maia barulhenta, e Pouchet deacreveu-a do aeguinte 
modo: "Alguna individuoa aSo tomadoa de delirio furioao que obriga a amairal-oB, 
para p61-oa na impoadbiidade de offender; dfto gritoe efltridentea, reviram e quebram 
tudo o que ae acha a aeu alcance; tdm oa olhoa fixoa, a face injectada, a anestheaia 
completa. Os makioa e oa javaneaea chamam a eeae estado de furia Ajnoh, porque 
aasim gritam oa intoxicadoa: Amohl Amokf (mata! matat) *'Se ae inteirogar, diz 
Roger Dupouy, eBsea individuoa, ao aahirem de uma criae de amok, dizem que viam 
tigrea, javalia, veadoa, cftea, diaboa, que elles queriam matar. Etiologica e clinica- 
mente o amok deve aer imputado ao htuchich, e n&o ao opio. Ellea miaturam o can- 
hamo ao opio e, aegundo Jeanaelme, o bang, que 6 uma miatura de folhas e fructoa do 
canhamo, 6 no Oriente frequentemente aeaociado ao opio, e provoca uma agitagfto 
particultfmente violenta. Chang ou gunjah doa indioa, o esrar, o Hf doa arabea 
(extracto de canhamo deatinado a aer fumado), o ckira da Tuniaia, nfto afio outra coiaa 
aenSo preparadoB do haachiehf diz o meamo autor, destinadoa a aerem fumadoa; eSiO 
aa vezea miaturadoa ao opio, e aeua effeitoa e&o maia nocivoa." 

O uao da maconha, em d^eea moderadaa, eatimula a circular, augmenta o calor 
-penphedcOy e acalma oe gaatralgiaa, deapertando o appetite, e ezcita oa oigftoa da 
locomo^. Aa ddeee altaa, m6rmente noe novi^oe, produz nauaeaa, vomitoa, languidez 
peso noa membros. 

Sobre oa orgftoe aezuaea parece exercer uma ac^fto exdtadora, que pode levar a 
grande lubriddade. A maior parte doa fumadorea ouvidoa diBBeram que a herva 
corrige '^oa eatragoa da edade." Um aoldado contou ao Dr. A. Fontea que quando 
fumava a maconha aentia effeitoa aphrodiaiacoe, tinha aonhoa eroticoa, e pollu^dea 
noctumaa. Eaae effeito ae eetende ia mulherea. O Dr. Alexandre Freire, medico 
que exerceu a clinica em uma villa do interior de Seigipe, referiu ter viato uma mulher 



158 PROCEEDINGS SECOND PAN AMEBIOAN SCXENTIFIC CONGRESS. 

embriagada -peilsk maconlia de tal f6rma ezcitada que, no meio da nia, nfto moBtnuido 
o menor respeito ao pudor e fazendo exhibi^Oes, soUcitava oe tranaeunteB ao conunerdo 
interaexual. As prostitutas, que &b vezes ee d&o ao vicio, excitadas i)ela dnga^ 
quando fumam em eociedade, entregamHBO ao deboche com fuxor, e piaticam entre 
ellas tribadiamo ou amor leebico. Yillard viu em um bazar, no Oairo, mna mulher, 
que se fsaiA notar pelas excentiriddades, manileBtando umagrande exclta^So: roBto yet- 
melho, olhos brilhantee, cabellofl em desordem, ria-ee sem modvo e falava sem ceeBar, 
agitava-se fazia meneios, ia de um individuo a outro . . . com gnmde hilaridade 
da assembly e soltando de vez em quando um ah prolongado, que 00 arabee preeentes 
imitavam, e que entre elles 6 indido de uma profunda voluptuoiddade." 

O abueo da substanda tern effeito opposto; todaa as funccOes nervosas ae depiimem. 
Os inveterados e os insadaveis no vido podem entiar em um estado de cadiexia, que 
nfto permitte viver muito tempo. Emmagrecem rapida e considecavelmente, ad- 
quirem cdr terrea amarellada, dyspepsia gaatio-intestinal, physionomia tziste e 
abatida, depressSo de todas as func^aes, bronchites. Nesse estado quad s^oapre a 
morte sobrev^m em pouco tempo, e diz o povo hayer uma phtysica da maconha, de 
I6rma ag:uda e rapida, exterminando a vida em dois ou ties meaes. Nesse estado de 
nuuxmhitmo dironico, o vido 6 imperioso, dominante e tyrannioo. YiUard observou, 
noe bazares arabes, oe vidosos irreductiveis "acocorados a um canto, extranhos ao 
que all se paasava; rosto sombiio, olhos fixos, traces xepuchados, s6 despertando para 
de novo tomar o naighileh, onde aspuavam bruscamente alguns serves, pan em se- 
guida deixar cahir a cabeya pesada sobre os joelhos." Sahem um instante do torpor, 
olham embruteddos ao redor, e apenas respondem aos que os intenogam. Nesse 
estado perdem toda a aptidfto profissional e toda habilidade. Os nossos airulnados 
pelo vido voltam ao cadiimbo logo que se vae diasipando o deliiio, e deqMrtam do 
torpor. 

A embriaguez causada pela fuma^ da maconha pode-se estender a outiaa pessoas 
que nfto a fumam, e apenas respiiam o ar della impregnado. Gontounne o pharma- 
oeutico C. Correia, j& mendonado, ter vlsto em Obidos cahir em naroose a aenhcn de 
um medico militar, que se achava perto de um fumante na mesma sala. 

Sfto dtados os phenomenos de atordoamento e vertigens causadas pelas emana^Oes 
das culturas do canhamo, e que sfto fatvoreddoe por um sol ardente. Ftovavelmente 
sfto eff eitoe da canabina ou seu piindpio volatil que se derrama na atmosphera. 

Entre n6i este effdto nfto 6 mendonado em virtude de serem limitadaw as plantagOes 
do canhamo, somente com o fim de ser fumado, nfto se conhecendo a utilidade industiial 
das fibras do liber, devendo ali^ a actividade da planta, aqui pioduzida, ser giande. 
canhamo obtido na Inglateira, diz Beniley, varia tanto em actividade que nfto sfto 
certos OS sous effdtos, e por iaso nfto 4 muito empregado. Na Suecia nfto tern efidto 
embziagante, e na Russia os fructos, de albumen oleoso, s&o empiegados na alimenta^fto 
das aves, e mesmo do homem. 

Na medidna popular 6 entze n6i empcegada a maconha como fumo, e raramente em 
infusfto; 4 dada na asthma, onde alifts a tosse ptovocada pela fum^ga fsa reoeiar um 
uso mais extenso na molestia; nas perturfoagdes gastro-intestinaes, naa nevralgias, nas 
colicas uterinas, e finalmente como aphrodisiaoo. Pereira chama o ranhamo hilaci- 
ante, inebriante, fantamnagoiico, hypnotico ou sopoiifico, e estupefauaente ou narootioo, 
taes sfto OS effdtos multiples por elle pcoduzidos. 

Como devem ser ctmddeiados os actos praticados pelo individuo em estado de 
embiiaguez pela maconha, ou pelo canhamo? 

Qual o gr&o de imputabllidade que se Ihe attribuir, e, conseguintemente, a respoDsa- 
bilidade pelos crimes commettidos nesse estado? 

Qual a capacidade para exercer os actos da vida dvil? 

O codigo penal brazileiro, de referenda & responsabilidade, diz: 

Artigo 27 Nfto sfto criminosos: 
§ 4^^. Os que se acharem em estado de completa privagfto de sentidos e de intelligencia 
no acto de commetter o crime. 



PUBLIO HEALTH AKD MBDICINB. 159 

Ccnnquanto a redac^fto defeituosa deete paragrapho jd tivease dado occaflifto ao 
redactor do Codigo de dedarar que por um erro typographico figura a palavra sentido 
em ves de aeiiflo, (xmiprehendeee bem que a lei penal n&o pode tomar responflavel 
pelos crimes commettidoe aquelle que no memento da ac^&o ee acha em eetado de 
nSo conhecer o valor do acto praticado e mum conaequenciae, e nfto esteja em estado 
de liberdale de pratical-o, condi^($eB eesenciaes ao d6lo e & culpa. "Qualquer acto," 
diz o Prof. Ziino, "que esteja alem da esphera racional, volitiva e moral, n&o pode 
eer imputavelf e quem o pratica n&o 6 obrigado a responder por elle diante da jiuti^ 
doe tribuuaes. Crimen enim eonirahUur ti et voluntas nocendi inUreedat, Const. 1° 
ad. L. Comeliam de dear., 0. IX, 16; " ou como ensina Pellegrino Rossi, "1^ que o 
agente tenha podido conhecer a existencia do dever e a naturezado acto em si; 2^ que 
tenha comprdiendido que o seu acto tenha por indole violar o dever; 8® que seja livre 
de commettel-o, ou de se abater." 

AoB crimes praticados durante a embrii^ez pela diamba se devem applicar as 
disposipdes penaes relativas & embriaguez alcoolica — O estado de delirio produzido 
pela maconha coUocaoindividuo em um estado de loucura ou insania, que o priva da 
consdencia e da liberdade neceasarias & responsabilidade; mas pode-ee a respeito 
desta embriaguez raciocinar como o prof. Dr. Charles Merder acerca da embriaguez 
alcoolica. '*£' perigoeo admittir em absoluto a ezcusa da embriaguez na justifica^&o 
do crime; e quem voluntariamente bebe at^ o ponto de se tomar um perigo para a 
sociedade, deveria ser punido em toda a plenitude por qualquer offensa praticada 
no estado a que o reduziu o seu proprio abandono." O sentimento de justly, porem, 
se oppOe 4 puni^ sem as condi^Ges da imputabilidade acima referidas. A lei 
ingleza n&o admitte a embriaguez como escusa do crime; colloca-se, portanto, num 
dos extremes da quest&o, desde que por si b6 a embriaguez ji, 6 considerada um de- 
licto. A lei penal brazileira, sem deixar de admittir a excusa do que pratica um 
crime no estado de delirio que traga a aboliy&o da consciencia e da libenlade, qualquer 
que seja a causa, fez da embriaguez uma circumstanciaattenuante dos crimes, somen te 
quando ella 6 acddental, e nfto procurada para infundir coragem, ou 6 habitual e 
tuibulenta. 

O $ 10 do art. 42, que enumera as circumstandas attenuantes, assim resa: — "Ter 
o delinquente commettido o crime em estado de embriaguez incompleta, e n&o pro- 
curada como meio de o animar a commetter o crime nesse estado, n&o sendo acostumado 
a commetter crimes nesse estado." 

Esta disposi^ pode ser perieitamente applicada ao embriagado pela maconha. 

Relativamente aos actos da vida dvU a embriaguez aguda, transitoria, n&o justi- 
ficaria medidas de interdip&o, ali^ perieitamente applicadas & embriaguez chronica, 
tal como a descrev^u Villard. Todavia, o estado de euphoria que o individuo, n&o 
dominado e perturbado permanentemente pelo vicio, sente ao fumar a herva, pode 
conduzil-o, naa suas expans(tes, a praticar actos da vida civil, que Ihe tragam serias 
obriga^des, como contractos, doa^Oes, vendas, assignatura de letras, os quaes n&o 
deven subsistir, provado o estado em que se achava o individuo no memento de asBumir 
easas obriga^^tes, sendo at6 certo ponto comparavel esse estado ao da primeira phase, 
ou ao periodo medico legal da paraljrsia geral. 

O testemunho do individuo intoxicado pela maconha n&o pode ter valor. E' em- 
pregada peloa africanoa para obter dedara^Qea, confiaB(!iea, revela^Oea de aegredoa 
e abrandar rsaistendas em materia de amor (filtro). 

De que meios se pode lan^ar m&o para extinguir, ou dominar o vicio? 

Extzaordinaria 6 a fascinay&o que exercem as drogas estimulantes e narcoticas 
sobre o organismo humane, muito principalmente se o terrene est& preparado para o 
bom desenvolvimento do habito, se alguma tara degenerativa exists congenitamente, 
ou se vidos anteriores predispuzeram a economia a novos vidos; s&o frequentes as 
asBociagOea do aloooliamo com outroa vidos, e com o habito de fumar a maconha. 
Do inquerito a que tenho procedido a respeito do use de fumar as sunmiidades flori- 
daa da planta que faz o objecto deate trabalho, 6 elle muito disseminado entre pessdas 



160 PBOGEEDINGS 8EG0ND PAN AMEBICAH SOIENTIFIO C0NGBBS8. 

de baixa condi^, na maioria analphabetos, homens do campo, trabalhadoreB 
ruiaes, plantadores de arroz, nas margena do rio do S. Frandaco, canoeiros, peecadorea, 
e tambem noe quarteis pelos soldadoa, os quaes ainda entre n^ Bfto tiradoa da escoria 
da noesa sociedade. Todoe os soldados do exercito que estadonaram no Amasonaa,. 
Par^ Maranhfto, e nos outroe Estados do norte at^ Sergipe, mas principalmente noa 
primeiros mencionados, e com quern conveisei sobre o aasumpto, me dedararam ter 
visto fiunar a maconha, e os seus effeitos deleterioe. Varias pessdas l^m-n'a usado 
por munitos annos, modeiadamente, sem inconvenientes palpaveis, experimentando 
apenas a sensa^ de uma ligeira euphoria. SSLo os sobiiosi como os ha em relagfto 
ao alcool, que parcimoniosamente usado, pode at6 ser uma necessidade, no pensar 
do prof. Charles Mercier, para fazer desprender as energias latentes ap^ o e^gotamento 
das iadigas do dia, assim como faz o assucar que se ajunta 4b aguas gazozas, provo- 
cando novo desprendimento de addo carbonico. 

O systema nervoso, no seu aperfei9oamento evolutivo at6 o homem, parallelamente 
com as vantagens adquiridas, como uma intelligenda penelzante, senaibilidade 
apurada, tomou-ee maJs exigente pelos estimulantes, e por isso maisindinadoesujeito 
aos habitos pemidosos como o vido da morphina, da cocaina, do alcool, o toxico 
rei, ao qual Shakspeare achou mais apropriado o nome de diabo (devil), da nicodana, 
do canhamo, e outros. '^Em relag&o d moral/' diz W. A. HoUis, ''na, historia da 
vida dos animaes inferiores ha sem duvida muitas outras fei9dee, que seria vantajoeo 
copiar." Noe degenerados e tarados, nos descuidados, o habito se estabelece, e com o 
habito o embotamento do systema nervoso, que reclama novos e cada vez mais fortes 
estimulos, e conseguintemente maior ddse do veneno. 

"O gosto do homem pelos toxicos embriagantes, escreve o Prof. E. R^gis, querido 
ou instinctivo, 6, em todo o caso, tfto velho quanto o mundo." Sujeito 4s dores phy- 
sicpis, como todos os outros animaes, e ainda ia penas moraes, diz Botta, o homem se 
esforga por escapar a sua existencia real, e procura em um mundo imaginario a felid- 
dade fictida de seus insaciaveis desejoe. 

Na Penitenciaria de Aracajd, onde de alguns annos para c4 6 prohibida a entrada 
da mac(»iha, por causa dos disturbios por ella motivados entre preeos, os sentendadoa 
se entregavam ao habito de fum|d-a ''para alliviaarem o espirito acabrunhado pela 
prisfto, e terem por esse modo momentos de distracyfto e alegria." 

A ddr physica 6 muitas vezes a causa do vicio. As nevralgias dentarias, as ddres 
rheumaticus, as gastralgias, as colicas uterinas em estados dysmenorrheicos, deter- 
minam muitas vezes o empr^o da planta pelos seus effeitos narcoticos e analgesicos; 
e obtido o resultado benefico, nfio hesitam os padentes em voltar 4 herva em um se- 
gundo accesso, ou como preventivo, e dahi se gera com facilidade o habito e o vido 
de fumar a maconha. 

Os pezares sfto outra causa frequehte do vido: para esqueoer, embora transitoria- 
mente, incommodes moraes, suavisar a dureza de uma vida atribulada, e passar mo- 
mentos alegres, distrahidos, esperangosoe, acalentados na phantasia alacre que oe 
embala no espago, como as espiraes voltejantes do fumo traigceiro, os abandonados 
da sorte se entregam ao dominio da herva; se n4o 6 um forte, o naufragio 6 irremediavel, 
prindpalmente se 4 ddr moral e8t4 assodada a tara oiganica. 

A imitag&o 6 frequentemente uma causa do habito, especialmente nos jovens. 
Como na nicociana, de uso universal hoje, muitos se entregam ao vicio de fumar a 
maconha por ver fumar aos outros, que por sua vez influem aos inexperientes, con- 
tando-lhes com enthusiasmo os gozos ineffaveis e os prazeres encantadores que a herva 
proporciona. D4r6e coisa semelhante ao que se passa com o vicio do opio, somente 
aqui nSo s&o inatniidos e letrados os propagandistas, como os de que falla o Prof. E. 
R^gis, nos seguintes termos: ''Coisa curiosa, todo letrado que aspira os vapores da 
dr6ga (o opio) se julga na obrigagfto, sincera ou n&o, de glorificar publicamente o& 
seus encantos; todo fumante toma-se um tentador; por um requinte de volupia per- 
versa, esse pecador tem necessidade de arrastar outros em seu pecado." E um senti- 



PUBOO HEALTH AND MEDICINE. 161 

mento gend do homem nfto querer estar 86 na queda, e esse sendmento egoista se 
exprime bem no rifSo popular: "Mai de muitos consdlo 6" quando consdlo e satis- 
fa^So devem ser o bem de todos. 

O amor dos prazeres e da.sensualidade, uma vida indisciplinada e descuidosa, sempre 
avida de novas e extranhas 8en8a90ee, que ^ o apanagio dos gozadores e sybaristae 
conduz igualmente oe desregrados a procurarem no vicio a felicidade e os gozos, que 
aitificiaeB e passageiros Ihes causam o extasis produzido pela abeorp^fio da fuma^ da 
planta maravilhosa. 

TJma instruct bem dirigida, refcn^da por pzincipios de 6& moral, o conhedmento 
claro do mal, necessariamente revigoram e fortificam o animo para a reeistenda ao vicio 
de qualquer natureza: nfto obstante espiritoe luddoe, geniaes, instruidos, como T. de 
Quincey, Coleridge, Edgard Poe, Baudelaire, e outros, entregaram-ee ao uso do opio, 
que tanto exaltaram nas suas produ^Oes literarias. Becentemente se tem chamado a 
attengfto, na Fran^, para o vicio de f umar o opio, espantosamente disseminado, sendo 
as caeas de iumar a dr6ga frequentadas por pessoas de certa instruct, como oe officiaes 
da armada, noe portos de Toulon, Marseille, Brest, etc. Comquanto o uso de fumar a 
maconha, no Brazil, ainda esteja, como foi dito anteriormente, limitado is classes 
ignorantee, tenho noticia de alguns lumadores com um gr&o de instrucgfio regular, e 
de um funccionario publico, bastante intelligente, dominado pelo vicio. Como quer 
que seja, creio na instruc^o e na educagfio como bons preservativos do habito pemi- 
cioflo, incumbindo aoe x>oderes publicos melhor cuidarem deste magno problema, tfto 
descurado entre nds, onde o analphabetismo 6 a r^ra. 

A prohibi^fto do commercio da planta, preparada para ser {umada,puder4 restringir 
a sua dissemina^ progressiva . Sei que em alguns Estados do norte as violendas com- 
mettidas durante a embriaguez da maconha t^m levado as autoridades policiaes a 
probibir a vendagem da herva nas feiras. Em Penedo, segundo informa^des que me 
deram, essa prohibit tem dado resultados, quasi extinguindo as brigas provenientes 
da embriaguez pela maconha. 

A cura individual depende da capaddade revigorante do animo do vicioso e da 
disdplina de sua vontade, sem a qual nada se pode obter. A respdto deste vicio t^m 
perfdta applica^o as palavras de Lydston, com relagfto & embriaguez alcoolica. 
Exaltando a educa^ physica como elemento poderoso no tratamento da embriaguez, 
accrescenta: "o elemento peychlco deve ser sempre tomado em considera^fto, pois sem 
a sua cooperagfto todo tratamento 6 futil." 

£ 6 aasim que nada existe sobre a terra absolutamente bom ou abeolutamente m^: 
compete ao homem, no seu aperfei^oamento, utilizar-ee da primeira face, dominando e 
tomando inefficaz a segunda. Os dons da natureza podem se transformar em verda- 
deiras calamldades quando mal empregadoe. As mais notaveis e maravilhoeas desco- 
bertas do genio e do saber do homem, por maiores vantagens e proveito que possam trazer 
i especie, muita vez se tomam em anna destruidora'e fatal. No processo da evolu9&o 
nilo chegou ao homem a capaddade de voar, que parou em certoe reptis, no dragfto 
voador {Draco voUms), o qual, no dizer de W. A. HoUis, ''reteve a arte de deslizar 
atravez do ar.'' A vida de peixe por sua vez desapparece no momento em que a 
creatura humana se destaca do seio matemo para viver vida propria. ** E esse primor 
da arte que 6 o homem,'' na phrase immitavel e sublime do autor do Hamleto, ''nobre 
em sua razfto, infinito em suas faculdades, expressive e admiravel em sua for^ e em 
seus movimentos, semelhante ao anjo pela ac^fto, pelo pensamento semelhante a Deus," 
se corta oe ares nas azas dos seus inventos surprehendentes, fazendo a viagem das aguias, 
que perderam o dominio das alturas atmosphericae; ou quando corre debaixo das ondae, 
espantando oe peixes no seu viver aquatico; nem sempre estfto colhendo beneficioe ao 
bem estar de seus irmHos na superficie da terra: esses portentosos engenhos de seu in- 
comparavel talento, quaes sfto o dirigivel ou o aero-plano, e assim tambem o barco sub- 
marinho, est&o actualmente empr^ados exclusivamente no funesto mister da des- 



162 PBOCEEDINGS SSOOim PAlSr AMESIOAN SOIBITEIFIO C0NQBE88. 

tniicfto, da extennina^ do que os p6yoe europeus, empeahadoe na maior g;u6rra que 
jamais o muudo vio, t6m de mais esperan^oeo e forte. 

No terreno da therapeutica, oe resultadoe esplendenteB que fomece, nas m&os pru- 
dentes e praticas do medico, eesa gomma concreta das papoulas, — o opio — o rei da ddr, 
e sob cuja ac^fio marvilhosa cessam estes soffrimentos physicoe, que tanto perturbam o 
cuno das molestias, tern o seu reveno no habito nefasto de comer ou fumar a dr6ga. 
A cocaina, de recente descoberta, se causa estupenda admiral peloe sous efieitos 
analgesicos locaes, permittindo sem ddr a realiza^ de delicadas opera^Ges ciruigicas a 
que assiste, quasi como um extranho, o proprio padente, tem-ee tornado entre os povoe 
civilisados e nevrosthenicoe um flagelo. 

E quanto se poderia dizer do mais antigo talvez doe vicios, da intozica^So por ex- 
cellenda, da embriaguez alcoolical 

A raga preta, selvagem e ignorante, resistente, masintemperante, se em determinadas 
circumstancias prestou grandes servi^os aos brancos, sous irm&os mais adiantados em 
civilisapfto. dando-lhes, pelo seu trabaDio corporal, f ortuna e conunodidades, estragando 
o robusto organismo no vicio de fumar a herva manmlhosa, que, nos seus extasis fan- 
tasticos, Ihe f aria rever talvez as areias ardentes e os desertos sem fim de sua adorada 
e saudoea patria, inoculou tambem o mal nos que a aistaram da terra querida, Ihe 
roubaram a liberdade preciosa, e Ihe sugaram a seiva reconstrutiva; e, na expressSo 
incomparavel do grande e genial poeta americano, o mavioso Longfellow, a ra^a ex- 
poliada, como o Sansfto da Biblia 

"The poor, blind slave, the scoff and jest of all, 
Expired, and thousands perished in the fall." 

NoTA — S6 ap<3e a minha volta do Congresso Sclentifico Pan-Americano f oi que recebi 
o resultado do inquerito, a meu pedido feito, pelo meu collega e amigo Dr. Francisco 
Fonseca, clinico n|i cidade de Marolm (E. de Serglpe), na zona de sua pratica. Essas in- 
forma^des confirmam pontos tratados nesta Memoria, e f oram principalmente f omecidos 
por um fumante inveterado de 60 a 65 annos, robusto, musculoso, sadio, attribuindo o 
seu vigor ao habito de fumar maconha, desde rapaz, no Estado das Alagoas, de onde 6 
filho, residindo ha muitos annos em Pirambd, povoa^&o e praia de banhos em Serglpe. 
Nessa povoa9^, e outras proximas, onde existem muitos pescadores, o vicio 6 grande- 
mente disseminado. Em logares de Sergipe e Alagoas, nas margens do rio de S. Fran- 
cisco, cultivam a planta, que vendem, preparada para ser fumada, sob a denomlna^&o 
de pelotaSf pela f6rma que tomam as infilorescencias, e & raz&o de 31000 o kilo, e 30^000 e 
401000 a airoba. 

Os informantes fazem as declara9des com difficuldade e timidez, receiosos de uma 
ac^ policial. Nesses logares fumam em reunmdes e logares determinados. 

Indaga^des obsequiosamente feitas em Penedo, por obsequio do Goronel Job4 An- 
tonio da Silva Costa, e em Villa Neva, do Coronel Lob6 Lessa, tambem me chegaram &a 
m&oe tarde, mas me eram oonhecidas as referencias feitas, e estavam exaiadas no meu 
trabalho. 



LUCHA CONTRA EL ALCOHOUSMO. 

Par RIOARDO SARMIENTO LASPIUR, 
Cirujano Je/e d$ lot HoapUaUs de Buenaa Aires, Argentina. 

"Contra un enemigo que amenaza al individuo en su salud moral y flsica, la familia 
en su foco, la raza en su reproducci6n, el pafs en su vigor, la humanidad entera en su 
esencia, la cienda y la filantropla deben diiigir en comtln acuerdo una formidable 
coalici6n."* 

1 Rene Bromard. 



PUBLIC HEALTH AND MEDICINE. 163 

Siendo, indiflcutible que la deepobladdn, la degeneraci6ii, la criminalidad y la 
locnia, no reconocen en la mayoria de loe caaos otzo agente detenninante que el fdco- 
holiono, y ante el numeroao contingente que aporta el alcoholiata y su prole a las 
enfennedades infeccioflaa, loe gobiemos, los m^coe e higieniBtas, economistafl y 
legiaLadored, deben aprefltane a la lucha, extremando todoe loe medioe para aalvar 
de su acci6n a media humanidad. 

Desde lu^o, hay que dirigirBe al factor etioldgico, combatir el mal en su eeenda, 
pueeto que la cura del alcoholismo adquirido, no hace nada mis que atenuar el mal 
de algunoS) sin consecuendas serias para las otras vlctimas, porque deiiia del alco- 
holista quedan una cantidad de nifioe, retardados y empobreddos en sus medios 
fiiBLcoe e intelectuales, los que a su vez predispuestos y siguiendo el camino trazado 
por sus padres, hardn otras tantas vlctimas. 

De manera que tratar al bebedor, y aislarlo, del medio social en que vive, para 
evitar su deplorable influencia, no es sino resolver una parte del problema, puesto 
que, como hemes dicho, no evita al mal reproducirse, y hacer nuevas vfctimas que 
^stas a su vez procreando lo etemizar&n afectando intensament^ a la colectividad. 
Asf, pues, es indupensable tratar la causa; pero como es Imposible suprlmir el alcohol, 
hay que dirigiise y luchar con todas las eneiglas para suprimir o por lo menos amen- 
guar la alcoholizacidn. 

Es alll donde se han diiigido todos los pueblos civilizados que han comprendido 
y han palpado los terrlbles peligros que entrafia el vicio del alcohol. Y es por ello 
que la lucha ha adquirido una intensidad gradualmente creciente en Inglaterra, 
Arnica, Suiza, Suecia, Alemacda, etc., y Rusia donde la cuesti6n del alcoholismo 
es un objetivo permanente no s61o para los poderes pdblicos, sino tambi^n para las 
clases ilustradas de la nacidn 

Las sociedades de temperancia se han multiplicado, la propaganda en contra del 
alcohol asume las proporciones de verdadera guerra, se han creado establecimientos 
especiales, privados y ptiblicoe para la cura de la borrachera; asilos donde el alco- 
h<Slico puede no 86I0 encerrarse espont&neamente, sino tambidn ser legalmente 
secuestiado y mantenido con un fin de utilidad y seguridad pdblica. 

Los palses del Norte de Europa, donde menos se habfa arraigado el abuso del alcohol, 
fueron loe que dieron el ejemplo m&s radical. Uno de los primeros en ponerse en 
campafia fu6 Magnus Hus, en Suecia, y sus indicadonee fueron eepecialmente teni- 
das en cuenta por las autoridades, tanto que el gobiemo sueco dict6 en 1885 una legis- 
laci6n especial que di6 fructlferos resultados. Las 1,300 destilerlas con que el pals 
contaba, fueron reducldas a 300. Se facult6 a las municipalidadee para prohibir las 
ventas de alcohol al x>or menor, y se disminuy6 el nthnero de despachos de bebidas, 
lo que progresivamente ha ido acenttiandose hasta el extreme de que existiendo en 
el momento de entrar en vigencia dicha ley una tabema por cada 100 habitantes, 
diaminuyeron en x>oco tiempo a 1 por cada 5,000. 

En Finlandia la prohibicidn fu6 mia absoluta todavfa, hasta el extreme de no 
permitir bajo ningtin pretexto la venta al menudeo de ninguna clase de bebidas 
alcoh61icas. Sin duda alguna, sus resultados fueron soiprendentes, hasta el punto 
de que en 1850 habfa 1 tabema por cada 100 habitantes y en 1900 s61o habfa 1 por 
cada 9,000. 

Inglaterra tambi^ ha tomado severas medidas, gravando con fuertes impuestoe 
la venta de alcohol bajo bus diferentes formas, y tratando de neutralizar las casas 
donde se expenden bebidas espirituoeas, creando caf^es y restaurants de templanzas. 

Estados Unidos, es el pals que mds se ha distinguido en la campafia contra el alco- 
holismo. El gobiemo ha anexado al ministerio de instmcci6n ptiblica, el departa- 
mento nacional cientffico de temperancia, que da ensefianza antialcoh61ica a una 
gran cantidad de educandos. 

Y exige a todos los funcionarios ptiblicos que formen parte de esa sociedad, que 
Ueven el distintivo especial de ella. La primeia sodedad de temperancia fu6 fundada 

68436— 17— VOL ix 12 



164 PBOCEEDINGS SECOND PAN AMEBICAN SCIENTIFIC CONGBESS. 

en New York en 1808, su vida fu6 corta, pero dej6 la Bemilla, y luego se fundaron 
muchaa otras, haata que en 1826 se fund6 la gran sociedad The American Temperance 
Society. 

En Italia y Alemania se ha tornado mds o menos id^nticas medidas. En la primera^ 
por una ley que no data de mucho tiempo, deroga laa franquicias a la libre producci6n 
del alcohol, dando con ello un gran paso en el terreno de la lucha anti-alcoh6lica. 

Como hemes dicho, todos los palses han bajado a la lucha, empleando todos loe 
medioB a su alcance, todos en^rgicos y algunos particularmente originales, como el 
empleado por Suecia, conocido con el nombre, de sistema de Gotembourg, que con- 
siste en que el privilegio de vender bebidas fuertes lo tiene una compafifa por acetones^ 
cuyoe miembroe estiman menos el interns pecuniario que el de diaminuir la venta y 
vender bueno. Establece un cierto nt!imero de tabemas, cuyo reglamento tiende a 
disminuir la venta, tanto como sea posible. Loe empleetdos de esta compalQlla son 
pagados por afio y no tienen ningtin interns en vender. 

Y, los beneficioB pecuniarioe de esta compafLla son empleados en obras de interns 
pdblico. Ha dado resultados notables, puesto que ha disminuldo grandemente el 
alcoholismo y sus consecuencias. 

Rusia participa del mismo principio, pero lo ha hecho de otra manera; ha cerrado 
una cantidad de tabemas y ha puesto muchas por cuenta del estado sin ningtin interns 
de vender. Tambi6n ha obtenido excelentes resultados. 

Los medios propuestos para detener la marcha invasora del alcoholismo son de 
dos 6rdenee distintos: unos se concretan a la curaci<5n de los bebedores y a la protec- 
ci6n de la sociedad, otros a la profilaxia del alcoholismo y diaminuci6n del consumo 
de las bebidas alcoh61icas. Para conseguirlo es necesario que la acci6n ptiblica y 
privada se unan, desarrollando una labor proficua, perseverante y entusiasta. 

Paia llegar a tales resultados hay que insistir en el aumento del impuesto al alcohol, 
sobre todo de las bebidas destiladas, en raz6n de su pemiciosa influencia sobre la 
salud ptiblica. 

Reducir el alcohol de consumo a su minimum de nocividad, evitando los fraudes 
y falaificaciones por un severe control, efectuado constantemente por inspectores 
t^cnicos. 

Poner obst&culos a su fabricacidn. 

Hacer efectiva la rectificaci6n obligatoria de los alcoholes, y llegar pronto al mono- 
polio de la venta de los alcoholes por el estado. Este se puede ejercer sea sobre la 
fabricaci6n, sea sobre la rectificaci6n, sea en fin sobre la venta de este producto. El de 
la venta, es el que debe adoptarse, puesto que sabemos que los alcoholes comercialea 
contienen una cantidad de productos t6xicos, y que cuando son librados al consumo 
sin previa rectificacidn, importa un grave peligro para la salud ptiblica. 

En varias naciones de Europa se han establecido, sobre diversas bases, slstemaa de 
monopolio del alcohol, pero el que ha dado los resultados m&s satisfactorios es el de 
Gotembourg, implantado en Suecia y Noruega. 

Para restringir el consumo de bebidas espirituosas se han propuesto dos claaes de 
medios: los medios de represi^n y los medios morales. 

La represidn de la embriaguez ha dado lugar a numerosas discusiones entre los legid- 
ladores en lo que se refiere a las medidas que deben adoptarse a ese respecto, y a sub 
resultados. Sin entrar a analizar la mayor o menor raz6n, que tenga cada uno de ellos, 
debemos aceptar como beneficioeas todas las medidas que se tomen; sea la aplicaci6n 
de multas a los bebedores, sea la permanencia en las casas de correcci6n; todas puedeu 
obrar y obran, aunque sea muy d^bilmente sobre el espiritu del borracho; y si no 
obrase sobre 61 directamente, por lo menos serviria homo ejemplo para aquellos que no 
son inveterados. 

Deben pues, dictarse severas medidas a este respecto. 

Otro medio para reprimir la borrachera, consistirfa en la intemaci6n de los alcoholistas 
en los asilos y casas creadas al efecto; mixime cuando se sabe que el beodo es un ser 
peligroso para sf mismo, para la sociedad y para el estado. 



PUBLIC HEALTH AND MJBDIOINE. 165 

Esta 68 una medida que ae impone, tanto mis, cuanto que 60 reparadora paia al 
flocledad y para ellos; debe hacerae en asilos eflpecialee, donde olvidando el vicio, se 
les haga trabajar, y se lea haga comprender por medio de ensefiaozas diarias las terri- 
bles coDsecuenciaB que lea acarreaii el vlcio a que se haa entr^gado. 

Entre los medioe morales, debemos citar en primer lugar, la reglamentacidn y la 
8upresi6n de las tabemas; en s^gundo lugar, la propaganda antialcoh61ica y la f unda- 
ci6n de sociedades de temperancia, y en tsrcer lugar, los medios morales propiamente 
dichos. 

Las tabemas desempefian un grau papel en nuestra sociedad modema, y es sin 
dada una ds las causas mius poderosas del alcoholismo. 

La instaiicci6n y moralizaci6n del pueblo, debe tenerse muy especialmente en 
cuenta. £s el nifio, el que debe ser el verdadero campe6n del anti-alcoholismo del 
porvenir; debe ser preparado para la lucha desde su primera edad, la que debe con- 
tinuar en la segunda infancia y en la adolescencia, de manera que cuando adulto 
ya, empiece a ejercer su influencia en la familia y en la sociedad, est^ impregnado 
de sus deberes y pueda luchar con resultados. 

La ensefiansa en la escuela; el maestro, desem]>efia tambi6n un papel importantfirimo 
en esta magna campafia; ensefiando a sus pequefios discipuloe las verdaderas pro* 
pledades del alcohol, el uso que deben hacer de ^1 y los peligros que les acarreari su 
abuse. En la Argentina se dictan cursos obligatorios, clases especiales, confoencias 
sobre alcoholismo, a loe obreros, a los soldados, etc. 

Hemes dicho ya, que todos los pueblos civilisados, dilmdoee cuenta de los progresos 
que hace dia a dla este terrible flagelo social, se habfan aprestado a la lucha fundando 
sociedades de temperancia, que son mis eficaces en la lucha antialcoh61ica que todo 
el climulo de medidas fiscales que ha dictado el legialador para impedir la propagaci<Sn 
del flagelo. 

La influencia de las sociedades de temperancia en la campafia contra el alcoholismo, 
es de resultados incontestables, y su obra salta a la vista en los pueblos que las han 
instituldo, como: Estados Unidos, Inglaterra, Suecia, Noruega, B^lgica, etc.; y donde 
han adelantado notablemente en estos (iltimos afios, debido a haber incorporado aa 
movimiento a las mujeres y a los nifios. 

En nuestra Repliblica, algo se ha hecho, debido a la pr6dica constante de hombres 
de ciencia, como el doctor Domingo Cabred, que no ha perdido oportunidad de 
difundir por todos los medios a su alcance, los peligros y las medidas que deben 
adoptarse, para oponerse a la propagaci6n del flagelo que mina las bases de nuestra 
sociedad. 

La lucha antialcoh61ica en este momento se ejercita de la manera siguiente: 

1^. La ensefianza obligatoria antialcoh61ica en las escuelas. Sobre esta medida, se 
pronunci6 el Gongreso PedagxSgico reunido en Buenos Aires en diciembre de 1900, 
aprobando uninimemente el veto propuesto por el Dr. Cabred, sobre ensefianza anti- 
alcoh61ica y sobre fundacidn de sociedades infantiles de templanza. £1 curso libre y 
gratuito sobre alcoholismo, establecido, por Decreto del gobiemo nacional, bi6 el 
primer paso dado en el sentido de la ensefianza antialcoh61ica obligatoria en las escuelas. 

2^. Restricci6n de la fabricaci6n y de la venta del alcohol, por grandes impuestos. 

30. DiBminttci<Sn de los derechos de importaci6n al caf6, al te y a la yerba mate. 

40. Disminuci6n de los impuestos a las lecherias. 

5^. Aumento de los derechos de importacidn a las esencias y 6teres usados en la 
fabricacidn de Ucores y aperitives. 

6^. Se establecieron penas privativas de la libertad para los autores del delito de la 
deetilaci6n clandestina. 

7^. Hospitalizaci6n obligatoria, de los alienados alcoholistas y de los ebrios con- 
suetudinarioe, dejando al criterio m^ico fijar el tiempo que debe durar la existencia 
hospitalaria del enfermo. 

8°. Creaci6n de una colonia agrfcola para la asistencia de bebedores no alienados. 



166 PBOCEEDINQS SECOND PAN AMERICAN SCIENTIFIC C0NQBES8. 

9^. Educacidn obligatoria de los hijos de loe alcoholktas. 

En cuanto a las medidas que correeponden a la iniciativa privada, y que se han 
pueeto en prdctica son: 
1^. Creaci6n de sociedades de templanza, para adultoe. 
2^, Creaci6n de sociedades infantiles de templanza. 
3°. Fundaci6n de caf^ y restaurants de templanzas, de salas de lectura, etc. 



EL PROBLEMA DEL ALCOHOUSMO Y SU POSIBLE SOLUaON.^ 

Por LUIS L6PEZ DE MESA, 
Boffotd, Colombia. 

•Una de las funciones m&s Utiles de los Congresos Intemacionales es, a mi mode de 
v^, la de dar un veredicto sobre las cuestiones cientfficas ya dilucidadas en el eatudio 
pormenorizado de los tratadistas, el presentar a la sociedad humana la sintesia de loa 
esfuerzos parciales que inicie aplicaciones pr&cticas. 

En este sentido nada mis importante para un Congreso Intemacional de Medicina 
que el eetudio de aquelloe flagelos que como la tuberculosis, la sffilis y el alcoholiamo 
constituyen la m^ seria amenaza para nuestra especie. 

Por ello voy a proponer un veto razonado sobre la restricci6n del alcoholiamo, 
siguiendo de un mode preferente las fasee que este problema tiene en mi patria, y 
atendiendo b61o a las ideas generales, sin entrar en {wrmenores ni citas de textos. 

0AU8A8. 

El alcoholismo es una enfermedad social en el triple sentido de que es consentida 
impunemente por la sociedad, transmitida por el contagio moral y creada por deee- 
quilibrios tambi^n sociales. A la manera como las virtudes en determinada exalta- 
ci6n se truecan en un yicio complementario, tambi^n asf las funciones de nuestro 
organismo pasan en vecee de su ordenaci6n fisiol6gica a perturbaciones que son del 
dominio de la patologia. Oada funci6n desviada o exagerada es una causa patoldgica, 
desde la irritabilidad elemental, dig&moslo aai, hasta los m&s nobles procesos morales. 
Ee el case del tomador de bebidas alcohdlicas que pervierte el simple acto de satia- 
facer la sed en una toxicomania delet^rea. 

Sobre el instinto de satisfacer una necesidad orgdnica como es la ingesti6n de If qui- 
dos, causa primordial fi8iol6gica, y sobre la existencia en el mercado de bebidas alco- 
h61icas, causa social, tambi6n primera, tejen su maralia inextricable las mil causas 
secundarias del alcoholismo, que hacen de 61 un problema de mtiltiples factores indi- 
viduales, sociales y legales. 

Hfbrido de la miseria y del lujo, la humanidad tropieza con 41 en todas las edades 
y en todas las esferas. CompafLero de la tristeza y de la alegrfa, de la fatiga y del ocio, 
es la sirena legendaria que fascina y estrangula al individuo humane en el encanta- 
miento de sub paraisos artificiales. 

En el individuo aproximadamente normal se inicia el alcoholismo segtin las leyes 
psfquicas del hdbito por la repetici6n, por la pasi6n que engendra y que, como todas, 
es una idea tenaz que dilata en tomo suyo emociones subordinadas con un imperio des- 

1 Bste tralM^o fu^ prasentado al ooocarBo qua d Mlntoterlo de Inatnicxd^n Ptlblloa abtld con motlvo del 
Congreso dentifloo Panamericano de WashiDgton, y el Jiiradoeallfloador oompuesto por los doctorea Roberto 
Franco, Pomplllo Martlnes, Carlos Esgoerra y Jorge Vargas exposo: "El problema del aloohoUsmo y to 
poslble solacion ha llamado tambito particolarmente nuestra atanddn. Debemos alabaren 41 niAs que 
todo la importanoia de sns oonoluslones y sa hermosa redaeeldn. Dleho trabc^ pnede Uegar a sar ptmto 
de partida de la Incha antialoobdUca y adna la seriedad de on Jnlolo rlgnroeamente cientlfleo al eatilo llano 
y elegante qne oonvence y agrada. 



PUBUG HEALTH AND HSDIOINE. 167 

p^Stico flobre toda la economia org^ica, y por la mis y m^ acentuada decadencia 
genera] que ezige para el complemento de las funciones el t6iiico fugaz, pero ya 
ixnpreecindible, del alcohol. 

En esta claae de individuos se verifica el contagio por la sugesti6n que ejercen laa 
bebidas alcoh61icaa mediante bu presencia, curiosidad; jnediante la inainuacidn 
amistosa, compafierismo; mediante la oportunidad de eludir un estado de tristeza 
ocasional o de ezaltar una emocidn alegre. 

En nueetra patria hay regiones en donde sigue un camino mis Irancamente social, 
como en Boyaci y Gundinamarca que han hecho de la chicha un complemento de 
alimentacidn y un liberador de la humildad y melancolia de la raza indigena, que 
vegeta tristemente en la pobreza y en la mugre. En el Tolima y en la Costa AtUkntica 
satisface la sed de eeas llanuras ardientes bajo la forma de guarapos fermentados y de 
ron. En Antioquia obra aobre la raza a mi ver par tree cauaas primordiales: por la 
cuidadoea difusidn que hacen del aguardiente de cafla loe rematadoree de eata renta, 
pues crean en loa puebloe tabemas que, con el nombre de atancos, son el sitio mia 
atzayente como lugar de descanao y de aolaz, y difunden en cada una de laa veredaa, 
con un eamero industrial prodigioao, laa ventas de bebidaa alcohdlicaa; aiendo una con- 
dicidn de notoria auperioridad en loe empleados de eata renta de aguardientea el que 
aepan difundir y eatimular el hibito, como me conata por laa excitacionea y aplauaoa 
que transmiten loa rematadorea a aus aubaltemoa y por el aobreaueldo que cobran 
^stos de su miai6n propagandiata. Tal aiatema de privilegio fu^ enaayado en Suecia 
por Guatavo III en 1780 con tan alarmante reaultado que hubo de auspenderlo poco 
despu^e; y ai en Antioquia ha aido haata ahora benefice ea por el celo riguroao de loa 
contrabandos y el alto precio del aguardiente que eatipulan los rematadorea, lo que 
comparado con la deatilaci6n ad libitum y la conaiguiente baratura de otroa tiempoa 
constituye un progreao en la reatricci6n del alcoholiamo. Otra cauaa se deriva de una 
oondicidn psfquica de la raza antioquefia: dotada de una grande capacidad para el 
trabajo y de una imaginaddn verdaderamente prodigiosa, se encuentra con mucha 
irecuencia ante el malestar de una suma de energias ociosas que crea el aburrimiento 
y ^ete a au vez incita a la bebida seductora y eflmeramente eficaz, pues la ialta de 
soficientes industrias y el escaso movimiento comercial hacen que en muchas pobla- 
cionee la vida se dealice dentro de una monotonia abrumadora y de una ociosidad 
inconveniente, a pesar de las notables cualidades de ese pueblo para el trabajo, verdad 
^sta que denota las corrientes de emigracidn a que tiene que condenarae. Por dltimo, 
hay una causa social, que es la carencia de distracciones honradas en un pueblo que 
s61o tiene trabajo y fiestas religioaaa, que ea poco aociable, porque la mujer no deeem- 
pefia ahi su acci6n aocial de refirenadora de la juventud, como ea el hecho dondequiera 
que ae comunica diacreta pero frecuentemente con loa hombres, pues estoy conven- 
cido de que ella es doble tdnico: funcional, haci^ndolos mis emprendedores y viriles, 
m&9 audaces, en una palabra, siendo como es y hay que decii las coaaa cientfficaa con 
palabraa exactaa, au tercera gUmdula genital; y im t6nico moral educative, suavizando 
las duras maneras del hombre, cre&ndole una atm^gfera de idealismo en derivaciones 
artlsticas, y de seducci6n pundonorosa. 

Las distracciones sociales, los $port8, los cinematdgrafos, los teatros, etc., alejan 
prodigiosamente de la bebida, pues el vicio es sobre todo ocasional. Una observacidn 
f4cil nos demuestra la disminucidn que ha suirido en Bogotd con las representacionea 
cinematogrificaa y el reciente entuaiasmo deportivo, que distraen de la tabema a 
centenarea de individuos. La vida de los estudiantes americanos que tienen la 
imaginaci6n pura y los m(!isculos fatigados por el ejercicio ae revela como ejemplar al 
lado de los estudiantes del centre y del sur de America que llevan la imaginaci6n 
calenturienta y la voluntad propicia al desenfreno moral. 

£1 aialamiento relative en que se educan los jdvenes antioquefios respecto de la 
Bociedad viene, pues, a sumarae a las otras causas del alcoholismo. Ese pueblo no se 
ha degenerado en el alcohol, a mi ver, por la resistencia de su raza, hablando en 



168 PKOCEEDINGS SECOND PAK AMEBIGAK SOIEKTIFIO GONGBESS. 

t^rminos impredsos para una aplicaci6n diferencial, de su raza, digo, y de aquella 
costumbre, resto de una moralidad excelente, de no tomar bebidas alcoh611cafi sino 
ocasionalmente, es a saber: en Ice diaa feriados y en descanfloe de su ruda labor, lo que 
hace que el alcoholizado cr6nico sea relativamente escaso at&n. Quiz& el aguardiente 
que consume sea tambi6n menos dafioeo, pues no tiene sino pequefLas cantidades de 
esencia de anls que mezclan en la destilaci6n de los guarapos. Pero no es diffcil prever 
un deterioro de la raza, y ya se ven las psicopatf as y neurosis con bastante frecuencia, y 
la criminalidad, homicidio y heridas es muy notoria; el misticismo domina a la mujer, 
sobre todo, que depositaria inmaculada de la moralidad de la raza, se desvia m^s bidn 
hacia el idealismo asceta. Y hago un poco de hincapi^ en este pueblo, porque ^1 es 
adn la mejor reserva nacional para la colonizaci6n de nuestras selvas y el desanoUo 
de la industria, fecundo, vigoroso e inteligente como se muestra todavla. 

Y no es que sea un pueblo vidoso, abstinente me parece, ya que no alcanza a con- 
Bumir dos litres de alcohol per capita: mia ello es que otros factores confuses adn me 
inclinan a pensar que en nuestra zona y en nuestras condldbnes de vida social el 
peligro se hace sentir con menos cantidades de alcohol que en otras partes. ^Nuestra 
pereza, nuestra neurosis, nuestro metabolismo viciado no indican acaso un terrene 
propicio para la intoxicaci6n alcoh61ica? Estudiando en este mismo pueblo antio- 
quefio no ya al individuo o a la sociedad en general, sino las familias, podemos ver 
con relativa frecuencia un decaimiento por el alcohol: de hombres patriarcales que 
se hicieron a una poeici6n sobresaliente por su esfuerzo personal, suigen despu^ de 
una o dos generadonee seres viciosos que conducen la familia a la oscura esfera del 
proletaiiado. Familias enteras son una aflictiva trama de intelectuales, locos y alco- 
holizados, en quienes el talento, superior a voces, s61o sirve para hacer m^ visible y 
penosa la d^eneracidn. Pero hay un fen6meno social interesantlsimo en AntiLoquia, 
que hace mis plausible una lucha antialcoh61ica, a saber: algunas poblaciones que 
surgen al amparo de industrias como la minora, en regiones aisladas y de mal clima, 
se forman en gran parte con los desechoe de la sociedad, viciosos, vagabundos y bandi- 
dos, y no pasan dos generadones sin que eea cepa, al parecer tan peligrosa, est6 repre- 
sentada por muy virtuosa sociedad, tan cambiados a voces, que hasta de radicales se 
truecan en conservadores muy sumisos e irreprochables feligreses. Y no es esto uno 
contradicci6n de las leyes de la herenda, sino el ejemplo de que los factores del vido 
son atin menos orginicos que circunstanciales, como fu^ mi objeto hacerlo notar al 
insistir sobre las condidones en que se desarrolla el joven antioquefio. 

La miseria, causa econ6mica que estudian con ahinco los Boci61ogos europeos, es, 
entre nosotros al menos, un factor menos importante, porque generalmente me ha 
parecido consecuente y no casual. Mucho se ha hablado entre nosotros de una deficien- 
da de alimentaci6n en la Altiplanicie andina oriental, que dizque conduce al uso de los 
excitantes alcoh61icos. Esto merece un estudio muy razonado, pues creo que el 
problema es inverse, a saber: que el abuse de las bebidas engendra la insufidencia de 
alimentad6n. 

Hay en el habitante de esta Altiplanide una diaminud6n de la urea y del 4cido 
tirico que va hasta 8.02 en las 24 horas para la primera; y un aumento de los productos 
amoniacales intermedioe que alcanza a 0.15, lo que significa, adenUe, que no hay 
una compensad6n. Esta inperfecci6n ureogen^tica es mis notoria en la clase obrera. 
Por otra parte tenemos una temperatura normal de 36.5. Como la media de gl6bulos 
rojos por milfmetro ctibicos es entre nosotros de 4,800,000 con 83.21 de hemoglobina, 
y respiramos veinte voces por minute una atm6sfera pobre en oxlgeno — 0.192 de 
gramo por Utro — ^nos queda un d^fidt de oxigenaci6n, a pesar del desarrollo tor&cico 
que en parte la compensa, y un d^fidt del metabolismo azoedo. 

El consume de came del habitante de Bogota apenas alcanza a 124 gramos por dla, 
y en la clase pobre hay necesariamente una partidx>aci6n menor de este promedio, y 
las albdminas vegetales no son suficientemente compensadoraB por su elaborad6n 
m&B diffcil, mis alejada de la capaddad digestiva del hombre. Este date seria conda- 



PUBLIC HEALTH AND MEDICINE. 169 

yente si no se pudieran aducir razones en contra: el soldado nuestro tiene por alimentar 
ci6n principal una aopa abundante de maiz, trigo, cebada o legumbres con un plato 
de papas, un pequefio trozo de came cocida y un pan pequefio y hace un trabajo que 
exige 2,800 cidoiias por lo menoe, adquiriendo, adem4s, deeairoUo fisico notable. Esta 
alimentaci6n es semejante a la que el pueblo conaigue a 20 centavos diarios, mitad de 
su salario mia o menos. 

Qu^ es, pues, lo que ocurre? Que el soldado no toma chicha y el obrero si; que 6eta- 
va creando una insuficiencia hep&tica con infecci6n gastrointestinal cr6nica; primer 
factor, org&nico. Y que el apetito por la bedida hace consumlr en elia el dinero que 
puede servir para una sana alimentaci6n; seguno factor, econ6mico. Luego la insu- 
ficiencia de nutrici6n depende de la chicha, segtin mi modo de x>ensar razonado, y 
de las condldones del clima. 

La elaboraci6n defectuoea de esta alimentaci6n estd comprobada por la casi uni- 
veraalidad del artritismo entre nosotros y nuestra depresidn de &nimo el reumatismo 
articular agudo es de una frecuencia alarmante y algunas afecciones neuroartrfticafl, 
la colitis mucomembranosa, y la neurastenia sobre todo, crecen dfi^por dia en todas 
las esferas sociales. 

La zona en que vivimos ejerce tambi^n ima acci6n depresiva. Pensando muchaa 
veces en la alegria sana y fecunda que traen los vlajeros que de nuestra patria van a 
Europa y Estados Unidos, en aquella exaltaci6n de la voluntad que demuestran en 
el tono franco y vivaz de su conversacidn, en la frase precisa que lanza ideas con brio, 
y en la imaginaci6n que asocia proyectos de trabajo en dUatadas perspectivas de 
future, pensando en todo ello, digo, comprendl una vez que hay un factor mesol6gico 
importante. iQ\i6 les ocurre a ustedes cuando van a Europa? pregunt^ a un into- 
lectual que regresaba por entonces, y con una maravillosa imagen me respondi6: 
''Es que alld sentimoe por primera ocaai6n, despu^s de los dfas de nuestra adolescencia, 
ima primavera espiritual. " Y es cierto. Algo les ocurre como un rejuvenecimiento 
como el entusiasmo de una primavera, con la placidez de su verdura y el nuevo 
despertar de la luz. 

Buscando una explicaci6n de la influencia depresiva de nuestra zona, he x>en8ado 
que la repetici6n mon6tona de una misma percepcidn o serie de percepciones fatiga 
los sentidos y el alma, asf como la vista de una luz igualmente coloreada conduce a la 
locura a los supliciados que a ella son sometidos, o como la repetici6n de un sonido y 
aun de una palabra noe trastoma. Greo yo que nuestra zona con la monotonia de su 
estaci6n permanente, la escasa variedad de su naturaleza y de su atmdsfera, apaga la 
vivacidad del espfritu, enerva el mtisculo y deprime la voluntad. Esto puede com- 
probarse por el mayor entusiasmo que se observa en un dia que aparece luminoso 
despu^s de una serie de inviemo, y aun en las horas de un torrencial que aigue a largos 
dias de verano. 

Por eao he crefdo que el Tr6pico no dar& nunca una clvilizaci6n aut6ctona sino una de 
infiltraci6n, por la acci6n capilar, digdmoslo asi, de las corrientes circundantes. 

De otra parte surge tambi^n el alcoholismo: la herencia similar de los padres alco- 
h61ico6 y la desemejante de los psicdpatas, neur6tico6, sifiliticos, dehilitados por la 
senOidad y los agentes pat6geno6, trae al mundo seres de un funclonamiento inarm6- 
nico que los lle\-a por un contagio m&s rdpido, predispuestos, o por una \ erdadera 
toxicomania, degenerados mentales, al alcoholismo. 

Me adhiero a la opini6n que hace del quimlsmo celular el sustent^ulo de la herencia 
y creo que el germen sufre en su composici6n intima — micelas de Naegeli, plasmonas 
de Wiener, como quiera interpretarse, variaciones a(in desconocidas, pero en alguna 
manera imagioables, segtin los experiraentos realizados en los vegetales (vid europea) 
para la creaci6a de yariedades por medio de una modificaci6n quimlca. Asi es m^ 
ttcil entender que un organismo intoxicado de una u otra manera d6 g^rmenes vicia- 
dos que no pueden diferenciarse en 6rganos arm6nico6 ni verificar las asimilaciones y 
adaptacionea a que deben some terse para prosperar dentro del modo de ser de su 
especie. 



170 PItOGEEDIKOS SECOND PAN AKERIGAN SCIENTIFIC CONGRESS. 

Este vido constitucional de las c^ulas germinativaa ae traduciii en el aer adulto 
por deficienciafl oig&nicafl, las que, a bu \ez, pueden afectar directa o indirectamente 
al fldstema nenioeo, como ee el caso de las neurosis y psicosis que ae producen en el 
adulto por la alteraci<Sn directa del cerebro o de cualquier otro digano. 

En lo que respecta especialmente al alcohoUsmo, encontramos en los predispuestos 
una ner\-iosidad que puede venir de un desequilibrio funcional del sistema nervioeo 
o de otro digano cualquiera. Esta nervioaidad presenta todos los grades, deade la 
emotividad caai nonnal hasta la fobla. 

La felicidad es resultante de la annonfa; y la euloria es el lesultado de un funciona- 
miento arm6nico de nuestro oiganismo. Los predispuestos al alcoholismo, como 
en general todos los tozicdmanos, ezperimentan como resultante de su funciona- 
miento perturbado una intranquilidad continua o peri6dica que se traduce en timldez, 
melancolla, miedo, ansiedad, en una palabra, en las emociones y sentimientoe de- 
presivos; y m^ tarde por una reaccidn de rebeldfa en initabiUdad, odio, misantropfa, 
egoismo, caracterfsticas de todos los deaadaptados sociales, buniUares, individuales y 
aexuales. Un dfa de esos el desequilibrado oiginico tropieza con una droga o con un 
licor que le da una armonia fugaz a su organiamo: ^ e rosados los horizontes de la vida, 
una cenesteaia enganosa le da percepciones de propio vigor y entereza. Es el paralso 
artificial que surge como espejismo en el desierto de una melancoUa conturbadora, y 
ya no serd posible desechar el nepente. 

En mi prictica he anotado procesos similares, conformes al descrito en los morfin6- 
manos, dipsdmanos, etenSmanos, etc. Y es ya de obsen acidn comtin el recurso de los 
toxicdmanos que cambian de excitante, haci^dose tomadores de caf6 los dipadmanoe, 
de cocafnalos morfin6manos, de clonU, de 6ter, etc., segdn hallazgos de ocaai6n. 

Puede uno preguntarae si hay una pasi6n definida por las bebidas alcohdlicas antes 
del resultado de un primer ensayo, y yo Uego a dudarlo en mucha parte. La pre- 
aentaci6n clfnica que hace un dipadmano ea la de una locura peri6dica depresiva, ya 
complicada de ideas delirantes, de foblas, de un estado en general francamente paico- 
pdtico, ya en nitida diferenciaci6n. Uno de elloa con quien habia hecho prevlo 
compromiao ae me preaenta un dia y me dice: ''Tengo el ataque." Xo ae ha tomado 
una copa adn, est& d^bil, presenta la cara del sufrimiento, temblor r&pido, miedo 
obsesionante, anorexia, insomnio, inquietud, sua manos frias est&n cubiertas de sudor 
y en BU caia hay como una aombra de vejez. Ve en perapecti^a la copa redentora y 
a61o ae contiene por un eafuerzo de voluntad ya prevenida por mi. Le aplico una 
fuerte doeia de estricnlna en inyeccidn hipoddrmica y le veo transformarae. Eaa noche 
eat4 con amigos, ^e licor y no lo prueba. Cesa la accidn t6nica antes de veinticuatro 
horas y recae en su depreaidn de la cual vuelvo a aacarlo con nue\ a dosLs de estricnlna. 
Ahl no hay vicio, es psicosis y nada mds. 

Los mondndmanos org&nicos que he tratado me han hecho revelaciones semejantes 
de melancolla con foblas de una gran perturbaci6n psiquica. Desde pequefios han 
Bidoraros:retraidos,alocados,iiTitables. . . . Lamorfinafudunhallazgoparaelequili- 
brio fugaz, como las combinaciones y sustituciones que hacen lo confirman. 

I Hay, me he preguntado a voces, una dipsomania permanente, no perL6dica? Asf 
lo creo, como hay melancollas crdnicas, paicastenias y neurastenias y definiti\as. 
Conozco un caso en que el ciclo dipsomaniaco es semanal. 

Por todo esto, que no analizo m^ por ser otro mi objeto, me incline a que es preciso 
hacer doe capltulos aparte, el de los vicioaoa accidentalea y el de loa \ icioaos oigdnicoa, 
y llamar a eata forma aencillamente, ain mis di\'iaionea, la paicopatia toxicomaniaca, 
adscribi^ndola a las locuras depreaivaa. 

Tenemoa, puea, variaa cauaas del alcoholismo, que para precisar mejor podemoa 
reunirlas bajo denominaciones sintdticas: cauaaa antropoldgicaa, como dicen los 
tratadistas de Derecho Penal modemo, a aaber: las perturbacionea orgdnicaa que 
conducen a una depresidn, toxicomauiacos, abtilicos, deeadaptadoa por debilidad o 
per\'erai6n. Cauaaa aociales: la industria de bebidas alcohdlicas, la deficiencia eco- 



PUBUO HEALTH AND MEDIOINB. 171 

nrtmira que posteiga la elevaci6n mond, la deficiencia de educacidn que deja inculta 
la vduntad reactiva, la faXtA de dktraccionee aanas que den el t^nico de la alegrfa 
a lafl znultitudeB. La influencia de loa climaB enervantee, causa mesoldgica. Y, per 
dltiino, el ejemplo, cauaa moral. Hay tambi^n cauau familiaiee que por reducine 
f&cilmente a las anteiioreQ no hay para qu^ diferenciarlas. 

Entre noeotios priman los oiguientee 6M;toree: la exiatencia de bebidas alcohdlicas 
al alcance de todoe; la acci6n depresiva del tri6pico; la deficienda de la educaci6n; 
la transmiflidn por heroncia similar y deeemejante, y por contagio; y la carencia de 
distracciones suBtitutivas. 

XFB0T08. 

La humanidad cuenta con las bebidas alcohdlicas deede la ^poca legendazia de Dioni- 
aoa Ohuib y No^. Pero hay dos grandee diferendas entre el mundo antiguo y el modemo 
respecto del alcohol: la antigtiedad no conocfa las bebidas destiladas y aromatizadas, 
con mucho las m^ peligroeas, puee fueron quizi los Arabes loe primeros en ensefiar a 
Europa la destilacidn del vino, y en llamar a su producto "el sutil/' con una palabra 
que reeulta ir6nica. AI siglo de las luces corresponde el triste honor de haber per 
feccionado y en su mayor parte inventado la destilacidn de las melasas y de los distintos 
miliceos, entre los cuales la papa con su alcohol amilitico; y a 61 corresponde la 
industria de centenares de licores aromdticos con base de esencias delet^reas. £1 
mundo antiguo se embriag6 con vinos y bebidas fermentadas, siendo, pues, franca- 
mente enolista, al modemo le cupieron en suerte el etilismo, el absintismo y el usismo 
en general. La otra diferencia fundamental es que los antiguos se embriagaban y 
los modemoB se alcoholizan. Porque si bien es verdad que la cirrosis, Hip6cTates y 
Seneca lo dejan entrever, y las perturbaciones ner\'iosas existieron, como ocurri6 
a Lticulo en el ocaso de su vida y de tantos otros se dice, no habla una producci6n 
suficiente, ni una vida propicia para el hdbito alcoh61ico generalizado. 

El siglo XIX marca el progreso del alcoholismo a la vez que inicia su estudio y su 
remedio. En 1850 se consimila 1.46 de litro por cabeza, y Ileg6 en 1900 a 4.66. Hubo 
en verdad, y subsisten, aJtemativas de consumo que aportan doe ejemplos aprove- 
chables: la acci6n ben^fica de la lucha antialcoh61ica y la necesidad de intensificarla 
en una ruta definitiva para que no recaigan loe pueblos en el vicio. 

En Colombia tenemos cuatro bebidas dominantes: el aguardiente de cafia, la chicha, 
el guarapo y la cerveza. El consumo de licores extranj^ros aunque no es despreciable, 
comporta menos peligros por su precio y manor radio de consumo. 

Colombia, con una poblaci6n aproximada de seis miUones, consume anualmente 
unoe once millones de litros de alcohol o sea poco mds o menos dos litros por cabeza. 
De estos solamente unos ciento veinte mil litros de licores extranjeros y el resto de las 
bebidas nacionales enunciadas, que est^ en la proporci6n de cinco millones cuatro- 
cientos mil en chicha, tres millones quinientoe mil en aguardiente, un miU6n seiscien- 
tos mil en guajajx) y doscientos mil en cervezas, anotados en ntimeros redondos y 
segtin cdlculos meramente aproximativos pero razonables. 

El consumo de estas bebidas se rex>arte en la Naci6n distintamente, siendo generali- 
zados el consumo de los aguardientes y cervezas, con un miiximum en Antioquia y 
Caldas por lo que hace a los primeros, mis circunscrito a la Cordillera oriental el uso 
de la chicha; y peculiar de los climas templados el guarapo. 

Pueden considerarse como grandemente adulterados y nocivos los licores extranjeros, 
coiiac, whisky, vinos blancos, tintos y secos, como de vicioea prepaiaci6n algunos 
nacionales, a saber: la chicha, que es una fermentaci6n de la haiina de maiz y que 
tiene de 6 a 10% de alcohol, 10.65 de azdcares, 10.80 almidones, 7.70 de glicerina, 6.15 
de icidos de fermentaci6n, 1.60 de aceite especial de mafz y sobre todo un principio 
azoado t6xico, del orden de las ptomainas, que parece ser la causa de las perturbaciones 
m^B serias del llamado chichismo. 

El aguardiente es producto de destilaci6n del guarapo (jugo de caSa de azdcar fer- 
mentado) o bien de ima 8oluci6n de panela (producto de evaporaci6n de eete jugo), 



172 PBOCEEDINGS SECOND PAN AMERICAN SCIENTIFIC CONGBEBS. 

con iin poco de esencia de anis. Tiene nnos veinte gradoe Cartier. Con un poco mis 
de eeencia y alcohol ee le denomina aniaado superior. 

Las alteraciones que producen estas bebidas son muy conocidas y apenas las anotar6 
Ugeramente por lo que respecta a los aguardientes y a la chicha. 

Las cervezas, siendo un mal menor, no las considero sin embargo tan descuidables 
como lo Buscriben algunos higienistas, x>orque el vido no se detiene en dosis pruden- 
tes, y en hallando excitante se cuida de alcanxar la proporcidn suficiente, como es 
i&cil observarlo y ocurri6 en Suecia en gninde escala cuando empez6 a sustitulr los 
licores destilados. 

Las perturbaciones que produce el aguardiente son las mimnas eetudiadas en todas 
partes. Pueden dividuse en doe grandee capftulos: de los tejidos y de la nutrici6n. 

La nutrLci6n tiende a espaciaise, las combustionee son incompletas y aparece un 
recargo de grasa que se localiza de preferencia en el tejido subcutdneo, el meeenterio, 
el coraz6n y los riiiones. Las reacciones defensivas contra el Mo, la fatiga y las inf ec- 
ciones se hacen deficientemente. La decadencia general fisica y psiquica es quiz& 
motivada por estainferioridad y se traduce en pereza, inconstancia, tristeza, ansiedad, 
indiferencia moral y afectiva, de una parte, y en afecciones artriticas de otra. 

Bajo el influjo del alcohol los 6rganos de toda la economla se deterioran, principal- 
mente los emuntorios y el sistema nervioso. 

Con las primeras dosis ima vasodilataci<5n se establece que causa las congestiones del 
perfodo inicial de la embriaguez con sus sensaciones de calor, de agiUdad, de euforia, 
de yiveza mental, hasta cierto llmite en que intoxicada la c^lula, sobre todo la cortical 
del cerebro, de suyo mis d^bil, viene un decaimiento de las funciones que constituye 
la torpeza mental y muscular del ebrio. El alcohol recorre y alecta preferentemente 
el est6mago y el duodeno, la vena porta y el higado, el pulm6n y el cerebro, meninges 
y capa cortical sobre todo. 

El oiganismo vuelve a la normal por las piimeias veces, pero poco a poco el dese- 
quilibrio mental se convierte en deterioro oiginico. Es la gastritis con d^eneraci6n 
gr^ulo — grasa de las gyindulas prepil6ricas, con la tiinica mucosa corrugada y esclero- 
sada en partes, en partes inyectada. Luego los adenomas de las gldndulas mucosas 
y las ulceraciones mis o menoe profimdas. En el duodeno obia el alcohol alteraciones 
semejantes y algiinas notorias en el ciego, en el pincreas y glindulas saUvares. Pasa 
a la vena porta que afecta tambi^n y va al higado a establecer el cuartel general de 
una patologla mis grave atin, haciendo degenerar el pam^quima hacia la transforma- 
ci6n grasa y escleroea. En 61 y en los pubnones se asocia con el bacilo de Kock para 
terminar su obra delet^rea por congestiones y degeneraciones sucesivas. En el cere- 
bro ataca las meninges que se cubren de placas opalinas, y v^etaciones fibroeas, como 
en general todas las membranas serosas del organismo. Hace deprimir por atrofia las 
circimvoluciones cerebrales, produciendo en la c^lula cortical una degeneraci6n 
granulosa y en los vasos nutricios dilataciones que son un dafio definitive y una ame- 
naza de muerte. Los nervios perif6ricos se inflaman. Neuritis opticas pueden sobre- 
venir. El coraz6n experimenta mtUtiples alteraciones, entre las cuales ban anotado la 
vegetacidn en las vilvulas y manchas lechosas en el pericardio y en el endocardio. 
El testiculo se hace flojo y amarillento, en degeneraci6n grasa. El rifi6n puede 
aumentar de volumen y hacerse piUdo y adipose. 

Ante este escorzo de anatomia patol6gica, iicil es hacer la separacidn de todas las 
afecciones mis o menos diferenciadas que crea el alcohol. Por ^1 se explica \mo las 
gastritiB, cirrosLS, esterilidad, delirioe, demencias, neuritis, etc. Y si a esto se afiade 
que el oiganismo asi lesionado es presa de cualquier infecci6n, comprendemos lo pre- 
cario de su porvenir y del porvenir de sus g^rmenes. 

Un punto me ha Uamado la atenci6n y es el de la cirrosis. Green algunos cllnicoe 
europeos que el vino da la cirrosis atr6fica clisica. En mi prictica he visto dos clases 
de cirrosis como mis frecuntes: la atr6fica en tm sindromo nftido, higado muy pequefio, 
seroflidad peritoneal abundante y pura, etc., de prondetico relativamente benigno; 



PUBLIC HEALTH AND MEDICINE. 173 

y la ciiToedB combinada con el bacilo de Kock, de lifgado graao, de serosidad a veces 
turbia, y que es mortal. En ningtbi caao ha intervenido el vino, bebida por otra 
parte eecasa entre noeotroe, ni tampoco el sullato de cal. 

El alcoholismo agudo, la embraguez, se diferencia segdn la bebida productora, la 
constituci6n individual y grado de intoxicaci6n. Eb asl como eadste la embriaguez 
moderada, alegre, optimiflta; la deUrante y convuMva, mis propia del ajenjo; la 
impulsiva, tambi6n determinada por eeenciafl o por hibridaci<3n con un temperamento 
epil^ptico. Sabido es que cada cual hace la embriaguez a su manera y quienes hay 
que exageran lo6 sentimientos altnxistafl y urbanoe como si hubiesen tornado hashich, 
9eg6ji el relato de un tomador de eeta droga; quienee son agreBivoe; quienes en fin son 
ailencioeos y como de inteligencia embotada. Dentro de ciertos limites, se entiende, 
que la inge0ti6n muy abundante a todos iguala en un como final y en todos se inicia 
cuando menos, una confusi6n mental y una amnesia m^ o menos profunda. 

Alcoholismo cr6nico es t^rmino empleado en psiquiatrla para deslgnar la alteraci6n 
de las facultades mentales que ya tienden a la demencia, pero en loe caaos en que 
^ta no es atkn muy marcada. En 61 predomina la p^rdida de loe sentimientos fami- 
liares, de la moralidad y de la voluntad, y ya se inicia ima perturbaci6n del juicio, 
de la autocritica sobre todo, un debilitamiento de la memoria y un comienzo de delirio. 
Las pesadillas son caracterlsticas por la frecuente zoopsia en el ensueflo, el temblor 
tambi^n diferenciado, las neuritis, desde el simple dolor a la presi6n muscular hasta 
la pardlisis. Y, en fin, todo el cuadro de la intoxicaci6n alcoh61ica como la perturba- 
ci6n de los reflejoe, la pereza del iris a la luz, la neuritis 6ptica, la impotencia, las 
alteradones del aparato digestive, de bus anexos y la alteraci6n de loe aparatos ciicu- 
latorio y renal. Signos notorioe diferenciales son de parte de la inteligencia lavivacidad 
incongruente y la ironia que anima un rostro de capilares dilatados; y el car^ter de 
los delirios, que parecen ser la prolongaci6n de un ensuelio. 

De ahf en adelante se va marcando la demencia que intensifican las alteraciones 
ateromatosas de las arteriaa cerebrales y las lagunas de desintegTaci6n que crean bus 
pequefias rupturas. Es frecuente, como en general en toda demencia, el transferir a 
otro lo que les parece desagradable en ellos mismos, como resto de crftica de una per- 
cepci6n errada. Esta demencia diferenciable por los signos ffsicos y los caracteres del 
delirio predominante es en veces tan diffcil de distinguir de la pariliBis general que 
exige la investigacidn de una linfocitosis c^falo-raquidea. 

Sobre este f ondo de alteraciones oig&nicas, y desde las primeras fases del alcoholismo 
hasta la demencia, pueden surgir otras manifestaciones clasificadas aparte como el de- 
lirio tremens, el delirio de persecucidn (paranoia alcoh61ica), la melancolla alcoh61ica, 
el delirio de celos y el sindromo de Korsakoff. He observado algunas de estas moda- 
lidades, entre ellas la melanc61ica en im case que no podr^ olvidar por la presentaci6n 
cllnica del enfermo, que presa de una ansiedad incurable vela aproximarse el fin de su 
existencia en medio de un malestar que comunicaba al espectador la angustia de su 
pena, respirando cuarenta veces por minuto, con un pulso d6bil y de gran frecuencia 
que a veces pasaba de ciento treinta pulsaciones: el relajamiento demencial se marcaba 
en la p6rdida de sus afectos, en el descuido de su persona y en la inmoralidad de algunos 
de sus actoe. Era un antiguo dips6mano y habfa tenido una infecci6n sifilftica atacada 
en^igicamente, a rafz de cuyo tratamiento sobrevino la crisis melanc611ca, como re- 
sultado de la doble intoxicaci6n y de las preocupaciones consiguientes sobre un 
sistema nervioso de suyo degenerado. 

Esto que anoto a la ligera como delineamientos generales provoca a hacer un aniilisis 
detenido de las perturbaciones nerviosas, con mucho las m^ importantes en esta 
materia. Es que en efecto las nociones de la neurologla contempor^ea, si bien hipo- 
t^ticas en muchas de sus aplicaclones, aportan cierta luz explicativa del mecanismo 
de la degeneraci6n nerviosa que no puede menos de detener un poco al observador. 

Dada la estructura de la c61ula nerviosa y su funcionamiento, ^c6mo la modifica el 
alcoholismo en cada una de bus etapas? 



174 PROCEEDINGS SECOND PAN AMEBJOAN SCIENTIFIO C0NGBB88. 

La vaaodilataci^n que se establece en las primeras copas de Hear cauaa una hiperhe- 
niia cerebral. La c^lula nervioea entra en un funcionamiento activisuno, pues sua 
excitantes mis poderoeoe son la hiperhemia y el CO'. Una r&pida articulaci6n de las 
dendritas por su ameboismo activado y la influencia de los nervi nervorum establece 
asodaciones que se manifiestan por la vivaddad de las ideas y el torrente de imigenea 
peculiaree del comienzo de la embriaguez, por la agitacl6n muscular y la exaltacidn de 
todas las funciones. Avanzando esta intoxicacidn los vasomotores no reaccionan ya, la 
c61ula adquiere un veneno que trastoma su quimismo y tiende a paralizar su funcio- 
namiento. En consecuencia una relajaci6n muscular y mental sobreviene. Es el 
estado de embriaguez avanzada en que el individuo no equilibra su marcha ni sua 
ideas; en que es im sonimbulo sin memoria de fijaci6n, ni julcioy pues le ocurre como 
a los animales fatigados que tienen sus c^lulas corticales desconectadas por la retracci6Q 
de las dendritas en estado perlado. Esta ialta de asociaci6n hace que no reconozca 
las personas ni las cosas a que est4 m^ habituado, que no d6 con su casa y se olvide 
hasta de si mismo. 

La sucesidn de estas intoxicaciones va formando im proceao degenerativo. Loe 
corpdsculos de Nissl, sustancia energ^tica celular, van desapareciendo del centro hacia 
la perifeiia; la redecilla celular se espacia tambi^n; las biomeras, bioblastos del reti- 
cule neurofibrilar, mueren, el ndcleo y el nucleolo, centres tr6fico8 y funcionales, no 
reaccionan, se fragmentan y desaparecen. La alb(imina protopldsmica dellcada y com- 
pleja se fracciona poco a poco en granulaciones grasas y crom(3genas, un estado vacuolar 
se inicia: es la cramatolisis con un cambio de constituci6nqulmica aparente, pues ya 
no se tifie con los colorantes con que se combinaba en su estado normal. Los leuco- 
dtos penetran en ella, no para restituir los cuerpos de Nissl, como es el hecho ordlnaiio, 
sine para englobarla como a organismo muerto. Las c^ulas van desaparedendo asi 
y dejando en su lugar grasa y tejido escleroso. Las drcunvoludones se hacen mis 
duras y pequefias. £1 cuadro anatomopatol6gico de la demencia gen^zica queda 
estableddo. En efecto al hacer cortes de la sustancia cerebral se nota la escasez de 
las c61ulas, y al examinar a loe dementes se observan sus lagtinas de desintegrad6n en 
el orden intelectual y moral, sus perturbadones trdficas y fundonales en el orden 
fisiol6gico. 

Ctianto m^ daiioso sea el alcoholismo en los j6venes nos lo ensefia el hecho de que la 
c^lula nerviosa es la mis lenta en su desarrollo, pudi^ndose decir que no es adulta 
hasta los veintidnco o treinta alios, y sabiendo como sabemos que no tiene regenerad6n 
poeible, que una vez muerta no tiene sustituto. La educad6n esti fundada fisio- 
16gicamente en el ameboismo celular, que facilita la articulaci6n de loe penachoe de 
Unas cilulas con otras, que las asoda en una complexidad inextricable. La voluntad 
probablemente se conduce por los nervi nervorum a los prolongamientos protoplismicos 
para constitulr las asodaciones apetecidas. Si una intoxicad6n de la c^lula, por 
cambio en su quimismo normal, paraliza su acd6n, ni la educaddn, ni la voluntad 
podrin ef ectuane, y de ahi esas perversionee de los heredo-alcoh61icos y de los adultos 
alcoholizadoB. 

Si de este cuadro de la demenda pasamos al delirio, podemos decir que unairEitad6n 
de las cdlulas exalta su fundonamiento en una inconexi6n que no permite asociar, y 
por lo tanto comparar, criticar y refrenar. Esta exaltaddn perturbadora se traduce 
en alucinaciones por el proceso de la transferenda, es decir: la localizad6n en la peri- 
feria sensorial de lo que es central efectivamente — ^transferenda que es fund6n del 
hdbito — y asi se constituye el fondo mismo del delirio. Lucgo asodando la idea per- 
turbada segdn las conexiones restantes, se forma la novela interior de los delirios, Idgica 
en su misma desviad6n. 

Esta mecinica nerviosa es cuanto podemos vislumbrar hoy por hoy, sin pretender, 
ni mucho menos, afirmarla como una verdad definitiva en este misterioeo reino de 
lapaiquis. 



PUBLIC HEALTH AND MEDICINE. 175 

Analizaxido ahora el efecto de nuestraa bebidas alcoh61icaB podemoe decir que el 
aguardiente produce una embriaguez agredva y que la chicha da un embotamiento 
y una insenaibilidad caracterlsticoB. Si fuera poeible un paralelo absolute dirfa que 
el aguardiente produce una imtabilidad moral y la chicha una insenaibilidad tambi^ 
moral. Qui^ sabe si a estas dos causas se deba en mucho la frecuencia de las rifiaa 
en Antioquia y el predominio del raterismo en el bajo pueblo de la Altiplanicie, la 
altanerfa all& y la socarronerfa en esta otra regidn. Son problemas de criminalogfa 
apenas esbozados. 

En efecto, la chicha produce peculiar embriaguez que se traduce con una palabra: 
torpeza. Torpeza mental y muscular. El alcoholizado con chicha marcha a peso 
corto y contracturado, atiende mal, responde tardfamente. Es un confuse mental, 
descuidado de su persona y torpe en todas bus reacciones. Presenta a voces el sin- 
dromo de la pelagra. El alcoholizado cr6nico por aguardiente, en camino de la demen- 
cia, da la impreei6n de cierta inquietud imaginativa y motora con gesticulacidn r&pida, 
palabra tumultuosa y una ironla a voces feliz. El intoxicado cr6mco x)or chicha es un 
alelado con m^ estupor y una incuria personal incomparable. Hay, pues, dentro del 
cuadro gen^co a amboe una modalidad en cada uno que hace del chichismo una 
intoxicaci6n m^ profunda y enervante. 

La chicha esti causando una degeneiaci6n de la raza india en los Departamentos de 
la Cordillera oriental. Es de f&cil observacidn la viva inteligencia de los nifios del bajo 
pueblo bogotano hasta la pubertad, 6poca en que, asf lo juzgo yo, aparece una pertur- 
baci6n por herenda homocr6mca, que los hace lerdos, humildes, perezosos y no poco 
inmorales. Lo creo asf aun descartando la infiuencia directa del licor que toman desde 
antes de ser destetados, pues en esa vivacidad de la infanda se esbozan dertas degene- 
neradones, a saber: la vagabunderla, el raterismo, la insensibilidad moral, la copro- 
lalia (notable por ser un pueblo de gran delicadeza en el trato con sus superiores). 
B^ones hay en el oriente de Oundinamarca en las que la acci6n combinada del bocio 
y del alcohol (chicha fermentada) ha conduddo a la raza a una degenerad6n alarmante 
a pesar de tener mucha sangre espafiola, a una po8trad6n moral intelectual y ffsica que 
es serfsima amenaza futura y ya triste presente. En todo este Altiplano he visto tam- 
bidn un ntimero crecido de reumdticoe y de cardiacos a los veinte afioe que me llam6 
la atenci6n. 

A esto se afiade que la falta de bafio frecuente es una causa poderosa del metabolismo 
vidado y de la depresi6n funcional, y que la tuberculosis y la sffilis crecen en Bogoti 
en muy seiias proporciones. La mortalidad infantil, de uno a diez afioe, ha alcanzado 
en algunos perfodos (1910) el 44 por 100 en esta dudad. En ella misma la mortalidad 
por tuberculosis alcanz6 en 1912 y 1918 el 9 por 100, y en el Hospital de San Juan de 
Dios ha habido aflo de llegar a 29 por 100, (1895 y 1896). La sffilis crece en nuestros 
medios urbanos, y me atrevo a pensar que atin proepera. La debilidad de la raza, el 
recargo nervioeo de la vida contemporinea y los tratamientos mal conducidos son una 
cosa alarmante a este respecto. He observado tantas vecee la sffilis cerebral precoz 
(menos de un afio) que me pregunto si es que hay variedades de triponema hiper- 
t6zico y neur6tropo. La sal de Ehrlich aplicada en un tratamiento discontinue es una 
amenaza muy seria, y a mi mode de ver en esta forma es a la sffilis lo que el opio al dolor, 
un sedante, que disimula apenas, si una prudente terap^utica no viene a conjurar el 
peligro. Remedio heroico bien empleado y combinado, requiere una prudencia digna 
del mayor encaredmiento. 

Son, sin embargo, los efectos familiares aquellos que mis apenan al moralista. La 
literatura ha logrado condensar en dramas de una emoci6n angustiosa el proceso fntimo 
del hogar afectado por el alcohol. 

Son los primeros ensayos del hijo o del esposo que furtivamente llega a su casa, 
ocultando con pundonor el trastomo mental y el desequiUbrio de las primeras embria- 
gueces. El remordimiento del dfa siguiente en una atmdsfera de reticencias. La 
esposa o la madre que inclinan la cabeza ante un vago presentimiento y arrojan sobre 



176 PKOCEEDINGS SECOND PAN AMERICAN SCIENTIPIO OONGBESS. 

el ser querido el manto de un disimulo cariiioso. Eb la primeia crifliB familiar que 
egtalla cuando el borracho va perdiendo la timidez de las reaccionee morales y se Uega 
a la casa con la cara vultuosa y el lenguaje ofensivo o altanero. La recriminacidn 
piimera y el primer desenfado. Las Idgrimas que empafian ojos discretes y queridos 
ante el ejemplo conturbador que el ebrio da a los nifios que le contemplan con mirada 
at6nita, desconcertados y medroeos. Las Idgrimas que se deslizan silenciosamente en 
la penumbra de la alcoba conyugal antes nido de amor y hoy refugio de dolores. Las 
l&grimas intitiles de quien ve un golpe de deshonor y de miseria cemerse amenazante 
en future que avanza con premura impasible. 

Y tras de eeas rebeldlas contra el martirio que comienza, van smrgiendo en el hogar 
las consecuencias fatales. Es el hambre que uno de esos dfas aparece. La desnudez 
que se inicia en las primeras desgarraduras del traje, m4s penosas ciertamente para el 
alma que para el cuerpo atezido. La noticia del escdndalo en la tabema. La primera 
prisi6n. Y, por dltimo, el golpe mortal: la aparici6n del vido en otro de la casa. 

La esposa envilecida en un ambiente de dolor y de miseria ve descorrerse los dias sin 
esperanza; ve Uegar con horror la noche en que el borracho, inmundo de la cabeza a 
los pies, ocupari su lecho, y torpemente lascivo, en utn entusiasmo fugaz le dejard en el 
cuerpo un desgraciado y en el alma asco profundo. 

En onda dilatada la suma de los dolores no se cierra nunca. Tras de la vergtLenza, 
de la desnudez y el hambre, cuando ya se va embotando la sensibilidad emotiva y 
moral, sugird m^ y mds airada la cat^btrofe interna: un dia llegar& la tisis con su 
cortejo de orfandades y otro dla la prostituci6n abrigard los cuerpos desnudos con lo9 
61timos harapos del honor . . . Despu^ el olvido recQgerd las pavesas de un hogar 
que consumi6 el alcohol. 

Sin embargo, no sucede siempre asf. Sobre la sociedad repercutir4 la onda de este 
naufragio. 

Consultando estadisticas vemos que los asilos y las circelee encierran de im 20 a 30 
por 100 de las vlctimas del alcohol. 20 a 30 por 100 directo a que debemoe agregar laa 
consecuencias de su acci6n mediata que lo elevan a la abrumadora proporci6n de un 
50. Y como los hospitales siguen ese mismo derrotero, y como la mortalidad infantil de 
61 toma su mayor contingente, y como los d^biles mentales, que ser&n el ludibrio de la 
sociedad y el tormento de los institutores, los retrasadoe con el cortejo de perturbaciones 
morales y su frecuente epilepsia, los imbeciles que adn conservan im aaidero intelec- 
tual, los idiotas, ciegoe ya de entendimiento: una verdadera falange de infortunados 
que son problema social que crea en su mayor parte el alcohol; y los neurdpatas, 
locos, los vagabundos, los perezoeos, los mendigos, los rateros, los criminales natos le 
deben tambi^n un crecido x>orcentaje; tenemos que inclinamos ante la evidencia de 
que es la plaga m^ lesiva que pesa sobre la humanidad. Y si pensamos que los otros 
grandes flagelos con 61 se hermanan y de ^1 reciben su mejor abono, hay para meditar 
un instante en si hacemoe o n6 sonar la hora de una lucha definitiva. 

Un hilito de tristeza se cieme sobre la vida contempor&nea. El desequilibrio mental 
ha hecho posible la profecla de que la humanidad sucumbir^ en una locura universal; 
el problema del proletariado se complica diariamente; el ndmero de hospicioe, asilos 
y circeles crece hora por hora sin llegar a satisfacer la demanda m&s y m^s uigente. 
Es, pues, hora de reaccionar antes de que el esfuerzo sea superior a nuestras capaci- 
dades. 

TBRAP^XmOA. 

£1 alcoholismo es una endemia social que se acentu6 prodigiosamente durante el 
agio tUtimo y que ha desafiado el rigorismo de todas las medidas profiUcticas. 

Hay restricciones policiacas, pedag6gicas, m6dicas, financieras y comerciales, etc., 
que van deede la propaganda abstinente hasta la prohibici6n absoluta, ensayada de 
un mode oficial en algunas partes. 



PUBLIC HBAJLTH AND MEDICINE. 177 

La restricci6n oficial por medio de ordenanzas de policia esti eetablecida entre 
aoflotrofl, como en todas partes, sin resoltado promiaoiio. Deja a cubierto el alcoho- 
liamo ''a potu nimio" y se cuida b61o de lo que ya ee irremediable: la embriaguez. 

Lob impuestoB m^ y mia altoe que peaaa sobre la industria y el comercio de las 
bebidas alcohdlicas b61o ban servido para encarifiar a los gobiemos con las plngUes 
rentas que de elloe derivan. 

La reetiicci6n en el ntimero de establedmientos de venta basta determinado por- 
centaje de poblaci6n es un tratamiento tenue, una terap^utica de fomentos sobre una 
gangrena alarmante, como lo prueba una comparaci6n entre Holanda y B^lgica, que 
consumen "per capita" igual cantidad de alcohol, habiendo esta restricci6n en una 
deellas. 

La labor educacionista es tambi^n palanca de poco alcance, porque necesitarla cu- 
brir con su piotecci6n todas las categorfas sodales en un esfuerzo de educaci6n intensa 
I>aia lograr quizA s61o efectos pardales. 

El tratamiento medico est& reduddo a tres recursos: el de la educaci6n de la voluntad, 
tarea dificil como pocas, que requiere cierta vocaci6n de parte del medico y no poca 
voluntad ya d^ enfenno, el de la correcci6n funcional: los t^nicos nervioeos flsicos y 
qufmicoe, los correctiYOs de insuficiendas orginicas espedales, y por tiltimo el 
remedio heroico, el intemado en una casa de salud. Fero el m6dico es recurso de 
uigencia o ya de angustiosas situadones, de suyo impropicias, y su acci6n eati cohi- 
bida por la voluntad del paciente y la deficienda l^al respectiva. 

Ninguno de estos tratamientos aidados podr6, pues, considerarse suficiente. Pero 
tree de ellos dar&n una combinad6n saludable: la prohibid6n absoluta de vender 
bebidas alcoh61icas, la legislad6n conducente a establecer el intemado en un aailo a 
los que se embriaguen determinado ndmero de voces, y la educaddn profiUctica 
respectiva. 

Yamos a analizar estas medidas draconianas, porque superfidalmente parecen un 
juego de imaginad6n. 

£1 alcoholismo es una endemia sodal que va minando la espede humana basta 
constituir su peligro mdzimo. Estamos en presenda de un enemigo capaz de efectuar 
un aniquilamiento de la espede, como lo acredita la r&pida desaparid6n de los Pieles 
Bojas, polinesios y alricanos tratados por el alcohol de la cristiana dviUzacidn euro- 
pea. Ante 61 queda justificada toda medida de repre6i6n, como se justifica el destie- 
rro de los leprosos, la prisi6n perpetua de los ciiminales patoldgicos, el aislamiento 
social de los pervertidoe. La moral lo autoriza, y la justida humana no seri cruel si 
redime las generadones futuras, como lo manda el esplritu de conservad6n y la misma 
dignidad de la eapede. 

Las vinculadones familiares tambi6n reclaman a grito heiido la liberad6n de la 
mujer y de los p&rvulos, a quienee el alcdiolismo martiriza impunemente con hambre y 
deehonor. 

El altruismo, la caridad cristiana, la simpatia del pr6jimo— como quiera enten- 
derse — ^neceaita dejar atris este fardo de miserias para consagrar su acddn al credente 
desequiUbrio del bienestar humane. La Asistenda ptiblica no debiera tener en un 
futuro feliz sine dos aplicadones: la de dar trabajo al adulto y aailo a los ancianos 
que rindieron ya una jomada de lucha. 

Ante los destines de la espede est6, pues, justificada la prohibid6n absoluta. 

Los financistas que se ban encarifiado con la renta que rinde el vido tienen que 
curar la miopia de sus ojos y comprender estas dos verdades de sentido palpitante: 
1.* que la contribud6n que suministia el vido puede subsLstir en otra forma, puesto 
que es un hecho indestructible que prueba esa capaddad contributiva; y 2.* que el 
Estado y la sodedad pagan con creces en gastos de correcd6n del vicioso y de pro- 
tecd6n de sus vfctimas el rendimiento de tan monstruoeo recurso fiscal. Como lo 
ensefia un libro de propaganda antialcoh61ica, en 661o los Estados Unidos hubo de 



178 PBOCEEDINGS SECOND PAN AMEBIGAK SGIENTIFIO C0NGBE8S. 

1860 a 1870 un gasto de mia de quince mil millones, cien mil nifios en lae caeas de 
caiidad, ciento dncuenta mil condenados a prisidn, diez mil locoe, mil quinientoe 
asesinatos, doe mil suicidiofl, y un mi]16n de hu^rfanoe a causa del alcohol. Las p^rdi- 
das ocaslonadas fueron calculadas en Fianda un afio en mil millones de francos; y en 
1895 gast6 Inglaterra miuB de tres mil millones. Paede dedise que el impuesto sobre 
el alcohol es apenas el logaritmo de los gastos que Me ocaaiona, y que un pueblo se 
haria inpitanttneamente rico si, conservando los otros &ctores econ6micoe, desechara 
en un momento dado el alcoholismo. 

Y podemos preg:untar a estos pseudo estadistas cuinto vale una vida humana, cu&nto 
yalen todas las vidas humanas tzonchadas por el alcohol. £1 espfiritu humane queda 
a6n como un enigma. Las Gompafilas de Seguros podr&n valuar el precio econdmico 
de un hombre segtin su categorfa; pero es predso preguntarae si hay peso o medida 
para la energfa moral y la eneigfa intelectual como factores inescrutables del progreso 
de la especie. Ante un nilio fracasado pasa indiferente la estulticia humana, pero 
el fildeofo Yuelve la vista y se pr^:unta si alguna nueva ruta se ceg6 con esa siega. 

Ante el problema del opio en Asia y del alcohol en Africa se ha levantado este argu- 
mento de la renta con la discrecidn que es del case, pero los mMicos no vacilan en 
lamentarlo, como que tiene sus rafces en el cultivo de la miseria humana, y lo hacen 
para con pueblos colonos y tribus salvajes tenidos en poco estimacidn. ^Gdmo pudie- 
la, pues, Bostener un ciudadano de un pais Ubre y ctdto la validez de un beneficio 
fiscal a cambio de una perturbaci6n econdmica infinitamente superior y de una per- 
turbacidn moral no menos alannante? La sola coeecha de vinos de 1890 vaEd mia 
de cuatro mil millones de francos. ^Cu£ntos miles de millones valdr& lo que el mondo 
consume int&tilmente en alcohol? ^ Y cu&ntos miles de millones hay que alEiadir a este 
gasto por los dafios que ocasiona? ^No se debe, pues, pensar que el desequilibrio eco- 
ndmico mundial tiene ahf un &ctor inequiparable, que quiz4 es este el factor supremo 
de la miseria en el mundo? 

Luego ante los presupuestos nacionales est4 tambidn juslificada la prohiblcidn 
absoluta. 

Si at&n subsisten argumentos en contra no alcanzo a vislumbrarlos. Quizd una pro- 
hiblcidn bnisca causarfa un desequilibrio comercial ruinoeo y una rebeldfa tan intenaa 
que podrfa causar la cafda de un gobiemo. Para este doble peligro politico y econd- 
mico hay una solucidn f^l: un impuesto adidonal y tenazmente progresivo, de Ice 
que ya pesan sobre las bebidas alcohdlicas, deetinado a la creacidn y conservacidn 
de Gasas de Salud para el tratamiento preventiyo y curativo de los alcohollzados ini- 
ciarfa la restricddn sin lesionar impnidentemente a los industriales y comerdantes, y 
crearfa los recursos suficientes para la profilaxis cientifica, siendo asaz justo, porque 
devolverfa a la sodedad en bienes lo que por males le sustrajera, y cerrando mia y 
mis el clrculo de las restricciones se llegarfa en tiempo no muy remoto a la abolicida 
completa, verdadero desideratum. 

Y si ocurriere que el impuesto adidonal encuentra ^*saturado" ya el precio de las 
bebidas alcohdlicas — que no lo esti generalmente — cumpUdndose entonces las leyes 
econdmicas disminuirA el consume, y obtendremos directamente lo que buscamos de 
un mode indirecto. 

La disminuddn del consume en Antioquia en mia de un litro por cabeza en los 
dltimoB clncuenta afios indica que es posible una disminuddn de consume con 
aumento de la renta. 

Los pueblos que tengan la costumbre de tomar vino en las comidas y los que tengan 
su mayor riqueza en esta clase de industrias resolver&n el problema mia diffdlmente 
que nosotroB. Pero no seria juidoso el que continuara el alcohol siendo en nuestra 
patria un peligro sin razdn sufidente para tolerarlo, ni slquiera una costumbre ancestral 
universallzada . 

El segundo capftulo de tratamiento, el intemado, queda atin como lo tknico racional, 
pues en dl beneficia el padente de una abstinencia absoluta, de una educacidn de la 
voluntad y de un corrective social. 



PX7BU0 HSALTH AKD IfSDIOIKS. 179 

\ Y 68 indiBpenaable para complemeiitar la acci6n prohibitiva, pues el fraude se 

iniciaii con ella de un modo audas y astuto. 

Pero esto oomporta gravw ptoblMiiafl. £1 intetiiado de loe ya denentea, el inter- 
It uado tianaitorio de loa dipedmanot, hecho generalmente cnando no lo neceBitan, es a 
oaber, al terminar mu ciiaii, eon medidaa inocentea. Como hay caMM de coireccidn 
para menorei debe haberlaa pan lot que ea inidan en el alcoholimo. Besulta, ea 
verdad, una aparente leitiiccidii de la libertad individual al tratar de cdiibir en el 
lilMre ejerdcio de aua deiw^oe y tiabajoi a una penona que apenaa haya cometido la 
falta de unas pocaa embriagueces, o de hacene notar como bebedor cotidiano de p^ 
quefiaa porciones. Mae ello et que ae caatigan dot delitoa tinilaret: el inlanticidiOy y 
el alcoholizado atenta contra tu prole; el suiddio, y el que abuta de laa bebidaa 
alcoli61icaa tiende a 41. Mia a<ln: te tiata de una deienta aodal* aupenor por lo 
miamo a lot intereaea indlvidualea. 

£1 intemado para aer benifico requiare una liyalaci^n rei^uladota que ettableica 
la autorisad6n para loa miembroa de la familia de aolidtarla de laa autoridadea com* 
petentea, y la obligac»6n de eataa autoridadea de proceder de ofido cftda Tea que llegue 
a 8tt conocimiento un caao deteiminado. 

Eate intemado, por otra parte eficaz tratindoae de individuoa pundonoroaoe %tax y 
conacientea, aerfa una cura por el trabajo, aobre todo muscular, y la educaci6n de la 
yoluntad. Deberia inidasBe deade el prindpio de la reatricci6n y confiimaiae a la 
generad6n aiguiente de la que aufriera la prohibiddn definitiva, puca de otro modo 
no habrfa eapado ni recunoa aufidentea para aplicar juatamente la ley. £a aabido, 
ademia que una generad6n abatinente levanta el nivel de la raza de una manera 
prodigioaa, y el intemado ea un tratamiento tan eficaa, que hoy miamo alcanza un 
40 por 100 de cuiadonea. 

Por lo que reapecta al tercer capitulo, la educad^ pTofiUetica, baeta con enuneiarla 
para comprender cuil aerfa au radio de acci6n y la contribudi6n que pudiera preatar 
a la 8olud6n de eate problema, puea ea quiad el campo donde ae ha inidado mia 
en^igicamente la ludia antialcoh61ica. 

Quedan por tratar doa gravea cueationea: laa bebidaa alc6h61icaa cauaan mudiaa 
Tecea un eapardmiento aaiatoao, que diacietamente uaadaa llevan al eapfrituel 
entuaiaamo memorable de una hora de eompafieriamo o de galanterfa aodal. iQu6 
hacer? ^Se tolera eato, prevlo permiao de una autorldad o de una junta de higiene, o 
ae hace tabla rBM de toda tentad6n7 Con lo primero la eapada de Damoclea no aerfa 
Yuelta a au vaina completamente. Con lo aegundo robarfamoa a la humanidad un 
poco de expanaidn alegre cuando en yerdad la vida ea irida y el ddor inaiate tenas* 
mente. . . . 

£1 otro problema ea el expendio oomo droga, en veidad lAcil de readver aparente- 
mente cuando ae pienaa que comportarfa una preacripddn mMica, pero expueato ain 
embargo cuando aabemoa que la morfina y aua hermanoa de vido aon propinadoa 
abundantemente a loa padentea ain que haya modo de aorprender el fraude por aquella 
etema connivenda entre el Interte del ooomciante y el intcrte del eonaumidor, bepe* 
fidadoB mutuamente a au manera. 

Maa eUo ea que adn aaf tendrfamoa hecho mia de la mitad de nueatro camino profilic- 
tico, y eatarfamoa preparadoa para un futuro mia riguroao. 

No quiero de propdaito deliberado entrar en la enumeracidn de lae bebidaa que 
deben aer eliminadaa del mercado, poique eate ea un detalle indtil en un eatudio de 
ideaa generalea y aendllo de eatablecer en la hora propida. Retpecto de noaotioa eg 
preciao anotar deade ahora, eao af, la neceaidad uiigente de que la chicha aea eliminada. 
Becuerdo que en un tiempo, redente adn, ae implant6 en Caldaa eate vicio con tanto 
entuaiaamo, que hn pocoa meaea ae obaervaron caaoa de alcoholiamo, y baatd un grava. 
men prohibitivo paia deaanaigario. Algo aenejante deberfa hacene en loa Departa- 
mentoa con eate y otroa iiooret como el aguardiente, el ron, el cofiac y eae mundo de 
yinoa mia o menoa adulteradoa que ae conaumen en variadaa proporcionea aegi^n loa 
bibitoe regionalea. 

68496— 17— VOL ix 18 



180 PROGEEDINQS SECOND PAK AMEBIOAK 80IEKTIFI0 CONQEESS. 

0ONCLn8l6N. 

No 68 diflcil prever sordas reBistenciafi, entre las cualee no serfa la menor el calificar 
de ut6pico este Intento. Sentemos desde ahora la verdad y digamos que ut6pico 66I0 
es lo que no puede realizarse con las fuerzae nonnaleB del hombre, y que fuerzas y 
derecho le asisten en este case para enarbolar la bandera de prevision y de cultuia 
con un gesto que no tiene de heroico mis que el no ser frecuente: y nunca ser6 una 
audacia el pensar que las facultades del hombre se hicieron para veneer las dificul- 
tades de la vida. 

Greo, pues, haber dejado razonado el siguiente vote que someto a la aprobacidn del 
Gongreso: 

El Gongreso Gientifico Panamericano de Wellington encarece a las Naciones repre- 
sentadas en ^1 la restriccidn gradual del alcoholismo haata su abolici6n, inidindola 
con un impuesto adicional y prudentemente progresivo sobre las bebidas alcoh6licas, 
dedicado exclusivamente a la creaci6n y con8ervaci6n de Casas de Salud donde sean 
intemadoB por disposici6n legal loe relncidentes de embriaguez y los notorlamente 
incUnados a la bebida. para que en ellas beneficien de un tratamiento '^preventivo." 

Col. John Van R. Hoff. I move that the resolution proposed hi 
the paper of Dr. Mesa be referred to the committee on resolutions. 

Seconded and approved. 

The Chairman. These papers are now open for discussion. 

Dr. Tom A. Williams. The problem of alcoholism is even more 
extensive and profound than the prevention of overt bad habits like 
alcohol, morphine, etc. It is rooted in the psychic foundation of the 
individual who indulges. I observed a smile in the audience when 
Dr. Wiley told of his boy, but I can confirm what he says with my 
own boy, who is now 9^ years old, and from what I have seen of 
many little patients who have been directed by me in rational 
psychological ways when I was consulted about the nervous troubles 
which arose from mismanagement. 

Persons who become addicted from social reasons or because 
they are oversuggestible are easily reached by prohibition. They 
have no real inner temptation. The diflSicult problem is the psychas- 
thenic person. In the search for euphoria, such persons adopt many 
other expedients than alcohol. One girl, for instance, an accoimt 
of intense mental suffering, used to pour boiling water on her feet. 
Some have recoiUBe to superstitious practices, carrying this even to 
the way in which they put on their clothes. One of my patients 
would take two hours to dress in the morning, even though helped 
by his father and mother — a time they could iU spare, the father 
being a United States Senator. The agony of the obsessions of 
these people can hardly be comprehended by those who have not 
felt it. Even suicide may be tried to escape from the suffering. 
The cause of their sufferings is often purely psychological and can 
be removed by proper readjustment of their attitude toward life. 

The reaction to narcotic drugs is more dependent upon the indi- 
vidual than upon the drug itself. Either expansive and joyous, 



PUBLIC HEALTH AND MEDICINE. 181 

or depressive and sad, reactions may result from the same drug in 

different people. 

Even the removal of the specific craving for alcohol, if it could 
be done by an antibody, would not cure these individuals, as the 
problem is much deeper. Dr. Doria's very learned treatise upon 
the takera of cannabis indica in Brazil is a beautiful illustration of 
this very point. These people seek for happiness and they find it 
in the temporary stimulation of the drug they take. They have 
the sensation so well described by the poet Bums when he said, 
"Kings may be blessed, but Tam was glorious, o'er all the ills of 
life victorious." When a miserable, half-starved peasant can feel 
like this, who can blame him for taking narcotics 1 Let us beware, 
lest in prohibition of alcohol, we do not drive people to worse vices. 
To prevent this we must see that human lot is ameUorated and thalL 
wise psychological management is given Our children. 

The Chaibman. I shall now call for the reading of the following' 
papers: 

An inquiry into the causes of crime, by R. B. von KleinSmid. 

Pauperism, by Edward T. Devine. 



AN INQUIRY INTO THE CAUSES OF CRIME. 

R. B. VON KLEINSMID, 
Pre$identf University of Arizona. 

A student in the field of eriminology is forced to wonder at times whether there is 
any other field in which it is jMsslble for him to encounter so great a diversity of 
opinion or such extreme and opposing views. It is to be said, however, that con- 
dusions heretofore reached have come largely from empirical sources alone rather 
than from scientific investigations, and that the extreme positions held are those 
dictated by the angles from which penal and correctional problems have been ap- 
proached. In general, these condusions may be grouped as four in number. 

The fint is that, to a greater or less extent, every man is guilty of crimes— the detec- 
tion, conviction, and sentence of some avoided <mly because of concomitant circum- 
stances. Were the eye of the law trained as carefully upon the free as upon others 
who are compelled to pay the penalty of their misdeeds they too must suffer the die- 
grace and the punishment meted out to other offenders. In other words, all have 
comndtted and do ccmmiit crimes, and it is very largely a matter of chance as to 
which ones reap the just harvest of their antisocial seed sowing. Out of this theory 
has grown the belief that, by no means, are aU of our criminals incarcerated in insti- 
tutions, nor indeed our wont ones, but that there are many, as Tarde points ont» 
who even go 80 ftf as to make a profession of the criminal life, operating with a cunning^ 
which, with rare exceptions, evades detection, and so escapes the penalty. 

The second belief on the part of certain of those who give attention to the problem 
of crime is that all criminals are vicious men, and consequently it is the duty of so- 
ciety to hunt them out wherew they may be found in order to mete out to them 
that degree of punishment appointed by legislation for the particular crime committed . . 
Out of the attitude of this faith have grown the hifjti wall, the whipping post, and the- 



182 PBOCEEDINGB SBOONa PAN AMBBXOAK SCIEKTIFIO CONQBESS. 

dtmgeoiiY together with all meaxiB of discipline and puniskment which humiliate and 
degiade, in the conviction that the vicious must be cowed and made afraid to vent 
their nefarious temper upon a society strong enough and determined enough to cope 
with fhem and to demand of them an eye for an eye and a toeth for m tooth. 

Another view held particularly by those of sociologioal oitereslB is that trapsyonssia 
oi the law would be very few in number, if any, exo^ for the peculiar and cqb^ 
^iaminating social environment. Those of this belief hold that society is to blantt 
•directly for the existence of the so-called criminal class because she n^ects to con- 
duct her economic and social afhtiiB so as to sunound all of her members with those 
influences which make for good ai<»(e. 

fitill a fourth condusion is to the effect that aSl tsiminals are defectives and thait 
no man of normal mental and physical status commits a crime. On the grounds of tilb 
belief there have sprung up among us, in the last few yean, a number of serious 
and, more recently, organised attempts to investigate the field of crime for the pm^ 
pose of determining the degree of abnormality of those who have been cowictod 
and incarcerated. 

While the truth is not te be found exduMvely in tibe theory held by «ny one "Of 
these particular groups, it is not at all unlikely that there is a considerible element 
of soundness in the arguments of all; in fact, may it not be the case when investiga* 
tions will have continued for a greater length of time and more exhaustive study 
will have contributed more generously to the sdence of criminology that it will be 
discovered that there is a large elemeniof identity in the theories adivanced and that 
these various condusions are not antagonistic te so great a degree as mifp(m&i7 Until 
quite recently the sdence of criminology was regarded as a legal sdence exdusivdy. 
Now there are indications that there are many who believe it to be a purely social 
sdence. On the contrary, if there be a sdence of criminology — ^which some deny — 
there are those who insist that it has its origin in the sdences of medicine and psy- 
diology. The legal sdence emphasizes the responsibility of the present criminal; 
the sodal sdence, the responsibility of eociety from which he came; the medico- 
psychological sdence, the responsibility of his ancestors not less than that of the 
individual criminal himself. May it not be that these different positions, too, have 
eome about only because of varying appgoadies to the earns trnth? H im gposut that 
the individual offender is vidons and should be pmished fteoovding te the law, wm 
still have to account te the fact that this aian is videuiaDd aone otiisr neoibsM of 
eodety are not. If we grant that the enviroHDasnt fern whadi he cmbs waa een- 
dudve to criminal activity, we stiU have to acoeoirt te the fact that maay otfaasi 
from the same environment do not beoome offenden. Gnmt a vickns atdtnde in 
his case and cardesness and nei^ect on the part of eodety tecraatonpsoper enwMa- 
ment f or him and we are conlronjted with the tet tint it was t^is paiticiite iaiiividaal 
who committed the crime who doubtless oanies wttbin himself the cause of his mhk 
deeds. However, just as sordy as we diecoiverlraa ft clinieal study of tfieindividiisl 
that the probable cause of his own downlsU lests in his omstttutional inferiority, w« 
shall find it necesatfy to lay the Uame te his conditM in teve part at the deor of 
shortdghtedsodetyandherinatitationa. Fnm the standpoi«t, then, ef the cUnioal 
research laboratory let us see what aitosition poesenta itself. 

One has not kbored long among those convaeted «f crime betoe he is etronffty 
impressed with the fact that he ia dealiBg with beings of letrogsade type— bengs 
who fail appreciably bdow the reosgniaed standard el normality, «nd who« in a very 
large percentage of cases, bear about in their bodies the BBarfcs of this degeneracy. 
In this matter, however; one must needs exerdae the giesitest cars to avoid the common 
enor of oendnding that the prssenoe of eAo or mete cfaaicatsriaCics, usually aeoepted 
as sdgsMta of degeneracy, is proof podtlve that ^be eubject is eubnoraBsl: the Darwin 
ear, the Mord ear, or the esr aurked with the entire absenoe of the lobulua, tb% mnO- 
focmed pelato, polydactyiism or hypertridms i s an y ef these may be found in Hie 



FUBUO HBALTH AKD MEDICIKl. 183 

purticulMr individtiil in whom the dosest nmlyaa wHI fail to ind uiy baab for a 
daanficatkn beloir the normal; aad yet Ilia number of theae aU^^ 
combinationa so frequently fcmnd among thoee convicted, of conne, k eofficient to 
cause dieir presence to be regarded aa a naual accempwiimeiit of oiminal activity. 
Assymetry of the face, microcephaly or ma crocephaly, dental deformitiea, abrabiamua, 
ndcrophthalmia, pigmentary ratinitb, albhuam, ayndactyliam, nasplaced and mal- 
formed limbe^ Hat feet, hypoapadiaa and hermapluodiam— these and many e^het 
aigns of degeneracy are constantly met irith. 

We do not aeek to eatabUrii a caosatiTe rdatkm here but merely to obaerre the 
accompaniment of stigmata with crime, lliifl of itself is of the utmost importance. 
On the ottier hand so frequent and so serious are the various phyrical and physiological 
abnormalities and defects as to challenge our earnest efforts to discover this elossggola 
tionahip. Phimosis, enlarged tonsils, adenoids, bad teeth, defective vision, poorty 
developed chest, stooping shoulders, pulnsnaiy lesftons, valvular heart lerions, and a 
serious nervous condition brought on by eye tiouble of one soft or another; "a sub* 
normal temperature, associated with an accelerated pulse and respiration," aa noted 
by Dr. Sleyster, "pervenlo&a of the aexual instinct, uncontrolled doMie for Honors^ 
migraine, disordera of the nervoua ajrstem, inaensibility to pain, defects of speech and 
reduced physiological tension,'^ as pointed out by Dr. Bowers; impotency and ster- 
ility; while by no means is this list to be accepted *4n toto" as naming positive evi- 
dences of degeneracy, aU of these conditions are bound to a ss ort themselves among 
either the primary or secondary causes of crime. 

From tiie philosophical standpoint it may be that we are not ready to admit of %ny» 
thing more than a paraOelism between mind and matter, yet it must be admitted 
tliat a seriously defective body could not express rig^itty a mind of even supernormal 
capabilities. "Aye, there's the rub." Ae tiurai^ not suffieiently afflicted with 
physical and philosophical defects, the criminal class aita lacking pathetically in 
mental ability, and it is an investigation along tids line that, in my thinking, we 
arrive at the real, fundamental, efficient cause of the greater proportion of crime. 

It has been recognised for aome time that the criminal class, as a whole, are of a low 
mental order, and yet only within the last two years have a sufficient number of 
laboratories been operating to furnish sodi data aa would support a rather widespread 
belief by the results of scientific investigation. In this work, however, there is much 
3ret to be derired. Tbe tHistiiemsrtves applied in the various climes are to be more 
th<ffOu^y tested, c er i e ci e d , and adapted through a longer period ol tim* and with 
a greater number of subjects. Too few scientists well trained for the work are in the 
field; and there is lacking at praaent a sufficiently strong public sentiment to demand a 
brsaldng away from tmditfton in the handling of law violatora, and toinaist upon the 
adoption of methods prescribed by the ecientifiediagnesss of llie eases. Nevertheless 
the returns to date are Indicative and of very valuable rignificance. The New York 
State Beiomiatory for Women at Bedford HiUa reports that S7 per cent of its inmates 
are defective. I>r. Rank L. Ohtistiaa, of the Reloimatory at Elmiia, reporta 42 per 
cent defective. Besidtsef our own laboratory work in the Indiana State Retematoiy 
at Jeffersonville, show quite 50 per cent to be subnomial. Returns from reliable 
sources at work among juvenile delinquents riiow a percentage as high or higher, 
nere is tittle question that when terminology and definition, standards and methods 
ef procedure are agreed upon among the various laboratoriea, the variation of results 
wOl faU witiiin a reasonably mall margin of difference. All of this sug g est s that in 
the paet we have disregarded quite entirely the peculiar mental conditions of what 
Hkely wfll pntre to be at least one half of the population of our penal and correctional 
Institutions. This situation belies the very purpose for which these institutions 
sse founded and maintained. Moreover, were ^is condition of these offenders known 
beforo trial, conviction, and sentence, it is quite certain tliat the necesaity of dill ereri t 
dlsperiiion ef the cases would have been recognised. 



184 PBOGEEDINOS SEGOIirD PAN AMEBIGAN SdEKTIFIO C0NGSB88. 

The range and degree of defectiveneaB affoid an interesting study. We have those 
of positive psychosis — ^the insane, Including alcoholics, drug fiends, epileptics, and 
feeble-minded — ^imbeciles, morons, and those of but slight subnonnality. As a class, 
of course, all these reveal to the clinician a long Ust of symptoms and reactions, which 
would have led an alienist at once, under any circumstances and suiroundings, to a 
correct diagnosis of their condition. While this group, representing approximately 
50 i>er cent of the population of our prisons and reformatories, is disposed of com- 
paratively easily, the remaining inmates, sharing with the subnormal many of the 
mental and psychic stigmata peculiar to the criminal dass, form a group which fur- 
nish a problem of the greatest complexity. Anomalies of intellect, emotion, and will 
are everywhere presenting themselves for analysis. Dr. Harold W. Wright, in a 
recent number of the Journal of the American Medical Association, calls attention 
to the fact that all offenders are characterized by one or more of the following attri- 
butes: *' Exaggerated suggestibility; exaggerated egotism; emotional instability; a 
lack of altruistic or unselfish sense; a lack of the power of sustained eneigy; that is^ 
abnormal nervous fatigue; a tendency to the easy disintegration of consciousness, 
which x>ermits the brutal or inferior qualities of the subconscious mind easily to 
become dominant when temptation occurs, and to be ungovemed by the critical 
quality of the conscious mind ; even when the critical function is sufficiently aroused, 
the power of direction by the will is in abeyance." The offender is marked, too, 
by instability and eccentricity, is given to self pity, moroseness, fault finding and 
hatred, and is therefore resentful and retaUative; he is lacking in the ethical sense 
and consequently is presumptions; he is deplorably deficient in judgment. All or any 
of those characteristics may be possessed in such a degree as to make it practically 
impossible for the unfortunate so to deport himself as to satisfy the conditions of good 
citizenship and healthy social relationahips. 

Responsibility for crime in the manifestly subnormal is quite out of the question; 
these wiU always be mere children and require a guardianship; the perpetuity of 
their kind among us is quite entirely a matter of eugenics; but who shall say that the 
majority of those not classified aa defectives by present-day tests would not be able 
to find factual defense of their crime in their own infirmities? Indeed, there are 
those who chose to call such ''borderland cases," believing that as all feeble-minded 
persons are potential criminals, so large numben, at least, of those criminals usually 
regarded as normal require only a peculiar series and setting of stimuli to reveal such 
serious defects as to prove the existence of positive Bubn<xmality, and often dear-cut 
psychoses. 

If asked the question, "Why did you commit the crime for which you are paying 
the penalty?" and pushed for an answer beyond that bom of the memory of the 
mere pleasure or gratification in the reward of the act, many must honestly answer, 
'* I really don't know; I guess I couldn't hdp it." Eitiier some instinctive tendency 
of low order, undeveloped and uncontrolled, pushed on the unfortunate individual 
to criminal reaction, or some specific mental function, too weak to do its ofllce work 
or perverted in the nature of its activity, compelled an inability to resist temptation 
when it offered. Tbke a case or two in point. 

Westlake, No. 4059, is an habitual criminal, a native of the State of Kentucky, 
whose mother conmiitted suidde at the age of 39. For some time previous she had 
been a nervous wreck, and had been separated from her husband for two years. The 
son never saw or heard of his father after the separation, at which time he was 7 yean 
of age. After the death of his mother he fell into the hands of an aunt and attended 
public schools more or less regularly. He failed of promotion twice, because of lack 
of attention to his work, and finally left school at the seventh grade. His associates 
were bad. He drank moderately, smoked cigarettes, and early suffered venereal 
diseases. His first arrest was at the instance of his aunt, who, no longer able to con- 
trol him, hoped by this means to keep him off the streets at night. His second arrest 



PUBUO HEALTH AND MEDICINE. 185 

was for petit larceny—he took money from the cash drawer of a pool room at night. 
He next broke into a store with others, stealing knives and revolvers. Again, with 
companions, he attempted to burg^ize for the purpose of getting money with which 
to secure a room in a hotel for immoral purposes. The crime for which he was sen- 
tenced to the reformatory consisted of the theft of a motorcycle. 

His physical condition at this time is &irly good. He is small in stature, but fairly 
well developed and not ^nattractive in appearance. He is not lacking in general 
intelligence. The Binet test classifies him adult, while he grades of high ordering 
information and other tests. In general, however, there is revealed an unsettled 
condition of mind. The nervous status of his mother, probably before his birth and 
during his early childhood, her consequent neglect of him and her suicide, all must 
have served to react upon him in such a way as to impress him for life with a lack of 
normal nervous organization and to stamp his subconscious mind with a character 
conducive to instability and consequent immorality. The correctives of judgment 
have never been furnished. For him the easiest way out is the best way. Some 
worthy ideals of boyhood may have prevented criminal activity earlier in life; but 
after the first offense relieved the tension, others, all- of the same nature, followed 
with quick succession. He is of the type that seeks pleasure in the activities sug- 
gested by the complex of emotion, as completely regardless of the intellect as though 
it did not exist. When once an action is begun the power of inhibition is paralyzed. 

An example of the bom criminal is found in Eastman, No. 4052, about 21 years of 
age, serving a sentence of from 2 to 14 years for assault and battery with intent to kill. 
He is a native of Buffalo, bom of Polish parents. His father was a common laborer 
up to the time of his death by accident four years ago. Eastman had no formal school- 
ing prior to the age of 8 years, when he was arrested and sent to a private reform 
school at Buffalo. Here he remained for six yean. After his release, arrest followed 
arrest, until he was sent to the Elmira Reformatory on the charge of burglary* Paroled 
in 1912, he, with three companions, worked his way West to Indiana as a common 
tramp. On being ordered out of a box car wherein they were stealing a ride, the gang 
opened fire on the train conductor, severely woimding him. From an early age East- 
man's companions were bad. His jail and reform surroundings probably only accen- 
tuated his disr^iard for the rights of others. He used both liquor and tobacco, con- 
tracting the habits when a mere boy. His physical condition is fair, though he is 
not free from certain physical stigmata. He claims to have suffered a fracture of the 
skull some years ago, from the effects of which he has not fully recovered. This acci- 
dent, however, was not experienced until after his life of crime had well begun. 
His mental tests were marked by a general spirit of indifference on his part. He 
cared not at all to make a creditable record for himself. Attention and application 
were out of the question with him, though he did not lack so seriously in point of 
general information. He was not interested by those motives which usually govern 
action. He confessed that he had never worked and did not care for the money 
which labor earned. Thoroughly selfish, he has no regard for ideals of honor, and no 
respect for law. and order. He is not impressed with the heinousness of his crime, 
nor feels any pity or remorse because others have been made to suffer through him. 
He fumiflhes a splendid example of those in whom there is an entire absence of the 
normal development of the instinctive tendencies in the ethical sphere. 

A type of criminal through passion is Southem, No. 4065. He is 20 years of age, son 
of temperate law-abidiog American parents, both living and living together. He 
remained in school through the eighth grade, where he failed in grammar, because, as 
he says, he liked arithmetic so much better that he put in his best efforts on that branch. 
After leaving school he purchased a car and opened a taxicab business, which he con- 
ducted for three years. After bankmptcy he became an instructor in a school for auto- 
mobile drivers. He smoked cigars, but confessed to no other bad habits. He was 
both honest and industrious. His single crime consisted of stealing an automobile 



186 PB0CEEDIKQ8 SECOND PAN AMESIOAN 8CIBKTIFIG C0KGBE8B. 

fpom va old gentleman who employed him through two weeks to overhaul hiB machine 
and then refused to pay him a fair wage, taking advantage of the fact that no contract 
had been made at the time of engagement. Enraged beyond control at this perfidy, 
Southern ran the car away to be revenged . His only motive was to get even. He was 
arrested, convicted, and sentenced for grand larceny. Physically he is none too strong. 
Re has suffered fh>m hernia from childhood and has had venereal disease. Wb men- 
tality, in general, is of high order. He easily grades adult with no marked deficiency 
in the tests applied, and yet, brooding over a wrong so accentuated his anger at his 
unfair treatment as to cause him to lose all control of himself. Here, too, as in the 
second case, the power of inhibition under severe strain was not sufficiently operative 
to support good judgment by strong will. 

Time will not allow a consideration of examples of the merely accidental criminal 
and of the weak subject of suggestion. These classes, too, show a defect of specific 
function which places the subjects completely at the mercy of circumstances. 

Grime, then, is more than a mere accompaniment of defective mind. It is the natural 
outgrowth of faulty mental processes. This doubtless accounts for the fact that pun- 
ishment can not cure the criminal, nor even deter others from committing crimes. It 
is foolish to insist that punishment deters the criminal even from repeating his crimes. 
Surely there is no fact more clearly proven to the criminologist Uum this one. Insti- 
tutions of punishment only serve to augment the antisocial attitude of the criminal 
and to return him to society even determined to perpetrate more daring crimes than 
he had known before. Statistics from investigators the world over call our attention 
to the fact that crime among us is increasing at a very rapid rftte. Treatment, not 
punishment, is what is needed, intelligent, sympathetic, and scientific treatment imder 
the best conditions and by the best advised scientists that can be secured for the work. 
This is not a call for the introduction of sentimentality; there are indications in many 
quarters that we have too much of the maudlin already. Warden Francis insists that 
the greatest menace to our progr o ss in institution affairs to-day is ''the long-haired 
man and the short-haired woman," and he is rig^t. 

Instead of indulging in expre s si ons of sentimental regard for the unfortunate offend- 
ers, society should rather give herself to the most careful investigation of those tolerated 
and even encouraged practices which everywiiere are shown to be those agencies that 
eontribute to the perpetuity and to the multiplication of the criminal class. 

Of a total of 416 new arrivals at the Indiana Reformatory in 1913, 246 came from disor- 
ganized families, and approximately this same proportion has been maintained through- 
out the last 10 years; that is to say, that 60 per cent of the criminal class, as represented 
by the boys of our institution have not had the possibility of normal family training. 
In a very large number of the dinnpted homes divorce luul been granted. In other 
cases the father, the mother, or both have died. Neglect of youth makes directly for 
crime. Clearly, it seems to me, society has a duty to perform by the children in disor- 
ganised homes. No one of us but recognizes the large place the home should and 
does take in the normal development of the child. Where its influences are made 
impossible because of one reason or another it is obligatory upon the state to act in loco 
parentis in order to assure the child that training without which we can not hope for 
hiB normal development. 

Again society not only harbors but seeks to profit by such agencies as play upon the 
weaknesses of the weak. Fifty-nine per cent of the inmatee received within the pa^ 
8 years at the same institution were users of intoxicating liquors, 80 per cent used 
tobacco in one form or another, while 50 per cent were addicted to the use of cigarettes. 
Whatever may be said In the way of excuse for a moderate use of alcoholic beverages 
and tobacco among adults, there can be no justification whatever for the use of these 
drugs on the part of adolescents; but in spite of legislation, the one purpose of which is 
to make it impossible for the ruination of the boys of our country to follow from these 
sources, the process continues among us to an ever increasing extent. 



FTTBUO HEALTH AlO) MEDIdKX. 187 

M<Mt Slates of our Nation booat rigid compobory education laws. In spite of tliia 
hctf over 10 per cent of the men entering one institation are abaolntely illiterate, 
while the number who have reached the hi^ school in educational progren is prac- 
tically negligible. Of nearly 500 arrivals last year 11 only claimed to have completed 
the twelfth grade; three of these had entered college and one the theological seminary. 
The greatest number left school at about the fourth grade. Here again so long as we 
are content to legislate merely for the purpose of keeping our State assemblies out of 
mischief while in session, with little thought of enforcing the laws which they make> 
we need not look for a bettering of those social conditions, out of which we annually 
recruit our law violators. 

PuUy one-third of the new registrations of last year were idle at the time of commit- 
ting the crime for which they were convicted. This is not to place the blame either 
hero or there, and yet it was no more true in the days of our youth than it is now that 
the devil himself puts to work any man who stands <m the street corners with his hands 
in his pockets. 

It may be aigued that the various social agendes are not to be blamed for the lack of 
results in their attempts to train those whom we have shown to be either mental defec- 
tives or at least more or less seriously disturbed in mental function. Nevertheless, we 
do insist that ^ere the peculiarities of mental reaction are due to a lack of proper 
nurture rather than to a defect of nature, sudi oversight could and should have been 
eocercised as would have enabled a considerable number of these men to live lives of 
happiness, haxmlessness, and comparative usefulnesB. While investigation in thia 
Held is still in its infancy then can be no doubt that the coming years will prove con- 
clusively what seems now to be indicated that, while the real efficient cause of crime 
is to be found in defective mental condition, the contributing agencies, in large part,, 
are those social institutions which fall to interpret the virion and with consecrated 
effort so purge themselves of carelessness and n^lect as to recognise not only their 
splendid o p port un ity but their grave and undeniable responsibility. 



PAUPERISM: AN ANALYSIS, 

By EDWARD T. DEVINE. 

FrofiU9oro/8oeidlSeonomy, Ooliimbia UfdvenUy, and Diredor of iKe New YbrkSehoolof 

PhUanihropy. 

Legally , In Eqf^and and in countriea winch haive leUowed Banish uff^ 
aa diatingoished from poverty , conaiits Disnly in the habitual receipt of officii 
relief. 

Etymologically, the word ia derived from the Latin piuper, meaning, as in Ua 
modem French and Spanish equxvalenta [panvie, pobte], amffy poor, wtthoeimeava 
of support; but whoa pudied tether back to its Latin and Greek origina [pancni» 
Gk. w4*v; paiio, Gk. mp] the word signifies not indigence but ineflcisncy* Making 
little, rather than needing much, is its original aoggestaoou The pauper ia thaa not 
one who from sudden, unforsseen miafortune is reduced to need, even if that need la 
to be supplied by public relief, but eae who brings forth little or nothing, the incapa- 
ble, the nonproduoer. 

Ecenomically, pauperism descfibea the state ol the social debtsr, the one who ie 
carried as a burden on industry and does not himself take any effective part in the 
production of wealth. 

Biologically, pauperism represents a ptimitive type, surviving in the strng^ fsr 
existence only by parasitism^ or a pathological type, emerging from abnormal 
environment. 



188 PB0CEEDING8 SECOND PAN AMEBICAN SOqSNTIFIO G0KQBE88. 

Sociologically, the pauper is a deviation from the normal, incapable of aanmilation 
through ordinary economic motives and social forces; presenting a distinct social 
problem, as do the criminal, the inebriate, the prostitute, the monopolist, and the 
revolutionist. 

Psychologically, i>auper]sm is poverty plus a mental attitude in which are mingled 
discouragement, lack of ambition and imagination, thriftlessness, irresponsibility, 
passive resignation to a parasitic relation to society. Vagrancy, the technical offense 
of living without regular employment when not having other visible means of sup- 
port, and mendicancy, the soliciting of alma from passera-by, are the more active 
expressions of pauperism, of which the ordinaiy, superficial test is simply the nece»- 
dty for some fonn of pennanent relief because of fault, deficiency, or weakness of 
character. 

Pauperism must be clearly differentiated from poverty— the laiger and more imixxr- 
tant problem— which presents many aspects that may be wholly unfamiliar to those 
who know only pauperism. Some of those aspects face towajd economic refoim; 
others toward health, housing, or the administration of justice. 

In recent yeazs there are two clearly distinguishable, often antagonistic views of 
poverty, one of which we may call, broadly speaking, the economic, and the other 
the biologic. According to the first view the differences among men are due mainly 
to their environment, their training and opportunities; according to the other, mainly 
to their inherent nature, their biologic inheritance, their protoplasm. True, biology 
concerns itself also with environmental influence, and economics recognizes unalter- 
able differences in human beings; but there is justificatioi^ for the distinction, if not 
pressed too far, in that the main preoccupation of economics is with the wants and 
activities of men in society, with their actual behavior in view of the rewards obtain- 
able for given efforts; while that of biology is with generation, reproduction, and the 
development of characteristics derived fnun ancestors. 

Both views are indispensable and they can be reconciled. By economic, sanitary, 
and social refonns, public hygiene and social insurance, effective oiganization of 
charity and the development of educational measures, economic poverty can be 
reduced in amount and the distinct hygienic problem of pauperism can be isolated. 
This residual problem is laigely one of mental defect, calling for segregation and 
humane treatment of individuals and the gradual elimination of defective strains; 
but it involves also far-reaching measures which affect pauperism incidentally and 
are to be advocated chiefly in the interests of those who are in no danger whatever of 
becoming jmupem. 

The reconciliation or assimilation of the biologic and the economic view of poverty 
justifies its consideratian in a scientific congress. If we think of pauperism as mental 
disease or mental defect, and of poverty which is not pauperism as an economic and 
social condition, the fonner to be eliminated or relieved by eugenic and sanitary 
measures acting on the individual, the latter to be eliminated or mitigated by economic 
progress and social refonn, resulting in greater efficiency and more just relations, we 
are at least thinlring in scientific terms, and relying upon remedies which science can 
examine and assess. 

This view of pauperism and poverty is in contrast both jvith the l egal conception 
which underlies Engjish and North American poo r laws and with the religious con- 
ceptlon which has more especiaUy colored thecharity of CatSblic countries m Central 
and South America. The En^ish law recognizes a l^al right to relie f. It c r eates an 
elaborate machinety for the administration of this poor relief. ~ The alma house * is 
its central feature. A hospital or i nfirmaiy , and in rece nt yeais a sanatorium f or con- 
sumptive and other special institutions, supplement the almshouse proper, whiclTS 
mainly for aged infirm or chronically disabled dependents. Outdoor relief rbywCcC 

» 

^ Alao called poor honae, poor farm, oounty borne, eto.; the eqnhraient of the English workhouse. 



PX7BU0 HEALTH AND MEDICINB. 189 

is meant aadstance given to the poor in their own homes, is another recognized feature 
of poor relief in nearly all communities in which the traditions and customs of the 
English poor law have been established. The fundamental idea of the English poor 
law is that the state is responsible for the relief of destitution and for the prevention 
of mendicancy and vagrancy; that whatever is required to maintain life and prevent 
actual suffering from hunger and exposure is to be done from funds raised by local 
taxation, except of course in so far as these needs are met by relatives, neighbors, 
relief societies, churches, trade unions, or other voluntary agencies. When other 
sources faO, in the last extremity, there is always the public relief ofSkdal — overseer 
of the poor, as he is oftenest called — whose duty it is to relieve the distress. This is 
conceived to be one of the most elementaiy and imperative obligations of the state, 
to be dischaiged through some appropriate governmental agency. 

The religious conception of charity, as a means of spiritual edification to the giver, 
not unfamUiar in English-speaking countries, but more emphasized and exemplified 
in Latin America, involves a different conception both of charitable relief and of the 
destitution which charity is to relieve. Not the light to relief, but the privilege of 
giving, is its central feature. Not the prevention of begging and of vagrancy, but the 
prevention of indifference and hardness of heart, is its aim. ''Our families,'' says a 
writer in the Buenos Aires General Census of 1910, ''have been essentially charitable 
St all times; the poor have never called at their doors in vain. Religious by tradition, 
inheritance, and personal connection, our ancestors were imbued with such jdefinite 
charitable principles that they never passed a poor person by. " " This is the cause, ' ' 
«dds the Aigentlne commentator, "of the existence of the legion of false beggars. " 

The scientific view of poverty is that it is the result of maladjustments, biologic, 
economic, and social, but above all psychologic, i. e., the survival of instincts and 
motives suitable to an earlier and more primitive stage of existence, but out of place 
in the modem world, and especially in the conditions of life of the western hemisphere 
in our generation. The scientific view of pauperism is that it is one of the worst, the 
most extreme of these maladjustments, with no adequate defense or justification from 
the religious point of view, no adequate provision either for relief or for prevention in 
any system of poor law yet devised, yielding neither to such coercive measures as have 
been applied by the state nor to acts done under the charitable impulse, however 
self-sacrificing ar heroic those actions may be. 

The bad tradition, inherited equally through church and state, is that poverty is a 
part of the natural order of things, to be constantly relieved by charity or by the poor 
law, but constantly repeated in each generation in order that charity may be kept alive 
and that the poor law may function. The new view, the natural view, as I venture 
to suggest, for North and South America, if by natural we mean that which corresponds 
to the conditions among which we live, is that poverty is not necessaiy or tolerable, 
that we'may confidently look forward to a time when misery, squalor, a positive lack 
of the necessaries and ordinary decencies and comforts of life, shall be absolutely 
unknown among us; when a standard of living sufi&cient for physical and moral well* 
being shall be possible for every class in society; when education, recreation, and 
leisure shall be within reach of all; when childhood shall be universally protected, 
the efllcient working life i»olonged, disease greatly diminished and its financial bur- 
dens distributed through insurance, old age postponed and amply provided for, so that 
it does not mean economic distress. 

For the realization of such an ideal the whole course of events in the western world 
in modem times has been preparing. The enormous increase of capital, the inven- 
tion and improvement of machineiy, the expansion of the scale of production, the 
organization of industiy, the division of labor, the development of transportation, the 
widening of markets, the progress of science and of technical education, the increase 
of efilciency caused by higher standards of living, and the conquest of disease, espe- 
cially of the tropical diseases, the perfection of administrative as well as of technical 



190 PBOCEEDINQS SEOOKD FAIT AMBBICAN 8CIEKTIFIC CONGBESB. 



procQBBGS— an ttmftzing series <^ reroSutionaiy clun^es familiar to the wbole worid, but 
of greatest significance when they are brought to bear upon the undeveloped, the all 
bift untouched, natural resources of our still sparsriy populated continentif of tha 
west — ^make possible here a civilization without poverty, a manner of life in wiiidii 
self-respecting economic independence riiall be as much a matter of course as p^tkal 
and civil liberty. 

This contrast between the old werld and the new, between Europe and the Amer- 
icas, was obvious before the devastating European war. It win be unhappily man 
obvious still in the yean which immediately follow the destmctioii of resounees for 
which the war is responsible. In that destruction all the woiM suffen, but in the 
nature of things the countries at war suifBr most, and even the hi ghe st tedmio^ 
efficiency is no substitute for the capital, the productive eneigy, and the raw materiidi 
which the war destroys. 

Our productive capacity, if it can be devoted to peaceful ends, our e e on e mi c re- 
sources, if they can be applied to the legitimate wants of man, are am|^ for a civil* 
ization without poverty. We have only to ai>ply the knowledge we already have, te 
take the trouble and meet the expense, in order to abolish poverty in the sense thai 
means actual deprivation of the conditions essential to a rational, pr os perous, and 
enlightened existence for all those who on their part meet its essential individual 
conditions. The comprehensive means to this end lie beyond the scope of this pi^ser. 
The prevention of pauperism is a part— « very specific and exceptionat part*— of Iftia 
larger task. 

The first and most stmtegic point of attack is in the treatment of the mentiJly 
defective. The report of the English Royal Commisrion on the care and contiel of 
the feeble-minded in 1908 sets forth conservatively and authoiitativeiy the cen* 
dusiotts on which we may base a sound public pdicy: 

1. That both on grounds of hat and of theory there is the highest d^;ree of mob*- 
bility that feeble-mindedness is usually spontaneous in origin — ^that is, not due to 
influences acting on the ijaient— and tenos stionc^y to be inherited; 

2. That, esperaally in view of the evidence cenceniinff fertility, the p s a v oa t is n ef 
mentally defective pemons from becoming parents would tend ku^y to diminiah 
the number of such persons in the population; 

3. That the evidence for these conclusions stron^^y supports measures, which on 
other grounds are of pressing importance, for placinr moitally defective peieuBt^ 
men and women, who are living at hi^ and uncontrolled, ia instittttions where they 
wHI be employed and detained; and in this, and in many other ways, kept under 
effectual supervision as long as may be necessary. 

Dr. Martin W. Banr, of Ftensylvania, writing in Chaxitieeiovr ysameailiir, i i ismi 
te the modem institutional care of itm feeble-minded aa the utiliintiiiB of • waste 
product, a forcible illustration of one of the greatest culminatiens of the nineteenth 
century. The recognition of the possibilities and limitatioDS ol the msntally deiectiip» 
leads te the creation of a sphere for him in which, trained and eaeomi^ed ia oon» 
genial occupations, he may attain to a certain degtee of independence, and cease te 
be either a menace to society or a helpless burden. 

It is not merriy because of their bioLogic character that the mentally defeetivv are 
unfit for parenthood. They are unfit guardians for children, being unable to give 
them moral or economic training. Their income, if earned throu|^ ^^*8n» i* irregular 
and insufficient to support a stable home life. Poverty, intemperance, immorality^ 
and neglect, even of the elementary physical needs of children, are the natural, 
almost inevitable, characteristica of their homes. Unfit to maintain domestic life, 
the mentally subnormal are equally ill-adapted to industrial life ae oiganiaed in n 
r^(ime of free competiticm. Tliey can not earn minimum wages and they ckg the 
wheels even of the best iurganised and most enl^jitened industries. They need 
occupatiMi, but under special supervision and protection. Their taska should be 
carefully selected and suited to their capacities, but need not, as is sometiines hastily 



PUBUO HBALTH AND MBDIGINB. 191 

iB&ned, be the dirtieit and most dlngzeeeble. The lecognition of the principle d 
guardianship Irom in&ncy; the aeig;Eegation ef retazded and backward children in the 
echools, in order that they may be studied individually, their physical defects dis- 
covered and remedied, and those who are definitely feeble-minded early identified 
«nd removed to appropriate institutions and colonies, except of couise in those casos 
in which without undue expense or difi&culty eflicient care can be given at home; tiie 
removal of the feeble-minded from prisons and reformatories to these special insti* 
tutftons, l^al punishment and reformation being obviously wholly inapplicable to 
them; and the creation in each State of a central authority— chiefly medkal— com- 
parable to our commissions of lunacy, to have the oversight of all mentally defective, 
aie the main features of a progressive policy for dealing with the chief cause of 
pauperism. 

Ftobably not more than 15 per cent of the demonstrably feeble-minded in the 
United States are as yet segregated in special colonies or institutions suitable for their 
case. It jsestimated that 85 per cent of tbe insane are treated in hospitals constructed 
and maintained especially for them. If it were necessary to choose it is a question 
whather it would not be preferable to reverse these proportious, leaving the insane at 
lai^ge, in spite of their disease, and segregating the mentally defective whose minds 
can not be cured but who can transmit their defect, with its train of pauperism, 
prostitution, criminality, and ether grievous consequences. 

Alcotholism, although a recognized complication in mental instability and defect, 
deserves also separate canmdflratinn. It has been attacked as a vice, as a crime, as a 
habit, as a weakness, as a disease. It is all of these things, but here we are interested 
in it chiefly as a disease, furnishing a problem for mental hygiene and resulting in 
pauperism. The international list of causes of death recognizes alcoholism, acute 
and chronic, and from this spedfic disease aa distinct from all organic diseases attri- 
buted to alcoholism, the United States census reports 3,744 deaths in the registratioB 
area in 1913, api»oximately one in 240 of all deaths— a number larger than the com- 
bined number of deaths from malaria, pellagra, rickets, lead poisoning, smallpox, 
anthrax, and rabies. Its importance, however, is of course but faintly indicated in 
mortality tables. As an obstacle to economic independence, as a cause of that unre- 
liability and inefficiency which result in pauperism, it is probably surpassed only 
by inherited mental defect. In many parts of the world there has been organised a 
^mptign against the manufscture and sale of alcoholic beverages, on the theory that 
the best way to affect the mind of the inebriate, present and prospective, is to withhold 
absolutely the means ol feeding the appetite. This is a drastic, but certainly not an 
illogical, method. Just as we seek to exterminate the tuberculosis bacillus by spittiog 
ordinances, and the malaria germ by warfara on the mosquito, both of which represent 
attacks on the external or exciting cause of the infection, rather than attempts to 
build up lesistang power, so by removing completely the exciting external cause d 
alcoholism we may hope to stamp out that disease. There are some dissenting or at 
least doubting voices in each case. Perhaps immunity or tolerance of an infection 
may be lost if for a generation or two the disease is kept at a distance throuc^ pprely 
mechanical devices. So a prohibition era may be followed by a greater destruction 
if alcohol comes back into use. The analogy seems to be warranted. Unlessweave 
afraid of humanity's loss of immunity from the conquest of tuberculosis, we need not 
fear the loss of immunity from the conquest <A strong drink. Nevertheless prohibition 
relies upon a material and coercive method, and if it should prove to be possible 
within a reasonable time to exterminate alcoholism on a spiritual basis, through a 
genuine temperance (which certainly for all those in danger of alcoholism meana 
abstinence) there are those who will prefer it and think no price too high to pay for 
such a conquest. A wise procedure would be to found local and national associations 
for the prevention of alc<^lism, similar to those already enlisted in the worid crusade 
against tuberculosis* The medical profossion, rsoQgnicing the wealmesses of some 



192 PROCEEDINGS SECOND PAN AMERICAN SCIENTIFIC CONGRESS. 

of lis own membera, but recognizing also its peculiar reeponsibility in all such hygienic 
camiMtigiiB, would naturally take the initiativei preventing rash mistakeB and giving 
its unique support to sound measures. Alcoholism as a physical disease, as a mental 
affliction, would thus be subjected to the same painstaking scientific study, the same 
manyndded attack, that medical authorities and laymen have given cooperatively to 
tuberculosis and hookworm, and are now beginning to give to venereal disease and to 
infant mortality. Out of such study and the sane experiments to which it would 
lead would come a program of social action, of mental and physical hygiene, directed 
towards the elimination of alcoholism. 

The drug habit and sexual immorality and excesses of all kinds contribute to tho 
problem of pauperism. Certain diseases like malaria and pellagra and the hookworm 
disease, which especially affect the spirit, undermining eneigy, reducing efficiency, 
lowering the standard of living, would likewise demand consideration in any completo 
discussion of pauperism. Indeed, sickness of any kind in wage-eameis' families,, 
unless its expense is amply covered by insurance, may lead to just that land of dis- 
couragement and hoplessness of which the pauper spirit is bred. 

Even if the native stock is not degenerate and the original capacity entirely normal, 
the educational system may be so inefficient and so ill adapted to existing conditions 
as to produce in effect a generation of paupers. Neither general nor technical edu- 
cation can make efficient workers from the mentally defective; but an inefficient and 
badly oiganized educational system can create a semblance of relative feebleness of 
mind and economic incapacity in what was originally the healthiest and most vigorous 
stock. 

Industrial exploitation is a contributing cause of pauperism, whether it take the 
form of excessively low wages, or a long working day, or a seven-day week, or the 
speeding process with its exhausting fatigue. So also are irregularity and uncertainty 
of employment, such as result even in periods of comparative prosperity from the 
custom of keeping about any industrial establishment, on the bait of occasional casual 
labor, a larger number of laborers than is normally required to do the work of the 
industry. 

Revolutionary changes in industrial processes, throwing out of employment those 
who can not readily adapt themselves to the new methods, are responsible for much 
of that pauperism which may be called a by-product of industry. Beneficial they 
may be to society, and at the same time disastrous to those individuals who can not 
quickly adapt themselves to the new demands. 

Any economic institution which discourages thrift and self-dependence, such as 
slavery or peonage, develops a mental attitude which may remain to the third and 
fourth generation, after the system itself has been abolished. Oppressive forms of 
taxation and of land tenure have similar effects. Class legislation and uneven admin- 
istration of justice in the courts, when long enough continued and when there is no 
adequate means of resistance or reform, may produce a pauper proletariat. 

Militarism, a feudal organization of society, and other rigid caste systems, however 
efficient they may appear externally, contain the germs of pauperism for the sub- 
ordinate classes, though these germs may first develop their handful influences only 
after democracy has replaced the social order in which they were planted. Probably 
the pauperism of backward communities in northern sections of the United States 
might be traced through genealogical studies to imported convicts of the colonial 
era, to inferior Irish immigration of the middle of the century, and to assisted criminal 
and pauper immigration from the Continent of Europe in more recent years. Proba- 
bly much of the criminality and inefficiency of laige classes of southern negroes is in 
effect high grade feeble-mindednees, which did not seriously interfere with the pro- 
ductivity of directed slave labor, but is revealed under the conditions of free com- 
petition. We may expect that natural eugenic influences, arising in the one case 
from more stable marriage and family institutions among the descendants of the slave 



FUBUO HEALTH AND KSDICnTB. 193 

populatioii, and in the other from the freer mingling of urban, aemiurban, and ruial 
populations made possible by modem methods of communication, will tend to elimi- 
nate these kinds of pauperism together with the mental inferiority to which it is due. 

Mental hygiene has its tasks with those who have the pauper spirit and with those 
who are in danger of acquiring it; but it has its tasks also with charitable givers, with 
public relief officials and with the citizens whose ideals the public relief policy of 
the State represents. Both official public relief and voluntary religious charity 
have been at bottom consciously or unconsdously pessimistic. They have assumed 
the continuance, if not the desirability, of a permanent class of dependent poor. 
The harsh, tmsympathetic attitude of almshouse keepers, and the sentimental, 
spiritually selfish attitude of volunteer dole-givers, are both out of harmony with 
the pragmatic, humane view which challenges the very existence of pauperism, 
which hopes to put an end to the need for official poor relief and for voluntary charity 
alike. Organized charity is the embodiment in practice of this new view. It dis- 
countenances indiscriminate almsgiving and every other custom, however sanctified 
by tradition and sentiment, which encourages the pauper spirit. It demands accu- 
rate knowledge of the individual circumstances in each case of need as a basis for a 
plan of relief. It advocates inquiry and careful records and intelligent cooperation. 
It ministers to the strength and not to the weakness of those who are in trouble. It 
emphasizes family solidarity and family responsibility. It believes that the best 
occupation for a sick person is to get well, that an able-bodied married man should 
support his family, that mothers of young children should nurse and nurture their 
offspring, that all who are earning to their full capacity should save something for 
future emergencies, and that those who are in need of charitable assistance should 
receive aid which in kind and in amount is determined not by the accident as to 
whether a benevolent individual passes their way, or a relief agency is or is not in 
funds, or an institution has or has not been established to provide for that need, but 
is determined, on the contrary, by a painstaking and discriminating study of the 
present situation and the previous exx)erience of the individual or the family in 
question. It insists that diagnosis rather than charitable impulse should be the 
basis of every decision, though charitable impulses, thus guided and directed to 
wise action, are by all means to be encouraged and strengthened. 

Doing different things for different persons, as organized charity demands, if they 
are to be in any high degree the right things, involves the training of professional 
social workers for relief societies, for the social service of hospitals and dispen- 
saries, for the probation and parole work of courts, and for many other kinds of work 
in which a technique and special literature already exist. Such trained workers do 
not replace volunteers, but increase their number and their efficiency. We might 
well hope that this discussion would give an impetus to the establishment in one or 
more of the capitals of South America of a school of philanthropy for the training of 
social workers in all the gathered wisdom of the church, enriched and supplemented 
by the social sciences and their practical applications in aU countries. 

We come then to the conclusion — that every rational economic reform, every step 
in the humanizing of industry, every means of preventing disease and of relieving 
the people of its financial burdens, every substitution of a reasonable adjustment for 
a social or economic maladjustment, will have a beneficial result in drying up the 
sources of pauperism; that the frontal attack upon pauperism lies in the segregation 
and humane care of the feeble-minded, the prevention of alcoholism, and the devel- 
opment of social insurance against sickness; that to these ends the professional and 
technical training of sanitarians for the public health service and the professional 
and technical training of social workers for the tasks of relief and prevention are of 
paramount importance. 



194 PBOCEEDINGS 8SC0ND PAK AMXEOCAN BCJSfiTTIFIC C0N0BE88. 

Dr. John N. Hubtt. We have listened (o two pape^B from mae- 
terB of their respective subjects, and I beUeve that every word they 
have told us is true — i. e., that it is within our power largely to get 
rid of crime, pauperism, and poverty. The fact that these evils 
exist seems to me to be evidence at the present time of our own 
incapacity to govern, to handle things. In order to bring about 
better conditions I believe that the child creed which has been pro- 
jected by the Indiana State Board ot Health lays a foundation. 
It runs this way: That every ehild has the inalienable right to be 
bom free from disease, with pure blood in its arteries and veins; 
every child has the inalienable right to be trained in mind, body, and 
soul, and to be protected from evil persons and evil influences, and to 
have a fair chance in life. Those inalienable rights we do not secure 
to our children. The essential thing to do is to see to it that they 
are well bom. We have long been told that you can not have figs 
from thistles. You can not, and yet we are striving for that very 
and. In these problems we may well consider the fact ihtA the 
human race since the beginning of time has bestowed an enormous 
amount of energy in simply striving to find a substitute for right- 
eousness. It does not exist; and as long as by relief, by doctoring 
and by all such practices we strive to find a substitute for right- 
eousness, we are simply wasting time and energy, for it does not 
exist. In a word, my whole argument is this: Instead of striving 
to keep men out of hell, let us strive to keep hell out of men. 

Adjourned at 12.20 o'clock. 



GENERAL SESSION OF SECTION VOL' 

New Ebbitt Hotel, 
Wednesday afternoon, December £9, 1916. 

Chamnan, Col. Johk Van R. Hofp. 

The session was called to order at 2 o'clock by the ohainuan. 

The following papers weie preeented at this session, several of 
which were read by title: 

Mechanical appliances in the treatment of Pyorrhea Alreolarisi 
by Dr. Felipe Gallegos. 

Higiane del embaraao y de la priioera infaQoia, by Dr. AtiUo 
Narando. 

Puericaltura, by Dr. P. Rueda. 

La Novocafna Olicero-iodada, by Dr. Juan D. Susini. 

Los dispensaries para lactantes (gotas de leche) como medio 
para diaminuir la mortalidad inf antily by Dr. Julio A. Bauaa. 

O error esseneial de pessoa na lei braadleini do eaaamento otTil^ 
by Dr. Rodrigaes Dona. 

M^todos modemos para la preYenci6n de la mortalidad infantile 
by Dr. Arthur L. Ouerra. 

Prophylazia do ophidismo na America, by Dr« Vital Brasil. 

Nota aobre tratamiento de la infeoei6n puetperal por loa baftoa 
tibios prolongados, by Dr. A. FiaBo Cabral. 

Acddn respiratoria del depresor cordis, by Dr. Teodoro Muhm. 

Lepra y autosangroterapia, by Dr. Luis Zanotti Cayaazoni. 

MECHANICAL APPUANCBS IN THE TREATMENT Of FTOSSHEA ALVB- 

OLASIS. 

By FELIPE GALLEGOS, 

SeenUary tf thi FamUif of DmUal Sutgiry, Ootta Rka, CmJtnd Ammea. 

P/oirhea alveolarifl is here, as in all parts of the world, a problem which confronts 
the dentin ahuost daily. My experience in 29 years' practice can be condensed as 
follows: 

When about half of the teeth in a mouth are badly involved with the disease, espe- 
daily when the bicuspids and first molars are affected, all efforts for a successful cure 
wiU fail. The lower indsors and the bicuspids of the upper jaw can be cured more 
often, especially in the early stage of the disease. By a successful cure I mean, of 
course, three things: 1, The disappeaianoe of pas from the pockets; 2, the reaffirming 
of the teeth as they originally were; 8, the nonrecurrence of the disease. 

The literature on pyorrhea alveolafli written in the last 10 yean will fill many vol- 
umes, yet I do not see many reports showing that success has been as frequent as is 
necessary and desired. Tbe majority of writers deal almost exclusively with the 
cleaning operations and the use of drugs, but no mention is made totheuse olmeohan- 
ical appUaaoes to help in the matter. 



> Then was no ftinogrftpbie report of this i 
68436— 17— VOL nc 14 196 



196 PBOOEEDINGS SBGOND PAN AMEBIOAN BOIENTIFIO 00NGBE8& 

I make this statement: That deanlineoB, medical treatment, and rest of the diseased 
organa-^hese three things are needed and help each other in the final saocess of the 
operation. 

As to the cleaning part I can not say anything new. The medical treatment may be 
difficult in cases needing oonstitutional treatment. LocaUy, the iodide of dnc tincture 
is about the best that we can use, if not too strong. We are now in a very interesting- 
period of experimentation; so far the emetine injectioofl, both subcutaneous and in 
the mouth, are reported by many writers as very beneficial in destroying the endame- 
has, found in the pus of tiie pyorrhea; and sudi discovery marks a progressive step^ 
throwing much Ufjbt in the etiology of this disease. 

Speaking now of the facts that I wish toemphasiae in this paper, it is my experience 
that no matter how well the diseased teeth have been cleaned, and how great the care 
taken in the washing and medication of the pockets, the final effort of the batUe has 
to be won by mechanical appliances used to hold the loose teeth in as secure a position 
as possible. No clumsy appliances, of course. Every dentist can make something to- 
suit each individual case— narrow bands of gold, fitted on the firmer teeth; gold wire, 
either on the inside or the outside of the inoBon, resting on the gold bands; and then,, 
platinum wire to tie the loose organs to the bands or gold wires. In many cases, and 
in the early stage of the disease, the platinum wire is all that is necessary to hold them 
firm. The use of such mechanical appliances is only common sense. If the ortiio^ 
dontist, working on healthy bone, after he has put the teeth in the right position, 
must make a good appliance to hold the teeth firmly in its new place, so that nature's 
process of repair finishes its work, how can we e^[>ect that Ioojm teeth with a diseased 
alveolus can get weU if we do not treat them similarly? The general surgeon puts the 
broken bone in plaster to insure rest. Why should we dentists not do something 
similar? 

In making this plea for mechanical appliances in the treatment of pyorrhea I do not 
claim originality; nevertheless, I consider it worth while to insist on the matter, as 
it seems that many dentists expect everything from the use of drugi alone. And 
writers in general do not mention medianical appliances at all; some of them because 
they consider it, perhaps, as a matter of course; others because they have forgotten it 
or do not give it great value. 

In finishing this paper let me call the attention of the profession to a good astringent 
medicine to be used on the gums, one which I have found of great service in making* 
the teeth firm again. It is a resinous red fluid obtained by making an incision on the 
bark of a tree very conmion in Central and South America, the Targua eokmdo, I 
find a notice of this tree by H. Pittier, as follows: 

Targua enphorliaiota. Groton Gossyphiifolius, Wahl.-Symb.-Bol.: 96.1791. Graion. 
Xalapensis H.-B. O K. Nov. Gen. et Sp.: 85.1817. 

I fioid, on inquiry, that other persons think that this tree is very similar to that 
described in the National Standard Dispensatory, Philadelphia and New York, 1905, 
as a kind of dragon's blood. I have used tUs astringent, mixed with two parts, 
alcohol, and I think it is worth while to experiment more with it. 



BEBC— HIGIENE DEL EMBARAZO T DE LA PRIMERA INF ANGIA. 

Por ATILIO NARANGIO. 
De la FaeuUad de Medicina de MarUevideo, Urugwxff, 

^Para que sirve este trabajo? 

Os diria que mi obra es innecesaria y casi afirmaifa la verdad. Hay en ella taata» 
cosas conocidas y tal repetici6n de conceptos vulgares que proclamada su inutilidad^. 
no podria deamentirse. 



PUBUO HEALTH AND MEDiaNJS. 197 

Y sill embargo entre aos p^lginM hay algo. 

Oi diiia miSji; cada texto de cienda amplifica los criteiios que yo aostengo en dia- 
qoiflicioQea seriafl y traacendentalea, que me han hecho meditar laigamente y que 
▼aleo den vecee m&s que mis deahilv»iadaa diaertadonea, 

Y ain embaigo hay en eate mi libio, que lo ea tambito de voaotrasy madiea por 
primera yea, nidae que aapir&ia coa legitimo oigullo a oetentar en fedia no remota eae 
honnaoatiibuto, unadertadrnpliddadquemeatievoaiiiainuar, peaeamimodeada 
y que BBti aeguramente la linica cauaa de que 6L pueda Uegar haata vueatco ceiebxo de 
una manera mia auave que loa infdioa de aeaudoa penaadorea. 

Ea que mia conodmientoa no acm aimple teorfa— eat^ fundadoa en la experien d a y 
eate eatudio ea m48 la obra de un padie que la de un medico. 

^Peio, cu&l ea mi pretanaidn al eacribirlo? 

Ou^, aino la de seroa dtil a voaotna^ madiea proaontea y futura% y por ello, me 
ver^ a menudo huir de laa explicadonea ambiguaa para deciioa daramente la verdad» 
Ul como la aiento y como pude ezpieaarl*. 

Bonrefoa pueey de mia atreTidaa pietanaionea, peio leedme, leedme que al paaar 
notar^ia m^ de una vea que algo de amor, de ainceiD afecto, de aano optimiamo b9 
raapira en laa p^jginaa de mi eatudio; algo que oa har& tanto bien como una carida d€ 
madre que adn aiendo indtil ea bicaihechiwa; algo, que llegar& a vueatioe corazones 
como la miiada de un padre, que ain aer aevera oa encamina al bien; algo que no ea 
mia que mi deaeo de aeioa dtil. 

Y ai lo conaigo, ai amablemente me deda un dia *'unA vea enconM en eata dbra un 
buen canaejo, una palabra de tranquiUdad en un inatante de zoaobra, una fraae de 
allento en un a^gundo de dea&nimo, un concepte conduyente en un memento de duda, ' ' 
eolnuw6iamiaaatiafacdone8» porque tal era mi dnica pietenaida al eacribirlo. 

OAPfruLo I.— El Bsni EarX bk Gamino. 

PBimBA TIBITA. 

Sintamoi generales de embaraxo — CtMidas e(moenierUe$—Lo que debe y to qus no debe 

haceree — MkKcoe y j>ariera$—-4La eUod6n ea dudoaaf 

Sefiora: oa tengo que dar eae nombre, y vueetra aonriaa me revela que a(in no oa 
h»b^ acoetumbrado a que ae oa llame aaf . Hace doa meaea cuando en vueetra caaa 
patema me anunciiateia la dedai6n de foimar un hogar, era yo quien aonrela: ocultaba 
aa( mia intenaoa sentimientoa, mia temorea, mia preocupacioneB. 

£1 trato del medico habia con loa afios afianzado la amiatad y no era a61o mi cliente, 
la que emprendia ima nueva y miaterioaa rata, er^ mia^ erAia mi pequefia amiga, caai 
mihija. 

Al contemplar vueatra figura, vueatro talle fuerte, vueatio pecho amplio, al penaar 
que oa halUbais dotada de una voluntad tranquila y una dega fe en d porvenir, rena- 
d6 en mf la confianza y dije: "cumpliii perfectamente au nueva vida/' 

Hoy oa vengo a ver por una indi8poaid6n paaajera; como tal la ha daaificado vueatro 
carifioao eapoao. ^Y qu67 ^Sefiora, mareoa, nauseas, dolorea raros, arrebatoe de calor 
al rostio? ^Sf7 |Y tambi^ vdmitoal lAh^ aefiorai esto ea mia grave de lo que 
penaiia. Eato tendii conaecuendaa, pero no oa alarmda, ellas aerin de tal grado que 
colmaiin todaa vueatraa eaperanzaa. Me habiia comprendido . . . ea claro y era 
Idgico. 

^Qu6 debda hacer? Por ahora nada. Ouidaroa en vueatraa caminataa, moderarlaa 
haata tranaformarlaa en paaeoa higi^nicoa, no viajarda en cocfae o aut(xn6vil, no har^ia 
ejercicioa violentoa y comeriia . . . corned todo lo que oa plazca y mucho — sano, 
nutritivo, poco condimentado a fin de que el oiganiamo aaimile por doa, ya que eae 
alimento aerviri tambiin para doa. 

Haced vueatraa digeationea tranquila, repoaada en un divin, eatiafecha de la alta 
m]ai6n que estiia cumpliendo, la mia grande, la mia noble de cuantaa Natiira os li.i. ji 



198 PROCEEDINGS BBCOKD PAN AMBBIOAK BOIBKTIFIG C0KQBE8S. 

depaitido. Manteneos correcto en vaestnw placefee tin olridar por «bo vuestrM 
uecesidades. No tratnodi^is y espeh) que vuMna afidetiM al bail^ serto inhlbldaa 
por las nuevaa de madie que debris cultivar esmenMiaaiente. Esto aacrfficio, pof 
otra parte, no durari mucho y aeri noarcido con crecee por laa satiafacciones poalerieiea. 
Ko abmidon^is vuestro hi^^flico bafio templado, matinal, que 00 sidvarft de mudiaa 
afeedones cuiAneai mis Mcilmeiite adquMbles en estoe momentoa en que ob encon- 
tr&iB frente al peligro, en eondidoneft de ligera inleriaridad 7 cuidad voeiitroe senoa» 
que a m&s de su "toilette" habitual loa deb^ frotar dkriamente con una pane de 
alcohol, agua de Oolonia o el agua de ruestio tocador, en doe de agua limpia. 

No olviddis de tolvenne a Uamar id quinto mea, o bien requerid a vueetra parlera 
de confianza. Gualquiera de loa doe os haremos mudio biMi pravtniendo laa pequefiaa 
complicadonea podbles que nada valen cuando ee pueden ttcHmente remediar, pero 
que M hacen graved cuando habiendo aido abandonadaa ee agigantan paia trana- 
termane en obst&culofi eerioa en el nomento Mol(Sgico del nadmiente. 

^ A qui6n deb^ia llamar? ^ A mf , o a la ttadacaa? He ahf una cneatidn que me 
molesta tespender. Bzlflten buetiaa, muy buenaa^ excelentos parteras^ a tal grade que 
a ellaB lee conffe el poner al tnunde a mis hijoa. Pedid que aean limpiaa, eacnipu- 
lone eu an oometido y cefiidiM a an obl^gacidu Anica de ayudar a bien nacer normal- 
mente, exigid que al menor ttDpieae aeudan al faumltativo y aeite bien aeryida. 
Faro, por ftiirtyr no da entreguM a coinadit>naa ain titnlo que haoen la pitetka a coatiliaa 
de sua dientea y que no aaben de libroa, ni ban piaado una aala de matemidad. Su 
ftdta de reapooaabflidad laa hace mla atteildaa y oa deblHa conyenoar que la m^or 
priUiitIca no podHl patangoname a quien ha hedio una tega y vigil»Aa oaitem en laa 
aulM leuhieiido a la expeHeiida de loa caaoa, la deiida de loa libroa. 

iPero, quertfa que ttek yo quiim mafttesga la 41reeddftr Biwi m uy prattle ea 
har^ una nueva viaita. Eapero no ech& en aaoo roto mia obaerradonea y oa ruege 
record^ aiempre que hab^ia perdido vueatra libertad de acd6n y oe hallardia obli- 
gada a obedecer la voluntad dd peqmfio tinum que eatA en camino. 



Vida al aire lUfr^—iQiii dMia eomerf—El eonS admMeulo de torhartt—Loe paeeoe f let 

Sefiora: Amablemente oa digo que oa hab^ equivocado. Vueetro deeeo ha Ida 
maa alU de mia indicadonee. Anotadlo bien. Yo no oa exigl un enderro riguroae 
en Yueatro domidlio dedicado a vueataraa mondtonaa coatumbrea que permiten tejer 
la red de vueatroa i)en8amientoa alrededor del becho fidol^gico future. Oa dije, Seliorat 
nada de exceaoa, caminataa, bailea, conerfaa. Oa ban dicho quietud, y Vueatro 
razonamiento ha corrido al extreme dej^doae dominar por d prejuido. ISst&Sa 
dentro del tercer mea; ea cierto que no ea conveniente hacer locuraa, pero ea tambifo 
-verdad que eae enderro ea penddoao para voa; por ende para (H, fiae pequefio bebC 
que eat& en camino llena toda vueatra vida. Lo deae^ bello, fuerte, el kniie her- 
moeo de loe beb^ paaadoe, preaentea y hituroa. Y bien ^quer^ia conaeguirlo? Lo 
repito, vida amplia, tranquila, ain a^tadonea morales o flsicas violentas. Ahl tenfiia 
un reaumen de mis pretendonea. 

Pero, quiero inculcaroe haata vueatro aburrimiento mis ideas, quiero convenceroa 
haata el cansando de que mis instrucdonee oe ser&n beneficioaas y por eao oa repetir6 
lo que pretendo de vueatra amabilidad y del respeto que oa debe imponer la denda. 
M&B afin cuando sois, sefiora, una de las privilegiadas de la suerte que pod6is ol vidar laa 
necesidades de una vida material paia entregaroa a vuestras comodidades a vueatroa 
caprichos. 

^Y d no fuera aaft i Ah aefiora ! d hi^raia una obrera que mantiene con au aalarla 
la familia entera, no podrfan llegaroa eatoa conaejoa, pero redbiii&ia con mia nUui 
grandea aimpatfaa^ loa fervientea votoa que expreao de una pronta aancidn de leyea 



PUBUO HEALTH AKP MSDICXITS. 199 

de iffoteccida y el ieaoo que albexgo d9 uiui reiJusacida aia|ilia de la m ate rn i d ad en 
todos loQ paiaofl. 

£ii cambio, oe enconthUs ea coadidones iiunejorablaa y debris oinoe. Voeetro 
apetito piobablemeote aa rodoblariL ^Qu6 deb^ hacer? Comer, coined todo b 
que OS plazca y refos de IO0 prejuicioB de la gente que oe dir^ que ciertoa alimentoe 
deben ser prefeiidoa en el estado en que oa encontr&is. Todo airve cuando el oiga- 
niemo lo pide. La voz de la natoraloza, aalvo en caaoe patoldgicoe, debe ser obedecida 
ciegamente, 

Pero, defendeos de los caprichoe de la moda y de las obligacionee de la vida mundana 
ysaprinudvueBtrocoiB^. Noosaaombr^. Esnecesarioabsolutamentequelodej^ 
xelegado para el dfa de vuestra primera aalida con el beb6 y entonces, quizi oigulloea 
de lo que hab^is side capaz» no oe acord6is de dl. £s una pequefia imposicidn que 
exlge explicarse. ^Veidad, sefiora? Puea bien, tened en cuenta que a(in modera- 
damente apretado serd perjudioial al cliente futuio que adoptar^ eefi;iuramente una 
nuda poaicidn, Impueeta por el encieno obligado. ^Y sabdis a que consecuencias 
conduce una poeicidn viciosa? Hay mis, el cors^ seri tambi^ perjudicial a vuestro 
eetado porque la pared abdominal, ampliamente elisdca, colocada entre dos tuersas 
que se contrairestan— el empuje intemo del pequefio que aepira a engrandecerse y la 
prefli6n externa del aparato de tortura^-^ afinia, se adelgaza, pierde su elastlcidad 
que no recobrard jam&B y que ea neceaaiia para vdver a daroa eaa figura airosa que 
OB caracteriza y que servird, con aeguridad, de modelo a un cincel ezigente. 

Si 08 pzeaentiia a vueatraa vlaitas con un ampUo veatido, bien libre, colgante, S0 
hard quizd patente vueatro eatado, pezo a laa sonxiaaa deb6ia reaponder con la afirmaddn 
oigulloaa de la verdad, que no oa debe produdr rubor la aatiafacci6n de cumplir la 
mda alta miaidn que la naturaleza depara a la mujer. 

Debiia aellora, y vuelvo antea de terminar a referlrme al tema inicial, abandonar 
Yueatra inmovilidad. No oa dird que bajo pretexto de hacer ejercicioa, oa dediqu^ia 
a deportee violentoa, talea como el ^'tennia" o la cairera, tampoco oa animar^ a que 
aprovechdia vueatraa veladaa en fieataa bailes, pero af oa acooaejo que no dejdia vuea- 
tro paaeo cotidiano en tren y a pie. Un viaje a las afueraa en tren; un ligero paseo en 
lofl parquea oa hardn la vida amable y abandonardia quisd eaa preocupaci6n vlolenta 
de auceaoa que ae realizardn fatalmente. Haced visitaa, ocupaoa de vueatroa que- 
hacerea y de la direcddn de vueatro hogar, abundonando laa tareas peeadaa al aervicio 
y penaad aiempre que ningiin aacrifido ea poco para conaoguir ver fuerte, sano, vigo- 
roao, al pequefio beb^ que eatd en camino. 

TBBOJBBA. YVKtA. 



^QuUn aUmenktrd al hMf-^Al^jooi de la nodrtMo—Una falta y un crinuvu^JHfi- 
cultad de la eleocidn de nodrita — Una mala y den peorea, 

Sefiora: Redbid mia felidtadonea mda ainceraa. £ao, progreaa evidentemente. 
£ao ea ya visible. No, ^Por qu6 ruboriaaroa? ^Ea acaso un delito? Cumplida la 
mdTima biblica de la multiplicacidn, oa deb^ aentir r^godjada, oigulloaa, capaa de 
acometer grandea accionea. 

No dir^t aefiora, que deb^ia imitar a vueatro marido que en au j<ibilo de padre futuro, 
ae conaidera aufidente para repoblar la Euiopa; pero al menoa vanagloriaoa de vueatra 
acddn. La irente alta, el pecho eiguido, aoia cad madre. 

Anotad con cuanto mds ardor beaar^ vueatra nuunita cuando deje caer aobre loa 
Tueatroa, ana ojoe manaoa, aoniientea y lacrimoaoa de futura abuda. 

Y ya que la he recoidado, mientraa el prdzimo cliente viene en camino tratemoa,. 
sefiora, una grave cueatidn. ^Quidn alimentard al beb47 Si no eacuchiis mda que 
la voz de la Naturaleza y laa pdabraa de vueatro corac6n eatarda diapueata a cumplir 
haata el final vueatroa debereadenuuire. Tal ea vueatra opinion, tal la mla. PeiOyhe- 
ahi el partido opueato. Lo encabaza vueatra mami. "Sf, dice, yo oa amamant^ a. 



200 PROCEEDINGS SECOND PAN AMERICAN SOlENTOnO 00NQBB88. 

todoe, pero eran otros tiempos; yo era fuerte, aana, mientras td, tan d^il, tan nerviosa, 
te fatigas tan pronto y adem^ te deformarfas. Eso es horrible. Cuenta diez, quince 
meses eaclavizada, sin teatroe, sin fiestaa, ^comprendes, hija? ^No 8er& demaoiado 
para tf 7 Y tu mazido tan bueno pero tan delicado ^no perderla sua ilnsiones vi^dote 
denodriza?" 

VueBtro esposo, poco preparado para su papel, no quiere Beguramente que se le 
eche en cara que por ahorrar unoe pesos que pueda costarle el ama oe obligue a cumplir 
tan desagradable como pemiciosa misi^ y se pondr& de parte de la abuela futura y 
voB, Sefiora, i q\x6 vHb a hacer? 

Vuestra madre, vuestro esposo, las personas a quienes quer^is entrafiablemente 00 
empujan y decidfs abandonar vuestro beb^ en manos de una mercenaiia que expende 
;8u leche al mejor poster. 

He llegado a tiempo por suerte, aunque veo que ya habfan hablado del punto. 
Prevenir mejor que curar, tal es nuestra miaidn. Y bien, Seiiora, prevenida quediis. 
Mi consejo es terminante: Vos y nadie m^ que vos tiene la obligaci6n de amamantar 
jJ beb^ que estd en camino; si asi no lo hici^reis cometerfais una falta y un crimen. 

Una falta contra vos misma, un crimen contra el nifio de la nodriza a quien le 
robdis su leche, y serdis, la pnmera castigada. Supiimir, despu^ de la matemidad, 
la lactancla, es dejar a medias un proceso fisioldgico, es detener la marcha regular y 
hermosa de los hechos. No lo olvid^, la zuituraleza no marcha a saltos y la ordena- 
cidn de leia funciones natundes es suave como la cafda de los p^talos. 

|Cu&ntas madres despu^ de exteriorizar una o dos criaturas sin haberlas lactado 
quedan deshechas, quebradas, viejas y cudntas se han hermoseado, han vista por 
piimera vez colores en su rostro y se han vuelto fuertes, vigoroeas, espldndidas en 
plenas funciones de amasl 

Cometer^is adem^, una grave falta contra vuestro hijo, el que se habfa formado 
recibiondo la vida por vuestra sangre y que notari seguramente el alimento extrafio 
que le proporcionarfa el seno mercenario. 

Quiero suponer, Seflora, que os hayan el^do una buena nodriza; que gracias a mi 
intervencl6n est^ seguia de su salud, que sea sobria, que sea honesta. Pero, ^d6nde 
encontrar ese fen6meno? Por una buena, dardis con cien malas, y estad s^gura, 
Sefiora, la vuestra estaii entre las cien. Os dir6 muy pronto el porqu^ de una afirma- 
cio. . Uui l<irmijiaiite. Sabed tan s61o que 411a e6t& basada en una laiga experienda. 
Mientras, no os preocupdis, yo os ganntizo que sola, ser^ capaz de llevar a hombre 
a ese pequefio beb6 que est& en camino. 

0I7ABTA YISrrA. 

Bl ama et $iempre una mercenario— El hijo de la nodrita — Ir^ueneia del medio en el 
eardeter del amor—Delito no penado por Uu leyu — La venida del ama impliea la vemda 
delkijo. 

SsJi^oRA: ^Hab^ reflexionado sobre mis Ultimas confidencias 7 |Ahl ... ^pero 
quer^is sabw porqu6 06 habl6 de crimei]7 Creo que me sedl £&cil explictoslo. ^a- 
bdis pensado alguna vez en el porqu6 de la existencta del alimento en el seno del 
ama7 Y si lo'habto pensado, vos, Sefiora, tan carifioea, tan amorosa de los pequefios^ 
tan afecta del futuro que viene en marcha, ino hab^is meditado un SQgundo, en el 
hijo abandonado por la nodriza, quien corre tras vuestro dinero, vendiendo un ali- 
mento que no es suyo, que es usurpado a su hijo, tinico propietario de la leche matema, 
iinico con derechos y a qui^ le es necesaria como el sol al capullo de rosa7 

Vuestro hijo es despojado de su alimento porque vos esteriliz^ la fuente de vida 
con que la pi^iga Natura os ha dotado, para transformarla en un adomo de vuestio 
cuerpo que no necesitarfa de 6\ para ser hermoso, y en cambio le d&is una extrafia 
:alimentaci6n robada a otro pequefio que gracias a €lla vivirfa y que sentir& su falta al 
par que el beso de amor que le hac^is impodble, rob^dole su madre. 



PUBLIO HEALTH AND MBDICINB. 201 

iVdifl, Sefioia, cuinto mal? 

iV^ c6mo amaig&ifl indtilmente vuestra vida, poique aendo como ooia todo 
corazdn, cuando el ama 06 diga que sa hijo muere en manos extrafiaa, poique se le 
alimentaba mal, recibir^ia la noticia lacrimowa y triste como si oe anaocann un pedazo 
de vuestro aer Intimo? 

Y mientnft— haflta por egoismo — comprended, Sefiora, que vuestra ama sabiendo 
que su hijo est& enfenno, no nutrtii vuestro lico beb4 m&B que por la bills del diagusto 
y no con la sana savia de la alegiia. 

Cuando ella oe diga, " Sefiora, me voy, me anuncian que mi hijo esUl grave y recobro 
mis derechos de madre. Vuelvo a su lado, aunque no sea Joia que para verlo morir." 
iCon qu^ derecho la retendr^ia? Y la verbis macchar pesarosa y doliente y oe pon- 
dr^ frente al conflicto de una nueva ama. 

Vuestro maiido y vuestra madre negatin duranMnte la patamidad de los malos 
coxisejoa y he ahf que una nube aombreaii el cielo de vuestra dicha con un matia de 
tristezas que no se borran porque repercuten sobre la vida del ser m&i querido, que es 
dl beb^. 

Os decia, Sefiora, vuestra nodriza seri mala. Y no puede ser de otro mode. Colo- 
cada en un medio que no es el suyo. Planta de arenal trasplantada a una rica capa 
oig^nica ''se ir& en vicios," he ahi el case. Golosa, encontrar& como producirae una 
indigestidn y la har& con vueatro asentimiento, porque penaar^is aiempre en que el 
alimento del ama no debe aer diacutido. Diacola, aabi& imponer aua caprichoa que 
le tolerar^ia por no diaguatarla. Sucia, capas de besar al nifio en la boca, con vueatra 
tolerancia porque no oa aentir^ lo auficientemente en&:gica para impedfnelo, estando 
en juego la vida de vuestro precioso beb4. 

i Ah, mi buena Sefioral No olvid^is que no hay poor tiraala que la de la ignorancia. 

Hay mia, Sefiora, comet^ia al contratar una ama un delito caatigado por laa leyes. 
Dad por aentado que el alimento ea propiedad del nifio. El ama robaeae alimento 
para vend^roalo. He ahi el delito. Sereia c6mplicedel hurto. ^Oaaonrefa? Si 
lo comprendo, no aar6ia penada por 6II0, pero ^ea por eaoun delito menor? |Ahl mi 
buena amiga. La naturaleza aabri caatigaroe mucho mis en^igicamente que lo 
harfan loa hombrea. 

Me decia: ' 'Doctor,^ y ai no tuviera leche?' ' No olvid^ia, Sefiora, que estar6 a vuestro 
lado y que mis recursos son infinitos dentzo de la relatividad del poder humane. Si 
no tuvierais leche, cosa improbable dado que oa halUia espldndidamente armada para 
que esto no suceda ... si no tuvierais leche . . . nada . . . ni un poquito . . . 
tranaaria con el ama . . . pero no cre^ que caiga en una contradicdfin. N5. Oa 
traeria el ama con au nifio a vueatro hogar. Meditad, Sefiora, el valor de mi traaac- 
ci6n y comprender6ia que aunque ello importe un aacrificio, ea neceaario hacerlo, por 
cuanto, y oe dii6 porque— ello importa la aalud futura de vuestro precioao beb6 que 
est^ en camino. 

QUINTA VISITA. 

El duarrollo de vna nueva vida — Cuando et eonvenimU d ejerekuH-Deikaeienda pra- 
juiciaa—Akargar la vida intrauterma et eoftuegmr tin ntHo ya eriado, 

SBfioRA: Perddn, me he detenido quizd demaaiado aobre el tema del ama, pero 
Xcomprend^ia, Sefiora, cuinta importancia tiene para la vida del futuro? Ha quedado 
por dilucidar, el porqu€, ai la neceaidad obliga, os debris quedar con el ama y el 
hijo — ^lo dejaremos por hoy, porque los diss pasan y el memento final de vuestraa 
fatigaa ae va a coronar a corto plazo con el resplandor de la dicha. 

^En qu6 lo he notado? 

Sefiora, hace ya tres meses que el futuro cliente nos ha avisado de su existencia. 
Fu^ suave, carifioso en su aviso, pero peraistente. Ha dicho el ''aqul estoy'' con 
vehemencia — ^y recordAis que os hice notar la cara de dicha con que me lo advertiateia. 

Gada movimiento, cada golpe ae traducla en una aonrisa de vuestro rostro felis. 
Vive, pues, y sigue su marcha presurosa hacia la luz. Me acusdateis despu^ ciertos 



202 PBOCBEDINOS 8R00ND PAK AMBBIOAK 80IBKTIFI0 OONGBBSS* 

doloreB en las caderaa y os afirm6 que no eran rnds que defectoe de capacidad. Pedis 
plasa para engrandecerae y vos, Sefiora, obediente a mi pedido sufristeia la ampliaci6n 
de Yuertra pelvis decidida a no entorpecer au mazcha piomtBora. 

Noa propuaimoa enaeguida ayudarlo y luchando contra vueatra mal entendida 
vergtkenza, deaobediente a mis mandatoa, que oa aconaejaban laa aalidaa en pleno 
dia, recorriateia laa callea de la Urbe del braao de vueatio eapoao, trotando fuerte en 
medio de la noche, cuadraa y m^ euadraa--^ me decfa hoy-^que ya no eatiia fatigada, 
que 08 aentia mejor, mucho mia aliviada. 

Oa dMf Seftora, que ai tal aucede ea que el future cliente ha encontrado el camino 
y la rata amplia que habian elab<»ado loa hueaoa de vueatra cadera al aepararae ha 
aido llenado por la cabeaa del pequefio. Bien, muy bien, todo marcha a la medida 
de vueatroa deseoa. Se cumplen fielmente laa leyea fisioldgicaa. Oa dais cuenta 
ahora, en que ae baaa nueatra cioicia: leyea inex<urables, fatalea, rigen loa deatinoa 
de la vida y de la muerte; todo est6 previsto pw reglas observadas y aiempre igualea, 
y cuando la excepci6n aparece fundando la regla, no vacilamoa en afirmar que se han 
torcido loa preceptoa naturalea, y tratamos de cozregir el error. He ahi todo. 

Oa halliia, Sefiora, en la entrada de la tkltima luna, sat^lite cuya traslaci6n divide 
vuestroe meaea, vale decir, comenz&ia el 61timo mes. £Qu6 debris hacer? Vuelta 
a la quietud . ' * Horror, ' ' dir& vueatra madre manteniendo un viejo prejuicio. ' ' Ahora 
ea cuando ea mis neceaario que caminea, chiquita." Error, digo yo que aoy vuestro 
medico y quiero explicarme, porque me entender^is f&cilmente. El divino beb^ 
en camino est& ya perfectamente complete. ^Me entend^ia? Ouanto mis largo aea 
eate dltimo perfodo, m&a perfeccionado vendr6 a la vida y por lo tanto m4s apto para 
afrontar sus peligros. 

M4b fuerte, sufrir& las inclemencias del cambio con en^rglas y oa encontrar^is, sefiora, 
con un pequefio pronto a todo, hecho y dispuesto a triunfar contai la enfermedad; 
vigofoeo, que absoiber6 su alimento con la tranquUidad y glotonerfa de un gastr6nomo 
aesudo. 

^Oa figuhUa, aefiora, qu6 memento ineetable de la vida, ea el del nacimiento? 

C6modamente encerrado en preciono estnche, arrobado por el calor ambiente, ali- 
mentado directamente con vuestra sangre, sin tener que cumplir los trabajos inhe- 
fentes a la vida libre, pobre ciis&lida paraaitaria que cumple su ciclo en un instante; 
tranfiCormarse en un ser que lucha, ae afana y crece por caenta propia. 

^ Y pretMid^is lanaarlo cuinto aatee? 

|Ahl n6, aefiora, detenedle, que aUf progreBar& sin peligro. AUf os sacrificaii 
mAa, ea cierto, pero os ahorrar^is temoree futures. 

Vuestra madre aif^umenta peligros para vos. ^Pero, cuAIeaf "Laenormidad del 
pequefio" . . . "Ba el primero yquiair— el memento ea diffcil." Estad (ran- 
quila, aefiora. BsttUa bien constituida, aoia fuerte, vuestros 6rganos son sanos y 
sabr&n cumplir fielmente su mi9i6n. Seii quiz&, un poco mis de dolor que se equili- 
brard despu^ con un mayoi caiifio. 

Por otra parte, ^no oa aentiriis herida en vueaCraa iluaioiiea al ver a vueatro beb4 
enclenque, raquitico, todo vioUceo y tembloroao, cuando pod^ obtener orgulloaa, 
un rico infante, ya criado, gordo, fuerte, aano y vigoroao? Eatad tranquila, pues, 
cumplid mis consejos que yo velar^ porque vuestros ideales se cumplan y que aea 
hermoso eee pequefio beb6 que estd en camino. 

8BZTA VI8ITA. 

UtUidad de e$ta$ etmvertaeionet-'Paldbrai que deben ur e^auchadat por las madm y por 
Uu que nolo 9onn^Conv€nieneia de vulgarigar la eievwia—Owrra dl pudor indiU y a 
la/arm, 

Sefiora: Mis palabraa llevadas a loa of doa mis ptidicoa no producirfan ni la mia leve 
intenci6n de pecado. Pr^dica? cientfficas, no aon para dichas en el altar de las pii- 



FUBUO HEALTH AHD MHDIOnn. 208 

blicas crfticas, sino para eflcachadas en el ambiente familiar, junto ai lecho donde el 
dolor engendra vida y donde la vida vivifica amoree. 

Oomo tal, aefiora, oe he venido hablando dulce y amablemento, mientras vuestro 
aacrosanto destino se ciimplfa, tranqnilo y sonriente como an caballero del Men. 

Pero hoy, sefiora, nna filoeofia amarga, puso un peear en mi canadn y una dada en 
mi cerebro 

Vo6, aefiora, aab^ia el Men que os deseo, sab^ia el fin de mis conaejoe, y loa recibfa 
con loa ojoa bajoa y el oldo atonto; ^aeri lo miamo para todaaf 

Bllaa aon, o aer&n madrea, eaa ea mi fe y ea por eao que a ellaa, van mia pUticaa. Lo 
demiua, aefiora, aerd coreado por mi aonriaa tranquila. 

La maledicencia no llegari a producirme encono, la a&tira Mp6crita de loa que 
nada valen engendrari mi deaprecio y peae al mundo, marcharemoa por el 6nico para 
noeotroe, auave camino, el del cumplimiento del deber. 

Voa, aefiora, y con voa eaa legi6n de madrea que me leen, aentir&n algdn dfa eaa tran- 
quila alegrfa de quien ae alento aoatonido en loa momentoa amargoa y peligroaoa. Yo, 
en cambio, ver^ eaa nueva generaci6n v igorizada aai como el labrador contempla aua 
mieaea m^ rozagantea, aeguro de que en algo ha ayudado a la aanta obra de natara 
madre. 

^Pero por qu67 me decfa, aefiora, ^por qu6 doctor?; eaa divagacidn, eae par^ntoaia a 
nueatraa charlas amablea y provechoeas? {Ah por qu^! ^Lo querela aaber? Sefiora, 
aabedlo, ae ha hablado de mi diacreto cucMcheo a vueatroa ofdoa matemoa, como de 
una charla pomogr^ca, ae ha hecho caeo omiao de au utilidad, para colocarlo en el 
' ' index " de las novelas pecamlnoeaa . Se ha dlcho nUis, ae ha dicho de la conveniencla 
de Impedir sua lecturas a las pequefias, futuras madrea. 

iVeis aefiora, que malosi Vuelven a la rutina, no salen del prejuicio. Pretenden 
volver a laa conversaciones aecretaa de amigaa avezadaa que repiton lo que han podido 
entrever en el descuido de loa padrea y que por lo tanto deacriben como un miatorio 
horrendo cualquler hecho fisiol^co. 

Quieren mantener aquella pemiciosa ignorancla que hacfa que nueatraa madrea 
rompieran el llanto colgadas del brazo del espoao idolatrado en el memento de la dea* 
pedida con igual vigor lacrimoao que el de loa aoldadoe eatrechando a loa suyoa en el 
supremo inatanto del adi6a. 

Pero eat&n perdidoa, pobrea avechuchoa prehiat^ricoa; la verdad penetra con pre»- 
toza en todaa partoa y ya nadie conserva eaa caatidad mal entendlda, efectiata o hip6- 
crita de conventual que era pemicioea y nociva en la formaci6n del hogar. 

^Y ai igual, aefiora, ae ha de aaber, no vale mia que claramento, cient£ficamente 
llevemos a Iob cerebros adn obacurecidoa, la luz de la verdad? 

Ahl aefiora, diaculpad mia enojoa, pero ea demaaiado para mf . . . y quizA para 
voa tambi^n, que hab^ia oido indulgente eata expansion de mi aer intimo amargado. 
Qniz& . . . pero . . . hemoa perdido miaerablemento el tiempo y no hemoa 
dicho ni una aola palabra del tema que hubiera querido tratar hoy — tema muy intere- 
aante— porque ataAe directamento a la aalud de eae pequefio beb6 que eat& en camino. 

aiPTIMA VISRA. 

Explioad&n del porque e$ necemrio aotptar el ama eon iu hijo—Cariilo y alimento — 
Dor para reeibir-'IHficuUaides $alvades—Un buen compaflero, 

Befiora: Os debla la explicaci6n del porque eva neceaaiio, en la tadctk diconatanda 
tolerable, que el ama fuent acompafiada por an Mjo. 

Oe veo ya convendda y por ello no har6 mis fuertea loa argumentoa de mi diaerta- 
ci6n. Sin embargo, deb^ tener preaente que toda vueatra tianquilidad depende de 
mio y no puede aer de otro mode. Gomi>rended, aefiora, que como reza en la ** Ver- 
bena," "la gento del pueblo tiene tambi^n au corazoncito," y que puesto a la prueba 
eae coraz6n late y ae aacude con igual fuerza que el vueatro. Seiiaia impla ai afirm^uraia 



204 PROCEEDINGS SECOND PAN AMERICAN 8CIENIIFIC C0NGBB88. 

lo contrarioi y no caben en vuestra gran alma f eliz pequeiios difltingos de clase que por 
otra parte no albergar4 jam^ vuestio cerebro bien intencionado. 

Y bien, sefioia ^qu^ pasaii teniendo a vuestro lado la nodriza con su nene? Ella 
reapirari el aire de felicidad con que rode&isal vueetro, y la paz de su almase traducir& 
en un mejor rendimiento con benepldcito para vos y con utilidad evidente para 
vuestro pequefio. 

No m^ sobresaltoe. Su nifio crecer& bajo la mirada maternal asf como el vuestro y 
hasta quedar^is ampliamente autorizada para erig:iros vos tambi^n en su egida pro- 
tectora. 

Adem&B, ese exceso de caiiiio que ya manifest&is para ese pequefio beb6 que est4 
en camino, lo repartir^is generosamente con el otro, a quien vos, sefiora, no considera- 
r^s )am^ como un '^ parvenu" porque €1 cede amablemente parte de su vida para 
d&rsela al vuestro. ^V^^is la compen8aci<3n7 £l os da una coea que es suya para que 
con ella consigiis hacer hombre a vuestro hijo; vos le ced^ algo de aquella vuestra 
extrema bondad, en cambio del dailo que le ocasiondis. 

Adivino, sin embargo, vuestra pregunta: ^Doctor, seri bastante, para los dos? S£, 
sefiora, si. Sana vuestra nodriza, feliz, bien alimentada; si en su hogar de pobre, 
Uena de sinsabores y desdichas, ^Ua puede criar un hijo sano, hijoquizd de un engafio 
y que viene para su dolor y su veigQenza, y puede Uevarlo a hombre . . . contenta, 
sinti^ndose bien querida, halagada por la seguridad de que no habr& zozobras en el 
porvenir de ese ser que adora, sentird doblar su vigor y Uenard perfectamente su doble 
miBi6n. 

Pero quer^, ya que oe veo alarmada daros una (Utima voluntad. Si vuestra ama, 
coea improbable, no pudiera con los dos, se salvard el mal trance de una manera muy 
sencilla aimque peligrosa. Se les dar& antes de cada vez una pequefia dosis de leche 
de vaca. lOh, sefiora! os causa aaombro mi tiausaccidn. Es que los peligros de la 
leche de vaca se aminoran cuando es factible que ella vaya seguida de un poco de 
leche matema que le sirve hasta para apresurar su digestidn. 

Tengo, sefiora, un axgumento final que me resulta convincente. ^Sab^is cu^ es? 
No tiene nada de cientl&co, es s61o de experiencia de la vida. 

Al proceder como os aconsejo, tendrd vuestro beb^ im compafiero fiel, amoroso y 
devoto paia toda su vida, por que el amor que se inicia en el seno comdn es imbonable. 

^Y sab6is, sefiora, lo que eso vale? 

El irbol crece m^ vigoroso cuando otros m^ pequefios lo libran de los embates del 
viento bajo. 

£1 hombre-cerebro iinidiar& m^ nftido su valer cuando otro se preocupe de desvas- 
tarle el camino de esas pequefiaa minudas embazazantes que preocupen intitilmente 
su marcha futuia. Y eso, vos y yo, sefiora, deeeamos para el pequefio beb6 que est& 
en camino. 

OCTAVA VISITA. 

Las %m/eeeume$ y Uu aneaiuias en el ternbU momento—El doroformo, la tooanalgina y 
la partoanalgia — Consejoa y dudas—La verdade$que la naturaUsa e$ aabia. 

Sefiora: Pod^ preguntarme. Soy todo oidos y sabedlo bien que no quiero que 
08 intranquilic^is per nimiedades. 

^No las considerdis asf? 

Ahl Sefiora, cu4n equivocada est&is. Es patrimonio de los d^biles el hacer de un 
Buspiro un vendabal y vos, sefiora, no sola d^bil; capaz como sois de acometer la magna 
acci6n de dar vida, no pod^ consideraroB ni por un instante como ima cobaide. 

S6, sefiora, c6mo os ban hablado del terrible memento; de inyecciones, de anestesias. 

Os ban dicho, ademds, que natura fu6 vencida por la dencia; que el mal trance se 
pasa entre sonrisas, o durmiendo. . • . 

|Pero, qu6 mal os han aconsejado, sefioial 



PUBLIC HEALTH AND MEDIOIKE. 205 

Hicisteifl bien, hablandome previamente y vueetra prueba de confianza merece una 
«xpUcaci6n. 

Os ban dicbo: "La sefiora X ha tenido uno, dos, tree alumbramientos bajo el doro- 
iormo, y ^ vieras qu6 bien? Nada, ni un dolor, ni un peligroi bu m^ico fu6 tan amable 
que ae lo administrd por pequefias dosis, como elloe dicen 'a la reina ' y ahi la tieues, 
madre tres vecee Bin saber lo que cuesta tener un hijo." 

No 08 har6 la crltica de la actitud del medico porque me temo tener que diflcutir 
con inconscienteB, pero, mi deber es poneros irente al peligro y preguntaroe: ^Sa- 
biendo que ob pod^ia morir en la anesteflia ser6i8 capaz de dejar a vuestro divino hi jo 
Bin madre? ^Por no suirir un instante har^ifi desgraciado o Bacrificar^ia a eee pequefio 
beb6 que e6t& en camino? 

El dolor, aefiora, y amiga mfa, lo verbis transfarmado en amor y enjugar^ia la ligrima 
de vuestra defldicha con la aonriaa de la felicidad. 

Con dolor, Befiora, amaaar^is vuestro carifLo y perdonad, que oa corrija eaa muequita 
ir6nica con que reveliia vuefltroB pensamientoB intimos que se podrfan traducir en la 
fraae que no viene a vuestroa labioa pw aiempre respetuoBOB, pero que traiciona vues- 
tro eatado de alma. ''Ahl doctor, como ae conoce que aoia hombre y no oa toca 
sufrir." Si, aefiora, hombre aoy, pero ^qui6n oe ha dicho que loa hombrea no auiren? 
Pobrea eapoaos ante el dolor de madre, de nueatra compaflera, una aenaaci6n de impo- 
tencia anguatioaa ae apodera de noaotroa y cada quejido ea una dilaceracidn de nueBtra 
alma. 

Natura ha aide injuata con vueetro aexo. Ella oa ha deparado loa dolorea ffncoa; 
es gentil que los hombres guarden para si laa amarguras moralea y a61o asi ae reata- 
blece el equilibrio y la igualdad triunla. Por 6II0, aefiora, me v^ia tan altamente 
respetuoBo de vuestro aexo, y ain querer me incline reverente ante la mujer preain- 
tiendo en cada una de ^Uaa a una madre que aufre, a un aer que el dolor engrandece. 

No ha mucho, aefiora, nuevoB procedimientoa ban venido a auplantar al cloroformo 
'•n el memento aolemne. Laa inyeccionea de tocanalgina y de partoanalgia parece 
que caiman por complete loa dolorea y que au influencia podria producir un trance 
menoB amargo ain peligroa. 

^V^ia que oa hablo dudando? 

£b que. yo, aefiora, no tengo experiencia de tal medicamento y conmigo la gran 
mayoria de loa m^dicoa. 

Sin embargo, me aaeguran que aon una compo8ici6n a baae de morfina o simple- 
mente morfina a alta doaia y que en loa caaoa empleadoa la enfenna queda en un estado 
let^ico prolongado y el pequefio nace muy a menudo en aemi-aafixia. 

^Oa propon^ia, aefiora, aervir de experiencia? ^Oa animiia a exponer a vueatro 
beb6 a un peligro probable? ^Y ai tuviera conaecuenciaa? 

D^ad, aefiora, a la inHnfnanit ciencia que buaque la comprobaci6n en laa clinicas, 
pero no me exij&ia que oa aometa a lo deaconocido, a lo problenULtico, a lo probable- 
mente male, para libraroa de una coaa tan paaajera como un dolor que no aer& tal 
cuando pod&ia mitigarlo con la aolemne alegria de aentir en vueatroa braaoa a eae divino 
beb6 que esU en camino. 

CAFtruLO II — ^El BxBi ha Llxoado. 

NOVXNA VI8ITA. 

Sait madre-~La obra magna de dor vida — Fe en la denda y €n la experiencia — No mde 

vieitae—El papel del upoeo. 

Sefiora: Sois madre; el grave trance ha pasado. Mece en vuestroa labioa la aonriaa 
de la dicha. Vueatxo eapoao afligido me ha contado horrorea. ^Seguramente hab^ia 
Bufrido mucho? pero no demaaiado. lAhl — !no tanto como eaper&baial Graciaa, Se- 
fiora, veo que aoia aincera. Al oir a vuestro eBposo pena6: "mi buena aefiora, me 



206 PR0CEEDIKG8 SBCOND PAK AMBBIOAK SCIENTEnC CONGRESS. 

recibiri seguxmmente quejoaa, me diii inaes ciudM Ules oomo: 8e conoce que no 
8oiB voe— podiaia haber sido m&s amable." Pero n6, con Yuestro gesto, con eaa dulce 
mirada de agndecimiento me pegiie con creces loe desveloa pasados. 

Sola madre, vale decir, hab^ia aacendido un ancho peldaflo en la eacala de la vida, 
aaC como en el mnndo de loa aerea inieriorea cuanto mSm alta ea la eapecie, mia compli- 
cada ea an vida org^ica; en loa hombrea, coanto mia ae ban elevado, mia miaionea 
deben cumplir. 

Pexo, Sefiora, eata que Natoia oa ba deparado mereceri vueatraa aatiafaccionea al 
par que vueataroa deaveloa y cuidadoa. Conatruir un hombie ea grande obra, piepa^ 
rark> para la vida, ea magna. Oa encamindia por una ruta nueva. 

^Guilea aer^ loa eacolloa que hallar^is al recoirerla? * 

^D6nde la infroctuoaidad en que cboqu^ia y recib&ia vueatro primer dolor? 

En la guerra conocer al enemigo y la poaicidn que ocupa ea gaoar la batalla. En la. 
vida ai conoc^iia loa peligroa Ueviia grandea ventajaa paia aalvarioa y combatirlos 
aerenamente piepanda. Tal aer& nueatra miai6n; y nueatra ciencia y experiencia, 
Sefiora, caer&n amablemente de nueatroa labioa, dicboaoa de aer l&tilea a voa, encama- 
ci6n de eaa caravana de madrea que al recibir al bijo, ae encuentzan extraviadaa en el 
misterio de au crianxa. 

No oa amedrent^, aefiora, nada nuevo exiate, que no baya aide piofundamente pre- 
viato y laa leyea natunJea ae cumplen irremediablemente como proleclaa de un aer 
infallible. 

Aaf, que ai vueatroa temorea oa pueden llevar a aer extremoaa en loa cuidadoa bacia 
eae pequefio aer que ba nacido, no deb^ enloquecer ante el miaterio del future que os 
dar6 a conocer con mia palabraa. 

Pero, aefiora, un primer cuidado boy. Oa balUia convaledente, debilitada ffaica- 
mente y preparando alii en la intimidad de loe tejidoa la vida de vueatro beb^. 

Deb6ia, pu^, permanecer tranquila. 

Mafiana, cuando el nuevo cliente reclame con aua llantoe aquello que eatiia elabo- 
imndo, deb^ reaponderle con becboa y n6 con palabraa. 

Y ^1, aefiora, cuando pide, exige y no entiende lazonea. 

Para ello, aefiora, nada de viaitaa. Vueatro eapoeo mia locuaa que de coatumbre, 

lea contari alii en la aala toda eaa aerie de infamiaB que me ba dicbo antea de llegar 

baata aquf , lea diri que peaa 4 Idloe y 200 gramoa, que ya rfe, y que a ^1 a61o ae parece. 

Todo eao, y mia me ha dicbo, aefiora, y aaombraoa; no ae ha quejado adn de aua ne- 

gocioa, ni de au eatancia en caaa. Ya viia, aefiora, cdmo, ain quecer, babiia enloqueddo 

a un hombre. Y como debo pradicar con el ejemplo, mafiana habUuramoe de vueatroa 

cuidadoa a fin de que podiia, aola, conaeguir ver en marcha a eae divine bebi que ha 

llegado. 

dAcima visita. 

Airtj luZf sol para la madre y d Mjo — El dgarrillo patemo — El ixddo es agua — Men^ 

de parturienta — Ledte ccmtra ceroeza — MenA definiUvo. 

Sefiora: i Y eataa tinieblaa pavoroaaa que oa envuelven? i Sabiia que en la calle 
reina un aol otofial magnffico y que paaamoe por uno de loa mejorea d faa del afio? | Todo 
cenradol ^Por qui? ^Teneia fiebre o cefalalgia? Nada. ^Entoncea a que eata 
tumba ? Ah, vueatra mami ba dicho ... Lo comprendo. 

Oa dije tranquiHdad, nada de charlaa imjwrtunaa pero no por eao oa iba a ezigir el 
enclauatramiento total. No, aefiora, aire, luz, vida para voa y para vueatro beb^. 
No tengiia miedo. La luz le bari entomar loa pirpadoa pero jamia le bari mal, a tal 
gndo que cuando il pueda moverae lo tendriia siempre curioaeando por eaa ventana 
por donde entra el rayo de aol vivificante y aano que coloreari aua mejillaa con tonos 
de roaa. No temiia al aire libre. £l dari amplitud a aua pulmonea que ae adaptan 
eaplindldamente al medio ambiente. Temed mia al confinado, al que ae reapira en 
eata pieasa en el que ae aobreagrega el acre olor de tabaco del cigarrillo patemo. 



PUBUO HBALTH AKD MSDIOIKS. ' 207 

i All, flefUxm I i Ftotend^ jtwtificM a yiMstro 6qK)to 7 4 Ha fuinado poco 7 Pues 
bien, aaftoia, decidle: '^£1 d<»cior ha dicho que oe piohibe fumar cerca del none," 
poique, Bofiora, in^ mal le faace 600 al pequafio cliente que un aire frfo peio caigado 
deozlgeiie. 

I Y que bebida indigna es eaa que veo eobze vuestia meM de lus? Gbldo . . . 
Ilaco . . . degallina . . . VueBtra mami tambi^n . . . Eededrquediedeayerno 
^flkab&alimentadODitequecontattidecalde. i No sab^ eetkxm que el caldo es 
aguaoonguetoa lal y a vecee con sabor de alguna leg^umbie peio cuyo valor alimeoticio 
eenulo? 

Abandonad eso; neofleitAie algo nutativao, fdUdo, que oe d6 fuenee. TiateBMM de 
compefiBar un "menu." Frimero un poco de jain6n cocido. No oi alanndie, Sefiora 
Mayor, lo digeriril vuefltro nieto en cuanto cumpla bus doe afloB y |»etend^ que a 
▼ueetia eefioia hija en plenitud de ealud le pueda ser nocivo. En seguida un buen 
plato de eopa de avena, excriente alimento mientraa neceeit^ Uenar el eil6ma0D 
iiiwiciable del dulce tinnuek). Desde luego un buen pur6e de papae, del que poddis 
eerviioe un plato bten oolmado; y coino poetie. ^Quequer^iedepoBlre? Unacrema, 
mia compela, Irutaa, lo que guelte, eefioca, y he abl vuestro "meni." 

Bb ouanio a befaidaa, oe ban bablado de la cenreia y oomo de opottunidad para la 
Iunci6n que eet&ie por cumplir., i Oe ban yanag^oriado la negra y baeta baa aeefURMLo 
que la extnuajeia con un Jabali dientudo como maroa, es la m^ favocaUe7 

Puei bien, aefiota, abf tentfe oCn> pr^uicio. Ebo no sirve para nada. No aportar4 
■i una Bola goto al alimento del pequefio cliente, y en cambio le i»opofcioiu«4 eerioa 
delons de vieoAre por el alcohol que contiene. 

Ague, agua para, he abf la bebida y leche en cantidad, abundanto, mejor adn n 
eMCQoMis aiguaa que no faaya aide diluida por la maiio mercenaiia del ezpendedor. 

Om ena doa llquidoe tendr^ aBCguradae laa fundonea fiaioUgioee noceBarim para 
conaervar viMatia aahid. 

Tened entendido, Bin embargo, que el mend propueeto, ee de ocaaite, mafiana; 
qoiaia paaMlo, yotwmi4m a yueBtsa alimentacidn ordinaria, porque ella eola eeri 
eapaa de aaciar el ooloaM apetito dd exigente beb6 que ha Uegado. 

UNDiCDCA TIfllTA. 

Detpertad a vn ntflo dorm,il6n — Comer donnido, 

Sefiora: Eae reBpetable caballero que eeU a vueetro lado y que Begtin aeogura 
Tueetro idolatrado eflpoeo comienaa a tiranizar el bogar, va a merecer boy una Bevera 
leocidn. No, no os riiia. ^Eb verdad que anoche atn>n6 la dulce quletud de vueBtra 
can con llantOB IntempeBtiyoB? lEe cierto que no quiere desprenderBo del lugar 
de BUB delicia87 

lAb picar6ni hiimos ligeramente tolerantoB dada bu pequellez, pero comienaa a 
crecer y requerir& un fuerte correctiyo a fin de que una yez por todftB Bepa que €L 
es aquf un intnuo, bLq gobiemo y cuya tknica miflidn es comer y dormir, y lo dem^ 
cuando le d^ la real gana. . . . 

^Anot^, Befiora, mi tono cbacot6n de boy? Eb debido al aura de felicided que 
aquf Be respira. 

Vofl^ con la pladdez del deber cumplido, el beb^ con la modorra del future buigute 
adinerado, yuoBtro espoBO con esa BoniiBa de Buperioridad de sujeto capaa y que lo 
ha probado hasta la eyidencia y yuoBtra mamita con la mirada de bonded infinita 
que embellece el rostro de las abuelas; todoB preparan nd eepMtu hada la alegrla. 

Eb que, Befiora, la yida ob hermoBa, cuando BabemoB diBtrutar de ^a, y oBto que 
pazece a primera yisto una majaderfa encieira bu fondo filoB^co que quiai no pueda 
jamiB deBcitrtofllo. 



208 PBOCEEDTNGS second pan AMEBICAN 80IBNIIFI0 C0NQBE88. 

Y bien, sefkHra, ^qu^ hace nuestzo pequefio cliente? Come y duenne, ^ademte 
llora? Tree cosas que reglamentar a fin de hacerle compiender de una vez por toda» 
que en la vida hay aiempre uno que manda. 

Comer: vuestro beb^ en eate primer mee de su vida no debe satiafacer eu apetita 
mia que cada doe horas y media. 

^Y fld llora, el pobrecito? 

Hay un solo recurso, y es algodonarse los ofdoB. Comprended, sefiora, que n. to9 
le d^ vueetro alimento antes de las horas prefijadas Me caer& en el estdmago ante» 
de que el anterior lo desocupe y el proceeo fisioldgico no podr& cumplirse. 

Estos intervalos se espaciitf&n pasado el primer mes, hasta ties horas. 

Ademis, sefiora, se requiere un deecanso nocturne de seis horas por lo menos^ a 
findedardescanso aldigano. 

Estos conceptos, dichos asf , a la ligera, merecer&n vuestra meditad^n y seguramente 
en el pniceso cerebral que los preaida aparecer& el recuerdo de cdmo fuenm cnados 
vuestios hermanos y vuestra bien querida Mamita aigumentaiA que ^a nunca us^ 
reloj para llevaros a todos, a mayores, y sin embaigo, est^is todoe sanos y robustos. 

Podrfa dedros tambi^ que ''hoy las ciencias adelantan que es una temeridad,"^ 
y que por ende hay que marchar a su vera, pero quiero mejor que sep^ en que est&n 
fundados mia asertos. 

El estdmago del nillo es extremadamente toteante. Admitui seguramente que 
lo caigu^ cada 30 minutes o quizds m^ a menudo, teniendo como thiico llmite la 
glotonerf a de su poseedcHr. Pero un 6igano a quien le ezij&is tal trabajo tendr& f atal- 
mente que sufrir y lo primero ^sab^7, lo primero que 8uceder& con €k, es que se 
dilataid, y ya en ese camino se har& disp^ptico y comenzar& a devolver su contenido. 

• Al principio lo arrojaril inmediatamente despu4s de recibido, case ttdl y peifecta- 
mente curable; despu^ lo volveri a anojar a la media hora, o a la hora, caao ya mia 
dilfcil y al final ya no digeriri y vuestro beb^ enfiaquecer& hasta el marasmo. 

• Quedamoe, pues, convencidos, sefiora, que para que vuestro admirable pequefio 
se haga hombre, deb^ cumplir estrictamente estos preceptos, evangelios de la buena 
nodriza. Y disculpad, sefiora, por que os honre con ese tftulo, porque 41 ea vuestio 
mejor galarddn. 

Sucede a menudo, sin embaigd, que a pesar de ser espadadoe los momentos de 
alimentaci4hi, el eetdmago devuelva inmediatamente despu^a de ingeridoe, parte- 
de su contenido. 

No OS alarmar^is por eso ^verdad? 

No, pero deb^ corregir la causa. 

Vuestro beb^ devuelve por que es un tragdn. No le quito un ipice al adjetivo* 
Trag6n, ai — que "chupa" — demaaiado. Puea bien, sefiora, ^qud hay que lutcerlef 
No dejarlo. 

He ahi resuelto el problema. Si comprob&is que estando quince minutes prendido- 
devuelve, dadle trece; si con trece, dadle doce. En fin moderad el tiempo hasta 
que notdis corrode el defecto. 

Y si duerme, decDs ^debo darle el alimento? Tentado eaioy de respoiid^ros: quien 
duerme, come; pero ai eao dijera podrfaie acuaarme de error. ' Es que hay nifios pere- 
10808 que no se acostumbran f^ilmente al horario alimendcio. Con dllos nos queda 
un t&nico camino: ponerlos al aeno atin dormidoe. 

Comprendo en vuestra mirada de compaaidn la pregunta que me vdis a hacer: 
''^Pero doctor no tendia liatima de despertarlo cuando est& tan pliddamente des» 
canaando?" No, sefiora, la l^atima ea un aentimiento que debe aer regido por la 
neceaidad y el bebd necesita alimento. 

iPor qud? 

Por que ai lo dej&ia dormir cuando deapierte tragari demaaiado y ae enfermari. 

Loa nifioa aaimilan ima cantidad fija a igualdad de edad y el perezoao que olvida au 
hora tiene para alcanzar al diligente, que absorber el doble con menoscabo de au 
aalud. 



PUBLIO HEALTH AND MBDICIKE. 



20» 



Dejamoo sentado pues eote otro precepto: ^'cuando Ilegada la hora vuestro peque- 
fiuelo duenne, lo p<Hidr6i8 al seno." 

Pero, pod^io decinne ^c6ino hacer si esU profundamente donnidoT 

Nada m6a i&cil. ^Hab^is visto alg;iiiia vez cebar a loe pichones? Oon apretarle las 
conxniflttras del pico y ponerle el alimento aobre la lengua 611oe se apuian a deglutirlo. 
Vuestxo picli<5n har& lo mismo con la dnica diferencia que, como 61 no tiene pico» oe lo 
deber^io poner entre los labios y hacerle ligeras compreoioneB en las m^illao. He ahf 
reouelta la grave cuestidn. 

Os ruego amableo clientes, que con deferencia me atend^io, que vayiia anotando 
mia procedimientos porque 411o8 har&n factible vuestxo deseo de ver traasfonnado en 
un perfecto hombre a ese precioso beb^ que ha Uegado. 

DUODlfcCIMA VIBITA« 

La revi$aei&n atil de mkdioo—EBtudio de lot fonUmeUu — La balanxa del pohre y la det 
fico—LoM pe9ada9^iC&mo eaber n mieetro nene progmaf — Tahlat maiemdiieai paro 
eada eaeo, 

Sefiora: ^Os admir&is de la levisaci^ prolija que hago de vuestio beb67 Com* 
prended, oefiofa, que es una miLquina pequefia, en verdad, pero no por 6Uo meno» 
compleja, y con mi levisacidn me as^guzo de que cada piesa esU en su lugar, apla. 
para hacer funcionar regularmente el mecanismo. 

^ Y bien, sefiora, que he notado? Nada y mudio. 

He observado la cabeza, palpado su tenue esqueleto, estudiado el espacio de sepan^ 
ci6n entie sus huesos (fontanelas), las he visto latir y me he asQgundo del estado de 
tirantez de las menbranas que llenan los espacios libres. 

^Para qu6? Os dir^, sefiora, para nosotros el hallar bien llenos esos espacios noa- 
garantiza la buena alimentacidn del beb^ asf oomo su hundimiento nos advierte que- 
hay alguna causa que impide la asimilacidn. Es "la bakaua del pohre'* quien sigue 
religiosamente sus indicaciones. No es necesario que os afirme que el diente ha. 
aprovechado bien del surtidor y que sus lontanelas lo ezteriorizan patentemente. 

Yos, sefiora, no necesitdis observar eso, pues, he puesto en vuestias manos una 
balanza de relativa precision. ^Para qu67 Ah, sefiora, sois curiosa y sin embargo, 
OS as^guio que no me alannan vuestras ansias de saber, al contrario, vuestras amable^ 
pr^guntas, me llenan de satiafacci<ki. 

La balanza, sefioii, ser& el medio de probaros que son i^gftimos vuestros temores de- 
falta de secreci^. 

^OSmo? Pesad al beb^ antes y despu^ de cada ves que ^1 eztrae sii alimento y 
anotad la diferencia. Os aaombrar^is de su glotonerfa. Verbis oomo al cuarto dfa 
Uega a tomarse hasta cuazenta gramos por vea, es decir, que en el dia ingiere, el tu- 
naate, casi cuatiocientos gramos de rico y sano alimento, y que ir&, poco a pooo^ 
aaoendiendo hasta absorber al noveno mes escasamente un litxo. 

|Un litro, verdad, que es asombrosol lEsta infima pezsonita, capaa de chupane uxk 
litro en seia vecesi 

Pero tened, sefiora: ahl os dejo un cuadro consolador para los casos de duda: 



Sdad. 


NAmero 

d«T0Oe8 

pordla. 


OntldMl 

POTTM. 


Total «i 
ddfa. 


Bdad. 


NAflMPO 

por dia. 


Cantldad 
por TW. 


Total «l 
•Idla. 


Idia 


oooooo 


4 

10 
35 
85 
40 
45 


Ormmoi. 
40 
100 
250 
850 
400 
460 


l»m«B 


FceM. 


70 

75 

00 

180 

100 

170 


Ommo§. 
680^ 


?4fm.. 


3*iiMia...... 


e7a- 


Sdfas 


3* mes.... 


730 


4 Almm , , 


0*mfli 


010* 


1*mn^fU1ll 


9*mM 


oeo* 




1 afto 


1,030> 









210 PBOGEE0IKOS BBOOND PAN AMBUGAK BOXBITTIFIC C0KQBB88. 

Noted deede lu^go la utilidad de vuwtra bftlaaza para conocer como aaimila el 
cliente el n^ter que le dispensto y con ^Uo os convencer^ia a menudo que vuestnui 
lamentecionea aobre el poco crecimieiito del beb6 sen ixihindadas. Pesad al beM 
innntdffttnTiwiitit deepu^ del bafto todoe loe dlaa e inflciibld en vuestra librete de 
<»denada ama de ca^a, sua progreeiToe aumentoe. Ob pioduciri adniiraci6n ver como 
vneetro beb^ Uega a hombre: 

S5 a 30 gramos por dia, el piimer mes. 

23 a 25 gramoB por dla, el segundo» teicero y cuarto mee. 

20 a 23 gramoe por d(a» el quinto y sexto. 

18 a 20 grunoe por dia, el e^ptimo y octevo. 

12 a 18 gramos por dla, loe tres dltunoe menes del primer afio. 

8 a 12 gramoB por dla» el primer aemestre del segundo afio. 

Retened eBtes clfras que no Bon ezactes peto que casi siempre Be acercan a la verdad. 

Veo en vuestroB ojos la dnda y la alarma. ^Porqu6, Sefiora? |Ah, Bfl lo com- 
prendo, vuestro heM ha bajado de peso estoB cuatro primeroB dlas y yo ob lo habfa 
advertidoy como una regla fatal. En cambio ahora, afirmo aumentoB progresiYOB. 
^No comprend^ mi dualldad de criterioT Eb que aqu611o ob la excepci6n. La 
primeraseuanaeBflBempre de xebaja, porqueel nifio deacaigaBUs desperdicioe acunm- 
ladofl y eBo Be traduce en una disminucidn de peBo» disminucidn real en la balanaa» 
pero iluaoria bi deaooBtaoMts el factor ennnciade. Vueatro niiSo pr o greo a deede bu 
nadmiento y Boguiril poco mis o menoBp la fligiiiento eacala que copio de un impreeo 
repartido profuBamente por el ConBultorio "Qeta de lecbe" que diiige en MonteTideo, 
«1 Doctor Julio A. Baaai: 



Oi 

Peao a loB Biete meeea 7,450 

Peao a loB ocho meaeB 7,850 

PeBO a loB nueve meaea 8,200 

PeaoaloBdiesmeeea 8,500 

Peao a loB once meBea 8,770 

Peaoalafio 1^,000 

Peao a loa doa afioa 11, 600 



Ormaot. 

Peaoalnacer 3,250 

Peao el primer mea 8,850 

Peao el aegundo mea 4,500 

Peao a loa trea meaea 5,200 

Peao a loa cuatio meaaa 5,900 

Peao a loa cinco meaea 6,500 

Peao a loa aeia meaea 7,000 

Oooaanrad tambi^n, eato cuadro. Oa preatari el gran aervicio de calmer vuealraa 
aflaoroaaa alannaa. Pans bo ea cilUUa demaaiado a aua totalea matom&tiooa, porque 
cada Ber tiene una regla propia que no ae encuadra en tablas demaaiado aevaraB. 
Yeriia en ^l, adena^, el porveaor iJaneAo que eq[>era al divino climte y que ae cumplixi 
realmente, siempre que sigAis loa conaejoB que disperao en eetaa piginaB y que llena- 
linla aapiraciidn real que albeigiis de ver pueato en maicbaaeate ptecioao beb^ que 
liallagado. 

DidMATBBCIA TISITA. 

Sigu$ Ul rmaooi^* Lo» q^ aanot y <n/€rme#— £a ciftahnia ptiniimto— JiMw twg ii lr 
Uamado dd oculi»ta^Lo9 fonyliot M mdUh^El eomidn^El eammo de Uu kermm, 
i VuMtro hM 9% eompUtot 

Sefiora me preguntibaiB ayer'' ^Pero, Doctor, ea que Iob nifios pueden nacer con loa 
ojoB enfermoa?*' Y lo hacfaia, al ver con que cuidado loa revifiaba en mi examen 
general. 

Si, Sefiora y muy a menudo. El pasaje del beb^ ea un eBcobill6n de arraatre de 
•cuantoe g^rmenes hay en su camino. Por eso, y nada mib que por eao, oa recomendaba 
«ztremar las medidas higi^nicaa loe dltimoa dfas, y la mejor prueba de que hab^ia 
•complido mis instnicdoneB eetS, en la carenda de todo fen6meno irritetiyo en el aparato 
ocular del pequefio. ^ Y si no fuera ad? Si aaf no fuera, me vetfais coiier con vueatio 
beb^ a caaa de un ociiliRte. EstaB af ecciones de la viste en un reci^n nacido aon gene- 
rthnente fataloB, cuando por un dcBculdo no ae tratan Inmediatamente. 

KguraoB el horror de una madre, y no ob hablo de una descuidada, sino tan b61o de 
«ina poco prevenida, que al Uevar a bu querido 4ngel al consultorio del medico, oye el 



PUBLIC HEALTH AND MEDICINE. 211 

fatal diagn6stico de ceguera. Y eso, que la mayorfa de las veces ^Uas habfan agotado 
el repertorio caflero de medicacidn ocular, enjuagaban I08 p&rpados supurantes con 
aguaboricada; buscaban colirioB de origen farmac^utico y con la convicci^n de la 
pronta desaparici6n de I08 afntomas, vivfan tranquilas. 

La oftalmla purulenta es una afecci6n gravlsima que exige IO0 mayores deeveloe 
para bu cura y sobre todo el mds r&pido tratamlento, a fin de que el pus no horade la 
c6mea y la lesi6n sea incurable. 

Atenci6n, puee Sefiora, y cuidad en el future con loe prdximos bienvenldos, que 
tal desastre no Uegue a suceder. 

Observe ademds, el cuello del pequeflo. ^Para qu67 Ob responder^ en doe pala- 
bras: BuBcaba gldndulas (ganglios). ^Y qu6 oe indica su exlBtencia? Su existencia 
me revela, Sefiora, segdn la diBp06ici6n que ^Uiu adopten, afeccionee del ofdo, de la 
garganta, de la boca, del cuero cabelludo o eetados generales deficientes. Cudntas 
veces la existencia de un ganglio noB obliga a investigar cuidadoeamente la causa. 
Y con 4II0 comprobamos afecciones que hubieran pasado inadvertidas a expertos 
ojoB de clinico. Os ruego, teng^ en cuenta esta indicaci6n para Uamanne apenas 
confirm^is su aparici6n. 

Revis6 cuidadoeamente el corasdn y comprob^ su ritmo normal, que nos asegura 
que el pequeflo ha completado cuidadoeamente su tabicamiento antes de venir a la 
luz. Por ^1, pod^ estar tranquila, sefiora, que, como medico y amigo os afirmo que 
vuestro beb6 es ya de buen coraz6n. 

Comprob^, ademib, que los caminos vulgares de las hernias se hallaban perfecta- 
mente cerrados y que por ende era improbable su produccidn atln en los mayores 
esfuerzos, y cuando me hube convencido de que loe <Srganos todos ocupaban el lugar 
elegido para su perfecto funcionamiento, os dije: ''6efiora, vuestro beb^ es complete, 
dormid tranquila y sofiad con dfas de felicidad que os depararA, a buen seguro, la 
vida de este divino beb^ que ha Uegado." 

DidMAGUABTA VISTTA. 

MarUeniendo el orden — Bnergia de los primeros diaa — El Uanto no causa hernias — La 
tUUidad del llanto — La disminuciSn del alimento causada por noches de vigilia. 

Sefiora: Oir6 vuestras lamentaciones con la estoicidad de un confesor y al final 
hablar6, porque creo que en mis explicaciones encontrar^ un lenitive a vuestras 
penas. 

Decis: *' Doctor, el beb6 no espera la hora; Uora, se sofoca, grita, se revuelve en 
esa bendita cama en que me habdiB exigido lo coloque y no puedo comprender la 
causa." 

''Doctor, me han asegurado que Uorando mucho se podrla quebrar." 

"Doctor, temo que con estas noches sin dormir, diaminuiri la provisi6n del pe- 
queflo." 

^y^is como OS he escuchado? Ya no podr^is decir que mi tiranfa cientffica hace 
ofdo de mercader a vuestros lamentos. 

Os he entendido y quiero que la tranquilidad vuelva a esa almita de madre carifioea 
que se desvela por el bien amado. 

Vayamos en orden y no me interrump&iB mis que al final de pdrrafo, porque yo 
como ciertos oradores, me inmuto, pretendo contestaros atropelladamente y quedan 
al concluir mis visltas varias preguntas sin respuesta, con pesar para vos y afilcci6n 
para ml. 

Sefiora, vuestro beb^ no espera su hora porque es un mal educado, y al calificarlo 
asf me acuso de haber side d6bil para con 61. 

Pero, estamos siempre a tiempo para su correcci6n. 

^Sabdis c6mo? 

68436— 17— VOL ix 15 



212 PBOOEEDINGS SECOND PAK AMEBIOAN SOIENTEFIO OOKGSBSS. 

El nifio no es mis que im pequefio hombre, y si ^ste es un animal de costumbre, 
aquel cuyo cerebro no tiene alin trazadas sus vlas, se impregnaii Mcilmente con los 
Mbitos que le dejamos adquirlr. 

Vuestro divino nene vivid tres o cuatro dlas a vuestro lado con la fuente de sus 
satisfacciones junto a los labios, amparado al calor de vuestro cuerpo. 
En esas condiciones, creed sefiora, que es f&cil acostumbrarse, y tan f4cll. 
Bien; resolvemos instituir el orden, compramos la cama, que yo mismo exigl ser 
quien la eligiera y que segdn vuestra buena mamita es fea, demasiado simple y pobre 
como la de una prisi6n, calificaclones las tres que dicen verdad, pero que mafiana, 
OS explicax6 por que no son justas, lo colocamos en 411a y comienzan los llantos del 
cUente. 
Uora entonces porque no est& a vuestro lado. 

Peroy como all! esti bien, convendri que de alii no saiga, y con vuestro asenti- 
miento, que revela sensatez, no se mover&. lQ\i6 puede faltarle en esa camita que 
es un nido? 

Nada. 

^Galor? lo tiene; esti rodeado de porrones que ciddadosamente envueltos y ale- 
jadoe, le proporcionan un calor suave. Su estdmago se colma cuando es neceeario 
paia su vida. Su limpieza est4 cuidadosamente vigilada y lo mud4is frecuentemente, 
y a medida de sus necesidades. 

lQa6 mis quiere? 

Si, yo 8^ lo que quiere. 

Quiere a vuestro lado tiranizaros, impediios hasta dormlr tranquila. 

Por qu6 no me digiis, sefiora, que dormiais feliz cuando no sabiais, si en plena 
inconsciencia, al daros vuelta, lo ibais a aplastar con el peso de vuestro cuerpo? 

Y no me mir^ como afirmando que lo que os digo sea una exageracidn, porque 
cuintas madres Uoran, por un nimio descuido de resultados tan pavorosos. 

Hay mis, a vuestro lado no podriiis resistir el fmpetu de besarlo apaaionadamente 
cada vez que entreabiiera los pirpados, el de mecerlo en cuanto hiciera un mohfn de 
diflgusto ese pequefio rostro de ingel. 

Eso no le conviene al beb^ porque si lo deaeiis sano y fuerte es necesario no baJan- 
cearlo y os dii-4 el porqu^ mafiana. 

Es necesario, ademis, dejarlo Uorar a fin de que se ampllfiquen bus pulmones, que 
entre en 611ob el aire a raudales y se forme alto y ancho el t6raz de atleta, que carac- 
terizari al beb^ ideal que pretendemos formal. 

En cuanto a las hernias de que os he hablado permitid que me sonrfa. 

Otro prejuicio que os han pretendido inculcar y que no resiste ni un segundo a un 
aniliflis un poco severe. 

Si el uillo tiene una hernia hay aparatos eepeciales que caai seguramente se la curarin 
en los primeros afios de su vida y ai no estari el bisturl del cirujano que ante su persis- 
tencia hari la cura radical en pocos minutos. 

Pero, sefiora, ^cr^eis poi ventura que una hernia se forma por el solo hecho de llorar? 
Con tales ideas, podriiis asegurar que no hay solo nifio que no sea quebrado, porque 
todos han llorado. 

^Y que pretenddis que hicieran? 

^Saben cantar, gritar, silbar? No. Entonces Uoran. 

Permitidles ya que no tienen otra, su mon6tona manifestacldn de vida. 

Pero esa no seri seguramente la causa eficiente de una hernia. 

Cuando existen son debidas a un defecto de formaci6n, a la persistencia de un con- 
ducto que deb fa haberse oerrado antes de que entrara el aire en los pulmones del nifio, 
y que permaneciendo abierto pennite la salida de las vlsceras con el esfuerzo del 
Uanto. 

No tom^ entonces como causa principal la que no es mis que cooperadora, con 
un papel secundario y sin efecto a no eidstir la primera. 



PUBLIC HEALTH AKD MEDIOINB. 213 

Quedamos, puee, que a iin niflo quebrado, que Uora se le hace vitdble bu hernia; 
ventaja al fin porque obliga a la institucidn inmediata del tratamiento. 

No 06 aflij4iB, porque el vueetro Uore, ^1 ha eido cuidadoeamente revisado y ob 
garantizo que estd perfectamente concluido. 

En cuanto a vuestro temor, no os dir^ que es infundado; las malas noches os hacen 
mal seguramente en vueetra mlBi6n de nodrlza y por ^llo es que me apresuro a enca- 
nilar la vida del beb4 que es tambi^n la vueetra y, como si a 61 lo dejIUs uno, dos, 
tree dias, si no es un obcecado, en lad condicLones que os he impueeto, la tranqui- 
Hdad volveiA a vuestro espliitu y podr^ entregaros al suefio despu^s de besar son- 
riente en su nidito de amor a ese pequefLo beb^ que ha Uegado. 

D^CIMAQUINTA VIBITA. 

El chupete y sus peligro9—El poblador de Mierobi(i»—Calmdi9 d Uanto y admnisMU la 

muerte — Ouerra al chupete, 

Sefiora: He ahf un verdadero instrumento de tortura. 

Ese aparato indigno que habdis olvidado sobre vuestra mesa de luz. iQu^l ^No 
lo habels dejado por olvido? Ah I ese es su sitial de honor. 

Gerca de vuestras manos y de la boca del dngel. 

^Pero, entonces, sefiora, sols inocente del gran error que os hacen cometer? 

iY qui^n? 

Vuestra mamita y varias amigas os han dicho que con esa tetina pod6is pasar buenas 
noches, pl^idamente dormida, y que cuando vuestro beb^ llore con solo sumerglrlo 
en un poco de agua azucarada y pon^r^elo entre los labios, ^1 se calmari y nimiar^ 
su rabieta tranquilo. 

Aht 09 han dicho eso, y vos, sefiora, etemamente obediente, claro lo hab^is mandado 
buscar y eetdis dispuesta a usarlo. 

Pero ^llas no contaban con mi visita. 

iTirad eso; a la basura con ^11 

Ese maldito *' chupete" ha hecho m^ victima.*^ que la escarlatina y todavla hay 
quien lo use. 

Oidme, sefiora, madre del hermoso nene que debe ser para vos vida y felicidad, 
presente y porvenir, que debe — ^iqu6 digo — debe?, que es un trozo de vos nusma, 
encamado en ese misterio divino que respira, escondido en su nido de amor. 

^Quer^ Btt vida? 

SI, y entonces, aabed: eaa tetina ee mala, es peor, ee perversa. 

Pero quiero justificar mi enojo, quiero que os ddis cuenta del enor. 

Vuestro beb^ mantiene entre bub labioB la fuente hermosa que le brindiLiB y se 
xecrea en 411a Beguro de que de alll no saldrd m^B que un sano y puro alimento en 
el que la industria no se ha inmiscuido y en donde la flora bacteiiana no puede ser 
prollfica porque es ahuyentada por los medioe defenaivos con que os ha dotado natuia. 

Vos, en cambio, le pon^s entre los labios un pedazo de caucho en el que se albeigan 
cuantos microbios existen y del que no extra6r& seguiamente ningdn jugo. 

Y lo perjudicdis, no b61o porque le rob&is bub derechos adquiiidoB al nacer de una 
mejor calidad de conswnacidn, sine tambi^n porque en ese pequefio "chupete" va 
muy a menudo escondida la muerte* 

No vale que lo hirv^s; ^talmente insidioso y desleal como es, 61 buBcar& microor- 
ganiBmos en vuestros vestidos, en vuestnus manos, perfectamente lavadas pero no 
as^pticas, en la ropa de vuestra sirvienta, o en las del mismo beb^ y con su armamento 
ofensivo se recreard en poblar la boca del cliente con cuanta bacteria maligna germine 
bajo el sol. 

Nada digo de cuando cae al suelo y que vuestra niliera se apreeura a levantar y 
restitmrlo entre los labios, porque b4, sefiora, que vuestra vigilancia Be mantiene ante 
unxMUgro. 



214 PB0GEEDIN6S SECOKD PAN AMEBIGAN 8CIEKTIFI0 C0NGBE88. 

^Peio olvid^ sefiQra, que a menudo vuestioB ojoe pueden disttaerae y el hecho 
acontecer? 

Pot otra parte, lazonad: el chupete causa loe pequefioe mte:ulo6 destiiiados a la 
Bucci6n y cuando vuestro beb6 prepare bus fuerzas para la acometida real a que tiene 
derecho, las encontrard debilitadas por el excesivo ejerddo. 

Ademds provoca las secredones naturales que se desperdidan sin cumplir bus fines 
digestdvos. Verbis que la saliva aparece en abundanda en la boca y no deb^ olvidar 
que esta secreddn Ueva aparejada por fen6menos reflejos la de los demis diganos, 
tales como est6mago, hfgado e intestinos que ser^ indtilmente perdidas, desaprove- 
chadas, siendo tan necesarias para el memento ef ectivo de la digestidn de los alimentos. 

Tirad, pues, sefiora, ese invento malhadado o mejor sefiora, didmelo. En mi 
bolsiUo estoy seguro que no recibir& honores por mucho tiempo, porque pronto pasaii 
al verdadero lugar que le depora la denda, que es el ca]6n de los desperdidos. 

He ahf, sefiora, como sin querer he roto mi plan. Ptetendla convenceros de que 
esa, mi cama, no es ni mala, ni pobre, ni fea, como lo asegura vuestra buena mamita, 
pero ^qu6 quereis? hoy me he detenido demasiado, aunque creo no haber perdido mi 
tiempo, librando de un real peligro a ese precioso b4be que ha Uegado. 

DtoMASBXTA YISrrA. 

La coma — Candkionea eseneiaUs — Tules, hlondaSf eintas y puntiUai — Cama finne^ 

nn movimienio — Aviso importante aunque jactaneioto. 

Sefiora: eea cama que ha recibido las criticas de cuantos la ban visto, que se ha- 
hecho la vlctima de los adjetivos amables de vuestra Mamita, se impondr& hoy a 
nuestra atenci6n. 

Me declais, ipor qu^ la habdis elegido doctor, tan sendllota y deflgarbadat y si 
no OS he respondido es porque todo ll^;a a su debido tiempo, y ni yo quiero moriime 
ni lo har^ a mi gusto sin antes haber terminado nuestras amables pl&ticas — que aunque 
^llas etemas fueran, mis lo ser^ seguramente mis deseos de vida laxga, plidda y 
fructffera. 

Pues bi^n, sefiora, ahf la tentis, no hermosa en verdad, peio sf c6modflr— y hasta, 
casi . . . casi . . . afirmarfa que no es fea. . . . 

Cuatro patitas rectas, dos laigueros, dos barandas, cabecera y pi6s de banotes iguales, 
el^tico de metal sin muchos resortes ni demasiados adminlculos, y un laigo soporte 
que desde la cabecera se eleva para terminar en un gancho que numtendri el moequi- 
tero, he ahi todo. 

Sencilla es, tenuis raE6n; pero estft toda niquelada. 

^Quer^is mis lujo? 

No tiene tules, blondas, ni puntillas, pero, i para qu6 le servir&n a ese predoso pAjaio 
tales adomoB, verdaderos nidos de tiena, focos de bacterias, guardadoros de insectos. 

La dencia os diri siempre que eso no hard mis que poner al alcance de bus pulnumes 
un aire viciado, Uenar el ambiente de impurezas, dafiar bus vias respiratorias eztre- 
madamente irritables con la presencia de cuerpos extrafios. 

Nosotros, ^verdad, Sefiora? no queremos eso para vuestro beb6. 

Todo lo contrario: aire puro, oxigenado en demasia, que al distender el alv^olo 
pulmonar renueve el oxfgeno de los gldbulos vertiginosamente; eso pretendemos, y 
eso no se conseguiri jamis, entre tules y cintas, entre blondas y puntillas. 

Admirad la sabidurla de la Naturalesa que ha sabido en el nido del ave mantener 
la dificil sencillez de bus consejos. 

Pero, si la admiriis, imitadla. 

Gada hecho, cada observaci6n, debe aleccionaros en la lucha por la vida. 

Habr^is notado, sefiora y seguramente lo ha advertido vuestra Mandta que las 
barandas tan altas con bus banotes parecen mantener en las celdas de una prisi6n al 
precioso beb^, y es que aflf debe ser, pues su nusidn no debe ser otra que protegerle 
contra una posible caf da. 



PUBLIO HEALTH AND MEDIOIKE. 215 

Lo6 pd]aio6 previsoreB, ahondan el nido a fin de que las aacudidafl producidas por 
el viento no volteen las crlaa, y habr^s observado que cuando un cicl6n sacude con 
Impetus inesperados el sost^n de sub viviendas, una catdstrofe conmueve los cimientos 
de la voUtil famiUa, dando por tierra con los pobres pichones. 

Para nueetzo caso, no debemos tener en cuenta las causas naturales extrfnsecas, por 
lo excepcionales, pero sf las intrf nsecas, dado que un pequefio movimiento hecbo por el 
beb6, puede hacerlo caer con la suficiente fuerza para producirle serias lesioneB. 

Y pasemoe a otra cosa. Notdsteis que mi cama es firme, fija, sin movimiento alguno. 
Sin las cuatio ruedas habitualee, sin el eje que le permita balancearla. ^Por qu67 
{Ah, Sefioml he hecbo la elecddn de exprofeso. 

No quiero movimientoe paza el beb6. Nada de sacudidas; aimque ^Uas fueran 
leves como una brisa suave no son neceeaiias paia su vida y son peijudiciales y dir6 
mis, altamente nodvas. 

Ese temblor, amable Sefiofa, que en vuestns manos es una caricia, en las de vuestra 
nifiera se transforma en un vendabal funesto paia la salud del cliente; y si el cerebro 
del hombre leaiste el sacudir de una hamaca, no asf el del nifio tiemo y delicado, casi 
08 diiia gelatinoso y que en cada vaiv6n se moviliza y golpea contra las paredes. A 
tal grado, que el sueflo del beb6 es en tales condiciones, no el pldcido repoeo natural, 
flino mia bien im mareo provocado. 

Por otra parte, el niiio que ha probado el amable "balanceo" acompafiado por el 
dbtico suave del "anror6" matemo, se acostumbra, y el pequefio tirano que hay en 
cada alma humana se rebela e impone condiciones. 

iGuidado, Sefioral 

Ser^ entonces su esclava y ya no b61o no dormir&, sino que no podr& vivir sin el 
dulce balanceo o las amables carreritas de uno a otro lado de vueetro dormitorio. 

No olvid^s lo ''del ^bol que crece torcido," y apresuraos a imponer condiciones, 
porque aquf es efectivamente cierto aquello que "quien da primero, da doe veces.'' 

lAh, Sefioral me olvidaba, nada de plumas, en las almohadas, 411as dan demaaiado 
calor y provocan fen6menos congestivos. 

Una buena almohada de g6nero de algod6n, un par de buenas colchas y porrones, 
y estad tmnquila; vuestro hijo no sabri resfriarse. 

Y par tiltimo, Sefiora, un consejo final que no lo tendrils en cuenta, seguramente, 
pero que para mf tiene un fin capital: poned a los pies de la cama un cartel que diga: 
" lObjeto de artel {Admirad, pero no toqu^is! " 

Tal aviso puede pareceros inneceaario y hasta de mala educaci6n. Pero no lo credia 
asf, Sefioora, son tan amantes a los beeuqueos vuestnus visitas y tan indiscretas que 
sabr&n pasarle de mano en mano como un mufieco de trapo a ese divino beb6 que ha 
llegado. 

DtolCASAPTUfA VlfllTA. 

La ropa — Inventario de un ropero ricamenU pertrechado — Manera de vestir al hebi — Lo 
que debe y lo que no debe haeene — El lenguaje del niflo — La$ reeervae naiurale$, 

Sefioira: Me he detenido hablando con vueatro eapoeo, quien me ha moslarado su 
trabajo de hoy. 

^SiMie en qu^ ae ha ocupado? 

^6? Pues bidn; con sua etemas manias de orden ha catalogado, conjuntamente 
oon vuestra mamita, la ropita del beb6 y me ha interrogado severamente sobre las 
necesidades del pequefio. 

** iBb que credis necesario, Doctor, paia el bieavemido, tan cdosal tnnuteauV* ^* lO 
estiia de acuerdo conmlgo, que es una exageraddn de mi espoea?" 

He revisado cuidadosamente la Usta, y ^qu^ credia que he opinado? "Que dadaa 
Yueslns eondicionea de fortona no era demaaiado y que con ella cuidadosamente 
goazdada servirfa para la "seguidiUa" de que 61 era capaa." 

OiguUoeo de mi contestacidn, con una sonriaa de fuena protectora que parecia decir 
"verdad que no serd el finico", colmada su satisfaccidn me entreg6 la lista que oa 
leerd, porque estoy seguio no la conocdis: 



216 PBOCEEDINOS SEGOin) PAN AMEBIOAK 8CIENTIFI0 OOKQBBBa. 

Existeneias del ropero del hehi, 
Secci6n ropaa, 

Gamiflitaa de g^nero muy fino, 4 tamalLoe, 1 docena de cada iino. 

Gamisitas de franela, 4 tamaiios, 1 docena de cada uno. 

Gamisitas de bombasf , 4 tamafioe, 1 docena de cada uno. 

Pafiales cuadradoe de madr&s, 6 docenaa. 

Mantillas de franela, 3 docenas. 

MantillaB de bombasi, 3 docenas. 

Fajas de un metro y medio de laigo, 2 docenas. 

Rebozoe de lana, N® 6. 

Batitas de lana (compradas) N** 12. 

Batitas de lana (regaladaa), N* 7. 

Baberoe de bombaaf , feetoneados, 4 docenas. 

Baberos de hilo con puntillas (compradoe), 6. 

Baberoe de hilo con puntillas (regaladoe), 5. 

Escarpines de lana (comprados), 24 pares. 

Escarpines de lujo (regaladoe), varioe pares. 

Pafiuelos de batista, 2 docenas. 

Fajitas de franela para el vientre, de 1} metros, 2 docenas. 

Gorras de lujo (regaladas), N* 4. 

Gasa as^ptica en pedazoe de 10 z 10, 3 metros. 

Fald6n de lana bianco con encajes para paseo, N* 1. 

Gapa adomada con encajes para las ocasiones, N* 1. 

Faldones de bombasi para salidas ordinarias, N* 3 (salvo error u omiai6n). 

Os admirto, Sefiora, y lo comprendo. 

Ob hab^is excedido ampliamente pero i es acaso una falta? 

Si vuestro bienestar fuera mis dudoso eea lista podrfa ser reducida a la mitad; mis 
adn, si os encontraseis en las condiciones de las mis, que se preocupan de mantener 
la higiene de las ropas del pequefLo en su propia casa, impoeibilitadas de pagarse el 
lujo de lavanderas para sus nilios. 

Pero veamos, Sefiora, ya que las tenuis, ^c6mo deber^is usarlas? 

Ante todo, os comprar^is un catrecito de patas largas (1 metro, 60 centfmetros), que 
OS lo har&n en cualquier carpinterfa y que os prestari grandes servidos. 

^Para qu6, Doctor? 

Vereis: mudar en la falda al pequefLo, ee inc6modo, mis que mudarlo en la cama, 
seguramente, pero como ^sta es en general baja, tendrdis que agacharos por demis y 
ceder^is demasiado pronto a vuestra niilera, la vigilante y personaUstma operaci6n de 
la mudanza del beb^. 

Por eso OS aconsejo el catrecito que no debe tener mis de 1 metro y medio de largo 
y que doblado no ocupari casi espacio para ser guardado. 

Os aseguro, Sefiora, que recibir6 vuestro agradecimiento por mi consejo. 

^G6mo vestir6is a vuestro beb67 

Golocad la camisita fina, enchuflada en la de franela y ^eta a su ves en la de bombaaf 
y con las tres asf preparadas pasad uno y despuis otro braso del pequefio, guiindoles 
con vuestros dedos en su travesfa por la manga, dejando las aberturas de las tres hacia 
atris. 

Extended sobre el catrecito, primero el cuadrado de bombasi, encima el de lana y 
arriba el de madris doblado en triingulo; de mode que el lado mis largo (hipotenuaa) 
coincida con el borde superior de los cuadradoe. 

Acostad encima de ^llos a vueetro pequefio que ya tiene el tronco cubierto por las 
camisitas y seguidme ahora en la operaci6n : paso la punta inferior de triingulo entre las 
piemas del beb6, bien; envuelvo con otra punta el vientrecito cubriendo la parte 



PUBUO HEALTH AND MEDIGINE. 217 

inferior de lajs camisetajB, muy bien; con la otra marcho en direcci6n contraria y 
vuelvo a envolver el vientre y la parte inferior del torax, y ya tengo mi primer pafUd 
colocado. 

Pero, sefiora, ^veia como soy pdlctico? y ain embaigo me he olvidado de algo 
previo: un cuadrado de gasa as^ptica en el ombligo y para mantenerlo nn par de 
vueltaa con la pequefia faja de franela y ato con la cinta de hilera. 

Sigo, y OS ruego no os aLarm^is, que esto es mis dif(cil describirlo que hacerlo. 

Coloco loe escarpines y ato d6bilmente la cinta de sost^n. 

Vamos ahora, a nuestro cuadrado de franelas. Un lado lo arrollo al cuerpo del 
cliente y como excede mucho a los pies, lo doblo en su parte inferior a una altura tal 
que permita a los piececitoe extenderse libremente; con el otro lado paso en direcci6n 
contraria por encima, y pronto el de franela; 

Repito la operaci6n con el de bombasi. 

Tomo la faja, previamente arrollada con la cinta en la parte m^ interna y a la 
altura de la parte mis inferior del t6rax, sin comprimirlo. ^Ois bien? sin apretar, 
suavemente le doy tree vueltas cuerpecito y ato. 

Con el rebozo, repito la operaci6n de los pafiales y lo fijo con dos aMleres de nodrisa, 
uno en la vuelta de abajo y otro asegurando el borde libre y con la batita de lana hago 
la misma operaci6n que con las camisitas, pero, dejo la abertura en la parte anterior; 
fijo el babero y cantando victoria puedo, Seflora, marchai con vuestro beb4 al polo. 

Nada de gorras, dejad que el buen aire y el buen sol desinfecten el cuero cabelludo 
y no temiis que vuestro beb^ se resfrie por eso, porque no conozco ninguna especie 
microbiana que atraviese el crineo para albeigarae en la nariz y provocar un resfrfo. 

Las guardar^ para las visitas de cumplido cuando el cliente se aderece con el rico 
fald6n de encajes y la soberbia capa que hard estremecer de envidia a cuantas madres 
aientan sobre lA la irritante desigualdad de nuestra sociedad cristiana. 

I Perd6n, Sefiora, ee un grito del alma, que como es el primero,deb6iB perdonar? 

^Sab^is que me ha costado trabajo la descripcidn? 

Pero, tenia tanto inters en hacerla, que no lamentar^ jamis el haberla producido. 

Hab6is ofdo hablar mis de una vez de la conveniencia de fajar las ptemas a fin de 
que no crezcan torcidas, de envolver los brazos hasta una cierta edad, de arrollar al 
pequefio como si fuera uno de esos laigos caramelos que compribamos en nuestra juven- 
tud y chupibamos con igual fruici6n que la experimentada por un buen sefior fumando 
su habano de postre. 

Esos enores han desajMurecido casi en la sociedad que habitamos, corridoe por la 
ciencia que demuestra que un nifto que pueda libremente mover bus piemas camina 
tree meses antes que un enclaustrado. 

Pero todavla verbis a muchas madres que comprimen el tiemo cuerpecito del nifio 
con la faja, temerosas de que un frio les provoque un ataque de colitis. 

Con 6II0 demuestran no entender el lenguaje del nifio, tan ficil de interpretar para 
una madre inteligente. 

Verbis, Sefiora, c6mo se traduce f&cilmente ese lenguaje. 

Vuestro beb^ Uora; bien, estari mojado, os decis. 

Lo acoetiis y comenziis a desprenderlo. 

El Uanto cesa; es s^lo un gemido. El beb6 os dice con eso "esto vi bien, mamita, 
•eguid sacando." 

Lo dejiis completamente desnudo, el beb^ sonrie, juega con sus mamltas, pretende 
Uevarseun piececito a laboca, ^qu^osmanifiestaconeso? "Estoy en la gloria, dejadme 
asf." 

Comenziis de nuevo a envolverlo y la sonrisa desaparece, es que el neoe expresa: 
^'estoy mejor; en verdad que estoy limpio; ^pero porqui recluirme?'' 

^Y esa, tan ficil interpretaci6n, cuinto trabajo ha costado vulgarizarla? 

Sabed, sefiora, que el nlfio do podii ser jamis un abandonadodela naturaleza que 
fli iUa da medios de def ensa a los animales, con mayor raz6n debe dirselos a los hombres. 



218 PBOCEEDINGS SECOND PAN AMERICAN SCIENTIFIC C0NGBBS3. 

Somoe nosotros, sefiora, los civilizadoe, loe que eosoberbecidos en nuestro papal de 
seres supeziores pretendemoe toicer leyes inevitables. 

Nosotroe que en nuestros prejuicios y nuestros errores ponemos en peligro la vida 
de nuestros semejantes. For eso, seliora, os asombrar^ mis de una vez, cuando os 
diga, dejad hacer, no os amedrent^; las reservas de la natuialeza son infinitas y cada 
ser trae en sf , aquilatadas, las necesaiias para su triunfo definitivo. 

Y ese optimismo bienhechor con que os hablodebe tnnquilizaios respecto al porve- 
nir de ese pequefio beb6 que ha llegado. 

DibCDCAOCTAYA YISFTA. 

Exageraciones de la veMtiment€t--^alida dd bebi—El bafio—iQuiSn debe efeeiuarloi — 
Condicumei del mismo — Manera de tostener al tUfio dentro dd agua — Lot lavados par- 
cidlee — Neeendad de kigieTie, 

SkSFora: He abl una cosa que os ]lamar& realmente la atenci6n. 

Dir^: ''^c6mo doctor, c6mo, esa carga de ropa, vos que sois tan amante de Um 
leyes naturales?" 

Me adapto al medio, sefiora. 

La civilizacidn ha defendido al hombre de las inclemendas del ambiente, dindole 
ropas y vuestiro hijo, nacido de padres que saben usar del agradable calor de una buena 
cobertura de lana y despellejan animales para envolverse en pi^es, no puede menoa 
que pagar tiibuto a esa modalidad. 

Pero ^sto no quiere decir que yo no haya exagerado un poco la vestimenta. Hablaba 
para un inviemo inclemente, riguroeo, y no para todas las 6pocas. 

En verano, por ejemplo, podr^is restar ropas hasta admurar la blancura de su cutia 
en todas partes como gust^is y el chico sabrd mantenerse en plena y lozana salud. 

Quiero recordaros, Sefiora, que es neceeario lo saqu^is tan abiigado como dese&is^ 
transijo en 6II0, pero lo llevarlais a respiraf el buen aire sano y puro que oxigenaxA sua 
incipientes pulmones. 

Llegada la tercera semana, elegir^is un dlade sol y alas doce o una de la tarda 
debris abrir ampliamente la puerta de la habitaci6n a fin de que por 611a pasa airoso y 
fragante ese capullo que va a recibir el bautizo de la vida libre, y he tardado tanto en 
daros tan grata nueva por el rigor de la e8taci6n, si fuera en pleno estfo, hace ya ocho 
dfas que vuestro divine beb6 entomaria sus p&rpados admiiados de tanta luz y entre- 
abrirfa sus labios al recibir la brisa, ansioso de acapararla para sf . 

Quiero tambi^n, Sefiora, antes de terminar esta segunda serie de amables conver- 
eaciones iniciadas, cuando el divino beb^ hizo su primer mohfn de di^gusto, hablaroa 
de algo que aunque b6, que ya est& instituido en esta vuestra casa no s^ como se ha 
hecho hasta ahora. 

Se trata, Sefiora, de la "toilette'' del cliente. 

iQuer^iB saber c6mo deb^ hacerla? 

Os lo dir6 en cuatro palabras. 

£1 bafio es una costumbre sana, de eabia higiene pr&ctica, que aseguraii una salida 
franca de la trasudaci6n cutanea, permitiendo una regulaci6n de la temperatura 
interna y siendo una ayuda eficiente a la funci6n renal. 

Traduciendo mi frase un poco libremente, os dir6 lo (inico que deber^is recordar; 
"El bafio del beb6 ser& para vos una regla invariable. Ser6 una de vuestras obliga- 
ciones primordiales; sano, dadlo todos los dfas y enfermo todas las voces que el medico 
ordene." 

iPero, c6mo? 

Muy ficil. 

Tenuis en vuestras manos la pequefia bafiadera pintada al esmalte que si no fuera asf , 
OB dirfa, tomad cualquier recipiente de lata suficientemente amplio, lavadlo cuida> 
dosamente y pedidle a vuestro esposo que os d^ una prueba de bus mtisculos com- 
piimi6ndolo lateralmente, hasta ovalizarlo. 



PUBLIO HEALTH AND MEDICINE. 219 

Tendifl un jabdn de coco, de Espafia, Marsell^B de almendras, cualquiera que no 
teiDga eeencias violentas, una esponja fina, un poco de talco finamente pulverizado, 
agfua fria y caliente y ya ten^ de todo. 

Un poco de voluntad y a la obra. 

Preparad el bafio a treinta y siete grados, o joAb f&cil combinad aguas haata que 
Bumergida vuestra mano no sintAiB ni Mo ni calor, y cuando Uegu^is a eee punto, 
agr^gad un buen jano de agua frf a. 

Desnudad r&pidamente al beb6 y colocaoa a la derecha del bafio. 

Oon vueetra mano izquierda envolved el nadndento del braeo izquierdo del beb6, 
cuatro dedoB pasando por debajo y el pulgar por el hombio. 

De eete modo la cabeza del cliente tendii un apoyo en vueBtro antebrazo que la 
liar& levantar o bajar a voluntad. 

Sumergidlo xipidamente en el agua y con vuestra mano libre enjabonadle lipida- 
mente la cabecita caida hada atnto, a fin de que el ]ab6n no vaya a Iob ojob y enjuagad. 

Lateralisad la cabeza a uno y otro lado y repetid la operad^n, cuidad entre las 
piemas y en todas las partes donde se fonnen esos riquiaimos rodetes, estirando la 
piel a fin de impedir que en ^los se hagan f ermentadoneB, origen de eczemas y otraa 
afecdones de la piel. 

Ya todo enjuagado, en la operaci6n completa no debris emplear arriba de tres 
minutos, lo retiiiis y lo envolv^ en la toalla, fricdonando suavemente con 611a, lo 
empolviifl con talco impalpable. 

Ahi ten^ desciita una operadAn que nadie mis que vos debris practicar. 

XPor qu6? 

Porque vuestra miiada vigilante y amoroBa deBcubrix& en la piel delicada del nifio 
la mis pequefia alteiaddn y pennitiii a vuestro medico daios un remedio o un consejo, 
caai siempre lo tiltimo y en caao extreme lo -pameio. 

Nada de perfumee. ^Para qu6? ^Quer^iB algo m^B bien oliente que un beb6 limpio? 

El bafio general podr& ser rapetido en el dia, en el beb^ aano y lo seriL seguiamente 
cuando enfermo, pero no ahorrdiB pequefiaa" tdletts" beneficioBas para la delicada 
piel del nifio y el olbtto de loe dicuuBtantes. 

^No OS figui&LB, sefiora, con que sensaddn de diflgusto y de compaaidn repaiamos a 
menudo en madies que no dvidarian jam4i el mis pequefio detaUe de bu peinado o 
de BU vestimenta y que os prasentan un beb6 mal oliente? 

^GoAntas veces, Befioca, afristimoB a una aleod6n de la piel que se inida en el jmIvo 
de afaniddn fennentado en loe pUegues de gordura del pequefio? 

^Bn fin, sefiora, y cuinto tenemos que lucbar con el prejuido de madies que ocultan 
una llaga supurante del nifio porque por 611as Balen los malos humores del ocganismo? 

Peio, quedad tranquila, sefiora, que pnmto antes de lo que penafiis, quizi ver^ en 
marcha este divine beb6 que ha Uegado. 

Caf^fulo III. — ^El BbbA bn Maboha. 

DtaUANONA VIBITA. 

Ml primer reB/rio—Sui euiidadoi y mum compUeaeUmeM-^Sl bafio Mn oomo de ei^ennedad— 
Loe BeKmot— Oivm inteeiinal'^u/dGU y neeeMoria amUnUdad. 

Sefiora: Heme aquf obediente a vuestro llamado, dispuesto a oiros seguro de que 
vuestros temores no llegar&n jamis a impresionanne Beriamente y no porque yo no 
tenga una migaja de carifio a eea ricura de beb6, sino porque ^Uos son hijos de vuestroB 
amantiaimoB sentimientoB de madre novel. 

£b evidente, orgulloea mamita, que vuestro beb6 ha progreflado lipidamente ignciBB 
ami? 

No. Gradas a vos y a bu conBtltuci6n que le permiten salvar los obst&culos de la 
Bubida con la tranquilidad de quien tiene alas. 

Hoy, sefiora, es vuestro primer di^gUBto; mi cliente se ha 



220 PBOGEEDINOS SECOND PAN AMEBIOAK SOIBNTIFIO CONGRESS. 

^Por qu^? Vale, qmzk mis, no averiguarlo, i>or cuanto es tan leve la causa, que a 
menudo queda en el teireno de las suposiciones. 

^Exceso de abiigo habitual? — Quiz&. 

Una coniente de aire Mo que ha pennitido a las bacterias vulgaies hacer piesa en la 
la mucosa nasal del beb6. Puede ser. 

En fin cerciortoonos del hecho y trataremos de cuiarlo. 

El punto de origen del mal es la nariz. Pues a 6Da. Una Boluci6n de sales de plata 
que OS receto depositada en gotas dos o tres voces al dfa, dominaii el mal. 

Lo tendrils abiigado, en una atmMera tibia, pero oxigenada. 

Pretendo con 6II0 asegurarme de que no ser^ capaz de colocar, en un reverbeio a 
alcohol o kerosene, en una estu&k a lefia, carb6n gas, im recipiente con agua y hojas 
de eucaliptus dentro de vuestro dormitorio cerrado. 

Permito sf , calentar la habitaci6n, mantenerla a una temperatuia constante de 16 
a 18 grades, hervir eucaliptus, etc., pero a condici6n que una de las puertas permanesca 
abierta, de manera que vuestro beb6 no redba directamente el aire, pero que Me se 
renueve ampliamente. 

Aire tibio, ht&medo y ozigenado. 

Tres condiciones que apresurar&n la cuia del resfilo. 

Haciendo asf , no tem&is complicaciones pulmonaras. 

Alguna vez, quiz&s, un poco de inflamacidn a las amfgdalas (gUmdulas) que curar^ 
con lavajes de agua bdrica, una obturaci6n de la comunicaddn del oido con la nails 
que podr6 producir una inflamaci6n del oldo medio, o fiebre de origen intestinal posible 
ya que los pequeftos degluten las flemas, y nada m^. 

^ Y nada m&B? ^Os parece poco doctor? 

No, no OS alann^is, revistaba posibilidades, quedad tranquilla, tenuis m^co, 61 
sabii hallar la pista de los males y no pennitirles tomar cuerpo. 

Os repito que debdis quedar tianquila, i)ero conviene a vos, que sois inteligente y 
cuidadosa, el poneros sobre aviso a fin de que cualquier cosa inexplicable que encon- 
tr^, aumento de fiebre, llanto frecuente, respiiaci6n anhelosa, me llam^. 

^Y suprimo el bafio, Doctor? 

I Ah! no, sefiora. £Por qu^? 

^Vos tambi^n cre^is que pueda hacerle mal? Convenceos de lo contrario. 

Si hasta ahora el bafio era conveniente, ahora es neceamo. 

La limpieza de la piel abre una via de escape a una cantLdad de sustancias tdxicas 
disueltas en el sudor, y si no lo bafiias, la descamaci6n natural de la piel, con la secre- 
ci6n grasa de sus glindulas y el polvo del ambiente formar&n un dique insalvable a 
aquellas secreciones naturales. 

Hago notar paia vuestra BatL8faux:i6n personal que entre los divines rises no he 
hallado caspa. 

Es una revisaci^n estrat^ca que hago a menudo, y que me asegura que mis pres- 
cripciones ban side bien Uenadas. 

No caig^, sefiora, en el grave prejuicio de permitir que vuestro nifio se llene de 
eczemas (arestln) con la conviccidn que 6II0 lo library de afecciones m&s graves. 

Esa horrible afecci6n que pone en un tormento al beb^ y a su madre, que os priva 
de la satis&ccidn de cubrirlo de beeoe, que os obliga a ocultarlo ante la mirada de 
horror que descubris en los ojoe de vuestras amigas, no es por cierto dtil, ni necesaria, 
ni siquiera dificilmente curable. 

LibraoB, sefiora, de aquel error que cometen algunas madres afirmando que por alii 
van a salir las impurezas de la sangre, de aquel otro que os garantiza que vuestro none 
va a ser bello, porque le dej^ su eczema, error este filtimo fundado en que el arestin 
toca mis i&cilmente a los nifios de tez fina y delicada. 

Pensad, sefiora, en lo espantoso del suplicio que le producfs a ese pedazo de vuestra 
alma, envolvi^ndole las manitas para que no se frote ni se arafie, con sus ufiitas cuando 
le pica. 



PUBLIC HEALTH AKD MEDICINE. 221 

Recordad con que fruici6n oe rasciis cuando una atrevida pulga forastera Be enaafia 
en vuestra piel y como no ced^is en ahinco hasta exteiminarla y figuraoe ahora, que 
aquella superficie coetzosa y Bupurante produce el ardor de milee de pulgas juntas y 
convendr6is entoncee conmigo, que es horrible y criminal la ignorancia de loe que 
perBisten en mantener la expectativa en un eczema infantil. 

M&xime teniendo en cuenta, sefLora, que aquel se curar6 rdpidamente con simples 
medidas de higiene. 

Higiene de la piel, con vuestxos bafioe y lociones; higiene del intestine, foco de origen 
de todoe esos males, cambiando el regimen alimentido que es, seguramente, en esos 
cases, defectuoso, o las mis de las voces metodizando las horas de la alimentaci6n del 
beb^ o la cantidad de alimento ingerido. 

Pero vos, seflora, no os preocupdis, que no rezan con vos estas advertencias, por 
cuanto s6 que vuestra obedienda inteligente conseguiri ver libre para siempre de 
tales plagas a este predoso beb6 en marcha. 

ViaAsnCA VI8ITA. 

Las diente»~—Su erupMn — Las enfermedades que se le aJtnbuyen — Cuidados del presents y 

ddfviuro, 

Seflora : Sf ; esos son los dientes, lejos at&n del borde de la enda producen sin embargo 
fen6meno8 initativos que son la causa de la baba que habdis notado. 

Os advierto que me admira vuestro inter^ en conocer la causa aun de los detalles. 
^Por qu6? Ah, sefiora, quizi me dirdis que soy male por mi respuesta. Pero la vida 
del medico trae aparejada terribles reveladones y all! donde uno espera madres tiemas, 
carifioeas, que vean aimque fuera por egoismo en bus hijos la prolongaci6n de sf mismas, 
ae encuentra con pequefias almas envaneddas, que tienen del beb6 un concepto un 
poco m49 elevado que el de su mejor Bombrero. 

Ayer, seflora, visitaba a una feunilia, pero; dejemoe eeo — ^no hagamos c&tedra de 
chismograffa. Los dientes, seflora, ajMoecen generalmente en el correr del sexto, 
sdptimo mes, por lo general mis taide en loe varones que en las nifias, pero, pasado el 
cuarto mes comienzan a incomodar al bebd. 

No producen sin embargo, en su erupci6n esa eerie de terribles fen6menos que se les 
atribuyen. Un nifio sano, el vuestro, por ejemplo, amamantado convenientemente; 
flin diBturbibs intestinales conseguir& exteriorizar bus dientes con un mfnimo esfuerzo. 
Un poco de dolor en las endas, un poco mis de baba y nada mia. Ni un quinto de 
fiebre. Las afecdones que generalmente se le atribuyen no Bon mte que vulgares, 
pero graves empachos (gastro-enteritis), que requeririn la presencia del m^ico. 

Yed, seflora; que en esos cases la denda se resuelve siempre a recetar un purgante o 
un desinfectante intestinal, y no Ber&, seguramente porque crea que con 61 conseguirA 
apresurar la salida de los dientes, sine porque es en el intestino donde est& la causa del 
mal. 

Cierto es, que la aparici6n de los dientes, por las molestias que causan, por las 
incomodidades que producen, ponen al organismo del nifio en un estado de menor 
resistenda que lo hace m^ vulnerable a cualqider ataque microbiano. 

^Pero, decis, sefiora; si es tan i>oca cosa Doctor la salida de los dientes, como expli- 
cHis ese debilitamiento? 

Ah, sefiora, olvidiis acaso lo que es im beb6. Tan pequefio, tan fragil, una ligera 
escaiamuza para nosotros es una batalla omenta para 3, de la que resulta victorioso, 
siempre que se halle atrincherado en un estado general perfecto que le permita no 
distraer sus reservas. 

H6me aquf, sefiora, que sin querer, he abusado de los tdrminos 6picos. Perd6n, 
porque son de actualidad y se hacen por ende f&cilmente comprensibles. 

^Quer6is saber ahora, como calmar esos dolores de las endas? ^Algtin jarabe, 
alguna droga? Nada de eso sefiora, todas las que se emplean contienen opio o cocaf na. 



222 PBOCEEDINOS SECOND PAN AMEBIGAN 8CIENTIFI0 G0NGBE88. 

For eeo caiman ^pero no daiSaiin la aalud del beb^? ^Puede benefidar a un nifio el 
U60 de alcaloides? 

YenenoB extremadamente tdxicoe, aun administrados en pequefias doeis son nodvos 
para loe adultos, con mayor raz^n para el pequefLo. Ob pennitir6, sin embargo, que 
llev^is a sua endas con yueetro dedo, previamennte lavado, un poco de miel puia. 
Con ello calmardis bu llanto, fomentando en verdad la glotonerf a pero conseguir6is con 
eso que la lengua se pasee largamente por bub enciaa inflamadaa pruduciendo una 
accidn sedante y por ende bienhechora. 

^Y me permitir^iB Doctor el ubo del aro 7 Si, pero con condidones. Aro de marfil 
de hueBO, eufidentemente grande para que no pueda ser tragado por el beb^, sin 
adomo de ningdn g^nero, nl cascabeles, ni cintas, nada que Uevado a la boca del 
nifio pueda infectarla. Un aro pelado a fin de que podiis sumergirlo en agua hirviente, 
den voces al dfa si fuera necesario. Eso, no os pareceii el^;ante, no bonito, pero es 
titil y no perjudidal. 

Y ganando tiempo, sefiora, im aviso x>ara el porvenir. Vuestro nene tendri dientes, 
nacer&n sanos, bien colocados, en muy buenas condidones. No olvid^ls siis cuidados. 
No caig&is en el error de muchas madres que pasan mil pesares temiendo por d me- 
mento de la salida y que ya en la boca olvidan higienizarlos y permiten a la carie 
hacer un nido a las bacterias mis terribles. 

Cuanto antes es necesario cepillarlos con \m poco de creta pieparada o de jab6n 
bianco y enjuagarlos cuidadosamente a fin de Bacar de los intentados los rastOB de 
comidas que fennentadas produoen BubetandaB corroBivaB paia el esmalte de los 
dlentes. 

No olvid^is que la acd6n de una buena dentadura es fundamental para aaoguiar 
una buena digesti<Sn y que una funddn bien empezada en la boca, dificilmente tendii 
un fin nocivo para la vida del nifio. 

Pero, sefiora, deb^ disculparme, el haber corrido demasiado. Son tan grandes mis 
deseos, que ya veo a mi cliente masticando pliddamente grandes churraacos y quieio 
convenceros de la necesidad de mantener su aparato dentario apto para tal fund6n. 
Disculpad, pues, mi apresuramiento, pero no olvid^ mis consejos. Ellos Berin 
Utiles cuando llegue el memento que no tardaiA seguramente dados los progresos que 
hace este divine beb^ en marcha. 

YIOisIMA PBUIKRA YiarFA. 

El detUU — iC6mo haeerlof — Martkat dtspado €» apruurar elfin, — La mamaiara y ni 
prtparaeiAn, 

Sefiora: La fuente vital con que os ha dotado Natura ha respondido a vuestro deseo 
y vuestro hi jo ha cumplldo su primer afio de vida, feliz, robusto, rozagante alimen- 
tindose del ideal surtidor. 

Os dirfa, sefiora, ^no es un crimen desprenderlo de tan rico bocado, a 61 que es 
goloBO y ferviente admirador de la calidad del artfculo elaborado? 

Es que en verdad cuanto m&a tiempo permanezca adherido al lugar de sua delidae 
m&B benefidos obtendri de eea sana allmentaci6n. 

Sin embargo, ha Uegado la hora de que hablemos seriamente del destete. Tema 
antlp&tico a mi entender y que he hecho lo posible por alejarlo, por cuanto tengo la 
absoluta convlcci6n de que cuanto mis tiempo permita mamar al nifio mis garanti- 
zamos su porvenir. 

Sefiora, vuestro nene se prende cada tres horas, es dedr mama a las seis, nueve, 
doce, de la mafiana y a las tres, seis y nueve de la tarde. 

£06mo hacer para iniciar el destete? 

Nada mis ficU. Suprimid el seno a las doce y lo reemplaziis por una mamadera 
de leche de vaca. ^Y c6mo prepararla? Verbis: tomad leche pura y fresca, hervidla; 
tomad agua y hervidla. Tomad, ahora, un frasco nuevo o una pajarita de porcelana 
de las que tambi^n Uaman patitos y que se expenden en todas las f armadas, hervidla; 



PUBUO HEALTH AND MEDICINE. 223 

comprad una tetma de caucho y como Iob anteriores, hervldla. ^V^is c6mo repito 
"hervidla?" Lo hago con el fin de que oe convenz&iB de que la ebullici6n es el 
tuuco medio pr^ctico de mantener as^ptico todo lo que pueda estar en contacto con 
la boca del beb^. 

Todo estd pronto. Echad ahora echo cucharadas de la lecbe preparada y cuatro de 
agua hervida dentro del frasco o la pajarita, a la que enchufar^is la tetina. 

Palpad por afuera si est^ a una temperatura conveniente o para mayor seguridad 
verted sobre el dorso de vueetra mano, volcando el frasco, unas gotas del preparado y 
fii lo toler&is, pod^is administrarlo sin temor. 

Si durante siete dlas notdis que nada ha cambiado, que vuestro beb6 sigue pro- 
gresando, aumentad dos cucharadas de leche y disminuid dos de agua. Si siete dfas 
despu^ todo permanece igual suprimid el agua y dad]e la leche pura que os traerft 
Yuestro lechero de confiauKa. 

Bien, ya ten^ institufda y probada una mamadera. Frobemos doe. ^C6mo hacwf 
. IfodifidUs el hcrario, una le dar^is a las nueve y otra a las tres de la tarde quedando 
la hora de las doce reservada para el seno. 

Asf, aefiora, quince dlas y entonces, (siempre, sinohaynovedad, es claro), entonces 
agreg^ una nueva mamadera a las doce. £s dedr que vuestro beb^ tomari tres 
voces el seno y tree la mamadera. 

Dejad im nuevo intervalo de quince dfas y suprimid el seno a las seis de la tarde 
para darle una nueva mamadera. Quediis asf alimentdndolo con vuestros medics a 
las seis de la maliana y a las nueve de la noche y d&ndole en las denis horas leche de 
vaca. 

Dejad jMUttr un nuevo perfodo y BU|Mimid la de la mafiana y tras otro tannine igual 
OS independiz&is del todo. 

"^Pero a qu6 Doctor, un m^todo tan laigo si yo he visto a madres que en veinte y 
cuatro hons han destetado al beb^?" 

Poor paza ^llas y para el nifio. 

Os decla, Sefiora, Natura no marcha a saltos y este es un case piobatorio de mis 
asertoe. 

Gomprended, sefiora, que una madre que suprime de golpe la funddn de sus 6rgano8 
lactantee se expone a terribles sufiimientoe. Las verbis recurrir a puigantes en^igicoe 
a fin de couseguir se les retire la leche, ese n^tar divino que tanto necesitan sus hi joe 
porque no me dig&is que no, sefiora. Si eeti, por algo est&, para algo sirve y no para ser 
desperdidada. Ahora si fuera el caso de una madre que hubiera tenido la horrible 
deflgrada de perder a su hi jo, ni cousejo serfa que echara el purgante a los perroe, porque 
con 6i no ver& disminuir ni una gota de su leche, y que levantara por un gran vendaje 
algodonado sus senos, lo que aliviarfa los dolores y le permitirfa poco a poco suprimir 
la secreci6n. 

Ob decia, ademiui, poor para el nifio. Y es asf. ^ Si en eea 6poca crftica de la vida 
del beb6 una nana cualquiera lo ataca, a qu4 clase de alimentaci6n recurrirfa esa madre 
para su hijo? ^No sabdis que la leche matema es el mejor remedio para un nifio 
enfermo? 

Y deepu^, sefiora, i a qu6 perpetuar esa terrible tragdia familiar que se desanolla 
entre el deeeo del nifio y la obBtinaci6n de la madre cuando se suprime bniscamente 
el seno, si siguiendo mi cousejo el beb^ va a abandonar por olvido su fuente actual de 
delicias? No seamos peoree de lo que somos, sefiora, y hagamos las coses bien cuando 
podemos. 

Vuestro beb^ consume en el memento que terminias el destete un poco mis de un 
litro de leche por dia y como no debris sobrepasar esa cantidad es necesario suplir las 
neceeidades credentes de la alimentaddn con otroe manjares nutritivos que ayuden a 
la leche. 

Pero, por hoy basta, hablaremos otro dfa de esas nuevas comidas que conseguirin 
mantener y vigorizar las fuerzas de este precioso beb^ en marcha. 



224 PBOGEEDINGS SECOND PAN AMEBIOAN SGIENTEBIO C0NGBE8S. 

YlQiSDUL SEOUNDA YIBITA. 

iDMis continuar criando ri os senAs con novedadeaf Alimentaei6n progrenva — Behi-' 
das — Nada de dleohol — Los hombones y los earamelos — Pdigfros, 

Sefloia: ^Hab^ cuchicheado la progunta y la lie casado al vuelo? Si seflora, si; se 
puede seguir criando. ^Y porque no? 

El nuevo beb^ que se va deaanoUando en la intimidad de Iob tejidoe aumenta de 
15 a 20 gramoe por dia. Eae aumento lo conBegiiii& robando elementos a vuestra 
aangre, la que para cubiir su ddficit no necesitaxi m^ que os decidiiB a aumentar un 
poco vuestia alimentaci6n. 

Lo de lo6 peligroB para el nifio que amamantAiB o paia vos o paia el nuevo, es puro 
prejuicio que conviene destniir. Yo b^ que oe digo levolucionaiA las ideas de cuantoe 
08 lodean. Vuestra-mamita encabezar& la rebeli6n y a la menor indJ8poflici6n del beb6 
me pretender^ demostrar que yo por mia consejoe modernistaB soy el culpable, aun- 
que la afeocidn que padece el beb6 sea una fiebre eruptiva. Pero no temo el ataque 
porque tengo convicci6n en mis afirmaciones ysi mucho me eadgfs oe dir^ exagerando: 
''aacar del pecho al mayor para poner al recidn nacido. " | Ahl sefiora, no est^ adn 
en el caso. Me alegro, pero ^sab^is por qu^? Porque hay verdadera convenienda en 
espaciar los nacimientoe a fin de que consig&is criar y encaminar el uno antes de que 
llegue el otro. 

Os decla, sefiora, evacuada la consulta interpuesta, os decfa en mi charla anterior 
que la leche ya no bastard para seguir el avance victorioso de vuestro beb^ y que era 
necesario recurrir a otros alimentos. 

Seguir^ para ello el m^todo que empledsteis para el destete. A las 12 cambiar^ 
la mamadera por una sopa de una harina cualquiera preparada en la leche que le 
tocaba absorber. 

En cuanto a haiinas todas son buenas y mejores las vegetales, de avena, de anoz, de 
papas, de cebada, de loitejas, de malz, etc., las que uaar^ altemando a fin de no 
cansar al beb6 y excitar su apetito. 

Quince dfas despu^ le dar^ tree sopas, despu^ cuatro y nada mis. Mantened de 
leche solo las mamaderas de las 6 de la mafiana y de las 9 de la noche. 

Altemar6is la leche con caldo de legumbres que preparar^ hirviendo lazgamente 
las legumbres de estaci6n adicionadas de porotos, garbanzos, lentejas y papas. En 
seguida tamizadlas por im pafio y moderadamente salados servir&n de substractum a 
las harinas que empl^is para hacer una buena sopa con que altemar con las de leche 
que le administr&is. 

Pasado algtin tiempo agregardis una media yema de huevo a doe de las sopas diaiias, 
perfectamente batidos en el caldo o en la leche. 

Y poco a poco Uegar6i3, sefiora, a una alimentaci6n mis amplia, una ciscara de pan, 
un i>oco de ensalada de verduxas cocidas, unas pastas de Italia en la sopa, un pur6e de 
papas, habas o lentejas, un poco de pescado hervido si ee fresco y no tiene espinas, 
una crema, un anx>z con leche y irutas. ^ V^is como voy ascendiendo? Lentamente, 
sefiora, llegar^s a comidas m^ s61idas: tallarines a la manteca, polio hervido, seso, 
sopas de fideos finoe, budines, huevos pasados por agua, o Mtos, jam6n cocido, frituras 
de papas, verduras de todas clasee, etc. Llegar^is a darle came cuando alcance a una 
mayor edad, cinco afios por lo menos. 

En cuanto a frutas os aconsejo mantengiis con severidad su administraci6n. Ellas 
no serdn jamds nocivas cuando sean elegidas i>or vos misma (lo que me garantiza su 
estado de madurez y su limpieza) y cuando se coman como postre despu^ del almuerzo 
y de la cena. 

Y en cuanto a bebidas, no voy aquf a iniciar una campafia antialcoh61ica, porque 
06 conozco inteligente y amoroea de vuestro hijo, pero os adveierto que m&9 de una 
vez he visto nifios de dos afios que terminaban de almorzar y ostentaban en su labio 



PUBLIC HEALTH AND MEDIOINE. 225 

saperior un par de bigotes de vino. I Hay padiee para todo, sefioral El agua y la 
leche bastard como bebidas a fin de mantener la funci6n renal. 

Vuestro beb6, sefiora, serd bien educado y no saldrd de bob cinco comidas diarias, 
deeayuno, almuerzo, merienda, cena y relrigerio noctumo. Admito, sefiora, que en 
las dos grandoB comidas se satisfaga plenamente, pero quiero aconsejaros contra el 
grave peligro de las pequefias comidas entre horas, fuera de las cinco citadas. ^Que 
el buen papito trae caramelos, bombones y masitas o frutas, con que saciar bu glo- 
toneria x>ersonal? ^Que el amigo o la vecina ban comprado para el beb6 pastillas o 
confites? . Y ya me veo al divino cliente con una estdpida indigesti6n. 

No olvid^is, el estdmago es un 6rgano, no una m^uina industrial — ^por ende necesita 
descansos — ^y adem^ fomentdis la gula del pequefio, el que no conseguir& la m4s 
pequefia moneda sin que corra al almac^n de la esquina a traducirla en comestibles 
de la peor calidad de acuerdo con su precio. 

Hago pues un llamado a vuestra eneigla de madre inteligente que sabrd sobrepo- 
nerse a las debilidades de una bondad mal entendida, a fin de conseguir ver pronto 
hombre a este divino beb6 en marcba. 

VIG^SIHA TBRCERA VI8ITA. 

TeTTUis iristes pero cuyo conociTniento es necesario — Afeeciones posibles — La vacunaeidn — 
Sue seguridadet — Lot convuUiones — Su tratamiento inmediato — Las lombriees — Su 
rrUtodo terapiutico. 

Seflora, mi presentaci<5n de hoy serd severa. Es que debo hablaros de cosas serias, 
debo preveniros de los peligros posibles, de las complicaciones de la vida del beb6, 
y^v^is? Ya sin querer, vuestros ojos alarmados se ban dirigido al nifio y a mf como 
clamando misericordia para vuestro hijo. 

N6, no es eso, seflora. Conocer donde eetd el punto d^bil, donde la causa, donde 
el contagio probable, es as^^uraros de que, si es necesario, los sabr6is mantener a 
distancia. En la vida, el conocimiento . . . 

^Decidme pronto, Doctor, qu6 puede pasarle a mi beb67 

Os hablar^ largamente de ello y quedar^is tranquila. Primero, seflora, es necesario 
vacunarlo. No os hab(a ind icado antes esa necesidad porque no es 6i)oca de epidemia, 
pero ya es bora que pensemos seriamente en ello. No os alarm^is. En un minuto 
quedard vacunado con una preparaci6n freeca, suficientemente garantizada de otras 
inf ecciones asociadas. Puede suceder, sefiora, que al tercer dfa de la operaci(3n vuestro 
beb^ tenga unos quintos de fiebre y una ligera incomodidad en el brazo y los ganglios 
de la axila se bagan pasajeramente dolorosos. Si en eso quedan las cosas, os conten- 
tar^is con mudar las gasas as^pticas con que prot^;er6 el lugar de la inoculaci6n, si 
no, me llamar^is y acudir^ presuroso a vuestro llamado. 

Pero sabed, sefiora, que estas molestias que ocasionamos a mi cliente ser&n resarcidas 
con la absoluta seguridad de que la viruela no estigmatizard jamis el rostro divino del 
beb^ con esa serie de irregularidades indelebles que caracterizan a los que sobreviven 
a tan terrible enfermedad. 

Ya este mal alejado, pensemos en otro. Las convulsiones. 

^Son acaso posibles con el regimen que hab^is ordenado a mi beb^7 

Deegraciadamente si, aunque i>oco probables, y digo si para colocarme dentro del 
terreno de la seguridad que he querido mantenerme con vos, que sois fuerte y valerosa. 

Sin embargo, como casi siempre el origen estd en el intestino y como el r^imen 
alimenticio adoptado mantiene la integridad de sus funciones, casi os podria afirmar 
que serin extremadamente raras en vuestro beb^. 

^Pero, si suceden, que debris hacer? Una cosa os exi jo y es la tranquilidad . Nada 
de deeesperaciones embarazantes que en estos cases, obrar pronto es obrar bien. 
Inmediatamente un buen lavado intestinal, que limpiard el cabo inferior. Unos 



226 PB0CEEDING8 SECOND PAN AMEBIOAN SCIBKTIFIC CONGRESS. 

buenos buches de agna tibia que llenazin el estdmago y pennitir&a su v6mito i&cil, un 
buen bafio caliente, y espenr al m^ico. 

^CuiLnttbs coflttB, verdad? Ver6is que sencillas. Una pera de caucho de las mis 
pequefias, con pico del mismo material, hervidla r&pidamente y caigadla con doe o 
tree cucharadas de glicerina. Introducidla en direccidn al ombligo, sin que tiemble 
vuestra mano y vaciad su contenido, y ya tenuis hecho el lavado. 

Inmediatamente le har^is absorber unos cuantos buches de agua tibia y con vuestros 
dedos o con una pluma de gallina que desinfectar^is por ebullici6n en agua, le har6ifl 
cosquillas en la garganta hasta provocar el v6mito. 

Con estas dos operaciones, hab^is hecho cuanto podfais pan limpiar el tube digestivo. 

Ahora, sumeigid vuestro beb6 en el agua, a 38 o 39 gradoe, poni^ndole continua- 
mente pafioe de agua fria en la cabeza y dejadlo allf, media, una hora, no importa, 
hasta que lo ve&is calmado. Entonces, nUb tranquila, esperad al mMico que hard el 
resto. 

Una cosa, repito, es necesaria y es la tranquilidad. Os conozco bien y s6, seftora, 
que con los pertrechos con que os he armado no temer^is ya a las terribles convul- 
siones, cuya sola menci6n hace palidecer a las madres y cuyo origen aunque 
multiple estd casi siempre en las vlas gastrointestinales. 

Y para no salir de ese terrene, hablemos ahora, de las lombrices: 

^Sab^, sefiora, que en un tiempo no remoto todas las alecciones de los nifios se le 
atribuf an a las lombrices? 

Que un nifio era demaaiado llor6n, que comla demaaiado, que se restregaba por 
dem4s las narices, que tenia retortijones intestinales, que tosia, todo era debido a 
lombrices. A tal grade se lleg6 en estas afirmaciones que se form6 una coitiente 
contraria que n^ su existencia. La verdad estd, como siempre, en el t^rmino medio. 

In medio Veritas. Hay a menudo lombrices y ellas pueden ser la causa de desarregloB 
intestinales o nerviosos. Pero de allf, a atribuir a tan modestos bichitos la causa 
eficiente de todos los males, hay un continente. 

Colocadas pues, en su verdadero terrene, veamos c6mo hacer para descubrirlas. 

El m^todo es verdaderamente f^il y est& fundado en la observacidn de las mateiias. 
Si un dia, dos, diez, observ&is lo que el nifio arroja, notar^is, si tiene lombrices, unos 
pequefLos bichitos blancos, tales como "vermicelli" que se mueven r&pidamente o 
una gran lombriz semejante a la que se halla en las tierras htimedas y que todos cono- 
cemos, con la tinica diferencia que la arrojada con las materias es blanca. 

^Qu^ hacer en estos ca^osd? 

Nada mis f^il, Uamar al medico. Desconfiad, sefiora, de los especfficos que os 
ofrecen y que son capaces de curar desde una callosidad en un pie, hasta la calvicie. 
Desconfiad de la "Santonina" que a menudo las madres administran sin medida, 
ignorantes de sus giandes peligros, y llamad al m^co el que conserva adn en su 
recetario el vermffugo necesario para su destruccidn. 

Ya no temer^is, pues, si os hablan de lombrices. Sab^ c6mo descubrirlas por 
ende, c6mo atacarlas, y sobre todo, sefiora, no olvid^ jam^, que la ciencia vela 
sobre la cabeza de este precioso beb^ en marcha. . . . 

VIQ^DCA CUABTA VISITA. 

ContinHa el tema triste—Las heridas—Sus cuidadot—De e&mo os podHs transformar en 
una ayydame Hail— El aislamiento como medida general— El atsUaniento debt ser 
efectivo. 

Sefiora, continue alecciondndoos sobre los peligros posibles. Entended que os digo 
posibles, no probables y por ende convenceos una vez por todas que ellos no tendr&n 
fatalmente que descaigane sobre la cabeza de vuestro divine beb^. 

^Quer^s que hablemos de heridas? Pues bien, sefiora, comencemos por ellas: 

^Frente a una herida qu6 debdis hacer? 



PUBLIC HEALTH AND MBDICINE. 227 

Gomo sLempre, lo primero ee no alarmaxos. Sale saiigre, mucha aaogre que impre- 
SLona por ea cantidad y sobre todo por ser sajigre. lYiis acaao a tomar vuestro pafiuelo 
o a recumr al viejo e inmundo procedimiento de la tela de arafia para aplacar la 
hemoiragia? ^Verdad que no, sefiora? 

Ante todo si no tenuis a mano gasa as^ptica y la farmacia se halla distante, sumeigid 
en agua hirviendo unas tiras bechas con sdbanas o pafiales viejoe y mientraa eso bierva 
lavaos friccionando fuertemente vuestras manos, lavaoe en B^uida con alcobol y ya 
asi preparada emprended la cura. t 

Deflinfectad cuidadosainente los bordes de la heiida con agua, jab6n y alcobol como 
blcifiteifl con vuestraB manos y tomando las gasas o los trapos que bab^ puesto a 
bervir limp Lad. de co^iguloe la berida. Tapadla en seguida con esas gasas o esos paflos, 
cubrid el todo con algod6n y vendad bien comprimido. 

Poddis asl esperar tranquilamente a vuestio mddico que no bai& mis que aprobar 
vuestra conducta y felicitaros por baber procedido de acuerdo con la clencia. ^Qu6 
peUgroe puede tener una berida de vuestro beb4? 

La hemorragiaquecombatisconlaconipresi6n, la infecci6n que prevenfs con la asepsia 
He ahi todo sLmplemente descrito porque la sencillez del tema no permituia bacerlo de 
otromodo. 

Veamos como debris proceder frente a una enfermedad . Ante todo debris aislar al 
pequefio, mixime cuando segtin las profecias de vuestro espoeo; este es el principio 
de una laiga serie de preciosidades de la que serto capaz dada la muestra. 

Aislarlo por cualquier malestar; no cuesta nada y os da planas ganntfas de no espareir 
la afecci6n. ^Sab^is acaso, sefiora, si esos tree quintoe de fiebre que tiene el beb4 no 
son el principio de una enfermedad contagiosa? 

Aifilad, pues, que vuestro m^ico dir& si bab^is becbo bien en adoptar tal medida. 

Al bablaros de eee aislamiento quiero baceros presente que 61 debe ser efectivo, 
porque figuraos corriendo de un cuarto a otro y siendo vos misma la portadora del 
microbio. . . . iGuAl serf a entonces [el aislamiento? Ninguno o muy deficiente. 
Entrad al cuarto del enfermo cubierta con un guarda polvo o con una de vuestras 
camisas de nocbe que al salir abandonardis y previo un cuidadoso lavado de manos os 
entregar^ls tranquila a vuestras otras obligaciones. 

Cuidad vos misma de las tazas y cubiertoe, de las s&banas y fundas del enfermo. 

Todo lo que ba aido tocado por el beb6 debe restituirse a la comunidad previa 
desinfeccidn. 

Asl y s61o as( bar^is un aislamiento efectivo el tinico que ser& beneficioso para la 
salud del bogar. 

Y ya que sab^is practicarlo pasaremos revista a las mdltiples alecciones que lo ban 
de menester y de las que conoci^dolas me ayudar^is a lucbar a fin de salvar a este 
divino bebd en marcba. 

VIOASIMA QUINTA VISITA. 

Fin del mismo tema — Sarampidn — Varicela — EsoarkUina — Tos convulm — Difteria — 
Viruela — Papertu — Cdmo ayudar al midioo — Es proceder sensato no abandonar cU bebi 
y recunir a la ciencia, — 

Sefiora: ^Os balliis preparada para continuar nuestro tema de tiistezas? Si. 
Toca boy a las enfermedades contagiosas. 

Os dii6, previamente, que en ^pocas de epidemia todos los cuidados son pocos para 
defender al beb6 del contagio. Aun contando con 611oe puede vuestro divino beb^ 
caer enfermo sin que pod&is descubrir d6nde estuvo la falta, ddnde la ranura en el 
cfrculo de cuidados con que le rodedis, que permiti6 la entrada del mal. 

Permitidme que, sin intemunpir nuestras cbarlas baga ligeras descripciones que 
06 servir&n de guia y que serin ratificadas por vuestro medico cuando lo llam^is. 

Sarampidn. — ^Enfermedad cuya incubaci6n es insidiosa, por 611o de diffcil diagn^- 
tico basta el instante de la erupci6n. — Fiebre de invasi6n generalmente moderada, 
38 a 39 grados, ojos del nifio inyectadoe lagrimeantes, resfrfo de nariz, estomudos, tos 

68436— 17— VOL ix 16 



228 PB0CEEDING8 SECOND PAN AMEBIOAN SGIENTIFIO CONGEBSS. 

hueca y fuerte, a voces angina y ligera erux)ci6n en la garganta y velo del paladar que 
precede a la erupci6n de la piel, la que aparecerd en primer t^rmino en la cara al 
tercero o cuarto dfa, para extenderse a todo el cuerpo al dla siguiente. GuidadoB: 
encerrad al nifio en su habitaci6n, la que calentardis a 18 a 20 gradoe, temperatura 
que debe permanecer invariable, purgad al beb^, desinfectad su boca con agua b6rica, 
administradle lavados intestinales y llamad al m6dice que se hard necesario para pre- 
caverlo de posibles y graves complicaciones. 

Varicela, — ^Afecci6n contagiosa, poco grave en general, se caracteriza luego que se 
produce la erupci6n, aparecen primeramente pequefias manchas rojas, diseminadas en 
la cara y en todo el cuerpo y extremidades, en nthnero de quince o veinte, que se 
irin reproduciendo en los dias sucesivos. En cada m^Tirhf^ se forma una ampolla con 
liquido transparante el que se tcansforma a las veinticuatro horas en pus. Se notan 
ademiis, pt&stulas en la garganta y paladar. 

Los ctddados necesarios se reducen a medidas de higiene y cuando pase el perfoda 
eruptivo, bafios jabonosos que os ordenari, sefLora, vuestro m^ico a quien no deb4is 
olvidar de llamar. 

Ewarlatina, — ^He aquf algo mds serio y que merecer& todos vuestros cuidados por 
un laigo perfodo. £s que en esta afecci6n la gravedad del mal o sus complicaciones 
puede prolongane y ser en todo tiempo de resultados f unestos. 

La invasion es generalmente brutal, precedida por chuchos, v6mitos, dolor de 
cabeza y angina. La fiebre alta, en la mayorla de los cases alcanza a 40 o 41 grades, 
y aparece en las primeras veinticuatro horas la erupci6n acompafiada de picaz6n y 
desasosiego. La gaiganta se llena a menudo de llagas y en 611as mora muchas vecee 
el bacilus de la diiteria. Llamad inmediatamente al medico qui^n instniird segura- 
mente un tratamiento en^rgico que serviri para prevenir graves complicaciones. 
Desconfiad, sefiora, de las erupciones que vienen sin fiebre y que estamos tentados 
de clasificarlas como benignas. Entre ^llas se esconden escarlatinas que no son claras 
porque no traen complete su cortejo de slntomas. 

To9 eonvuUa. — Afecci6n muy contagiosa, cuyo primer slntoma es la tos, sin ninguna 
caracteristica en los primeros echo dfas; para hacerse en los periodos subsiguientes 
por sacudidas, por accesos en que despu^ de seis, siete, diez expiraciones viene una 
inspiracidn silbante. A menudo al nifio se le inyectan los ojos por efectos de la bru- 
talidad de los accesos, o vomita por la misma causa. Tiene complicaciones, jk>i ende 
OS aconsejo llam^ al m^ico que aunque por el memento se halla poco armado para 
la tos misma, puede imponeros el regimen conveniente paia salvaros de las compli- 
caciones. 

Diftena. — ^Enfermedad grave, gravisima, mortal si os descuid^ un instante en 
llamar al medico. Aquf sf se hace necesaria vuestra diligencia. Fiebre m&s o menos 
violenta, decaimiento general, lengua sucia y dolor de garganta. Observ^dosela 
notar^ una membrana blanca que cubre una o las dos amfgdalas. Pensad que esa 
membrana crece por instante, que puede Uegar a la laringe, obetruirla, ahogar a 
vuestro beb6 en un ataque de crup, 

Llamad al m6dico y prevenidle de vuestros temores, a fin de que no pierda tiempa 
y tenga en su visita todo lo necesario para darle el suoo Salvador. 

Tendria que hablaros ahora de la viruela, afecci6n grave, a menudo mortal; pero 
ya OS habl4 de la vacunaci6n, que nos as^ura el alejamiento de tan virulento msil. 

Es evidente, sefiora, que cada dfa se desconoce m^ esa afecci6n, por cuanto la 
vacuna la va relegando a los iMifses de baja civilizaci6n o a las gentes no creyentes o 
descuidadas. 

Los hechos, a despecho de los poco convencidos, demuestran basta la evidencia que 
la viruela no ataca a los nifios vacunados y cuya vacuna les haya prendido, o si Ice 
ataca lo hace de una manera benigna y f&cilmente curable. 

Vos, sefiora, que ten^ locuia por vuestro beb^; que os horrorizdis ante la sola 
idea de que una mintiscula cicatriz se grabe en el rostro terso del cliente, os babuls 



PX7BU0 HEALTH AND MEDIOINE. 229 

apresurado a vacimarlo y goz&ie de la tranquilidad de haberoe prevenido contra el 
peligzx) que acecha. 

Y una palabra final, sobre las paperaSj afecci6n tambi^n eminentemente contagiosa 
y que se caracteriza por un dolor por delante de la oieja, con tumefacci6n que baja 
hasta el borde del maxilar, e impedimentoe para la ma0ticaci6n. Esa enfermedad 
trae aparejada graves complicaciones que os obligar&n a recurrir al m^co a fin de 
que las prevenga u os diiija en su curaci6n. 

Y bien, sefiora; termino mi re vista Idgubre, que os habr& impresionado. Todo 
eso puede tocarle a este precioso beb^, todo y m^. 

Pero no valen lamentos ni desesperociones. 

La vida del nifio es una etema cuesta arriba sembrada de piedras sueltas que debris 
a su paso sepaiar con cuidado, pero si una de 611as se os pusiera irreparablemente en 
el camino, es necesario que sep&is como salvarla con ^xito. 

Tfld ha sido mi misidn de hoy. Deciros, ''Sefiora, tal enfermedad es asf, poco m^ 
o menos. " ''Frente a 611a debris proceder de este modo y no de otro. " 

Y vuestra buena voluntad, la ciencia de vuestro medico y sobre todo el poder 
vital que trae acumulado desde su nacimiento y que como ^gel de la guarda, de la 
Leyenda Gristiana, acompafia al beb^, — os garantizar^ que aunque grandes fueran 
loe obst^ulos, mayores son los recursos con que contamos. 

Pod^, entonces, Sefiora, entregaros pldcidamente a vuestra misi6n, sin temores, 
sin aprensiones; el mundo es de este pequefio beb^ en marcha. 

YlQtBOUL 8EZTA VI8ITA. 

La mardia. — Oudndo d behS debt eomemar a oaminar. El masaje preparador. De la 
manemcomodeheiniciarseelaprendizaje. Mediasnaturalesporendebuenos. Eloastigo, 
Ignoranda o aalvajitmo. 

Sefiora: Los plazos fijados se cumplen religiosamente, es hora ya que vuestro 
beb6, fuerte, vigoroso, active nos demuestre su poder. Me decis: ''Doctor, cuando 
lo tengo entre mis manos se sostiene solo y hasta creo que ha ensayado pasitos. " 

^Eeo es una creencia o una seguridad? ^Lo hab^s probado, verdad? lAh Sefiora t 
cuidadosamente habfa obviado mi conversacidn sobre la marcha a fin de no apresurar 
el memento solemne del primer paso. ^Porqu6? Sefiora es conveniente y es necesario 
retardar lo m&s posible el instante de independencia i>orque si comienza tarde lo 
har& mejor. Ya a loe nueve meses habrdis notado que se para solo, que tiene fuerzas 
suficientes para iniciar el aprendizaje, que se siente capaz de emprender la marcha 
y sin embargo os dfsteis cuenta de mi mutismo al respecto. 

Es que esperaba a que sus mr!isculos se desarrollaran con el ejercicio de vigoroso 
pataleo en el bafio y cuando lo muddbais y me aseguraba como dentro de sus roftitos 
de gorduia se iban desarrollando progresivamente los mtisculos. Por eso, instituf el 
masaje. Os dije, ^lo record&is?: ''despu^ del bafio debris, con vuestras manos cu- 
biertas de talco, hacer fricciones ligeras de las piemas y muslos del divino beb6 e in- 
temdficarlas progresivamente. Debdis pellizcar entre vuestro pulgar e fndice, de un 
modo suave y acariciador como sois capaz de hacerlo, las masas musculares, de abajo- 
arriba, es decir, del pie al muslo. Deb^ practicar enseguida movindentos de flexi6n 
y extensidn de los miembros, varias veces y sin esfuerzo. 

^Con qu6 fin os orden6 todo eso, sefiora? 

Ahora debris comprenderlo. Era necesario fortificar los mfisculos, los ligamentos 
a fin de que resistan el pesado oiganismo de vuestro bebd sin necesidad de andadores, 
ni de sostenes de clase alguna. 

^Credis que no notd vuestra impaciencia? 

Todas las madres sois iguales. Cuando not^ que el bebd mueve sus piemitas, se 
sacude o endurece afirmiis su capacidad pedestre. 

Y flin embargo no es asf. 



230 PBOOEEDINGS SECOND PAN AMERICAN SCIENTIFIC C0NGBES8. 

£1 beb6 aprenderd a marchar como supo llorar, mamar o reir, vale decir, que lo 
hard Bolo, con vuestra ayuda o sin ^Ua, pero a su debido tiempo. 

Para 6II0 iqu6 oe aconsejo, sefiora? 

Nada o muy poco. Dejad al beb^ en el suelo, sentado sobre una alfombra y vigilad 
que no saiga del espacio tapizado. Lo ver^, piimero, caer hacia atrds y volver a 
sentarse; en seguida, voltear sobre sf mismo quedando atin el vientre piano sobre la 
alfombra. Este ejercicio repetido lo Uevard a encoger siu piemas y quedar de rodillaa 
apoyado adem^ en sus manitas, en cuatro patitas, gateando. 

Un buen dfa cuando ya lo not^is un diestro marchador, le acercar^is una siUa de 
Yiena y en su asiento colocareis el juguete que mds agrade al cliente. Lo ver^ 
entonces tomar apoyo en sus manos e irse elevando gradualmente hasta x>ararBe en 
sus piee. R&pidamente tomard al chidie y al pretender darse vuelta caerd cu&n largo 
es. Entonces, nada de aspavientos proque sabed sefiora que una cafda de tan pequefia 
altura sobre una alfombra no le producird jam&s una Ie8i6n seria. Refos y oe asom- 
brar6is de ver como el valiente amigo corea vuestra tisa y pretende repetir el acto. 
Y pronto, mucho mds de lo que cre6is, verbis al beb6 marchando presuroeo como ed 
muchas obligaciones fatigantes le absorbieran su contado tiempo. 

Un nifio que comienza a caminar, corre al igual que un apredis de dclista cuando 
empieza el pedaleo hace disparar a su mdquina. 

Es que, sefiora, es mds fdcil mantener el equilibrio andando ligero. 

Nada de andadores ni de fajas de sost^n, pues tienen el serio inconveniente de 
comprimir el t^rax y hacen adaptor posiciones viciosas al pequefio y ademis, sefiora, 
un beb6 que se convence que tiene un apoyo donde librarse de una caida no querr6 
jam&s desprenderse de 611a, tomard miedo a andar solo y costard el doble conseguir 
verlo en marcha. 

El m^todo que os aconsejo es muy sencillo. ^Por qu6? Porque es copiado de la 
Naturaleza y tiene pues el sello de lo mds prdctico y beneficioso. 

No olvid^is, sefiora, los cuidados que en estos momentos requieren las manos libres 
e inteligentes del pequefio beb^. 

Nunca mds que ahora es que debris vigilarlo porque bus manos tomardn cuanto objeto 
est6 a su alcance y rdpidamente lo Uevardn a la boca. Vigilad, pues, y apartadle Iob 
objetos cortantes, los sucios, los que puedan ser un peligro en sus manos. Vuestra 
actividad estd en juego y vuestras energfas sufrirdn una ruda prueba. 

La arcilla estd blanda; es a vos a quien toca modelarla. El nifio forma en estos 
instantes su cardcter y se adapta tal como la arcilla. 

Ahora bien, si pretend6is el triunfo necesitdis energfa firme y persuasiva; nada de 
gritos ni de castigos. 

Vuestras manos hardn menos que vuestra mirada. 

La obstinaci6n del pequefio la verbis dobl^arse ante vuedtra constancia, y pensad 
en el cuadro horrible de una madre que castiga brutalmente a su hijo porque se Ueva 
a la boca un juguete ! 

Si no fuera ignorancia se dirfa salvajismo. 

Por eso vos, sefiora, educada como lo hab^is sido entre mimos y halagos no sentirdiB 
la tentaci6n jamds de levantar vuestra mano sobre este divino beb6 en marcha. 

VIOisiMA S^PTIUA VXaiTA. 

l}ltima vmta — TendencUu convenient^ — Buena direcddn al principio — Disciplina 
de amor — Nada de gritoe — Constancia persuasiva — El halago y el miedo — Las relado- 
nes con el mkdico — La riqueza motivo de orgtUlo — La superioridad de los mayores — Los 
compafleros del bebi — El maestro— La madre Unica consejera. 

Sefiora: Mi tlltima visita la dedicaromos a hablar del porvenir. 

^Qu6 serd vuestro beb^? 

^M^dico, abogado, ingeniero, arquitecto u honrado comerciante como lo es su padre? 



PUBLIO HEALTH AND MEDIOINE, 231 

He ahf una grave cue8ti6ii que no os atrev^is a conf esar pero que ya la hab^is medi- 
tado en lo m^ hondo de vuestro cerebro. 

iVerdad? 

Hab^is hecho bien, senora, porque es a vob a quien toca deddir. 

iC<5mo a mil, Doctor? 

Sf a V08, senora. No os dir^ que encarril^lB brutalmente sus gustos hacia un fin 
determinado. No, porque cometerlais un grave error de resultados funestos para 
el porvenir de vuestro beb^; pero, es a vos, seflora, a quien toca observar donde estd 
la afici6n, donde est& el interns mayor de su inteligencia, hacia que punto se orientan 
BOS habilidades, cu^ ee la senda que le serd mds fdcil recoixer, y, armada de esos 
elementos proceder en consonancia. 

Depende de la buena direcci6n del principio, la formaci6n del cardcter que va a 
presidir los actos de su vida entera. 

Os debris apresurar pues, en guiarlo hacia una buena iniciacidn, y asf como para 
los cuidados flsicos me vlsteis siempre partidario de dejar hacer a la Naturaleza y so 
cooperar a su obra; en la parte moral, en cambio me encontrar^is en un terreno 
decisiones absolutas que os causar&n admiraci6n. 

Primero y ante todo, el niiLo debe ser disciplinado. No vaydis a creer que entie 
por tal la disciplina del cuartel. Nada de eso, sino una mezcla de cariiio, respeto 
y obediencia que serdn altamente beneficiosos a su marcha futura. 

Habituadlo a comprender que no valen llantos y rabietas para satisf acer sus caprichos 
y que a vuestra negativa no le queda otro camino que el silencio. 

Comprended, senora y amiga mia, que si cuando pequefLo le permitis cons^uir sus 
deseos con llantos y gritos, cuando hombre, sentird pesar sobre si amargas contrarie- 
dades, pues en la vida, el ^xito est& muy lejos de ser obtenido por los que solo saben 
hacer gestos. 

Cuando vuestro nifio acostumbrado a conseguir sus satisfacciones personales im- 
poniendo sus caprichos obtenga la primera decepci6n, 611a serd funesta porque va 
contra los hdbitos creados que forman su s^gunda naturaleza. 

Pero tampoco os acostumbr^is a dar voces, cada vez que pretend^ imponer vuestra 
voluntad, una n^ativa severa ahora que sus facultades comprensivas no estdn todavla 
desarrolladas, una negativa explicada m^ adelante; pero nada de gritos, ni golpes. 

^Sab^is por qu6? En cada hombre por m^ pequeiio que €1 sea existe el secrete 
placer de exacerbar a quien manda y vos, sefiora, f oment&is ese mal instinto exhibiendo 
vuestros enojos. 

No buflqu6i8 para imponer vuestra voluntad los dos vulgaree y pemidosos medios 
del halago y del miedo. ^Sab^a a qu6 me refiero? 

Con solo deciros doe frases frecuentemente empleadas, os dar^is cuenta: "Beb^, 
81 te quedas quieto te voy a comprar carameloe." ''6eb6, si no te portas bien te va a 
comer el Guco." 

He ahf, sefLora, propoaidonee que jamds deben aparecer en vueetros labioe. La 
primera porque transforma a vueetro beb^ en un ser interesado que no procederd 
jamia sin la eaperanza de una remunerad6n, aerd honeato con paga, vale dedr, no 
86r6 jamia espiritualmente honeato, y la aegunda porque inculc&ia un aentimiento 
nodvo para su vida: el miedo, y porque forj&is un aer imaginario que obrar& aobre el 
eaplritu del beb6 como una etema peaadilla doloroea. 

Con mayor raz6n adn oa pido no supliia al Cuco de la aegunda fraae con el Doctor, 
porque si 6ste no es un ser imaginario es al menoa un aujeto titil y con quien conviene 
que vuestro beb^ conserve las mia ampliaa amistadea, amistades que desaparecerdn 
en el instante miamo que lo tranaform&ia en un inatrumento de terror. 

Por eso tambi^n, oe pido no cometdia la torpeza de muchaa madrea que cuando el 
medico le dice al nifio "Mu^trame la lengua,'' ae apreauran a agregar: "Mu^traaela 
querido, no te hard mal," y el nifio aleccionado de que ea posible que el buen aefior 
que pretende hacer obaervacionea en au lengua puede producirle un mal, ae apresurai^ 
a cerrar la boca, apretar los dientea y rumiar una rabieta. 



232 PBOCEEDINOS SECOND PAN AMERIOAN 80IENTIFI0 00N0BB88. 

De todos estofl detalles, nace eoa comedia de llant06 que se reproduce en cada viaita 
del m^co a nifios que han aide mal enaefiadoa. 

Madrea, que preguntan, al mMico en preaencia de 8U hijo enfenno: ''^ Y c6mo hago 
doctor para adminiatrarle el medicamento ai no quiere tomarlo?" o que ponen en 
duda la obedienda de loa hijoa a sua 6rdene8, diciendo "ah doctor, lo toma por que 
eetd Ud. delante y deapu^?" V6iB, Sefiora, con 6II0 consiguen avivar la perepicada 
de sua hijos que saben aaf, que ai 611oe no quieren, van a salvarse poniendo obstdculoe 
o que es neceearia la presencia impoaitiva del Doctor para obedecer a sua mandatoa. 

Vos, seguramente, no proceder^ia asi, por cuanto eapero que vueatra inteUgenciA 
comprensiva oe habr& evidenciado loa perjuicioe que reportan talea procederea. 

Vueatra po8ici6n social, aunque deecubierta por el nifio, no deber& ser jamia un 
motivo de oigullo. Para ^Uo ea neceaario, Sefiora, que buaqu^ia entre ana compafieroa 
de colegio a un hijo eetudioeo, de laborioeoa obreroa, que eeiA au amigo, y haata 41 oa 
debeia inclinar para repartir vueetro carifio. 

Hacedle ver que la deaigualdad de fortuna no es un m^rito y que 61 es, cuando mia, 
igual a su amigo o inferior a 61, si aquel tiene condiciones intelectuales superiores. 

Demostradle que el dnico prestigio entre los hombres lo da el talento y que para 
conseguir ese prestigio no bastan las dotes naturales aino que es necesario an perfec- 
cionamiento por la labor diaria. 

Hacedle comprender que el dinero no es el fin de la vida, que hay algo m&s grande, 
mis noble, y que vale m^ que la riqueza material, pero no por eso dej6ia que lo 
malgaste en nimiedades pemiciosas e instituid el ahorro desde la primera edad. 
Con 6II0 se acostumbrard vuestro beb6 a ser econ6mico, empleard su dinero como un 
medio de producirse satisfacciones honestas y de un orden superior. 

Alejar^is los peligros reales que rodean al beb6 tales como los del juego, los objetoa 
cortantes y las caldas pero no vay&is a cometer el error de infundirle miedo. Eate 
aentimiento es m^ de educaci6n que innato. Pensad que si cada vez que lo dej&is 
solo agregdis ''No temas, eh!, que ya vuelvo," el beb6 razonard asf: "Mi madre dice 
que no tema, en Nonces algo me puede suceder" y es claro que a la segunda vez que 
tent^is la experioada romper tfen llanto y os seguirii. 

Es necesario que el nifio comprenda la superioridad de sus m&yares para lo cual hb 
evidente que no os debris mostrar jam^ en vuestros instantes de debilidad. 

Por ello OS digo, sefiora, no mint^ jam&s al nifio. Si una vez comprueba que no le 
hab^is dicho la verdad dudard de vos para siempre, y esa duda se traducirft en deeobe- 
diencia. 

Las pequefias querellas dom^sticas tampoco deben ser presenciadaa y vueatra vida 
debe ser de etema armonla para 61. S6, sefiora, que hasta ahora se prolonga la luna de 
miel de vuestros amores. Sabed que la deseo etema, pero si alguna nube oacurece el 
cielo de vuestra dicha, el beb6 nada deber& saber. 

Ese respeto mutuo, ese carifio constante, esa igualdad de opinionea y de procederea 
que hacen la paz del hogar, deben quedar en evidencia para vuestro beb6, que al 
notaros de acuerdo se sentihi tentado a plegarse a la mayorfa, y modelar& sua accionea 
a vuestros deseos. 

• En las conversaciones que entabl&iB poned siempro el sello de vuestra superioridad 
y no manteng&is jam4s una duda. Cuando la pregunta ea del g6nero de 6sa8 que no 
quer^is responder, amparaos en una supuesta ignorancia y no aliment6is su suepicacia, 
diciendo: "{Ah! pillfn, eso no se pregunta:", por qu6 ^sab6is entoncea qu6 har& 
vuestro beb6? Inquirird hasta satisfacer su curioddad animada por vuestra respueeta, 
mientras que vuestra ignorancia confeaada lo dejard conforme y con la convicci6n de 
que cuando vos no lo sab6iB, 61 tambi6n puede ignorarlo. 

El nifio debe ser para vos como un p&jaro en la jaula. Con amplia libertad i>aia 
BUS pequefioe vueloe pero defendido por los barrotes de vuestro carifio que aunque 
disminuyan su independencia lo amparan y protegen contra el abuso de la vida y 
BUS contagios pemiciosos. 



PXTBLIO HEALTH AND MEDICINE. 233 

Por eso deb^ifl elegir sua compafieroe y ouando 61 vaya al colegio, que seri lo mis 
tarde poedble, debris cooperar a la acci6n del maefltro a quien conmderar^ un amigo 
y para quien prodigar^is en todos IO0 iiustantes y con conocimiento del niflo vuestraa 
alabanzas y agradecimientoe. Tal proceder influiid en la mente del educando quien 
sentdid amor y respeto por su profesor, amor y lespeto que se traducir&n en una mayor 
dedicaci6n y provecho en bus estudioe. 

Paaaron los tiempoe en que se afirmaba '4a letra con sangre entra"; se abolieron Iob 
IdtigoB y las palmetas y el reinado del canfio hace de nuestros profesores seres dignoe 
de veneraci6n para quienes no basta el agradecimiento de nuestra vida entera. 

Ensefiadle pues a amar al maestro que en ello vuestro beb4 pagaril un poco del 
enorme saciificio que importa la brega diaria por su in8trucci6n. 

Y continuad la acci6n del profesor en vuestracasa. ^Sab6is c<Smo? Interes&ndoos 
vos tambi^n en sus estudios, haci6ndole notar bus progresos, sosteni^ndolo en los 
momentos de desaliento, demostr^ndole que todo se consigue, pero que es menester 
iuchar. 

Ese aprendizaje demostratiyo de que no hay nada f&cil en la vida, lo en8efiar& a ser 
pertinaz y constante y le ahorrard enormes decepciones. Frente al fracaso se dir&: 
"no he trabajado bastante'^ y no se entregarft a la desesperacidn de los seres d^biles 
que se creen siempre vfctimaB del error o de la injusticia de los hombres. 

Habladle a menudo al ofdo de vuesjtro caziilo y de vuestra amiistad a fin de que 
aienta en vos su mejor confidente y os permita vuestro consejo en todos los actos de su 
vida infantil. 

Y llegado el memento de su independenda total cuando eintdis que aquel ser 
bien querido ya ha formado las alas que le permitii^ escalar libremente las alturas, 
OS sentir^is regocijada de haber prooedldo segtin mis consejos, porque habr^is cons- 
titufdo un ser fuerte de cuerpo, sano de alma, conformado con la esencia de vuestra 
bondad y con la pujanza de vuestros sentimientos de madie. 



PUEMCULTURA. 

Por P. RUEDA, 
Jtfe de la Sola de Clinica Midica del Hospital de Niiioe^ Roeario de Santa Fe^ Argentina 

• 

El niHo enfermo exige un euidado md» prolijo ei es posiJble, que el adulto, pues mientras 
iste dene el recurso de la queja, aquel recompensa eon el earirU) mds sincero y el m6t 
profundo olvido hasta las f altos de cuidado que yodemos kaeerU si^rir. 

Es hoy dla de Intima satisfacckSn, porque puedo realizar en la forma que aspiraba 
un proyecto que me ha ocupado mds de una vez; la Ensefianza Prdctica de la Pueri- 
ciiltura — que por primera vez se implanta en el pais ' — a una entidad social tan 
respetable como lo constituye el noble gremio del magisterio. 

No es mi idea precisamente aumentar la densidad de vuestros conocimientos, 
pues ello estd mds que garantizado por la vasta erudicidn del personal docente de 
vuestra casa, mi finalidad es contribuir dentro de mi modesta esfera a la 8oluci6n de 
un verdadero problema social, de \ma cuestidn de la mayor trascendencia en nueetro 
pais— como en muchos otroe— de un asunto, diria, tan viejo como la historia y que 
sin embargo espera resol verse todavia. Me refiero como ya lo sabdis vosotras al tema 
de actualidad etemamente palpitante: La protecci6n del nifio. 

Compleja y dificil es la aplicacidn del remedio a mal tan viejo, si no se estudia 
con m^todo la cuesti6n, ezplorando minuciosamente su origen, sus causas y sus 
modalidades; como seria imposible curar una difteria, por ejemplo si el encargado 

i Primer corso pr&ctico de puericultura dictado en la RepAbllca Argentina, inldado en 8ei>tiembre da 
1915 por el autor. Dedleado a 4* aflo dn la Esonela Nonnal de Maeitroi. 



234 PBOCEBDIKGS SECOND PAK AMERICAN SCIENTIFIC CONQBESS. 

de tratar la dolencia desconociera el mal. £1 problema se aclara empero y el dxito 
se f adlita, cuando el terapeuta poeee pleno dominio de la enlermedad y el medicamento 
que debe aplicar. Pretendo yo si no ae me apura ofrecer la completa curaci6n del 
enfermo. 

Deede luego, pienflo que lo6 libroe han hecho ya su tiempo, agradezcdmoslee su 
euBefianza y sin dejarles del todo, reconozcamos que su sola acci6n no ee suficiente. 
En efecto, la vieja difusidn impreea no ha podido resolver la cuestidn, como lo prueban 
por una parte la excesiva mortalidad infantil y por otra la neceddad en que se han 
visto las nadones mis civilizadas de seguir nueva via. La ensefianza de los librae 
es incapaz de corregir el mal, por varias razones; pero bastaii enumerar la siguiente: 
porque mucha gente que sufie no sabe leer y muchoe de los que saben no leen. 

Las conferencias te6ricas muy dtiles son signo evidente del esfuerzo que hace la 
sociedad para Uegar al fin deseado; es esto un buen sintoma porque nos muestra que 
el pueblo empieza a preocupaise de yeras, constituye pues un gran progreso hacia el 
perfeccionamiento. 

Pero ee indiscutible que la tinica fonna razonable y v^da es la ensefianza eeencial- 
mente pr&ctica. £s tiempo ytL que la accii6n se inicie, que los hechoe reemplacen 
a las teorf as, para que se infiltre en el hogar el pleno dominio de los sanos e indispensa- 
bles consejoe. 

Ensefiar hadendo, ensefiar mirando, ensefiar palpando y sintiendo en todas las 
formas posibles a conocer el alma y el cuerpo del nifio para interpretar mejor sua 
necesidades y suMmientos y alejarle un tanto del mal que le acecha, es como haremos 
obra dtil, mediante el concurso inestimable de nuestra feliz intervenci6n en esta 
cdtedra. 

Hadendo prictica, se impresionari vuestro espititu con sensadones diversas: tristes 
y dolorosaB las m^, matizadas a voces de alegres nagoB, cual la mirada risuefia y 
picaresca de un bebe robusto y sano. En esta forma, lo espero, cosecharemos 6puno6 
fnitos. 

Impresionando la exquisita sensibilidad de la mujer, se marcar&n huellas profundas 
en el coraz6n y sobre todo en el cerebro que puedan guiar las pr&cticas dentlficas, ora 
ejercitando en came propia, ya predicando con criterio firme para aliviar muchas voces 
las amarguias del hogar ajeno. 

Sin desechar por complete el libro impreso, pienso que al leer en este libro viviente: 
que llora, rfe y sufre, que ofrece su Mgil cuerpedto hambriento a voces, y a voces 
lastimado por achaques m^ cruelee, al leer esta pdgina sentida y paipitante en la 
fuente original y pura de las necesidades sodales, aprender^is de la maneram^ 
pat6tica, a reflexionar con provecho y a resolver con 6xito algunos pzoblemas que con 
harta frecuenda se presentan en los hogares. Procederemos asf con las ventajas de la 
previsi6n sobre los Uunentoe de la desesperanza. 

iCuando veais ese nifio que Uega anhelante, p&lido y ansioso tortuiado despiadada- 
mente por intemo mal, sin aliento para lanzar, ni un d^bil quejido, dltimo recuiso 
que le queda para implorar el auxilio, Uegado en una palabra en estado fisico miserable; 
cuando veais repito ese nifio tan pr6ximo a la muerte, capaz todavia de recuperar la 
salud de que parecla irremisiblemente privado, cuando ausculteis las mil circuns- 
tancias que como una consigna fatal le acechan; habr^is Uegado a comprender la 
magnitud d el problema y la urgencia de resol verlo I M^ atin, si penetr&iB fntimamente 
la pr4ctica hospitalaria, podr^ comprobar la nefasta acci6n que la ignoranda ha 
provocado en el vulnerable oiganismo del nifio; podr^ comprobar tambi6n con que 
frecuencia, felizmente, la vfctima tan gravemente atacada reacdona a prescripdones 
de la m^ pura 16gica. 

Keunid todas esas impresiones, considerad todas esas contingencias y os asom- 
brar^is con justo motivo de la inexplicable «pB,ti& con que se ha mirado siempre esta 
fase de la higiene infantil, asf comprenderds mejor la justida de mi entuaiasmo por 
esta verdadera lucha, la necesidad imprescindible de difundir los conodmientoe de 
puericultura en los hogares, implantando el tinico sistema eficaz para su ensefianza. 



PITBLIO HEALTH AND MBDIGIKB. 235 

Con este prop6eito decik yo en im proyecto elevado a la Diiecci6n de Ensefianza 
Primaiia y Especial, en el afio 1912, solicitando la creaci<Sn de c&tediafl de pueiicultura: 

''Podr& objetane a piimeia vista que es este asunto del resorte exclusivo de la 
medicina, no dudo empero que si esta cienda esti encaigada de profundizar, de eepe- 
cializar por asf decir su estudio, de la pueiicultura, necesita a su vez, como auxiliar 
poderoBO la preparaci6n del pueblo, ladifusidn de conocimientos en la sociedad, fonnar 
el ambiente, en una palabra, para conseguir una penetraci6n ttLcil y obtener el resultado 
que al cosechar sus frutoe constituiri el engrandedmiento de la ]>atiia." 

Es la maestra por su doble car&cter, particularmente en el ejercicio de su nobillsimo 
ministerio, en contacto fntimo con la masa social, quien desarroUari un gran papel en 
la impregnacidn de cuestiones tan vitales para el progreso de nuestro pueblo; es la 
maestra, el factor poderoeo que contribuiri con su pr^ica constante y tenaz a la 
realizaci6n de la gran obra, que en ^poca no lejana nos pennitiri mostrar nuestra patiia 
como un modelo en el concierto univenal de las naciones. Ser& solamente por su 
inestimable concuiso que lograremoe alcanzar la perfecci6n obtenida en la actualidad 
por los suecos que ban hecho descender la mortaUdad iniantil a una ciira verdadera- 
mente ideal, vale decir, al 4 por ciento (40 por 1,000) de la natalidad. 

Es un pais joven, en formacidn conu> el nuestro, son mfiltiples las preocupaciones 
que solicitan intensa y urgentemente la atenci6n del estadista, necesitan por ello— 
tanto las instituciones, como los problemas vitales, como el que me ocupa— el esfuerzo 
individual, la tenacidad del luchador iniatigable, para que hecho came en el espfritu 
del pueblo, pueda merecer el apoyo eficaz y dedsivo del Gobiemo. 

Emprendamos pues la tarea y cuando hayamos aunado esfuerzos, orientado ten- 
dendas, maicado rumbos definitivoe, madurado en una palabra el problema, confiemos 
en que la aoddn ofidai se plasmaii en forma ticH y estable. 

iQae bagaje de conocimientos Ueva, hoy por hoy, al nuevo hogar la futura madre, 
por lo que a la higiene infantil se refiere? 

^Como inidaii el cuidado de su primer hi jo 7 

Ser4 f atalmente inevitable la acd6n perjudidal de su intervenddn en los menores 
actos, es entonces que empieza, todavla no siempre, a apreciar la necesidad del 
estudio de estos conocimientos y el provecho que su f&cil dominio le prestarfa, impi- 
diendo la aplicaci6n tan difundida de las mis detestables pr&cticas a que iiremiai- 
blemente tiene que conducirla la ignoranda de los preceptos dentfficos. 

Puedo afiimar satisfecho que con la perseverante visita de vosotras a este hospital 
suprimiremos una serie no escasa de sufrimientos y dolores a m&s de un nifio. 

Es de esta manera que cumpliremos la sabia mibdma de Emerson, es asf como 
protegeremos al nifio, fuerza latente que encieira tanta esperanza. 

Es practicando ampliamente que podi^ foimaros un ciiterio mds liberal y esca- 
par^ con seguiidad de caer en la rutina, tambi^n comprender^ que a veces puede 
uno distandarse un discrete trecho de la via que marcan los rumbos generales y asf 
por liltLmo aprenderds a reflexionar mds detenidamente sobre las mil cuestiones que 
tan diveisas ofrece la vida diacLa. 

Guidemos pues dentfficamente a los nifios, los continuadoies de nuestras obras, de 
esa masa espiritual en foimad6n saldr^ los artffices que perfecdonen nuestros cono- 
cimientos, ellos aliviar&n muchos males que todavf a pueden atacamoe. 

La nifiez proveeri los heroes de la accidn y el pensamiento. 

La nifiez resarciii con creces el mfnimo esfuezo que desarrollemos en su piotecci6n. 

Nifiez sangre de nuestra sangre, prolongaddn interrumpida de nuestra existencia 
que al iluminar su camino en la vida no hacemos m&s que conducimoe a nosotros 
mismoB. 



236 PBOOEEDINGS SECOND PAN AMEBIOAN SOIENTIFIO C0NGBES8. 

LA NOVOCAlNA GLiCERO-YODADA. 

Por JUAN D. SUSINI, 
ExrJefe IrUerino del Servieio Odontoldgieo del Departamento de Polida de Buenos Aire». 

introducci6n. 

Se puede soetener, con justicia, que eBt&n a nueetro alcance tma variedad de anee- 
t^sicos locales, que con mayor o menor 6xito vienen piestando grandee s^idcioe y 
llenando una alta misi6n en dentistica operatoria. 

Eetas Bubetancias agregadas a la t6cnica de las inyecciones, hacen que las opera- 
ciones en cirugfa dental sean cari indoloras o indoloras por complete en la mayorla 
de los cases. 

£1 perfeccionamiento credente de la anestesia en esta tiltdma d^cada, hace que 
nuestro trabajo sea complementado por el paciente que ya no llega a la clfnica con 
el temor y la excitaci6n de antafio, resignadb a sufrir un dolor realmente grande^ 
que ni la habilidad del operador ni la rapidez de la intervenci6n podfan evitar. 
Felizmente, hoy estos inconvenientes se hallan descartadoe en gran parte por la acci6n 
segura de los aneet^cos, y el enfermo, ayudado al grade de ilustraci6n general de 
la 6poca presente, se nos presenta casi siempre en un estado de inimo mis bien sereno 
confiado en su acci6n comprobada, salvo ese temor instintiyo al dolor, aumentado 
muchas voces por observar de cerca nuestros preparatives e instrumentos, y otras, 
raras por suerte, por consejos sin fundamento de ciertas personas pesunistas en cues- 
tiones de medicina. 

En poder de tan preciosos elementos, nos ha colocado en condidones de actuar con 
seguridad aiin en los casoe que antes eran de una dificultad absoluta. Y esa acci6n 
segura, por demis comprobada en la pr&ctica cientifica, va abriendo cada dia nuevoe 
horizontes en dentfstica operatoria, o mejor dicho, en el campo de U cirugfa en 
general. 

Prestando siempre preferente atend6n al estudio de la anestesia local, elemento 
precioso que complementa de una manera eficiente nuestras intervendones, he eetu- 
diado detenidamente la acci6n, ventajas e inconvenientes de las piindpales Bube- 
tancias en pr&ctica actualmente, y despu^ de muchas observadones clinicas, he 
utilizado una combinaci6n que por bus cualidades especiales, ha Uenado por completo 
mis aspiraciones de haUar una fdrmula que en los casos de extracci6n del 6rgano 
dentario a causa de periostitis alveolo^entaria, a la par que se obtenga con ella la 
anestesia local, posea una acd6n antis^ptica, a fin de ayudar de este mode al trata- 
miento post-operatorio. 

Los casos elf nicos ^ constatados que acompaf&an este trabajo demuestran un resultado 
altamente satiafectorio, que me ha decidido hacer esta comunicad6n. 

CONSIDBIULCIONBS 0BNB&ALB8. 

La periostitis alveolo-dentaria, puede ser originada por causa diversas: traumatismoe, 
aparatos de ortodoncia, cambios bruscos de temperatura en la boca, dep68itos de 
t&rtaro, restos de ruberdam o hilos de seda en el cuello de los dientes, absorcidn de 
substancias medicamentosas (dlusticos, deeinfectantes), mechas de algod6n abando- 
nadas en los canales, descomposici6n parcial o total de la pulpa, y en una palabra, toda 
infecd6n o irritaddn que ataque al perioetio alveolo-dentario. 

De miis eetd decir que con los medios que hoy posee la odontologfa, existen siempre 
muchas probabilidades de un tratamiento conservador; pero cuando la complicaci6n 
perii^stica es rebelde a todo tratamiento poniendo al digano dentario en la impoeibilidad 

1 La aplicaci6n de mi fdrmula fa6 beoha a un gran ntbnero de enlenuos, con ezoelentes resultados. S^lo 
aoompafio algunos casos detallados, que he considerado de verdadero interns clinioo. (£i Editor: Se 
somete un easo al fin como Uustrad6n del trabiUo.) 



FUBUO HEALTH AND MEDICINE. 237 

de segnir deeempefiando siu fundoneB ficnol^gicas y comprometiendo el estado general 
del paciente, la eztracddn esti indicada, mizime tratdndoae de rafcee. 

La extracci6n en tales casoe trae gian alivio al padente. Y se explica, ella es de- 
congeetionante, y la distenfli6n de las extremidades nenriosas por los vasos dilatados, 
desaparece. Esa decongesti^n en ttni6n de la acci6n anestMca, hacen que el padente 
se encuentre en pocos momentos en un estado de alivio complete y se retize tranquilo, 
contiastando con el estado en que se faaUaba momentos antes. 

Pero, generalmente, este alivio es moment^eo y el dolor aparoce de nuevo per- 
flistiendo por horas y muchas voces algdn dia. Por lo regular, los buches antis^pticoe 
y analgMcoe no act(ian como debieran en estos caaos obUgando a una medicad6n 
interna. En otros, m4s delicados, donde el proceso se ha abandonado, el dolor re- 
crudece, entra un malestar general que es &ivoreddo por la falta de alimentaci6n, 
insomnio, etc., aparece la fiebre y nos encontiamos en presenda de una infecci6n grave 
en la regi6n donde se ha hecho la eztracddn. 

lOvM es la causa efidente de esta persLstenda del dolor en la mayorla de los cases, 
y de la nueva infecci6n en otros? 

^G6mo es posible suponer, admitiendo que el padente haya seguido las presciip- 
dones del caao, que sea tan probable una nueva infecd6n, halUndose la herida bajo 
una acd6n antis^ptica regularmente continuada poniendo banera a la invasion 
microbiana? 

La decongestidn produce un alivio casi inmediato. Pero debemos tener presente 
que esdste una inlecd6n del periostio y que la hemonagia que produce la extracci6n 
no la hace desaparecer. Con el diente quitamos la causa de la infecd6n, pero Ma 
adn queda en el alveole. 

La extracci6n produce una herida grande, y esta herida abierta favorece el avance de 
la invasidn microbiana, que en oigamsmos debUitados, ya por la misma afecd6n, por 
una enfermedad general o una diitesis, la hacen inminente, m^xime si se tiene en 
caenta la septiddad del medio bucal. 

La acd6n fagodtaria del oiganismo, es de nuevo llamada a contianeetar la nueva 
infecci6n, y esa nueva reacddn inflamatoiia, ayudada al estado general de la regidn, 
produce al paciente ese dolor continuado de mayor o menor intensidad de acuerdo con 
el grade de la iuflamacuSn. 

De manera que lo indicado seria poner la herida en condiciones tales, que la reinfec- 
ci6n no pudiera realizarse inmediatamente; y que, complementado luego con los 
buches antis^pticos, est^ a cubierto de nuevas infecciones. 

En una palabra: preparar el terreno antes de producir la herida; escudar ese tejido 
debiHtado allf donde momentos despu^s estari en condiciones de ser vulnerable. 

El tratamiento preventive de poner tintura de yodo en el alveolo despu^ de la 
extracci<5n, como desinfectante y revulsivo, no llena el fin que se destina. Porque 
hay que tener presente que la tintura de yodo actda mal en un terrene hdmedo. La 
hemorragia, mucha o poca que sea, impide se depodte como debiera en el tejido, y 
que, unido a la saliva y a los buches que hace el paciente despu69 de la extracci6n, 
obstaculiza su acd6n a tal punto que su efecto desinfectante es Infimo. Y si ademis 
de esto se agrega el tiempo que pasa desde la extracci6n hasta el momento que el 
paciente se halle en posesidn del antis^ptico prescrito, vemos que transcurre un 
tiempo bastante apreciable que es bien aprovechado por los microiganismos que 
acttian sobre un punto debilitado. 

Y 6Bto siempre en el supuesto de personas aseadas que siguen las indicaciones de no 
tocarse la herida, no fumar, etc. 

En consecuenda, he creldo que es indispensable unir al anest^co, una substanda 
que sin neutralizar su acd6n, ayude al tratamiento post-operatorio, que despu^ de 
la extracci6n pueda defenderse de un nuevo ataque exterior, y en una palabra, como 
lo he dicho antes, que prepare el teireno antes de producirse la herida. 



238 PB0CEEDIN6S SECOND FAN AMERICAN SCIENTIFIO CONGBESS. 

Eso me ha induddo a agregar a la novocafna, la tintuia de yodo y la glicerina, qu e 
he denominado "Novocaina-glfcero-yodada, " solucidn que a la par de ser anest^ca, 
es revidsiva, deaiiifectante y ligeramente ciustica, y que llena ese fin, como proebau 
las observacionee clfnicas que acompaflo. 

La inyecciiSn se hace in aitu ' procuiando que ella Be deposite con preferenda en 
la regi6n afectada. La tintuia de yodo durante el tiempo que pasa antes que el 
anest^sico acttie, va esteiilizando el medio, cuya accidn es fadlitada gradas a la cons- 
tituci6n anat6mica del diploe, de modo que, cuando la anestesia se ha producido, el 
terrene se halla en condiciones de reeistir a una nueva iniecci6n deq>u^ de la 
extracci6n, pues gran parte del medio est& ligeramente cauterizado. 

La revulfli6n produce deconge8ti6n de los vaaos del peziostio, y en consecuencia 
menos dolor, por cuanto la irrLtaci6n de las extremidades nerviosas por los vasos dila- 
tadoB desaparece, y por tanto ayuda la acci6n del anestMco. 

La esterilizacidn que produce antes de la extracci6n, igualmente favorece, por 
cuanto la irritaci6n microbiana igualmente disminuye. Y por tiltimo, la cauteriza- 
cidn pone al tejido en condiciones favorables de no iniectarse despu^ de produciise 
la herida, que complementado con los buches desinfectantes, hacen un ambiente 
impropio para los microorganismos impidi^ndoles romper el equilibrio. 

Y si atin as! se produjera una nueva infecci6n, ella siempre ser& sin importancia, y 
el organismo eetar& en condiciones de contrarrestarla en una forma r&pida y segura. 

De ahf, entonces, que la inyecci6n a la par de ser anestMca, simplifica y forma 
parte del tratamiento al mismo tiempo que proporciona una seguiidad del resultado. 

En una palabra, la adici6n de la tintuia de yodo en la formula, ^vorece la acci6n 
del anest^sico, acttia como discrete hemost4tico, calma el dolor post-operatorio, 
dificulta una nueva infecci6n, &u;ilita la cicatrizacidn y es un tratamiento preventivo 
que importa ima seguridad para el tratamiento general. 

Y con esta nueva pr&ctica, la conciencia profesional eetar& en un grade tal de segu- 
ridad de su tratamiento, que le obliga a convencerse de que una complicaddn no sea 
probable, por haber tratado de esterilizar el medio, atin en personas despreocupadas, 
en los refractarios a los medicamentoe, en los desaseados, y en principal modo, en loe 
enfeimoB de las clfnicas ptiblicas. 

NOVOOAInA QlicSRO-TODADA. 

Esta 8oluci6n, como su tftulo lo expiesa, se halla compuesta de novocafna, tintuia 
de yodo y glicerina, y por consiguiente, como ya he indicado, es una 8oluci6n anes- 
t^co-revuhdvo-desinf ectante y ligeramente c&ustica y hemostitica. 

Los componentes entre si no neutralizan las cualidades que aisladamente poseen 
cada imo de ellos, y su combinaci6n forma un Ifquido trasparente de color amarillooro. 

Quiz^ podrla suponerse que esta 8oluci6n fuera dolorosa por el alcohol de la tintuia 
de iodo y por la misma acci6n cdustica del yodo, pero los casos observados me hacen 
ll^;ar a la conclusi6n que no sdlo no es dolorosa sine que el x>oder de la novocafna no 
ha disminuido. Quiz^ su poder anest^co sea sensiblemente menor por hallarse en 
disoluci6n a las dos substancias, cuyo tftulo de la 8oluci6n de la novocafna, es por 
tanto menor del inicial, pero adn cuando pueda existir esta diminuddn del poder 
anest^eico, su accidn es completa y suficiente paza el fin que se destLna la novocafna- 
glfcero-yodada. 

Como se ve, los componentes son bien conocidos y estudiados, y tal vez parecerfa 
de mia una deecripci6n de ellas recordando sua cualidades e indicaciones, pero sin 
embargo, he crefdo del caso recordarlas de paso y someramente por ocupar en terapia 
un lugar preferente. Novocafna es un cloridrato de paramino-benzoil-etil-amino- 
etanol, ha sido descubierta por Einhom en 1904, es uno de loe anest^cos miu3 impor- 
tantes que hoy se posee, y lo demuestra de una manera concluyente el gran campo 

1 Bin embargo, en varios casos, la inyecddn la he hecho subperitetica, gingtval, con buen resultado. 



PUBLIC HEALTH AND MEDICINE. 239 

que logT6 abiiise en cirugfa, que en un lapso de tiempo relativamente corto, las 
experiencias clhiicas ban demostrado su bondad a taL grado de dejar en un orden 
secundario no o6lo a otroe anest^icos, sino hasta a la misma cocaina. Su poca toxi- 
cidad, 8U f&dl eBterilizaci6n ain que sue cualidades ae alteren, su poder aneetMco 
comprobado, que para algunos quiz^ sea igusX al de la cocaina, unidae a sub escaeas 
contraindicacionee, son condiciones por si solas elocuentes. 

Por eso se ba visto en breve tiempo ser el anestMco preferido, no s61o en dentistica 
operatoria, sino tambi^ en cirugla general, donde basta citar aparte de los reeultadoa 
tan halagikefios en la raquinovocainizaci6n en los hospitales de Buenos Aires, ^ y IO0 
importantes trabajos de Sonnenburg (de Berlin), del Prof. Beclus de la Facultad de 
Paris, de Barker (de Londres), de Pringle (de Glasgow), de Kununell (de Hambuigo), 
etc., y por Ultimo la opini6n del Prof. Reynier emitida en la Facultad de Medidna de 
Paris, en que expresa bus condiciones de eeta manera: ''La be comparado con otroe 
anestMcos tales como la cocaina, la estovaina, la nirvanina y la eucaina. Esta 
comparaci6n ha sido favorable para la novocaina, pues reune, en efecto, las cuali- 
dades que, segtin Braun, debe poseer un buen anest^aico.'" 

En dentistica, su uso es general; su eficada y buenas cualidades la hacen indicada 
en todos los casos. 

PeiBonalmente he tenido oportunidad de observar bus buenos resultados en nuestn 
facultad de medidna por nuestro maes&o, Dr. Nicasio Etchepareborda en las inyec- 
ciones dipldicas. La anestesia se produce dentro de un promedio de 5 minutos mis 
o menos' cuya duraci6n es en algunos casoa basta 20 minutos, oper4ndose completa- 
mente sin dolor y ain observarse en loe muchos casos he presendado en la clinica, 
intervenidos por mi maestro, ningtin caso de slncope ni fracaso. 

Igualmente, en el curso de mi distinguido maestro Dr. Le6n Pereira, se utiliza en 
las extracdonee la novocaina como anest^co local, con excelentes resultados. 

Respecto del yodo (tintura) su uso es universal en medidna y toda ponderad6n que 
se haga de este metaloide seila de m6B. 

Miquel ha demostrado de una manera concluyente su valor como desinfectante; es 
revulaivo, cdustico y antiptitrido. Su acci6n es en superfide y no en profundidad. 

Como desinfectante en drugf a mayor y espedalmente en cirugia, se ha comprobado 
SUB cualidades del todo inmejorables. 

El tf tulo de la solud6n de la tintura de yodo usada en la combinad6n, es la del 
Codex Argentine o sea 1/12. 

En cuanto a las inyecciones de yodo, el oiganismo las soporta muy bien, dentro 
de la doflis de la 80lud6n que uso. Segtin las experiencias de BOhm, un hombre de 
70 kilogramos puede soportar sin acddentes la inyecd6n en la sangre de 1^ a 2 gramos 
de yodo libre. Si bien se ban registrado fracases en operadones que se ban querido 
tratar con inyecciones de yodo, se debe tener presente que las canddades inyectadas 
eran muy grandes. Ya se observaron 35 casos de muerte a consecuenda de estas 

I Enrlqne P. Bagnati. Contribuci6n al estadio de la raquinoyocalnlxaci^n en cirugla. Dr. Leopokio 
Bard (1907-8); Dr. Jos6 Aroe en 1909 (Congreso de Medicina de Rio Janeiro); Dr. Emilio Dlax Arano (tesis 
1913) haoe una estadistics de las anestesias realixadas en el Hospital Italiano desde 1904 hasta 1913, en donde 
se ye que hasta 1904 eldoroformo se usaba como anest^sicoen una proporcldn de 92.83 por ciento del total de 
las intervenoiones, y la raquinovocainiiacldn en el primer scmestre de 1913 Uevaba un porcentaje 67.87 por 
ciento, mlentras que la raqulnovocainlzaddn en 1907 era sdlo de 8.06 porcitnto. Por tiltinoo el Dr. C. C. 
Bagnati (tesis 1913) en su estadistics declara que en 4,200 operaeiones practicadas desde 1911 a 1913 en el 
Hospital Italiano, en 2,400 se nsd como anest^co la novocaina; y termlna xnanllestando que ''entre las 
4,200 intervenciones las hay desde la m^ pequefia hasta la mis alta cirugla. " 

Eusebio Albina (revista C. E. Medicina y C. M. Argentine, agosto, 1914), en su trabajo tilulado la novo- 
caina en la cirugla del cuello, mendona entre otros casos, uno operado por el Dr. l^alnr a en el Hospital San 
Roque, y se trataba de un sujeto que tenia un tumor de los ganglioe de la cadena carotldea derecha. Dicha 
persona, de 63 afios de edad, era un ''arterio-esclcroso, con insuficienda adrtica mal compensada, pucs 
acababa de sallr de un ataque asistdlloo." La anestesia fu6 hecha localmente con novocaina, con ez- 
oelente resultado. 

> E. P. Bagantl. Contrlbuddn al estudio de la raquinovocainiuiddn en cirugla. 

* Casos en que me fu6 indicada la observaddn por nd profesor (1912). 



240 PBOGEEDINGS SECOND PAN AMEBICAN SGIENTIFIO C0NGBE88. 

inyecciones, dice Nothnagel y Rossbach, y en el mayor ntimero de estos acddentes 
deben ser atribuf dos a las inyecciones hechas de una manera imprudente. > Y refiri^- 
dose al caso de Roee, atin no bien aclarado, continda diciendo, que es Men diffdl 
atribuir el fiacaso dnicamente a la acci6n del yodo a. se admite con Boinet que 200 
grainos de yodo pueden ser inyectados sin peligro en los quistes del ovario, es decir, 
en el organismo. 

De manera que la cantidad de yodo que se usa en la 8oluci6n anestMca que presento 
no puede producir ningtin accidente consecutivo local o general. 

Olicerina. — ^He agregado esta substancia a la f6rmula, como un suavizante a fin de 
evitar un pequefio ardor que he observado despu^s de la desax)a]ici6n de la accidn 
anest^ca de la novocalna y que considero es debida & la acci6n dLustica de la tintuia 
de iodo. La adicl6n de la glicerina para este fin es excelente, conigiendo ese defecto 
y aportando adem^ a la formula sub cuatidades antipdtridas y ligeramente desinfec- 
tantes. 

Como se sabe, la glicerina como cuerpo neutro que es, no modifica en absoluto la 
acci6n de los otroe dos componentes, que, per el contrario, tiende a favorecer su re- 
sultado. 

Bitio de la %nyecei6n. — ^Ella debe ser con preferencia dipldica, pero sin embargo, 
la he hecho subperi6stica y gingival, con buenos resultados. 

La inyecci6n debe ser lenta, lo que da lugar a que puede actuar progresivamente 
con escaso dolor, pues si se hace con rapides podria resultar dolorosa. 

Antes de la trepanaci6n de la tabla 6sea, si fuera dipl6ica, para la desihleccidn de 
la mucosa y anestesia, como tambi^n si fuera subperi68tica o gingival, he usado la solu- 
ci6n clorof6rmica de yodo como lo aconseja Ghaasevant, por ser inalterable.' 

Se seca bien la encfa y luego se embroca el punto a trepanar. 

Este procedimiento bi6 aconsejado igualmente por el Dr. Texo, quien manlfestaba 
que con 61 se evitaria anastrar elementos s^pticos con la aguja. Cod, este agente, dice, 
cuintos procesos infiamatorioe y dolores post-operatorioe se evitarfan, atribuldos a 
otras inocentes causas. ' ' * 

F6rmida, — ^La formula de la novoecAna^licenhiodaday es la siguiente: 

Sol . Novocaf na al2^ Ogr.50. 

Glicerina neutra para gr. 50. 

Tintura deyodo t A <^o 9^^* 

(Para una ampoUa:) 

En esta proporci6n resulta una solucidn completamente If mpida de color amarillo-oro. 
Si se aumentara la cantidad del yodo, aunque en pequefia cantidad, la solucidn se 
enturbia y se precipita. La f6rmula citada es estable y no se altera. 

CONCLT7SI6n. 

Como he dicho, la inyecci6n debe ser in situ, y por eso es preferible que sea intra, o sea 
para que actde alll donde la afecci6n est^ localizada o procurando que abarque gran 
parte de ese medio (gingLval o subperi<56tica). 

El yodo es revulsive; de manera que la congestion sangufnea va desapareciendo por 
su acci6n, lo que trae por consecuenda una diminuci6n de dolor, por cuanto la disten- 
sidn de las extremidades nerviosas i>or los vasos dilatados, es menor; conjuntamente 
a su acci6n revulsiva, es desinfectante poderoso y duistico, de manera que comienza 
a esterilizar el medio cauteriz&ndolo levemente, teniendo presente la cantidad em- 
pleada en la soluci6n. 

1 Nothnagel y Rossbach: Matltee mMicale et tbfirapeutlque, p. 262. 
s Monde rnddical, No. 300, p. 957 
* La odontoloxia, No. 4, p. 280. 



PUBUO HEALTH AND MBDIdNB. 241 

De modo que por de pronto ataca las causas de la inflamaci6n. mientras se eepera la 
actuacidn del anest^co, cuya accidn favorece grandemente, pues precisamente son 
ellas las causas que por lo regular le impiden actuar como debiera. 

Esta acci6n revulsiva, oen una palabra, vaso-constrictora, es durable. Cuando la 
anesteaia se produce y se procede a la extracci6n del 6tgano dentario, la hemorragia 
es poca generalmente. 

La iaquemia se mantiene despu^s por largo rato. 

A primera vista podriase suponer que esta propiedad sea debida dnicamente al 
anest^co, pero tedricamente se comprende y pr&cticamente lo he comprobado, que 
gran parte de esta acci6n es debida al yodo, que si bien al principio su ef ecto es ocultado 
por el anest^co, la falta de ese dolor post-operatorio caracterfstico, cuando la anestesia 
ha desaparecido y la hemorragia inaignificante casi siempre, prueban de una manera 
evidente su importante acci^n complementadora al anest^co y al tratamiento conse- 
cutivo de la periostitis. 

La glicerina favorece la acci6n conjunta de una manera apredable as^gurando el 
resultado de la formula. 

Si se observa el alveole y encla de un diente, unas horas despu6s de extraido, vemos 
que se hallan en un estado que indica hallarse en camino de cicatrizaci6n. Esta 
observaciiSn la he hecho en todos los cases intervenidos, en algunos de ellos con colec- 
ci6n purulenta, y en la mayorfa personas especfficas, cardio-renales, enfermos del 
hfgado, etc. 

El complementar el tratandento poniendo tintura de yodo en el alveole despu^s de 
la extracci6n y la prescripci6n de buches antis^pticoe y analg^ricos, son precauciones 
indispensables para coadyuvar al tratamiento. Sin embargo, en muchos cases he 
prescindido de esto, en personas desaseadas (como lo son gran parte de las que he 
tratado teniendo presente su condici6n social y el ambiente en que se hallan), unos 
por experiencia y otros porque estaba convencido de que no s^guirfan las indicaciones, 
la cicatrizaci6n fu6 completa y sin inconvenientes, ^icamente mis lenta y el dolor 
desaparecid menos rdpidamente que con los buches arriba citados. 

Por consiguiente, la soluci6n cuya f6rmula me permito presentar, Uena el fin que 
me he propuesto, de tener s^uridad y abreviar el tratamiento poniendo al paciente 
dentro de lo posible, al abrigo de complicaciones que a causa de la extracci6n puedan 
ocurrir, muchas voces debida a ignoranda, males consejos, pobreza, falta de comodi- 
dad o una infecci6n a que se halla expuesta toda herida abierta con el agravante que 
ya tuvo una por la periostitiB y que es probable otra, no s61o por ser un punto debili- 
tado no por falta de higiene, sine por el medio ambiente en que se encuentra localizada. 

La esterilizacidn se hace en forma completa gradas a la disposici^n anat6mica del 
diploe, y si bien el If quido inyectado podr& ir m^ alU del sitio deseado, no importa 
una dificultad y resulta mia bien una precauci6n que felizmente noe facilita su consti- 
tuddn aerolar. Pero aparte de esto, la inyecci6n nunca podr& abarcar una regi6n 
muy extensa dada la cantidad inyectada (1 giamo), pero suficiente para toda pre- 
visi6n« 

En cuanto a la cantidad de tintura de yodo utilisada en la solucidn anestMca que 
aconsejo, es muy suficiente para esterilizar ese medio en una forma completa y si 
tenemoB presente que Miquel con b61o gr. 25 eBteriliz6 un liizo de caldo de cultivo, 
no hay duda alguna que una cantidad propordonal, eaterilizari bien y completamente 
un centfmetro ctibico, si asf se me permite cakular el espacio del medio a esterilizar 
en una periostitis alveole dentaria. 

Con esto termino este breve trabajo, y contindo extendiendo mis observacioneB 
en otros cases de medicina general, los que, si bien inidados, la falta de tiempo me 
impide incluir en el presente. 

Y con esta pr&ctica, no dudo se podii soetener una vez mis el tan lacional af orismo 
que dice: VaU md» prevewir gue curar errf'ermk^ 



242 PB0GEEDIN6S SECONp PAN AMERICAN SCIENTIFIC CONGRESS. 

PouclA DS BusNos Aires, Capital Fxdbral— Diyisi6n Sakidad. 

EI que susciibe Jere de la DivisLdn Sanldad del Departamento de Policfa de la Capital, autorlca al Dentista 

Don Juan D. Susini para que hagA las aplicaclones de la solocidn " Novocainthfflieenhfodada" en el Gonsolto- 

rio Odontoldgico de este Departamento, a fin de que el pexsonal de osta oflcina compruebe la eficacia del 

medioamento, que ha sido, por olTa parte, debidamente analisado en la Seoci6n Qulmica de esta Division. 

Buenos Aires, Oetubre de 1914. 

(Fiimado) F. C. Babraxa. 

ORaERYAaON Tercbra. 
Fecha: Octubre 9 de 1914. 

Nombre: M. R. 

Edad: 26 afios. 

Ocupacidn: Agente de pollda. 

-Apariencia general: Hombre bien formado; buen desarrollo esqueldtico y muscular. 

Anteoedentes hereditarios 7 personates: Sin Importancia. 

Estado de la boca: En buenas condiciones. 

Diagndstiioo: Periostitis alyeoknlontaria producida por raSoes de la segunda molar inferior Izquierda. 

Tratamiento: Eztraocidn previa anestesia oon novocalna-gUbero-yodada.' 

Inyeooidn: Gingival. 

Cantidad de anestdsioo empleado: 2 centlmetros cAbioos. 

Tiempo en que se produjo la anestesia: Un i)ooo mUs de un minuto. 

Duracidn de la anestesia: Dos mlnutos y medio. 

Resultado: Satis&ctorio. Aousd poco dolor a pesar de ser una extraocidn laboriosa. No hubo mareos nl 
malestar. Se retira bien del oonsultorio. 

Revtsado: A los tres dias. Durante ese plaso tuvo un poco de dolor, pero un dolor muy soportablei 

En la feoha de la revisadtfn, easi ha desaparecido. Herida en vfas de eicatrlzacidn completa. 

Comprobado: 

(Flrmado) Juuo Tello, 

DenMa da Departamento. 



LOS DISPENSARIOS PARA LACTANTES (GOTAS DE LECHE) COMO MEDIO 

PARA DISMINUm LA MORTALIDAD INFANTIL. 

Por JULIO A. BAUZA, 
Director del ConsuUcrio Oota de Leehe No. 1, de Montevideo Uruguay. 

El criterio casi nniliiimo de Iob que estudian loa medios pii&cticoB para diBinintrir 
la mortalidad in! antil, cooflidera a los DiBpensarioB para Lactantes (Gotaade Leche) como 
un baluarte que la modema civili£aci6n opone al ciecimiento de la mortalidad iulantil de 
los doe primeros aflo6, cuya tendenda a piogresar en algunos paiaee y ciudadee ha dado la 
voz de alarma, por cuanto, por sii contribucidn a la mortalidad general ha resultado la 
existencia de ciudades con crecimiento negativo caai nulo (Paris) o negative (Santiago, 
Valpaiaiso). 

£1 movimiento emprendido en todos los paisee de civilizacddn superior en defensa 
del nino ha dado resultados indiscutibleB en los (iltimoB 10 afios, habi^ndoee produddo 
casi universalmente un descenso en la mortalidad en el primer afio, que llega en 
algunos paises hasta caai un 50 por ciento. 

El Uruguay no podia quedar rezagado en este sentido y gracias al apoyo prestado 
por el superior Gk>biemo, pudo la Asistencia Ptiblica, abrir el primer Oonsultorio Gota 
de Leche a principios del afio 1908 en la ciudad de Montevideo. Hasta fin del afio 1913, 
se hablan aaistido en este Gonsultorio 7,000 nifioe diferentes, habi^ndose distcibuido 
600,000 litros de leche y gastado 77,000 010 (d61ares). Desde 1914, aiete Gonaultorios 
diiigido cada uno de ellos por un m6dico especialista se hallan repartidos en distintas 
sonas de la ciudad, correqsondiendo a un consultorio por cada 50,000 habitantes. 
Aun cuando la mortalidad inf antil en el Uruguay no es muy elevada en Montevideo, 
11.5 por ciento nacidos vivos, no debe olvldarse que teniendo en cuenta que la alimen- 
taci6n natural es la m^ difundida, repreaenta esa cifra un coeficiente bastante elevado 
y que podr& ser reducido a 7 u 8 por ciento en un porvenir no lejano. 



PUBUO HEALTH AKD MBDIOIKE. 248 

Ba indudable que los DiBpenuarios para Lactamtes, cuando eet&a bien dirigidos, y 
cuando se emplean todoe los medioe de propaganda posibles, conferencias, concuiaoa 
con premioe en dinero etc., contribuyen poderoflamente a dilundir la conveniencia 
de la lactancia natural y a prevenir loe peligros de la alimentadon artificial. 

La mejor demoetracidn de c6mo con pocos recureoe pueden conaeguirse buenoe reeulta- 
doe, la tenemos en el hecho de que si se compara el n6mero de nifios ingresados 
alimentados a pecho en 1908 y en 1914 en la Gota de Leche No. 1 a mi cargo, se 
observa que se ha triplicado la proporci6n de los nifios nutridos ezelusivamente por 
seoo matemo en el afio 1914, en reladdn a 1908. £ste resultado lo atribuyo al estf- 
mulo que repreeentan los concursos mensuales para nifios a pecho, los que inducen 
a las madres pobres a inscribir a sus pequefios en el Gonsultorio desde los primeios 
meses, consigui^ndose asf dirigir y prolongar en lo posible la lactancia natural, 
sustituyendo el m6dico a la madre en la direcci6n de la crianza del nifio. 

Es indispensable para conseguir un buen resultado, que el Dispensario para lao- 
tantes posea tambi^n la seccidn Grota de Leche, es dedr que est6 en condidones de 
siuninistrar diariamente leche esterilizada o leches espedales, para completar la 
alimentaci6n a pecho o para suatituirla en Ice cases en que esta no sea posible. 

Es naturalmente ventajoso que sea siempre el mismo m^ico, el que atienda a las 
madres y haga las prescripciones para cada case; de esta manera se gana mis i&dl- 
mente la confianza de las madres, que ven en el m^ico que atiende siempre a su 
hijo, a la persona mis indicada para dirigir su credmiento o jMura mejorarlo en caso 
de enfermedad. 

^Son polidinicas las Qotu de Leche? Es indudable que originindose buen ndmero 
de enfermedades, por defectos de alimentaci6n en cantidad o en calidad, y siendo 
igualmente dertos trastomos digestives del nifio secundarios a otra enfermedad para 
intestinal, nadie estd mis indicado que el m6dico del Dispensario para indicar el- 
g6nero de alimentad6n mis conveniente en cada caso; por consiguiente los Dispen- 
saiios para lactantes, deben ser conddeiados como verdaderas pdicUnicas. 

Gonsiderindolo asf , se comprenderi fidlmente que la promiscuidad de nifios sanos 
y enfermos en un mismo local no esti libie de inconvenientes. La trasmisidn de 
enfermedades contagiosas, mientras madres y nifios est&n en la sala de eepera no sdlo 
es posible, sine que es muy probable. ^Gdmo podria salvazse este inconveniente? 
Lo mis prictico a nuestro modo de ver, es sefialar dfas diferentee en la semana para 
nifios sanos y para enfermos. Este procedimiento, que hace poco se ha puesto en pr&c- 
tica en el consultorio a mi caigo, si bien adolece de algdn inconveniente, habitda 
a las madres a la disdplina, y ofrece ventajas indiscutibles en locales cuy 
in8talaci6n no es completamente adecuada. Por lo pronto se eliminan de los dias 
destinados a nifios sanos los enfermos con tos convulsa, sarampi6n, varicela, asf 
como la mayor parte de los enfermos agudos. Las madres que desen consuitar para 
enfermos en los dfas de los sanos, son objeto de un interrogatorio minudoeo y son 
aialadas en caso de sospediarse una enfermedad contagiosa. 

En los dfas destinados a nifios enfermos, las madres son interrogadas sobre el objeto 
de la vidta y aisladas en una pieza espedal, si sus nifios tienen alguna enfermedad 
trasmisible. 

Como consecuencia de las consideraciones presentee, se comprenderi que es neoesa- 
ria una instalacidn as^ptica y ficilmente desinfectable, como una policlf nica de un 
hospital de nifios. Una enfermera competente deberi interrogar a las madres a la 
entrada, antes de pasar a la sala de pesadas y a la de espera; en los casos en que el- 
nifio presente sfntomas de una enfermedad trasmirible resolveri su aislamiento y 
en caso de duda requeriri la opinidn del medico. La sala de aislamiento debei^ 
estar dividida en varies "box," separados por tabiques vidrieras. 

Consideramos innecesario insistir sobre la necesidad de que estos establedmientos 
estin dotados de calefacddn en todas sus secciones, para evitar el efecto pemicioso 
del frf o, espedahnente en la pesada y en la consulta. 

68436— 17— VOL ix 17 



244 PSOOEEDIKOS BEGOKD PAN AlCEBICAN 8G1ENTIFIG CONGBB88. 

No menos 6tQ serfa igualiiiente la iiiBtalaci^n de una Becci6n de l>afio8 para nifica ] 

y madies, dado que muduM madres no cuinplen con esta reg^ higiWca por no dis. 
poner de una in0talaci6n adecoada. Ann cuando no ee tan frecuente su inobservancia 
en los njfioB, serfa ventajoso una instaladdn pan elloe. 

Tunbi6n seiiade suma neoesidad Iain0talaci6n de una pequefia fuente, que suminio- 
tre agua pan beber a las nuulres que lo deseen, lo que paaa muy frecuentementa en 
lot diae caluroaos del venno. £1 agua debe poder bebene al suigir dd surtidor en 
fonna de napa diiectamente ain xequerir lecipiente de witi gima. dase. 

OOOINA DS LB0RS8. 

W La oodna pan la elabond6n y e8terilizad6n de la leche es la Becd6n nUb impor. 
tante del Gonsultorio; eUa reemplasa al eeno matemo y es superfluo dedr que cons- 
tituye el conite del dJapenfluio, ya que es la encaigada de nutrir a centenares de 
nifioe. En Montevideo la oodna centnl de ledies se halla ^n«*a^i«ii^ en d Goneultoiio 
N® 1, y en ella ae piepann laa ledies pan los nete consultorioe. Su inntalackSn 
comprende variasaecdones. 

1®. Manipulaei6n de la Uthe eruda. 

El local que le esti deetinado pos^e apantos pan filtnddn de la leche, enfriamiento 
a 4 o 6 gnudoe mediante una mAquina enfriadon en la que ae utiliza una mesda 
frigorflica de hielo y aal y una llenadon automitica que puede llenar aimulttoeamente 
doce botellafl haata de un litro. El derreea por medio dediacoadecartdnpanfinado. 
Eata aecd6n fundona ado en verano, puea no ae condden neoeaario uaaria todo d alio. 

2^. Preparaei&n de ledies espedalee. 

En eata aeccidn ae hace la preparacl6n de la leche eaterilisada, Bauberre, Sopa de 

Malta, Leche Deacremada, Pcgninizada etc., que ae emplean en la alimentaddn de loe 

niiloa chicoa o enfennoa. Comprende: 1^, una codna a vapor, con doa recipientea de 

10 y 20 litroe de capaddad reepectivamente y que airve pan preparar aopa de malta; 

2®, un aponto mezclador, pan preparar laa diatintaa dilucionea y en comunicacidn 

con un Uenador autom&tico de fnacoa; 3®, un autoclave, en el cual ae colocan los 

frascosdespu^dellenos panseresterilizadosa 104ol06^ por 15 minutos; 4®, de una 

batea en la que los frascos son enfriadoe despu^ de una esterilizaci6n, por agua, pul. 

Yeriaada por medio de un apanto especial; 5®, de una desnatadon, utiliaada para 

obtener la leche deacremada, que ha de uaane aola o que ha de emplearae pan la 

obtencidn del Babeurre, dejibidola agriar y agr^g^ndole 12 grunoa de haiina y 40 de 

asdcar por litro. 

3^. Limpiega defrascoe y hoteUoi. 

Los iraacos aon lavadoe con agua caliente y aoda, y deapu^ aometidoa a la accidn de 
cepiUoa intemos y eztemoa; fiyifiSyAnHftMi con enjuagadoe por un chorro de agua fria. 
La miquina lavadon ea movida por un pequefio electromotor. La peraona que tnbaja 
en eata swd^ no interviene pan nada, en la prepsracidn de laa lechea. 

4^. Oenerador de vapor. 

Con dicho genendor ae auministn vapor de agua pan el autoclave y cocina, ad- 
mismo agua caliente pan la limpiesa de frascoa y dtilea. 

Finalmente, se dispone tambi^ de un pequefio laboratorio en d cual ae hace el 
aniUiaia diario de la leche ledbida pan reconocer au puresa. Sirve tambi^ pan el 
^am^pn qulmico, hematoldgico y bacterioldgico de loa caaoa de la policlfnica. 

LA LBOHS. 

Pan que todo el engranaje funcione amuSnicamente, ea neceaario que todo ek 
penonal cumpla au ob]igaci<$n con la mayor eacrupuloddad, coea que ae ha con- 
«guido deapu^ de varies afios de prtetica. Ahon bien, pan que el resnltado se ponga 
de manifiesto, en lo referente a la salud de los nifios que toman el alimento prepaiado 



PUBLIC HEALTH AKD MEDIOINB. 2^5 

en la cocina de leches, ee indiflpensable que la materia prima, es declr, al leche, sea de 
caUdad Ixrepiochable. Este es el gran problema, de diffcil Boluci<5n, que atin no ha 
sido reraelto en el Oonsultorio Qota de Leche N^ 1, a mi cargo. 

IRe imposible, que una leche que contiene millones de g^rmenes por cent cub., no 
sea peijudicial para ioe nifios d^biles o convalecientes, aun cuando sea hervida o esteri- 
lizada antes de ser utilizada. 

Es indudable que si no exclusivamente, jMr lo menoe en gran parte es esta la causae 
de la excesiva mortalidad infantil en los meses de verano. La leche se recibe en la 
Qeta de Leche N** 1, despu^ de 12 o 14 horas de ordefiada; los tarros de leche que 
llegan a la ciudad, deben permanecer varias horas caldeados por el sol de verano 
hasta la llegada del tren que los ha de conducir a Montevideo. A pesar de la propa- 
ganda que se ha hecho, no se ha conseguido at&n emplear vagones frigorificos. No debe 
eztrafiane por tanto que ciertos dlas U^ue la leche tan alterada que no pueda ser 
utHizada para la alimentaci6n de los nifios. 

Gomo se comprendeWL, este hecho, aun cuando no se produce frecuentemente, 
trastoma profundamente el prestigio de la Instituci6n y desorienta a las madres que no 
saben qu^ alimentacidn deben emplear. 

Opino que en estos casos, serfa preferible, durante los meses de verano, suprimir el 
reparto de leche a los Dispcoisarios y entregar a las madres gratis, o a precios reducidos, 
bonos por la cantidad de leche necesaria para adquiiirla en las vaquerfas o lecherfas. 
higi^nicaa debidamante controladas. 

CUNA TBMPORAJUA. 



Desde que Marbeau fund6 en Paris el afio 1844 la primera Casa Cuna hasta la 6poca 
actual, su ndmero ha ido aumentando tipidamente, hasta el pimto de contarse ix>r 
centenares en Francia, Alemania, Italia, Estados Unidos, B^lgica, etc. Su existenciar 
estA justificada por la necesidad imperiosa de trabajar, de las madres que no poeeen 
recuiBos suficientes, sea por enfermedades o fallecimiento del marido, por abandono a 
por insuficiencia de aalario, etc. En una palabra, su necesidad est4 justificada por la 
miseria. No siempre la madre puede obtener trabajo, de realizar en su habitaci6n af 
lado de su hijo. Muchas voces tendiA que procuribnelo fuera de ella, en f&bricas <y 
talleres, o como criada. En estos casos, iqu6 se hace del nlfio?; o bien la madre lo* 
depoflitaen el Asilo de Nifios, y las mibs de las voces lo olvida, o bien si no tiene alguna 
peiBona de la lamilia que pueda cuidar de 61, lo entregar& a una mujer a quien deber6 
abonar la casi totatidad de su jomal para que lo cuide y alimente: el resultado es 
deplorable en la inmensa mayorfa de los casos. 

Ahora bien, si la madre sabe que su hijo puede ser alimentado y cuidado bajo el 
control medico en el Oonsultorio Qota de Leche, su elecci6n no seri dudoea: lo pre- 
feanrA por las ventajas de todo orden que le ofrece. Si el nifio esti a pecho, dste no le 
serA suprimido. El mWco se esforzari para que la madre siga amamantando a so 
hijo, y eventualmente se "podri conseguir vaya a medio dfa a darle el seno, ofrecito- 
doaele a ser posible, como en ciertas Ounas de Norte America la comida de medio cEfa. 
Durante la permanencia del nifio en la Cuna s61o nece8itar& dos biberones de ledie y 
una comida ligera, si se trata de nifios mis crecidos. 

No han ftdtado tampoco en este caso, criterioe que se oponen a la instalacidn de las 
Cunas. Se ha dicfao en primer t^imino que favorecen el desarrollo de enfennedadiBS 
contttgiosBS. l^lsto puede ser cierto, para los casos en los que la admisi6n se hace sin 
control: no es el caso cuando el medico ezamina diariamente a los nifios a su entrada, 
impidiendo el ingreso de los contagiosos. Una enfermera competente puede, sin 
inconveniente, reemplasar al m^co a la hora de ingreso. Adem&s, entendemos que 
la Cuna debe disponer de una secci6n de bafios, en la cual todo nifio al ingresar es 
bafiado y sus ropas son reemplazadas por las que ha de llevar mientras est^ en ella. 
D^gasenoe ahora si no eetSk en mayor peligro de adquirir alguna enfermedad contagiosa 
en la prosmicuidad del inquilinato, que en un local queposea las condiciones mencio- 



246 PBOCEEDINOS SECOND PAK AMERICAN SCIENTIFIC C0NGBE88. 

nadas. Se ha dicho tambi6n que la separad^n aunque aea temporaria durante las 
horas del dia, de la madre para con su hijo, afloja loe vfnculos matemalea. No ea eate 
nueetro modo de penaar. La madre verti todoa loa dlas a bu hijo al retizarlo y apre- 
ciaiA 8U0 progresos, su crecimiento y su inteligencia; a medida que ei tiempo traacuxra 
aumentar^ los lazes de carifio que la vinculan a su hijo: su abandono en el aoilo ea 
poco menoe que imposible. 

Otra ventaja existiifa en la anezi6n de una "Cuna" a la Gota de Leche. Los dlas 
de fiesta en loe que la nuidre puede conservar a su pequefio todo el dia a su lado, red- 
biria la ledie preparada a la que el nifto est& habituado: se evitarfa as( que el nifio 
saiga de la Cuna sano, un s&bado, e ingrese enfermo el lunes siguiente, hedio com- 
probado en mudias Cunas y que estertliza a voces la labor de toda la semana. 

Otra objeci6n que se hace fitecuentemente, es su costo relativamente elevado. 
Hasta se ha pretendido que serfa mte convenlente abonar un jomal a la madre, 7 
«vitar asf el ingreso del nifio. Si bien esta objed6n puede tener cierto valor, y aun 
cuando ee derto que las Cunas pueden resultar costosas en Eun^pa, 1 fr. 60 a 2 irancos 
por nifio y por dIa, debe tenerse en cuenta, que por ellas la madre aprende a querer y 
a cuidar bien a su hijo, atendiendo los consejos de la enfermera. 

CimSOa DB PUBBIGUITUKA.. 

Son de importancia cada vez mayor para la instrucd6n popular que las madrea 
adquieren dla por dla, loe cursos de puericultura instalados con tanto ^to en Estadoa 
Unidos, Franda, Alemania y otros paises. 

La ignoranda y los prejuidos de las madres son las causas de gran n6mero de 
enfennedades del nifio. Este es un hecho que no necesita demostrad^n. No cabe 
ninguna duda de que como conaecuencia de ello, la mortalidad inlantil es ToJm 
elevada de lo que seria, si la instruccidn de la maaa popular fuese m&s avanaada de 
to que es en realidad. La casi totalidad de las madres de la claae social inferior, 
atribuyen la mayor parte de las enfennedades del nifio a la salida de los dientes. La 
bronquitis, lo miamo que la gastro-enteritis, son atribuidos a que el nifio eeH echando 
los dientes y antes de que el medico las interrogue, se apresuran a dedr que vienen a 
consultar p<»que el nifio esti enfermo a coosecuencia de la dentiddn; y como conae- 
cuenda de ello, la madre no consulta sine cuando ve que su nifio esti cmfermo grave- 
mente. En muchos cases, la intervenddn m^ca se efect^a tardiamente con le* 
sultados desfavorables a veces^ o consigui^ndoae la mejorfa deq[>u^ de mucho tiempo 
y fatiga de parte de la madre, quien se la hubiese ahoirado si hubiera practicado 
la maxima, de que es mejor y mis ec6nomico prevenir que curar. 

En el Uruguay, la alimentaddn artificial estd poco eztendida. Su pdbladdn de 
origen espafiol e itaUano en su gran mayorfa, tiene los h^itos de sus antepasadoa» 
La lactanda natural es la regla, o por lo menos la lactanda mixta. La lactaodLa 
artificial en los primeros meses es relativamente rant; a pesar de Mo, la mortalidad 
infantil en el primer afio es alrededor de 11 por 100 nadmientos, dfra relativamente 
elevada ai consideramos, como hemes dicho, que la alimentari^n natural o mixta 
constituye la regla. Las gastro-enteritis son sumamente frecuentes en el verano^ 
hasta el punto de constituir m&B de un terdo de la mortalidad total del primer alio. 
Las causas deben buscaise en la fiilta de reglamentad6n de las tetadas, que general* 
mente son muy frecuentes, y en el h&bito de dar al pequefio toda clase dealimentoe 
861ido6 e Indigestos, h&bito general en la mujer del pueblo. De aquf que las gastro- 
enteritis que son relativamente raras en la clase acomodada, sean muy frecuentes en 
la clase pobre, asf como tambi^n otras enfennedades debidas a la ignoranda y a loa 
malos culdados, como por ejemplo: las bronco-neumonlas, la tos convulsa y las infec* 
dones umbilicales. Estos hechos demuestran hasta la evidenda la necesidad de que 
an Consultorio Gota de Leche tenga organizadoe cursos de puericultura para las ma- 
dres del presente y del future, en los cuales se les instruya de todo lo referente a la 
higiene, cuidados y allmentaddn del nifio. Estos cursos cuya duraci^n minima debe 



PUBLIC HEALTH AND MBDICnTE. 247 

(Mr de seiB meses, do6 veces por semana, aerian te6rico pr&cticos, utilizdndoee el mate- 
rial del Con0iiltQrio y de la Gnna. 

8u frecuentacidn con aatduidad y un examen final darfa Ingar a la obtenci6n de nn 
certificado de aptitades, que podrfa aervir, a la que lo obtuvieee, para alcanzar una 
biiena plaza como nifiera o cuidadora. La alimentaci6n natural, la hlgiene del nifio 
y de 8U habitaci6n, la preparaci6n de alimentoe egpeciales, ad como los primeroe cui- 
dadoB para el nifio enfeimo, constituirian otros tantoe c^>(tulo0 sobre loe cuales Be 
inaistuia especiahnente. 

De todo lo que acabamoa de decu*, ae deduce ain mayor eafuerso, que ya no eatamoa 
en loe tiempoa en loa que un pediatra diitingfuido afinnaba que para implantar en 
una ciudad ** La Qota de Leche, ** s61o ae neceaitaba un medico abn^gado y un aparato 
Soxhlet. Loa diapenaarioa para lactantea modemoa neceeitan, ai ae deeea obtener el 
mJTimum de reaultado, una inatalaci6n eapecial que haga poaible la reali£aci6n de 
todas las ideas ezpueataa en eate trabajo. Montevideo que cuenta con la Aaiatencia 
Pdblica Nacional a61idamente oi]g;anizada, no debe demorar m^ la inatalaci6n de una 
in8tituci6n en la forma que dejo relatada. 



O EBRO ESSENCIAL DE PESSOA NA LEI BRAZILEIRA DO CASAMENTO 

CIVIL. 

Por RODRIGUES DORIA, 

Profu9or de Medieina Pvhlica da FaaUdade de Direito e eathedraHoo, em diiponihUf da 

Faculdade de Medieina da Bahia, 

O casamento civil 6 uma inatitui^&o relativamente nova no Brazil: veio com a 
Bepublica, e foi promulgada com o Decreto 181 de 24 de Janeiro de 1890, pelo Govenu> 
Proyiaorio, alterando prohmdamente oa coetumea e os habitoa, e contrariando a» 
cren^aa de um pdvo, na sua grande maioria cathoUco e auperBticloeo, que a6 admitte o 
eaaamento peiieito como aacramento, e garantida a unifto firme e perpetua doa conjugea 
pela ben^fto aacerdotal. Nfto foram poucoa oa deaaatrea havidoa noa primeiroa annos da 
«xecu9&o da lei, entre peaadaa de pouca inatnic^fto que fugiam ia garantias legaea do 
caaiunento, contrahindo a imifto conjugal aomente diante do altar. Illegltimidade doe 
filhoa perante o Estado, perdaa de herangaa, foram as conaequenciaB doe actoa impon* 
deradoB doa que aaaim procederam, e t^m procedido, at^ que um grio mais adlantada 
de inatrucgSo e civilisa^ fa^ perder as abusOes, e oa sacerdotea de todas as religldea, 
ayatematicamente, nfto celebrem o casamento religloso sem que Ihea aeja apreaentado 
documento probatorio da precedencia do casamento civil. ' 'O govemo maisdespotico e 
meticuloeo, a l^gisla^&o mais obedecida e rigorosa/ ' diz Tarde, **6o uso, comprehendidc^ 
por isBo eaaea mil e um habitoe recebidoa, quer tradicionaea, quer novos, que r^gulam 
H conducta privada, nfio de cima e abstractamente como a lei, mas de muito perto e- 
no menor detalhe, e que comprehendem todas as necesaidadea artificiaea, traduc$S4> 
livre daa necesaidadea naturaea, todoa oe gostos e os deeigoetos, todas as particulacidade* 
de costumes e de maneiraa proprias a'um paiz e a um tempo.'' E muito mais impe* 
liosa 6 essa legisla^fto do uso se ella se misturam sentimentos religiosos. 

Cauteloso o govemo revoluclonario, receiando certamente nSo abalar em maior 
eztensfto os habitos e os costumes de pdvo, podendo chegar a consequencias grave* 
mente compromettedoras da asaocia^fto conjugal, nfto creou o divoicio, como uma 
consequencia natural, logica e juridica do contracto a que ficou excluaivamente 
ledusido o eaaamento, em que peso ao receio de juristaa actuaea, que, no dizer do f eate* 
jado jurisconaulto bruileiro, Dr. Clovia Bevilaqua, n&o podendo manter hoje, no* 
diieito definitivamente seculaiisado, eaae exotismo do aacramento, dizem que 6 aetOf 
como ae contracto nSo foaae igualmente um acto juridico. Contracto eapecial, continda 
oautor do' Direito da familia," poraeconstituirmedlanteumaccordodeinteresaes, uma 



248 PROCEEDINGS SECOND PAN AMERICAN SCIENTIFIC CONOBESS. 

coincidencia de vontade, ou como dizia lord RobertBon, a mais ImpQrtante de todaa 
as tranaacydeB humanas, base da consfdtui^So da sociedade civilsada, ou como 
diz Mathew Woods, o mais sagrado dos la$06, a mais profunda das responsabilidades, 
incluindo a mais inflexivel das obriga^des (Divoice). 

Nada impede que esse contracto seja sanctificado pela ceremonia religioea, que 
eatiafaa e tranquilisa a consciencia dos crentes. 

O casamento pode, por6m, ser annullado, e entre as causas de nullidade fig:uia o 
'eno esuncidl de pessda, 

A lei do casamento civil aaaim dispde: 

AsT. 71. Tambem seiA annullavel o casamento quando um dos conjuges houver 
«onsentido neUe por eno essencial em que estivesse a respeito da pessda do outio. 

Abt. 72. Considera-se eno essencial sobre a pessda do outro conjuge: 

i V. A ignorancia do seu estado. 

§ 2^. A ignoiancia de crime inafian^avel e nfto preecripto, commettido por elle antea 
mIo casamento. 

§ 3^. A ignoranda de defeito physico irremedlavel e anterior, como a impotencia 
e qualquer molestia incuravel ou transmissivel, por contagio ou heran^a. 

A annullagfto do casamento por eno essencial sobre a pessda s6 poder& ser pedida 
pelo conjuge, victima do engano ou d61o, dentio de dois annos da data do casamento. 

O que se deve entender, ou, antes, entende a lei por etiado do conjuge, cuja igno* 
Tancia possa dar logar & grave consequencia da nullidade do casamento? 

A pressa com que foram otganisadas as leis do govemo proviaorio da Bepublica den 
lugar, algumas vezes, ao emprego de phrases ou termoe ambiguos, como o apontado, 
•o que nfto deve existir num systema de legidagSo bem oiganisado, sem as neoe«- 
earias restricyOes ou a precisfto do sentido em que devem ser entendidos os vocap- 
bulos. Estado quer diser, lezicolpgicamente, situa^ ou modo de ser de uma pessda 
•ou coisa, e nesse case pode a palavra ser entendida de maneins differentes. £ 
«pplicavel, por exemplo, d situa^fto economica de uma pessda, dis o Dr. Clovis Bevi- 
laqua, e 6 repugnante a todos oe principios que se proponha a annullagfto de um 
•casamento sob tal fundamento; e, lembnndo essa feigSo do termo, accresenta o notavel 
jurisconsulto que apenas salienta "a inconsistencia do vocabulo," que elle ainda 
4enomina "vago e elastico, vacillante e equivoco." 

Pode o termo ser comprehendido como exprimindo a situa^ do individuo em 
relagfio & sociedade, i familia e is leis, e tambem 6 religifto. O projecto de Codigo 
OivU, oiganisado pelo Dr. Coelho Rodrigues, faa a restric^fio do estado civil e religioso, 
•e neste caso tratarse de saber se o individuo 6 solteiro, vluvo ou caaado, se gosa de 
plena capacidade ou soffre de alguma interdic^fto, ou se pertence i religifto que rei>elle 
a do outro conjuge. 

Nfto tendo aido a lei do casamento civil feita pelo Congreaao, de cuja diacuaafto se 
pudesse tirar elementos para a interpretapfto de phraaea ou vocabuloa incertos, ao ler 
o paragrapho apreciado, a primeira ideia que auige ao eapirito 6 a da referencia ao estado 
de viigindade da mulher, o que eat& excluido pela diapoai^ do projecto Coelho 
Rodriguea, e alnda pela interpreta^So do Dr. Clovia Bevilacqua. Todavia, este sen- 
tido 6 perfeitamente plauaivel, poia a integridade da hymen 6 eaaencial ao casamento, 
como teatemunha da moralidade e doa coatumea da mulher, jmib de outroa aignaee se 
pode repetir o gracejo bocacciano, citado por Ziino: 

Bocca baciata non perde Ventura 
Anzi rinnova come fa la luna. 

Os hebreus chamavam & donzella alma, clautira, aegundo Calmet, e tal era entre 
•elles o valor da viigindade no casamento que a sua ausencia podia ser um motivo de 
repudio, e um crime a imputa^fto falsa de desviiginamento, desde que o pae da mulher 
demonstrasse esaa falsidade: et eetse haee nmi signis virgmitatU fiUae meae: expandent 
iuenimentuin coram seniorihus civita^, Deuteionomio, Cap. XXII, 17. A vii^glndade 



PUBLIO HEALTH AND MEDIQINB. 249 



ultrajada sempre encontrou vingaii9a nas leis. Tfto preciosa 6 conaidenMla essa con- 
di^o da mulher, que o Chrigtianiamo erigiu o culto da Viigem. Jiuto 6 que pefca 
00 seuB effeitos, como bo no houvera, o caBamento em que o desviiginamento lol 
doloeamente occulto ao homem confiante, pais seria um escandalo ena condi^ estac 
tuida no contracto, como profeeea o direito eccleaiastico que a redu2 a impedimento 
impediente, e n&o dirimente. 

O piojecto do Godigo Civil do Dr. Glovis Bevilacqua, modificado pela commktfo 
especial da Gamara doe Deputados, em 1902, comprehendeu o desvuginamanto anterior 
ao casamento e ignorado pelo marido, como eno essencial de pesiOa, quer no prajecto 
primitivo, quer no segundo, que deu melhor disposiyfto a este caso particular, e nelle 
sold: 

Aar. 280. Tambem 8er4 annullavel o casamento quando um doe conjuges houver 
consentido nelle, por eno essencial, em que estivesse sobre a pessda do outro. 

AjtT. 281. Considerarse erro essencial sobre a pessda do outro conjuge: 

1^. A ignorancia de seu estado civil ou religiose; 

2^. A ignoranda de crime inafin^vel e nfto prescripto, commettido antes do 
casamento; 

3^. A ignorancia de defeito physico irremediavel e anterior, como a impotencia> e 
qualquer molestia grave, incuravel ou transmiasivel; 

4^. O desviiginamento da mulher, si o marido nfio tinha conhedmento desse facto. 

As nullidades contidas nos tres primeiros numeros deste artigo podem ser requeridas 
dentro de dois annos, a datar do dia do casamento, ou da data da lei, se tiversido anterior; 
pradentemente, porem, foi marcado para o ultimo caso o praso de des dias, que s^gundo 
Toulmouche, 2Uino, e outros, constitne o maior lapse de tempo para que a perida 
medico-l^gal possa descobrir as cicatrizes dos retalhos da hymen, e determinar a epodia 
do defloramento, evitando por esse mode possiveis explora^Oes e abusos. 

Releva aqui observar: Em umpaiz,cuja constitui^ftoprescreve a liberdadede con- 
sdenda^em que a egreja esti separada do Eetado, em que este nada tern que ver com 
ascren^as religiosas de cada qual, como se pode admittir figure na lei que seja aannl- 
lavel o casamento civil, em virtude do estado religiose de um dos conjuges, quando 
a celebra^ do contracto, ou do acto, se quizerem, obedeceu a todas as exigencias e 
formatidades da lei? 

N&o vi raaOes que justifiquem essa excrescencia do projecto, nem o seu autor as deu. 

Parece-me de necessidade que a lei, como erro essencial de pesida, fisesse a eepeci- 
fka^ da identidade, evitando por esae mode a repetiyfto da fraude de Labfto, tubati- 
tuindo a sua filha Rachel, eebelta e fonnosa, dada em casamento a seu flobrinho Jacob, 
por Ida, menos bella e nfto requestada. 

O grande jurisconsulto bradleiro Teixeira de Freitas, no seu Esbo^ de Codigo.Civil, 
admittiu como erro etoendal: 

''Quando versar sobre a pessda, isto ^, quando um dos contrahentes acreditou ter 
casado com uma certa pessda, entretanto que o casamento foi celebrado com pessOa 
diveisa." 

A. arte proposito, na Commissfto da Gamara dos Deputados, que reviu o projecto 
Glovis Bevilaqua, o Dr. Aniaio de Abreu, da referida commissfto, propos a seguinte 
emenda que n&o foi aliiui acceita, permanecendo a disposiyfto do projecto: 

"Ignorancia do seu estado civil e religioso, ou de sua identidade pessoal, ou da 
int^gridade physica da nubente, se fdr esta solteira'' comprehendendo, portanto, 
nesse numero, a quest&o da viigindade. 

O segundo caso de nuUidade de casamento por ignorancia de crime inaffian^avel de 
um dos conjuges 6 obvia; nenhum contracto pode ser valido nessas condi^Oes, espe- 
cialmente o que prende para uma vida em commum, para a bda ou m4 fortuna, na 
maior intimidade, duas creaturas, uma das quaes se apresenta um monstro aos olhoa 
da outra. 



250 PB0GEEDIK68 SECOND PAN AMEBIGAN SCIENTIFIC C0NGBE88. 

O torceiro cam de erro eesencial de pessoa 6 constituido por "defeito phymco irre- 
mediavel e anterior como a impotencia, e qualquer molestia incuravel ou transmiBsivel 
por contagio ou heran^a." 

A impotencia nem sempre se manifesta por um defeito phyaico; ella pode aer func- 
cional, por falta de erecgfto, que 6 um acto reflexo, cuja determina9&o parte do centro 
nervoso especifico, collocado na porgfto lombar da medulla. 

E como deve ser aqui comprehendida a impotencia? 

Distinguem-Be em medicina legal duas formas da enfermidade — a impotencia para 
exercer o acto conjugal, impotencia eoeundi, e a impotencia de gerar ou de conceber, 
gerierandi out coneipiendi. Ambas as fdrmaa podem-ee apresentar no homem, ou na 
mulher. 

A primeira fdrma da impotencia, no homem, pode exifltir com a apparencia normal 
das partes genitaes, vidadas apenas na sua funcdonalidade ao ponto de gerar a inap- 
tidfto absoluta, quer em consequencia de uma doen^ da medulla espinhal no nivel, 
ou acima do centro espedfico, quer por estados psychopaticos que annullem os estimu- 
los partidos do cerebro, ou por gr&os de degenera^, que comprdiendem a natura 
firigida do direito canonico — *'Jrigiditai et( membri, quam vi$ opHme eonformatif flaed- 
diia$ qutudam et tnercitofriitt moUities** (Gaspani). Esta f<3rma da impotencia pode 
reeultar tambem da ausencia ou deleito do membro viril, impotencia instrumental, 
proveniente, no primeiro caso, de uma amputa^ ciruigica, ou accidental, como um 
case do meu conheclmento, em que a voracidade de um peixe arrancou a um menino 
todos OS orgtkNS genitaes extemos; ou no segundo, originar-se de um defeito congenito, 
como a epi ou a hypMpadia, e o hermophroditmo. 

Na mulher a impotencia coeundi pode igualmente ser congenita ou adquirida, a 
saber: estreitamento exagerado da bada, nfto dando ao alastamento dos ramoe do 
pubis a amplitude necessariaparapermittir a intromissfto do oigfto viril, uma oblitera^io 
da vagina, reduzida a cordfto fibroso, a abertura da vagina no intestino, ou conforma- 
(Oes viciosas do orificio vulvo-vaginal e do canal, i>or lesOes ou processos morbidos 
graves, e cicatrises consecutivaB, adquiridas antes do casamento, ou um estado de 
hyperesthesia excessiva (vaginiamo doloroso). 

A fdrma de impotencia de gerar resulta da ausencia de cellulas nemospermicas 
(espermatoEoarios) no liquldo seminal, ou de affeccOes que impe^am a formagfto 
desse liquido, como a epididimite blenorrhagica chronica e dupla, e o testiculo 
tuberculoso ou syphilitico. Na mulher a impotencia coneipiendi di-se por ausencia 
die utero e ovarios, pela obtura^fio do orificio ou do canal do coUo por vereOes on 
flexOes. 

NSo havMido a lei feito dlstinccfto entre as fdrmas da impotencia, qualquer della 
pode servir de fundamento & nullidade de casamento? 

No tempo do imperio, quando havia religifto do Estado, e somente o casamento 
religioso, reconhecido e garantido pela lei, as questdes de nullidade de casamento per- 
tenciam ao fdro ecclesiastico, e se faziam de accordo com os preceitos do direito 
canonico. Oartigo 158 da '^Consolida^fiodasLeiBCivis" reza: 

"As questOes de divorcio ou sobre nullidade do matrimonio, ou sobre separa^ 
temporaria ou perpetua dos conjuges, pertencem ao Juiz Ecclesiastico. A respeAto 
dellas nenhuma ingerencia pode ter a jurisdic^fto secular.** 

O direito ecclesiastico s6 encarava, e encara, como causa de nullidade de casamento, 
OS impedimentos dirimentes, e a respeito do impedimento por impotencia, diz llioinaB 
Bellacosa. — Theologiae moralis nu/tmmta.— Tertia editio: 

" Impotentia est inhabilitas ad copulam habendam. Impotentia dirimit matrimo- 
nium an sit antecedens et perpetua, sive sit absoluta, eive sit respectiva." 

E em nota acreecenta o autor: ''Hunc si quis est habilis ad coeundum et impoa 
ad generandum potest contrahere; sterilitas enim non est impedimentum." 

D'aqui se v6 que, perante a egreja catholica, 86 a impotencia de exercer o acto 
sexual, constitue motive de nullidade do casamento, com exclusfto da impotencia de 



FUBUO HEALTH AKD MBDIOIVE. 251 

gcnur ou de coiiceb«r, comqnaato o fim do casamento seja a procrea^So ou a perpetua^ao 
da6Bpeci6. 

O artigo 66 da lei do caaamento civil dlz: "Sfto effeitoa do caaamento: 1 1^. Con- 
etitiiir Iftmilia legitima e legitimar filhoe havidos de um doa contrahentes com o outro, 
salvo 88 um destes ao tempo do naacimento ou da concept dos mecimos filhoe eetiver 
caeado com outra peasda." 

Em rigor, parece que todoe as f6rmas de impotencia poderiam ser allegadas, como 
moUvo de nidlidade do contracto matrimonial, pois constituir familia, formar familia, 
tern como objectivo a procrea^, a perpetual da especie. O casamento 6 conse- 
guintemente a legitima^ desse objectivo, a que precede naturalmente a satisfac^fio 
dos prazeres sexuaes; repugmi, porem, aoe nossos usos, tradi^fto e costumes, essa 
interpreta^, comquanto sejamoe um paiz novo, carente de popula^fto, que nfto pode 
dar unides esteris. Seria, porem, um escandalo para a nossa sociedade se um dos 
conjuges, apto 4 procrea^, tentasse a nullidade do casamento, allegando ser o outxo 
esteril, comquanto perfeitamente apto ao acto sexual. Poderiamos a este respeito diaer 
com o Plof. Brouaidel em rela^ & legisla^ franceza, comparada com a allemft, da 
qual *'dedu£-se que a uni&o matrimonial tem um s6 fim, procrear filhos; quando este fim 
nSo 6 attingido, aquelle esposo que possue ainda faculdades procreadoras pode procurar 
tttilisal-as em circumstancias mais favoraveis. Em Fran^, continua o autor dtado, 
6 legislador se coUocou em outro ponto de vista: um dos fins do casamento pode ser ter 
filhos, mas um pacto muito mais solemne liga os conjuges de modo indissoluvel, os 
une para seguirem juntos a bda ou a m& fortuna." 

Fela compara^fto da l^^islaySo auatriaca e allemft com a brazileiia, chega-se is 
mesmas concIusOes do professor da Faculdade de Medicina de Paris. A palavra 
familia, cuja constitui^ legitima 6 principal effeito do casamento, tem tido com o 
tempo accepgOes juiidicas diversas, ora comprehendendo toda a descendencia de um 
tronco commum, ora o conjuncto mais limitado de parentes e pessOas vinculadas ao 
grupo. "No direito modemo, die o jurisconsulto brazileiio Dr. Oovis Bevilacqua, 
familia 6 o conjuncto de pessoas ligadas pelo vinculo da consanguinidade, cuja efficacia 
se estende, ora mais larga, ora mais restiictamente segundo as varias legisIa^Cies. 
Outras veaes designamyse por familia somente os conjuges e a respectiva familia.*' 
Portanto, se algum erro de intelligenda me nfio oblitera a comprehensfto, a familia 
eet& constituida pelos conjuges, mesmo antes da prole, ou quando esta nfto appare^a. 

Jft o direito ecclesiastico definla o casamento: Nuptiae sunt conjunctio maris et^ 
feminae consortium omnis vitae, di vini et humani juris communicatio . Tr . 1 . D . 28, 2. 

O art. 00 do Codigo Civil austriaco diz: ''Uma impotencia completa e incuravel 4 
consumma^fto do dever conjugal, produzida durante o casamento di igualmente direito- 
ao divordo." 

O art. 696 do Codigo prussiano reinroduz pelas mesmas palavras a mesma doutrina, 
da qual se segue directamente que, se depois do casamento sobrevier a impotencia a. 
mn dos conjuges, pode ter lugar o divorcio pelo motive de que cessou a faculdade de 
procrear, e, conseguintemente, essa impotencia nfto ser& somente a impotencia eoeuruH, 
mas tambem a de fecundar ou conceber, pois alii o que se quer obter com o casamento- 
6 a prole. 

A nossa legisla^fto, acompanhando a doutrina do direito canonico, exige que a im- 
potencia seja anterior ao casamento. Por conseguinte, desde que a enfermidade- 
Bobrevenha ao contracto, nfto pode ser admittida como motive de sua nullidade. 
No "Direito da familia," do Dr. Clovis Bevilacqua, 3a edi^So, 1906, 4s paginas 162, 
enoontEa-ee a seguinte nota: 

"Quando fallamos de impotencia, que consiste na inaptidfto para gerar, referimo-nos^ 
mais directamente ao homem {impoUntia coeundi); comtudo, ainda que mais nuna> 
mente, ella se encontra na mulher sob outra feigfto {impoUntia eondpiendi) . No dtado • 
UvTO, cujas opini(Ses sfto, com justissima razfto, grandemente acatadas pelos nossos- 
cultores da sdencia do direito, ainda se 16, 4s paginas 3: "Os foctores da constituigfto da. 



252 PBOOBBDINGS SEOOKD PAlsT AHEBIOAN SOIBKTIFIO C0NGBBS8, 

familia Bfto: em primeiro lugar o instincto geneaico, o amor, que approxima ob doifl 
flexes; em segundo lugar oa cuidadoe exigidos pc^a a conBervagSo da prole, que tomam 
mais duradoura a aasocia^^ do homem e da mulher, e que determinam o surto de 
emogdes novas, a philoprogenie e o amor filial, entre procreadorefl e procreados, 
emo^Oes esBW que tendem todas a consolidar a afHocia^ fa mili a l ." 

De tudo o que venho examinando, parece-me poder^ logicamente concluir que, 
entre n6B, a impofledbilidada de procrear conflidenHM uma coneequencia da unpotenaa 
4X>6U9uli— aquella que pode motivar diflBolu9&o do vinculo matrimonial.^ 

Entra 08 defeitos que podem acarretar a impotencia eatk o hermaphrodiamo, ou a 
reunifto, no mesmo individuo, de orgftos sexuaes, glandulas, ou canaes excretoreB e 
•orgSos da copula, sem a poadbliidade da auto-fecunda^, como no hermaphrodiomo 
vegetal, e em alguns animaes inferionnente collocadoe na escala. 

At6 a sexta semana da vida intrauterina o sexo de embrySo 6 indedao, iflto 6, nfio se 
enoontra differenga de estructura e organiza^ entre o que ha de ser homem, ou 
mulher. A naturesa noe seua indecifraveis e mysterioflos proceaooB de aperfei^oamento, 
naa eapecifica^dea e aepara^fto daa func90ea, nem aempre caminha placida e aeg^un^ 
enoontrando is vezea tropegoa que Ihe deaviam a orienta^&o e perturbam a m a rch a do 
trabalho infatigavel. Ou pela heranga, que 6 uma giande forpa de fixagfto naa eapectea 
novaa, podendo no entretanto fazer recordar f6nnaa antigaa, qualidadea abandonadas, 
revivendo oigftoa quaai extinctoa; ou por um abalo no deaenvolvimento do embryfto, 
que 6 uma reproduc^fto da hiatoria anceatral, tomando oa indicioa primitivos da hi* 
aexualidade, demonatrada por Waldeyer, impulao evolutive em direc^fto paralella; 
como quer que aeja, quaeaquer que poaaam aer aa influenciaa perturbadona da mardia 
normal do deaenvolvimento, a criatuia humana nSo ae acfaa ao abrigo deaae deqgaixo da 
natureza, que redunda ia maia daa vesea em tenivel caatigo a aeu portador innocente. 

O hermaphrodiamo apreaenta gr&oa differentea, e na maioria doa caaoa, pode ser 
uma cauaa de impotencia coeundi, e conaequentemente uma cauaa de nullidade de 
caaamento, ae o outro conjuge ae nfto conformar com a aituagio embantgoaa que a aorte 
Ihe deparou. 

Gr&oa menoa adiantadoa deaae defeito, o falao hermaphrodiamo- como a epispadia 
ou a hypoapadia, pode accarretar a impotencia, ae nfto 6 remediavel curuigicamente, 
como at^ certo ponto me pareceu o caao por mim obaervado, ha um anno, do qual del 
conhedmento 4 Sociedade de Medidna L^al da Bahia, e que aqui reproduso. 

Beata finalmente, o erro easencial de pesaoa que consiate na ignorancia de moleatia 
incuravel ou transmiaaivel por heran9a. 

Hoje, que a tendencia 6 melhoiar a ra^a humana, 4 aemelhanya do que ae pratica 
com oa diveraoa aidmaea, formando-ae uma adencia nova--a Eugenia — ^para conaeg:uir 
^aae deaideratum, nfto ae poderia admittir um contracto, em que a fraude de uma das 
partea, nfto 86 obrigaaae a outra aoe riacoa de uma moleatia que Ihe foaae contanunar 
a exiatenda, como tambem eatragar a prole com a infecyfto grave. 

Medidaa aeriaa deviam meamo aer tomadaa antea do caaamento, para que nfto foaaem 
levadaa para o Idto conjugal moleatiaa que, como a ayphilia e outraa infec^des venereaa, 
podem cauaar a degenereecencia da ra^, contaminar a mulher, e tomal-a eateril e 
enferma a vida inteira. Todavia jd 6 um progreaso a dispoaig&o da lei. 

CA80 DB HTP08PADIAS, BtMULANDO HERHAFHBODISMO.' 

De paaaagem pela villa de S. Paulo, no aertfto do Eatado de Sesgipe, a 4 de Janeiio 
deate anno, fd-me moatrado um menino, que me diaaeram, na linguagem popular, eer 
macho e femea. Logo foi grande a minha cuiioaidade em examinal-o, nfto me aendo 
entfto poaaivel faael-o, aenSo, muito auperfidalmente, eatando o menino de p^, e 
ainda offerecendo todaa aa reaiatenciaa poeaiveia, chorando muito, com receio de uma 



> Esta Memoria toL remettlda ao Coogresso Sctontlfloo Pan Americano antes de ser approvado pelo Coo- 
«resso o Codigo Ciyil Biasileiro. 
• Obserra^fto aprasantada & Sooiadada de liedldna liflgal e Crimlnologia da Bahla. 



a: 

i 



« 
I 



PUBLIC HEALTH AND HBDIOIKE. 253 

opera^fto, ou pelo vexame que Ihe cauaava a obaerva^ do defeito, de que era portadw 
e que servia de chac6ta aoa outroe meninoe. Efifectivamente, oe oigftos sexuaee 
extemoe tinham a apparencia de uma vulva com clitoriB grandemente deeenvolvido e 
flaliente. 

Gonsegui, n2o sem difficuldade, que em principio de Fevereizo o pae o trouxeese a 
Axacajti, onde pude examinal-o melhor, e obter as duas photographias que, 00b oe 
numeroe 1 e 2, junto a esta rapida descripgSo. 

F. G. de M. tern 7 annos completos, de cdr morena, com miBtura de caboclo, e 
iq[»roBenta regular deeenvolvlmento. O pranto em que estava, quando foi photo* 
graphado, deixa ver ae cofltellae salientes do lado direito, parecendo magrem. 

O pae, de estatura regular, ou talvex baixa, de boa complei^fto, tern 26 annos de 
idade, e um maia do que sua mulher, acaboclada e menoe robusta do que o marido. 

Beferiu-me este que o menino tern, pelo lado matemo, um piimo com defeito 
semelhante, e que 6 casado e tem filhoB. O defeito deste deve ser bastante menor, 
poiB F., chegando 4 idade adulta, nfto poderi fecundar, uem mesmo exercer a copula 
vaginal. 

A photographia numero 1 apresenta o menino de p^, tendo os oig&os sexuaes extemoa 
a apparencia doe de pesBte do sexo feminino, cujoe grandee labios efto muito afoetados 
na parte anterior, pela saliencia de um eimulado e volumoeo clitoria, e respective pre- 
pucio. Fazendo deitar o menino, e conaervando as cdxae approximadas e dobradaa 
eobre a bacia, contintia iTapaiencia ffeminina doe orgftoe sexuaee, em virtude de ter 
escroto, na parte m^dla, um profundo buIco, adaptando-ee uma a outra as duas metadea 
ou lobulos na parte posterior, como se foesem dois verdadeiros grandes labios, de cuja 
parte anterior exhuberava o volumoso clit(»is. 

Ahtftadas as cdxas, como na photographia numero 2, separam-se os dois lobulos do 
escroto, nSo existindo vestigio algum de orifido vaginal, no fundo do sulco, onde a 
pelle^lisa. 

Nas partes salientes e livres dos fingidos labios, a pelle tem a apparencia fransida 
da pelle eecrotal. 

Examinando os lobos do escrdto, separadamente, verifiquei em cada um delles 
am pequeno corpo ovoide, como uma pequena oliva, correndo dentro de uma bolsa, 

05 quaes eram ev identemente testiculos. 

A saliencia que se vd na parte superior do sulco (photographia n? 2), de 3 e meio 
cmtimetros de comprimento, tem a conformagfto de um pems, com a glande toda 
descoberta, e cujo coUo pode-se distinguir na photographia. Esse perns ^ totalmente 
adherente ao sulco pela parte inferior ou uretral, e toma a fdrma de um arco. A glande 

6 imperhtrada, comquanto se note em sua extremidade uma depress&o ligeira, alongada, 
em seguimento ao freio, para diante, e onde devera ser o meato urinario. 

Na raia do penis se descobre, elevando um pouco a glande, um pequeno orifido, 
em fdrma de fenda antero-posterior, que 6 o meato urinario, e por onde o menino fas 
a evacua^fto da bexiga. 

A ere^So tender^ a accentuar a curvadura do penia, e, em virtude de sua adherencia 
tofiU, seri imposnvel a intromissfto desse membro na vagina em acto de ajuntamento 
sexual, 86 podendo o paciente obter o prazer genital por manobras outras, sendo 
perdida a ejacula^fto. 

Por esta descrip^So se poderi deduzir a aitua^ phyqica e moral deese menino, 
quando chegar & idade adulta. Pareceu-me, no entretanto, que uma opera^fto 
clrurgica, consistindo no desbridamento do penis, despregando-o do sulco inter- 
escrotal, poderia de algum modo permittir a copula vaginal, sendo aasim remediada 
at^ certo ponto a impotencia coeundi, penistindo, porto, a de fecundar, pela situa^ 
da desembocadura do canal uretral. 

As informa90e8 sobre os habitos do menino pouco adiantaram; diase-me a mfte que 
elle dava preferencia, ou parecia dar, a brinquedos proprios de meninas. Essas 
inlorma^des, porem, nfto eram filhaa de ob8er\'a^ intelligente, e pareceu-me que 



J 



254 PBOCEEDINGS SECOND PAN AMERICAN SCIENTIFIC CONOBES8. 

esta questfio foi despertada no espirito da mulher pela minha indaga^So. Ob brin- 
quedoa das crean^as eetSo sempre de accordo mais com o meio em que eSio criadas. 
Neste caso 6 preciao attender i e8qui\ an^a do menino em rela^So aos de sua idade, 
em consequencia do defeito que 6 moti^ o de zombaria dos companbeiros, e por iflso 
toma o menino mais retrahido e cazeiro. 

Sem entrar, par escusadas neste meio, em considerables anatomicas e de ofdem 
moral, sobre o defeito com que a natureza, nos sens der ios, nutfcou penosamente o 
pequeno P., concluimoe: 

1? — Que F. 6 um bypospadico, com apparencias, apenas, do sexo feminino, ou de mn 
false bermaphrodlBmo, e idctima de impotencia coeundi atque ffenerandi. 

2?-— Que F. est& comprebendido, se algum dia pretender contrshir casamento, no 
art. 72, { 3, da lei do casamento ci il, sal o se a opera^ cirurgica suggerida -vier 
remediar o defeito, desde que as nossas leis nfio fazem da impotencia de gerar motivo 
de impedimento ou nullidade do casamento. 

3? — Oaso a cirui^ possa remediar o caso de mode que a copula carnal seja possi^ el« 
permanecerd a impotencia de fecundar, pela posi^fto do orificio da uretra, HSo se 
fazendo a ejacula^So dentro da vagina. 



MfiTODOS MODERNOS PARA LA PREVENCION DE LA MORTAIIDAD 

INFANTIL. 

Por ARTURO L. GUERRA, 
Mienibro de la Washington Diet Kitchen Assodation. 

Al escribir este trabajo no intento discutir Ios tecnicismos relacionados con el 
euidado y alimentaci6n de Ios nillos, sine m^ bien dar un breve resumen del trabajo 
que se est& llevando a cabo en esta Naci6n, con el objcto de reeguardar la aalud de loa 
nifioe, reduciendo por estos medios la mortalidad anfaintil. 

Para dar una idea de la energfa con que Ios Estados Unidoe eelAn tratando el pro- 
blema, b&stame decir que en algunas secciones de Manhattan se publican libroa en aiete 
idiomas sobre el euidado de loe niilos y se reparten gratis a las madree con el objeto 
de que sus esfuerzos al aprender a salvar las vidas de sus hijos puedan ser reducidoa a 
lo mfnimo. Los Estados de Louisiana y Texas ban equipado carros de exhibicidn que 
viajan por lugares rurales y por medio de demostraciones pr&cticas siembran por 
doquier loe principios fundamentales de la higiene iniantil. £1 Departamento de 
Nillos establecid un Centre de Salud Iniantil en la Expoeicidn PanamA-PacificOy 
donde grandes auditories observaron Ios miles de nifios que allf fueron examinado0 
y tratados, no s61o haci^doles un gran bien, sine tambi^n educando las mawaii en 
general. Sin discutir m^ lo que la Naci6n estd haciendo, vuelvo a mi prop6sito, qne 
es el de hablar de lo que la Asociaci6n **Diet Kitchen'' de Washington, por medio de 
Ios Centros de Salud Infantil, Ueva a cabo con el objeto de prevenir la mortalidad 
infantil en esta ciudad. 

Anterior a 1905 estas instituciones eran casi desconocidas, y el sistema que al presenie 
se sigue, se desarroll6 durante Ios dltimos cinco afios. Hoy hay en Washington cinco 
Centros de Salud Infantil, localizados en las secciones mia populosas de la ciodad, 
con objeto de que est^n al alcance de las multidudes de madres y nifius que habitan 
estos distritos. 

Cada e8taci6n se compone de un 8al6n, amplio, limpio y bien ventilado, donde ae 
examina a Ios nifios, y otra sala de espera en donde Ios desnudan y pesan. Una o dos 
enfermcras asisten a Ios pacientes, y un cuerpo de doctores atiende las conferencias, 
las cuales tienen lugar tres veces por semana. 



PUBLIC HEALTH AND MEDICINE. 255 

Lo8 reeultadofl que se obtuvieron de este trabajo fueron halagadores deade el prin- 
cipio, a juzgar por la estadfstica de estos afios: el tanto por ciento de defunciones de 
menoreB de un afio con respecto al ndmero de nacimientos f u6 anualmente como sigue: 
de 1906 a 1910, 16.18; en 1911, 13.61; en 1912, 12.83; en 1913, 11.99; en 1914, 10.02. 
Ecrta reducci6n muestra lo que se puede lograr con un continue y sistemitico af^ 
par infltruir a las madres y conservar la salud de los nifioe. Las estacionee de la ' *gota 
de leche " eran antes lugares adonde acudlan las madres, porque alii podian obtener 
leche a un precio muy bajo. Hoy estas instituciones modemas ban variado de cate- 
gorfa; no siendo ya estaciones de lecbe, sine mis bien Centros de Salud Infantil, 
donde las madres reciben inBtrucci6n en los principios de la higiene y bus nifios son 
fttendidos par mddicos competentes. Su objeto no es el fomentar los alimentos arti- 
ficiales; los centaros saben e inculcan en las madres el hecho de que la lecbe humana es 
el alimento ideal para el nifio de pecho y s61o recurren a la alimentaci6n artificial 
cuando las circunstancias absolutamente los obligan a ello. Frecuentemente se logra 
inducir a las madres a que vuelvan a dar de mamar a sus nifios despu^ de haberlos 
destetado y baberse limitado a alimentarlos con mamadera. Los Centros de Salud 
Infantil llevan a efecto dos clases de conferencias, las prenatales, para mujeree 
en cinta, y las postnatales para sus bijos. Las primeras son de suma importancia. 
En ellas se ensefia no solamente la bigiene durante el embarazo, sine tambi^n el cuidado 
de los nifios al nacer; adem&s se les presta atenci6n facultativa prepar&adolas lisica- 
mente para el gran acto de la matem idad . Para mostrar lo necesario que es el cuidado 
prenatal citar^ como ejemplo una de las estadisticas copiladas por Williams. Entre 
705 ietos muertos cuyas causas 61 investig6, 186 murieron de slfilis, y tiene razones paza 
creer que el 40 por ciento del resto murieron por la miama causa. Como esta en- 
fennedad es, basta cierto punto, curable bajo un r^imen debido, esta alta mortalidad 
deberia baber side mucbo menor. Mor&n nos dice que el 42 por ciento de los nifios 
que mueren anualmente no completan el primer mes de vida, y siete d^imos de elles 
mueren como resultado de condiciones anteriores a su nacimiento. Si estas mujeres 
hubieran side vistas o puestas bajo tratamiento m^ico, ^serfa posible estimar cuintos 
de estos nifios hubi^ramos podido salvar? 

En la ciudad de Wiahington las defunciones ocasionadas por partos piematuros 
suben a 35.54 por mil de nacimientos. Esta proporci6n es 50 por ciento mayor que 
la de los muertos a consecuendas de desdrdenes di&rricos que fueron re^^strados 
durante el miamo perfodo. Los Centros de Salud con sus medidas pr^ticas y su 
generoeo inters, son un gran factor actualmente e influirin mas atin en el future 
em la reducci6n de la mortalidad infantil causada por los partos prematuros o 
cualquieia otra condici6n evitable o curable, existente antes del nacimiento. 

La impartanda de este problema se est4 comprendiendo rdpidamente en todas 
partes y actualmente, 38 Departamentos de Salud, de ciudadea y 247 agenciaa par- 
ticulares ban emprendido el trabajo prenatal en 110 lugares de los Estados Unidos. 
Los m^todos empleadoe en los Centros de Salud de W^usbington concuerdan por 
regla general con los empleados por las mismafl instituciones en todos los lugares de 
los Estados Unidos. 

Las madres tienen conocimiento de estos centros por medio de alguna amiga, cuyo 
bijo est& asistiendo a las conferencias y recibiendo visibles beneficios; otras \eces 
las madres empiezan a im estigar, despuds de baber lefdo algun artfculo, acerca de 
lo que a menudo se publica en los peri6dico8 y en los cuales, se babla del gran bien 
que bacen al pdblico estas instituciones . La Sociedad de £nf ermeras I nstructoras fre- 
cuentemente tiene noticias de estas madres, ya sea por medio de a^gtln paciente 
o de la Asociaci6n de Caridades. Una de las enfenneras visita a la madre y general- 
mente logra convencerla de que para el bien del nifio, no podrla bacer mejor cosa 
que llevarlo semanalmente a las conferencias. Los doc tores frecuentemente sin en 
<ie agentes para aumentar la concurrencia a los centros, pues ellos saben bien que 



256 PB0GEEDIN68 SECOKD PAN AMEBIOAN 8CIENTIFIG CONGBESS. 

Moe son loa lugares por excelencia donde las madres, faltas de recunos, pueden ser 
educadas y al mismo tiempo lecibir ateiici6n facultativa para ellas y para bob nifioB. 
Otro isctor que ayuda a atraer la ateiici6ii de las madres hacia los pentros, consiBte 
en las exhibiciones que de evz en cuando se dan en teatroB, iglesias y Centros 
de Salud. E^tas exhibiciones no sdlo educan a las madreB, aino que las penuaden 
de que el aaistiT a las conferencias vale bien su tiempo y trabajo, pues su aaistencia 
a ellas no puede resultar Bino en favor de bus x>equefiueios. 

Guando las madree asisten a las conferencias prenatales la enfennera las instruye 
cdmo deben vestirBe; la clase de trabajoB que deben evitar; cuimto deben donnir, y 
en general las hacen comprender que la salud del futuro hijo depende en gran parte 
del estado de salud de ellas. Despdes de Mo el medico las examina completamente 
y guaida relaci6n exacta de lo que se refiere a su condici6n previa y la pzesente y 
de loB reBultados del examen fkico: dimenaones de la pelvis, reenltado del examen 
de la orina, pred^n de la sangre y reacci6n de Wasserman. Durante Iob tUtimos 
meses bo hacen eximenes abdominales y vaginales cuando ee necesario. Estas 
pacientes se reciben cada doe semanas, observ&ndolas, de estamanera, cuidadosamente 
durante la gestacidn. La mira de los Gentroe de Salud es que laB madree empiecen 
a asistir a las conferencias al comensar el embaraso, para asf poder obeervar y dirigir 
cada caso desde su <»rigen. En las conferencias las madres reciben adecuadas y 
completas direcciones sobre c6mo deben tratar y cuidar a bub futuroB bijos. Se ineteu- 
yen en la manera de aiimentarloe, vestiiloB, bafiarlos, y en el departamento Uamado 
"sewing circle" aprenden a haceilee ropa. 

Gomo es evidente, estos esfuersoB evitan muchas muertes. Frecuentemente ea 
poflible prevenir abortos y malpartos ; las preeentadioneB petigrosaB se pueden caaeffx y 
al educar a la madre se consigue aumentar las probabilidades de salud y vida pax» el 
nifk>. Dob ventajas miB se obtienen tambi^ de las conferendaa prenatales: 1a pie- 
venci6n de la ceguera, y el matricular oportunamente a la madre en los Gentros de 
Salud. 

Uno de los deberee de la enfennera es inveetigar las condiciones de la caaa en que yive 
la madre, y si dichas condiciones son tales que impidan el parto alll, se le recomiendan 
los ncMnbres de algunos buenos hoBpitales donde la mujer recibir6 toda la atenci6n y 
cuidado debidos. Guando el parto occure en casa las aaisten medicos competentee 
que han hecho eetudios eBpedales de obstetiicia y a quienes siempre puede llamtoelee 
por teltfono. Despu^ del parto, durante la convalecencia son aBistidaB por una de 
las enfermenuB del DiBtrito. 

Guando la madre sale del hospital, una enlermera del DiBtrito y otra del Gentro de 
Salud, la viaitan y hacen que siga las Instrucciones que le fueron dadas antee que 
naciera el nifio. Despu^ aaiste a las conferendaB una vea por semana y alll vuelve 
a recibir instnicci6n sobre el cuidado de su hijo. 

UNA OONFEBBNCIA EN UN CBNTRO DE BALUD IMrAMTIL. 

Guando la madre por primera yez trae al nifio a los centres, sub nombres non regis- 
trados en los libros de la institucidn. La enfennera desnuda al nifio en la sala de 
espera y lo pesa. En una tarjeta de tamafio apropiado se registra la edad del nifio en 
semanas, y debajo de esta, eu peso. Esto se hace semanalmente. Guando gana en 
peso, ^te se marca con tinta n^;ra, y con roja cuando el peso es menor que el de laves 
anterior. Las madres temen mucho estas tiltimas marcas porque son para ellas una 
eefial de peligro que inmediatamente estimula bus eneigias para encontrar la causa, 
lo cual las hace seguir las instrucciones del doctor con mis cuidado y perfecci6n. 

Despu^ de pesar al nifio la madre )o lleva al consultorio donde el m^ico toma 
cuidadosamente la historia de Ice doe. Las condiciones hereditarias se estudian en 
detalle, asf como las circunstancias presentes durante el nadmiento, lugar del parto. 



i 



PT7BLI0 HEALTH Ain> MEDIOUSTB. 257 

eetado y peeo del nifio al nacer, y cualquiera otro detalle que pueda influir de un 
modo secundario. Al terminar esta inveBtigacl6n ee desnuda al niilo y se le examina 
c<»npletamente, anotando con cuidado cualquier formacidn defectuosa, Bfntomas de 
raquitismo o de enfennedadeei cong^nitas. Ouando se tennina este examen ai el 
nifio 00 estd lactando debidamente, se le dan completas inBtnicciones a la madre con 
relaci6n al tiempo que debe estar el nifio en el pecbo, y ee le explica como conservaii 
mejor su salud si se le da de mamar Bolamente cada tree o cuatro boras con r^^acidad. 
Tambi^n se la Informa Bobre lo necesario que ee darle agua varias vecoB al dfa, aef 
como reepecto al ndmeio de bans que debe dormir. El doctor aconseja luego a la 
madre con relaci6n a b( misma, advirti^ndole el mejor alimento poeible, el debido 
ejerdcio y que duerma las mis horas que pueda. 

Cuando el nifio no puede lactar de la madre por alguna raz6n que realmente lo 
impide, el doctor hace lo posible por encontrar la f6rmula de leche que wt6 indicada. 
En taloB casoe bo siguen las slguienteB reglas: bo UBa leche en estado natural y la madre 
la modifica en caaa, agregando aimplemente cierta cantidad de agua puia, o agua de 
cebada, y uno de loe asticares, generalmente el de malta. La aalud de algunoB nifioe 
progreaa mejor cuando reciben el alimento cada cuatro boraa, otroe en cambio lo 
requieren cada tres. Sin embargo, la cantidad total de leche que reciben en las 24 
horaB es la misma, lo tinico que varfa ea la cantidad de agua que ae uaa. Cuando ae 
completa la f6rmula la madre recibe inatruccioneB eacritaa que explican c6mo debe 
preparar eata leche, puea ella prepara diariamente por la mafiana la cantidad total que 
el nifio deber& consumir durante el dfa. La enfermera encargada del Centro de 
-Salud Biempre prepara la leche la primera vez cuando cada madre recibe au 
fdrmula, para eneefiarla a medir y mezdar laa almplea aubatandaa que forman la dieta 
de au hijo. A la primera oportunidad la enfermera viaita la caaa para cercioraiae de 
que todo marcha debidamente, y para ver ai la madre eat^ Uevando a cabo laa ina- 
truccioneB que recibi6 en la conferencia. 

Loa deberea de la enfermera de loa Centroa de Salud aon de auma importancia. 
Aparte de lo que hace durante laa conferenciaa, ea au deber el visitar a cada nueva 
madre el dia que ea admitida a las conf erenclaa y eacribir un inf orme complete acerca 
de la condlci6n social de la familia y la situaci6n de la caea; si eBt& ubicada en una 
Becci6n limpia y sana de la ciudad, o en una ateatada de gente y malaana, donde loa 
nifioe crecen diifcilmente ain calor y faltoa de aol. Da parte tambi^n de la aalud 
aparente, educaci6n e inteligencia de loe miembroa de la familia, eapecialmente de la 
madre; de loa recuraoa de loe padrea y por lo tanto de laa comodidadea que ae pueden 
ofrecer a su nifio y de laa condicionea hlgi^nicaa del hogar. ^Hay limpieza, recibe la 
luz del aol, ae puede calentar debidamente en el Inviemo? La enfermera rinde loa 
informea aobre estOB aauntoa con el objeto de que el tiabajo aocioldgico y mMico de laa 
conferencias pueda llevaiae a cabo mejor. 

El objeto primitive de loa Centroe de Salud Infantil ea el de cuidar nifioa en 
estado de aalud . Eato, como ea natural, ea un aaunto dificil de inculcar en las madreB, 
quienea peraiaten en traer a aua nifioa enfermoe a que reciban atencidn facultativa. 
En eatoa caaoe ae recomienda algdn buen hoapital donde puedan recibir tratamiento 
adecuado. Eato no indica que a loa centroa jamia aaiatan nifioa enfermoa. Al con- 
trario, allf ae tratan de continue un gran ndmero de criaturas que padecen de algunaa 
de laa enfermedadea mis graves que un nifio puede tener, tales como dea^rdenea 
nutritivoa, y el tratamiento de eatoe casos se considera como una parte del objeto de 
estoB centros. 

En el tratamiento de estas condiciones no se usan sino remedios sumamente aimplea, 
y se conf fa caai exclusivamente en medidas di^t^ticas. Los Centros de Salud 
Infantil est^ provistos de la mejor leche que es posible obtener para el use de loa 
nifioa. Laa madres pobres que no pueden pagar la reciben gratis; las que poeeen 
medioa la reciben al costo. 



258 PBOCEEDINGS SECOND PAN AMERIOAN SCIENTIFIO OONaBESS. 

He aqxif un breve resumen de lo que en esta dudad est^ llevando a cabo loe Centroe 
de Salud Infantil. Que estos esfuerzos ban sido premiadoB por el ^xito, lo demueBtia 
la popularidad de que gozan, su ntkaero de pacientes que cada d(a ee mayor, y, 
mia que todo, la mayor rebaja en la mortalidad Infantil que anualmente ee registra 
desde que estas iuBtitucioneah ban existido. 

Antes de terminar deseo ezpreear mi gratitud bada el director m^ico de la Asocia- 
aidik ''Diet Eitcben" de Wdabington, Dr. Joeepb S. Wall, de esta dudad, y a U 
Sra. Max West, de la Oficina de Nifios, a quien estoy muy reconoddo por baberme 
facilitado las vistas de proyecd6n. 

BIBUOaRAViA. 

Van Ingen. Am. Journal Diseases of CbUdren, Sept. 1915. 

Wall. Escrito in6dito. 

Moiin. Endowment of motberbood. 

PROPHYLAXU DO OPHIDISMO NA ABfERICA. 

Por VITAL BRAZIL, 
Director do ImtUuto SenarUherapieo de BtUantan, Sdo Fauh (Brazil). 

£ sempre melbor e mais fladl evitar do que corrigir. Este concdto, tiU> Bimples 
e t&o verdadeiro, encontia inteira applica^fto aos accidentes opb