The Sanitarian

Google

This is a digital copy of a book that was preserved for generations on library shelves before it was carefully scanned by Google as part of a project

to make the world's books discoverable online.

It has survived long enough for the copyright to expire and the book to enter the public domain. A public domain book is one that was never subject

to copyright or whose legal copyright term has expired. Whether a book is in the public domain may vary country to country. Public domain books

are our gateways to the past, representing a wealth of history, culture and knowledge that's often difficult to discover.

Marks, notations and other maiginalia present in the original volume will appear in this file - a reminder of this book's long journey from the

publisher to a library and finally to you.

Usage guidelines

Google is proud to partner with libraries to digitize public domain materials and make them widely accessible. Public domain books belong to the
public and we are merely their custodians. Nevertheless, this work is expensive, so in order to keep providing tliis resource, we liave taken steps to
prevent abuse by commercial parties, including placing technical restrictions on automated querying.
We also ask that you:

+ Make non-commercial use of the files We designed Google Book Search for use by individuals, and we request that you use these files for
personal, non-commercial purposes.

+ Refrain fivm automated querying Do not send automated queries of any sort to Google's system: If you are conducting research on machine
translation, optical character recognition or other areas where access to a large amount of text is helpful, please contact us. We encourage the
use of public domain materials for these purposes and may be able to help.

+ Maintain attributionTht GoogXt "watermark" you see on each file is essential for in forming people about this project and helping them find
additional materials through Google Book Search. Please do not remove it.

+ Keep it legal Whatever your use, remember that you are responsible for ensuring that what you are doing is legal. Do not assume that just
because we believe a book is in the public domain for users in the United States, that the work is also in the public domain for users in other
countries. Whether a book is still in copyright varies from country to country, and we can't offer guidance on whether any specific use of
any specific book is allowed. Please do not assume that a book's appearance in Google Book Search means it can be used in any manner
anywhere in the world. Copyright infringement liabili^ can be quite severe.

About Google Book Search

Google's mission is to organize the world's information and to make it universally accessible and useful. Google Book Search helps readers
discover the world's books while helping authors and publishers reach new audiences. You can search through the full text of this book on the web

at|http: //books .google .com/I

No.

Boston
Medical Library

Association,

19 BOYLSTON PLACE

V

THE

SANITARIAN,

A MONTHLY MAGAZINE

DEVOTED TO THE

PRESERVATiiON -e^^EjyvrH, MENTAL
A N D Vp y^SiJiX- C U i/t U R E .

VOLUME XXII. JASUAET TO JUNE.
., A.M., H.D., Editor.

• Edltora.

HEW TOBK: A. ]

lasB.

SEP 17 1890

Entered eoeordliig to Act of Onngren, A.D. 1869, by A. H. BBIJ^ ta the oflee of the UbrttUa

of OoncrMs, at Wertilngton.

\*

^0

THE SANFTARIAN

JANUARY, 1889.

Number 230:

POLLUTION OF WATER-SUPPLIES.*

In its report at the last meeting of the association your
committee explained in brief the ground of its beh'ef in the
harmfulness of sewrage in waters used as potable supplies,
whether these were derived from wells or larger sources ;
whether the water-supply of an isolated dwelling or that of a
populous city. Chemical analysis was shown to be in most
instances inadequate to the detection of sewage, unless the
sewage was present in unusual quantity or the water unusually
free from other organic matters ; and the conclusion was
reached that the inability of the chemical methods is of no
practical importance, as the presence of sewage in the water-
supply can be determined by the sanitary inspector ; and
further, that for protective purposes the knowledge that sew-
age enters the water is all that seems to be required, because
where there is sewage there is danger of typhoid infection.

Your committee desires to give special emphasis to the last
stated clause, because it believes that the endemicity of
typhoid-fever in our cities is in great part due to the sewage
in the water-supply. Many of our public water-supplies con-
tain sewage, and its harmfulness in a general way is unques-
tioned even by those who have a financial interest in them.
Yet there appears to be a hesitancy to acknowledge the real,
the specific, danger. Typhoid-fever is present in all our cities,
giving annual death-rates of from 15 to 100 and over in every
100,000 of the population ; but in the enumeration of its

* Report of the Committee of the American Public Health Association on the
PoHution of the Water-Supply, at the Milwaukee meeting, November 20th,
1888.

Palhaian of Water-Suppltes.

causes its prevalence is ascribed to many unsanitary conditions
before mention is made of the public water-supply. It is
allowed in .certain local epidemics to be propagated from wells
which have become infected by an infected sewage, but the
sewage in the public supply is seldom considered other than
as a sentimental objection to the use of the water. It is
allowed in many instances to arise from leaks in the plumbing
of houses, by which exhalations from infected sewers reach the
interior of the dwelling, but the water-supply into which the
sewage of these very sewers is poured is used without a
thought of its deadly qualities, unless, as in the case of Plym-
outh, Pa., the fact is forced upon the public mind that a
public water-supply has as little disinfecting power over the
germs of typhoid-fever as the private water-supply of an in-
fected well. Health officers condemn the well, and generally
it is closed as soon as it is found that sewage percolates
through its area of drainage ; they should condemn the public
supply on the same grounds.

The large financial interests involved in the establishment
of a public water-supply may be assumed to be at the bottom
of this hesitancy to acknowledge the specific danger attaching
to the presence of sewage. Millions of dollars, perhaps, have
been invested in that water-supply, and many more millions
would be required to replace it by water from a purer source.
These large sums are alone considered, and not the vast and
annually increasing totals of the loss by sickness and death
, that might have been prevented. A public or private well
involves but a small sum, so small that it does not stand in
the way of sanitary progress. It is closed, and with its closure
one more possible centre of typhoid infection is removed ;
but the decreasing influence exercised by this on the annual
rate of prevalence is small indeed if the public supply continue
to disseminate the disease. The dollars and cents represented
by the existing water-works may be regarded as a barricade
to sanitary progress, or an altar on which typhoid-fever sacri-
fices its victims.

The efforts that have been made from time to time to quiet
the public mind by demonstrating the destruction of sewage
and the self-purification of the water which contained it, are
in part attributable to these financial interests ; but only in

PoUuUon of Water- Supplies.

part, for many sanitary inquirers have been deceived by partial
or imperfect observations. Unfortunately, however, those
analysts who have had much practical experience in following
the track of sewage in its passage down-stream recognize in
this so-called self-purification only the results of sedimentation
and dilution. Undoubtedly the natural processes of purifica-
tion— the transformation of organic matter into ammonia, and
the nitrification of the latter — operate in the current of a
running stream ; but these account for but a small proportion
of the seeming purification, and there is no ground for sup-
posing that the infectious principle of typhoid-fever is given
up to the action of these purifying agencies. We acknowl-
edge that typhoid-fever is propagated by an infected sewage
in a well-water when all organic trace of the sewage has disap-
peared through the instrumentality of the agencies referred
to. There are two kinds of organic matter in the dangerous
sewage — matter which, by the absence of life, is given up to
decomposition and reduction to harmless inorganic forms, and
matter which by its vitality is preserved from these influences ;
and we acknowledge that in the well-water the former may be
reduced, while the latter retains the full measure of its viru-
lence. Analogy shows conditions of a similar character affect-
ing our river-supplies, and the seeming apathy with which
they are regarded can only be accounted for by assuming that
individually we have fought against the barricade erected by the
dollars and cents, and been defeated by its solidity and strength.
In this country the relation between the distribution of a
water which contains sewage and the prevalence of typhoid-
fever can be readily observed by any one* who studies the
mortality returns of our cities in connection with the character
of their water-supply. The records in many instances are
complete and trustworthy for the past twenty years. Brook-
lyn, New York City, Boston, Cincinnati, Philadelphia, etc.,
have a death-rate from typhoid-fever proportioned to the
quantity of sewage which enters their water-supplies. Where
the water-supply, as in the first-mentioned city, is free from
sewage, the death-rate is low, about 1 5 in every 100,000 of the
population, these cases being due to indirect infection and
other local causes. When care is exercised in excluding sew-
age from the water-shed which furnishes the public supply^

6 PoUuHon of WaUr-JShysfpliea.

there is a corresponding freedom from typhoid-fever^ as in
New Yorky which has a rate of 25, and Boston, which loses
about 40 annually for every 100,000 of her people. In Phila*
delphia and other cities, in which less attention is given to the
purity of the public supply, the typhoid death-rates are corre-
spondingly increased. Moreover, the records of some of these
cities give interesting information when viewed in connection
with the history of the water-supply. The city of Baltimore
has had a steadily diminishing rate since its water-supply was
first introduced, and this decrease has been more notable since
1880, when the supply was largely extended. And this same
city of Baltimore shows that its improved condition is not due
to the introduction of a system of sewerage, but to the use of
a purer water than was formerly furnished by its infected
wells. Ordinarily a sewerage system and public water-supply
are contemporaneous improvements, and heretofore any bene-
fit to the health of the community has been credited to the
sewerage, although it seems as if the inflow of a wholesome
water had really more to do with the lessened death-rate, for
the small typhoid rate of New Orleans, La., cannot be attrib-
uted to the sewers of that city, since it has none ; but it may
be attributed to the water-supply, for that consists of rain-
water, which is free from sewage, inasmuch as the cisterns in
which it is stored are not sunk in the soil, but raised consider-
ably above the surface.

Testimony of a similar character has recently been developed
by the experience of Vienna. In that city, from 185 1 to 1874,
well water of an impure character was used to a large extent
in addition to a sjrstematized supply from the Danube. Dur-
ing this period the deaths from typhoid-fever ranged from 100
to 340 annually in every 100,000 of the population. In the
last-mentioned year a spring-water was introduced, and the
death-rate from t)rphoid-fever fell immediately to 50. Since
then, by the disuse of impure wells and the extension of the
new supply, the rate for the past three years has fallen to 1 1 ;
and, inasmuch as the sewerage system was in existence during
the period of high rates, the fall since 1874 is necessarily re-
ferred to the use of a water which is free from sewage. The
fall in the typhoid rate experienced an interruption in 1877,
when, owing to the freezing of some of the sources of the

J^oOuUon of Waier^SiippUes^ 7.

sprii^supply, the water of the Danube had to be pumped
into certain of the mains ; and it is of importance to observe
that the sections of the city which were chiefly affected by
this epidemic were those in which the Danube water was dis-
tributed. According to Professor Nothns^el* typhoid -fever
has become such a rarity since the introduction of the spring
supply that when a case occasionally comes to hospital from
outside the city he shows it to the students as one of unusual
interest.

In the face of such testimony to the influence of a pure
water on the typhoid rate, we cannot shut our eyes to the
relation that exists between sewage in our streams and
typhoid-fever in the cities that are supplied by them, no
matter how great may be the financial interests that are in-
volved or sunk in the contaminated supplies. Now comes
the inquiry. What are the measures that have been or should
be adopted to lessen the evil ?

As a rule, the only effort made by our municipal authorities
and water companies to purify our public supplies is by sedi-
mentation. They select a pond which forms a natural sedi-
menting reservoir, or they throw a dam across a stream to
form an artificial one, or, in the case of large water-courses,
they pump directly from the stream into specially prepared
basins. Primarily these basins or reservoirs were intended to
facilitate distribution and guard against a temporarily inade-
quate flow in the stream which furnishes the supply ; but
they were found to answer the purpose of clearing, and to
that extent of purifying, a turbid water, provided they were
large enough to permit the water to remain undisturbed for
the needful length of time. When it is proposed to have ad-
ditions made to the water-supply of a city, the construction
of new basins is usually implied. As an instance, there are
now at the city of St. Louis, Mo., four settling basins, holding
eighteen million gallons each. The floors are paved with brick
on edge, and slope toward the centre and the river side. The
sediment is floated of! from the floor of each basin once in
about four months, the quantity removed annually amounting
nearly to 200,000 cubic yards. The wants of the city permit
the water to settle only from eight to eighteen hours, while a
period of thirty hours is required for a satisfactory subsidence.

8 PcUuHon cf WaUT'&i^pjpUes.

On this account an extension of the work is at present in con-
templation. Surveys have been m^de, and land purchased,
for larger settling-basins and conduits to carry the water to
the present high-service or clear-water pumping-plant. The
estimated cost of these improvements is three and a half
million dollars.

The storage of a turbid water in such basins undoubtedly
tends to improve its quality. No argument is required to
show that the St. Louis water is better with its suspended
matters at the bottom of the reservoirs than choking the dis-
tributing pipes, collecting in every containing vessel in the
city, or settling in the alimentary tract of the water con-
sumers. The subsidence of the inorganic matters which con-
stitute the mass of the turbidity carries down a considerable
proportion of the associated organic materials, and the clear
water gives markedly better results as well on chemical anal-
ysis as on bacteriological examination.

Chemically considered, the tendency of the cleared water is
to further purification. Organic matter steadily diminishes in
quantity, and is replaced by ammonia and nitrates^ ; but as
this is effected by bacterial agencies, biologically the stored
water progressively deteriorates after it has become clear by
sedimentation. The bacteria increase at the expense o/ the
organic matters which they destroy. A water which every
chemist and every bacteriologist would pronounce a fair
sample of potable water will be found, after a week of storage,
to be swarming with bacteria. Daily experience forbids the
condemnation of a good water merely because it has been
stored for a week ; yet the bacterial colonies that may be de-
veloped from it are infinitely more numerous than those that
are found in a water which is impure even to the senses. In-
deed, the bacteria in an ordinarily pure water, after storage,
, may be vastly more numerous than in another portion of the
same water intentionally contaminated with sewage or other
impurity and similarly stored for the same length of time.
This it is which deprives the bacterial cultivations of that
value which but a short time ago they were expected to de-
velop as indices of the wholesomeness or unwholesomeness of
a water. A chemical evidence demonstrating a tendency to
purification by the conversion of organic matter into nitrates.

PoBuUan cf Water-StippUea. V

through the instrumentality of bacterial organisms, is more
consistent with every-day observation than the bacteriological
evidence which suggests unwholesomeness by demonstrating
the numbers of the bacteria.

But although the general tendency is to the reduction of
organic matter in stored waters, it often happens, particularly
if the water is rich in ammonia or easily decomposed albumi-
noids, that vegetable growths other than bacteria will be de-
veloped, giving a bad taste or odor to the water, and perhaps
causing diarrhoea in the consumers. These, which may be*
considered the accidents of storage, have been studied by
many health boards and water companies ; and the influence
of heat, aeration, exposure to sunlight, etc., on their develop-
ment, has been determined with practical benefit in many cases.

Sedimentation is sometimes an exceedingly slow process,
particularly when the mineral particles consist of finely divided
clay. A week or more is required in some instances to give a
clear water, and this involves a large expenditure for storage-
basins. Hence, many have turned their thoughts to filtration
as a prompt and efScient means of purification. Filtering-
beds are in general use in England, but in this country they
have been constructed only by a few cities, and in an experi-
mental way. The results do not appear to have been satisfac-
tory. The expenses attending them are large, and the cold-
ness of our winters begets difficulties which have not to be
encountered in the milder climate of England.

But the failure of filtration on. the large scale, and the im-
perfect results of sedimentation as carried on in the reservoirs,
have given an impetus to the construction of filters for do-
mestic use ; and the success which has attended attempts to
supply a clear water to manufactories and other large estab-
lishments has gradually led to more ambitious efforts. OC
late some municipalities have investigated the means by which
this filtration is effected ; and the ability of the filters to sup-
ply a clear water on the large scale appears to have been dem-
onstrated. As the method is patented, a certain hesitancy
has been manifested by members of the Association in referring
to it ; but, patented or not patented, if it have a value above
others in supplying a pure water, we should have full accounts
from such of our members as have a practical knowledge of its

10 Pollution qf WcOer-SuppUsi.

operations in all their aspects. A member of the American
Water- Works Association did not hesitate, at its last meeting,
to invite attention to the success achieved at Atlanta, Ga.
He expressed himself as knowing but little of the chemical
improvement that took place in the quality of the water, but
so far as the mechanical results of the filtration were concerned
he was perfectly satisfied. The surface of the water in the
impounding reservoir is nineteen feet above the layer of coke
and sand which constitutes the filter-bed, through which it is
carried by gravity into the clear-water basin. The reservoir
water is generally so muddy from red clay and other suspended
impurities that it is rarely fit for bathing or laundry uses ; yet
in the clear- water basin small objects may be plainly seen
through it at a distance of twenty feet. The capacity is three
million gallons daily, although the quantity actually filtered
for distribution at the time of the report was only two million
gallons. The cost of the filters and clear-water basin was
$SS»ooo, and the daily expenses eight dollars for alum and two
dollars and fifty cents for labor.

So much experience has been gained in the construction of
these filters that filtration can no doubt be effected more rap-
idly and economically under the supervision of the patentees,
than on new plans which must be at first regarded as merely
experimental. But if the attention of boards of health, water
companies, and sanitary engineers were directed to the devel-
opment of the best filtering plant, other and better methods
might be suggested and carried into practice ; or, if the patent
process were proved to be superior to all others, the ability to
express a prompt approval would be substituted for our pres-
ent hesitancy. The passage of water through a filter-bed, the
regular cleaning of the filtering material, and the addition of
alum, iron, lime, or other precipitant, to the water, are the
essentials of the process ; but the patents necessarily cover
only the specific mechanism by which these are brought into
operation in that particular process. The natural laws of
filtration, and of mechanical and chemical action, are open to
the ingenuity of the world.

Recently Mr. L. H. Gardner, of New Orleans, has been ex-
perimenting on the large scale with solutions of iron, not as
an adjuvant to filtration, but to hasten sedimentation in the

PoUutum of WaUr-Supplies. 11

settling basins. Iron as a precipitating or filtering agent has
been used in various forms and to a considerable extent, on
the large scale, as a water-purifier since Medlock, in 1857, pat-
ented a process in which water was treated by contact with
metallic iron. Spongy iron attained even a popular repute as
a filtering material, but at the present time in Europe it has
been displaced by the Anderson process, which is said to be in
successful operation at Antwerp, Ostend, Paris, and Vienna.
The water in this process is first partially sedimented and then
forced through a revolving purifier consisting essentially of a
wrought-iron cylinder mounted on hollow trunnions, which
serve for inlet and outlet pipes. Curved ledges, running
lengthwise of the cylinder on its inner surface, scoop up and
shower down fine borings of cast iron through the current of
the water. By the combined action of the cylinder and the
water-current every portion of the latter is brought into con-
tact with the iron, the particles of which are kept constantly
bright by friction against each other and the sides of the cyl-
inder. After this the water is passed through sand filter-beds
to remove excess of iron. The results claimed are that the
organic matter is altered in its chemical nature, and the albu-
minoid ammonia lessened from one fourth to one half of its orig-
inal amount ; that the water is softened, the scale in boilers
becoming greatly reduced, open, friable, and loosely adherent
to the plates ; and that the microscopic life of the water is, to
a large extent, destroyed or removed. At Antwerp the quan«
tity of water thus treated is two million gallons daily, and the
engineer in charge of the works and the municipal authorities
have expressed their satisfaction with the results attained.

The various methods of purification by iron that have been
tried in Europe involve the contact of the water with natural
or prepared ore or cast-iron borings or turning^s, with a subse-
quent filtration through sand to eliminate any excess of iron ;
but Mr. Gardner has suggested the introduction of a solution
of iron in the precise quantity needful for the desired purpose.
He tried a solution of red haematite ore in hydrochloric acid
on Mississippi water at the New Orleans water-works, and the
clarified water gave satisfactory results to Professor Chandler,
of New York, and other chemists. Later, he treated a body
of thirteen million gallons in the St. Louis settling basins*

Xi PMutim of Waisr-Supplies.

The solution used, the water in various stages of precipitation,
and the clear resultant water, all met with favorable reports
from the analysts. The action is chemical, not mechanical.
The combinations of lime and magnesia iii the Mississippi
water become converted into chlorides by the chlorine of the
iron solution, and the precipitated oxide of iron settles
promptly, carrying the suspended matters with it, and leaving
the water clear. A solution of the specific gravity 1.6 in the
proportion of one part to 20,000, clarifies the muddiest of
river waters without hardening them or leaving in them any
excess of the precipitant. The Mississippi water at New
Orleans can be thus clarified by a rest of eight hours in the
reservoir at an expense of one cent for every thousand gallons.
Mr. Gardner's object at the present time is to procure a
cheaper iron solution.

In the efforts to attain to a prompt and efficient method of
purifying water by sedimentation or filtration, with or without
the use of precipitants, it is of the utmost importance that the
object of the purification be kept steadily in view lest we fall
into the error of supposing that the end has been accomplished
when a clear water has been obtained. The agents of a cer-
tain patent filter place in the show windows of some promi-
nent store two companion glass jars, one filled with an opaque
and discolored turbidity overlying a stratum of heavy sedi-
ment, and labelled *' Water taken this morning from the pub-
lic mains */' the other, sparkling like a consolidation of dew-
drops, and labelled " The public water after passing through
so-and-so's filter." A glance at these gratifies the passer-by,
by seeming to instil into his mind so much sanitary knowl-
edge. They sow seeds of reflection which develop and mul-
tiply with bacterial fecundity, so that in a few minutes they
have done the work of an octavo pamphlet on " Potable
water : its impurities and the methods by which they are re*
moved." But the sparkle of the filtered water, although
honest in itself, hides a fallacy which undermines the whole
of the suggested argument. It must be remembered that
clear waters are not necessarily wholesome waters. Their
sparkle is no proof of their purity. From the laundresses'
point of view, or the paper-makers', the result is satisfactory ;
but the object of the filtration of a water-supply for domestic

JPalltUion of WaUr-StbppUes. 18

or public service is its wholesomeness when used for drinking,
and its transparency gives no testimony on this subject.

During sedimentation the heavier and grosser particles of
mineral matter readily subside, and carry down with them
much of the flocculent organic matter which would otherwise
continue in suspension for many days. The effect of sedi-
mentation at St. Louis, Mo., has been mentioned, but it will
perhaps be better appreciated when stated in other words.
The lake supply of Cleveland, Ohio, which is usually of excel-
lent quality, tis occasionally turbid, particularly during the
spring months. When in this condition of turbidity the
twenty million gallons, which are distributed daily, contain
ten and a half tons of suspended matters, and the odd half
ton consists of decomposing organic substances. Who will
say that the city of Cleveland would not be benefited if it did
not have that daily distribution of half a ton of semi-putrefac-
tion ? But sedimentation does more than free the water from
suspended matters. During the so many hours or days of its
continuance the processes of nature are at work transforming
the semi-putrefied matters into ammonia and nitric acid, both
of which are harmless in the quantities present. The purify<-
ing influence of sedimentation may be easily determined by
chemical analysis, and in many cases it is so marked as to render
the process of infinite value in the absence of a better method.

Most surface waters, which are turbid from particles of min-
eral matter, contain the germs of nitrification, and the process
of purification takes place in them during storage ; but if
these germs be absent, months may pass with but little im-
provement in the character of the stored water. Hence, cis-
terns which do not contain these bacteria have usually a less
pure water, as judged by the ammonia and albuminoid am-
monia which it yields, than those which do contain them.
Where wooden tanks, as at New Orleans and other Southern
towns, are used for storage, it is a common occurrence for the
analyst to find water of poor quality in new or recently cleaned
cisterns, while water of a much better quality is discovered in
those that have not been cleaned for a year or two, and have
a fermenting sediment a foot or more in depth covering their
floor. The nitrifying agencies accumulate with the sediment,
and, notwithstanding the sediment, they succeed in reducing

14 PolluHon of Woaer-SuppUes.

the organic matter of the water to the inorganic condition*
The sediment is thus an advantage, but the end is better ac-
complished by keeping it out of the cistern and introducing
the bacterial workers through the medium of a layer of clean
gravel or sand.

But withal^ it must be remembered that it is only organic
matter in a state of decay that is thus reduced to the inorganic
condition, and only organic matter in a tangible form that is
thus carried down by the heavier particles of the mineral sedi-
ment. Organic matters that are endowed with vitality remain
uninfluenced by the destructive and reconstructive bacterial
agencies that are operating in the water ; and these, as has
been seen, are the matters from which most is to be feared if
sewage has unfortunately had access to the supply. The in-
fected water which prostrated 1200 of the 8000 inhabitants of
Plymouth, Pa., and killed 130 of those whom it prostrated,
passed through three storage reservoirs on its way to accom-
plish its deadly mission.

Nor is filtration more efficient as a purifier when viewed
from the standpoint which sees typhoid-fever disseminated by
an infected sewage in the water-supply. A satisfactory filtra-
tion removes the haze or cloudiness which may pervade a sedi-
mented water for days after the grosser particles have subsided,
and in so far its results are better than those generally effected
by sedimentation. The finer particles of clay, some no larger
than barely distinguishable molecules under the ordinary
working powers of the microscope, are removed, and with
them organic shreds of similarly minute size, and even many
of the bacterial germs which were present. A water thus freed
from foreign matter in suspension seems to offer the lustre of
its transparency as a voucher or visible symbol of its purity,
and chemical analysis may show in it only the merest trace of
organic matter in solution, for the processes of decomposition
and recomposition of the organic elements take place with
much greater rapidity when the water percolates through the
pores of the soil, as in the natural process of filtration, than
when it is merely stagnant in a reservoir or flowing in the cur-
rent of a stream. It is now well known that the bacterial
agencies which effect these changes have their habitat in the
three or four feet of soil which constitutes the surface of the

PoduUcn of WaUr-SfwppUu. 16

earthy and that in soaking through this layer the organic
matters of a water are transformed into matters which the
roots of living plants can absorb and assimilate. Chemical
analysis may therefore show in such a water merely the small
quantities of ammonia or nitric acid which are the results of
this bacterial action, and the water may be claimed to be pure
on much stronger evidence than can be advanced on behalf of
any water which is massed on the surface in a lake, pond,
river-bed, or settling basin, these surface waters having at
work in them only those straggling bacteria that have been
washed from their habitat in the soil into the current of the
stream. In fact, so far as can be demonstrated by chemical
tests, the naturally-filtered water may be free from everything
of an organic nature.

In view of our knowledge of the conditions needful to a per-
fect natural filtration, it is impossible to allow that artificial
means, operating after nature's methods, will ever produce as
pure a supply as can be procured in suitable localities by
digging a hole in the ground. Comparatively speaking, only
a small quantity of rain falls on a stated area — a depth of so
many inches during the course of a year — and of this a large
proportion is turned aside for the general police of the surface,
and, having fulfilled its mission, is carried off by surface chan-
nels to the ocean, while another part of the fall cools the over-
heated surface of the soil by its evaporation, and gives the air
that proportion of moisture which is needful to the continu-
ance of life under present conditions. Only a few inches of
the annual rainfall penetrates the soil, and, escaping the roots
of the living vegetation, collects on the suriace of some imper-
vious stratum as the surplus water poured into a flower-pot
drains into the saucer below. Artificial filtration has neither
the time nor the surface to effect percolation after nature's
method. Filtering-beds of gravel are prepared which permit
more water to pass through them in a day than nature per-
colates through the same area in a year, or special filters are
constructed which transmit, under pressure, as much water in
half an hour as nature purifies on the same area annually. The
bacteria of nitrification cannot be harnessed to the work of
artificial filtration, and hence the results of such methods,
although manifesting a satisfactory freedom from suspended

16 Polhdion of Waier-Swpj^ieB,

matters, can in no instance compare with the organic purity
which characterizes the spring and well-waters that are found
in the laboratory of nature. Since the bacteria of the artificial
filter! ng-beds are unable to deal with the organic matters dis-
solved in the percolating water, it is needless to expect them
to reduce the masses of oi^anic matter which in progress of
time clog the filter with their accumulated foulness, and lessen
its efficiency as a filtering medium. The artificial filter can-
not, therefore, furnish a water which will be as pure as a nat-
urally pure water. In fact, artificial filtration amounts to
little more than the mechanical separation of a water from its
suspended particles, while the essential of natural filtration is
the thorough nitrification of the albuminoids of the water, the
removal of suspended matters being incidental and merely
secondary.

The decay of once-living organisms, animal or vegetable^
gives more or less taint of a putrefactive nature to the surface-
waters of the earth, and this taint, when of sufficient strength,
is known to induce diarrhoeal tendencies in the human system.
Moreover, among the fermentations which take place during
the destruction of organic matter, is one which gives origin to
an influence — the malarial — which is always disabling, and
often deadly, to human life, pervading the surface-waters to a
dangerous extent, particularly in warm climates and seasons.
By the process of filtration nature removes both the putrescent
and malarial taints from the water, yielding a supply which is
held to be pure and wholesome by the ever-increasing testi-
mony of the generations of the world. The malarial influence
is attributed to a micro-organism. If this view be correct —
and the tendency of medical science is to accept it as the only
theory which gives a satisfactory explanation of the malarial
phenomena — the vitality of the germ should preserve it from
the putrefactive and nitrifying agencies, for these operate only
on dead matter. It is therefore probable that only the me-
chanical part of the process of natural filtration is concerned
in the removal of the malarial influence from a water, and that
an artificial filtration which gives satisfactory mechanical re-
sults will be of value in the prevention of malarial disease.

Although the bacteria of the soil do their work so thor-
oughly that no chemical trace of existing organic matter can

PMvtian of WaUr-JSkipplies. 17

be found in the percolated water, it sometimes happens that
this water is unwholesome. When collected at a distance
from the haunts of man, it is as pure as it looks, for nature's
methods always suffice for her necessities ; but where the
activities of human life create artificial conditions, such as re-
sult from the aggregation of individuals in cities and towns,
her methods fail because they cannot be carried out. The
soil becomes more and more contaminated by animal excreta,
and the wells reservoirs in which are collected the teachings
or washings of this impurity. If the impure soil be colonized
hy the infection of typhoid-fever, it is immediately converted
into a breeding ground for the germs of that disease. The
vitality of these germs preserves them from putrefactive
agencies, and their size seems to offer no obstacle to their pas-
sage through the soil. They therefore drain into the well,
and confer upon its clear waters powers of a most deadly char-
acter. In the records of sanitary science are to be found many
epidemics of typhoid-fever chargeable to wells that have
become contaminated by sewage. Indeed, the more the trans-
mission of typhoid-fever is studied, the more evident it is that
the water-supply is the main agency concerned in its propaga-
tion. Hence, sanitary officers have not only closed up wells
into which sewage has entered, but those which, from their
situation, are merely exposed to this danger.

Since natural filtration is powerless against the infection of
typhoid, it is evident that artificial methods can give no guar-
antee of protection.

The purifying influence of precipitation by means of such
chemicals as alum, iron, or lime can readily be demonstrated
by chemical analysis. The hydrated alumina, ferric oxide,
and lime carbonate, as they materialize into particulate exist-
ence from their solution in the water, entangle and carry down
with them organic particles that would otherwise be less easily
removed ; and biological research shows that bacterial germs
are swept from the water in like manner. That this operation
is imperfect is demonstrated by the number of colonies which
can be developed from the cleared water ; that it is purely
mechanical and not germicidal is indicated by our experi-
mental knowledge of the action of such substances on various
bacterial organisms, and by the fact that their presence does

18 JPoUtUion of Wdter-Supplies.

not exercise even an antiseptic influence on the bacteria of the
water, as the number of these bacteria subsequently increases
in the cleared water as rapidly as in a stored water which has
had no such chemical treatment. The commercial interests
concerned in artificial filtration invest these substances with
the title of coagulants, as if the albuminoid constituents of
inorganic life curdled into a bacterial rig'or mortis as soon as
the water became pervaded with the presence of the precipi-
tant ; but there is no warrant for a belief in any protective vir-
tue other than that connected with a mechanical entanglement
and precipitation.

The processes of purification that have just been reviewed
remove suspended matters and more or less of the dissolved
saline and organic substances that are present in the water,
but none of them can lay claim to the removal or destruction
of the causative agencies of the acute infectious diseases that
are known to be propagated by an infected water-supply.
These processes have been closely studied by the English sani-
tary authorities, who long ago came to the conclusion that
sewage in a water is harmful because it may contain the germ
of cholera or typhoid-fever, against which the most efficient
method of artificial filtration constitutes no effective safeguard.
Hence, the object of sanitary legislation in England is not to
preserve the rivers as a drinking-supply, but to prevent them
from becoming a nuisance in their character of open sewers.
The solids of sewage consist of a highly nitrogenized organic
matter, the proper disposition of which in the economy of
nature is as materials for the growth of the vegetable king-
dom ; and if these be separated, the water may be purified by
percolation* and filtration and returned to the rivers. Sewage
has accordingly been treated in various ways for the separation
of the solids and the reclamation of its water. In country
houses and small communities a cesspool can be provided for
the deposition of .solids, the liquid overflow being conveyed
by drain-pipes into the soil. The effluent water in such cases
may be as pure to chemical tests as that of the stream into
which it is discharged. But as communities grow, the diffi-
culties attending the disposition of their sewage are propor-
tionately augmented.

Various methods of precipitation have been tried with the

PdliutUm of Water-Sufpplies. 19

vie^r of paying expenses by the sale of the soh'ds as a fertil-
izing material, while the separated liquids are turned into the
water-courses, with or without an intermediate filtration
through the soil. Sewage irrigation has also been tried on
the large scale, and in many instances with satisfactory results.
The advocates of irrigation point with considerable enthusiasm
to the purity of the effluent water, and consider that this
system will ultimately settle the vexed question of the dispo-
sition of sewage ; and, indeed, such is the purifying influence
of the soil, that the clear water of the outflow gives relatively
good results on analysis. But, as we have seen in speaking of
sewage-polluted wells, the purity which is evidenced by chem-
ical tests fails to give an assurance of protection from typhoid-
fever, and it is this protection, not chemical purity, which is
the object in view. These advocates claim that typhoid-fever
does not prevail in the fields which receive the sewage of an
infected city, but it is the propagation by drinking-water, not
by exhalation, in which we are interested, and typhoid-fever
is known to have prevailed on fields where the effluent water
was used for drinking. Indeed, how could we expect other-
wise when we know that typhoid-fever is propagated by an
infected sewage in a well-water which has undergone a more
efficient filtration through the soil than that to which the sew-
age is subjected in the irrigating fields, or when we remember
that the spring-waters which occasioned the epidemic at
Lauzen were derived from a sewage-polluted stream spread
over the fields of an adjoining valley for purposes of irrigation ?
In view of the considerations which we have thus briefly re-
viewed, we cite the opinion of the English commissioners, to
give it greater emphasis as reaffirmed after the passage of
years which have added much to our knowledge of the propa-
gation of infectious diseases by means of the water-supply :
" Of all the processes which have been proposed for the puri-
fication of water or of water polluted by excrementitious
matters, there is not one which is sufficiently effective to war-
rant the u^e, for dietetic purposes, of water which has been so
contaminated. In our own opinion, therefore, rivers which
have received sewage, even if that sewage has been purified
before its discharge, 2[re not safe sources of potable water."
A water to which sewage has access should from that fact

30 PoUutian of Water-Supplies.

alone be excluded from all further consideration as a possible
water-supply for drinking purposes.

The introduction of a water-supply into a growing city is
ordinarily only a question of money. Engineering difficulties
fade into insignificance when surveyed from a satisfactory
financial standpoint. It is often said to be beyond the power
of money to purchase health, but the sanitary student can
readily demonstrate that in many cases this is not so. Money
expended in the distribution of a wholesome water-supply will
purchase health for the thousands who otherwise fall victims
to the fever which is endemic in our cities and towns. Ty-
phoid-fever is a disease to which every one is exposed. The
susceptibility to it is inherent in our constitutions, and, so far
as we know, immunity can be purchased only by submitting
to attack. Ordinarily the human constitution succumbs to its
influence before maturity is reached, but if up to that period
we fortunately escape, we have no assurance of future im-
munity. Uncertainty overhangs us like a cloud. Danger is
as present with us in the daily routine of our peaceful lives as
on the battle-field, only that the embodiment of evil is an
invisible and intangible germ instead of a fast-flying bullet.
Danger flows beside us in our streams, in our mains, from the
taps in our houses. The germ of the disease may not be in
this pitcherful or in that, in this tumblerful or in that, but it
will find us some day if we continue to use the water which
contains it. In a town of 50,000 inhabitants one victim is
taken daily, and as the average duration of this disease is
about a month, there are always in that city thirty persons
whose lives are unnecessarily trembling in the balance.

What is the local suffering from yellow-fever in Jacksonville,
Pensacola, or New Orleans, once in so many years, compared
with the totality of the destruction caused by the steady prog-
ress of this general and ever-present scourge ? Thirty thou-
sand people die of typhoid-fever annually in the United States
of America, and Vienna lowered her losses by this fever from
340 to 1 1 annually in ^wtry 100,000 of her population by intro-
ducing a spring-water supply instead of the sewage-tainted
waters of the Danube. Calculate the loss by sickness asso-
ciated with these 30,000 deaths — the loss of work, the unprofit-
able work of nursing, and the actual outlay necessitated by

Pdhaian of Water-Supplies. 21

each visitation of the disease — and you will find that saving
money by drinking sewage in the water-supply is a penny-wise
policy that in the long run will fail to pay even for the funerals
and the mourning goods.

In many instances it is, on this continent, an easy matter to
obtain a suitable supply for a community. Some neighboring
lake offers itself as a natural reservoir, requiring only the con-
struction of conduits for the transmission of its waters ; or an
artificial reservoir may be formed by damming certain of the
radicles of a neighboring stream. The drainage area of this
supply must be kept under the closest supervision by the sani-
tary authorities of the community, for it is not enough to ob-
tain a supply which is free from sewage ; it must be kept so.
Constant vigilance is the price of safety. The sanitary in-
spector should be ever on guard and familiar with every square
yard of the surface, and the health authorities should be em-
powered to protect the many against the carelessness or wanton
encroachments of the few. The question of water-supply is
here reduced to its simplest terms : the raising of sufiicient
money to bring in the wholesome water, and the investment
of the health officer with power to preserve the wholesome
quality of the public supply and to prevent the use of water
from sources which are known to be unwholesome.

In other instances, it is difficult to obtain a suitable water-
supply. The whole face of the country has been more or less
settled, and the natural drainage of every valley brings sewage
and manufacturing waste into its outflowing stream. Never-
theless, now is the time to act, for these unfavorable conditions
will increase and multiply in the future, so that what may be
done now cannot be done then without a tenfold expenditure
of time and money. Fortunately, when difficulties occur from
the density of the settlement, there is also more wealth to
meet the increased expenditure, but it is beyond the power of
that wealth to give life to those who have in the mean time
fallen victims, or consolation to the hearts that are in mourn-
ing. What is to be done should in all cases be done at once.
It is we who are interested in this matter — now, in our own
time and generation ; for what does it avail us that the city is
supplied with pure water ten years hence, if at that time it be
remarked of us, Oh, yes, I remember him well ; he died of

8^ Pollution of Water-Supplies.

typhoid- fever eight or nine years ago. And it is an easy
matter to so arrange the financial burden that part of it shall
fall on those who will hereafter participate in the benefits.

In well-settled sections of the country it may be impossible
for the towns and villages to obtain a water free from sewage
in their main streams or their neighboring tributaries, and
equally impossible for any one of them to go to the nearest
sources of pure water for a supply, but those favorably situated
for combined action may easily perfect their arrangements for
bringing in the water from long distances. Nor should it be
forgotten that if water free from sewage is not to be obtained
on the neighboring surface, it may sometimes be found be-
neath the surface, as at Brooklyn, L. I., or, more notably, at
Memphis, Tenn., where, after a thorough investigation of the
whole subject by a committee of citizens, it was ultimately
developed that they had a source of the purest water within a
hundred yards of their domestic hearths.

Many communities have a water-supply which was pure
enough when originally introduced, but which has become
dangerous by the subsequent growth and' development of
which it formed the nucleus. A water-bed or basin cannot
be used for concurrent purposes of water-supply and sewage
discharge. If the drainage area be given up to settlement and
commercial enterprise* with their consequent sewage and
manufacturing waste, the city must be prepared to find an-
other source of supply for its daily wants, or pay the penalty
of an increased death-rate from preventable disease. In the
race for material prosperity this penalty is too often forgotten,
and the endemic fever is regarded as one of those visitations
of Providence that are inevitably consequent upon conditions
of aggregation. Yet every intelligent medical man knows the
fallacy of this reasoning, and that the progress of this malady
can be checked by suitable measures as surely as exotic disease
can be kept out of the country by properly enforced restric-
tions on commerce. To permit the citizen to enjoy life,
which, according to the Constitution of the United States, is
his right, the most stringent laws should be enforced to pre-
serve the purity of the supply of drinking-water ; or, if the
settlements on the area are too valuable to be destroyed, a
new source of supply should be obtained and guarded.

PMutian of Water-Supplies. 23

The protection of the citizen requires that every advantage
be taken of our knowledge of the natural history of the typhoid
infection, that it may be destroyed before reaching any of our
water-courses. It is well enough to insist upon the purifica-
tion of sewage by processes of precipitation, filtration, or irri«
gation before its water is delivered into the natural courses,
for thereby the latter will be prevented from falling into the
condition of open sewers, which is the lot of so many small
streams in well-peopled districts ; but these processes cannot
be depended upon to remove the typhoid infection. This in-
fection passes from the patient to our surface-waters directly
by the sewers, or it drains through the soil with the subsoil
water, and reaches the surface on some lower level. Of course
in either case it may be lost in the mass of water in which it
is diffused, but it was not so lost at Plymouth nor at Lauzen.
To protect the citizen and stamp out this fever, it should be
made the duty of every medical man who attends a case of
fever to see that the excreta are disinfected before being con-
signed to the sink, cesspool, or sewers, and the utmost care in
this regard should be taken in cases occurring on a water-shed
which is utilized for a public supply. So far as our knowledge
goes, sewage would be deprived of that which, under ordinary
conditions, constitutes its only dangerous element, were this
system of bedroom disinfection efficiently practised.

Local authorities, such as water companies and boards, citi-
zens* committees, health boards, and commissioners, should
exercise a jealous guard over the public water-supply ; but in
many instances these would be powerless without the interven-
tion and co-operation of the authorities of the State. Massa-
chusetts, Illinois, and Minnesota have already taken steps in
this direction. In the first-mentioned State the Board of
Health is invested with the general supervision of the water-
supplies. No sewage, drainage, excrement, or other refuse or
polluting matter of such kind or amount as — either by itself
or in connection with other matter — will corrupt or impair the
purity of a water used for domestic purposes, is permitted to
be delivered into a water-course or any of its -feeders within
twenty miles above the point where a water-supply is taken.
Upon the application of a city or town to the Supreme Court,
alleging the pollution of its water-supply in violation of law.

24 Pollution of Water-SuppUes.

an injunction may be issued, or the polluting 3ubstances re-
quired to be so cleaned or purified that they shall no longer
be deleterious. The limit of twenty miles in this law is a de-
feet, but sanitary legislation is a thing of slow progress, and
our friends in Massachusetts undoubtedly secured as much as
was possible for them to obtain at the time.

The board is required to examine the waters from time to
time, for the purpose of ascertaining whether they are adapted
for use as domestic water supplies, or are likely to impair the
interests or imperil the health of the public. It is required to
conduct experiments to determine the best practicable methods
of purification, of drainage, and of the dis[iosal of refuse, and
to recommend measures for the preservation of the purity of
the waters. Moreover, it is the legally constituted adviser of
cities, towns, corporations, firms, or individuals, in matters
pertaining to the introduction of water supplies or sewerage
systems, making use of its knowledge and facilities on their
behalf in regard to source and quality of water and methods
of sewage disposal, having regard to the present and prospec-
tive needs and interests of other communities or individuals
that might be affected thereby. The approval of the board is
a legal requirement to the consideration by the Legislature of
any application for authority to introduce any system of water
supply or sewerage.

The board is also empowered to consult with and advise
those engaged, or intending to engage, in any manufacturing
or other business as to the best practicable method of inter-
cepting, purifying, or disposing of any drainage or refuse that
might result from the business to the detriment of the waters
of the State. It is required to bring to the notice of the
attorney-general all instances which may come to its knowl-
edge of omission to comply with existing laws respecting the
pollution of water supplies and inland waters, and to report to
the Legislature any specific cases not covered by the provi-
sions of existing laws which, in its opinion, call for further
legislation. Finally, and very materially, the board is pro-
vided with funds to sustain the corps of engineers, chemists,
and inspectors, whose labors are needful to the proper per-
formance of its duties.

The report of the board's proceedings under these heads.

PaUtUion of WcUer-Supplies. 25

submitted to the Legislature in January of this year, shows
the excellent work that may be accomplished in this way.
Eleven applications from cities and towns for advice concern-
ing water supplies were received ; eleven for advice concerning
sewerage ; two soliciting action to prevent the contamination
of particular water supplies ; and one from a manufacturer for
advice concerning the disposal of drainage from certain works
which he purposed establishing. The important question of a
water supply for the cities of Boston, Chelsea, and Somerville,
and the town of Everett, was one of those that came before
the board. There are 123 sources of public water supply in
the State ; but over 200 samples are investigated chemically
and biologically every month, the samples being from rivers,
ponds, and other sources that may be utilized in the future.
Experiments are also in progress on methods of sewage dis-
posal, which will add considerably to our knowledge of the
results which may be obtained in that direction.

With the aid of the State, the local authorities in their
efforts to obtain and preserve a wholesome water supply would
experience no difficulty that could not be overcome by the
expenditure of the necessary funds. The twenty-mile limit
will in progress of time be blotted out, and the waters of the
State be sharply divided into those which may be used as
sources of domestic supply and those which carry off the waste
water. The water-supply and sewerage systems of the State
— of the country — ^should be as distinct as those of every
household, and the sooner this is accomplished the sooner
will the rates of sickness and death be decreased among our
people.

Your committee, therefore, urge a livelier interest in this
important matter on the part of State boards of health, an
interest which is not satisfied with discussing and subscribing
to sanitary views on the subject, but which will leave nothing
undone that will tend to invest them with power to act for the
preservation of the public health. With all our boards oper-
ating, each within its domain, there would be no need of a
committee of this Association to investigate the subject of
water pollution. In concluding, we submit the following reso-
lution :

Resolved^ That it is the well-considered belief of this Asso-

26 " The Future of the N&u) Torh Water-supply^

ciation that it is an imperative necessity, especially in the
more populous States, that State Legislatures should give
their boards of health that financial support which would
enable them to act intelligently on all questions pertaining to
the public water supplies, investing them at the same time
with the supervision of the said supplies, and with power to
preserve these waters from contamination by sewage or other
injurious matters.

Charles Smart.

S. W, Abbott.

G. C. ASHMUN.

W. W. Daniells.
Edward Playter.

•'THE FUTURE OF THE NEW YORK WATER-
SUPPLY.''— A CORRECTION.

Editor of The Sanitarian :

In an editorial in your December number on the " Future
of the New York Water-Supply," p. 545, you quote from a
paper by me addressed to the New Aqueduct Commissioner,
who had called for my opinion on the advisability of the con-
struction of the Quaker Bridge Reservoir ; but you do me an
injustice in stopping short in the quotation without giving the
very point for which my article was written — ^viz., the means
through which it was proposed that disease germs could be
prevented from dangerous extension, and the waters of the
Croton basin of 362 square miles rendered safely potable. I
had before me at the time a copy of The Sanitarian of
June, 1885, wherein Dr. Edson, of the New York Health De-
partment, reports upon the outbreak of typhoid at Plymouth,
Pa., where from the dejecta from a single patient thrown upon
the surface of the snow, no less than 1200 individuals suffered,
ten per cent proving fatal. Dr. Edson puts a paragraph in
italics in his report, which I had in mind when writing the
article from which you quote. I beg leave to repeat it here.
" Neglect on the part of attendants to disinfect the stools of per *
sons , suffering from infectious enteric diseases s/tould be made a
criminal offence.'' I did not quote this, but say ''that the

&wpplyy 27

only sure method of destruction (of disease germs) is clearly
within the province of the attendant physician to carry out
under the authority of intelligent health boards/' and close
with the statement of the opinion " that there is no danger to
health, now or in the hereafter, in the use of impounded Croton
water, which an intelligent application of the means at our dis-
posal will not suffice to render harmless."

I am free to confess that with your view of the danger to
be anticipated from human remains I may have undervalued
the possible extent of pollution of the water from the Croton
shed — or of any water-shed used for gathering a public water-
supply, which embraces in its area settlements, villages, or
even farms, where private cemeteries are in use ; but unless
the same legislative authority to which Dr. Edson would ap-
peal to prevent the spread of infectious diseases be invoked, to
compel cremation in all cases, very difficult of attainment on
isolated farms, I fail to see any practicable remedy for pollu-
tion of the water-supply of New York short of abandoning the
Croton entirely, and going to the wilderness of the upper
Hudson, the Adirondack. This scheme is entirely practicable,
including a supply for all the towns on the Hudson, including
New York and Brooklyn, a water-shed of 3000 square miles of
area, and over 50 square miles of lakes and reservoirs from 1 5
to 18 feet deep, the drainage into which can ever be retained
virtually as a wilderness.

Dr. W. W. Laman advocated this scheme before the Legis-
lature of New York for several sessions, and at one session it
would have passed but for an unexpected adjournment of the
Legislature, and only his death, over a year since, prevented
the ultimate incorporation of the " New York and Hudson
Valley Aqueduct Company," with a capital of $50,000,000.
Dr. Laman's enthusiasm in the cause was unbounded, and his
perseverance knew no pause, and he had persistently advo-
cated a measure which was conceived in the sanitary and
manufacturing interest of one half of the total population of
the State ; and had he lived it would have become a law ere
this, and the benefits which the carrying out of the scheme
would have conferred will yet, it is believed, lead to the re«
vival of the project.

Assuming 40 inches of rainfall on the upper Hudson yearly.

28 The Origin and Prevention of Tuberculosis.

and a waste of one half, or 20 inches, by floods, evaporation,
and processes of nature, leaves 20 inches, which would equal
a mean daily flow of 2,856,000,000 gallons. In times of ex-
treme drought this might be reduced 20 per cent, or leaving
16 inches of the annual rainfall as available, equalling 2,285,-
000,000 gallons daily; from this,estimating 6^ inches (892,-
000,000 gallons) as applicable to the canals and manufacturing
interests, leaves gi inches, or 1,392,000,000 gallons daily as
available by means of adequate storage in the mountain lakes
for draught in times of low water for the supply of the towns
and cities of the Hudson Valley. The grade line of the open
conduit after leaving the upper Hudson (from 350 to 200 feet
above tide level) is so high upon the hills as to pass back of
and above the villages of the Hudson Valley, giving ample
head for service, and relieving the water from danger of pollu-
tion from this source, and the valleys opening into the Hud-
son would be. passed by iron pipes.

I can see nothing which looks to getting rid of the kind of
pollution to which you refer of water-supply to the city of
New York and its adjoinings, comparable in thoroughness to
this. It has been well worked out in all its details, including
surveys of the lakes in the Adirondacks, by an engineer of
prominence, J. T. Fanning, who has twice reported at large
on the subject ; and to show you how near it came to succeed-
ing, I send you a copy of the bill of incorporation. I should
observe that, to my knowledge, Dr. Laman had secured the
promise from capitalists of all needed financial aid to the carry-
ing out of his scheme. J. W. Adams.

THE ORIGIN AND PREVENTION OF TUBER.

CULOSIS.*

By D. E. Salmon, D.V.M., Chief of the Bureau of Animal Industry, Department

of Agriculture, Washington, D.C.

There can be h'ttle doubt in the mind of the thoughtful
sanitarian that questions relating to the origin and prevention
of tuberculosis will, for years to come, be among the most
important subjects that will attract his attention.

* Read before the American Public Health Association, Milwaukee, Novem-
ber 22d, 1 888.

Ths Origin and Prevention of Tuberonlosis. 29

In the census of 1880 there were reported for the year 91*55 1
deaths from consumption in the United States. We find it
necessary to make a correction here in order to give the actual
mortality from this disease. The total number of deaths from
all causes reported to the census officers for that year amounted
to but 1 5. 1 per 1000 inhabitants, while they admit that the
actual number of deaths was between 17 and 19 per 1000 in-
habitants ; or, as nearly as could be ascertained, 18 per looo.
There were consequently 3 deaths per 1000 inhabitants that
were not reported, and to obtain the correct number we must
increase the figures as given in the census to the extent of 20
per cent.

Admitting now that the number of deaths from consump-
tion should be increased in the same proportion as the general
death-rate, and we find that the mortality from this disease in
1880, instead of being 91,551, was actually 109,861.

Since 1880 the population of the United States has increased
from about fifty millions to over sixty millions of people. If,
therefore, we desire to know the actual mortality from con-
sumption in this country at the present time, we must increase
the figures given for 1880 by at least 20 per cent. This gives
us as the present annual mortality 131,833.

Now consumption, as we know, is but one form of tuber-
culosis. The bacillus of this disease, instead of selecting the
lungs for its habitat, may prefer the brain or the abdominal
organs, or other portions of the body. It may well be doubted
if the number of deaths from these different forms of the
malady can be calculated from existing data with even approx-
imate accuracy ; but I think it would be a moderate estimate
to place the total annual number of deaths now caused in the
United States by the bacillus tuberculosis at 150,000.

We are so accustomed to using large numbers in this gener-
ation, that there are few of us who stop to ask ourselves a
question as to the significance of this enormous number of
deaths in our country each year from this malady. It means
that for every hour of the day and night not less than seven-
teen of our people fall victims to the attacks of this insatiable
microscopic destroyer. It means that within the brief space
during which I occupy your attention this evening more vic-
tims will be claimed in the United States by this ever-present

80 The Oriffin and Prevention of Tuberculosis.

demon than have fallen by the hand of the notorious White-
chapel fiend during the weeks that the world has been horri-
fied by his crimes. And while in the latter case we would be
inexpressibly shocked at any neglect on the part of the author-
ities which would tend to increase the number of deaths by a
single victim from the slums of London, we see this other
enemy of human life entering the homes of the high as well as
the low, striking down indiscriminately the brightest, the
loveliest, the most useful of our citizens, and what are we
doing to arrest its ravages ? And to make the matter still
worse, we know where the destroyer lives, and we have his
photograph in our possession.

The blame for this apathy is not all to be placed upon sani-
tarians, however ; we may be guilty with the rest of our peo-
ple, but without a strong and enlightened public sentiment to
support our boards of health, what can they do in a work of
this magnitude, which will largely increase their expenditures
and which demands the exercise of arbitrary powers ?

Such a public sentiment is rapidly being formed, there is an
increasing demand for adequate measures for the prevention
of this disease, and I venture, therefore, to take up the matter
in a general way, hoping that discussion will lead to further
consideration, and that in the end our ideas may become
better defined and that action may be agreed upon which will
mitigate if it does not control the losses from this plague.

I assume that it is unnecessary, before this Association, to
enter into any arguments to demonstrate that tuberculosis is
a specific, communicable disease, that it is caused by the well-
defined germ which we know as the bacillus tuberculosis^ and
that without the presence of this particular germ the specific
disease in question cannot be developed. With this admitted,
it is extremely important for us to inquire where this micro-
organism lives and multiplies, how we come in contact with it,
and by what channels it gains an entrance into the bodies of
men and animals.

The careful investigation that has been made by scientists
of the life-history, characters, and conditions of growth re-
quired by this microbe make it apparent that in our climate,
at least, its multiplication does not occur outside of the human
or animal body to a sufficient extent to demand the consider-

The Origin and Prevention of Tuberctdasis. 31

ation of sanitarians. Its reproduction and development take
place within the body, and every individual who is affected
with it has obtained it either directly or indirectly from some
other person or animal that was previously affected with it.
These statements must be accepted as axioms by sanitarians
before we can hope for substantial and satisfactory results in
the prevention of this terrible malady.

The contagiousness of tuberculosis among cattle is so appar-
ent that it was admitted on all sides by veterinarians long
before Koch discovered or cultivated the parasite. With
people, as you know, the case is different, and its contagious-
ness has been strongly contested, and it is only recently that
sanitarians have generally admitted that it may occur in a
limited number of cases. From a study of the facts which
bear upon this question, it appears to me that the greater con-
tagiousness in the one case is due simply to the conditions of
life. We know that when the lungs are affected the sputum
contains myriads of the peculiar germs of this disease, and
that the dissemination of the germ from the diseased person
must be chiefly through this medium.

On the other hand, experiments make it reasonably plain
that the germ must find its way into the body either by the
respiratory organs, the alimentary canal, or through wounds
on the surface of the body. It is apparent, therefore, that
with the conditions of life under which we live in this country,
it is not to be expected that the contagiousness of tuberculosis
can be made very clear except with persons in such relations
as husband and wife, where saliva may be transferred in the
act of kissing. But judging from the newspaper accounts of
domestic infelicities, we should not be astonished at the rather
rare cases which have been recorded where the disease was
evidently contracted by the wife from the husband or by the
husband from the wife. Perhaps a more conclusive reason
why such recorded cases are rare is the fact that the conta-
giousness of tuberculosis has not until recently been accepted
by physicians, and even now a considerable proportion of all
those who graduated longer ago than five years reject this
doctrine and have serious prejudices against it. As a result,
I am convinced that many clear cases of contagion have not
been referred to this cause.

32 The Origin and Prevention of Tvberculosis.

Contagion from dried sputum^ or that which is partially
dried, would pass unnoticed, because people are nearly as
much exposed to consumptives outside of their families as
within them. Who has noticed the wholesale use of un-
washed drinking-cups at our hotels, railway stations, and other
publit places without seeing there a means by which the bacil-
lus tuberculosis can be widely scattered by sputum or saliva
without the remotest chance of tracing the contagion ? Again,
when we see how tuberculosis sputum is distributed over our
streets and sidewalks to be dried by the winds, ground into
powder by the feet, and then carried by currents of air into
our mouths and nostrils, how can we expect to trace the en-
trance of this germ into the body and determine by observa-
tions upon people whether it is or is not contagious from man
to man ? We are all more or less exposed to contagion from
persons outside of our families, and if we do not contract the
disease and die of it, it is probably because nature has en-
dowed us with a degree of immunity which enables us to resist
the dose of these germs which we are accustomed to take, and
for that reason we are spared.

When we observe this disease as it occurs among cattle we
find it much simpler to trace the contagion. Different herds
of such animals are practically isolated, and an outbreak of
tuberculosis in a herd can usually be traced to the introduction
of an affected animal. Owing to the opportunities for con-
tagion, feeding out of the same mangers, eating forage soiled
by saliva, drinking from the same vessels, the infectiousness
of the disease is frequently extremely well marked. I know
herds in which the malady has persisted for years. There is
one instance in my mind where the introduction of a tuber-
culous cow in a thoroughbred herd affected nearly every
animal, breaking up the herd, and causing a loss of from
twenty to thirty thousand dollars. Instances where this dis-
ease is introduced and spreads through whole herds are now
so frequent that every veterinarian I am acquainted with, who
has a cattle practice, is thoroughly convinced not only that
the malady is contagious, but that it is easily transmitted.

This brings up the question as to the identity of human and
animal tuberculosis, and I unhesitatingly answer it in the
affirmative. Not only are the germs in the two cases indis-

I%e Origvn and Prevention of Tuberculosis. 88

tinguishable under the microscope, but their growth in differ-
ent culture media and their other biological characters are
identical. Again, the infection of swine, rabbits, fowls, etc.,
from man produces the same lesions as when these animals are
infected from the bovine species. The infection of man from
cattle is a proceeding which can hardly be undertaken experi-
mentally except in rare instances. It is said to have been suc-
cessfully accomplished, however, in one case. What is of
more consequence, we have the observations which now begin
to accumulate connecting tuberculosis in man with the use of
milk from tuberculous cows.

Admitting the identity of tuberculosis in man and animals,
and many important questions suggest themselves to us in re-
gard to the propagation and prevention of this disease. What
animals have we to fear ? What are the media of communica-
tion ? How can we guard against infection ? What moment-
ous questions are these !

I can only answer in general terms. The time at my dis-
posal is too brief for details. Notwithstanding the fact that
swine are very susceptible, as shown by experiments, tuber-
culosis in these animals appears to be a rare disease. This is
probably in some degree because hogs are slaughtered at from
six months to two years old, and there is not with them the
opportunities for the development and propagation of a dis-
ease so slow in its progress. The same remark may be applied
to fowls, so that for practical purposes it is the bovine species
to which we must direct our attention as the one most fre-
quently affected, and from which most danger is to be appre-
hended.

I am unable to give you data to show the proportion of the
cattle in this country which are affected. The disease is prob-
ably no greater than in other countries, but its widespread
prevalence is certain. I have encountered it from the Atlantic
Ocean to the Rocky Mountains, and having been no farther
west I cannot speak for the Pacific slope. It is most fre-
quently seen in milch cows, but often also in beef cattle. An
inspection of about half a million head of cattle, mostly dairy
cows, which has been made during the last two years by the
Bureau of Animal Industry, in the work of eradicating pleuro-
pneumonia, has brought herds affected with tuberculosis very
3

34 n^ Origin and Prevention of Tvherofdaeis.

frequently to my attention, on account of the dilBculty which
sometimes is met with in making a differential diagnosis.

Experiments upon other animals show that the contagion is
contained in the tuberculous matter, in the liquids expressed
from the affected organs, often in the milk, and sometimes at
least in the blood and in the juices expressed from the muscu-
lar tissue. Whether butter and cheese may serve as infecting
material has never to my knowledge been determined. That
oleomargarine^ butterine, and similar mixtures, which contain
oleo oil, a substance expressed at a low temperature from
tissues frequently tuberculous, may also be infecting, goes
without saying, if we accept the results of the experiments to
which allusion has just been made.

The effects of cooking upon tuberculous material has not
been worked out as carefully as is desirable. The experiments
of Toussaint and others, however, show that the disease is
produced by infectious substances even after they have been
subjected to a boiling temperature for a considerable time.
The inference is that beef cooked according to prevailing ideas,
and particularly when very rare, has not been subjected to a
sufficient temperature to destroy the germs.

We conclude, therefore, that from a sanitary point of view
bovine tuberculosis is dangerous to the public health, and that
the contagion may be conveyed in either the beef or the milk.

With all these facts before us, what action is indicated to
lessen the mortality caused by this disease ? I have my
doubts if direct contagion from affected people is a sufficiently
important factor in the production of tuberculosis to warrant
such action as would be needed for its prevention. Sputum
might be disinfected more often than it is without causing
hardship to any one. It appears out of the question to isolate
affected persons, and I certainly have not the hardihood to
attack the time-honored practice of kissing, even when re-
stricted to husband and wife. And when it comes to kissing
among lovers, and even among members of the fair sex when
they meet and part, I must leave it to some of the older mem-
bers of the Association to make recommendations. Drinking
vessels at water fountains and about public places might be
kept cleaner than at present, and public sentiment created
against their use in common to the extent now seen.

Indid^JitUiher Pa/oement. 35

The most important matter, however, which presents itself
to me is to guard the food supply from contamination. The
carcasses of tuberculous cattle or of other animals should be
condemned and destroyed. Our dairy cattle should be in-
spected regularly and every animal affected with this disease
should be slaughtered and put beyond the possibility of4foing
harm. If you ask for the details of this work, to whom it is
to be intrusted, where the money is to come from, how marked
the results will be upon human tuberculosis, I am not in a
position to give satisfactory answers. My idea is, that as
public sentiment develops the boards of health will gradually
cover this ground, and that all will see the value of the 'work
is greater than its cost. The complete eradication of tuber-
culosis may be a dream, but it is none the less a duty to pro-
tect the public health against its fatal contagion in every prac-
ticable way, and to stop its dissemination by tuberculous
cattle appears to me the easiest and one of the most promis-
ing steps in this direction.

India-kubber Pavement. — The authorities of the city of
Basle, says the India-rubber and Gutta-percha Journal^ intend
repaving their principal thoroughfares, and are now consider-
ing the material best suited for the purpose. In one street a
trial was given to wood pavement, but somehow it does not
give satisfaction. The decision, therefore, turns upon asphalt
or India-rubber. The latter was invented by the German
engineer, Busse, in Linden, near Hanover, and was first prac-
tically used about fifteen months ago for paving the roadway
over the Goethe Bridge in Hanover, which required about
one thousand square metres of material. This first experi-
ment proved so successful that during the present year another
street in Hanover was paved with India-rubber, to the extent
of fifteen hundred square metres. Berlin is already consider-
ing the advisability of availing itself of the same pavement,
and has given it a fair trial by laying it down over a consider-
able distance near the Liitzow Bank, which example is being
followed by Hamburg. The India-rubber pavement is said to
combine great elasticity with the hardness of stone, to be
completely noiseless, and to suffer neither from cold nor hot
weather. Moreover, it is not slippery, like asphalt, and is
more durable.

86 Ths TeOoW'Fever Infection.

THE YELLOW-FEVER INFECTION, AND THE PRO-
POSED METHOD OF THE DISINFECTION OF THE
U. S. S. "BOSTON/'

OFFICIAL CORRESPONDENCE.

Navy Department* Opfics op Detail, Washington, >

December 29, 1888. (

Editor of The Sanitarian :

... By direction of the Secretary I send you herewith a
copy of the report asked for, accompanied by a copy of Ad-
miral Gherardi's letter of transmittal, and the various indorse-
ments placed thereon in the Navy Department.

I also forward a letter from Norman Wiard, Esq., bearing
upon the same matter, and have to request if the report of the
Board is published that the other papers may be published
also, in order that a clear understanding of the reasons govern-
ing the Department in its decision may be arrived at.

J. G. Walker,

Chief of Bureau.

U. S. S. ** Boston, " second rate, Navy Yard, New York, \

December 4, 1888. )

Sir : In compliance with your order of the 3d instant, to
" make a careful and thorough investigation of all the circum-
stances attending the recent outbreak of yellow-fever on the
U. S. S. * Boston,' " and to state if in our opinion ** further
disinfection of the vessel is necessary or not, with such recom-
mendations, if any, as you may deem requisite to submit/'
we beg to make the following report :

The U. S. S. "Boston" sailed from Sandy Hook, October
4th, at 5 P.M., and arrived at Port Royal, Jamaica, October
loth, finding a prevailing temperature at that place of 90^ F.
On the following day the ship was "swung," and on the
morning of the 12th was hauled into the coal wharf at Port
Royal, and coaled all that day and night, and the morning of
the 13th, taking about 295 tons of Cardiff coal and patent
fuel ; none of the crew of the ship being employed in any way
in the labor of coaling, except as tally-men. She was hauled

Ths Yellaw^Fev&r InftcAon. 87

out from the wharf to a buoy, and sailed at 3 P.M. of the 13th
for Livingston, Guatemala.

During her stay at Port Royal this place was reported per-
fectly healthy, and only telegraphic communication was had
with Kingston. Nothing but fruit and mess*stores were taken
on board, and officers only went on shore. On the passage
down there was difficulty with the condensers, which made the
condensed water not potable, and only water brought from
New York was used for drinking.

At Port Royal, by recommendation of the Health Officer,
2000 gallons of water from a Government spring, which was
found to be of excellent quality, were taken on board and
used for drinking until the ship's, return to New York.

The transition to the heated and enervating climate of Port
Royal caused the firemen to become so exhausted that a daily
ration of spirits was supplied to them, and at Port Royal
fifteen gallons of rum were taken on board, and served out to
the men of the engineers' force (firemen and coal-heavers) as
they came from watch in the fire-room. It is significant that
none of these men became ill at any time during the cruise.

The ship arrived at Livingston, Guatemala, October 17th,
and found that place also healthy (the thermometer at noon
being 76° F.; from 5 to 9 P.M. it was 80**), but damp from pro-
tracted rains. Only fruit and poultry were here taken on board.

Leaving Livingston on the 20th, wet weather was experi-
enced until the 23d, when at 6 p.m. the ship anchored at the
Com Islands, opposite Bluefields, and about sixty miles from
Greytown, remaining there until the evening of the 24th.
These islands were stated to be perfectly healthy, a mild form
of benign remittent-fever occasionally prevailing, never fatal,
and limited to drinkers of impure well water.

Greytown was reached at 10 A.M. on the 25th, and oppor-
tunity was taken of the sunshine to thoroughly dry the vessel
and its contents. A canoe came off twice. Only a few oranges
were taken on board.

On the 28th she sailed for Port Royal, steaming against a
fresh trade wind, and arriving on the afternoon of the 31st,
having had considerable rain on the passage.

The Health Officer again reported the town and harbor per-
fectly healthy, as was also the case at Kingston.

38 Ths YeU&a)'Fm>er Infection.

The ship was again coaled, 380 tons of Cardiff coal and pat-
ent fuel being taken on board, the men on this occasion aiding
in receiving the coal from laborers who brought it to the
wharf, and delivering it to other negro laborers who were em-
ployed in the bunkers stowing and trimming it. The coal«
sheds from which this coal was obtained are established on a
sandy peninsula exposed to a sea breeze, and the coal kept
under cover.

Several officers and stewards visited Kingston for periods
never exceeding two hours. Of these officers and servants
Dr. Simon was the only person who at any time subsequently
became sick. Only a few mess-stores were taken on board.

The ship sailed from Port- Royal at 6 a.m. November 4th,
with no sick list of any consequence, and arrived at Fort au
Prince on the evening of the 5th, anchoring^ in the outer har-
bor about two miles from the landing, but in a direct line to
leeward of the nightly land breeze, and having the vessels in
the inner harbor between her and the town. The nearest
ship, a French man-of-war, ** Le Bison," was three-quarters
of a mile distant. She remained at Port au Prince until day-
light of the i6th, no officer or man being allowed outside the
vessel except on duty. Captain Ramsay himself was on shore
every day, sometimes twice, for short periods, and only on
one occasion, Sunday, November nth, was detained after
dark by an interview with the authorities lasting from 2 to
9 P.M. Of the officers i^ho at various times accompanied him
none ever became sick. The steam cutter, having a crew of
five men, none of whom ever became sick, was used for all of
the work of the ship, except that on the night of November
nth, when Captain Ramsay was detained, and the officer in
charge fearing that an accident might have occurred to the
steam launch, despatched the second whale-boat, which did
not land, but anchored off the cutter and was towed back by
the latter. The apprentice boy, Kelly, who was taken ill on
the 15th, four days later, and died on the 20th, was one of
this boat's crew.

During the stay of the " Boston" at Port au Prince the Min-
ister and the Vice-Consul-General, Dr. Torres, a physician of
thirteen years* residence in the place, insisted that there was
no fever ; but Dr. Torres subsequently admitted that this
simply implied *' no fever cases to-day."

2^ TdUm-Feeer Infection, 39

The ** Bison" had been at anchor three months in the
harbor^ making occasional trips to sea, and her commanding
officer declared there had been no sickness on board that vessel.

Prior to the occurrence of the two cases of Kelly and Dr.
Simon on the 15th, Captain Ramsay declares that, wearied
with the diplomatic delays of the Haytian officials, he had
determined to sail on the following morning, and so announced
to the Minister, who then, recognizing his decision as final,
admitted that in a conversation with Dr. Torres he had learned
that there was a very malignant type of fever prevailing among
the shipping of the inner harbor, and consequently directly to
windward of the " Boston" (about a mile and a half distant)
during the land breeze, which ordinarily prevailed from 11
P.M. to II A.M. or noon of the following day, when the sea
breeze alternated from the opposite direction.

On the night of the 14th it was learned that a man had died
of yellow- fever on board the steamer " Haytian Republic,"
which was in the inner harbor close to the landing.

Captain Ramsay and Ensign Hines were on board this vessel
twice, for short periods, none of the crew visiting her, and his
boat laying off during his visits.

Notwithstanding Dr. Torres's declaration that there was no
prevailing fever, he strongly recommended as a sanitary pre-
caution that none of the crew should be allowed to sleep on
the exposed decks under awnings, or to keep watch there, and
this advice was so strictly observed that a man was punished
for exposing himself in this way, although not asleep.

Careful scrutiny of the medical journal of this vessel show,
that:

(i) On Thursday, November 8th, Cassimir Laissi^ cabin boys
rated cook, was admitted to the sick list with headache,
malaise, muscular pains, anorexia, and vomiting, but without
fever being noted, and was discharged on the 12th.

(2) On Friday, the 9th, Albert Lassiter^ a berth-deck cook,
was admitted with headache, backache, suffused eyes, temper-
ature 103^ F., and was not convalescent until the 28th.

(3) On Wednesday, the 14th, McSharer, a coal-heaver, was
admitted with headache, etc.

(4) On the morning of Thursday, the 15th, the boy, Kelly ^
a gun-deck sweeper, was taken on the list with fever, etc.»
stating that he had felt badly on the 14th.

40 The YeUoW'Fever Infection.

(5) The medical journal shows a record of the admission on
the same day of Finch, a landsman, with ** febris intermittens,"
attended with malaise, pains, etc., similar to the others.

(6) On the afternoon of this day, November 15th, the sur-
geon of the ship, Dr. W. y. Simon, was compelled to relin-
quish duty and to go upon the sick list with fever.

At 2 P.M. of this day Passed- Assistant-Surgeon Lumsden
went on shore for a bill of health, and then learned from Dr.
Torres that the health of the place was ** very bad." He was
nevertheless given a clean bill of health.

On his return to the ship Dr. Lumsden informed the com-
manding officer of the bad condition of things on shore and in
the harbor, and of the occurrence of the new cases on board,
and recommended that the ship go to sea as soon as possible.
Captain Ramsay informed him that he had already determined
to sail the next morning. The thermometer was then ranging
from 76^ to 87° F. The ship sailed at daylight of Friday, the
i6th, getting the northeast trades at six o'clock that evening.
The extremes of temperature were 76° and 86® F.

(7) On Saturday, the 17th, Thrapp, a seaman apprentice,
second class, was admitted to the list with unmistakable
yellow-fever, and died on the 20th. The thermometer still
ranged from ^^'^ to 82*^ F., the trade's blowing fresh.

(8) On Sunday, the i8th, Frank Thomas^ seaman, reported
himself sick, having a temperature of over 100® F. and pulse
of 120°.

(9) On this same day two marines were admitted with yellow-
fever, Uzelminy who died on the 21st, and

(10) Ritzel, who died on the 23d.

(11) An ordinary seaman named Van Pamelin was admitted
to the sick list the same day with headache, malaise, epigastric
pain, etc.

The temperature still ranged from 74** to ^^^ F.

(12) On Monday, the 19th, Charles Mitchell^ ordinary sea-
man, and

(it,) McKenna, a landsman, were admitted with headache,
malaise, epigastric pain, great debility, etc.

(14) On the same day also a landsman named Crank, as hav-
ing *' intermittent-fever," with headache, malaise, epigastric
pain, and

k

The TeUoW'Fever Infection. 41

«

(15) An apprentice named Ailmer with the same symptoms.

On this day, ipth, Kelly declared himself much better, but
became delirious and died a few hours later. The range of
the thermometer was 72** to 75° F.

No cases of any kind appeared after this date.

Thrapp died on Tuesday, the 20th ; Uzelmin on Wednes-
day, the 2ist ; Ritzel on Friday, the 23d ; and Surgeon Simon
on Monday, the 26th.

On the 20th it commenced blowing, and the ship was in a
gale until her arrival at New York. The temperature rapidly
fell to 47-55*' on the 22d, 39-51'' on the 23d.

The ** Boston" arrived at New York at 3 a.m. the 24th, and
at 9.45 P.M. of the 26th Dr. Simon died, the last fatal case.

Of the fifteen cases specifically referred to, the two marines
were berthed on the port side of the forward compartment of
the berth-deck ; Mitchell down on the forward orlop ; Cas-
simir Laissi aft on the starboard side of the gun-deck, and
all the others on the gun-deck, most of them relatively near
each other. Kelly and Thrapp slept close together.

The Board are of opinion that all these fifteen cases were of
yellow-fever infection^ of varying degrees of intensity ; the re-
suit of exposure to the strong land breeze every night coming
directly from the infected port and shipping in the inner har-
bor, and sweeping through the vessel riding head to it ; and
thdy attribute the escape from more serious consequences to
the prompt departure of the vessel, and to the very thorough
and effective sanitary precautions practised throughout the
whole cruise.

Relative to the second question submitted to them, the
Board find that the ship was visited soon after her arrival at
Quarantine by the health authorities of the port of New York.
The two mild cases of enlisted men were removed to the
Quarantine Hospital on the 27th. Surgeon Simon's condition
had not previously warranted it.

The apartments occupied by the sick, excepting Dr. Simon's
stateroom, have been washed with mercuric chloride solution,
and fumigated with sulphur dioxide, but the Board are of
opinion that while there is no danger of any further outbreak
of fever at this season, or in this port, dependence cannot be
placed on its non-reappearance should the vessel return to

42 The YeUoW'F&ver Infection^

yellow-fever habitats. They accordingly recommend as a
matter of additional precaution that she be sent to the Navy
Yard at Boston ; that her entire crew and officers be tempo-
rarily transferred to the receiving ship at that yard ; that as
much of the coal as possible now in her bunkers be used up
on the passage, and if there be any remaining coal, that it be
burned at Boston ; that all other stores be removed from the
vessel and placed in sheds at the Navy Yard, where they may
be freely aerated ; that the sides, ceilings, decks, and interiors
of all apartments, store-rooms, and bunkers, one after the
other, be first thoroughly washed with a solution of mercuric
chloride, one to one thousand, and after with soap and hot
water ; that a strong solution of mercuric chloride be thrown
into the bilges, pumped out, and replaced with water contain-
ing no sewage ; that all bales of woollen goods, felting, and
similar fabrics be sprayed with mercuric chloride solution ;
and that finally the ship be permeated, one compartment after
another, with superheated steam of 220° F., after which the
stores may be replaced and the men and officers return on board.
The Board do not wish to imply that this work might not
be safely done at this station, but it is believed that greater
conveniences at Boston will permit it to be more expeditiously
done, and with less inconvenience to other persons.

Very respectfully,

Albert L. Gihon,

Medical Director U. S. Navy.
Delavan Bloodgood,

Medical Director U, S. Navy.
Edw. Y. Bogert,

Medical Inspector U. S. Navy.
Rear- Admiral Bancroft Gherardi, U. S. N.,
Commandant U. S. Naval Station^ New* York.

Commandant's Office, Navy Yard. New York, J

December 6, 1888. f

Sir : I have the honor to forward herewith the report of the
Board appointed to investigate the recent outbreak of yellow-
fever on the U. S. S. "Boston." The report and recom-
mendations are approved, except as noted below, in regard to
sending the vessel to Boston.

I am informed by the commanding officer of the ** Boston"

The Tellaw^Fever InfeOion. 48

that before again proceeding to sea it will be necessary that
certain work be done on her boilers. Crown-sheets and back-
tube sheets must be scaled, and leaky tubes re-expanded.
Four of the boilers can be got ready in two weeks' time, and
all of them in three or four weeks.

The vessel has now in her bunkers loo tons of coal ; of this
amount 80 tons is New River coal put in before leaving New
York, the balance is part Cardiff and part patent fuel received
during the cruise. The daily consumption at present for heat-
ing, dynamos, etc., being 4^ tons, more than half the amount
on board would be consumed before the vessel could be got
ready for sea.

The berthing capacity of the receiving ship here being so
great, and other facilities being equal for carrying out the
recommendation of the Board relating to fumigation, I can see
no reason why the vessel should be sent to Boston.

Although the matter of pecuniary expense should not be
taken in consideration with that of obtaining perfect safety in
the future, still I feel it my duty to call attention to the ex-
pense that will be involved in carrying out the recommenda-
tion of the Board, in the proposed introduction of steam in the
different compartments of the vessel. The inside wood-work,
ceilings, panelling, etc., being all of kiln-dried wood, will
probably be warped, twisted, and torn from its fastenings to
such an extent as to render it necessary to remove and replace
it, and, in fact, in some cases entirely renew it.

Very respectfully,

Bancroft Gherardi,

Rear Admiral^ Commandant.
Hon. W. C. Whitney,

Secretary of the Navy^

Navy Department, Washington, D. C.

First Indorsement.

Navy Dbpartmbnt, Office of Detail, Washington.)

December 13, 1888. \

Respectfully referred to the Chief Constructor for his infor-
mation, and for such statement and recommendation as he
may think proper.

By direction of the Secretary.

J. G. Walker,

Chief of Bureau.

44r The YeUoW'Fefoer Infection.

Second Indorsement.

Bureau of Construction and Repair, )

December 13, 1888. )

Respectfully returned to the Office of Detail.

Referring to that part of the report of the Board where they
recommend ** that finally the ship be fumigated, one compart-
ment after another, with superheated steam of 220° F., after
which the stores may be replaced and the men and officers
return on board."

This bureau suggests that the recommendations of the Board
to turn superheated steam into the several compartments of
the vessel be dispensed with, if possible. The greater part of
the wood-work in the living quarters of the officers is of hard-
wood veneer, and the remainder of the wood-work — ue.^ ceil-
ing overhead in ward-room, steerage, cabin, etc., is pine pan-
elled, the ceiling between decks in the superstructure, and
wood-work of magazines, shell-rooms, and all store-rooms are
made of kiln-dried lumber, and the damage that would be
caused by turning steam into these compartments is at this
time impossible to estimate. As the most of this wood-work
would have to be taken out, repaired, and in many cases
entirely renewed, the expense involved would be very great.

T. D. Wilson,

Chief Constructor ^ U. S, N.^ Chief of Bureau. \'^

Third Indorsement.

Office of Detail,)

J. S

December 141 1888.

Respectfully referred to the Surgeon-General for his infor-
mation, and for such statement and recommendation as he
may think proper.

By direction of the Secretary.

J. G. Walker,

Chief of Bureau.

Fourth Indorsement.

Navy Department, Bureau Med. and Surg., Washington,)

December 14, 1888. f

Respectfully returned to the Office of Detail.
Referring to the report of the Board, this bureau respectfully
suggests as follows :

The YeUoW'tever Infection. 46

As the work can be done at the Navy Yard, Brooklyn, it is
recommended that the officers and men be transferred to other
quarters ; the stores and coal removed, the coal to be con-
sumed as soon as practicable (not to be placed on any vessel) ;
that the ship, in every portion, be subjected to sulphur fumi-
gation, followed by a thorough appUcation of a solution of
bichloride of mercury, one to one thousand ; that the bilges
be pumped out until no sewage is perceptible, and then be
washed out with the mercuric solution ; that all bales of
woollen goods, felting, and like fabrics be placed in a room
where they can be subjected to the fumigation process, and,
if necessary, sprayed with the mercuric solution.

The bureau respectfully recommends that Assistant-Surgeon
William Martin, U. S. N., be ordered to report to the Com-
mandant of the Navy Yard, New York, for duty in charge of
the disinfection of the " Boston."

J. Mills Browne,

Surgeon^General U. S, Navy.

Fifth Indorsement.

Navy Department, Washington, )
December 15, i888. (

The best evidence obtainable is to the effect that the disin-
fection can be made effective without resorting to the use of
steam at 220^ F. Such, I am informed by the Surgeon-General,
is the opinion of Assistant-Surgeon William Martin, whose
experience in the matter of yellow-fever is perhaps the largest
in our navy, and this opinion is concurred in by the Surgeon-
General. It would not be wise for us to adopt a method
likely to cause so great an injury to the ship as would occur
from the use of superheated steam, unless absolutely necessary,
and I therefore concur in the recommendation of the Surgeon-
General.

W. C. Whitney.

St. James Hotel, Washington, )
December 19, 1888. (

My DEAR Sir : I notice in one of the papers to-day a state-
ment that it is proposed to continue the disinfection of the
'* Boston*' by injecting steam into her compartments. It will
be most dangerous to the integrity of her hull partly immersed
in cold water, while all her deck-beams, sides, and other steel

46 Ths Coole&t Town in the World.

parts are heated even to the lowest temperature of steam, 212®
F., will generate a force by unequal expansion that will cer-
tainly do great damage, if it does not destroy her altogether.
If you will take the trouble to confer with Mr. Melville, of the
Engineer Bureau, I doubt not he will confirm my statements.
I know him to be familiar with such subjects. The unequal
expansion caused by unequal heating and the obverse is the
evil genius of metal structures of large dimensions, such as
iron and steel ships, steam boilers, and cannon. I hope my
suggestions will not come too late.

Very respectfully.

Your obedient servant,

Norman Wiard. |

Hon. W. C. Whitney,

Secretary of the Navy^
Washington, D. C.

The Coolest Town in the World.— In the Berlin
Meteorologische Zeitschrift for June, so says Nature^ Dr. Hann
gives an interesting account of the winter temperature of
Werchojansk (Siberia), deduced from several years' observa-
tions. The town, which lies in the valley of the J ana, about '
nine feet above the level of the river, in latitude 67° 34' N.,
Ipngitude 133° 51' E., and at a height of about three hundred
and fifty feet above the sea, has the greatest winter cold that
is known to exist upon the globe. Monthly means of — 58° F.
occur even in December, a mean temperature which has been
observed nowhere else in the polar regions ; and minima of
— 76° are usual for the three winter months (December-Febru-
ary). In the year 1886, March also had a minimum — ^^^^
and during that year December and January never had a mini-
mum above — 76^, while in January, 1885, the temperature of
— 89** was recorded. These extreme readings are hardly cred-
ible, yet the thermometers have been verified at the St. Peters-
burg Observatory. To add to the misery of the inhabitants,
at some seasons the houses are inundated by the overflow of
the river. The yearly range of cloud is characteristic of the
climate ; in the winter season the mean only amounts to about
three tenths in each month.

The Ohio State Sanitary Association. 47

THE OHIO STATE SANITARY ASSOCIATION.

« <

ABSTRACT OF THE PROCEEDINGS OF THE SIXTH ANNUAL
MEETING, HELD AT CANTON, NOVEMBER I4TH AND I5TH,
1888, G. C. ASHMUN, M.D., HEALTH OFFICER OF CLEVELAND,
PRESIDENT.

The sessions were held in the Assembly Hall of the High
School.

The first paper read after the usual formalities of opening
the proceedings was by Dr. R. Harvey Reed, M.D., Secretary
of the Association, of Mansfield, on

How to Prevent the Spread of Typhoid -Fever."
Typhoid-fever," he said, "is an acute febrile affection,
particularly characterized by stupor and low muttering de-
lirium, accompanied with diarrhoea and a peculiar eruption of
the skin. It is undoubtedly a communicable disease, being
capable of direct and indirect communication from one person
to another, through a proper medium, such as water or milk,
but not a contagious disease like small-pox, measles, or scar-
let-fever. It is caused by the swallowing of a germ peculiar
to typhoid- fever. This germ usually finds its way into wells,
springs, rivers, and creeks which are used as a water supply.

" Deep wells cannot always be trusted or looked upon as a
safeguard against typhoid-fever, as was clearly proved by the
Dudlow Lane well near Liverpool, England, which had a total
depth of 443 feet, yet it was fouled by the percolation from
cesspools. Surface wells surrounded by cesspools or stables,
hog-pens, manure piles, sewers, or any kind of surface filth,
in all stages of decomposition, are still more dangerous and
objectionable. Typhoid-fever is a preventable disease, and
can be prevented by the use of pure water. There are six
facts to bear in mind :

" I. Typhoid-fever is caused by the introduction of a spe-
cific germ into the alimentary canal.

" 2. That this specific germ multiplies in the alimentary
canal and in turn is throw off in the stools of the patient.

48 The Ohio State Sanitary Aesodation.

'* 3. That its vitality is much greater than at first supposed.

" 4. That the germ may be communicated from one person
to another, by water, milk, foods, and air.

**' 5. To prevent its spread all the dejecta should be burned
at once or thoroughly disinfected.

"6. If the water supply is of a suspicious character, thor-
oughly boil it before using, and then place it where there is no
possibility of its becoming infected."

At the afternoon session the most important subject was a
paper by Mr. Josiah Hartzell, of Canton, on " Canton's
Water Supply." He said :

" The water used in Canton for drinking and culinary purr
poses is derived from four sources : Cisterns, an artesian well,
surface wells, and Nimishillen Creek.

*' In a comparatively few ways where rain-water is used,
cisterns always made of brick and cemented are provided with
filters which are made in various ways. The usual way is to
have a box filled with sand or coke near the surface of the
ground through which the water must pass before entering the
cistern. Such water is strained rather than filtered. The
principal disadvantage of a brick-wall filter is that the organic
matters held back by it cling to its sides, remaining under
water long enough to admit of chemical changes which pro-
duce new compounds that the brick filter is powerless to arrest.

" About 250 families get their drinking water from an
artesian well which was bored in 1884, under the superintend-
ence of Mr. C. W. Chapman, in quest of natural gas. Its
depth is 2720 feet, but the water that flows out at the surface
was struck at a depth of 1 10 feet. The water from this well
first attained its very considerable popularity by its obvious
purity and its gratefully pleasant taste.

** The water supply of the city is driven through the mains
by two Worthington direct-acting pumps of two millions and
three millions daily capacity respectively. Over twenty-five
miles of cast-iron mains are in use. The attachments number
1625 in all, of which 200 have been made since March ist last.

•* Water was first supplied to the city by the Canton Water
Works in 1870. From that date until 1881 the supply was
obtained from Meyer's Lake. In i88l, owing to the subsid-
ence of the water level and the threatened consequent impair-

The Ohio State Sanita/ry Aeeoeiatwn. 49

ment of the property for amusement purposes, the proprietors
of the lake got out an injunction against the further use of the
lake as a source of city water supply.

'* As a source of supply for drinking water, Meyer's Lake
must be sanitarily considered a stagnant pool. The water, it
is true, arises from deep springs sources, but during a portion
of the year above named, this supply is not sufficiently abun-
dant to keep good the surface evaporation. The water fur-
nished to the city has, since the lake source was abandoned,
been obtained from the west branch of the Nimishillen Creek.
This is a spring stream. In respect to quantity it is very safe
for a city considerably larger than Canton. The need of purer
water is generally recognized. During the past summer the
water-works trustees have caused to be bored an artesian well
near the pumping station. This well passed through about
40 feet of alluvium and 160 feet of rock. Flowing water was
reached in loose sand rock at the depth of 140 feet. The fact
that the water-bearing stratum at this point is found relatively
at the same depth as in the Chapman well, and considering
the similarity of the rock formations in which the water is
found, the probability of their common origin easily suggests
itself. Two more wells of larger diameter are to be sunk near
the first with a view to ascertaining whether a supply adequate
to the wants of the city can thus be obtained.*'

The evening session was the occasion of a public reception
and a large attendance, Dr. Murdock, Chairman, pro tern.
Hon. John F. Blake, Mayor of the city, welcomed the Asso-
ciation, and as the head of the municipal government, ex-
tended to them the freedom of the city* The response was
made by Dr. Ashmun, President of the Association. He
accepted with thanks the hospitality of the city, and followed
with an address on " What is Sanitation ?" He gave the gist
of his practical experience as the health officer of Cleveland
for many years ; pointed out the relation of the medical pro-
fession to sanitation, with special reference to the prevention
of infectious diseases by reporting the first cases ; and the
relation of municipal governments to sanitation, with special
regard to cleanliness of soil, air, and water.

At the conclusion of Dr. Ashmun's address, Dr. Slusser, of
Canton, stated that the matter of " Hot Air vs. Steam for the

4

60 The Ohio State Sanitary A^eociation.

Heating and Ventilating of Dwellings and Public Buildings,"
would next come up for discussion, the discussion to be opened
by Thomas Hubbard, M.D., of Toledo, But Dn Hubbard's
paper, instead of presenting the subject in both of its aspects,
according to the impression of his purpose which had before
obtained, confined himself whoUy to the advantages and
superiority, in his mind, of the "Hot Air'' process, and espe-
cially of the Smead method, so fully described by Mr. Isaac
D. Smead, the proprietor, at the previous meeting of the
Association (Sanitarian, ypl/lci|(^7p>^T3)t This, according
to the gist of his paper, sdCpr^-eminenQy^'^ltDDfilled all the con-

-'-«♦•«<.

ditions of heating and/l^ntilatioru that he^emed to notice
other methods only for the pkiEffi>s£il sIlGwAg their inferiority.

At the conclusion ofyBrj^^HnMrard^ p^cti the chairman
indorsed the views that n^/^be^PviSTfjiressed^^as being in full
accord with his own, and proc^e^ed^e-xsCll upon several mem-
bers of the same way of thinking, which, for the time, seemed
to create some dissatisfaction. But Dr. Ashmun, of Cleve-
land, being called upon, at once remarked that he was opposed
to the hot-air process. Indeed, it seemed to have been well
known that he had repeatedly so declared himself, and that re-
cently an extended interview with him appeared in a Cleveland
paper, in which interview he pronounced the hot-air system
in the Cleveland schools a failure, and gave expression to the
assertion that it was dangerous to a locality to have disease
germs from a dry-air closet sent out of a flue in a thickly popu-
lated part of the city ; but his remarks did not carry out these
impressions of the auditors. He stated in substance that he
was opposed to hot air, particularly the system in use in the
Cleveland schools ; but, nevertheless, said that the system had
been acting admirably, hence his objections in that instance
were not sustained. In one school in Cleveland the dry-closet
system was in use, but the defects in it were caused by the
foul-air flue being lower than some portions of the building.
The flue was extended and the system was working properly.

Mr. Oby, a leading steam and gas-fitter of Canton, followed.
He stated that he had an impression that the society had
arranged for the subject to be handled by its members, after
which would come a general discussion. He now saw that he
was in error. He knew much of steam as a heating agency.

Tis Ohio State Sanitary Auoeiation. 61

but he felt he could not do the subject justice without prepa-
ration. He would have been glad to have prepared a paper
on the subject if he had received notification of the matten
As it was, he would have to defer it until a later day.

Dr. Reed, of Mansfield, was sorry that the steam men were
not prepared to discuss this matter with those in favor of hot
air. He thought there was nothing like hot air. He had
made exhaustive research into the matter, and came to his
decision only after the conclusion of his research. He then
gave an interesting account of a thorough investigation he
made of the heating and ventilating of railroad sleeping cars.

Mr. Geswein, of the Board of Education, asked the question'
whether or not the system of dry closets was preferable where
there was a perfect system of sewerage. He was informed by
Mr. Oby that the dry-closet system, if placed properly, was as
efiicient in its work as a system of sewerage.

Secretary Paul Field, of the Canton Water Works, asked
Mr. Oby if it would not be an improvement on the present
system in use in the high school building if the closets were
disconnected from the ventilation of the building.

Mr. Oby thought not, if the system was placed in the build-
ing in a proper manner.

Mr. Field proceeded to state that he was not a scientist ;
he was only an observing youth. In the matter of the system
in use at the high school building, he had to go on only the
old saying that " fools and children tell the truth." He heard
from the school children that the system was a rank failure.
Odors were found throughout the building, disagreeable odors,
and from the closets in the basement. Those in charge grew
greatly alarmed over the matter, and finally placed it to odors
from the laboratory, when, in fact, at that time there was not
a chemical in that room. When it was found this wouldn't
do, the odor was placed to the removal of a vault at the Ault-
hbuse property. These odors were noticed for weeks after.
He wanted to know if there had been a wholesale removal of
vaults in that neighbprhood. He could not see how a furnace,
made up of small pieces and puttied together, could give satis-
faction. In view of the frequent trouble had with the system
in this city, he was surprised to hear no voice raised against it
by those present.

Dr. , of Cleveland, stated that he had tried various ^s-

68 The Ohio State SanUary Aeeaciatitm.

terns in schools, and found the steam system of heating the
best. In the schools there had been put in a hot-air system,
the Smead system, and there was continual trouble with it.
He pronounced it a failure. On Friday afternoon the fires in
the furnaces would be permitted to die down and remain out
until Monday morning. By this the rooms were filled with
obnoxious gases from the closets, a menace to the health of
thousands of scholars.

Mr. Robert Cassidy gave a lengthy history of how the
School Board had come to purchase the Smead system. He
was a member of the Board at the time. The points as given
by him are familiar to every citizen of Canton, they having
been kept green in the memory by the long-continued warfare
recently ended in the Board of Education, on the system of
heating and ventilating for new buildings. He had heard
much concerning the system in use in this city, but believed
it to be the best. From the adverse comment on the system
in this city the past year he had expected to hear the steam
men tear the system to pieces, figuratively speaking, and place
the matter in such a light that nothing but steam would here-
after be used. He was disappointed.

Mr. A. McGregor thought the system a failure. He thought
it wrong to imperil the health of the children by its use. Not
only this, but it had been decided upon for a number of new
buildings without those pushing the matter waiting to see
whether it were true or false. He appealed to the people of
Canton if the system was not a failure, and putting the system
in other buildings under the circumstances was a rank failure.

At this moment Mr. Joseph A. Bour, member of the Board
of Education, and Attorney J. J. Clark arose, but Mr. Bour
was given the floor. Mr. Bour relinquished the floor to Mr.
Clark, and that gentleman spoke as one having authority to
speak, he having been instrumental in securing this system of
heating and ventilating. He quoted Scripture frequently,
drawing a parallel case between the horde who cried '* Crucify
him, crucify him," to those who were now fighting the Smead
system. He stated that there was no more justice exhibited
in one case than there had been in the other.

Dr. James Fraunfelter arose to a point of order. He stated
that the subject was Hot Air vs. Steam, but that those partic-
ipating had made it Smead vs. Steam.

Tm Ohio StaU Sanitary Assaciatum. 58

The president sustained him, but stated that as the question
was of unusual interest locally, the speakers were not held to
such strict accountability as they otherwise would be.

Judge Underbill didn't see what could be gained by this
discussion. It was merely assertions. One faction said the
Smead system was defective, the other said it wasn't. He
advocated a microscope, as with it could be told whether there
were any disease germs about.

Joseph A. Bour scorched the system. He wanted to know
how one could get pure air when the source was impure. He
asked the chairman whether in building a house he would
attach his water-closets to the house ventilation or have them
separate. The chairman would have them separate. He said
it was the same with the schools, only in one case there were
only a few affected, while in the other case hundreds were in
danger. The closets at the Central High School building had
gravel bottoms where they should be cemented. Another thing
was the gravel bottom closets were only a short distance from
the school pump from which the drinking supply was received.

Dr. T. Clark Miller, of Massillon, didn't see that the system
made any difference. The air had to be heated, and it was not
particular just how it was heated. The one point was not to
make the heat red-hot. He thought the Smead system a good
one, but not perfect, by any means. He scoffed at theidea of
disease-breeding germs falling from the foul-air flue in buildings
where the hot-air and dry-closet ^stem wasin use. He thought
that Smead was doing all he could to perfect his system.

Dr. Hubbard closed the discussion by giving some estimates
on the quantity of air passing from a building and the quantity
passing into a building under a perfect system of heating and
ventilating. The meeting then adjourned.

At the second day's sessions. Professor J. J. Bums, principal
of the Canton schools, read a paper on the *' Contagion of
Health." Mr. Burns's article was full of wit and humor, and
it was much appreciated by the audience.

Professor Staley, of Cleveland, followed with a paper on
*• Sewers for Small Towns."

The forenoon was principally occupied in the discussion of
the sewerage question. Professor A. W. Smith, of Cleveland,
read an essay on ' ' The Water Supply of Cleveland. ' '

54 How to Use Canned Ooods.

Other important papers read» of which we regret the want
of space for abstract, were : *' Heating and Ventilation/' by
Mr.. Francis C. Bodine, of Mansfield ; " Fraud in Dressed
Meats," by Lewis Slusser, M.D., of Canton ; " Meteorology
as Related to Morbility," by E. R. Eggleston, M.D., of Mt.
Vernon ; and " Cousin Marriages Unobjectionable," by E. S.
McKee, M.D.

The following officers were elected for the ensuing year :
President, Dr. E. H. Bechtel, of Cleveland ; Vice-Presidents,
Mr. Josiah Hartzell and Dr. Lewis Slusser, of Canton, and
Professor E. A. Jones, of Massillon ; Treasurer, Dr. J. M.
Weaver, of Dayton ; Secretary, Dr. R. Harvey Reed.

The next place of meeting will be at Dayton, but the Exec-
utive Committee will fix the date at a future time.

How TO Use Canned Goods. — An ** expert," writing to
the Grocers* Chronicle ^ well says that canned goods should be
turned out and eaten as soon as possible. If kept at all, the
food should be covered up and put in a cool place — always,
however, turned out of the original tin. The liquor around
lobsters, salmon, and all vegetables, excepting tomatoes, it is
desirable to strain off and throw away. Lobsters and prawns
are improved by being turned out into a sieve, and rinsed with
clear cold water. Never on any account add vinegar, sauces,
or any kind of condiment to. tinned foods while they are in
the tins, and never leave such mixtures to remain an hour or
two, if from forgetfulness it is done. All tinned goods are
put up as fresh as it is possible to be, but, unless corned or
salted, will not keep if turned out, as freshly cooked goods
will, and certainly not longer, as many thoughtlessly suppose
or expect they will. Sardines, if preserved in good oil, and if
of good quality, will be an exception ; as long as the oil is
good, the fish can be kept in the tins. But seven days is long
enough to trust these before eating. Consumers should not
buy larger packages of canned goods than they can consume
quickly ; if they should, most of the fish and meats can be
potted after recooking, sauces and seasoning being added. If
the nose and eyes are properly used, it is as impossible to par-»
take of an unsound tin of canned food of any kind as to par-
take of bad meat, fish, or vegetables from a shop.

Eiitar's Table. 65

EDITORS TABLE.

^S^All correspondence and exchanges and all publica*
tions for review should be addressed to the Editor, Dr. A. N.

Bell, 113A Second Place, Brooklyn, N. Y.
1
Subscribers will please conform to conditions of detach-
able order on advertising page xv.

Typhoid Fever in Brooklys.— The Medical and Surgical
Reporter, in a recent number, says :

" It is reported from Brooklyn that there is an epidemic of
typhoid-fever in that city, and this report has led to an ex-
planation by Dr. Charles F. Chandler that the cases of typhoid-
fever are to be attributed to water drunk by the patients at a dis-
tance from the city, and that it is not attributable to the drink-
ing of Croton or any river water. It is interesting to note
this important discovery at a time when typhoid-fever is pre-
vailing in what is practically a part of New York City, in view
of the well-known fact that when typhoid-fever occurs in more
than minimum proportions in the city of Philadelphia, our
neighbors in New York rarely let slip the opportunity to
charge the outbreak upon the maligned but patient Schuylkill.'*

By this it appears that the Reporter is so ignorant of the
topography of New York and Brooklyn as not to know that
the water supply of New York is as distinct from that of
Brooklyn as it is from the Schuylkill. The statement is the
more erroneous because it implies that typhoid-fever is less
liable to occur as the result of drinking river water than of
that which is derived from other sources — a conclusion based,
apparently, upon the ** Sanitary Chemistry of Waters," etc.,
as given by Professor C. F. Chandler {Public Health, vol. i.,
p. 533), quoting, with apparent approval, the sentiments of
the late Dr. H. Letheby, Medical Officer of Health to the
Corporation of London, twenty- five years ago. Dr. Letheby
contended against water pollution as the means of propagating
cholera, and held that river water was so self-purifying that it
might contain one twentieth part of its volume of sewage and
yet, after flowing a distance of ten or twelve miles, be abso-

56 mHor's TaUe.

lutely pure and wtiolesome — because he and other cftemists were
not able to detect the impurities.

But with the progress of sanitary knowledge since that time»
the well-recognized results of drinking water polluted with
sewage are regarded as conclusive evidence of the danger of
such pollution, whether detected by the chemist or not. Yet
we would not by any means be understood as denying that
typhoid-fever is, taking one year with another, increasingly
prevalent in Brooklyn, and that it is, in our judgment, prob-
ably due for the most part to sewage pollution of the intensest
and most loathsome kind — the seepage of graveyards.

The subsoil water of Long Island, from which the Brooklyn
supply is taken, is well known to be a moving volume from
the " backbone*' of the island toward the seashore. This
process of filtration through the sand, discovered by the sur-
veys preliminary to the Brooklyn Water Works, thirty years
ago, was regarded as a guarantee of purity — fortified by the
negative results of chemical analysis. Deemed to be free from
sewage pollution, little or no account was taken of the seepage
of cemeteries and numerous small. graveyards within the scope
of this moving volume of water, and some of them in danger-
ous proximity to the reservoirs.

Moreover, dangerous proximity in this case, considering that
the dead bodies are placed at a depth conveniently exposed to
the subsoil water current, carefully protected from contact
with the earth by the coffins until long after the access of
water to them ; that cases are on record in which typhoid-
fever has been traced to the seepage of sewage through soil
more than a mile in extent ; the specially favorable nature of
the soil and course of the subsoil current, and that there are
several graveyards within a quarter of a mile of the reservoirs
— surely such conditions are alike dangerous and revolting.

The danger of sewage pollution of drinking water and the
nature of sewage, in the ordinary acceptation of the word, are
so thoroughly described in the leading paper of this number,
that every reader's attention is invited to it. Graveyard
seepage is sewage intensified. In its nature it is essentially
the same as the very small proportion of putrescible matter of
the mass of ordinary sewage. Like it, it consists of all that
is soluble of putrescible organic matter, but in a more concen-

Mitor's Tabu. 67

trated form ; and, unfortunately, as just above shown, the
putrescible dead bodies are so placed as to afford the greatest
possible facility for the soluble portion to be taken up by the
subsoil water-courses and conveyed to the storage supply —
scarcely less effectually, indeed, than if the dead bodies were
at once cast into the water-courses, after the manner of the
ancient Hindoos, and with scarcely less fatal results.

Remarkable, indeed, it is that the increased prevalence of
typhoid-fever, diphtheria, and some other filth disease in
Brooklyn, in recent years, bears a much closer relation to the
population and proximity of the graveyards to the reservoirs
than it does to the increased energy of the health service for
the prevention of such diseases. And we reg^ret that, in so far
as the excellent paper to which we have just called attention,
on other pages of this number, cites the purity of Brooklyn's
water supply as measured by the typhoid-fever standard,
Brooklyn is given a rank which she does not deserve.

Health Commissioner Griffin, in his annual report for 1888,
for the eleven months ending with November, under the head'
of typhoid-fever remarks that :

** In the fall of each succeeding year, with unfailing regu-
larity, an increase from month to month in the number of
cases and in the mortality dependent thereon takes place.
Beginning with August, there is a progressive increase to
October, and then a gradual subsidence. The causes which
lead to this seasonable outbreak are indeterminable and at
best but the subject of speculation. ... If, as no doubt
happens, the germs of the disease are always present in the
city, whether dependent on sewer emanations or pollution of
the water supply, no explanation can be afforded of the failure
to show an increase during the prevailing high temperature of
summer, which should be most influential in the growth and
development of disease-bearing atoms. . . •

** The total number of deaths from typhoid-fever in Brook-
lyn, during eleven months of 1887, was 128, while during the
corresponding portion of 1888 there were 127, notwithstanding
that there has been a very marked increase of population in
the latter year, probably reaching 33,000. The total number
of cases reported for the year up to date has been 445, with a
mortality of 127."

It is common to most infectious diseases to have their sea«
sons of special prevalence. Typhoid-fever is no exception in
this regard. This condition doubtless depends upon some

58 Mitar's TaMe.

natural characteristic or stage of growth of the infective germ
when it is the most potent — a condition, indeed, common to
all organic bodies.

There is good reason to believe that the number of cases of
typhoid-fever reported is far from the total number that occur.
Estimating by the rate of mortality common to this disease
(about eight per cent), there were in Brooklyn during the last
twelve months not less than seventeen hundred cases.

Diphtheria, in relation to filth generally — not excepting
prolluted water — is a congener of typhoid-fever ; it chiefly de-
pends upon the same conditions. Neither one is created by
filth, in polluted water or otherwise. But water polluted with
sewage, equally with unhealthful surroundings, foul air from
overcrowding and sewer-gas, are the breeding-places of the
germs of these and other infectious diseases. Such conditions
do create, however, a general condition of ill-health ; impair
the powers of resistance to and combat with the infectious
germs, contracted by contagion or otherwise, and promote
fatal results. Of this disease, the commissioner reports the
whole number of cases for the year 3297, of which 888 were
fatal.

Scarlatina, too, or, at the least, its fatality, is greatly pro-
moted by the same conditions ; but, like diphtheria, eminently
contagious. Of this disease the whole number of cases re-
ported in Brooklyn for the year 1888 was 2672, of which 445
were fatal.

Inferentially, every cemetery and graveyard on Long Island
is susceptible of such drainage as will effectually deprive them
of danger to the living. And it should go without saying that
the Brooklyn Department of Public Works is equal to the sug-
gestions of the Health Department in all measures for the
protection of the public health.

THE NEW MAUSOLEUM COMPANY.

Madison Squarb Bank Building,
Nbw York, Januarjr 5, 1889.

Editor of THE Sanitarian :

In behalf of the company which I represent, please accept
my thanks for your favorable mention of the mausoleum plan
for the disposal of the dead, in your December number, in
connection with the sanitary condition of the Croton Valley

EdUar'B T(Me. 69

water-shed, and permit me to state that the reason why we
have not presented the subject to the public is because we
have preferred to seek first the approval of the medical pro-
fession, of sanitarians, and of other leaders of opinion. The
approval of The Sanitarian was especially desired, and your
words give us courage in the encounter with an old but unsat*
isfactory custom.

It is proposed to erect in or near this city an elegant struc-
ture which shall be absolutely fire-proof, and, beyond any other
building, time-proof — a grand tomb of fine proportions to con«
tain at least ten thousand spaces, each adapted to the recep-
tion of the remains of a lost friend. These spaces will be
arranged in compartments or singly, as may be desired. As
each space is filled and sealed dry air is forced in, thus facili^
tating the elimination of the fluids and gases of the body, and
the desiccation of the solid matter until it becomes odorless
and harmless, although the figure retains its accustomed form
for a period of time which cannot be measured. Experiments
now being conducted in the University Medical College dem-
onstrate the feasibility of desiccation, even when applied to a
lai^e body in the heat of midsummer. None of Ihe horrors
of the festering tomb take place. " The small cold worm that
fretteth the enshrouded form" is unknown in desiccation.
The gases and fluids are drawn to a central furnace placed in
a sub-cellar far from the spaces allotted to the loved ones, and
they are there rendered wholly harmless before they are con-
ducted to the atmosphere. Let me further state that the pro-
posed building will be of concrete, and that the thousands of
spaces and all the arched halls and corridors will be built up
in conjunction with the outer walls, forming in that way an
almost perfect monolithic structure that will outlast any con-
temporaneous building, memorial, or vault. For the sake of
ornamentation the concrete can, within and without, be faced
with granite or other time-defying stone.

Similar buildings would, in my opinion, solve the burial
problem in the Croton Valley water-shed, as well as else*
where ; and your mention of the new plan in that connection
isy I assure you, highly appreciated.

Respectfully,

Charles A. Harvey, Secretary.

60 MiUn^s TcMe.

THE r6lE of infective MICROBES AND THE ADVANTAGES

OF WOOLLEN CLOTHING.

New York. January s» 1889.

Editor of The Sanitarian :

Two subjects have been themes of especial interest to me
for the last two years — to wit : the rdle of microbes in disease,
and the Dr. Jaeger theory of sanitary clothing. For this
reason, as well as others^ I have read with peculiar interest
your article entitled ** Some Observations on Yellow-Fever and
its HabitudeSy'' in the December number of The Sanitarian.

On page 505 you say : ** Impatient at the continued delay
and increasing prevalence of the disease, the writer took the
responsibility of having evety person on board the ' Dela-
ware,' except necessary keepers, washed and dressed in new
flannel suits (sailors' shirts and pants), procured for the pur-
pose, and transferred to the hospital, where he provided them
quarters, and from that time there was not anot/ier case of fever
among them^ though there were five cases on the day before.
So much for elimination as against development under changed
conditions."

Of course, such an assumption of responsibility was not
without scientific grounds, or the warrant of some precedent.
Will you permit an earnest student to ask what those grounds
were, and what the rationale of the preventive efficacy of the
flannel clothing ?

Respectfully yours,

R. C. Rutherford, M.D.

, The Rdle of Infective Microbes is to battle with the physi-
ological powers of the system which they enter, and to put
it upon the defensive immediately that they are distributed
to the tissues of the body, by means of the blood which carries
them to every part. If the system they enter be weak from
any cause, constitutionally so, or feeble from recent disease ;
by reason of unhealthful surroundings, such as a foul atmos-
phere, sudden exposure to excessive heat or cold without suffi-
cient protection ; deprivation of sleep ; deranged digestion or
mental disturbance ; above all, by debauch ; in short, if by
anything which disturbs bodily vigor, the microbes have the
advantage—- and they never fail to avail themselves of it— and

EdiU>r'9 TcMe. 61

generally overcome the power of resistance. It is not because
they are cowards and only attack the weak ; they attack the
strong and the weak alike on every opportunity, but the
strong — with all the functions of the body maintained in a
state of vigorous health — are able to cope with microbes and
overcome them. The feeble, on the other hand, are taken at
a disadvantage, and the more if the circumstances of their
enfeeblement are in any degree maintained.

" The future of preventive medicine," said Professor Ray
Lankester, in a lecture which he delivered at the London
institution recently, " is the education of the white blood
corpuscle." A corpuscle is a minute cell of protoplasm which
floats in the human blood. " This minute creature eats,
and lives, and flourishes, and dies almost like a human being.
Its special function," said the lecturer, " is to eat up the poi-
sonous element which finds its way into the blood. When a
wound heals it is because these indefatigable corpuscles have
found their way to the sore and have eaten away the injured
part. When bacteria get into the system the duty of the
corpuscles is to go for them and eat them up. If they suc-
ceed, the patient recovers. If they are out of appetite, or
the bacteria too tough a morsel for them to attack, the patient
dies. Sometimes, with unconscious heroism worthy of Marcus
Curtius, they purify the bodies in which they live by eating
up poisonous particles and then ejecting themselves, thus
sacrificing their own lives. But such heroic self-immolation
is not necessary, if you educate your corpuscle. His educa-
tion proceeds by inoculation. By accustoming your proto-
plasmic cell to a low diet of mildly poisonous matter, such as
the vaccine lymph, it becomes acclimatized, as it were, and is
strong enough to eat up without inconvenience the germs of
small-pox, which would otherwise prove fatal. It is these in-
valuable corpuscles which enable confirmed arsenic eaters to
swallow with impunity a dose sufficient to kill six ordinary
men." Professor Lankester is of the opinion that they can
be trained so as to digest the most virulent poisons and deal
with a great number of diseases.

With the foregoing suggestions it is apparent that the indi-
cations in dealing with the microbe (infectious disease) are to
strengthen the power of resistance to and combat with it in

$2 ScUtar's Table.

conjunction with the use of every available means of prevent-
ing and destroying the conditions favorable to its existence,
both within and without the human body.

The conditions most favorable to the propagation of yellow-
fever, as also of other infectious diseases, were painfully
familiar to us long before the event referred to ; and not to
have applied the best means of resisting it with which we were
acquainted, under the circumstances, would have been crim-
inal negligence.

Woollen Clothing is so well known as the best possible means
of protecting the wearer against the ill effects of sudden
changes of temperature ; of preserving the equable tempera-
ture of the body while it admits of thorough ventilation of the
surface with the least risk from exposure ; as a means of ab-
sorbing perspiration as fast as it is emitted, and — if unre-
strained by overclothing of other material — allowing the per-
spiration to pass off into the atmosphere insensibly almost as
fast as it is generated, and thus keeping the skin dry even in
the hottest weather, and warm in the coldest ; and as a gentle
stimulus to the skin, removing scurf, keeping the pores open
and clean, and promoting its healthy action for the promotion
of health or the elimination of disease : for all these reasons,
and more might be cited, woollen clothing commended itself
to us on the occasion referred to, as it has on many other
occasions more or less similar, where it has before been
neglected^ and by this we mean as the most healthful apparel
for the strong and well, as well as for the sick and feeble,
under all circumstances — it invigorates the white corpuscles.

The Yellow-Fever Microbe— got Him?— Dr. Paul
Gibier was appointed by the French Government to investi-
gate the whole question of yellow fever. He has been doing
the most of his work in Cuba. He claims to have discovered
in the black matter always found in the intestines after death
of a yellow-fever patient, a bacillus presenting many points of
resemblance to the so-called comma bacillus of cholera. It is
generally curved, and in some cultures occurs in a spiral form.
It also possesses the property of liquefying gelatine. When
this bacillus is cultivated in certain medicines, as, for instance,
in peptonized broth, it blackens the sides of the tubes in which

Mitor's TdHU. 63

the culture is made. All the cultures of this bacillus have a
characteristic odor. A moist heat of 60^ C. destroys them in
a short time. Dr. Gibier believes this to be the reason why
inland districts are exempt from the scourge — the comparative
dryness of the air destroying the virus. He believes that
yellow-fever is due to the development of the microbe in the
intestines — the affection being therefore purely a local one.

Dr. James E. Reeves, of Chattanooga, is also reported as
having cornered the yellow-fever germ. His recognized fame
as microscopist is» to say the least, a suflBcient guarantee that
he has discovered something unusual — probably hitherto un-
recognized. Verifications by other microscopists are in order,
and will be looked for with hope ; but the probabilities are
not very encouraging.

Bed-rooms which have been, as too commonly, occupied
as sitting or sewing-rooms during the day, should be thor-
oughly flushed with air before the hour of retiring, cooled to
a temperature of about 60^ F., and ventilation provided for
during the sleeping hours. An excellent means of ventilation
is by a closely fitting strip of board under the lower window
sash. Thus provided, the lap of the sash in the middle ex-
cludes rain or snow and admits the air with an upward current,
and thereby never exposes the occupant to draught.

Setting Wash-Basins.— S. B. inquires of the Metal
Worker : Will it ever be known what reason some so-called
plumbers have for joining wash-basins to marble slabs by the
use of common putty ? Marble will absorb oil about as rap-
idly as a sponge will water. The writer has stopped at a
number of hotels where the ''plumbing" has been done by
native talent. The marble work in the wash-room may be as
elaborate as can be, even to a large silver-plated tablet that
informs the washer that the marble work was done by the boss
gravestone artist of the town. So far, the work may be well
done, but where the wash-basins join the marble, there is
where the trouble comes in, for, by using putty as a cement,
the marble has been discolored for three or four inches about
the basin, giving the work a very unsightly appearance. To
set a wash-basin properly, it should be ground so as to make
a close joint with the marble, and the basin held in place by

64 Mitar'B Table.

three brass clamps, the bolts to hold which are to be leaded
into the marble slab. The joint between the slab and basin
should be made tight by means of plaster-of-paris. With
some, it is customary to fit the wash-basins into a board which
forms the top of the wood-work that supports the marble slab.
If a number of basins were to be set, and they were to be held
in place by a board, it might not be convenient to use plaster-
of-paris, for fear the plaster would become hard before the
slab could be placed in position. On this account it may be
thought necessary to use putty, as every one knows it dries
slowly enough to accommodate most any one. By setting the
bolts in lead, the brass clamps can be applied, and the basin
held in position without it being necessary to have a board on
top of the wood-work to serve as a support for the basin.

The Durham House Drainage Company, of New York,

is at present fitting up the following buildings with its patent
system of screw-joint wrought-iron pipe house drainage :
Eight-story building for the New York Life Insurance, at
Montreal ; ten-story building for the same company, at St.
Paul, Minn.; the State House, Columbia, S. C, and four new
school-houses for the New York City Board of Education.

The Durham System of House Drainage has required five
or six years, since it was first introduced, to overcome prej-
udices and superficial objections urged against it by some
manufacturers of cast-iron pipe, plumbers, and others for in-
terested motives, but we are gratified to learn that its excel-
lence is more and more appreciated, as it is certain to be by
all who will take the trouble to examine it.

Practical Illustrations of the Neglects and Bene-
fits OF Vaccination. — In Paris, where the law requiring
vaccination is feebly enforced, the mortality from small-pox
ranges from 136 to 10. i to the 100,000 inhabitants, while in
the principal German cities, where the vaccination laws are
rigidly enforced, the death-rate is but 1.44 to the 100,000
inhabitants. London, under compulsory vaccination, has a
death-rate from small-pox of but .6 to the 100,000 inhabitants.
On the other hand, in the Canton of Zurich, in Switzerland,
since the compulsory vaccination law was repealed in 1883, the
death-rate from small-pox has risen steadily from 8 to 85 to
the 100,000 inhabitants.

MUor's T(Me. 65

A report lately published by Mr. Ritchie, President of the
British Local Government Board, with reference to the recent

*

epidemic of small-pox in Sheffield, shows that of the children
under ten years of age, 95,000 were vaccinated and 5000 were
not. Among the vaccinated there were 189 cases of small-pox
with 2 deaths ; among the un vaccinated there were 172 cases
and 70 deaths. Keeping these proportions, if all the children
in Sheffield had been vaccinated, there would have been 200.
cases of small-pox among them and a fraction more than 2
deaths ; if none of the children had been vaccinated, there
would have been 3337 cases and 1330 deaths, 600 times the
mortality with universal vaccination.

Ten Good Things to Know.— k That salt will curdle new
milk ; hence in preparing milk porridge, gravies, etc., the salt
should not be added until the dish is prepared.

2. That clear boiling water will remove tea stains and many
fruit stains. Pour the water through the stain and thus pre-
vent it spreading over the fabric.

3. That ripe tomatoes will remove ink and other stains from
white cloth ; also from the hands.

4* That a tablespoonful of turpentine boiled with white
clothes will aid in the whitening process.

5* That boiled starch is much improved by the addition of
a little sperm salt or gum arabic dissolved.

6. That beeswax and salt will make rusty flat-irons as clean
and smooth as glass. Tie a lump of wax in a rag and keep it
for that purpose. When the irons are hot, rub them first with
the wax rag, then scour with a paper or cloth sprinkled with
salt.

7. That blue ointment and kerosene mixed in equal propor-
tions and applied to the bedsteads is an unfailing bedbug,
remedy, as a coat of whitewash is for the walls of a log-house.

8. That kerosene will soften boots or shoes that have been
hardened by water, and render them as pliable as new.

9. That kerosene will make tin tea-kettles as bright as new.
Saturate a woollen rag and rub with it. It will also remove
stains from varnished furniture.

10. That cool rain-water and soda will remove machine
grease from washable fabrics.

5

66 EiUor'9 TaSU.

THE PROGRESS OF INFECTIOUS DISEASES AND MORTALITY
RATES AT THE MOST RECENT DATES, BASED UPON OFFICIAL
AND OTHER AUTHENTIC REPORTS.

Alabama. — Mobilt^ 4p^ooo : Reports 66 deaths duritig No*
vember, of which 26 were under five years of age. Annual
death-rate, 19.8 per looa From zymotic diseases, 13, and
from consumption, 7.

California.— The Secretary of the State Board of Health
reports the number of deaths during the month of November,
1888, from 68 localities, comprising a population of 654,400,
997, representing an annual death-rate of 18.00 per 1000.
Consumption caused 142 deaths — over one seventh of the total
mortality. Zymotic diseases, 137 — diphtheria and croup, 53 ;
typhoid and typho-malarial fevers, 40 ; cerebro-spinal- fever,
9 ; small-pox, i — in Merced.

' San Francisco, 300,000 : Deaths during the month, 562 ;
from zymotic diseases, 64. Consumption, 78.

Los AngeleSf 80,000 : 69 ; from consumption, 9 ; zymotic
diseases, 12.

San Diego, 30,000: 21 ; from consumption, 3; zymotic
diseases, i.

Sacramento, 35,000 : 41 ; from consumption, 9 ; from zymotic
diseases, 3.

Connecticut. — The Secretary of the State Board reports
for November, 1888, the total number of deaths returned by
166 towns, comprising a population of 733,626, 850, represent-
ing an annual death-rate of 13.9. Deaths under five years,
149 — 17.5 per cent. Deaths from consumption, 115; from
zymotic diseases, 162 — typhoid and typho-malarial fevers, 37 ;
diphtheria and croup, 58.

" There was only one small town in the State from which
no report has been received. The total deaths reported in
November — viz., 850, and the total in October, 959, shows a
diminished mortality of 116 and a death-rate of 13.9 against
15.7 of the previous month. The difference is due very
largely to the diminished fatality from typhoid- fever, diar-
rhoeal diseases, and consumption. In October there were 62

MUar'9 TM$. VI-

deaths from t)rphoid-fever, and only 29 in November, There
were 46 from diarrhcea, and only 18 in November, and there
were 128 in October from consumption and in November only
115. From diphtheria there were exactly the same in each
month, 58. The lessened mortality from t)rphoid-fever is
very marked. The health of the State is exceptionally good*
The death-rate is less than in any previous month in the
year."

Florida and Yellow-Fever. — Dr. John C. L'Engle,
Chairman of Sanitary Committee, reports to the Surgeon-
General, United States Marine Hospital Service, from Jackson-
ville, November 13th, 1888, as follows :

" By referring to the topography of this city, you will notice
that it is situated on the north bank of the St. John's River,
the river turning at right angles and passing to the east of a
portion of the city recently added to the corporation ; that
this tract of country is low and flat, much of the land being
marshy ; that we have a creek on the west passing partially
around to the northwest ; another on the east extending to
the northwest. This country lying between these two creeks
is low and flat, and has never been thoroughly drained, and
the water, in some places for acres, could be found a foot
deep, with plank-walks through the yards and to the out-
houses, and with wells containing only surface water or drain-
age from the seeping. The marshes and low lands along the
sides of these creeks also emitted miasmatic stench deleterious

*

to health, or supposed to be, and all demanding attention.
The area of fever has been five miles from east to west, and
ten miles from north to south, and the outlying district, where
this condition existed, is inhabited by the lower classes, prin-
cipally negroes, who have had a large share of fever and are
now having it."

Dr. J. F. Hartigan reports the condition of Enterprise,
under date of December 17th, 1888, as follows :

" Over its territory are scattered numerous ponds and
marshes, generally without an outlet or an attempt at one.
Perhaps the most pernicious of these is just west of the hotel.
In it is dug a pit about fourteen feet by ten, lined by boards,
which has been a rec^tacle for the hotel sewage. The in-

6» EdiUrr'% TdhU.

tentton was to regularly mix this with dried muck and use it a^
a fertilizer, but it had not been properly carried out, and the
matter for a long time kept leaking through, as was evident
from the surrounding exhalations.

" I found the streets and vacant lots generally overgrown
with weeds and decaying vegetation ; here and there were
scattered heaps of all kinds of garbage ; the drains were ob-
structed, and there was no system of disinfection or removal
of excreta. Perhaps the worst death-trap that was ever found
in a Christian community existed here. In the court-house
yard the jail was situated ; almost adjoining the latter a privy-
house was built over a cesspool ten feet square and four feet
deep, with a six-inch pipe communicating. Not only was this
intended for the excrement from the jail, but it was an open
place where the passer-by entered. On account of the po-
rosity of the soil, the fluids percolated, and there was hardly
ever an overflow. Two and a half years ago this pest-hole
was established by authority ! having been permitted to exist
since. Of course it was a subject for early attention.

The epidemic is suspended.

>i

Illinois. — Chicago^ 800,000 : Reports 1061 deaths during
November, of which 422 were under five years of age. An*
nual death-rate, 15.92 per 1000. From zymotic diseases, 253,
and from consumption, iii.

Maryland. — Baltimore, 431,879 : Reports 539 deaths dur-
ing the four weeks ending November 24th, of which 180 were
under five years of age. Annual death-rate, 16.21 per 1000.
From zymotic diseases, 84, and from consumption, 83.

Massachusetts.— 5^j/^», 415,000: Reports 732 deaths
during November, of which 238 were under five years of age.
Annual death-rate, 21. i per 1000. From zymotic diseases,
117, and from consumption, 112.

Michigan. —The Secretary of the State Board of Health
has just issued his fifteenth annual report. The first part is
taken up with an abstract of the work of the board during the
fiscal year, and includes the remarks made by the members of
a committee of the board before the Regents of the Univer*

MiUyt'9 TdHU. 69

sity urging the necessity of a laboratory of hygiene at the
State University.

The second part of the report consists of eleven papers, ab*
stracts, and reports.

Probably the most important part of this report may be
divided into two general heads : The first quarterly report of
the Michigan State Laboratory of Hygiene, by Professor
Victor C. Vaughan, M.D., Ph.D., Director of the Laboratory,
and the Study of the Causation of Diseases, by Henry B.
Baker, M.D., Secretary of the Board.

Professor Vaughan 's investigations with tyrotoxicon are
treated of in an article by him on '* The Chemistry of Tyro-
toxicon : Its Action Upon Lower Animals, and Its Relation
to the Summer Diarrhoeas of Infancy." This article gives
the experiments by which the identity of tyrotoxicon and
diazobenzol is established, and contains rules for the preven-
tion of the formation of tyrotoxicon in milk, and the preven-
tion of cholera infantum and summer diarrhoeas.

Professor Vaughan's report includes three subjects : (i)
The important results of the investigations into the " Causa-
tion of Typhoid-fever," stating the details of the experiments
whereby the "germs" — the bacilli of typhoid-fever — were
proved to be in the water supposed to have caused the typhoid-
fever at Iron Mountain, Mich., in October, 1887 ; and where-
by, through the injection of the *' germs," a disease in some
respects similar to typhoid-fever was produced in an animal,
and, through injection of a ptomaine formed by the germs,
and chemically separated from the germs, an abnormal rise of
body temperature was produced in an animal. (2) The com-
plete account of the four cases (three fatal) of tyrotoxicon
poisoning near Milan, Mich., in September, 1887, and the
experiments indicating that the poison may be generated in
soil saturated with decomposing milk. (3) The investigations
which exposed a fraud which was putting into the hands of
pharmacists and physicians a drug claimed to be a harmless
product of the honey locust-tree, but which was found to be
a dangerous mixture of cocaine and atropine.

Dr. Baker's studies of the causation of disease are contained
mostly in three articles : (i) '* Principal Meteorological Con*
ditions in Michigan in 1886," (2) " Contributions to the Study

70 mUar's Tails.

of the Causes of Sickness" — a statistical report based on
weekly reports of sickness in Michigan during the year 1886
and preceding years, and (3) a paper combining these two
lines of study, and entitled " The Causation of Cold Weather
Diseases/* This important paper includes a study of the
principal diseases of the air-passages and those communicable
diseases which are most prevalent in cold weather. Over
forty-one thousand weekly reports of sickness and over one
hundred thousand observations of atmospheric temperature
are gathered together in tables and graphically represented in
diagrams showing that diphtheria and scarlet-fever, follow in-
versely the curve for temperature. Similar large numbers of
facts are grouped together in the same way, showing that in-
fluenza, tonsilitis, and bronchitis are related to the atmos-
pheric temperature in the same way — rising as the temperature
falls and falling as the temperature rises.

Dr. Baker states the facts which lead him to believe that
the non-volatile salts of the blood exuded in excess into and
upon the mucous surfaces of the air-passages are capable of
causing an inflammation which is called ''influenza/' " ton-
silitis," or " bronchitis/' according to the portion of the res-
piratory tract involved. Other things being equal, the non-
volatile salts are left by evaporation on the mucous lining of
the air-passages, in proportion to' the dryness of the air in-
haled. Inasmuch as the absolute dryness of the air ordinarily
depends upon its coldness, the inflammations of the air-pas-
sages should be expected to rise as they do after the cold, dry
weather, and fall after warm, moist weather. The reason why
the communicable diseases increase after the cold months is
believed to be because of the greater susceptibility of the air-
passages in those months, and this is the reason why the
curves representing the rise and fall of these communicable
diseases follow the curves for influenza, tonsilitis, and
bronchitis.

A report by J. H. Kellogg, M.D., on Dangers in Gasoline
embodies facts collected by him, including the views of lead-
ing insurance agents, etc., concerning the dangers in the use
and storing of gasoline, and giving rules to be observed in
handling this substance, declared to be " more dangerous than
gunpowder."

JBdUar's Tails. 71

Among the most concise articles in the report may be men-
tioned the President's annual address by Hon. John Avery,
M.D.» which gives a good presentation of the work of the
board in the past, a forecast of its future work, and the eco*
nomic value of public-health work.

For the month of November, 1888, compared with the
preceding month, the reports indicate that tonsillitis increased,
and that typho-malariaUfever, diarrhoea, dysentery, cholera
morbus, and cholera infantum decreased in prevalence.

Compared with the preceding month, the temperature in the
month of November, 1888, was lower, the relative humidity
was more, the absolute humidity and the day and the night
ozone were less.

Compared with the average of the month of November in
the nine years, 1879-87, diphtheria, intermittent-fever, con-
sumption of lungs, typhoid-fever, pneumonia, typho-malarial-
fever, whooping-cough, and remittent-fever were less prevalent
in November, 1888.

For the month of November, 1888, compared with the aver-
age for corresponding months in the nine years, 1879-^7, the
temperature was slightly higher, the absolute humidity was
slightly more, the relative humidity was about the same, and
the day and the night ozone were much less.

Including reports by regular observers and others, diphtheria
was reported present in Michigan in the month of November,
1888, at twenty-six places, scarlet-fever at forty-one places,
typhoid-fever at twenty-three places, measles at six places,
and small-pox at seven places.

Reports from all sources show diphtheria reported at ten
places less, scarlet-fever at nine places more, typhoid-fever at
twenty places less, measles at one place less, and small-pox at
seven places more in the month of November, 1888, than in
the preceding month.

Detroit, 230,000 : Reports 244 deaths for November, of which
51 were under five years of age. Annual death-rate, 12.90 per
1000. From zymotic causes, 57, and from consumption, 29.

Minnesota. — The Secretary reports the distribution and
mortality of specified diseases in Minnesota, for the month of
October> 1888 :

72 JScUtar'i TahU.

Measles and scarlatina slowly increasing, diphtheria markedly
so. There were from the last 64 deaths in 24 localities and
19 counties, in September, while for this month there are
reported 80 deaths in 27 localities.

Croup, 9 deaths in September, 20 in October.

Typhoid-fever, 84 deaths last month to 1 14 in October. In
19 localities then to 29 now. We repeat the warning of last
month, and call earnest attention to the circular published
then, and the further notice below. Send for as many copies
of the circular as you can use for distribution.

Erysipelas, slight mortality, but 4 deaths and in 4 localities.

Puerperal diseases, same as last month.

Diarrhceal diseases of children, a very large reduction, 187
deaths in September to 52 in October.

Infectious diseases reported during the month of October :
Diphtheria, 118 cases, 39 deaths ; scarlatina, 21 cases, 2 deaths.

Diseases of animals : Cases of glanders remaining isolated
or not accounted for, 35 ; reported during the month, 7 ;
killed, 10 ; released, i ; isolated, 3. Remaining November
1st isolated or not accounted for, 31. Most of these are cases
exposed, and isolated for further observation.

St. Paul^ 175,000 : Reports for November 138 deaths, of
which 57 were under five years of age. Annual death-rate,
9.39 per 1000. From zymotic diseases there were 53 deaths,
and from consumption, 7.

Missouri. — St. Louis: Annual report of G. F. Dudley,
M.D., Health Commissioner for the fiscal year ending April 9th,
1888. Population, 420,000. During the calendar year 1887 •

Birtlis reported (exclusive of 740 still-births "not included
either in the mortality or in the births "), 10,443 — "nearly
9000 of which were reported by midwives ; but one conclu-
sion can be drawn from this fact, and that is that physicians
do not report all births occurring in their practice ; and it is
highly probable that many physicians neglect altogether this
important duty. ' '

Deatfis, 9155 — 3795, or 41.4 per cent, of which were of
children under five years of age. From consumption, 829 —
8.94 per cent of total ; from zymotic diseases, 2549 — 27.84
per cent. From the chief zymotic diseases, respectively, the

mUar's Tolls. 73

number of deaths was : Measles, 40 ; scarlatina, 48 ; diph-
theria, 927; whooping-cough, 12; typhoid-fever, 116; diar*
rhceal diseases, 477. Seventeen cases of small-pox occurred
during the year, but they were so promptly reported and ex-
cluded as to prevent the spread of the disease, from which
there was no death.

Thomas G. Kaye, Inspector of Dairies, reports that of 371
dairies inspected — exclusive of places where from one to three
cows are kept — *' 166 were found to be connected with the
sewers, and all the Blth of these dairies is emptied into the
sewers, and in many cases, I have no doubt," he remarks,
*' have much to do with stopping up or choking the sewers ;
105 were found where the cows are kept continually confined,
. • . 223 feed swill, and last fall, when the price of feed
was high and the pastures very bare, swill formed the main
part of the feed of many dairies. • • • The work of in-
specting the dairies is too much for one person to do, if the
work is done as it should be. • . • It is impossible for
one person to visit them more than once in every sixty days."

That diphtheria and typhoid-fever should be especially
prevalent with such conditions is surely no matter of surprise.

Thomas Cleary, Superintendent of the Poor House, reports
the continued overcrowding of that institution, the anti*
quated, worn-out structures and appurtenances, and the con-
sequent increased misery of the occupants.

Dr. H. C. Dalton, Superintendent of the City Hospital,
reports 6479 admissions against 5960 during the preceding
year ; general improvement in the results of treatment since
adopting antiseptic methods in the surgical wards during the
latter part of the year ; some improvements by way of repairs,
but more needed with regard to worn-out flooring — inconsis-
tent with thorough antisepsis. He urges a dynamo-plant for
the purpose of electric lighting, and better protection against
danger from fire.

Dr. W. B. Dorsett, Superintendent of the Female Hospital,
reports 1701 admissions against 1644 the year previous, but
loi were children not ill in the care of their mothers. This
institution appears to be especially affected with chronic
decay, complicated with overcrowding and disgraceful neglect
of proper provision for nurses — 135 deaths against 119 the

74 EdUar'9 TahU.

year previous, and 272 births against 280. " Puerperal fever,
that above all dreaded in hospitals, cannot be successfully kept
down with the accommodations we now have for lying-in
women."

Dr. Le Grand Atwood, Superintendent of the Insane
Asylum, reports 763 patients— 516 at the beginning of the
year and 247 admissions since. Percentage of deaths on the
whole treated, 3.84; recoveries, 11 ; on those admitted dur-
ing the year, 25. ** All of the evils heretofore represented in
fifteen consecutive annual reports, as affecting this institution
through overcrowding, continue and are intensified." Alto-
gether, the general results comprehended in this report are
creditable to the officers in charge, but disgraceful to the civil
authorities responsible for the inadequate force for the pro-
tection of the public health and for the dilapidated and
death-dealing provision for dependent persons.

Reports for November 614 deaths, of which 236 were under
five years of age. Annual death-rate, 16.74 per 1000. From
zymotic diseases, 118, and from consumption, 56.

New Hampshire State Board begins the year with an offi.
cial organ of twenty-four pages, under the title of *' The Sani-
tary Volunteer." It is filled with a useful excerpt of sanitary
literature, but no reports of State sanitation.

*' Our object is," it says salutatorily, ** to produce a publi-
cation that will educate the people to a higher appreciation of
the means of preventing disease, and to a better understand-
ing of its causes ; to point out the dangers that come from
unhealthful surroundings, conditions, etc., and to give infor-
mation and instruction in matters pertaining to health that
will be of practical service to all. The evils of unhygienic
environments should be known by all classes." Irving A.
Watson, A. M., M.D., editor. 50 cents a year. Concord, N. H.

New Jersey. — Hudson County, 270,232 : Reports for No-
vember 469 deaths, of which 178 were under five years of age.
Annual death-rate, 20.8 per 1000. From zymotic diseases,
105, and from consumption, 52.

Newark^ 176,969 : Reports for November 287 deaths, of
which 102 were under five years of age. Annual death-rate,

Miiar'$ TaMs. 75

19.45 per 1000. From zymotic diseases, 48, and from con-
sumption, 31.

New York.— Official Bulletin of the Secretary reports 6987
deaths during the month of November (7292 in November,
1887). representing an annual death-rate per 1000 population
of all reporting localities of 17.80, that of the cities and larger
villages and towns specified being 20.80 ; the actual and rela-
tive mortality is materially less than in October. The per-
centage of deaths under five years of age is nearly the same as
in November, 1887, and lower than that of last month. Zy^^
motic diseases caused 17.45 per cent of the total number (19.63
in October and 20.00 in November, 1887). There is a notable
diminution in the death-rate of typhoid-fever, and also of
whooping-cough. Scarlet-fever shows an increase (2.45 per
cent of all deaths — 1.59 last month). Diphtheria also shows
a marked increase (7.68 per cent— 5.48 last month, but 11.56
in November, 1887). Single cases of small-pox were reported,
to December 26th, from Troy, Fort Edward, and Frankfort,
the two last of very mild type. Consumption caused 12.75
per cent of all deaths, and 18.30 per cent of deaths above the
2^e of five years. Fifteen per cent of all deaths were from
acute respiratory diseases.

Severally, the populations and death-rates are as follows :

Maritime District. — New York City, 1,526,081, 21.52 ;
Brooklyn, 757,755, 19-67 ; Gravesend, 5000, 24.00 ; New
Utrecht, 4742, 30.31 ; Long Island City, 21,000, 25.14 ; New-
town, 10,000, 24.00; Oyslttt Bay, 12,000, ; Hempstead,

18.000, 17.84; North Hempstead, 8000, 28.50; Huntington,

8100, 14.81 ; Jamaica, 10,089, ; Southold, 7267, 13.20;

Sag Harbor, 3000, 20.00; New Brighton, 15,000, 10.40;
Edgewater, 12,000, 21.00 ; Northfield, 7014, 18.85 \ West-
field, 7000, 20.57; Yonkers, 27,500, 21.85; Westchester,
6900, 13.71 ; Sing Sing, 6500, 12.92 ; New Rochelle, 5500,
15.27 ; Port Chester, 4000, .

Hudson Valley District, — Albany, 102,000, 21.30 ; Cohoes,
20,000, 13.80; Troy, 65,000, 23.50; West Troy, 13,000,

12.93 ; Hoosick Falls, 6000, ; Lansingburg, 10,000,

24.00 ; Green Island, 5000, 24.00 ; Greenbush, 8000, 21.00 ;
Coxsaclde, 4000, 15.00; Catskill, 4500, i6.oo ; Hudson,

76 EdUar'B TahU.

10,000, 7.20 ; Kingston, 21,000, 16.00 ; EUenville, 3000, 8.00 ;
Marbletown, 4000, 3.60 ; Esopus, 4736, 8.00 ; Saugerties,
4000. 21.00 ; Poughkeepsie, 20,200, 14.25 ; Fishkill, 10,732,
13.26; Wappinger Falls, 5000, 16.80; Newburg, 20,000,
21.60; Port Jervis, 9500, 11.35; Middletown, 10,000,21.80;
Goshen, 4387, 21.87 ; K.amapo, 5000, 26.40 ; Haverstraw,
7000, •

Adirondack and Nor tJurn District. — Greenwich, 3861, 21.75 ;
Argyle, 3700, 10.00 ; Salem, 3500, 24.00 ; Fort Ann, 4267,
2.81 ; Fort Edward, 4880, 19.68 ; Glens Falls, 10,000, 15.60;

Crown Point, 4287, ; Malone, 9000, 19.75 ; Potsdam,

4000, 18.00; Ogdensburg, 11,000, 19.64; Gouverneur, 5500,
15.28; Plattsburg, 7000, 10.28; Watertown, 12,200, 15.74;

Lowville, 3188. ; Clayton, 4314, 8.40 ; Ellisburgh, 481 1,

12.50.

Mohawk Valley District. — Schenectady, 20,000, 10.80 ;

Schoharie, 3350, 7.13; Coblcskill, 3371, ; Middleburgh,

837^* » Amsterdam, 14,000, 8.40 ; Johnstown, 6000,

10.00 ; Gloversville, io,ouo, 10.80 ; Little Falls, 7200, 23.33 1
Herkimer, 3000, 12.00; Ilion, 4200, 11.43; Utica, 43,000,
22.05 ; Rome, 12,045, 15.00 ; Boonville, 4000, 6.00 ; Camden,
3400, 21.18; Waterford, 5400, 13.33; Ballston Spa, 3200,
7.50; Saratoga Springs, 10,000, 22.80.

Southern Tier District. — Binghamton, 30,000, 16.00 ; Owego,

6000, 10.00 ; Candor, 4323, ; Waverly, 3000, 16.00 ;

Homellsville, 10,000, ; Elmira, 25,000, 12.98 ; Horse-
heads, 3500, 6.88; Bath, 3500, 17.14; Corning, 8000, 12.00;
Olean, 8000, 16.50; Salamanca, 6000, 6.00; Jamestown,
14.000, 16.00 ; Westfield, 3000, 12.00.

East Central District. -^WaAton, 3540, 16.88 ; Delhi, 3000,
4.00 ; Cooperstown, 3000, 8.00 ; Oneonta, 7000, 24.00 ; Wor-
cester, 3000, 12.00; Cazenovia, 4363, 11.00; Brookfield, 3685,

13.00; Hamilton, 3912, 3.06; Baldwinsville, 3000, ;

Skaneateles, 4866, ; Syracuse, 80,000, 13.65 ; Cortland,

9000, 10.67 ; Homer, 3000, 8.00.

West Central District. — Auburn, 26,000, 12.46 ; Ithaca,
10,000, 9.60; Groton, 3450, 3.48; Waterloo, 4500, 16.00;
Hector, 5000, 9.60 ; Manchester, 4000, 3.00 ; Phelps, 7000,
5.14; Canandaigua, 6300, 7.61 ; Geneva, 6000, 18.00; Penn
Yan, 4500, 2,67 ; Dansville, 3700, ; Batavia, 7000, 6.85.

Mitor'8 Table. 7T

Lake Ontario and Western District, — Oswego, 24,000, 13.00 ;
Richland, 4000, 3.00 ; Fulton, 4000, 27.00 ; Clyde, 3000,
20.00 ; Lyons, 6000, 16.00 ; Newark, 3500, 7.00 ; Palmyra*
4800, 20.00; Rochester, 110,000, 13.86; Brockport, 4500,
10.67; Medina, 4000, 15.00; Albion, 5000, 19.20; Buffalo,
230,000, 15.64; Tonawanda, 4900, 14.40; Amherst, 4578,
8.00 ; Lockport, 15,000* 8.80.

North Carolina. — Official summary of the mortality re«
turns for fourteen towns, giving a total population of 85,700,
for the month of October, 1888 : There were 8 deaths from
typhoid-fever, 15 from malarial-fever, 8 from diphtheria, 4
from pneumonia, 14 from consumption (5 white and 9 colored),
6 from heart disease, 5 from brain disease, i from Bright's dis-
ease, 7 from neurotic disease, 15 from diarrhoeal disease, i
from accident, and 33 from all other diseases.

The mortality rates of the chief towns were : Of Durham,
white, 13.3, colored, 24 ; Charlotte, white, 9.06, colored, 32 ;
Fayetteville, white, 2.06, colored, 19.2 ; Goldsboro', white,
4.02, colored, 10.90 ; New Berne, white, 3.6, colored, 12.4 ;
Raleigh, white, 22.5, colored, 27.4; Tarboro\ white, 9.2;
Washington, white, 15, colored, 37.5 ; Wilmington, white,
7.9, colored, 24 ; Henderson, white, 6.7, colored, 27.9 ; Ox*
ford, white, 39.9, colored, 15.

Ohio. — Official Monthly Record of the Secretary reports
1 1 1 1 deaths during the month of November, representing an
annual death-rate per 1000 population of 52 cities and towns
of 12.92. Deaths under five years of age, 275. From zymotic
diseases, 238 — chiefly croup and diphtheria, 141 ; typhoid-
fever, 50; diarrhoeal diseases, 15 ; scarlatina, 10; whooping-
cough, 6. Deaths from consumption, 137. Severally, the
populations and death-rates were as follows :

Akron, 30,000, 4.40 ; Alliance, 7000, 15.41; Ashtabula,
6500, 14.77; Ashley, 800, 45.00; Bellaire, 12,000, 11.00;
Bellevue, 3500, 20.57; Bloomingburg, 800, 30.00; Canton,
25,000, 6.72 ; Chagrin Falls, 1400, 17.13 ; Chillicothe, 14,000,
13.71 ; Cincinnati, 325,000, 13.69 ; Cleveland, 225,000, 11.57 ;
Clyde, 3000, 12.00 ; Columbus, 101,000, 7.47 ; Cuyahoga
Falls, 2800, 17.14; Dayton, 52,000, 13.39; Defiance, 7000,

78 manor's TMe.

10.28 ; Delaware, 9000, 8.00 ; East Liverpool, 10,000, 8.40 ;
Galion, 6000, 22.00 ; Galipolis, 5000, 9.60 ; Hamilton, 20,000,
8.60 ; Hartwell, 2000, 18.00 ; Kent, 3750, ^19.48 ; Mansfield,
15,000, 7.20 ; Marion, 8000, 7.50 ; Middletown, 7000, 20.93 ;
Mt. Sterling, 950, 50.52 ; Mt. Vernon, 6000, 22.22 ; Monroe-
ville, 1500, 40.00; Nelsonville, 5000, 4-80; North Amherst,
1600, 22.50; Oberlin, 4000, 6.00; Piqua, 10,000, 13.20; Ply-
mouth, 1500, 16.00 ; Portsmouth, 14,000, 8.57 ; Ravenna, 4000,
6.00 ; St. Mary's, 2500, 28.80 ; Shawnee, 4000, 6.00 ; Shelby,
2500, 9.60; Springboro', 500, 72.00; Toledo, 80,000, 9.50;
Urbana, 8000, 7.50 ; Versailles, 1900, 12.63 ; Wadsworth,
2500, 9.60 ; Washington Court-House, 5200, 18.42 ; Wapa-
koneta, 3300, 10.91 ; Warren, 8000, 7.50; Winchester, 1000,
84.00 ; Wooster, 8500, 5.63 ; Xenia, 10,000, 10.80 ; Youngs-
town, 24,300, 7.90.

Pewsylv ASl A.— PAiiadelpAia, 1,016,758 : Reports for four
weeks ending November 24th, 1356 deaths, of which 421 were
under five years of age. Annual death-rate per 1000, 17.4.
From zymotic diseases, 181, and from consumption, 185.

Pittsburgh^ 230,000 : Reports for four weeks ending Novem-
ber 24th, 270 deaths, of which in were under five years of age.
Annual death-rate, 15.75 P^^ 1000. From zymotic diseases,
52, and from consumption, 19.

Rhode Island. — Official Bulletin of the Secretary reports
the health of the State generally, so far as relates to acute dis-
eases of importance, as good during the month of November
as the average of the same month in previous years. During
the last part of the month typhoid-fever increased with more
than usual rapidity in the city of Providence and along the
eastern borders of the towns of Johnston and Cranston.

Scarlet-fever was prevalent in rather unusual numbers in
OIneyville and vicinity, but elsewhere the State was unusually
exempt.

Diphtheria, measles, and whooping-cough exist in small
numbers only, from places reported.

Bronchitis and pneumonia, as was to have been expected,
were increasing in number and fatality, but to no unusual
degree.

Miiar's TMe. 7»

The number of deaths recorded in the different towns and
cities from which returns have been received was 380^ Under
five years of age, Jo6. Deaths from consumption, 43. The
towns making returns represent an estimated population of
268,540. The annual death-rate upon the estimate given is
16.2 in every 1000 of the population.

Investigation of infectious diseases of domestic animals was
made on thirteen different days. Eight horses were destroyed
because of having glanders.

Tennessee.— Official Bulletin reports for the month of No-
vember the principal diseases named in the order of their
greater prevalence : Malarial-fever, catarrhal troubles, pneu-
monia, consumption, bronchitis, tonsillitis, and rheumatism.

In the chief cities the respective annual death-rates for the
month per iocx> of population are reported as follows :

Chattanooga,

white

t, 8.00 ; c

olore

d, 18.40 :

11.40

Clarksville,

4.80;

12.00 :

7.50

Columbia,

12.00 ;

.00 :

7.20

Knoxville,

9.20;

11.45 :

9.66

Memphis,

16.41 ;

31-99 •

: 21.94

Nashville,

15.48;

20.58 :

: 17.29

Virginia. — Richmond^ 100,000 : Reports for November 171
deaths, of which 48 were under five years of age. Annual
death-rate per 1000, 20.52. From zymotic diseases there were
22 deaths, and from consumption, 21.

Wisconsin. — Milwaukee^ 195,000 : Reports for the month
of November 225 deaths, of which 54 were under five years of
age. Annual death-rate per 1000, 13.8. From zymotic dis-
eases there were 38 deaths, and from consumption, 18.

Canada. — Montreal health report for the year 1887, by Dr.
Louis Laberge, Medical Health Officer, exhibits an example
of executive skill, conciseness, and lucidity of sanitary service
and statistical results, by which the health officers of many
cities of the United States would do well to profit. Under
the head of

Relative Contagiousness of Different Diseases, " it will be
seen that diphtheria exhibits a greater tendency to spread
than the other diseases mentioned, with the exception of

80 Mitor's Table.

measles. In 72 per cent of the houses infected by this dis-
ease, only one occupant was attacked ; but in 16.72 per cent,
2 cases occurred ; in 6.64 per cent, 3 cases ; in 2.22 per cent,

4 cases ; in 1.18 per cent, 5 cases ; in 0.35 per cent, 7 cases,
and in o. 1 1 per cent, 9 cases.

"In 82.14 per cent of the houses in which diphtheritic
croup prevailed, only one occupant was affected ; in 14.28 per
cent, 2 cases occurred, and in 3.75 per cent, three members
of the same family contracted the disease.

'* One occupant in 76.92 per cent of the houses invaded by
scarlatina was affected; 2 in 15.38 per cent; 3 in 5.12 per
cent ; and 4 in 2.56 per cent,

•* Only one occupant in 93.96 per cent of the houses where
typhoid-fever occurred suffered from the disease ; 2 in 3.93
per cent ; 3 in 1.83 per cent ; and 4 in 0.26 per cent.

** With diphtheria, in its liability to spread, may be ranked
measles. In only 57.22 per cent of the houses where this dis-
ease existed one occupant was attacked; in 16. 11 percent,
2 ; in 13.77 per cent, 3 ; in 8.33 per cent, 4 ; in 5 per cent,

5 ; and in 0.55 per cent, 6."

Of the diseases here referred to, the number of cases re-
ported was as follows: Diphtheria (including 208 "croup"),
1448 ; scarlatina, 104 ; typhoid- fever, 413 ; measles, 341 ; vari-
cella, 7—2313.

Under an order of the council requiring enforcement of the
statute "which requires the production of a certificate of
vaccination in the case of children over three months of age,"
vaccinators were appointed, who proceeded to inspect, index,
and execute the work. There was not a case of small-pox in
the city during the year.

Upon the ist of July, 1887, the estimated population of
Montreal was 189,051 (exclusive of 6803 of a newly annexed
ward two months later) ; births, 8249 — 43.63 per 1000 of popu-
lation ; marriages, 1984 — 10.46 per 1000 ; deaths, 5286 — 27.96
per 1000 ; 58.81 per cent of the entire mortality was of children
under five years of age. From zymotic diseases, 31.08 per
cent ; from consumption, 8.08 per cent.

Deaths during the month of November, 427. Under five
years of age, 234. From zymotic diseases, 151 — chiefly diph-
theria and croup, 121 ; typhoid-fever, 7. From consumption,
31. Annual death-rate, 27.10.

Ohituary. 81

Havana, 200,000 : Deaths during the month of November,
532. Under five years of age, 130. From yellow- fever, 42 ;
pernicious-fever, 10. Consumption, ill. Annual death-mte,

31-5-

Small-pox. — Deaths reported from this disease in foreign
cities, at the most recent dates, as follows : Four weeks end-
ing December 8th : Ostend, 7 ; Anvers, i ; Jemappes, 2 ;
Quaregnon, 6 ; Paris, 17 ; Havre, 4 ; Prague, 50 ; Trieste,
23 ; Lemberg, 4 ; Bucharest, 14 ; Warsaw, 27. During the
month of November : Marseilles, 16 ; Bordeaux, i ; Amiens, 34,

OBITUARY.

Edwin Miller Snow, A.M., M.D., of Providence, R. I.,
died on Saturday, December 22d, 1888. He was born in
Pomfret, Vt., May 8th, 1820 ; received academic education at
New Hampton, N. H.; collegiate education at Brown Univer-
sity, R. I., from which he graduated in 1845, ^^^ received his
degree of A.M. in 1848. He pursued his medical course at
the College of Physicians and Surgeons, New York, graduating
in 1849. Soon thereafter he began the practice of his profes-
sion in Holyolce, Mass., but removed to Providence, R. I.,
the following year. He was married in Providence, May 2d«
1850. During his practice in Holyoke in 1849, ^"^ ^^ Provi-
dence in 1854, he saw about 150 cases of cholera and became
much interested in the study of its causes, which laid the
foundation of his devotion to the study of preventive medi-
cine, to which he gave almost exclusive attention in the subse-
quent years of his life, contributing many useful reports and
papers to its promotion, particularly on vital and social statis-
tics. He was for many years Superintendent of Health of Prov-
idence, and more recently Registrar of Vital Statistics and up
to the time of his death. He was also, from time to time.
State Prison Inspector, Health Officer of Quarantine, Member
of the State Board of Charities and Correction, Chairman of
the Board of Cattle Commissioners, etc. In 1872 he was
State Delegate to the International Prison Congress in London,
and one of the United States official delegates to the Inter-
national Statistical Congress at St. Petersburg.
6

63 OMuary.

He was a member of the Rhode Island Medical Society, and
at different times secretary^ vice-president, and president ; of
the American Medical Association ; of the American Public
Health Association, vice-president and president ; American
Statistical Association, and other scientific bodies, in all of
which he was, as he also was in private life, and by aill who
knew him, highly esteemed for his quiet, unassuming life and
congenial fellowship.

Nathan Allen, A.M., M.D., LL.D., of Lowell, Mass., died
January ist, 1889. He was born in Princeton, Mass., April
25th, 1 81 3. He was a graduate of Amherst College in 1836, re-
ceived his M.D. from the Pennsylvania Medical College in 1841,
and his LL.D. from his Alma Mater in 1873. He settled in
Lowell in 1841, where he continued to reside up to the time
of his death. He became a member of the Massachusetts
Medical Society in 1842, and has since that time contributed
many papers and special reports to its proceedings on subjects
of local and professional interest. He was for many years
Member of the State Board of Charities and Correction ; State
Commissioner of Lunacy ; Examining Surgeon for Pensions,
etc. ; Member of the American Medical Association ; Ameri-
can Academy of Medicine ; American Public Health Associ-
ation, and a frequent contributor to their proceedings ; besides
writing many essays on social statistics, physiological, psycho-
logical, and sanitary subjects ; and only last year compiled a
volume of 350' octavo pages of his essays, with the title of
'' Physical Development, or the Laws Governing the Human
System.'' He was particularly devoted to the subject of
physical exercise, and among the foremost advocates of its
general introduction into educational institutions. As a
trustee of Amherst College he took special interest in the in*
troduction of physical education in that institution, and made
it the subject of several essays. Dr. Allen was, indeed, a pro-
fuse essayist, and all readers of The Sanitarian are more or
less familiar with the general trend of his writings. He was
married to Sarah H. Spaulding, daughter of Dr. Thaddeus
Spaulding, of Wakefield, Mass., in 1841, who died without
issue in 1856 ; and in 1858 to Annie W. Waters^ daughter of
Captain William C. Waters, of Salem, Mass., who survives
him with four children.

lAiera^y Notices. S8

LITERARY NOTICES.

The Prevention of Consumption : a Mode of Preven-
tion Founded on a New Theory of the Nature of the
Tubercular Bacillus. By C. Candler, Melbourne, Vic-
toria. 8vo, pp. 246. London : Kegan Paul, Trench & Co. ,
I Paternoster Square. The author of this work unequivocally
accepts the discovery of the tubercle bacillus of Koch, and
declares his conviction that consumption is due to it ; but he
rejects Koch's definition of the conditions and growth of the
bacillus. Koch's premises are that '' the tubercle bacillus can
grow only at the temperature of (the blood) 30^ to 41^ C, and
that in its process of development it is limited to the animal
body, and is, moreover, not an accidental, but a pure parasitic,
and can only originate in an animal organism. . . . That
this parasitic organism only finds conditions suitable for its
existence in the animal body, but cannot, as the bacillus
anthracis, outside of it, exist under ordinary natural condi-
tions.*'

These conclusions, the author of the work before us thinks,
were reached on insufficient grounds, are inconsistent with the
true botanical position of the tubercle bacillus, and therefore
untenable, which he proceeds to show, and with such success
as to justify the title of his book. And here it may be pre-
mised that Koch's discovery, as noted prefatorily, has been
practically useless, save in the matter of diagnosis ; whereas
if the conclusions of our author are as sound as they are
plausible, ** the prevention of ordinary pulmonary consump-
tion, at all events, is," as he remarks, '* well within the
domain of practical hygiene."

The pure parasitism of the tubercle bacillus seems to have
been inferred by Koch without critical examination of its
nature. In common with pathologists generally, in the prog-
ress of knowledge on pathophytes, having discovered the rela^
tion of this one to tubercle, he there rested, and drew his infer-
ence without undertaking to investigate its autonomy apart
from the relations in which he found it. This our author very

84 lAterwry Notices.

clearly points out, and proceeds to show the botanical rela-
tions of the tubercle bacillus under conditions favorable to its
existence in spores or otherwise under such a variety of cir-
cumstances as to leave little or no room for doubt that con-
sumption is almost invariably caused by the presence of the
bacillus in the air breathed — ^by a local bacilliary malaria —
*' from matrices external to the body."

The premises which lead to this conclusion are examined
with much care^ and authors on the relation of phthisis to
heredity and other conditions are cited in their verification.
The environment of consumptive families and heredity is given
its due position, and found to be in no way inconsistent with
this conclusion, but rather fortifies it ; pretty clearly demon-
strates that houses which have been occupied by consump-
tives— perhaps for generations — and so constructed or
neglected as to exclude an abundance of fresh air and sun-
shine, are no less likely to retain tubercle bacillus than the
bacilli of other diseases well known to be fostered by such
conditions.

The required conditions of the tubercle bacillus fostered by
certain occupations predisposing thereto, the predisposing re-
lations of debilitated persons, and the deprivation of light, are
also logically considered and shown to be consistent with the
nature of the bacillus as described by the author : all conduc-
ing to the practical bearing of the concluding and longest
chapter — that which gives title to the book.

We urgently commend the work to the medical profession^
and to sanitarians in particular, as one of the most important
contributions to preventive medicine recently published.

Medical Diagnosis : a Manual of Clinical Methods.
By J. Graham Brown, M.D., Fellow of the Royal College
of Physicians of Edinburgh, late Senior President of the Royal
Medical Society of Edinburgh. Second edition. Illustrated.
Eleventh volume of the Series of Medical Classics. 8vo, pp.
285. Cloth, $2.75. E. B. Treat, Publisher, 771 Broadway,
New York.

This work appears to be a thorough embodiment of the
labors of Dr. Brown, of Edinburgh, who has won a just celeb-
rity as one of the ablest of medical diagnosticians. The sub-

LUerary NcUce$. 85

ject is divided into eight chapters. First, the General Aspect,
and following this the several systems— circulatory, respir-
atory, int^umentary, etc. — taking up the leading symptoms
in each and tracing them in various diseases. The work is re-
markable for its completeness and clearness, and is a hand-
book of great utility to every medical practitioner.

Eating for Strength. By M. L. Holbrook, M.D.,
Professor of Hygiene in the New York Medical College and
Hospital for Women, Editor of the Herald of Healthy Author
of the '* Hygiene of the Brain," ** How to Strengthen the
Memory," " Parturition without Pain," etc. i2mo, pp. 236.
New York : M. L. Holbrook & Co.

This is a particularly useful little manual for vegetable, fruit,
and pastry feeders ; gives a fair representation of the physi-
ological requirements in a state of health ; a good summary
of alimentary products, and many good recipes, but makes
the popular mistake with regard to the nutritive value and
the proper mode of cooking rice, which, instead of being de-
fective as an article of diet, as here taught, is one of the most
valuable and useful of foods ; pound for pound, it is greatly
superior to potatoes, and is the chief food of some of the best
specimens of physical manhood in the world ; though the
author of the book before us suggests that " it is possible that
the small stature of many Hindoos, who live largely upon
rice, is owing to its lack in tissue-building material.'* He
thinks it well suited to invalids, but errs as greatly in his direc-
tions for preparing and eating it with cream and sugar or for
puddings as he does in his estimate of its nutritive value. He
would do well, on getting out a new edition, to refer to Pro-
fessor Atwater's " Chemistry and Nutrition of Foods," in last
year's Century^ and to Miss Parloa's " New Cook Book.

»*

Neurasthenia, by Landon Carter Gray, M.D., Pro-
fessor of Nervous and Mental Diseases in the New York Poly-
clinic, is a clear elucidation of the subject, a pamphlet reprint
from the New York Medical Journal,

Public Health Resorts vs. Institutions for thb
Treatment of Bacillary Phthisis, by Paul H. Kretz^

8^ Literary Notice$.

SCHMAR, M.D., Brooklyn, N. Y., a pamphlet reprint from
the Medical Register^ practically illustrates the superior bene-
fits of out-door air and recreation for consumptives over medi-
cation and hospital treatment.

Cataract Extractions, with only the Eye Operated
UPON Closed by Adhesive Strips ; and the Great Value of
an 0.25 D Cylinder in the Relief of Headache and Eye Pains.
By Julius J. Chisholm, M.D., Professor of Eye and Ear
Surgery in the University of Maryland, and Surgeon-in-Chief
of the Presbyterian Eye and Ear Charity Hospital of Balti-
more. Reprints from the Journal of the American Medical
Association. Two pamphlets of practical use to ophthalmol-
ogists.

Physical Culture. Price, ten cents, Philadelphia : A.
J. Reech & Co. A pamphlet of seventy-two pages» with
numerous illustrations of apparatus and how to use them in
exercises promotive of healthy development.

A Practical Treatise on Headache, Neuralgia,
Sleep, and its Derangements, and Spinal Irritation.
By J. Leonard Corning, M.A., M.D., Consultant in Ner-
vous Diseases to St. Francis Hospital ; Fellow of the New
York Academy of Medicine ; Member of the New York Neu-
rological Society, etc. Author of " A Treatise on Hysteria
and Epilepsy," " Local Anaesthesia," '' Brain Exhaustion,
with some Preliminary Considerations on Cerebral Dynamics,"
"Carotid Compression," "Brain Rest, being a Disquisition
on the Curative Properties of Prolonged Sleep," etc. Price,
$2.75. New York : E. B. Treat.

This is a practical work of much importance, replete with
suggestions deduced from an unusually large field of personal
observations and a thorough knowledge of the subjects treated
of ; of interest to all medical practitioners. To the impor-
tance of the subject the author adds a lucidity and force of ex*
pression well calculated to awaken thought, as well as to
impart information.

The Canadian Practitioner has made a new departure
significant of the success which has been the reward of its gen-
eral excellence in matter, management, and make up, as

Literary Nai%oe$. Vt

among the foremost representatives of medical progress, and
particularly in the Dominion. Beginning with the new year,
it will hereafter be published semi-monthly instead of monthly,
as hitherto, but at the same price, $3 per annum in advance.
Toronto, Can. : J. E. Bryant & Company.

Calendars for the year appear in great variety and of vari-
ous degrees of beauty and utility. Among the most beautiful
is the issue by the Smith & Anthony Stove Company, of
Boston, manufacturers of the celebrated Hub ranges. It is
in six sheets, tied together by a ribbon, each sheet being a
fac-simile of a delicate water-color drawing, by Miss L. B.
Humphrey, of Boston, and made especially for this purpose.

The designs consist of six charming sketches of child life,
drawn in Miss Humphrey's happiedt way, together with deli-
cate landscape scenes, and which are simply exquisite in color-
ing and treatment.

The set of six sheets can be had by sending 25 cents in
stamps or currency to the above address. Our readers will be
fortunate if they secure a set of these art gems.

The most useful \s " The Don't Forget //," by E. B. Treaty
Publisher, 771 Broadway, New York : a monthly turn-table
of every day in each month, with sufficient space for recording
matters to be attended to on time according to previous ap-
pointment ; besides which it has marginal readings of special
interest to physicians.

The Medical Bulletin Visiting List possesses some
advantages not common to other visiting lists, by which it is
rendered much less bulky for the same amount of useful
memoranda than any other which has fallen under our notice.
For example, instead of a whole page for each weekly record
of the month, after the first week the pages are clipped longi-
tudinally, retaining the head-line figures of the days of the
week only, has a column for ledger page, and is adapted to
continuance till full without regard to time of beginning or
ending. For 70 patients. Monthly or Weekly, $1.40 ; for 105,
$1.50. Philadelphia : F. A. Davis.

Grimshaw's Boiler Catechism is the title of one of those
practical books for practical men which should find a conveni-

88 LUerwry Notieei.

ent place for reference among all those who have anything to
do with boilers. The many questions relating to the construc-
tion, placing, or management of boilers are herein appropri-
ately and concisely answered, and with numerous data and
tables all carefully arranged and conveniently indexed. The
book presents a ready means for the uneducated to obtain
necessary information, and offers a handy reminder to those
who have forgotten their acquired knowledge. Price, $2.
New York : Practical Publishing Company, 21 Park Row.

Inebriate Asylums and their Work. By T. D.
Crothers, M.D., Superintendent of Walnut Lodge, Hart-
ford, Ct. ; Editor of the Journal of Inebriety ; Secretary of
the American Association for the Cure of Inebriates, etc. A
lecture delivered before the Young Men's Christian Associa-
tion at Toronto, Canada, October 2d, 1888.

Report of a Case of Laparotomy with Exsection of
A Portion of the Ilium ; and the Description of a novel
Operation for the Cure of Urethra-Rectal Fistula. By JOHN
A. Wyeth, M.D., Professor of Surgery in the New York Poly-
clinic ; Visiting Surgeon to the Mt. Sinai Hospital, etc.

Mineral and Thermal Springs of California. By
W. F. McNuTT, M.D., M.R.C.S., Ect L.R.C.P., etc., San
Francisco. Pamphlet reprint from ** Transactions of the
Ninth International Congress.

f »

The Preferable Climate for Phthisis. By Charles
Denison, A.m., M.D., Professor of Diseases of the Chest and
Climatology, Medical Department of the University of Den-
ver ; author of ** The Rocky Mountain Health Resorts," etc.
Pamphlet reprinted from the " Transactions of the Ninth In-
ternational Medical Congress.'* A cogent statement of the
advantages of altitude, dryness, coolness, sunshine and vari-
ability for the prevention and cure of phthisis.

Failure of Dr. J. B. Thomas's Treatment of Ure-
thral Stricture by Electrolysis. By Robert Newman,
M.D., New York. Pamphlet reprint from the Journal of the
American Medical Association.

Msdical Mau&rpt. 89

MEDICAL EXCERPT.

Climatic Treatment of Pulmonary Tuberculosis. —
Dr. Knight, of Boston, in the Medical News of November
24th, gives the results of his considerable personal experience.
High altitudes (4000 to 6500 feet above sea level) he believes
to be indicated ; in subjects presenting the earliest physical
signs of tuberculosis of the apex, who have as yet shown little,
if any, general disturbance from the disease, and who com-
plain only of morning cough and expectoration ; those with
more advanced disease, showing some consolidation, but no
excavation, nor any serious constitutional disturbance ; hem-
orrhagic cases without marked febrile reaction, or much phys-
ical evidence of disease ; convalescents from acute pleurisy
or pneumonia, in whom the eruption of tubercle is dreaded ;
patients in whom the tubercular process has seriously invaded
the larynx, provided they can have the benefit of good local
treatment.

High altitudes are contra-indicated ; for patients over fifty
years of age ; those of neurotic temperament ; in advanced
disease, with cavities or severe hectic symptoms (the existence
of a small cavity, in a case in which the disease had become
quiescent, would not contra-indicate high altitude) ; patients
in an acute condition ; case? of so-called fibroid phthisis or
interstitial pneumonia in patients over fifty, or with dilated
heart, or great bronchial irritation, producing harassing cough ;
those with cardiac dilatation or disease of the large blood-
vessels, and in diabetics.

The True Relations of Filth to Diphtheria.—

" Diphtheria is a contagious disease. There is probably no
spontaneous origin of diphtheria, any more than there is a
spontaneous origin of cholera or scarlatina. When an attack
of diphtheria has made its appearance, it is well enough to ex-
amine the hygienic condition of the house, with its deterio*
rating influences on the general health of the inmates^ and to look
after the source of the case in the persons of friends, attend-
ants, and help."

90 MeduHd JSecerpt.

In my " Remarks on the Nature and Treatment of Diph-
theria/' made by invitation before the Section of Diseases of
Children of the British Medical Association, August, 1888
{British Medical JaurnaL, September 22d, 1888), there are
found the following sentences : ** Foul air and sewer-gas do
not create diphtheria; they do create dysentery and typhoid,
or such a condition of general ill-health and malaise as to
afford the diphtheritic virus a ready resting-place. There
were plenty of malodorous privies and foul smells fifty years
ago, but no epidemic of diphtheria. Besides, and mainly
through the careful observations of English physicians, such
as are contained in Dr. George Turner's report on diphtheria
in lower animals and many others, the sources from which
diphtheria may come are very many. Pigeons, fowls, turkeys,
chickens, pheasants, cats, horses, sheep, cows, are just as
many sources of diphtheria for man. Foods of all kinds, vege-
tables and milk, will transmit it. It sticks to furniture, floors,
and wall-paper, railroad cushions and school desks. No spon-
taneous generation is required to explain its ravages." — A.
Jacobin M.D.y Archives of Pediatrics.

Alimentary Regim£n for the Gouty. — Gouty patients
may eat all kinds of meat, especially white meats. Use in
moderation, eggs, fish, moUusks, crustaceans, and fatty foods.
Vegetables should constitute a large part of their diet, ex-
cepting gooseberiies and spinach, which contain large propor-
tions of oxalic acid. Use with care, nourishing nitrogenous
vegetables, such as cabbage and cauliflower ; starchy grains,
such as peas, beans, and lentils. For bread, potatoes should
be substituted. Fruits are all admissible, and raisins may
mitigate the condition of the feet. As a beverage, water, and
particularly water which is slightly alkaline, to dilute light
Bordeaux wines and slightly alcoholic white wines. No cham-
pagne, gaseous water, strong beer, or alcoholic beverages are
allowed. Coffee should be drunk very weak. No tea is
allowed, as it contains a large proportion of oxalic acid. The
bowels should be kept in proper condition by the use of min-
eral purgatives. The stomach should be emptied every two
hours. Lotions of the body, massage, and exercise in all
forms are advised. — Dujardin-Beaumetz in Revue Internationale
des Sciences Medicales.

Mediicdl Maoeerpi* 91

Cigarette Smoking.— Professor Dudley {Medical News)
rejects the popularly held opinion that the baneful effect of
cigarette smoking is due to the adulteration of the tobacco
with noxious drugs, and by experiments on mice shows con-
clusively that the toxic agent is carbonic monoxide, which,
however, results alike from the combustion of tobacco, whether
consumed in cigarette, pipe, or cigar.

A spectroscopic examination of the blood of three mice*
dying after a very brief exposure to an atmosphere of cigarette
smoke, showed an entire conversion of oxyhemoglobin into
carb-oxy-hemoglobin, the cause of death being CO poisoning.
As is well known, CO is exceedingly poisonous, and in contact
with blood converts the life-supporting oxyhemoglobin into
the lethal carb-oxy-hemoglobin, a non- oxygen-carrying com-
pound, difficult of oxidation, which may cause death by suffoca-
tion, although there may be free entry of pure air into the lungs.

Cigarette smoking is only more harmful than cigar or pipe
smoking because those addicted to the first habitually inhale
the smoke, drawing into the greatest depth of the lungs the
poisonous CO, the result of the combustion of the tobacco.

[A consideration of Dr. Dudley's experiments suggests that
a wide difference exists between the effects of tobacco smoked
and chewed, and that if the latter habit is filthier it is far less
harmful. It is to be regretted that the evil resulting from
smoking is not limited to the consumer of tobacco, but must
extend to those who are unfortunate enough to be in the
smoker's proximity. Patients should be cautioned against
remaining in unventilated apartments in which smoking is
going on, for the air in such places must soon become vitiated
by the noxious CO. The ill effects of an atmosphere of
tobacco smoke on young children and delicate females is thus
explained.] — The Polyclinic.

Effects of Lanolin on Micro-organisms. — The results
of Gottstein's experiments on this subject are thus given in
the Deutsche Medical Zeitung^ Berlin : (i) The bacteria which
effect a spontaneous decomposition of glycerine fats belong
presumably to the class of anaerobes ; a number of afe'robe
germs (even the putrefactive) perish on a medium containing
fat. But the term of continuance of this retrogressive meta-

93 Medical JEaeerpi.

morphosis is decided by the proportion of fat to the other
ingredients of the nutritive medium. (2) Free fat contains
anaerobes for some days after it is exposed ; but lanolin has
under similar circumstances neither aerobe nor anaerobe germs,
(3) Glycerine fats may be so impregnated with bacteria that
the latter can pass through the fat to the lower-lying infectible
substances, while lanolin cannot be permeated by bacteria.
It acts, therefore, as a preventive of decomposition when laid
over infectible substances. — British Medical Journal.

** Matzoon.** — This is the name given to a fermented milk
food largely used in Armenia and the adjacent countries. For
some reason it does not seem to be used as a food to any ex-
tent elsewhere. We have been unable to purchase it in Great
Britain, Germany, France, or Switzerland, yet it is made in
New York City, but as far as we can learn there is only one
producer there who supplies the States. Its use appears to
be largely confined to the Oriental countries. The average
makers there, like our bread-bakers here, only know that if
" Matzoon/' which is to them what our yeast is to the bakers,
is placed in warm cow's milk and kept at the temperature of
the hand for a few hours more " Matzoon" will be produced.

We learned by making four cultures from ** Matzoon," that
the ferment is Pcnicillium Glaucum. By placing a small colony
of these hyphomycetes in two ounces of warm milk, kept at a
temperature of the living body for twenty-four hours, we had
a pure " Matzoon*' produced. By placing one tablespoonful
of this into a quart of warm milk kept at about 100^ F. for
eight hours, we had the entire mass transformed into a semi-
liquid condition ; at this stage it must be placed and kept in a
cool medium to prevent further fermentation. Unlike
" koumys,*' it is almost free from carbon-dioxide, which fact
permits of its use in cases of indigestion that are associated
with weak hearts. We have found it tolerated by patients
suffering from gastro-intestinal catarrh when no food other
than the liquid meat foods were borne. Some children can
digest ** Matzoon" when cow's milk is rejected. — Professor
Samuel G. Dixon^ M.D.^ University Medical Magazine,

Salol in Dysentery is the subject of a communication to
the Medical Brief by R. B. McCall, M.D., of Georgetown,

JIMical Heoerpt. 93

OhiOy reporting cases in which he used the remedx with such
success as to warrant its further trial. Of an extreme case he
reports :

** In all my experience I never saw the efficiency of a medi-
cine so unmistakably portrayed by characteristic results, the
effects following close in the wake of the cause. Dose for first
two days was two grains every three hours, increased to three
grains, and continued at that as the maximum for three days
longer ; after which it was given for five days longer in dimin-
ishing quantities till left off.

" In about ten days nearly two hundred grains were taken,
by a child five years old, and that without the least sign of
oppression, disturbance of any kind of stomach, heart, or kid*
neys, or of brain or mind. I believe salol is perfectly safe to
be used in suitable doses at any age, and am persuaded from
the above case and from a little experience in summer diar-
riiceas, wherein its influence was unquestionably kindly and
effective, that it is destined to be a valuable agent.

" I am desirous to give it a trial in one of those cases of
infants under two years of age where the almost countless
stools, distressing and agonizing tenesmus, uncontrollable rest-
lessness, insatiable thirst, rapid emaciation, profound debility,
and early supervening coma, have well-nigh invariably been
followed by dissolution."

SULPHONAL, the now fashionable hypnotic, is the subject
of very varied professional opinion. Some extol it, others
condemn it. The truth probably lies, as usually happens,
between the extreme statements. Sulphonal has a clearly
defined usefulness, and belongs not so much to the class of
narcotic agents, which produce sleep by stupefaction, as to
the remedies which assist the natural periodical desire for
sleep. The new drug is, however, by no means so harmless
as has been hitherto asserted by its manufacturers. Dr.
Bornemann has just reported a case of severe poisoning result-
ing from the administration of the drug. The patient, to
whom sulphonal was given for insomnia caused by cerebral
excitement, was a physician. The result was a pronounced
intoxication showing very complicated symptoms. There was
a distinct interference of co-ordination, first in the lower and

94 Jledioal EaooerpL

later in the upper extremities. He could not, for instance,
raise a cup of coffee. A very prominent feature of the poison-
ing was his perverted feelings and illusions. The patient
believed he had two heads, four feet and arms, etc.; or he
believed he was on a boat or in a railway car, and that some
one was about to kill him. These illusions may be termed
reflectory. The ataxia referred to is a central one, as it re-
mained unchanged no matter whether the eyes were opened
or closed. This distinction between central and sensory ataxia
has been made by Professor Mendel. The drug did not exert
any unfavorable influence over the heart and circulation, which
appears opposed to the warning of Dr. Schmey not to use
sulphonal in angina pectoris and arterio-schlerosis. — Berlin
Letter y Medical and Surgical Reporter ^ December 22^, i888.

Camphorated Naphthol. — As is well known, crystallized
carbolic acid liquefies when mixed with an equal weight of
camphor, and this property has been made use of in obtaining
a liquid which may be used as a painless cautery. According
to M. Desesquelle {Archives de P/iarnuuie^ September sth,
1888), both alpha and beta-naphthol possess similar properties ;
a mixture of ten parts of beta-naphthol and twenty parts
camphor produces a syrupy, colorless liquid, which is insoluble
in water but miscible in all proportions with fixed oils. In
order that liquefaction be rapidly produced, it is essential that
the substances first be finely powdered. An interesting ques-
tion arises whether naphthol in these conditions preserves its
antiseptic properties, or whether they are modified in some
way, as is the case with carbolic acid. Experiment only can
answer this question, and if the reply be affirmative it is highly
desirable that the mixture be subjected to study, since the
antiseptic power of the former is more marked, and, as has
been determined by Bouchard, its toxic properties are less
than a similar mixture of carbolic acid and camphor. — Thera-
peutic Gazette.

Comparative Efficacy of Antiseptics. — Dr. G. Riedlin
has made experiments to determine the comparative efficacy
of certain agents reputed to be antiseptics, regarding their
power to destroy, or prevent the development of bacteria in
culture-gelatin. Though the conclusions to be derived from

Medical JEsoe&rpt. 96

this series of experiments may not be altogether transferable
or applicable to all other methods of antisepsis, yet they are
of value so far as they show the penetrating power of the vari-
ous agents.

1. Iodoform. This behaves toward the several bacteria either
as an almost indifferent powder, or as a feeble antiseptic.
Toward cholera bacilli, however, it acts as a powerful anti-
septic ; its vapors alone are sufficient to prevent their develop-
ment in a ID per cent culture-gelatin down to a depth of about
ID millimeters.

2. Oil of Turpentine. In a i per cent solution^ this acts as a
powerful preventive of bacterial development. Addition of
I part of oil of turpentine to 200 parts of culture-gelatin
renders the latter sterile. But a i per cent emulsion of the oil
is insufficient to kill the bacillus anthracis. When poured
upon gelatin, the oil penetrates to a depth of about 10 mm.,
and thus far renders it sterile.

3. Oils of Lavender^ Eucalyptus^ and Rosemary are the best
antiseptics among other essential oils, particularly when used
undiluted. The two first-named penetrate culture-gelatin to
a depth of 10, the latter to 15 millimeters.

4. Next after these oils comes oi/ of doves. Others, such as
the oils of thyme, fennel, peppermint, anise, juniper, and
camphor are of little account as antiseptics.

5. lodoi has proved to be inert and indifferent toward bacteria.

6. Balsam of Peru is a rather powerful antiseptic, being
especially destructive to the cholera bacillus. It penetrates
culture-gelatin to a depth of about 8 mm.

7. Sulphichthyolate of Sodium^ in 5 per cent aqueous solution,,
is a very feeble antiseptic.

8. Aniline^ best in saturated aqueous solution, is a most
prompt antiseptic. A ten per cent culture-gelatin prepared
with one fifth of solution of aniline is incapable of propagating
bacteria. — Centralbl. f. Ther.

Disinfection of the Hands. — Dr. Mugnai states that
for perfect disinfection of the hands more or less time is re-
quired according whether they have previously been disin-
fected or not. In the latter case it is sufficient to brush them
in a two and one half per cent solution of carbolic acid ; in the

96 Medical Exeerpt.

former case they should be washed for one and a half minutes
in a one per cent solution of sublimate and immersed for the
same length of time in this solution.

Plait's Chlorides is an odorless, colorless, saturated solu-
tion of those chloride salts which have proven most reliable
and acceptable as deodorants, disinfectants, and antiseptics, is
at once clean, powerful, and stainless (contains no mercury),
and is especially designed for the hygienic uses of the physi-
cian and the practical domestic uses of the housekeeper. Its
sanitary value as a purifier of the sick-room and its worth as a
general disinfectant for the household have been fully demon-
strated for the past seven years, and it now proudly claims the
indorsement of over sixteen thousand practising physicians,
among whom are the most eminent in both schools of medi-
cine.— Medical Bulletin.

A Warning to Anaesthetists. — ^The announcement that
the anaesthetist in a fatal case of chloroform narcosis, at
Sydney, has been found guilty and sentenced to pay two hun-
dred pounds damages, on the ground that the anaesthetic had
been improperly administered, comes with rather a startling
effect. While no conscientious man, be he lay or medical,
will dispute the justice of such a verdict when negligence is
clearly proved, difficulties arise when such matters are adjudi-
cated upon by a jury of persons who, whatever their intelli-
gence, are profoundly ignorant of what constitutes negligence
in this respect. It would be but a step further for juries to
enforce an opinion which has been gaining ground as to the
inadvisability of giving chloroform at all unless specially indi-
cated. Still, this is a matter well within the discretion of the
medical man, and it would be impolitic, as well as unjust, to
fetter the exercise of that discretion by a fear of legal conse-
quences. Short of negligence amounting to a criminal act,
we cannot conceive of such a verdict in this country, and we
sincerely hope that the example will not be the means of
imposing an additional horror to the life of medical men, who
have quite enough to attend to in guarding themselves against
vexatious actions for having signed lunacy certificates, and in
avoiding the wiles of designing women with an eye to black-
mail.— Medical Press and Circular^ October 2^h^ 1888.

r

THE SANITARIAN

FEBRUARY, 1889.

Number 231.

PROBLEMS IN REGARD TO YELLOVV-FEVER AND
THE PREVENTION OF YELLOW-FEVER EPI-
DEMICS.*

By Jerome Cochran, M.D., State Health Officer of Alabama.

In the practical application of sanitary science, the question
of questions in all our Southern communities is that which
concerns the management of yellow-fever and the prevention
of yellow-fever epidemics. The natural habitat of this disease
is in the West India Islands, which are in constant communi-
cation with our gulf and Atlantic ports ; and these again are
in constant communication with all the cities and towns of our
Southern States. The railroads, with locomotives running
from twenty to forty miles an hour, have virtually abolished
distances, and brought the whole interior of the country down
to the shores of the sea.

Up to the present time yellow-fever has never gained a per-
manent footing in any part of the United States — has never
become naturalized among us ; but we are now confronted
with the danger that it may by possibility find an abiding
domicile in the more southerly portions of Florida — that is to
say, in that part of the State of Florida below the frost line.
Last winter it hibernated as far north as Tampa and Plant
City, but last winter was exceedingly mild in Florida, and
furnishes the first instance of hibernation that has occurred in
the epidemic history of the State. In Jacksonville the winters
are always cold enough to eradicate yellow-fever. If we have,
this coming winter, an average amount of frost and cold in
Florida, I am of the opinion that there is not likely to be any

*Read before the American Public Health Association, Milwaukee, Wis.,
November 22, 1888.

7

98 Problema in Regard to YeUow-Fever.

hibernation of the disease in any of the places where it has
prevailed this summer, unless it may be in the small towns on
the Manatee River ; and even in these small towns the chances
are even that it will die out for want of material. In a large
majority of epidemics that have visited Key West, where frost
was never known to show itself, the fever has disappeared in
the month of August ; and it has never been known to hiber-
nate there.

Yellow-fever is certainly infectious, and the specific poison
that causes it — a poison as specific as atropia or hydrocyanic
acid — can be transported from place to place in the ordinary
vehicles of travel and traffic, in the bodies and baggage of
men and women. This specific poison is undoubtedly con-
nected in some way with the presence of. some living organ-
ism, some bacterium, some microbe, some living disease-germ
of some sort, and probably belongs to the class of chemical
substances known as ptomaines. As yet neither the poisonous
ptomaine nor the living organism which generates it has been
demonstrated ; and so there are many unsolved problems con-
nected with the etiology of the disease. A few of these I will
briefly indicate :

(i) Does the pathogenic organism multiply its generations
within the human body, or outside of it ? or does it find con-
ditions favorable to its growth and multiplication, both in the
body of the patient and in the patient's environment ? Its
multiplication within the body of the patient has been denied,
but 1 think not with sufficient reason. If the organism is not
itself active within the body of the sick person, I know of no
clue to the explanation of some of the facts connected with the
propagation of epidemics. In the mean time its growth in the
environment seems hardly to admit of question. Upon no
other hypothesis can we explain the infection of localities.

(2) How does the specific cause of the disease find its way
into the body of the patient ? Is it absorbed through the
skin ? Hardly, I should think. Does it find its way through
the pulmonary vesicles in the act of respiration ? I know of
no facts which favor this presumption. On the contrary, both
the pulmonary vesicles and the expired air are singularly free
from the presence of germs of any sort. Only one other
avenue is left open for its introduction — the alimentary mu-

Proilema in Regard to YeUow-Fever. 99

cous membrane. In support of this doctrine, also, the paucity
of facts is remarkable. In all the literature on the subject,
so far as it is known to me, nothing is recorded to connect its
introduction with the alimentary ingesta — with any sort of
food or drink. Can it be that the germs first find lodgment,
in the act of respiration, in the mucous membrane of the mouth
and phar)mx, to be subsequently swallowed along with what
we eat and drink ? It must get into the system in some of
these ways, and it seems to me that the probabilities are most
favorable to the one last mentioned. But in regard to this,
let it be remembered that for the present all is pure specula-
tion— mere guess-work, and nothing more.

(3) If the germ is generated within the body, how does it
find its way out so as to become an agent for the infection of
communities and localities ? Is it thrown off with the exhala-
tions of the skin ? with the sweat ? Or is it thrown off with
the expired air in the act of breathing ? Or is it eliminated
through the kidneys ? Or does it make its exit through the
great sewer of the intestines in company with the alvine ex-
cretions? We have absolutely no facts to* enable us to answer
these questions, but it would seem to be the more probable
supposition that it escapes from the body with the dejections
from the alimentary canal ; and, if this is the case, Parke was
right years ago when he called yellow-fever a fecal disease.

(4) In the production of the clinical phenomena of yellow-
fever, the poison permeates the entire system of the patient.
It causes marked nervous disturbance. It leads to fatty de-
generation of the liver and other organs and tissues. It at-
tacks the blood corpuscles so as to cause them to part with
their coloring materials. It develops acute desquamative
nephritis, with albuminuria and urinary suppression, and the
whole train of symptoms characteristic of what we ordinarily
call uraemic poisoning. All these pathological phenomena may
be ascribed, with great plausibility, to the action of the
hypothetical ptomaine, which would readily find its way into
the circulating blood, and so to all the tissues and organs of
the body.

(5) Of the germ itself, as already stated, we know nothing
in any positive and direct fashion. It has never been demon-
strated. No man has ever seen it with his eyes, or touched it

100 Problems in Regard to YeUow-Feoer.

with his fingers. The cryptococcus zantho genicus of Friere and
the peronospora lutea of Carmona are not real existences ; and
the germs of Finley and Gibier have not been shown to have
anything to do in the production of yellow-fever. It may be
accepted as tolerably certain that in yellow-fever no distinctive
organisms are to be found in the blood or in the tissues. This
seems to me to have been settled once for all by Sternberg's
Havana researches in 1879. ^^ ^^Y ^^ite, all those at present
engaged in this research have, by common consent, turned
their attention to the flora of the alimentary canal. Theoret-
ically, a microbe in the alimentary canal, generating a poison-
ous ptomaine, to be subsequently absorbed into the circula-
tion, would account for all the phenomena of the disease.

Fortunately it is not necessary that all these problems of ul-
timate pathology should be solved in order that we may frame
some rational scheme for the prevention of the spread of yel-
low-fever. A few of the leading facts, derived from observa-
tion of the habits of the disease, and attending its dissemina-
tion in time and space, I proceed to mention very briefly :

(i) Yellow- fever, .as already stated, is infectious, and is
propagated by the introduction into the human system of a
specific poison, or of a specific organism which generates a
specific poison, and which is transportable from place to place.
In an immense majority of recorded epidemics the outbreak
of the disease is in traceable connection with the introduction
into the stricken community of some person from a place al-
ready infected, who has the fever at the time of his coming or
within a few days thereafter. In a much smaller number of
instances it is traceable to the introduction of baggage, cloth-
ing, or bedding, brought from some infected place, and which
has been used about some one who had the fever. Other
agents and vehicles of infection are so infrequently the causes
of epidemics as not to require any special mention here.
. (2) While the disease spreads from the patient, it is not,
perhaps, at all, and certainly not to any considerable extent,
contagious from person to person, like small-pox. In its
transmission it is probably somewhat analogous to typhoid-
fever and cholera. It seems to take root in the locality — in
the soil, as it were — and to be contracted from the environ-
ment of the patient rather than from the patient himself ; and

Problems in Regard to TeUow-Fever, 101

the locality remains infected after the patient has been re-
moved— remains infected for weeks, and even months.

(3) But yellow-fever does not always spread on the intro-
duction of an exotic case. On the contrary, it is the rule, in
the large majority of instances, that one or two cases occurring
in a community may fail to establish an epidemic. A thou-
sand sparks may fall on the roof of a house, but perhaps only
one of them kindles into flame and causes a conflagration.
Doctors and nurses are frequently exposed for a long time
before they take the fever ; and very often they pass through
an epidemic, and even through several epidemics, without
contracting the fever. The great factor in the dissemination
of the fever is human intercourse. It is known that scarlet-
fever and diphtheria can be carried from place to place by cats
and dogs, and I know of no reason why the poison of yellow-
fever cannot be carried in the same way. Yellow-fever is not
disseminated ordinarily to any large extent by atmospheric
currents. Ordinarily, it will not cross a street unless somebody
carries it across. Ordinarily, it will not surmount a wall
twenty feet high. It is usually not very dangerous to walk
the streets of an infected city in the daytime. The danger is
greater at night.

(4) The golden rule of prophylaxis in yellow-fever is non-
intercourse — non-intercourse with infected places, non-inter-
course with infected persons, and non-intercourse with infect-
ed things. If you keep away from the fire, you won't get
burned, and it is not necessary to keep very far away either.
The instances are very numerous in which prisons, jails, and
cloistered convents, in the very midst of epidemics, have
escaped infection. The instances are also numerous in which,
in the midst of epidemics, private residences have in like man-
ner, by the observance of strict isolation, escaped infection.
These facts are of the utmost importance, and should be gen-
erally known and generally acted upon when yellow-fever is
on its travels.

(5) It seems reasonable to believe that in infected places all
persons who are at all exposed must receive into their bodies
some portion, larger or smaller, of the poisonous ptomaine
which generates the disease, or some number, more or less, of
the specific germs which generate the ptomaine. But all who

102 Problems in Regard to YeUow-Feoer.

are so exposed do not take the fever. In other words, the
question of dose seems to be, in this case, as in other cases, a
consideration not to be overlooked. Some of those exposed
suffer no ill consequences whatever. Others suffer more or
less malaise for longer or shorter times, but escape any decided
attack of the fever. Others have the fever in mild form, and
readily recover. Others, still, have it in every grade of in-
creasing severity up to those malignant explosions that cause
death in a few hours. It seems to me fair to conclude that
these varying results are due to the interaction of two factors
— differences in the quantity of the poison received, and differ-
ences in the power of resistance to the influence of the poison
possessed by the several classes of persons mentioned.

(6) As to differences of susceptibility, there can be no ques-
tion about that. Whites are far more susceptible than blacks.
Men are more susceptible than women. Adults are more
susceptible than children. Besides these broad distinctions,
there are others not so manifest, but I think equally certain.
Among the whites, those with dark hair and skin and with
what is sometimes called the bilious temperament are less sus-
ceptible than those with light hair and fair skin and the san-
guine temperament ; and the same individual is more suscepti-
ble at some times than at other times.

(7) For the purposes of the sanitarian, the length of the
period of incubation is a consideration of importance, as upon
this depends the rational period of detention of persons in
quarantine. Our information in regard to this question is not
so precise as we could wish it to be. It is commonly assumed
that the solution of this question depends on the ascertained
facts in cases where yellow-fever occurs after a single exposure.
In such cases as these, so far as I have been able to find out,
the period of incubation is frequently only one or two days,
and is rarely more than five days. Refugees who have yellow-
fever at all usually have it within five days after leaving the
infected locality ; but I am not at all sure that the same rule
always obtains in the infected locality. Here doubtless the
poison is passing into the system from day to day, and at the
same time passing out of the system from day to day. If the
elimination of the poison keeps pace with the introduction of
it, the man does not have yellow-fever at all ; but if the pro-

Problems in Regard to Yellow-JFever. 103

cess of elimination is defective, the poison accumulates until
at last the resistance is overcome, and the febrile explosion
follows.

(8) I cannot dwell on the question of diagnosis, although it
is practically one of the utmost importance. If the case is
severe, with yellow discoloration, suppression of urine, black
vomit, and death, no physician of reasonable knowledge ought
to have any difficulty in saying that it is yellow- fever. But
suppose the case is a mild one, without discoloration, without
suppression, without black vomit, and without a fatal termina-
tion : how is the diagnosis to be made then ? Even in such
cases the expert finds but little difficulty. He recognizes his
old acquaintance under all sorts of disguises. There is the
three days of the initial fever, continued or quasi continued.
There is the want of parallelism between the pulse and the
temperature, which is usually observable to some extent even
in mild cases ; but the most certain diagnostic in this class of
cases is the presence, to some extent, of albumen in the urine
on the third or fourth day, usually on the third.

But all the problems so far suggested are preliminary to the
great practical question of the prevention of the spread of yel-
low-fever, which may be discussed under three different heads :
(i) To prevent the introduction among us of yellow-fever
across the sea from foreign countries. (2) To prevent the
transmission of yellow-fever from one part of our own country
to another by land. (3) To prevent the spread of yellow-fever
in our towns and cities after the outbreak of a few cases.

(i) The methods of maritime quarantine in this country may
now be considered as definitely settled. They include the in-
spection of ships at the port of departure and at the port of
arrival, with such detention and disinfection as may seem ad-
visable. The larger number of our seaport quarantines are
little more than inspection stations. These are supplemented
by a sufficient number of thoroughly equipped refuge stations
to which infected vessels are sent for treatment, said inspec-
tion stations being under the management of the Marine-Hos-
pital Service. I take some special interest in these refuge
stations because they grew out of a recommendation made by
me to the National Board of Health in 1879. I" ^^^ mean
time a few of our large cities have well-equipped disinfecting

104 Problems in Regard to YMow-Feoer.

stations of their own, that at New Orleans being probably the
most complete and the most efficient in its appointments. I
think it may be fairly admitted that our maritime quarantine
affords us a considerable degree of protection ; and, fortu-
nately, an immense majority of the vessels that come to us from
infected ports are themselves free from infection. I should
say that nineteen out of twenty of all vessels from infected
ports are free from infection, and might be allowed pratique
without any preliminary detention or disinfection. However
this may be, and in spite of all possible quarantine diligence,
yellow-fever will sometimes find a lodgment in some of our
seaport cities. There is contraband of revenue, and there
must be contraband of quarantine. The appearance of yellow-
fever in one of our seaports is the signal and the warrant for
the imposition of quarantine by land.

(2) The difficulties attending the administration of sea quar-
antine are many and great ; but they are few and small indeed
when compared with the difficulties attending the administra-
tion of quarantine by land. Land quarantine virtually resolves
itself into the quarantine of the railroads ; but the railroads are
so numerous, they link together the towns and cities of the
country in such an intricate network of connecting and inter-
secting lines of travel, and the travel over them is so rapid
and continuous, flowing always, day and night, in never-ceas-
ing currents and counter-currents, that any adequate super-
vision of them becomes a matter of great perplexity and mag-
nitude. The principle that underlies the practice of railroad
quarantine among us is, that neither persons nor things shall
be allowed to leave the infected place. To this end the rail-
road trains, both passenger trains and freight trains, are pro-
hibited from stopping in or near the infected town, so that
nothing can be taken on that is tainted with suspicion ; and
inspectors are kept on the trains so that nothing from the
stricken community can be put off where it is not wanted —
neither goods nor persons. This system of railroad quarantine
is fundamentally correct, but in the administration of it the
most outrageous excesses: have been committed. The ex-
penditures have been often so heavy as to be very burdensome
to the corporations that have had to foot the bills ; and com-
merce and travel have been interfered with to an extent not

PrcMema in Regard to YeUow-Fever. 105

warranted by the imminence of the danger. The remedy for
these evils is not far to seek. The several States concerned
must place the administration of their quarantine laws in the
hands of yellow-fever experts, and must give to such yellow-
fever experts the power to overrule and supplement the work
of non-expert municipal authorities. I have merely glanced
at the subject of railroad quarantine, and must hasten on to
the principal subject of my paper.

(3) What I want specially to consider is the management of
yellow-fever in our towns and cities after the occurrence of a
single case, or of a few cases, so as to prevent its dissemination
generally through the community ; and in my judgment this
sort of work depends on principles I now proceed to formu-
late. I confine myself to towns and cities, because in sparsely
settled country neighborhoods yellow- fever shows very little
disposition to spread. It is urban and not rural.

(4) The extent and populousness of the town is an important
consideration. The problem is difficult in proportion to the
number of inhabitants, and in proportion as residences and
business houses are crowded together. In a small, sparsely
settled railroad town, where the houses are scattered about at
considerable distances one from another, the problem is sim-
ple. In a densely populated city it is a problem of great com-
plexity and difficulty.

(5) The golden rule of prophylaxis in yellow-fever is isolation
— non-intercourse — non-intercourse with infected places, non-
intercourse with infected persons, and non-intercourse with in-
fected things. Don't go near the fire and you won't get
burned. Non-intercourse can be enforced in a very simple,
very inexpensive, and very effective way. Let the people,
with one accord, by common consent, in the exercise of the
commonest sort of common-sense, keep away from the infected
houses and localities, and refuse to have anything to do with
infected persons or infected things. To do this so as to secure
absolute safety, it would be necessary for the members of every
family to shut themselves up in their own premises, and to
enforce a strict domiciliary quarantine against all the rest of
the world. But a reasonable degree of safety can be had with-
out resorting to quite such extreme measures.

(6) At the beginning of an outbreak the infection is re-

106 ProblemB in Rega/rd to TeUow-Fever.

stricted within very narrow limits — a single house, a block of
houses, a single city square ; and then it is necessary only to
avoid the infected place or places, and to keep at a respectful
distance the persons' and things that have been exposed to the
infection. Intercourse with other parts of the town is still
perfectly safe. And, indeed, at this time a certain amount of
intercourse with the infected region is also comparatively safe.
You may go into the infected region many times and not take
the fever. You may even nurse the sick for a long time with-
out taking the fever. But while all this is true, no communi-
cation with the infected region should be allowed beyond what
is strictly necessary. The pitcher that goes often to the well
is apt to be broken in the course of time.

(7) In small places it would hardly ever be necessary to put
guards around an infected house or an infected district. A
simple warning to the people should be sufficient. In more
populous communities guards may sometimes be desirable.

(8) But the sick must be taken care of — must have nurses
and doctors. What must be done with these ? The doctor
who spends but a little time with his patient is not likely to
carry the infection with him into other houses he may have
occasion to enter. Still, by possibility he may become a car-
rier of the infection, and his intercourse with other people
should be restrained according to circumstances. The nurse
has no need to leave the premises of the patient, and should
be kept under the strictest surveillance. When the area of in-
fection begins to extend and cases to multiply, arrangements
should be made for the isolation of nurses and of all other per-
sons engaged in taking care of the sick. Take a house within
the infected region, or near by, or as many houses as may be
needed, for this purpose. I cannot dilate on this ; only let it
never be forgotten that the most- active agents for the spread
of yellow-fever in any community are nurses and doctors and
other attendants upon the sick, when they are allowed to eat
and sleep in their own uninfected homes or boarding-houses ;
and in dealing with these attendants upon the sick, let it never
be forgotten that among all the agencies that have been in-
voked to prevent the spread of yellow-fever, non-intercourse is
the first in importance — is so decidedly first in importance that
all the others sink almost into insignificance.

ProUema in Regard to Ydlow-F&oer. 107

(9) The practice of disinfection is mostly based on hypo-
thetical grounds* But I think we have good reason to believe
that it does good. The agents most to be trusted are heat»
cold, the mercury bi-chloride, and sulphur fumigation. It is
not proven that the yellow-fever poison is connected in any
way with the excretions of the yellow- fever patient ; but I
think thealvine dejections and the urine should be disinfected
and disposed of just as we would the excreticms of typhoid-
fever.

(10) The probability that a few cases of yellow-fever will
spread into an epidemic depends very much on the latitude of
the place and the season of the year. It is very generally be-
lieved by those who have studied yellow-fever, that it requires
for its prevalence and dissemination a long-continued temper-
ature of not less than seventy degrees Fahrenheit. It takes
some time for yellow-fever to gain a footing anywhere and
under any circumstances. It cannot make any considerable
headway in less than two weeks, and often it requires a much
greater length of time. Yellow-fever in July or August is
much more to be dreaded than yellow-fever in September or

I October ; and quarantines may be still useful a hundred miles

I south of an infected town long after there ceases to be any

excuse for it a hundred miles north of said town.

(i i) When a few cases of yellow-fever occur in a city, the
general opinion is that depopulation is the surest way to pre-
vent it from expanding into epidemic dimensions. Take
away the fuel, and the fire will soon cease to burn. This plan
is plausible at first sight, and I do not question its efficacy.
But it is attended with so many incidental disadvantages that
it seems to me to be the most objectionable plan for general
adoption that has ever been devised. It is not very difficulty
indeed, to depopulate the infected district so long as it is re-
stricted within narrow limits ; and I believe that depopulation
of an infected district may often be the highest dictate of san-
itary wisdom. It would be quite possible, also, to depopulate
a small town of only a few hundred inhabitants, or perhaps
even a city of a few thousand inhabitants. But it would be
folly to attempt to depopulate a great city like New York or
New Orleans. But there is never any urgent need for the de-
population of small and sparsely settled villages. In them

108 ProbleriM in Rega/rd to TeUaw-Fever.

yellow-fever can be managed easily by other methods. And
just precisely in proportion as the population increases in num-
bers and density, just in that same proportion increase the
danger of the epidemic and the consequent desirability of de-
population, if that is to be accepted as the proper plan of man-
agement. In other words, the more we need the remedy, the
greater becomes the difficulty of using it.

(12) With us depopulation, so far as it is accomplished at
all, is accomplished only in one way — namely, by the wild and
reckless stampede of a demoralized and panic-stricken people.
Almost all who are able to go do so, and a great many who
are not able. The impecunious are left behind to the mercy
of the pestilenca and the charity of the compassionate. In
the mean time the depopulation is never complete. From one
third to one half of the people are obliged to stay at home,
because they are not able to pay the expenses involved in get-
ting away and living somewhere else. And this is not the
worst. These flying people spread panic wherever they go,
the panic being far more infectious than the fever ; and then
follows an epidemic of quarantines. The big towns quaran-
tine because they have so much at stake ; and the little towns
quarantine because they think they have as much right to be pro-
tected as their big neighbors. And such quarantines! — unlaw-
ful, extravagant, absurd, grotesque, foolish, cruel — in one word,
abominable beyond all that words have power to give expres-
sion to. If the history of them could be writtien, it would
fill up a goodly portion of that history of human folly which
Professor Porson proposed to write in five hundred volumes.

(13) Another agency in the management of epidemics needs
to be mentioned here — the agency of refugee camps. A priori
one would think they would serve a good purpose, but practi-
cally they have always been failures, and they must continue
to be failures. In the first place, it is next to impossible to
get a place for the establishment of a refugee camp. People
don't want refugee camps anywhere in the neighborhood of
their residences, and won't have them. In the second place,
when you succeed in establishing a camp, it accomplishes com-
paratively little because you cannot drive the people of the
infected town into it ; and I don't blame them for their re-
luctance. If you had the power of a Russian czar, by force

Fusible Metal. 109

of arms you might drive the people into the camp, but in no
other way.

(14) I have thus endeavored, in a very brief and imperfect
fashion, to indicate what we know of the natural history of
yellow-fever, and of the conditions which mark its propagation
in time and space. I have, also, in the same brief and imper-
fect fashion, indicated some of the evil consequences of our
present methods of managing yellow-fever epidemics. I need
not go further back than the history of this present year to
point the moral I have in mind. We have seen the people of
the entire South, wild with panic, flying recklessly from their
homes, and scattering consternation and dismay all over the
country. I suppose there is no other single consideration that
stands so much in the way of Southern development as this
spectre of yellow-fever which is always associated with our
sunny climate in the minds of the people who desire to settle
among us. How is all this to be changed ? There is but one
way. VVe must educate our people, our doctors, and even our
health officials, to a better appreciation of the true character
of the enemy we have to battle with. Let it be understood
that yellow-fever is not contagious from person to person as
small-pox is ; that in a majority of instances, when introduced
into our communities, it fails to spread at all ; that when it
does spread, it spreads at first very slowly, so that the threat- '
ened people always have plenty of time to await the progress
of events ; that if it becomes desirable for the people to leave
their homes, there will always be opportunities for them to
do so in a systematic and orderly way. In a word, we must
manage our yellow-fever epidemics in a common-sense, busi-
ness way. We must get rid of our panics, our stampedes, and
our shot-gun quarantines. The guardians of the public health
owe it to themselves and to the people they serve to effect
such a change in public opinion as will make it possible in the
future to avoid the follies which have convulsed and disgraced
the country in connection with our yellow-fever epidemics
during the last fifteen or twenty years.

Fusible Metal, which liquefies at the same temperature as
boiling water, is a compound of eight parts of bismuth, five of
lead, and three of tin.

110 Origin and Sou7'ces of Pathogenic Bacteria.

SOME OBSERVATIONS ON THE ORIGIN AND
SOURCES OF PATHOGENIC BACTERIA.*

By Theobald Smith, M.D.. of the Bureau of Animal Industry, Department of

Agriculture, Washington, D. C.

That all pathogenic micro-organisms have been derived at
some time in the past from those living in the soil, water, and
decomposing organic matter will be seriously questioned by
no one who has paid any attention to them. The marked
similarity in form and physiological characters of pathogenic
and harmless species strikingly confirms this view. Thus we
have several forms of bacilli which resemble those of Asiatic
cholera in most of the features which serve us as means of
differentiation. Typhoid-fever bacilli resemble ordinary forms
so closely that a diagnosis between them is rendered very diffi-
cult. Hog-cholera bacilli cannot be distinguished from many
putrefactive forms, excepting by their peculiar and fatal eflfect
upon experimental animals. Anthrax bacilli diHer so slightly
from the ubiquitous hay bacilli that Bilchner was at one time
led to try to transform one into the other, but without suc-
cess. Not much more than ten years ago Nageli saw no
necessity for separating the various bacteria into distinct
species. The morphological monotony which presented itself
under the microscope led him to say that " the same species
assumes in the course of generations forms unlike both mor-
phologically and physiologically, which in the course of years
and decades produce the souring of milk, the formation of
butyric acid in sauerkraut^ the gelatinification of wine, the
putrescence of albuminoids, the decomposition of urea, the
reddening of foods containing starch, typhoid, relapsing fever,
cholera, or intermittent-fever."

Such views, if true, would make us totally helpless in our
conflict with this microscopic world. If the most harmless
can become our deadly enemies in the course of a few years,

* Read before the American Public Health Association, Milwauicee, Novem-
ber 22, 1888.

Origin and Sources of Pathogenic Bacteria. Ill

the problem would be war against all bacteria. But the great
majority are indispensable to the great rotation of matter
which goes on incessantly between the organic and the inor-
ganic household of nature.

Nageli's extreme views, happily for us, have very little
ground to stand upon. We do not believe that the transfor-
mation of harmless into pathogenic forms may take place at
any time, or that variation among bacteria goes on constantly
within very wide limits. We have learned that there is a
marked fixity of characters in these simplest forms, which
seems the more remarkable the longer we devote ourselves to
their study. This fixity has very likely been reached by a grad-
ual adaptation to special conditions extending over very long
periods of time. As a necessary consequence of this adapta-
tion there are bacteria corresponding to various grades and
forms of parasitism, ranging from those which produce disease
only incidentally to those which cannot subsist excepting in
the animal body. We now know of bacteria, such as the
cholera spirilla, which can only live outside of the body itself
in the alimentary tract and poison the organism with the pro-
ducts of their metabolism, and we know of bacteria, such as
the bacilli of tuberculosis and leprosy, which have adopted,
perhaps, the most complete parasitic habit, an existence within
the protoplasm of the cell-body itself.

Granted a marked fixity of physiological characters and a
scale of forms corresponding to different degrees of parasitism,
we cannot evade the inference that there must be going on
even now imperceptible changes in the characters of some
bacteria, and hence of diseases caused by them. The question
may then be asked. Have we any evidence in history of the
changes in the nature of prevailing diseases or of the appear-
ance of new ones ?* This could only be approached by a care-
ful study of infectious diseases and the epidemics they have
caused from antiquity up to the present. Even if I were suffi-
ciently familiar with the literature of this subject, I doubt
whether much could be gained by such a study, owing to the
doubtful value of the testimony of medical history. Have we
not witnessed, as late as our day, the confounding of one dis-
ease with another, because nothing was known of their etiol-
ogy ? It is not very long ago that typhus, typhoid, and re-

112 Origin and Sources of Pathogenic Bacteria.

lapsing fever were looked upon as one disease. Now we know
that typhoid and relapsing fever are due to very different or-
ganisms ; and as to typhus, we are aware of its claim to a sep-
arate place in the list of maladies, although its etiology is still
unknown. Scarcely a decade ago, all swine diseases were one.
Now, this one disease turns out to be three, caused by readily
distinguishable microbes. These illustrations will suffice to
show that the history of medicine cannot be relied upon to
help us in tracing any changes which the same disease may
have undergone, or in heralding the presence of a new disease
during centuries and tens of centuries. The problem is still
more complicated by the fact that epidemic diseases have fre-
quently come from unknown quarters of the globe.

There are a few indications, however, which point to varia-
tions in the severity and character of some infectious diseases.
The Black Death of the fourteenth century manifested a char-
acter somewhat different from that of the Oriental plague, with
which it has been in general identified. Liebermeister states
that typhoid-fever has become modified in severity since the
beginning of this century. It is believed that Asiatic cholera
may have developed its endemic character not before the last
century, having been a sporadic disease before that time, like
the cholera nostras of European nations. Only during the
present century has it invaded Europe as an epidemic disease.
Attention has been called in Germany to the recent develop-
ment of an epidemic character in cerebro-spinal meningitis.
We may not be far from the truth, therefore, when we assume
that there is a birth, change, and decay of diseases due to very
gradual changes in the micro-organisms which are the causes.
In weighing evidence of this kind, however, we must not lose
sight of another factor, the varying power of resistance pre-
sented by individuals and races under different internal and
external conditions to the same micro-organism.

When we pass to present bacteriological researches we ob-
tain some positive facts concerning the variation of pathogenic
bacteria within narrow limits. We have become familiar with
the conception of variability through the persistent successful
labors of Pasteur. He has taught us that anthrax bacilli can
be attenuated by heat so as to form physiological varieties.
This change is, no doubt, a degeneration on the part of the

Origin and Sources of PatJiogenic Bacteria. 113

bacilli needing no comment, for it is the common heritage of
all organisms to degenerate. But to cause an increase of patho-
genic activity is an important and striking fact, not only in
biology, but in epidemiology. Pasteur succeeded in increasing
the virulence of rouget bacilli bypassing them through a series
of pigeons — f>., inoculating each with the blood of the one
preceding in the series. The bacilli obtained from the last of
the series were more fatal to swine than those obtained direct-
ly from the latter animal. We may draw upon his investiga-
tions of rabies for another valuable illustration in variability.
In commencing to inoculate a series of rabbits beneath the
dura with the virus of rabies, from the streets, the animals
lived about fifteen days. From the spinal cords of these a
second pair were inoculated, from the second a third, and so
on. Later on in the series, the duration of the disease fell
from fifteen to twelve, eleven, nine, and eight days. After
the eightieth to the one hundredth passage it was shortened to
seven days. It remained at seven days after the one hundred
and thirty-third passage, rarely falling to six.

Gamaleia, in a recent communication to the French Acad-
emy of Sciences, claims to have found a method of augment-
ing the virulence of cholera spirilla. After passing the germs
through a guinea-pig, he inoculates a pigeon, which dies of a
" dry cholera" with exfoliation of the intestinal epithelium.
The germ appears in the blood, and after several successive
inoculatioiis it acquires such a virulence that one or two drops
of blood are sufficient to kill pigeons in from eight to twelve
hours ; guinea-pigs are likewise destroyed by the inoculation
of very small quantities. If we bear in mind that guinea-pigs
could only be infected by Koch through the stomach made
strongly alkaline^ and that the comma bacilli did not appear
in the blood, the experimental results obtained by Gamaleia
are certainly very remarkable. The same observer came to
very interesting conclusions of a similar bearing concerning
the microbe of fowl cholera. It is well known among bacteri-
ologists that a certain number of animal diseases, such as fowl
cholera, rabbit septicaemia, swine plague, and an infectious
disease among game which has been described in Germany
under the name of Wiidseuche^ are caused by what is supposed
to be the same micro-organism under different conditions.
8

114 Origin and Sources of PatAog^io, Bcbcteria.

Just what these conditions are^ whether depending on varia-
tions in the germ itself, or in the infected animals, or both, it
is impossible to state, I have encountered this same organism
as a saprophyte in the nasal mucus of healthy swine, as well
as the cause of a fatal infectious pneumonia in the same species.
I have found it in a few cases of interstitial pneumonia in cat-
tle and in diseased rabbits. In these different situations it
presented minor physiological variations, the most important
of which had referencetoitssensitiveness to temperature while
multiplying, and its pathogenic activity when tested upon the
same species of animal — as, for example, the rabbit. Gamaleia
found this same species of organisms as ordinary inhabitants
of the digestive tract of pigeons. By passing them through
several rabbits in succession they became virulent enough to
prove fatal to pigeons and fowls after inoculation.

Besides this physiological modification of bacteria produced
experimentally in the laboratory by which their pathogenic
effect is augmented, we are frequently brought face to face
with modifications going on in nature. Several years ago I
pointed out certain minor differences between hog-cholera
bacilli from two different localities. In culture liquids one
variety always formed a surface membrane, the other not.
This tendency was not lost or changed even after the germ had
been passed through a series of animals. The same variety
was also more sensitive to the reaction of the solid media em-
ployed. So far as pathogenic activity was concerned they
were the same. The production of coagulation-necrosis in the
liver of mice and rabbits peculiar to hog-cholera bacilli was
common to both.

But differences in form and growth upon artificial media are
less common than sameness of form and growth combined with
a difference in virulence. Thus I have had occasion to observe,
in the study of infectious pneumonia in swine, that the germ
of one epizootic when introduced beneath the skin of rabbits
caused a septicaemia fatal in less than twenty-four hours. The
bacteria inoculated were present in large numbers in the blood
and spleen. In another epizootic the germ was incapable of
destroying rabbits in less than from three to eight days. In-
stead of a true septicaemia there would be an extensive sangui-
nolent, gelatinous, or cellular infiltration of the subcutis ex-

Origin and Sources of PcUAogenie Bacteria. 115

—- ■ 1 1 ITT ■ ■ IMI Ml^-B- ■___!_ - ---

tending from the point of inoculation, together with a partly
cellular, partly fibrinous exudate in the neighboring abdominal
cavity. While the bacteria were very numerous in this exudate
they were nearly absent from the blood and spleen. I have
also observed a difference in the virulence of glanders bacilli
as manifested in inoculated guinea-pigs. In many the disease
lasted three or four weeks accompanied by swelling of the
limbs, suppuration of the testes, and ulcers on the surface of
the body. In one animal, however, it lasted but ten days
without external lesions, but with extensive formation of
nodules or tubercles in spleen and lungs. The reaction of
these experimental animals is usually so uniform that I should
not credit this to any weakness on the part of the guinea-pig.
Moreover, the source of the material confirmed the view taken
of a difference in virulence.

• I do not intend to convey the impression that it has not
been frequently asserted that variations in the severity of
epidemics were due to differences in the specific germ. I
simply call attention to some facts which demonstrate what
have been hitherto rather vague and unproved assertions.
They serve to illustrate variations going on or already existing
in nature and revealed in the laboratory, not so much by form
or culture as by inoculation, which brings into play the very
delicate vital forces of the animal in opposition to the invasive
tendency of the temporary parasite.

We have thus far taken for granted that our disease-germs
are derived from forms like those living in our surroundings,
and that they have adapted themselves in some unknown way
to various degrees of destructive parasitism. In some this
habit has become so perfected that they have nearly or quite
lost the capacity of living outside of their hosts. They fail to
grow in artificial media, or else develop only when their
natural environment has been imitated as closely as possible.
Among these forms are the well-known bacilli of tuberculosis,
leprosy, and the still hypothetical microbes of syphilis and
rabies. In a number of other disease-germs the parasitic habit
is but slightly developed, and the saprophytic mode of life
still as marked as with many harmless germs. They are culti-
vated on various substrata without difficulty, and it seems as if
their invasion of the living animal organism were more of an

116 Origin and Sources of £athegenie BasieriQ^

accident. If this be so» and it seems very probable^ then we
luust conclude that they have acquired their pathogenic properties
outside of the body. Huppe, in a recent address on the rela-
tions between putrefaction and infectious diseases, is the first,
to my knowledge, who has presented this view as a deduction
from present bacteriological researches. He discusses it in a
very suggestive way, and points out the important fact that
this property must have been acquired under circumstances
very near those obtaining in the animal body, such as are pre-
sented by the decomposition of albuminoids or putrefaction.

Let us see how far this theory accords with facts. Condi-
tions favorable to putrefaction are offered, first of all, in the di-
gestive tract of man and animals. Hence, we may expect to
find some pathogenic bacteria in this locality. Dr. Sternberg
has found a microbe in saliva, not distinguishable from the
organism identified later on as the cause of one form of croup-
ous pneumonia and cerebro-spinal meningitis in man. Gama-
leia, the author already referred to for several valuable dis-
coveries, recently discussed at length in Pasteur*s journal the
etiology of croupous pneumonia. With the aid of animal in-
oculation he was able to demonstrate the presence of the
diplococcus pneumonia in every case of this disease which he
examined. He concludes that this organism is the sole cause
of pneumonia, and that the pneumococcus of Friedl^nder is a
mere saprophyte in the diseased lung tissue. One of his co-
workers made careful investigations as to the presence or ab-
seRce of the diplococcus in the saliva of healthy persons, and
he actually found it in one half of the persons examined.
Experiments on siheep showed that intratracheal injections of
this saliva germ were incapable of. producing pneumonia, unless
the lungs had been previously diseased or injured. This would
interpret the results of clinical observation in making two fac-
tors necessary for the development of the disease, external
meteorological influences and the infectious agent. This also
harmonizes with our observations concerning the development
of infectious pneumonia in swine, for the germ of this disease
or one not distinguishable from it may be found in the upper
air-passages of a certain percentage of healthy swine. The
bacillus of malignant cedema, so markedly pathogenic when
introduced bi^eath the skin or into the muscular tissue, may

OrifM and Scmroes qf Pathogenic Bacteria. 117

be found ia tbe intestines of most of our domesticated ani-
mals. I have already referred to the presence of fowl cholera
or rabbit septicemia germs in the intestines of pigeons in Rus-
sia. The digestive tract must thus be regarded as one of the
sources of pathogenic forms, and the future will no doubt
bring to light new forms h'ving as harmless saprophytes at one
time or in one species of animals, and producing disease at an-
other time or in another species. The decompositions and
changes which they induce in the former situation must be
considered as preparatory stages in the final acquisition of patho-
genic properties. In fact» one microbe, the cholera spiril-
lum, produces disease without possessing any invasive power.
As Hiippe has pointed out, Asiatic cholera is simply an ab-
normal putrefactive process going on in competition with the
bacteria ordinarily present in the small intestines.

The illustrations given under the head of variability show
that these pathogenic germs living on the mucous membranes
are not in the condition to produce disease until some abnor-
mal condition of digestion, some congestion of the lungs or
catarrhal condition of the air-passages, the reduction of vital-
ity by the ptomaine poisons of putrefaction, pave the way.
By these means a nidus is frequently furnished where the bac-
teria in question may multiply and thus gain a preliminary ad-
vantage in numbers, and very likely in virulence. Expressed
in another way, these bacteria are always potentially but not
kinetically disease-germs.

Besides the digestive tract and its contents, we may regard
the putrefaction going on around us, the filth which the
crowded condition of large cities so abundantly furnishes, as
another and, perhaps, the most fruitful source of disease-
germs. Koch isolated at least four kinds, capable of produc-
ing septicaemia and pyaemia in animals from decomposing blood
and other matter. Mori (Zeitschrift f. Hygiene, IV.) found
three bacteria fatal to animals in the water of sewers. The
staphylococci, causing suppuration, may be considered ubiqui-
tous organisms. It is true that this group may only produce
disease by gaining entrance through wounds and injuries, and
thus are of more interest to the surgeon than to the student
of hygiene. Yet they merely present another phase of the
problem before us — the sources of pathogenic bacteria.

118 Origin and Bcmrces of PtUkogenio Baetetia.

The statements which I have made to-day may» for the sake
of greater clearness, be briefly summarized as follows : Obser-
vation and experiment seem to show that in our surroundings
the process of putrefaction so called is shared by a number of
true disease-germs, some of which require a slight impulse to
produce sporadic or epidemic diseases in man and animals ;
that the pathogenic property of these germs has been acquired
through unknown periods of time, and is now simply latent,
bursting forth occasionally to again subside. This does not
apply to strictly parasitic forms, but to the causes of those
still mysterious lung and intestinal diseases of man and ani-
mals, as well as septtcaemic, pyaemic, and. puerperal diseases,
which seem to hold on to an unknown saprophytic existence
while acting accidentally as true disease-germs.

It may be said that if such views are true, if disease-germs
are present as saprophytes in the excreta and secretions of man
and animals, and in the filth that is in great part formed by
these in our environment, it is a hopeless task for the sanitarian
to grapple with them. This may be true with reference to
such germs as we carry in our own saliva, and which are pre-
sumptively the cause of pneumonia, but with regard to the
great majority it is a purely superficial inference. The re-
moval of (ilth from human habitations and its proper disposal,
the prevention of soil and water pollution, have always been the
self-imposed tasks of sanitarians, and the difficulties are neither
increased nor diminished by regarding such filth as dangerous.
In fact, it has always been looked upon as a nidus of disease,
until the earlier researches of Koch and contemporaries took a
somewhat different ground, by failing to recognize the possible
variability of pathogenic organisms. They looked upon their
presence in putrefactive processes as accidental. Now we are
slowly returning to the older position, and filth will resume
its former importance in the eyes of Public Health. It is true
that putrefaction may and does destroy the more highly para-
sitic bacteria, but there is a no less destructive competition
between the outspoken putrefactive bacteria themselves.
Hence, even if they do destroy cholera spirilla in a few days,
it does not militate against the assumption that the latter like-
wise carry on a kind of putrefaction, a fact of which any one
may convince himself by smelling a culture of these germs.

Origin and Sourees of Pathogenic Bacteria. 119

In conclusion, I must say that I have presented what may
appear to be mere theories supported by a few positive, inter-
esting facts. Theorizing as to what bacteria in general do
from what one or two are known to do has always proved a
rather dangerous pastime, not because it is more apt to go
wrong than in other lines of research, but because of the im-
portance of the consequences involved. But I believe that
while we must hold fast to every old fact and every new one
which comes to light, we must likewise entertain theories as
to what we do not yet know, theories that invariably go with
already known facts and not against them. It is a fault of
most of our theories that they do not frankly square up with
the present, and in so far they are harmful. I have endeavored
to do a little of this squaring up, and in so doing have indi-
rectly pointed out the great importance of cleanliness as a pre-
ventive of disease.

I would also point out that almost all new ideas have been
derived from observation of and experimentation upon animal
diseases. The study of animal epizootics and of microbes
pathogenic in animal life is to my mind of inestimable value,
in casting a strong light upon corresponding diseases of man,
their causes, genesis, and mode of prevention. In the latter,
observation is limited, and certain lines of demonstration, such
as inoculation, are entirely suppressed. Analogy must then be
invoked to produce conviction in sceptics, and this is best ac-
complished when the student of public health makes himself
thoroughly familiar with the results of well-rounded, trust-
worthy investigations of infectious diseases among animals.
Here, as in physiology and pathology, animal diseases must form
the chief, in some directions the sole stepping-stone to human
diseases and to the solution of those problems which they are
forcing upon us in increasing numbers. At the same time it
becomes the duty of those intrusted with such investigations
to make public their results in such a way as to bring them
within reach of the medical profession in general and of sani-
tarians in particular, to point out any analogies existing be-
tween human and animal diseases, and to make such sugges-
tions and draw such inferences as may throw light upon the
obscurity that still prevails with reference to most human
maladies.

J 20 Recovery and Immunity from. Infective Diseaiaes.

THE THEORY OF RECOVERY AND IMMUNITY

FROM INFECTIVE DISEASES.

By Arthur Hanau, M.D., First AssisUot io the Zttrich Pathological lostitute.

While I was engaged in preparing a paper containing a de-
tailed criticism of the theory of " phagocytes*' from the point
of view of general pathology, together with certain views of
my own on the pathology of the infective diseases, I received
the recent memoir of Sahli, dealing in a comprehensive way
with a similar but more general theme. I have therefore given
up my original purpose, and propose now to limit myself to
certain points in which my views are divergent from his, or in
which I can supplement or extend them.*

I have always held that any theory which professes to ac-
count for natural recovery from the infective diseases, and the
immunity from further attacks which in many of them is
thereby brought about, must be in clear accord with the
known facts of general pathology, and more especially with
what is known of their clinical course and symptoms, before it
can claim to explain the phenomena common to these diseases.
The fulfilment of this preliminary condition is more important
than the demonstration of a series of interesting discoveries of
a histological or bacteriological kind, which are capable of being
interpreted as favorable to any given theory. Holding this
opinion, I some years ago expressed f my conviction that the
entire doctrine of the destruction of bacteria by phagocytes
was still without foundation, and wrote : " It appears to me
that of late many have generalized much too widely the theory
of the direct destruction of living pathogenic bacteria by ' de-
vouring ' tissue-cells, relying too much on Metschnikoff' s
observations, which are far from being clearly demonstrated ;
I consider the objections raised by Baumgarten.:^ among

* For an account of the ** phagocyte " theory of Metschnikoff, see Dr. Lauder
Braoton*s Pharmacology^ etc, (third edition), p. 85 ; and for a discussion of the
prevailing views on the nature of immunity, see Klein, PractiUctur, xxxlii. 247.

f ZHischri/tf, Jkiin. MeJ., vol. xv. pp. 3, 4.

t Berliner klin, WochtnschrifU 1888, p. 818.

Meoavery and Immunity from Infective Diseases. 121

others, to Metschnikoff's theory as thoroughly well-grounded.
At most the hypothesis explains the acute local phlogogenous
(septic) processes, though even in them the blocking of the
lymphatics and blood-vessels is a fact more definitely proved
than the ' eating-up ' [of the living bacteria]. For diseases
having a regular typical course the theory fails entirely. The
peculiar succession of symptoms in croupous pneumonia, in
small-pox, and other acute exanthemata, in intermittent and
relapsing fevers, can only be accounted for on the assumption
of corresponding phases of development in the micro-organisms
that cause them. It is impossible to believe that the phago-
cytes, after they have fought the invaders for days ancipite
marte^ should within the few hours of the crisis swallow them
up alive and entirely."

Without contesting the facts established by Metschnikofif I
must still maintain this opinion. The organisms which give
rise to the above-mentioned diseases, each with its typical
clinical course, are from the outset exposed to the alleged at-
tacks of the phagocytes, and nevertheless the morbid process,
after a definite period of incubation begins, persists for a
definite period of hours, as in intermittent, or days, as in relaps-
ing fever, with a steady or gradually increasing intensity, and
then suddenly a rapid return to the normal condition takes
place in the few hours of crisis, in certain of the affections to
be followed by a fresh relapse after a definite interval. Had
the phagocytes been active from the beginning, as they are
said to be, we should expect the disease to come to an end
gradually and terminate by lysis. If it is urged that the phago-
cytes require time to develop their characteristic properties,
that is only propping up one hypothesis by another.

Weigert * has with justice objected to a remark of Metschni-
koff*5 in speaking of relapsing fever, that the detection of
spirilla enclosed in the splenic cells at the time of the crisis does
not prove that the latter were in the act of removing living
spirilla from the circulation. He further argues that while
there is no ground for the assumption that the vigor of the
phagocytes increases, there is much {e.g,^ the loss of their mo-
bility) to suggest a weakening of the spirilla as the attack draws
to a close. The essential factor in the process of recovery

* FarUchritU der Medicin, v. (ibSy), No. 22, and vi. (1888), No. 2.

12d Jtecavery and ImmimUy/rom Infective Diseases,

would thus consist in the impaired vitality of the micro-
organisms.

How then is this " weakening" of the micro-organisms
brought about ? Weigert discreetly leaves the question open.
Sahliy who states that it is only in cases of slight infection by
so-called " hemipathogenic*' bacteria that spontaneous death
of the micro-organism occurs, attributes the disappearance of
the microbes in the " immunifying" diseases to vital influences
originating within the tissue-cells but operating outside them :
the natural recovery is the result of immunity already begun.
He does so probably in order to answer by anticipation the
question — Why do anti-bacterial influences only become active
on a particular day of the disease ; have they only then devel-
oped, and developed suddenly ? So far as the question of im-
munity is concerned, I am rather inclined to admit that an
anti-bacterial influence is exerted by the ** vaccinated " and
non-infectible body, inasmuch as in this case we have to do
with micro-organisms entering a body in which ad initio they
are incapable of living and multiplying ; but I cannot at all
accept the proposed identification of the phenomena of recov-
ery and immunity. It is matter of experience that in one
whole series of diseases (croupous pneumonia, erysipelas, sep-
ticaemia, gonorrhoea) recovery from one attack is no protection
against subsequent infection, and in another series (intermit-
tent and relapsing fevers) a single infection gives rise to a suc-
cession of subsequent attacks each of which is recovered from.
Sahli is not unaware of this difficulty, and seeks to meet it by
supposing that the immunity conferred may be of very short
duration, and that on the other hand the increasing mildness
of many recurring infections is due to a gradually increasing
immunity {e.£',f in recurring erysipelas, pneumonia, and diph-
theria).^ I am unable to follow him in this view, and, while
pointing out the contrast between the imperfect and gradually
developed immunity he imagines, and the rapid and complete
recovery that terminates each successive attack, would illus-
trate my position further by a few examples.

(i) Recurrent (or habitual) erysipelas almost always attacks
one and the same part of the body, the cause usually being
that the avenue by which the virus first gained entrance re-

* Z^". nV., p. 510.

Reeovery and Immunity Jrom Infedti/oe Diseases. 133

mains open. The earlier attacks usually leave behind a chronic
inflammatory condition, such as elephantiasis-like changes in
the legs, which from mechanical causes (obliteration of lym-
phatics and thickening of connective tissue) prevents the con-
tinuous propagation of the micrococcus erystpelatts, and this
continuous propagation is one of the conditions of its continued
life. The patient, however, has by no means a complete im-
munity from infection, for he is probably as apt to suffer in a
hitherto intact portion of the body as any one else ; it is only
the limb or part in question that is mechanically inaccessible
to the virus.

(2) Intermittent fever not only confers no immunity, but
persistent and repeated attacks actually favor the supervention
of the malarial cachexia. That this cachexia is probably not
a mere sequela of the malarial process, but rather a very chronic
form of the disease itself, appears from the fact (i) that it may
occur as a primary result of continued exposure to the malarial
miasm, and (2) that the blood-changes characteristic of the dis-
ease are found in patients suffering from the cachexia.**^ Last-
ly, a true pernicious malarial fever may follow upon a succes-
sion of previous slight attacks. According to Hirsch (** Geo-
graphical and Historical Pathology," vol. i., 1883), repeated
infection markedly predisposes to severe remittent and haemor-
rhagic forms of malarial fever. On the other hand, persons
who have, without apparently suffering, dwelt long in mala-
rious districts enjoy a relative immunity. The immunity of
the negro in particular is confined to adults, for many of the
children sicken and die of malaria.t The relations of malaria
in this respect seem, however, to be unusually complex, for
persons who possess the relative and local immunity are at-
tacked when they migrate to other regions.

(3) In relapsing fever, though the subsequent attacks are of
briefer duration, the fever is usually more intense.:^

(4) Gonorrhoea certainly confers no immunity against sub-
sequent attacks, and yet it is often enough recovered from
spontaneously, though to the end of the attack the urethra

* Coancilman, Fortsckriite der Median^ vi. (1888).
f May not this be a case of selection by survival ?

I On the other hand, Metschnikoff has produced a relative immunity in the
monkey by means of inoculation, Virck» Arch,, vol. cix.

12 i Recovery and Immumiy from Infective Diseases.

contains an infectious secretion. It may be said that the
later attacks are usually less severe, but the advantage in this
respect is counterbalanced by the increased risk of the affec-
tion becoming chronic. I suspect, therefore, that the dimin-
ished severity of the inflammatory symptoms is due merely to
a relaxation of the mucous membrane produced by the first at-
tack, analogous to the loosening of the conjunctiva following
an attack of ophthalmia.

(5) The most remarkable relation between recovery and im-
munity is met with in the case of syphilis. The patient who
has been constitutionally infected is immune as regards re-
infection from without, but not as regards the virus which per-
sists in his own system ; while it is probably only in the latest
stages of the disease that this virus loses its infective property
as regards another individual. A genuine re-infection of a
syphilitic patient is actually considered to be the best proof
that the first attack has been completely recovered from. In
this instance, then, recovery and immunity stand in actual
antithesis one to the other.

While, however, I cannot regard recovery from infective
disease as due to incipient immunity, I do not reject the doc-
trine that the former is brought about through the destruction
of the virus by some direct action of the infected body, so
far, at least, as the general infections are concerned. In the
case of local septic processes, I should, on the other hand,
admit that many micro-organisms may be destroyed indirectly
by the process of encapsuling and consequent isolation.*
This process begins, as I have already suggested, by the block-
ing up of the lymphatics and blood-vessels. But it must not
be forgotten that the encapsuling may also only begin as a
secondary process, after the virus has already ceased to live.

Sahli, who, in my opinion, is fully justified in his contention
that recovery from the infective diseases does not always take
place in the same way, thinks that many of these affections
terminate by reason of the spontaneous death of the exciting
bacteria ; but he limits this mode of recovery to the slighter
disorders attributable to the hemipathogenic microbes, and,

* The organisms are by this process prevented from multiplication and diffu-
sion ; they are confined to their original nidus, and may gradually die away
im situ.

Seoovery and Immunity Jram l7\feciive Disectses. 125

as will be understood from the foregoing remarks, to those
disorders which confer no immunity. The possibility of the
spontaneous death of the microbes, he says, '' explains in the
simplest manner the phenomenon of natural recovery from
many of the infective diseases, but by no means from all of
them." I should myself go further, and explain recovery from
a disease presenting a definite clinical course as the last act of
the cycle of phenomena whose regular sequence constitutes
the clinical t}^e of the disease. As I have said before, the
peculiar succession of symptoms in croupous pneumonia, in
small-pox, etc., can only be accounted for on the assumption
of corresponding phases of development in the micro-organisms
that cause them. The specific character of the disease rests
on the specific nature of the exciting micro-organism, and in
like manner it must be maintained that the several phases or
stages in the course of the disease are due to corresponding
definite phases or stages in the condition of the micro-organ-
ism : recovery is, in all but the absolutely fatal forms, simply
one of these stages. Whether the developmental phases of the
virus are always evidenced by definite morphological changes
(on the analogy of those occurring in trichinosis), or whether
they are only biological, having reference to its chemical or
local relations, is a question which we are of course not yet able
to decide. Many circumstances, however, point some to one
and some to the other of these alternatives.

That the view I am here maintaining is entirely new I do
not for a moment assert ; I believe rather that in principle it
corresponds to one of the older explanations of the normal
course run by the several infective fevers, and especially by
the polyleptic or remittent fevers. Recently, however, the
changes which microbes undergo in the course of these affec-
tions have been somewhat neglected in favor of a number of
other factors. In regard to the remittent affections I do not
stand alone, for Klebs, in speaking of relapsing fever, after he
has called attention to the differences between it and malarial
fever, adds : " These peculiarities point to corresponding pe-
culiarities in the micro-parasites. Either the duration of life in
these organisms is remarkably long or they reach the blood in
rapidly succeeding swarms (Heydenreich)."

On yellow-fever, he remarks further, "If we assume the

126 Recovery and ImmAmity from Infedme D^UeoMB.

micro-parasitic theory of the disease, it follows that the stages
of invasion and relapse must depend on the multiplication and
diffusion of the microbes into the circulatory channels ; in that
case the term invasion would be literally appropriate." More-
over, in Ziemssen^s lecture on " Antipyresis and Antipyretics,"
there is a passage in which he comes to the same conclusion
as myself concerning recovery in general. After giving reasons
against the view recently upheld that pyrexia has a sanative in-
fluence, which acts injuriously on the microbes either directly
or by altering the tissues, he adds, " This view does not accord
with clinical experience, and especially with the fact that the
acute infective diseases generally run through their typical
course, whether the pyrexia be high or low. The exceptionally
high temperature in relapsing fever has been by some casually
associated with the disappearance of vital activity in the Spiro-
ctuBta^ but there are many other ways of accounting for the
death and disappearance of the spirilla without attributing it
to the intensity of the body-heat. I am rather forced to the
conclusion that the life and activity of bacteria in the human
body has for many species a definite period of duration, which,
though different in different fevers, is independent of the
pyrexia, of the treatment, and of the external conditions."
Ziemssen illustrates this proposition by reference to the vari-
ous infections that run a typical course, and suggests that the
shortening of the duration of the affection in certain cases may
depend on some alteration in the biological properties of the
micro-organisms or of the patient affected, as in the varioloid
of vaccinated persons. He lays special stress on the sudden-
ness of the recovery, afKrming that "it is particularly impor-
tant for the understanding of this process (of recovery) to note
the sudden extinction of the vital activity of the microbes
which is indicated by the occurrence of the crisis. When we
see that in one hundred cases of croupous pneumonia eighty-
five end by crisis before the eighth day, and that whether the
fever is high or low, we may well imagine that there is some
regular vital property of the pneumonococcus which prevents
it living and acting in the organism for a longer time," In re-
lapsing fever he accounts for the successive attacks by assum-
ing the invasion pf successive generations of microbes.

It is obviously impossible as yet to demonstrate completely

Becovery and Immunity from Infealive Diseases. 127

the explanations I have proposed^ as the gaps in our knowl-
edge of the behavior of many of the bacteria in the human body
are still numerous, and as it happens it is precisely in those
affections with a typical course, to which I have specially re-
ferred, that the true nature of the parasitic virus is in part un-
discovered. These affections, however, I regard as the best
type of the infective diseases ; their clinical picture is the
sharpest in its outline, and in each species the individual cases
are the most uniform and regular. Most of the affections
whose contagium is better known are due to more variable
micro-parasites ; I refer to anthrax, septicaemia, malignant
cedema, typhoid, etc. Again, I think we must admit that in
many diseases some of the possible forms of the correspond-
ing micro-organism are still unknown ; for example, in re-
lapsing fever we know the spirillum which circulates with the
blood, but do not know its preliminary stages as they must
exist in the prodromic swelling of the spleen or after artificial
inoculation. I would remind my readers of the behavior of
the embryos of Filaria sanguinis hominis^ which are discharged
in swarms into the circulation from the maternal parasite set-
tled in a lymphatic vessel, and after a definite time disappear
again. Such developmental phases have long been known in
the case of animal parasites. The example of syphilis is also
worthy of note. Its manifestations in the various stages of
the disease, in respect of its extent, its diffusion, its anatomi-
cal characters, its contagiousness by inoculation, its transmis-
sibility to the foetus, vary in a remarkable manner. Perhaps,
however, there is only one infective disease in which it has so
far been demonstrated that the developmental phases of the
parasite stand in direct relation to the symptomatic manifes-
tations ; I refer to malaria, and to the discoveries of Golgi and
Councilman, on the assumption that they are right in consid-
ering the so-called Plasmodia as the causative parasites of
malarial disease.

If the suggested interpretation of the several phases of an
infective disease be accepted, I do not see why there should
be any difficulty in interpreting the phenomenon of recovery in
the same sense. The death of the affected host seems to me
an intercurrent accident, which prevents the disease from run-
ning its full course, and is not to be referred to any hypothet-

128 Becovery and Immunity front Infective Disease.

ical failure of the resisting power of the body against the in-
vading parasites. When a patient suflfering from trichinosis
survives, the trichina in his body are not dealt with differently
from those in a patient who dies. He dies when the number
of these organisms is so large, or so localized, or so operative,
that vital organs are thereby gravely injured. In many affec-
tions the occurrence of what is called the normal or typical
course may well depend on whether or not the parasite is per-
mitted to arrive at a certain developmental stage. Thus, in
the case of the Empusa musca^ it is only in the event of the
death of the infected fly not occurring till autumn that the
fungus can grow through the cuticle of the abdomen, and then
develop and shed its spores.

But while I cannot admit that in the general or non-local
infections the body exerts a direct antibacterial influence, I
do not at all deny that it may have an indirect influence on
the vitality of the invading microbes. Just as the life of the
host is essential to the life of certain parasites, and just as in
other cases {e.g.^ the parasitic worms) it makes possible the
attainment of certain developmental stages which the parasites
could never attain to outside the host's body, it is not im-
possible that the influence of the body may bring about the
development of a phase in the parasite in which the life-
period, or the number of generations it can produce, is strictly
limited. An intestinal trichina dies spontaneously a certain
time after the eggs are laid ; but if it reaches a muscle the
trichina may vegetate for years in its capsule before it dies.
When the parasite reaches the intestine it speedily arrives at
sexual maturity, and as a consequence its life is shortened ;
but this does not argue that the body of the host has exerted
any destructive influence upon it. In analogous fashion I
conceive the death of the microbes in many of the non-fatal
infective diseases to be brought about. I say in many of
them, for the apparent assumption of some writers that the
death of the micro-parasite is a conditio sine qua non of recov-
ery is quite untenable. At least two other modes of recovery
are possible : the parasite may be transformed into an innocu-
ous form, or it may leave the body altogether. In the case
of bacterial diseases the former mode has not as yet been cer-
tainly demonstrated, but its possibility must not be left out
of account. Trichinosis is, however, a perfect example of it,

Reccvery and Immwnity from Infectvoe Diseases. 129

and this example should warn us against assuming ^/r/^rt
that in every instance of recovery the parasite must have been
destroyed. Suppose for a moment that our means of exam-
ination were insufficient to detect the encapsuled animal, but
that we were familiar with the clinical course of trichinosis,
how natural would be the erroneous hypothesis that recovery
resulted from the death of the parasite. In this connection I
may mention, without insisting on it further, the suggestive
fact of the attenuation of the virulence of many bacteria by
passing them through the bodies of certain animal hosts.

The second mode, that of the elimination of the parasite
from the body, has so far only been recognized in the exam-
ple, cited in this sense by Sahli, of an abscess which is spon-
taneously evacuated. In this example I would call special at-
tention to the fact of the necrosis and solution of the abscess*
wall by the purulent exudation, a process in which the tissue
plays merely a passive part. The less the resistance of the
overlying tissue the sooner occurs the reparative process of
evacuation ; compare the behavior of a whitlow on the dorsal
with that of one on the palmar aspect of the finger. What
takes place at a stroke and en masse in the case of an abscess,
when the liquid and solid necrotic matters are removed by
evacuation, to my mind occurs gradually by epithelial exfoli-
ation in the case of catarrhal inflammations. The organisms
which penetrate and, perhaps (as Sahli instances in gonor-
rhoea), multiply in the cells of the mucous membrane bring about
the shedding of the epithelium, and are with it washed away
by the accompanying secretion. In the so-called catarrhal
pneumonia, which Fleck produced by injecting micrococci
into the air-passages, he appears to demonstrate this process
histologically. A rapid regeneration of the lost epithelium,
starting from the deeper layers, and compensating or more
than compensating for that lost by desquamation, is of course
a necessary condition of complete recovery. The success which
attends slight cauterization of the conjunctiva in gonorrhoeal
ophthalmia is thus intelligible, even if we believe that the
benefit is in part due to the direct destruction of the specific
microbe settled in the cauterized epithelium. According to
Klebs, in diphtheria the loosening of the false membrane itiay
bring away with it the infective bacteria.

As regards the expulsion or rather the exit of the patho-

9

130 Hecovery and Imrmmity from Infecti/oe Diseases.

genie organisms in the general infections, I agree with Sahli
that their elimination by the kidneys, and still more by way
of the intestine or the mammary gland, is to be regarded
rather as an accident fraught with danger to these respective
emunctories than as a truly sanative process. Rapid and
abundant elimination, which alone he regards as likely to be
effective, scarcely ever occurs in this way. But it seems to
me that we have something of the kind taking place through
the skin in the acute exanthemata. In two of these, small-
pox and measles, the fever falls with the outbreak of the erup-
tion, and ceases with the appearance of its last stage. In
scarlatina it is true the fever persists during the eruption.
That in some way, however, the virus is being removed in
these infections is further supported by the fact of the des-
quamation or ** decrustation** following the eruption, which
can hardly be regarded otherwise than as a separation of
necrotic layers or regions of the skin. The contagiousness of
this stage not only favors the view that the virus is then in
process of elimination, but it further negatives the hypothesis
that recovery is due to the death or destruction of the specific
m icro-organ isms.

The ** immunifying" influence of the chemical products of
bacterial action Sahli explains, and I think rightly, as due to
a kind of ** re-minting" {Utnprdgen) or special alteration of the
tissue-cells, and not to any direct anti-bacterial property of
these chemical substances.* We find, moreover, analogous
effects in the animal kingdom as the result of the use of cer-
tain food materials, and that under perfectly normal condi-
tions. Bees can rear a queen from an ordinary working bee
larva by feeding it when very young with so-called " royal **
food. Fabre and Newport's researches furnish a still more
striking example in the transformation of the larvae of certain
parasitic beetles {Melo'e^ Sitaris). Bees carry one of these, in
the form in which it leaves the ovum, into the hive, and there
it enters the brood cell of the comb, already containing a bee's

* The immunity which follows an attack of an infective disease cannot, how-
ever, be regarded as due to any " habituation " or " acquired tolerance " in tbe
tissue-cells ; it is brought about far too rapidly for this ; moreover, I cannot give
my adhesion to any explanation which rests, as this does, on the hypothesis of a
*' struggle for existence " between the cells of the parasite and those of the
host.

Centenarians. 181

ovum and the honey intended for the larval bee. The Meloe
larva first devours the egg, and then is metamorphosed into a
second form capable of living on honey. Before the larva has
eaten the egg it is quite incapable of assimilating honey, and
similar larvae introduced into simple honey-cells have been
found still in the first form, and dying or dead, at a time of
the year when the first form is normally never found.

The supply of a special food in the case of many other ani-
mal parasites seems to me the necessary condition for a par-
ticular transformation and for the normal development of a
particular form, and this supply depends ultimately on some
specific quality of the parasite's host. But in none of these
cases does the host acquire any immunity. The animal para-
site is itself a somewhat highly organized creature, which de-
rives its nourishment merely from the chyme or tissue-juices
of its host. In the case of the unicellular parasites, however,
we have a more intimate and more mutual relation between
the invading cell and the tissues of the host ; each is affected
by the products of the other's metabolic activity. The conse-
quences of this mutual relation we may well imagine to be two-
fold. On the side of the parasite it may result in the develop-
ment of various morphological or biological phases, which in
their turn condition the several clinical phases or stages of the
corresponding disease. On the side of the host it may ulti-
mately result in his acquiring immunity from further invasion.
— Tke PractiiioMer.

CENTENARIANS.

Mr. Emile Levasseur has recently presented to the Acad-
emy of Sciences a very interesting communication apropos of
the " Centenarians in France, according to the Census of
1886.*' The number of such persons is much less than is gen-
erally supposed. Young women have the affectation to re-
main young, while the old men that are cited for their great
age have the vanity to grow old in order to be admired.

In Bavaria, according to the census of 1871, there were 37
centenarians ; but, when the fact came to be verified, only one
authentic case was found.

In Canada, 421 were cited. Out of this number, the social

182 The Largest Woman in the World.

state of 82 was ascertained by the aid of bona fide documents,
and there remained after the examination but 9 genuine cen-
tenarians— 5 men and 4 women.

In France, the same delusion exists in regard to centena*
rians, as is proved by the reports emanating from the Bureau
of Statistics.

After the reception of documents relative to 184 centena-
rians, it was found by reference to authentic records, such as
registrations of baptism, half-pay lists, etc., that the number
dwindled down considerably, say to about 60. Among these
there was a person named Joseph Ribas, who was born at San
Estevan de Litera, in Spain, on August 20th, 1770, and who
lived at Tarbes.

We add to these details two little known documents on ex-
amples of extraordinary human longevity. The first of these
consists of an engraving, accompanied with the following
legend: "Jean Causeur, butcher by trade, aged 130 years,
bom in the village of Ploumoguer, in Lower Brittany. Painted
in August, 1 77 1, by Charles Caflfieri, sculptor, by commission,
to the king, for the navy, at Brest."

The second document is relative to Mr. Noel des Querson-
nieres, whose portrait was published from a lithograph made
in 1845. At this epoch, Mr. Des Quersonnieres was 117
yearS' of age. He was still living the following year, as is
proved by a biographical sketch published on his account.
Frangois Marie Joseph Noel des Quersonnieres was bom on
February 28th, 1728, at Valenciennes, where his father was
king's counsellor. He became commissary-general of military
supplies in 1789, and was in disgrace under the empire. He
went to live at London, where he married. At the age of 117
he was still vigorous. His face is pleasant, says his biography,
his hearing and sight have preserved an astonishing delicacy
of perception, and his head is not entirely devoid of hair. — La
Nature,

The Largest Woman in the World.— The death of a
colored woman in Baltimore, on September 4th, 1888, who, it
is said, weighed eight hundred and fifty pounds. If the fig-
ures are correct, the deceased was, in a physical sense, the
largest woman in the world, if not the largest that ever lived.

The New Marine- Hospital Service Law. 133

Even the famous Daniel Lambert only reached the compar-
atively ordinary weight of seven hundred and thirty pounds.
We have no record of any man exceeding the supreme obesity
of the Baltimore woman, with one exception. In the year
1798 the State of North Carolina became the birthplace of Mr.
Miles Darden, who, in the course of years, reached the height
of seven feet six inches, and the weight of over one thousand
pounds. North Carolina has shown pride in her agricultural
and political resources, but she has never done historical jus-
tice to her greatest man — physically speaking.

The New Marine-Hosvital Service Law.— The follow-
ing is the Act to regulate appointments in the Marine-Hospital
Service of the United States which has just become a law :

'* Be it enacted by the Senate and House of Representatives of
the United States of America in Congress assembled^ That med-
ical officers of the Marine-Hospital Service of the United
States shall hereafter be appointed by the President, by and
with the advice and consent of the Senate ; and no person
shall be so appointed until after passing a satisfactory exam-
ination in the several branches of medicine, surgery, and hy-
giene before a board of medical officers of the said service.
Said examination shall be conducted according to rules pre-
pared by the Supervising Surgeon-General, and approved by
the Secretary of the Treasury and the President.

** Section 2. That original appointments in the service
shall only be made to the rank of assistant surgeon ; and no
officer shall be promoted to the rank of passed assistant sur-
geon until after four years' service and a second examination
as aforesaid ; and no passed assistant surgeon shall be pro-
moted to be surgeon until after due examination : Provided^
That nothing in this Act shall be so construed as to affect the
rank or promotion of any officer originally appointed before
the adoption of the regulations of eighteen hundred and sev-
enty-nine ; and the President is authorized to nominate for
confirmation the officers in the service on the date of the pas-
sage of this Act. "

From the above it will be seen that hereafter there is but
one way to enter the Marine-Hospital Service, and that is
through the portals of the Medical Examining Board.

134 Ths Medals f Jekms^ and Tokens lUustroitiee qfSanitaUon.

THE MEDALS, JETONS, AND TOKENS ILLUSTRA-
TIVE OF SANITATION.

By Dr. Horatio R. Storbr, Newport, R. I., Member of American Pablic Health

Association, etc.

X. Epidemics. Continued from Volume XXI., page 448.

III. Small-pox.

a. In itself.

A. England.

Dr. John Freind (1675-1728). Two epistles to Dr. Richard
Mead ; the one concerning confluent small-pox, etc. London,
1729, 8"".

890. Obverse. Within beaded circle, nude bust, to left.
Beneath, on neck, S. V. (St. Urbain.) Inscription : Joannes.
Freind. Coll. Med. Lond. Et. Reg. S. S.

Reverse. Within similar circle, a physician in the dress of
a former century clasping the hand of one of the last. Be-
tween them, a globe, plants, compasses, books, etc. Legend :
Medicina. Vetus. Et. Nova. Exergue : Vnam Facimvs |
Vtramqve. At margin, to left, S. V. Bronze. 58 mm.

Duisburg omits the dot after Et on obverse, and, as Kluys-
kens had done, after the words in legend of reverse. Kluys-
kens does the latter in his description, and has in his figure
Coil, instead of Coll., having copied carelessly where the two
last letters run together. In his description he omits the dot
after Joannes, as did also Rudolphi, who with Kluyskens
considers the figures upon reverse as intended to represent
Hippocrates and Freind himself. In the Mead Catalogue,
1755, the name is given as Friend. Frossard in his Thirty-
eighth Catalogue wrongly classifies the medal as Masonic.

Gaetani, ii., p. 412, pi. 202, No. I ; Moehsen, i., p. 329,
fig. ; Snelling, pi. 29, No. 6 ; Rudolphi, 1829, p. 58, No. 239 ;
Kluyskens, i., p« 327, fig. ; Duisburg, p. 221, dlxxxvi.

This is in my own collection, through the courtesy of Dr.

The Hedaley JeianSj and Tokens lUue^cMve of Sanitation. 135

J. R. Chadwick of Boston, and in that of Dr. Lee. Dr. Will-
iam Dickinson of St. Louis has it also.

891. Obverse as last, but inscription, engraved : Joannes.
Freind. Med. Anglus.

Reverse as last, but engraved, and exergue blank. Bronze.

Rudolphi, 1829, p. 58; Duisburg, p. 221.

Rudolphi had this, but Duisburg considers it was merely a
pattern piece, and that no others were struck.

Dr. Richard Mead. " A treatise on the small-pox and
measles" (etc.), London, 1747, 8°. " A discourse" on the
above, etc. London, 1748, 8®, and 1755, 8°. " Abhandlungvon
den Kinder-pocken und Masern" (etc.). Augsburg, 1762, 16°.

Dr. Mead has been already referred to in the present Sec-
tion, under general epidemics, might also have been spoken
of in connection with The Plague, and will be again men-
tioned under Section XIL, Climate.

B. Denmark.

*

Thomas Bartholin of Copenhagen (1619 [1616, Appleton*s
Cyclopedia ; Thomas, Biographical Dictionary ; and Index
Catalogue of S. G.'s- Office] — 1680 [Mercklin wrongly says
1665] ). He is classified under Germany by Duisburg. ** De
Variolis hujus anni epidemiis," Hafniae (1656), 4^.

892. Obverse. Bust. Beneath, Moltedo F. Inscription :
Thomas Bartholinus.

Reverse. Natus Codaniae An. 1619. Obiit An. 1680. —
Series Numismatica Universalis Virorum lUustrium. 1844.
Durand Edidit. Bronze.

Duisburg, p. 113, ccciii.

Unknown to Rudolphi, Kluyskens and Renauldin.

C. Sweden.

Peter Jonas Bergius, of Stockholm (1730-90). " t)t variolis
curandis." Upsala (1754), 4^

893. Obverse. Busts of Bergius and his brother. Beneath,
C. E. (CarlEkbladorEnhorning.) Inscription : B(enedictus).
Bergius Fisci Commis. P. J. Bergius M.D. Prof. Histor.
Natural.

Reverse. Erudito Fratrum Pari Sociis Suis Munificis Acad.
R. Scient. Stockholm.

136 The Medals^ JetonSj and Tokens Illustrative of Sanita4,ion.

Silver, 32 mm.

Kluyskens omits the dot after Histor.
. Sackl6n, p. 727 ; Rudolphi, 1829, p. 15, No. 59; Kluys-
kens, i., p. 104 ; Duisburg, p. 207, dxliv.

D. Italy.

Antonio Cocchi. " De morbo variolar] quo affectata est
Maria Livia Borghesia." 1739.

Already described under Section I.

Dr. Domenico Cotugno of Naples (1735 [1736, Thomas,
Biographical Dictionary ; Index Catalogue Library Surgeon-
General's Office] — 1822). Physician to the Court of the Two
Sicilies. '' De sedibus variolarum syntagma." Louvain,
1786, 12°.

894. Obverse. Bust. Beneath, V. Catenacci F. Neap. In-
scription : Dominicus Cotunnius.

Reverse. A figure presents the bust of Cotugno to Minerva,
who holding the staff of iCsculapius contemplates a statue
with strongly developed muscles that is being studied by a
female representing Art. Legend : Rerum Abdita Monstrat.
Exergue: Hippocrati NeapoHtano, 1824. P. D. R. M. P.
Bronze. 45 mm.

Kluyskens has Fee. and Cotonnius.

Rudolphi, 1829, p. 38, No. 147 ; Desgenettes, Journal
CompUm.^ xxiii., p. 132 ; Kluyskens, i., p. 229 ; Duisburg, p.
35, xcix.

There exist the following medals and tokens relative to the

small-pox.

A. England.

895. Obverse. View of the Hospital. Beneath, Jacobs.
Inscription : The Small-pox Hospital Near | St. Pancrass

Reverse. An armorial shield. Inscription : P. Skidmore.
Medal. Maker. Coppice-Row. Clerkenwell. Above, London.
Upon rim : I promise to pay on demand the bearer one penny x

Neumann, No. 23,461.

Unknown to P. and R.

B. France.

There exists a small oval ecclesiastical medal of silver,
which I own, of St. Martial, struck in 1830. The friend
(French) from whom I received it, informs me that it was

The MedalSy Jetana^ and Tokens lUustratwe of Sanitation, 187

struck at Limoges, and used as a reminder to prayer for inter-
cession toward preservation from the ** peste noire/* or con-
fluent small-pox.

C. Germany.

a. Zweibriicken-Birkenfeld.

896. Obverse. Jugate busts, to right. Below shoulder,
I(ohann)' W(eichinger)* Inscription : Carolo Avgvsto-Mariae
Amaliae.

Reverse. Hygieia feeding a serpent entwined about an
altar. Inscription : Salvti-Principvm" Exergue : Vot'Car-
oli Mont 1 MDCCLXXXix. Bronze. 40 mm.

P. and R., p. 139, No. 384.

Upon the recovery of its rulers from small-pox.

D. Austria.

897. Bust of the Empress, to right. Beneath, M'KrafffF-
Inscription : M'Theresia D*G'Rom"Imp*Hung'&Boh'Reg'A*
Ausf

Reverse. An allegorical group, Minerva, Saturn, Hygieia,
etc. Legend : Providentia — Votis Et — Arte. At base, to
left, K In front, Parenti Optimae | Clementi lustae | Resti-
tuta Salus | 1767. Silver. 52 mm.

Moehsen, i., ?• 9 ; P- and R., p. 136, No. 375.

Upon the recovery of the Empress Maria Theresa from
small-pox.

898. Obverse. Bust of the Empress, to right. Beneath, to
left, A'Wideman" Inscription : M'Theresia'D'G'Rom'Imp.
Ger-Hung-&Boh-Re-A-A-

Reverse. A female kneeling at an altar, upon which, A. W.
Legend : Deo Conservatori Augustae Exergue : Ob Reddi-
tam Patriae | Matrem 22 Ivlii | MDCCLXVII* Silver. 46 mm.

Moehsen, 1., p. 17 ; P. and R., p. 137, No. 376.

Upon the same occasion as the last. This is in my collection.

899-901. Obverse. Bust, to right. Inscription : M'The-
resia | D-G'R- — Imp-Hu'Bo-Reg-

Reverse. The female at the altar. Legends as in preced-
ing, save 1767. Silver. 25 mm.

P. and R., p. 137, No. 377.

There are three varieties of this type, of which one is in the
collection of Dr. Fisher, and another in my own.

188 The MedoiUy Jetans, and Tokens lUue^aUve ofSaniiatian.

902. As above save smaller, and M. Theres. 21 mm.
Moehsen, i,, p. 17 ; P. and R., p. 137, No. 378.

903. A large monogram. Legend : VIVat DIVa C Laete
Constanter aMen. Exergue : ex ore et corde | HumiLL :
Devotis :

Reverse. Above, the Eye of God. Legend : Deo sit
gLorIa — Marla-Theresia | per preCes nostras | VeresInCeras"
I nobls-RestltVta esf Silver. 46 mm.
P. and R., p. 137, No. 379.

904. Obverse. Mailed bust, to left. Inscription : Car*
Alex-Loth" — Dux Belg-Praef : Under shoulder, R(oettiers).
This last is omitted by P. and R.

Reverse. Belgium as an erect female, to the right, extends
a crown toward sunbeams from clouds. At right, a lion.
Legend- : Deo Sospitatori — Augustae. Exergue : Belgica |
Gratulabunda | MDCCLXXVII. Silver. 34 mm.

P. and R., p. 137, No. 380.

The above all commemorate the recovery of Maria Theresa.

905. Obverse. Bust, to right. Beneath, Wideman. In-
scription : M'Josepha Austr-Ferdin-IV'Vtr'Sicil'Regi'Des-
pons'8 Sepfi767'

Reverse. An angel with torch flying with female figure to
right. Beneath, to right. P'K' Inscription : Ad Aetemas
Nvptias Dvcta XV. Oct. MDCCLXVII. Exergue : Nata XIX"
Martii | mdcclI" Silver. 42 mm.

P. and R., p. 138, No. 381.

Upon the death of the Crown Princess Maria Josepha, of
small-pox.

A INOCULATION.*

A. The United States.

Benjamin Franklin. " Some Account of the Success of In-
oculation for the Small-pox in England and America." Lon-
don, 1759, 4''.

* Besides the chapters upon the medals of Inoculation and Vaccination in
Pfeiffer and Ruland's *' Pestilentia in Nummis" (Weimar, 1880 and 1882), these
authors published anonymously and without date a reprint of the former,
under the titl^ *' Beschreibendes Verzeichniss der zu Ehren William Jenner*s and
Aloysio Sacco's sowie auf die Schutzpocken-Impfung und die Blattern- Inocula-
tion greprSfften Medaillen/' while Kluyskens issued a pamphlet upon the medals
of Jenner, '* Numismatique Jenn6rienne ;*' both of which are in my library.

Ths Medals, Jetans^ and Tokens lU/ustrtUwe of SaniUUian. 189

Already described in Section VII. » Ventilation.

Dr. J. M. Toner of Washington. " History of Inoculation
in Pennsylvania.*' *' History of Inoculation in Massachusetts. ' '
Boston, 1867.

Already described in Section I., and repeatedly referred to
besides.

Since the publication of the earlier portions of this paper, an
additional medal with which Dr. Toner is identified has ap-
peared. It is the larger of the two of the International Med-
ical Congress of 1887.

906. Obverse. Nude bust of Washington, to right. Be-
neath, C. E. Barber. F. Inscription : United States of America
I + Founder of the Republic. +

Reverse, ^sculapius seated, with serpent feeding at his
side. Before him a seated woman, with sick child in her lap.

In background two aged cripples, the one with crutch, and the
other with bandaged head and a cane. Beneath, C. E. Barber.
F. Exergue : Washing^ton, 1887. Inscription : International
Medical Congress. N. S. Davis, Pres. J. B. Hamilton, Sec.
Gen. E. S. F. Arnold, Treas. J. M. Toner, Reg. Bronze. 48.

In this medal the serpent-entwined staff of ^sculapius is
very properly a rod rather than, as has so often been given, a
club like that of Hercules. It is a pity that in so pretentious
a medal even trifling blemishes should have been permitted.
It was hardly necessary, however, for the engraver to have
presented his name, like an advertisement, upon the reverse as
well as the obverse, and it was a grammatical fault to place a
period after it, in both instances, before the abbreviated F.
That both these errors appear upon many other medals does
not warrant their existence in the present instance. It is in
ray collection. Dr. Toner, who designed it, has published an
interesting account of its history, with figures. Journal of the
American Medical Association, December 15th, 1888, p. 851.

B. England.

Baron Dr. Thomas Dinsdale (1701 [Index Cat. S.-G. O ;
171 1, Am. CycL] — 1800). Invited to Russia in 1768 by Cathe-
rine II., to inoculate herself and her son. " The present
method of inoculating for the small-pox. To which are added
some experiments introduced with a view to discover the effects

140 The MeddUy Jetons^ and Tokens lUmtrati/oe of Sanitation.

I • — —

of a similar treatment in the natural small-pox." Dublin, 1767.
London, 1767, 1769, 1772, 1779- ** Observations on the intro-
duction to the plan of the Dispensary for General Inocula-
tion," etc. London, 1778. ** Remarks on a letter by J. C.
Lettsom to Sir Robert Barker and Geo. Stacpoole, upon gen-
eral inoculation.*' London, 1779.

The medal is described a little later, in this same Section ;
No. 923.

Dr. John Ingenhousz (1730-99). Called to Vienna in 1768
to inoculate the imperial family. Made Aulic Counsellor and
Imperial Physician, with pension for life of £(xxi,

907. Obverse. Bust, in high relief. Inscription : J. Ingen-
housz. Cons. Et Archiat. Caes.

Reverse plain. Lead.

Wellenheim, ii., 2, p. 686, 13,980 ; Duisburg, p. 183,
ccccxciii.

Unknown to Rudolphi and Kluyskens.

908. Obverse. Inscription : J. Ingenhousz. Cons. Aul. £t
Archiat. Caes. Reg. Soc. Lond. Etc. Socius. 1779. Bronze.
90 mm.

Duisburg omits the dot after Socius.

Kluyskens, ii., p. 61 ; Duisburg, p. 183.

Unknown to Rudolphi.

For the medal of the inoculation of the Austrian Crown
Prince by Dr. Ingenhousz, see No. 924, in this same Section.
He will be again referred to under Section XII., Climate.

Dr. Sir Hans Sloane (1660-1753 [1752, Blake, Biographical
Dictionary ; Renauldin, loc. cit,'\ ).

The inoculator of several of the royal family.

909. Obverse. Bust, to left. Beneath, A. Dassier F. In-
scription : Jo. Sloane Equ. Baronettus.

Reverse. Doctor Medicus Socius Regiae Societ. Londi-
nensis. 1744. Bronze. 53 mm.

Rudolphi and Kluyskens omit the dot before the date.

Frost. Mynt-og Med. Samling, 1827, p. 169, No. 227 ; Ru-
dolphi, 1829, p. 148, No. 617 ; Renauldin, p. 452 ; Duisburg,
p. 223, dxci.. No. I.

Rudolphi 's specimen, from the collection of Hans Henrik
Frost of Copenhagen, was perhaps unique. Sloane having
been elected President of the Royal Society in the same year

The MedcdSy Jetons^ and Tokens lUustrative of SanztoHon. 141

that the medal was prepared, it^ reverse was suppressed, and
that of the following substituted.

910. Obverse as preceding.

Reverse. Praeses Societatis Londinensis. 1744. Bronze.
53 mm.

Gaetani gives Hans instead of Jo. and Kluyskens omits the
dot before the date.

Gaetani, ii., p. 239, pi. 184, No. 2 ; Snelling, pi. 33, No. 3 ;
Rudolphi, 1829, p. 148, No. 618 ; Renauldin, p. 452 ; Kluys-
kens, ii., p. 454 ; Duisburg, p. 223, dxci.. No. 2.

C. Holland.

Dr. Peter Camper of Leyden (1722-89). " De emolumentis
et Optimo method© insitionis variolarum." Groningen,

1774, 8^

911. Obverse. Head, to right. Inscription: IIOAAilN^
ANTASI02 ANAPinN,

Reverse, -^sculapius to left, seated before a column bear-
ing Telesphorus and entwined by serpent. Inscription :
GEONAISKAHniON. Silver. 25 mm.

Designed by Hemsterhuis and executed by Schapp.

Rudolphi and Duisburg give the inscription in small letters,
as does Kluyskens in his descriptions.

Rudolphi, 1829, p. 30, No. 116 ; Kluyskens, i., p. 179, fig. ;
Duisburg, p. 182, ccccxci., No. I ; De Jonge, Notice sur le
Cabinet etc., de S. M. le roi des Pays- Bas, p. 70.

The dies were early broken, and only five specimens ?ire
known to exist.

912. Obverse. Bust, to right. Inscription : Petrus Camper.
Reverse plain. Silver. Oval. 75x58 mm. Engraved by

K. Lanting of Amsterdam.

Rudolphi, 1829, p. 30, No. 117; Kluyskens, i., p. 179;
Duisburg, p. 182, ccccxci., No. 2.

D. France.

Dr. Guillaume Joseph de L'Epine. " Rapport sur le fait
de Tinoculation de la petite verole." Paris, 1765, 4^ ; Supple-
ment, 1767, 4®.

913. Obverse. Bust, to left. Beneath, Du Vivier F. In-
scription : G. J. De L'6pine Parisin. — Sal. Fac. P. Dec.

142 The Medals^ J^cmSy and ToJcena lUfmtrative of Sanitation.

Reverse. Olim Dati | Obstctricib. Prof. | Restit. 17. Mail
1745. I J.. Ex. Bertin 18 Mail. | J. B. Astruc 14. Jun. Ejusd. A.
I — I Bibliotheca | Publici Juris Facta | Die Jov. 3. Mart. |
MDCCXLVI. Beneath this inscription a serpent, to left. Ex-
ergue : G. J. De L'fepine Dec"* Silver. 30 mm.

Kluyskens omits F and P on the obverse, has L for J, and
Parisinae ; on reverse he has Obstetricibus, Restitut., Mai in
both places, and Anni ; and he oixiit$ the dots after 17 and 14,
and has the final date in Roman numerals. Rudolphi and
Duisburg have also several of these errors.

Hauschild, No. 478 ; Rudolphi, 1829, p. 50, No. 202 ;
Kluyskens, ii., p. 145 ; Duisburg, p. 85, ccxliv.

This is in my collection, from that of the late Dr. Ch6reau.
I have described it when speaking of Bertin and Astruc in my
paper upon the Medals, Jetons, and Tokens of Midwifery and
the Diseases of Women (M E. Med. Monthly).

914. Obverse similar to the above, but engraved, and with-
out the' engraver's name.

Reverse. Plain. Duisburg, p. 86.

This is in the Imperial Museum at Berlin, according to
Duisburg.

915. Obverse as preceding.

Reverse. An amphitheatre ; to left, D. V. Legend : Pul-
chrior Exurgit. Exergue : Inauguravit J. De Winslow. 18.
Febr. MDCCXLV, Beneath, 1744. 1745. 1746. Copper. 30 mm.

Wellenheim, ii., 2, p. 662, No. 13,617 (Friedlander MS.) ;
Kluyskens, ii., p. 145.

This was unknown to Rudolphi, and is omitted by Duis-
burg. It is not in the Ch6reau collection, now my own, and
is probably a mule, the reverse being identical with that of one
of the jetons of Elias Col de Vilars, the immediate predecessor
of L'Epine, which is in my possession from the Ch6reau col-
lection.

E. Germany.

Rev. Johann Georg Eisen Von Schwarzenburg (1717-79).
Noted for his zeal in inoculating (Duisburg).

916. Obverse. Wilhelmus I Dei. Grat. Com. Regn. In
Schaumburg etc. Exergue: 1774.

Reverse. Two comucopis. Inscription : Herbarum Con-

The Medalsy Jeians^ and Tokens lUuittatvoe of SanitaHon. 143

servatori. J. G. Eisen. Eccl. Torn. In Livon. Past. Beneath,
Populis Alimenta Ministrat. Bronze. 40 mm.

Duisburg omits several of the dots.

Lengnich, i., p. 338 ; Rudolphi, 1829, p. 48, No. 196 ;
Kluyskens, i., p. 282 ; Duisburg, p. 129, cccxliii.

Dr. Johann Andreas Murray of Gottingen (1740-91 [1797,
Ind. Cat. S. G. O.] ). ' ' Fata vartolorum insitionis in Suecica.
Gottingae (1763), 4^. " Observationum et animadversionum
super variolarum insitione Satura. Sectio(nes) prima, secunda,
tertia." Gottingae (1779), 4^-

917. Obverse. Bust and name.
Reverse plain.

Rudolphi, p. 114, No. 471 ; Duisburg, p. 135, ccclxiv.

Already mentioned in this Section, under The Plague.

Dr. Theodor Tronchin (1709-81). An advocate of inocula-
tion, among his patients having been the Dukes of Chartres
and of Parma.

918. Obverse. Bust. Inscription : Theodorus Tronchin.
Reverse. An allegorical representation of vaccination.

Legend : Tutissimus Ibis. Exergue : Securitas Populi Par-
mensis. 1 764. Silver.

Rudolphi and Kluyskens give the date as 1 734.

Haller, i., p. 165, No. 283 ; Miiller, Merkw. Ueberbleibsel
etc., Zurich, 1773, 4** fig, ; Rudolphi, 1829, p. 160, No. 666 ;
Kluyskens, ii.,p. 315 ; Duisburg, p. 130, cccxlvii. ; P. andR.,
p. 136, No. 374.

F. Switzerland.

Daniel Bemouilli (1700 [1706, Index Cat. S.-G. 0.]-82).
" Essai d'une nouvelle analyse de la mortality caus6e par la
petite v6role, et des avantages de Tinoculation pour la pre-
venir." (Acad, des Sciences de Paris.)

919. Obverse. Bust. Beneath, A(bramson). S. Inscrip-
tion : Daniel Bernouilli.

Reverse. An observatory, with ship in the distance. Le-
gend : Maris Et Coeli Mensor. Exergue : Natus, 1700. Sil-
ver, tin. 40 mm.

Kluyskens has Memor.

Von Haller. SchweirerischesMunz- und Med. Kabinet, i.. p.
88, No. 141 ; Hauschild, No. 60 ; Rudolphi, 1829, p. 16, No.
63 ; Kluyskens, i., p. 114; Duisburg, p. 132, cccli.

144 Ths Medals J JetonSj and Tokens lUvstrati/oe of SamUUion.

The name of a second D. B., a nephew of the preceding, ap-
pears upon a medal to Johann BernouilH, his brother. The
two are not to be confounded.

G. Sweden.

Catharina Charlotta de Geer (by birth. Ribbing). The first
of the Swedish nobility to permit inoculation in their families.

920. Obverse. Upon a band entwined with an oak wreath,
Cath. Charlott Ribbing. Within, Ob | Infantes | Civium
Svec. I Felici Ausu | Servatos. Beneath, 1756.

Reverse. A serpent-entwined altar, with patera. Legend :
Sublato Jure Nocendo. Exergue : Variolorum. 30 mm.

P. and R., p. 136, No. 373. The reverse is figured.

Dr. Nicolas Rosen a Rosenstein, of Stockholm (1706-73).
Court Physician, and did much for inoculation in Sweden.

921. Obverse. Bust. Beneath, G. L(jungberger). Legend :
Saecli Decuslndelebile Nostri.

Reverse. Nic. Rosen De Rosenstein Eq. A. Archiater Reg.
Suec. Et Acad. Sc. Membrum. Artis Sal. Discipulis Desideratus
Obiit A. Ch. 1773, Aet. 67. Silver. 35 mm.

Rudolphi and Kluyskens have no dot after Membrum.

Sackl6n, p. 520; Rudolphi, 1829, p. 137, No. 569; Kluys-
kens, ii., p. 386; Duisburg, p. 200, dxxxiii.. No. i.

922. Obverse. Bust. Beneath, C. F(ehrman). Inscription :
Nicolaus Ros6n. A. Rosenstein Archiater Eq. O. De St. P.

Reverse, -^sculapius. Legend : Phoebo Ante Alios Di-
lectus. Exergue : Artis Medicae Clarus Antistes. Ob. 1773.
Silver, bronze. 25 mm.

Rudolphi and Kluyskens have C. E. for initials of engraver.

Sackl6n, p. 520; Rudolphi, 1829, p. 137, No. 570; Kluys-
kens, ii., p. 387 ; Duisburg, p. 200, dxxxiii., No. 2.

Struck by the Swedish Academy in 1814.

Dr. David Schultz a Schultzenheim of Upsala (1732-1823).
Inoculated the Swedish princes, and wrote upon the general
subject.

923. Obverse. Bust. Beneath, M Frumerie. Inscription :
Dav. A. Schulzenheim Praes. R. Coll. San. Com. Ord. Vas.

Reverse. Minerva, at altar of iGsculapius. Legend :
Acumine Et Viligantia. Exergue : Claro Per 54 Ann. Soc.
Acad. R. Sc. Sv. 18 14. Silver. 34 mm.

Duisburg has Acumen.

The MeddU, Jetons^ and Tokens lUuBtratwe of Sanitation. 145

Sackl^n, p. 177 ; Rudolphi, 1829, p. 146, No. 607 ; Kluys-
kens, ii., p. 436; Duisburg, p. 21 1, dlxii.

The name of Schulzenheim also appears upon a medal of
Berzelius, already given under Section IV,, No. 172.

There are the following additional medals of Inoculation.

A. Austria.

924. Obverse. Busts, jugate. Beneath, A. Wideman. In-
scription : Josephus'II* M'Theresia'Augg*

Reverse. Ferdinandus | Maximilianus | Eorumque Neptis
I Theresia | Archiduces Austriae | De Insertis Variolis* | Re-
stituti 29*Sepf | MDCCLXVIII. Bronze. 41 mm.

Schau- und Denk-mlinzen, welche unter der Regierung
Maria Theresia gepr^t worden,sind. Wien, 1782, fol., p. 282,
fig. ; P. and R., p. 138, No. 382.

Upon the inoculation of the Crown Princess of Austria by
Dr. Ingenhousz, already referred to. The dies of this medal
are preserved at the Imperial Mint at Vienna.

B. Italy.

The medal commemorative of the inoculation of the Duke
of Parma has been already described in the present Section,
No. 916, in speaking of Dr. Tronchin.

C. Russia.

925. Obverse. Bust of the Empress, to right. Beneath,
the engraver's name, in Russian. Inscription, in Russian :
(Catharine II, Empress and Czarina of all the Russias).

Reverse. The Empress, holding her son by the hand,
speaks to a female, at the left. Behind her, a boy leaning
upon the Russian Arms, and a second who extends his arms
to the Empress. Behind, at the base of a temple, a slaugh-
^ tered dragon. Inscription, in Russian : (She herself gave the

example). Exergue, in Russian : (Upon Oct. 12, 1768).
Bronze. 65 mm.

P. and R., p. 138, No. 383.

Upon the inoculation of the Russian Court by Dimsdale,
already mentioned in this Section. The dies of the medal are
preserved at the Imperial Mint at St. Petersburg. In the Lee
and Fisher collections.

{To de cotUiniud.)
SO

146 Mitar's TaiiU.

EDITOR'S TABLE.

t^*ALL correspondence and exchanges and all publica-
tions for review should be addressed to the Editor, Dr. A. N.
Bell, 113A Second Place, Brooklyn, N. Y.

«

Many subscriptions for 1889 are still due ; and some there
are for previous years, which, unless promptly paid, will be
placed in the hands of persons authorized to collect them.
Subscribers will please conform to conditions of detachable
order on advertising page.

INFECTIOUS DISEASES AND QUARANTINE.

It is surprising that one with the opportunities of Horatio
R. Bigelow, M.D., foreign correspondent of the Journal of
the American Medical Association^ should write as he has re-
cently written referring to quarantines that,

** Their history at any time of the world's history, and
whenever enforced, have never shown them to be productive
of preventing the spread of an epidemic or of arresting its loc-
alized progress. America with a strict quarantine is scourged,
while England with no quarantine escapes. The advance of
any epidemic can only be arrested by improving the condi-
tions upon which it depends for an existence, and history fails
to record a single instance in which it has been stopped in any
other way. ' '

Notoriously, to all well-informed persons on the subject,
England maintains against infectious diseases of every kind,
the strictest ** quarantine," except in name, of any nation in
the world. While she wisely ignores the word quarantine,
she uses preventive measures against the importation of infec-
tious disease at her ports of eAtry with the utmost strictness ;
and in the exercise of her internal measures is equally strict in
enforcing the isolation of all persons affected with infectious
or contagious diseases.

Through her well-informed and thoroughly-organized sani-
tary service she practices the knowledge which all nations and
communities should acquire and practice with the same par-
ticularity, internal ^s vf ell as external measures for thepreven-

Mit<yr'8 TahU. 147

tion of disease. Yet there are Englishmen '' abroad/' and on
the platform of her home gatherings, who appear to be no bet-
ter informed than the correspondent of the Journal^ or who
by their purblindness would hoodwink the necessity of any
measures suggestive of possible restriction against England'^
commerce, at whatever risk of introducing disease into other
communities.

Moreover, with special regard to yellow-fever, Dr. Bigelow
writes that,

" At a time when Montevideo was suffering disastrously from
yellow-fever invasion a doctor in charge of the hospital there
succeeded in quieting the people, who had a superstitious dread
of contagion, that it was not personally contagious by taking
his two young children with him each time that he made his
visits to the fever wards." This, considering the context, is
evidently intended to correct an implied fallacy entertained by
the physicians in the United States. Whereas it would be
difficult to find one familiar with yellow-fever, who believes it
to be personally contagious. Yet they do not, on that ac-
count, believe it safe to have free intercourse with infected
places.

Nearly thirty years ago the following resolution was formu-
lated by the late Alexander H. Stevens, M.D., and A. N.
Bell, M.D. :

" Resolved^ That in the absence of any evidence establishing
the conclusion that yellow-fever has ever been conveyed by
one person to another, it is the opinion of this Convention th^t
personal quarantine in cases of yellow-fever may be safely abol-
ished, provided that fomites of every kind be rigidly restrictr
ed.*' This was adopted by a vote of 70 yeas to 4 nays, April
29th, 1859. — Third National Quarantine and Sanitar/ Conven--
tion, p. 2Q\.

Among the voters in the affirmative on this resolution were
our foremost sanitarians of the time : Drs. John H. Griscom,
Stephen Smith, Elisha Harris, R. La Roche, William M.
Kemp^ E. M. Snow, J. W. Sterling, William C. Anderson, and
others, comprehending many of the most distinguished memr
bers of the medical profession at that time. If any one among
them ever subsequently recanted his opinion, we have never
heard of it* •

148 Mitar'8 TabU.

It is gratifying to observe that, as one of the results of re-
curring opportunities to study the nature of yellow-fever, under
the light of increasing attention to preventive measures gener-
ally, the non-contagiousness of yellow-fever is more and more
extensively recognized, though with surprising delay in some
unexpected quarters. For example, at the recent meeting of
the Mississippi Valley Medical Association, resolutions were
adopted of the same purport as the one just above quoted with-
out recognition, adopted nearly thirty years before, so slow is
the progress of sanitary knowledge, even among physicians
' supposed to be well informed.

Disinfection with Steam, in the slow progress of the
knowledge of its efficiency, is closely related to the foregoing.
It was first effectually applied to a vessel infected with yellow-
fever more than forty years ago ; frequently repeated, and its
efficacy thoroughly proven by numerous experiments subse-
quently. But persons who had no practical knowledge in the
premises " knew better ;" and because certain organic germs
were found to inhabit hot springs of 300° F. and upward, as-
sumed that nothing less would kill disease germs, and that dry
heat only could be relied upon. But in the progress of bac-
teriological knowledge, the discovery was finally made that,

" A temperature much below the boiling point destroys mi-
crococci and bacilli in active growth. Thus, I have fixed the
thermal death-point of the micrococcus of pus (from an acute
abscess) at 140** F. (60® C), the time of exposure being ten
minutes. This temperature is also fatal to the swine plague.
The micrococcus of fowl cholera is destroyed by exposure for
fifteen minutes to a temperature of 132** F. (Salmon). Nine
or ten minutes' exposure to a temperature of 54° C. (129.2° F.)
is sufficient to destroy the vitality of anthrax bacilli in blood
(Chauveau).

*' A temperature of 132.8° F. is fatal to the bacillus of an-
thrax, the bacillus of typhoid-fever, the bacillus of glanders,
the spirillium of Asiatic cholera, the erysipelas coccus, to the
virus of vaccinia, of rinderpest, of sheep-pox, and probably of
several other infectious diseases.

'* A temperature of 143.6° F, is fatal to all of the pathogenic
or non-pathogenic organisms tested, in the absence of spores,

Editor's Table. 149

with the single exception of Sarcina lutea^ which in one experi-
ment grew after exposure to this temperature" (Sternberg).

Under the head of " Superheated vs. Simple Steam :"

" Dr. E. Von Esmarch, Assistant in the Hygienic Institute
in Berlin, has recently made some investigations to determine
the comparative disinfecting power of superheated steam not
under pressure as compared with the same kind of steam not
superheated. He found that when applied to anthrax spores,
steam, as it is raised above lOO® C. (the boiling point of water)
gradually loses its disinfecting power until the temperature of
the steam reaches 1 50^ C. or upward, at which temperature it
becomes destructive to the fabrics.

" Or, estimating the disinfecting power of steam at various
temperatures, freely flowing steam of 100° C. killed anthrax
spores in ten minutes, at no** C. in twenty minutes, at 123°
C. in forty minutes. The only explanation why steam grad-
ually, within certain limits, loses its disinfecting power as its
temperature is raised, is that the superheated steam is dry
steam, and that a certain amount of moisture is necessary to
soften up, as it were, the envelop of the bacteria that the steam
or the heat may prove destructive to the organism within." —
{Sanitary Inspector for November.)

Notwithstanding, in the official correspondence on the Pro-
posed Method of the Disinfection of the United States Steam-
ship *• Boston," in our preceding number, we find a board of
medical officers of the navy recommending the use of super-
heated steam of the temperature of 220** F. for two hours ! — at
such a temperature and for such a length of time as to prohibit
its use, lest in the opinion of an expert builder (of iron ships)
it materially injure, if not, indeed, destroy the vessel. We are
constrained to express our surprise at the recommendation,
considering the evidence of the superior efficiency of steam at
a lower temperature, with which the officers are supposed to
be familiar. But it is a striking illustration of the slow prog-
ress of practical sanitation against preconceived notions.

VACANCIES IN THE MEDICAL CORPS OF THE NAVY.

Among the first subjects of importance to which the atten-
tion of the Secretary of the Navy is called, in the recent report
of Surgeon-General Jno. Mills Browne, U.S.N., Chief of the

160 Mitar's Table.

Bureau of Medicine and Surgery, is the continued deficiency
in the medical corps.

Medkral Director Gorgas, President of the Board of Exam-
iners, in Maylasty reported : " I have been greatly disappointed
at the results of our work this year ; seven of the twelve appli-
cants were rejected physically, and but one of the others has
passed professionally." There still remain, at the date of the
report, eleven vacancies ; but at the time of this writing
/aurUen.

''The Examining Board is now in session at the United
States Naval Hospital, Philadelphia, for the examination of
candidates for admission into the medical corps of the navy as
assistant sui^eons. The board will remain in Philadelphia
until the 31st of March, 1889.

" After the ist of April, 1889, the board will hold its ses-
sions at the Naval Hospital, Brooklyn, N. Y.
' " Further information may be obtained by addressing the
President of the Examining Board."

A National Board of Health is again proposed, by bill
introduced by Senator Harris, February 4th, which provides
for a board to be organized in the Treasury Department, to be
composed of seven members, three to be appointed from civil
life by the President, and to draw salaries of $5000 each ; three
to be medical officers, one from the army, one from the navy,
and one from the marine service, and the seventh to be an
officer learned in law, to be appointed from the department of
justice. The four officials, members of the board, are to re-
ceive no other emolument than their official salaries.

Hygiene is recently making considerable progress in Spain,
particularly in the cities of Barcelona and Madrid.

Sefior Decio Carlan, in his report published in El Siglo M^d-
ico^ says that the Sociedad Espafiola de Higiene has the most
brilliant sessions of any medical society in Madrid. The meet-
ing held on the 27th of December, ult., was the most success-
ful yet held. Two of Spain's greatest orators, Casteiar and
MORET, the Governor, representatives of different societies,
and a large attendance of ladies were present, and With the
members of the society filled every available space in th6 hall.

Seflor Fulido, one of the editors of Et SigloMMtc&, delivered

Editor's TdhU. 151

a discourse which elicited hearty applause from the vast audi-
ence. Sefior Moret distributed the prizes, and the ex- Secre-
tary of State then made one of the most eloquent discourses
that he has ever pronounced in public on the sanitary condi-
tion of Madrid and the necessity of a rigid inspection of every
house, that sickness and disease may be prevented.

. Graveyard Pestilences. — Apropos to our remarks in the
January number on the probable pollution of the water supply
by graveyard seepage, as the cause of the prevalence of typhoid-
fever in Brooklyn, and to which we shall again recur. The
Sanitary Journal^ December 17///, 1888, reports that, at a re-
cent meeting of the Scottish Burial Reform and Cremation
Society, Sir Spencer Wells said : ** In the cemetery at Ilford,
connected with the city of London, nine thousand persons are
buried every year. Think what a dreadful state of things that
represents ! Whether in coffins or wicker baskets, you have
that enormous amount of material decomposing within a short
distance of a large centre of population. I cannot doubt that
if it goes on unchecked there will be some terrible pestilence,
which will be worse than the plague of London or the ' Black
Death ' of the Middle Ages. We shall not only get diseases
resulting from impure water and impure air, from the decom-
position of dead bodies, but we shall get the propagation of
specific diseases. As Pasteur has shown, the germs of these
diseases are preserved in the burying-ground, and they are
brought from the grave to the surface of the earth where they
poison the grass that the cattle feed on an^the water that they
drink, and they spread the diseases from which the animals
die. There was a remarkable instance in Yorkshire, where a
number of scarlet-fever patients were buried in the church-
yard. A part of that churchyard was closed, but was after-
ward included in the garden of the rector, who had it dug up,
and the scarlet-fever from which those patients had died thirty
years before broke out in the family of that clergyman, and
spread to the surrounding houses. There are many instances
in which other diseases have spread in the same way/'

CATARACt OF Glass-Makers. — A Paris correspondent
writes the Jtmrnal of the American Medical Association as
follows :

152 MUor's TdbU.

In a note in the Petit Journal de la Saute on the cataract of
glass-makers, the author remarks that a German physician
found that of 442 glass-makers aged less than 40, there were 42
— that is to say, 9.5 per cent — affected with the commencement
of cataract ; and of 64 glass-makers aged more than 40 years,
he found 17 — that is, 26.5 per cent — affected with the same
malady. This proportion is far above the average. In order
to account for the cause of this sing^ular predisposition, the
author made some researches, and came to the conclusion that
the trouble of the crystalline lens is due, on the one hand, to
the direct action of the intense heat on the eye, particularly
the left eye, which is the most frequently affected ; on the
other hand, the enormous loss of water caused by the exces-
sive perspiration under the influence of the heat. It is by this
excessive loss of water that may be explained the production
of cataract in diabetic subjects.

Dr. Kilvington. — The Northwestern Builder sxys : " Min-
neapolis's indefatigable health officer. Dr. Kilvington, has suc-
ceeded in forcing upon the public, against much opposition,
what Mr. Beecher might have called a means of grace — viz.,
a garbage crematory ; and his furnace is said to be considerably
in advance of others used for like purposes. It is quite inex-
pensive in operation, gives off no odors, and consumes all
kinds of refuse. A number of cities have sent their health
officials to see this crematory in operation, and it is said Mil-
waukee already is building two upon the Minneapolis plan.''

An International Exhibition of Alimentary Sub-
stances will be opened at Cologne on May i8th, and will re-
main on view until October 15th. Austria-Hungary, Great
Britain, Russia, Italy, Holland and Belgium are already named
among the nationalities to be represented, and others are ex-
pected to give in their adhesion shortly. The grounds set
apart for the exhibition are eminently spacious and pictu-
resque, and every effort is being made to insure its utility and
attractiveness.

A New Institute for the Practical Study of Sani-
tary Science has been organized at Rome, being the tenth
school of this kind to be undertaken in Europe. Government

Mitor's TaHe. 158

aid, through the Italian National Board of Health, will be
given toward forwarding original research in sanitary subjects.
Upon the completion of definite prescribed courses a diploma
will be granted.

Prize Essay.— Dr. L. D. Mason, Vice-President of the
American Association for the Study and Cure of Inebriety,
offers the sum of one hundred dollars for the best original
essay on ** The Pathological Lesions of Chronic Alcoholism
Capable of Microscopic Demonstration.^*

The essay is to be accompanied by carefully prepared .micro-
scopic slides, which are to demonstrate clearly and satisfac-
torily the pathological conditions which the essay considers.
Conclusions resulting from experiments on animals will be
admissible. Accurate drawings or micro-photographs of the
slides are desired. The microscopic specimens should be
accompanied by an authentic alcoholic history, and other com-
plications, as syphilis, should be excluded.

The essay, microscopic slides, drawings or micro-photo-
graphs are to be marked with a private motto or legend and
sent to Dr. W. H. Bates, the chairman of the committee, 175
Remsen Street, Brooklyn, N. Y., on or before Oct. ist, 1890.

THE PROGRESS OF INFECTIOUS DISEASES AND MORTALITY
RATES AT THE MOST RECENT DATES, BASED UPON OFFICIAL
AND OTHER AUTHENTIC REPORTS.

Alabama. — Under a joint resolution of the General Assem-
bly, the Governor of the State has issued to the Governors of
the States of Texas, Florida, Louisiana, Mississippi, South
Carolina, North Carolina, Georgia, Tennessee, Kentucky, and
Illinois, invitations to appoint delegates to a Quarantine Con-
ference to be held in the city of Montgomery, beginning on
Tuesday, the 5th of March next, and to continue for such
number of days as the business in hand may render necessary.

The reason for the limitation of this notice to the Gulf States
is, we are informed, with a view to such concerted action
among them in the event of yellow-fever hereafter, as may be
deemed least embarrassing to travel and commerce, while
most effectual for the prevention of the spread of the disease.

154 Editor's Table.

Notwithstanding, we should certainly not be purblind to the
continued liability to yellow-fever of many seaports north of
the States named in this invitation, and the equal importance
of properly equipped stations to arrest and destroy it in limine.
And it might go without saying that some of our northern
seaports, Philadelphia, for example, and some on the Pacific
Coast are so extremely deficient in this respect that, in our
judgment, it would have been better to have extended the
scope of the conference, and given it a national instead of a
mere sectional bearing.

Mobile, 40,000 : Reports 89 deaths during December, of
which 17 were under five years of age. Annual death-rate,
26.7 per 1000. From zymotic diseases, 12, and from consump-
tion, 12.

California. — The Tenth Biennial Report of the State
Board of Health for the fiscal years from June 30th, 1886, to
June 30th, 1888, comprises a general abstract of the proceed-
ings of the board, a detailed account of the diseases which
have prevailed and their mortality, the means which have been
used for their prevention, and the expenses.

The most prominent subject of the report, and that which
has required more attention than any other, is small-pox, which
prevailed epidemically in San Francisco during the winter
of 1887-88; and during the early part of the year 1888 ex-
tended to numerous places widely distant from each other in
dififerent parts of the State. As reported upon by Dr. S. S.
Herrick, there were in San Francisco from May 3d, 1887, be-
ginning with the second case, a Chinese passenger from the
steamship City of Sydney, to June 30th, 1888, 568 cases.
The first case, after an entire exemption from the disease for
more than a year, was reported February 23d, 1887, but the
origin of this case appears not to have been traced. Of the 568
cases reported, 494 were white, 72 Mongolian, and 2 African ;
69 died.

** Justice to the San Francisco Board of Health," Dr. Her-
rick remarks, " demands the explanation that repeated efforts
were made, beginning in the early course of the visitation, to
have enforced the rule requiring all public school pupils to be
protected by vaccination. But opposition was made on the

Mitar's Table. 15S

ground that the Board of Health had no right to use a school-
house for a health office. It would be unfair to say, that the
school authorities, generally, were opposed to the enforcement
of the vaccination rule ; but it would be a suppression of the
truth not to state that the superintendent, Mr. James W.
Anderson, and Mr. Thomas P. Woodward, a member of the
Board of Education, were conspicuous in obstructing the in-
spection of the school children, by which means alone the
Board of Health could be satisfied of the protection of these
children." Twenty-nine school children were admitted to the
small-pox hospital, who had never been vaccinated, and of
these 3 died.

Accepting these school officers, who obstructed the only
certain means of protecting the health and lives of school chil-
dren from small-pox, as an index of the intelligence of the
community on the subject, it is no longer a matter of surprise
that the disease became epidemic in San Francisco, and ex-
tended to other parts of the State. The whole number of
deaths reported from it was 94 ; but the Secretary remarks,
** There were other deaths from small-pox in the State not
reported."

The cost of the epidemic to San Francisco, consequent upon
the neglect of vaccination which led to it, and the public ex-
pense involved to meet the emergency, is estimated by Dr.
Herrick to have been nearly $50,000. In addition to this, the
steamship companies declare their extra expenses in quarantine
and otherwise, during the period of May 1st, 1887, to June
30th, 1888, to amount to about $200,000. " The total loss to
the city and to the steamship companies considerably exceeds
$300,000." Such epidemics and such expenses are the legiti*
mate fruit of purblind negligence of timely sanitary measures.

Of other preventable diseases in the State generally, taking
the years separately, from June 30th, 1886, to June 30th, 1887,
deaths reported from diphtheria, 376, and ** at least 300 more
that were not reported ;" croup, 164 ; scarlet-fever, 60 ;
measles, 34 ; whooping-cough, 64 ; diarrhoeal diseases, 334 ;
typhoid-fever, 289. Deaths from consumption, 1617 ; pneu-
monia, 611 ; bronchitis, 186. Total deaths reported from all
causes, exclusive of 357 still births, 9959. By adding 6000, in
default of deficient returns, the Secretary estimates the death-

166 Mitor'B TabU.

rate at 13.50. On the same basis, the percentage from con-
sumption was 10.7.

From June 30th, 1887, to June 30th, 1888, the number of
deaths 'reported was, from diphtheria, 358 ; croup, 203 ;
whooping-cough, 42; scarlet-fever, 59; measles, 139; diar-
rhoea! diseases, 416 ; typhoid-fever, 414 ; cerebro-spinal fever,
144. Deaths from consumption, 1832 ; pneumonia, 1039 ;
bronchitis, 262. Total number of deaths reported from all
causes, exclusive of 329 still births, 11,993. Pursuing the same
course as for the preceding year, adding 6000 as an allowance for
deaths not reported, the death-rate is estimated at 14.6. Per-
centage from consumption, 10. 1 2.

But it is evident from the whole tenor of the report, with-
out detriment to the interest manifested by all the members
of the board, and the indefatigable labor of a skilled executive
officer, that the deficiency in the returns is so great as to well-
nigh neutralize the effort to submit even an approximate ex-
hibit of the ravages of preventable diseases and mortality
statistics. The blame rests upon the Legislature for neglecting
to pass effective laws for protection against small-pox, an
efficient registration law, and for not making needful and
timely appropriations for the work of the board, in default of
which thousands of lives have been lost and over $300,cnx)
wasted.

For the month of December^ 1888, the Secretary's abstract of
the reports received from 75 cities and towns, with an aggre-
gate population of 700,600, the number of deaths was 917,
" exclusive of those towns reporting no deaths, having a popu-
lation of 10,500, so that actually in a population of 719,100,
the mortality gives the exceedingly low percentage of 1.27
per 1000 for the month of December, when the death-rate is
cxpectedly increased everywhere within the temperate zone."
Annual rate, 14.55. Deaths from consumption during the
month, 137 ; percentage of total, 14.9, which, it will be ob-
served in this exceptional month upon reliable returns from 75
localities, is much larger than for the estimated returns in the
biennial report, though a decrease on the preceding month.
From pneumonia 90, against 108 in November. From zymotic
diseases : Diphtheria and croup, 56 ; typhoid-fever, 36 ; typho-
malarial fever, 4 ; remittent and intermittent fevers, 5 ; cerebro-

JSaUar's TaMe. 157

spinal fever, 7 ; diarrhoeal diseases, 6 ; whooping-cough, 4 ;
scarlatina, 3 ; small-pox (in San Francisco), 2.

San Francises. — Health Department reports for the fiscal
year ending June 30th, 1888 : Population, 330,000 ; deaths,
530 Chinese, 5506 other nationalities. Death-rate, 18.27.
Estimating the Chinese population at 30,000, their death-rate
was 17.63 ; of other nationalities, exclusive of Chinese, 300,-
000, death-rate was 18.36. Deaths from zymotic diseases
during the year : Small-pox, 67 ; diphtheria and croup, 241 ;
typhoid-fever, 152; scarlatina, 28; cholera infantum, 94;
cerebro-spinal meningitis, 64 ; other zymotic diseases, 242 :
888. From consumption, 905 — 15 per cent of total.

The small-pox epidemic is reported in detail. Forty-five
Chinese cases were landed from the steamers. In the city,
the Chinese never report cases, and usually the finding of the
dead body of some one who had died of the disease was the
first intimation of its existence. The cost of the epidemic has
already been referred to. More than 80,000 vaccinations were
effected, and for the vaccine matter alone, $7526.80 was paid.

In default of a quarantine station — ** During the prevalence
of small-pox, the steamship companies were obliged to detain
the passengers on floating hulks at a great expense to them-
selves and inconvenience to the passengers. In one instance,
several hundreds of Chinese were cooped up for more than a
month on a hulk exposed to the ravages of both typhus-fever
and small-pox. On another occasion a quarantine ship was
wrecked in the bay during a severe gale, the passengers barely
escaping with their lives."

A properly equipped quarantine is an urgent necessity.
*' Certain factories employed in the business of making mat-
tresses, coverlets, and other articles, were found using un-
cleaned rags for the purpose. The Board of Health at once in-
sisted upon the cleaning and disinfection of these rags before
use. A microscopical investigation of these rags was made,
the result being that the germs discovered (on being cultivated)
were found to be capable of producing infectious diseases."

Each factory was directed to erect and use a steam disin-
fecting apparatus, on a plan devised by the Health Depart-
ment.

During the month of December, 1888, the number of

158 mUor's Tabu.

deaths was 473. From zymotic diseases, 48 ; 2 of which were
from small-pox. From consumption, 83 — 17.5 per cent.

Los Angeles y 80,000: 65 ; from zymotic diseases, 15 ; con-
sumption, 10.

Oakland^ SSiOOO : 65 ; from zymotic diseases, 7 ; consump-
tion, 5.

San Diego, 32*000 : 12 ; from zymotic diseases, 2 ; con-
sumption« 12.

SacratnentOy 30,000 : 47 ; from zymotic diseases, 12 ; con-
sumption, 4.

Connecticut. — The Secretary of the State Board of Health
reports for December, 1888, 950 deaths from 167 towns, com-
prising a population of 737,276, representing an annual death-
rate of 15.4. Deaths under five years of age, 174 — 18.3 per
cent. Deaths from zymotic diseases, 136 — 14.3 per cent.
From consumption, 125 — 13 per cent.

In New Haven, during the year 1888, the number of deaths
from typhoid-fever and diphtheria has been nearly twice that
in 1887. There have been 150 more deaths in New Haven
during the year 1888 than in the previous year.

Florida. — ** Gainesville^ January 3d, 1889. — That you may
have all necessary information relative to the health of Gaines-
ville, Fla., since Dr. Martin concluded his labors here, I will
report that during the month of December and up to this time,
there has been only one case of yellow-fever. This case oc-
curred just outside the corporate limits in the person of a Mr.
York, a carpenter, who had worked, however, daily in the city.
He was taken on the i8th (December), and died on the 22d.
His case was typical, unmistakable. The two succeeding
nights after he was taken were quite cold, ice forming each
night, and no other cases have occurred. I feel confident
that there will be no other cases now. The same precautions
were taken relative to this case that were taken during the ex-
istence of the epidemic — ^bedding burned, house fumigated,
family isolated," etc. N. D. Phillips, M.D., to Surgeon-
General Hamilton. " In the opinion of this bureau, travel
may safely be resumed throughout the State. An inspection
service will be maintained, and in case of any appearance of

EdUar's TabU. 159

fever, the public will be notified." — Weekly Abstract of Sani-
tary Reports^ United States Marine- Hospital Service, January
lUA, 1889.

The Governor has called an extra session of the State
Legidature for the purpose of establishing a State Board of
Health.

Pensacola. — Board of Health report : ** Mortality for week
ending Saturday, January 19th, 1889. Estimated population,
15,000. Deaths, 5. Death-rate per 1000 per annunty 1.73."
There is an evident mistake in the decimal point, for, accord-
ing to our calculation, 5 deaths in seven days in 15,000 is equal
to 260.7 for the year, and to an annual death-rate of 17.38 per
looo.

Report for the week ending January 26th, no death. Pen-
sacola appears to be a healthful city, and the Board of Health
can well afford to make correct reports.

Iowa. — Monthly Bulletin for December reports :

Keokuk. — November. — No deaths from contagious diseases.
Total deaths, 14. Death-rate 1000, 0.88.

Dubuque. — October — Membranous croup, i ; whooping-
cough. Total deaths, 23. Death-rate, 7.88.

Davenport, — -November — Diphtheria, 16; membranous
croup, 4; croup, 2. Total deaths, 41. Death-rate, 14.59.

Burlington. — Deaths from diphtheria from November ist to
December 17th, 7. Several deaths from membranous croup.

Des Moines.^ November — Typhoid-fever, 2. Total deaths, 23.

Fort Madison. — November — Croup, i. Total deaths, 6.
Death- rate, 0.75.

The interest of this report would be greatly increased by
giving the latest estimated populations of the several locali-
ties, and by uniformly giving the annual death-rates.

Illinois. — ** It is a matter of record — a fact which I under
stand has now passed into the authentic history of epidemics
in this country," says Governor Oglesby in his message to
the General Assembly, January 9th, 1889, " that the labors of
the State Board of Health in this direction resulted in a saving
of nearly $3,500,000 to the people of the State in 1881 and
1882, when srnall-pox was epidemic. Through the preventive

160 Editor's Table.

and protective measures then established and since enforced,
there has been no repetition of that disease in an epidemic
form.

** The wise and inteHigent policy of the Board on the sub-
ject of quarantine has been of great value to the material in-
terests, not only of Illinois, but of the whole Mississippi Val-
ley. While vigilantly guarding agfainst the introduction and
spread of the dangerous, contagious, and infectious diseases,
it secures the least interference with commerce and travel, and
so averts unfounded panics and prevents loss and interruption
of business and industry. During the past few months a
striking illustration of the value of this policy was afforded by
the action of the worthy Secretary of the Board, who refused
to sanction any expenditure of money from the public treasury
in the maintenance of quarantine restrictions, which his wide
and varied experience and scientific knowledge enabled him
to pronounce unnecessary for the State. His firmness in this
instance alone prevented the loss of thousands of dollars, be-
sides great inconvenience to travellers and vexatious interfer-
ence with business ; and the example thus set materially helped
to check the ruinous and needless quarantine enforced in other
States.

*' In 1883 the Board began a sanitary survey of the State,
with the object of preparing it against a threatened invasion
of Asiatic cholera. This work, which is still being prosecuted,
embraces a house-to-house inspection, which results in abate-
ment of private as well as public nuisances, in the sanitary de-
fects and unhealthy conditions. It is claimed that in conse-
quence of this work the cities, towns, and villages of Illinois
have steadily improved in their sanitary conditions, until the
State is now one of the healthiest and most favorable to long
and vigorous life of any in the Union.

** An important agency in the preservation of health is an
abundant supply of pure water. . . . The Secretary of
the Board has made the pollution of streams and the character
of water supplies the subject of personal study for many years,
and an exhaustive investigation, involving hundreds of chem-
ical analyses, microscopic and biologic examinations, and the
engineering questions involved, is now being made by the
Board under his immediate supervision. . . . There is

Editor's Table. 161

reason to anticipate from these, in many localities, an abun-
dant supply of pure water, not liable to contamination from
sewage or other pollution, and constant at all seasons. If
these expectations are realized, not only communities but in-
dividuals— farmers, stock raisers, manufacturers, and others —
will be largely benefited by this work of the Board.

** A separate and distinct line of duty and responsibility is
devolved upon the Board by the Medical Practice Act. Dur-
ing less than the twelve years of its existence, this act has done
much to protect the sick and the afflicted from charlatans and
quacks ; it has driven out of the State most of the ignorant,
unqualified, and unprincipled men who were preying upon the
miseries of their fellows ; and it is not too much to say that
it has elevated and ennobled the practice of medicine, both
in the State and throughout the country. The methods of
medical education have been improved as a consequence, and
the standard of attainments required of the physician who is
to deal with the weighty questions of health and disease, and
of life and death, is being steadily raised.

** The Illinois State Board of Health is now regarded as the
pioneer in this work, and it is quoted as authority both in thi.3
country and abroad. Since the passage of the amended act
— in force July ist, 1887— the Board has refused licenses to
itinerant vendors of nostrums, with show accompaniments ;
the amount of these licenses would aggregate over $20,000,
but the sum which the itinerants would fleece from the cred-
ulous would figure up hundreds of thousands a year.

" That the Board has been prudent and economical in the
expenditure of appropriations subject to its order, is manifest
from the fact that the contingent sum of $40,000 for 1885-
86 was conveyed back into the Treasury untouched. Of a
similar amount appropriated for 18^7-88, only a small amount
has been expended. I recommend the usual appropriations
to sustain the Board and continue its usefulness to the State ;
and have no doubt that it will be wise to continue the usual
contingent appropriation."

Chicago^ 800,000 : Reports 1166 deaths during December, of
which 488 were under five years of age. Annual death-rate,
17.49 P^*" icxx). From zymotic diseases, 250, and from con-
sumption, 104.
II

162

Editor's Table.

Maine. — The Secretary of the State Board has issued a cir-
cular urging the necessity of isolating infectious diseases, and
the importance of reporting and prompt action in first cases.
That, '* Every house in which a case of diphtheria or scarlet-
fever exists should be placarded, the teachers of the schools
in the neighborhood should be notified, and children from in-
fected houses should strictly be excluded from school, Sabbath
school, churches, and all places where they would be liable to
infect other persons."

Maryland. — Baltimore^ 431,879: Reports 780 deaths dur-
ing the five weeks ending December 29th, of which 272 were
under five years of age. Annual death-rate, 18.77 P^*" lOOO.
From zymotic diseases, 84, and from consumption, 113.

Massachusetts.— The Forty-sixth Report to the Legis-
lature relating to the Registration and Return of Births, Mar-
riages, and Deaths in the Commonwealth, together with the
reports relating to the returns of libels for divorce, and to the
returns of deaths investigated by the Medical Examiners for
the year 1887, is a volume of 440 pages, chiefly statistical.

There were during the year: Marriages, 19,533; births,
53,174 ; deaths, 40,763. Estimating the population at 2,010,-
388, on the ratio of increase from the State census of 1885, the
rates per 1000 of population for the year 1887, and the aver-
age for periods of five years preceding, and for the year 1888,
were as follows :

1887
1885
1880

1875

1870

*i865

i860

i8S5
1888

marriages.

1 1

« t

1 1

< «

i»

««

1 1

1 4

9.72

9-03
8.00

9.09

10.05

4.03
9.08

11.07

9.12

births, 26.45
25.01
24.08
27.06
26.01
25.04
29.05
28.08
25.69

« «

I <

f i

• 1

i i

< I

«<

1 1

deaths, 20.28
19.08
19.02
20.08
18.02
20.07
17.09
18.07
18.85

t «

1 1

« «

1 1

( t

« t

« I

«<

Of the causes of death, 19.07 per cent were caused by zy-
motic diseases ; in 1886, 18.05 \ '^^ 1885, 19.00 ; in 1878, 25.02,

* Including the years of the Civil War.

Edii&r's TaMe. 163

and for ten years previous, 21.05. There was, also, for the
same period a decrease in the percentage of deaths from con-
stitutional disease from 25.02 to 22.06. Deaths from local dis-
eases increased from 34.07 to 42.27 per cent. Consumption
caused 5871 deaths — 14.40 per cent of all deaths during the
year, and at the rate of 1.02 per 1000 of the living, in the de-
cade 1878-87, a decrease from 1.39 in the decade 1868-77*

The Medical Examiners report 1556 deaths investigated, of
which 52 were from homicide, 173 suicide, 748 accident or
negligence.

Divorces, 796 : i to 24 marriages ; an increase from an
average of i in 32.07 in the ten years, 1868-77, to i in 27.07 in
the ten years, 1878-87.

Boston, 415,000: Reports 781 deaths during December, of
which 233 were under five years of age. Annual death-rate,
22.05 P^"" looo.

There were ii8desLths from zymotic diseases, and 135 from
consumption. For the year 1888 there were 10,197 deaths —
3599 under five years of age. Annual death-rate, 24.57 per
1000.

There were 1841 deaths from zymotic diseases, and 1464
from consumption.

Michigan. — The Secretary reports that, for the month of
December, 1888, compared with the preceding month, pneu-
monia and consumption of lungs increased, and that typho-
malarial fever decreased in prevalence.

Compared with the preceding month, the temperature in
the month of December, 1888, was lower, the absolute humid-
ity was less, the relative humidity and the day ozone and the
night ozone were more.

Compared with the average for the month of December in
the nine years, 1879-87, intermittent-fever, consumption of
lungs, inflammation of kidney, tonsillitis, and remittent-fever
were less prevalent in December, 1888.

For the month of December, 1888, compared with the aver-
age of corresponding months in the nine years, 1879-87^ the
temperature was higher, the absolute humidity was more, the
relative humidity and the day and the night ozone were less.

Including reports by regular observers and others, diphtheria

164 EcUUyr'a Table.

was reported present in Michigan in the month of December,

1888, at fifty-two places, scarlet-fever at fifty-seven places,
typhoid-fever at thirty places, measles at ten places, and
small-pox at six places.

Reports from all sources show diphtheria reported at twenty-
six places more, scarlet-fever at sixteen places more, typhoid-
fever at seven places more, measles at four places more, and
small-pox at one place less in December, 1888, than in the
preceding month.

Detroit^ 230,000 : Reports 284 deaths for December, of
which 71 were under five years of age. Annual death-rate,
14.53 pci" 1000. From zymotic causes, 61, and from consump-
tion, 23.

Minnesota. — The Secretary reports the distribution and
mortality of specified diseases in Minnesota, for the months
of November and December, 1888 :

Diphtheria, cases, 223 ; deaths, 56 ; scarlatina, cases, 52 ;
deaths, 6.

Diseases of animals : Cases of glanders remaining isolated
or not accounted for, 31 ; reported during the months, 8 ;
killed, ID ; released, 14 ; isolated, 4. Remaining January ist,

1889, isolated or not accounted for, 15. Most of these are cases
exposed, and isolated for further observation.

'* The death-rate in Minnesota has steadily decreased dur-
ing the last five years. In 1883 the death-rate per 1000 of
the population was 11.46; in 1886, the rate was 11.06; and
in 1887, 9.9. Very few understand what so apparently trivial
a reduction as 1.06 in 1000, or o. 106 per cent, means here. It
represents the saving of human lives between 1886 and 1887,
and it means that 1438 men, women, and children escaped
death who, had the mortality rate of 1886 continued in 1887,
would have died.

>>

Missouri. — At a conference of local health oflRcials, held
by invitation of the State Board of Health at St. Louis, De-
cember 4th, 1888, Dr. George Homan, Secretary, after ex-
plaining the urgent necessity for such action, submitted a pro-
posed bill by the State Board of Health for an act to create
county and other local boards of health, defining their duties

Editor's TahU. 166

and powers, and providing for the compensation of their mem-
bers and officers. The objects of the proposed bill were
briefly stated to be " to make quarantine regulations more
simple and effective, to facilitate and encourage the registra-
tion of births and deaths and other vital statistics, by provid*
ing compensation for the county officials charged with such
duty, and requiring the State Board to make biennial reports
to the Legislature instead of annually, as now, to the Gov-
ernor, the executive to have the right to call for special re-
ports by the Board on public health matters at any time.'*
The proposition was approved and recommended to the Leg-
islature for enactment.

As an incentive to such legislative action as the Conference
recommended, Dr. Homan submitted :

A Graduated List Showing t/te Total Amounts of Appropriated
Revenue Available in the Year iZiifor General and Special
Public Health Uses and Prevention of Epidemics by the Vari-
ous State Boards of Health in the United States.

The plus mark (+) affixed to the totals appropriated of cer-
tain of the States indicates additional sources of revenue or
advantage, as epidemic funds without definite limit, fees from
different sources, free printing, etc. Arranged by the Secre-
tary of the State Board of Health of Missouri.

Massachusetts, $111,300; Texas, $61,000; Illinois, $49,-
0004- ; Mississippi, $46,550 ; Minnesota, $29,000 ; New York,
$25,000 ; New Jersey, $21,500+ ; Wisconsin, $20,500 ; Michi-
gan, $16,145-}-; Alabama, $13,000; Maryland, $13,000;
California, $12,500; Connecticut, $10,000+; New Hamp-
shire, $8500+ ; North Carolina, $5500+ ; Indiana, $5000+ ;
Iowa, $5000+ ; Louisiana, $5000+ ; Pennsylvania, $5000+ ;
Maine, $5000 ; Kansas, $4500 ; Ohio, $4000 ; South Carolina,
$4000 ; Tennessee, $3000+ ; Rhode Island, $2700+ ; Ken-
tucky, $2500+ ; Vermont, $2500 ; West Virginia, $2000 ;
Delaware, $350.

The communication was ordered made a part of the pro-
ceedings ; and the following resolution adopted :

Resolvedy That we hereby endorse, and by this action would
extend our thanks to our very efficient State Board of Health,
who have, without remuneration from the State, and at great

166 JEditor'9 T(Me.

expense to themselves individually, attended to all the duties
contemplated in the execution of our State law governing the
Board of Health.

• St. Louis, 420,000 : Reports for December 648 deaths, of
which 240 were under five years of age. Annual death-rate,
17.67 per 1000. From zymotic diseases there were 162
deaths, and from consumption, 72.

New Hampshire.— Seventh Annual Report of the State
JBoard of Health, for the fiscal year ending April 30th, 1888,
pp. 326. The increased demand for the services of the Board
during the year is very properly interpreted in the opening re-
marks of the report, to mean a better appreciation of its work
by the people, an intelligent recognition of the value of prac-
tical sanitation in the promotion of their best interests.

Sanitation at summer resorts, drainage and sewerage, public
water supplies, the condition of almshouses, school-houses,
notification and restriction of infectious and contagious diseases
have been, as in previous years, subjects of primary impor-
tance in measures for the protection of the health of the people.

The total number of deaths reported for the year 1887, ex-
clusive of still and premature births, was 6250. The death-
rate per 1000, based upon the last census, was 18.01. Over <
one fifth of all the decedents was under five years of age ; 776
—12.41 per cent — were caused by consumption.

In a special paper on the '* Extent and Distribution of Con-
sumption in New Hampshire," by Irving A. Watson, Secre-
tary of the Board, it is shown that the danger of contracting
this disease is about equal at all periods of life, and not, ac-
cording to the popular idea, shared to some extent by the
medical profession. The apparent greater susceptibility dur-
ing a particular period of life, between twenty and thirty years
of age, is chiefly due to the fact that there are more persons
living at that period.

** The average death-rate from consumption for the years
1885, 1886, and 1887, is 12.86 per cent of the total mortality
of the State. In Massachusetts, for the ten years ending 1886,
deaths from consumption averaged 16. 10 per cent of the total
mortality ; and in Rhode Island, for a period of twenty- five
years ending 1884, 16.30 per cent."

Editor's Tabu. 167

Of zymotic diseases, the number of deaths from diphtlxeria
was 175, against 156 in the previous year, 78 in 1883, no in
1884, and 109 in 1883 ; 84 deaths were returned from croup.
Typhoid- fever, 134, including 8 reported *' fever," 7 bilious-
fever, and I typho-malarial fever ; and yet the lowest annual
mortality from this cause since a registration report has been
published, the next being in 1885, when 136 deaths were re-
ported ; in 1886 there were 193. A fuller and more minute
report of the vital statistics of the State is deferred to the reg-
istration report, to be made hereafter.

New Jersey. — Hudson County, 270,232 : Reports 606 deaths
for December, of which 270 were under five years of age.
Annual death-rate, 26.9 per .looo. From zymotic diseases
there were 131 deaths, and from consumption, 63.

Newark^ 178,033 : Reports for December 292 deaths, of
which 97 were under five years of age. Annual death-rate,
19.68 per 1000. There were 39 deaths from zymotic diseases,
and 34 from consumption.

Paterson^ 80,000 : Reports 121 deaths during December, of
which 39 were under five years of age. Annual death-rate,
18. 1 per 1000. There were 16 deaths from zymotic diseases,
and 17 from consumption.

New York.— Official Bulletin of the Secretary reports 8369
deaths during the month of December (7886 in December,
1887), ^^ which 7050 were reported from a population of 3,862,-
000, including all the cities and larger villages, giving a death-
rate of 21.90 per 1000 annually. The infant death-rate is
lower than in December, 1887. Zymotic diseases caused 17.90
per cent of the total mortality (19.00 in December, 1888, and
17.48 in November, 1888). There is an increase in the preva-
lence of scarlet-fever and diphtheria. Small-pox is reported
from Lyons, Rome, Newark, Middlebury, Wyoming County,
Rochester, Malone, and Weyland, Steuben County ; it also
exists, as previously reported, at Troy, Syracuse, and Frank-
fort. Consumption caused 11.67 per cent of all deaths, and
17.31 per cent of deaths above five years of age. From acute
respiratory diseases, 16.63 per cent of all deaths occurred.

Severally, the populations and death-rates are as follows :

168 Editor's Table.

Maritime District. — New York City^ I,526y08i» 25.17;
Brooklyn, 757,755, 22.93; Gravesend, 5000, 24.00 ; New
Utrecht, 4742, 27.80 ; Long Island City, 21,000, 25.14 ; New-
town, 10,000, 13.20; Oyster Bay, 12,000,18.00; Hempstead,
18,000, 12.00 ; North Hempstead, 8000, 12.00 ; Huntington,
8100, 10.36; Jamaica, 10,089, 19.00; Southold, 7267, 14.80;
Sag Harbor, 3000, 8.00; New Brighton, 15,000, 15.20; Edge-
water, 12,000, 17.00 ; Northfield, 7014, 29.14 ; Westfield, 7000,
25.85; Yonkers, 30,000, 20.40; Westchester, 6900, 20.57;
Sing Sing, 6500, 14.77 I New Rochelle, 5500, 17.45 ; Port
Chester, 4000, 3.00.

Hudson Valley District. — Albany, 102,909, 21.11; Cohoes,
20,000, 19.20; Troy, 65,000, 24.74; West Troy, 13,000, 24.-
00 ; Hoosick Falls, 6000, 10.00 ; Lansingburg, 10,000, 20.70 ;
Green Island, 5000, 26.40; Greenbush, 8000, 19.50; Cox-
sackie, 4000, 12.00; Catskill, 4500, 21.33; Hudson, 10,000,
12.00; Kingston, 21,000, 13.14; Ellenville, 3000, 24.00;
Marbletown, 4000, 30.00 ; Esopus, 4736, 8.45 ; Saugerties,
4000, 9.00; Poughkeepsie, 20,200, 23.36; Fishkill, 10,732,

; Wappinger Falls, 5000, 14.40; Newburg, 20,000, 18.-

00; Port Jervis, 9500, 15.38; Middletown, 10,000, 27.60;
Goshen, 4387, 19. 14 ; Ramapo, 5000, 24.60 ; Haverstraw,
7000, 15.43.

Adirondack and Northern District. — Greenwich, 3861, 6.20;
Argyle, 3700, 6.50; Salem, 3500, 24.00; Fort Ann, 4267,
8.40; Fort Edward, 4880, 7.35 ; Glens Falls, 10,000, 14.40;

Crown Point, 4287, ; Malone, 9000, 15.67; Potsdam,

4000, 9.00; Ogdensburg, 11,000, 27.27; Gouvemeur, 5500,

17.45; Plattsburg, 7000, ; Watertown, 12,200, 19.67;

Lowville, 3188, ; Clayton, 4314, 13.00; Ellisburgh,

481 1, 22.45.

Mohawk Valley District. — Schenectady, 20,000, 12.60;

Schoharie, 3350, ; Cobleskill, 3371, 14.28 ; Middleburgh,

8376, ; Amsterdam, 14,000, 10.80 ; Johnstown, 6000,

16.00 ; Gloversville, 10,000, 16.80 ; Little Falls, 7200, 20.00 ;
Herkimer, 3000, 16.00; Ilion, 4200, 8.57; Utica, 43,000,
17.86; Rome, 12,045, 10.00; Boonville, 4000, 12.00; Cam-
den, 3400, 24.70 ; Waterford, 5400, 28.89 ; Ballston Spa,
3200, 11.23 ; Saratoga Springs, 10,000, 24.90.

Southern Tier District. — Binghamton, 30,000, 14.40 ; Owe-

Editor's Table. 169

go, 6cxx>, 1 2.00; Candor, 4323, 5.50; Waverly, 3000, 20.00;
Hornellsville, 10,000, ; Elmira, 25,000, 18.00 ; Horse-
heads, 3500, 27.42 ; Bath, 3500, 17.14 ; Coming, 8000, 12.00 ;
Olean, 8000, 15.00; Salamanca, 6000, 4.00; Jamestown, 14,-
000, 11.20; Westfield, 3000, 16.00.

East Central District. — Walton, 3540, 10.20; Delhi, 3000,
8.00 ; Cooperstown, 3000, 12.00 ; Oneonta, 7000, 15.43 ; Wor-
cester, 3000, 4.00 ; Cazenovia, 4363, 8.22 ; Brookfield, 3685,
13.00; Hamilton, 3912, 15.38; Baldwinsville, 3000,4.00;

Skaneateles, 4866, ; Syracuse, 80,000, 16.80 ; Cortland,

9000, 14.66 ; Homer, 3000, 32.00.

West Central District. — Auburn, 26,000, 14.30; Ithaca, 10,-
000, 15.60; Groton, 3450, 17.14; Waterloo, 4500, 21.33;
Hector, 5000, 12.00 ; Manchester, 4000, 6.00 ; Phelps, 7000,

; Canandaigua, 6300, 15.40 ; Geneva, 6000, 27.00 ; Penn

Yan, 4500, 18.67 ; Dansville, 3700, ; Batavia, 7000,

Lake Ontario and Western District. — Oswego, 24,000, 14.00 ;
Richland, 4000, 18.00 ; Fulton, 4000, 12.00 ; Clyde, 3000,
18.00; Lyons, 6000, 10.00; Newark, 3500, 10.30; Palmyra,
4800, 6.00; Rochester, 110,000, 20.72.; Brockport, 4500,

; Medina, 4000, 24.00; Albion, 5000, 28.80; Buffalo,

230,000, 16.22 ; Tonawanda, 4900, 16.80 ; Amherst, 4578,
; Lockport, 15,000, .

North Carolina. — Official summary of the mortality re-
turns for twelve towns, giving a total population of , for

the month of November, 1888 : There was i death from
typhoid-fever ; 2 from malarial-fever ; 8 from diphtheria ; 6
from pneumonia ; 14 from consumption ; 5 from heart disease ;
8 from brain disease ; 10 from diarrhceal disease ; 2 from acci-
dent ; 42 from all other diseases, and 2 from suicide.

The mortality rates of the chief towns were : Of Durham,
white, 12.00, colored, 24.18; Charlotte, white, 12*1, colored,
24.0: 1 5. 1. Fayetteville, white, 7.02^ colored, 24.0: 12. i ;
Goldsboro', white, 7.02, colored, 12.8: 12. i. New Berne,
white, 12.0, colored, 24.0 : 18.0. Raleigh, white, 7.2, colored,
12.8 : 12. 1. Washington, white, 12.6, colored, 8.6. Wilming-
ton, white, 7.2, colored, 13.0 : ii.o. Henderson, white, ,

colored, 24.3 : 12. i. Oxford, white, 12.6, colored, 6.0; 9.6.

170 EdiUyr'a TaUe.

Ohio. — Official Monthly Record of the Secretary reports
nil deaths during the month of December, representing an
annual death-rate per looo population of 47 cities and towns
of 13.78. Deaths under five years of age, 332. From zymotic
diseases, 196 — chiefly croup and diphtheria, 50 ; typhoid-fever,
35 ; scarlatina, 5 ; whooping-cough, 10. Deaths from con-
sumption, 139. Severally, the populations and death-rates
were as follows :

Akron, 30,000, 6.40; Alliance, 7000, 18.85; Ashtabula,
6500, 24.00 ; Ashley, 800, 45.00 ; Bellaire, 12,000, 13.00 ; Belle-
vue, 3500, 13.71 ; Bloomingburg, 800,45.00; Canton, 25,000,
I3»^9; Chagrin Falls, 1400, 17.13; Chillicothe, 14,000, 6.00;
Cincinnatf, 325,000, 16.06; Cleveland, 225,000, 11.57; Clyde,
3000, 8.00; Columbus, 101,000, 10.93 ; Conneaut, 1500, 24.00;
Cuyahoga Falls, 2800, 17.14; Dayton, 52,000, 13.20; Defi-
ance, 7000, 17.14; Delaware, 9000, 17.33; East Liverpool,
10,000, 26.40; East Palestine, 1600, 30.00; Forest, 1300,
18.46; Gallon, 6000, 22.00 ; Galipolis, 5000, 31.20 ; Hamilton,
20,000, 9.00; Hartwell, 2000, 18.00; Huron, iioo, 21.61;
Kent, 3750, 12.80; Logan, 3700, 13.00; Mansfield, 15,000,
4.00; Marion, 8000,-10.50; Middletown, 7000, 18.85; Min-
ster, 1500, 10.00; Mt. Sterling, 950, 50.52; Mt. Vernon,
6000, 12.00; Monroeville, 1500, 16.00; Nelson ville, 5000,
9.60 ; New Straitsville, 3000, 12.00 ; North Amherst, 1600,
22.50; Oberlin, 4000, 6.00; Oxford, 2000, 30.00; Piqua,
10,000, 18.00; Plymouth, 1500, 24.00; Portsmouth, 14,000,
1 1. 13 ; Ravenna, 4000, 9.00 ; St. Mary's, 2500, 24.00 ; Shaw-
nee, 4000, 9.00 ; Shelby, 2500, 9.60 ; Springboro*, 500, 72.00 ;
Toledo, 80,000, 11.70; Urbana, 8000, 12.00; Versailles,
1900, 15.17; Wadsworth, 2500, 24.00; Washington Court-
House, 5200, 18.46 ; Wapakoneta, 3300, 10.91 ; Warren, 8000,
3.00 ; Winchester, 1000, 84.00 ; Westminster, 1000, 24.00 ;
Wooster, 8500, 9.88 ; Xenia, jo,ooo, 10.80; Youngstown, 24,
300, 14.81.

Cincinnati, — Twenty-first Annual Report of the Health De-
partment, for the year ending December 31st, 1887 : The late
presentation is due to the death of the late registrar of vital
statistics, after a long-continued illness, and consequent ac-
cumulation of work which devolved upon his successor.
The number of deaths recorded for the year was 6490, an in-

Mitor's TalU,

171

crease of 320 over the previous year. Based on an estimated
population of 325,ocx>, the death-rate was 19.97 ; 883, or 54.74
per cent, of the decedents were of children under five years of
age, 161 3, 24,23 per cent, were caused by zymotic diseases,
and 817, 12.59 per cent, by consumption ; 494 were caused by
pneumonia, and 243 by bronchitis.

Of the zymotic diseases, there were from typhoid-fever, 403
deaths, just one less than twice the mortality from the same
cause of any preceding year on record ; from diarrhoeal dis-
eases, 535, 99 more than during the previous year. It is in-
teresting to observe in connection with this excessive preva-
lence of typhoid-fever and other intestinal diseases, that an
analysis of the drinking water at about the time of their great-
est prevalence showed, in samples of one hundred thousand
parts by weight, taken from the localities designated, the follow-
ing results :

Stage of River, 36 Inches.— Locauty.

Pumping- works

Eden Park Reservoir

Ohio River, three miles above the)
month of the Little Miami River. . . f
Sewage

Ammonia.

Residues Dried at |

aia» r.

i

•

■O ft

•0

•

•

1

0 a

u

9«;

S

Ibumin
Ammo

p

rganic
VoUtil

fe

<

>*

0

H

O.OI38

0.0097

9.2

7.5

16.7

0.018

0.0084

10.7

6.1

16.8

0 0054

0.0074

10.3

5.4

15.7

0.7200

I.II50

121. 4

82.2

203.6

V

.9
o

O

1.85
1.76

1.70

8.30

** The sewage given in the table was taken because of its
close proximity to the intake. It is a surface drain of some
size, and serves as a receptacle for all manner of filth from
several tenement-houses located along its course. A portion
of its contents cannot fail to enter the intake whenever the
river has a depth of less than fourteen feet— a state of affairs
generally occurring during four or five months of each year.

*' The pipes leading out into the river have been blocked up
during the last fifteen or twenty years, it having been found
impossible to keep them open on account of 'drift.' The
shorewater coming from the densely-settled district above,
charged with sewage, is taken directly in through the arch at
the river wall at the pumping-house and forced up into the
reservoir. Many drains and four sewers, with an unknown

172 EdUor'a TabU.

«•

i f

number of water-closets emptying into them, are located above
the water-works.

C. R. Holmes, M.D.

Karl Lange^beck, Anafyf teal CAemist/*

After a general review of the deficiencies, in concluding his
report, the health officer urges the following important sub-
jects as eminently necessary for the promotion of the health of
the city :

" Improvement in the water-supply ; extension of the sew-
erage system ; compulsory connection with sewers when built,
and abandonment of the present system of vaults ; incinera-
tion and more frequent removal of garbage, and more rigid
enforcement of the ordinances against the mixing of garbage
and ashes ; removal of all insanitary conditions which are a
standing invitation to disease, and the rigid enforcement of
all laws and regulations in regard to sale of adulterated or un-
sound articles of food.'*

Pennsylvania.— i%/Az^i^//M: Bureau of Health reports for
the year ending December 31st, 1887 • Births, 24,113, an in-
crease of 892 over the preceding year ; marriages, 6355, an in-
crease of 140 ; deaths (exclusive of 1507 still and premature
births), 21,719, an increase of 1714 — 9086 were of children
under five years of age. Death-rate, on estimated population
of 993,801, 21.85, ^^^ the exact average rate for twenty-seven
years previous. The highest and the lowest rates, respective-
ly, were (in 1872), 26.19 ^ind (in 1879) ^7-^71 2800, 12.89
per cent from all causes, were caused by consumption, a de-
crease of 34 from the previous year, but 480 more than the
annual average for the preceding twenty-six years. But there
were besides 63 deaths from hemorrhage of the lungs, and 37
from consumption of the bowels, larynx, and throat.

Three thousand five hundred and seventy-two were caused
by zymotic diseases, of which the chief were : diarrhceal dis-
eases, 1 187 ; typhoid-fever, 621 ; croup, 442 ; diphtheria, 416 ;
measles, 358; scarlet-fever, 159 ; whooping-cough, 130 ; septi-
caemia, 69 ; erysipelas, 59 ; cerebro -spinal fever, 45.

Total deaths from typhoid-fever for twenty-seven years, 1861
to 1887, inclusive, 13,657, an annual average of 505.8. The
largest number in any one year was 773, in 1865 ; the small-
est in 1879, 344- The number for 1887 was three greater only

Editor's Table. 173

than in 1886, and one less only than the average for the five
years preceding. Estimated by the usual rate of mortality,
the average number of cases of typhoid>fever in Philadelphia,
annually, for several years, is about 8000.

Reports for five weeks ending December 29th : Population,
1,016,758 ; the number of deaths was 1665, of which 553 were
under five years of age. Annual death-rate per 1000, 17.2.
From zymotic diseases, 196, and from consumption, 251.

Pittsburgh^ 230,000 : Reports for three weeks ending De-
cember 29th, 194 deaths, of which 75 were under five years of
age. Annual death-rate, 15.0 per 1000. From zymotic dis-
eases, 26, and from consumption, 14.

Rhode Island. — Newport, 22,000 : Reports for December
22 deaths — 4 under five years of age. Annual death-rate,
12.0 per 1000. From zymotic diseases there was but one
death, and from consumption none.

During the year 1888 there were 315 deaths — 99 under five
years of age. Annual death-rate per 1000, 14.31.

Deaths from zymotic diseases, 68, and from consumption, 25.

Texas.— Report of Texas Quarantine for 1887-88, by
R. Rutherford, M.D., State Health Officer, shows a justifiable
pride in the result of his constant vigilance and prompt action
against all the avenues of yellow-fever, considering the local
and climatic conditions of numerous harbors of that State in
commercial relations with Vera Cruz, Tampico, and other
places where yellow-fever is wont to prevail, and the special
danger of the recent epidemic in Florida. To the few people
in Texas who are disposed to condemn the whole system of
quarantine as a useless expenditure, he addresses the question
whether, ** from 1837 ^^ 1867, there was ever two years con-
secutive in the cities contiguous to our coast between these
dates that yellow -fever was not epidemic in some one of them ;
and further, that since 1878 no epidemic of any serious nature
has occurred, they are not indebted to the quarantine system
of the State for the immunity. Even during those years when
fever did obtain a foothold it was due and directly traceable to
negligence of the rational rules governing this source of pro-
tection.

'* With the yellow-fever epidemic still in a number of towns
in Florida, and undoubted past evidence that it will hibernate

174 Editor's TaUe.

there, demands of the Legislature a more liberal appropria-
tion to meet exigencies almost beyond doubt foreshadowed."

Wisconsin. — Milwaukee, 195,000 : Reports 262 deaths in
December, of which 1 16 were under five years of age. Annual
death rate, 16. i per 1000. From zymotic diseases there were
57 deaths, and from consumption, 19.

Canada. — Montreal, 189,051 : Deaths reported for the
month of December, 461 ; under five years of age, 240 ; from
zymotic diseases, 147, of which 121 were from diphtheria and
croup. Deaths from consumption, 37 — 8.03 per cent of total.
Death-rate, 28.5.

Cuba. —Havana, 200,000 : Deaths reported for the month
of December 566, under five years of age, 133. From con-
sumption, 129 — 22.8 per cent of total mortality. From yellow-
fever, 26 ; other fevers, 22. Death-rate, 33.3.

Naval Statistics. — The Chief of the Bureau of Medicine
and Surgery reports for 1887 • Main strength of the navy, in-
cluding officers and men on duty for the year 1887, officers,
1368 ; enlisted men, 8250 : 9618.

Total number of cases of disease under treatment during the
year 1887, in naval hospitals, 1450 ; at navy-yards and shore
stations, 21 11 ; on board vessels afloat and receiving ships,

7912: 11,473-

Total number of deaths from all causes during the year 1887,
in naval hospitals, 54 ; at navy-yards and stations, 11 ; on
board vessels afloat and receiving ships, 34 : 99.

Death-rate per 1000 for the year 1887, 10.29. Of the causes
of death, the number by phthisis pneumonica, was unusually
large : 13 in hospitals, 3 in vessels, and i at navy station —
17.17 of the deaths from all causes.

Excerpt from the special medical reports is deferred, till
next number.

INFECTIOUS DISEASES ABROAD DURING THE FOURTH QUAR-
TER, 1888.

By returns at hand from abroad, the number of deaths re-
ported from infectious diseases during the three months ending
December 31st, 1888, was from :

JEdiior's TcMe. 175

Small-pox in London, 2 ; Sheffield, i ; Bradford, I ; Hull,
3 ; Prague, 168 ; Paris, 44 ; Havre, 12 ; Nancy, i ; Amiens,
85 ; Trieste, 76; Marseilles, 31 ; Bordeaux, i ; Rouen, 2 ;
Vienna, 4 ; Nice, i ; Turin, 5 ; Lyons, 2 ; St. Petersburg, 8 ;
Warsaw, 97 ; Cracow, i ; Bucharest, 55 ; Odessa, 3 ; Pesth,

1 ; Jamappes, 8 ; Quaregnon, 8 ; Dixmude, 7 ; Bruges, i ;
Wasmes, i ; Hornu, i ; Anvers, 2 ; Gand, 3 ; Liege, i ;
Louvain, i ; Ostende, 20 ; Roulers^ 2.

Measles in London, 1488 ; Liverpool, 290 ; Glasgow, 40 ;
Birmingham, 53 ; Manchester, 88 ; Dublin, 26; Leeds, 152 ;
Sheffield, 38 ; Edinburgh, o ; Bradford, 10 ; Belfast, o ; Bris-
tol, 32 ; Hull, o ; Newcastle, o ; Amsterdam, 76 ; Rotter-
dam, o ; Paris, 288 ; Lyons, 2 ; Marseilles, 26 ; Hague, 14 ;
Bordeaux, 6 ; Saint ]£tienne, 8 ; Havre, 4 ; Rouen, 2 ;
Rheims, o ; Nancy, 3 ; Amiens, 2 ; Nice, i ; Berlin, 109 ;
Hamburg, 15 ; Munich, 48 ; Dresden, 7 ; Leipzig, 3 ; Bres-
lau, 8 ; Koenigsberg, 1 ; Cologne, 46 ; Hanover, i ; Magde-
burg, 36 ; Bremen, 9 ; Frankfort, 3 ; DUsseldorf, 31 ; Stutt-
gart, 28 ; Nuremberg, i ; Strasburg, i ; Dantzig, $ ; Altona,

2 ; Chemnitz, 5 ; Mayence, S ; Metz, i ; Bale, i ; Geneva, i ;
Vienna, 33 ; Pesth, 3 ; Prague, 48 ; Helsingfors, 3 ; Copen-
hagen, 2 ; Christiania, i; St. Petersburg, 26; Odessa, 15;
Warsaw, 15 ; Turin, 9 ; Bucharest, 16 ; Brussels, 87 ; Anvers,
67; Gand, 6; Liege, i ; Jamappes, 26; Bruges, i ; Ostend,
I ; Roulers, 37 ; Tournay, 3 ; Lierre, 2 ; Wetteren, 3 ; Lede-
berg, I ; Ecloo, 9 ; Blankenberg, 3 ; Hornu, 2 ; Ninove, 18 ;
Kockelberg, i ; Borgerhout, 6 ; Mons, 1.

Scarlet-fever in London, 321 ; Liverpool, 76 ; Glasgow, 63 ;
Birmingham, 11; Manchester, 50; Dublin, 18; Leeds, 30;
Sheffield, 55 ; Edinburgh, 3 ; Bradford, 6 ; Belfast, 9 ; Bris-
tol, 9 ; Hull, 8 ; Newcastle, 7 ; Amsterdam, 4 ; Paris, 26 ;
Lyons, 5 ; Marseilles, 2; Nantes, 3 ; Bordeaux, 4 ; Saint
^tienne, i ; Havre, 3 ; Nancy, 2 ; Amiens, 2 ; Berlin, 52 ;
Hamburg, 29 ; Breslau, 22 ; Munich, 37 ; Dresden, 7 ; Leip-
zig* 3 ; Magdeburg, 16 ; Frankfort, 6 ; Koenigsberg, 43 ;
Hanover, i ; Dusseldorf, i ; Nuremberg, 2 ; Bremen, 5 ;
Chemnitz, 5 ; Dantzig, 74 ; Stuttgart, 6 ; Strasburg, 3 ; El-
berfeld, i ; Altona, 2 ; Mayence, 9 ; Bale, 3 ; Metz, 14 ;
Geneva, i ; Vienna, 50 ; Zurich, i ; Pesth, 24 ; Prague, 30 ;
Trieste, i ; Debreczin, 2 ; Cracow, 20 ; Copenhagen, 37 ;

176

Editor's Table.

Stockholm, 41 ; Christiania, 8 ; St. Petersburg, 155 ; Odessa,
43; Warsaw, 213; Bucharest, 114; Jassy, 47; Brussels, 2;
Anvers, 3 ; Bruges, i ; Tournay, 3 ; Turin, 4 ; Malines, 2 ;
Ostend, 2 ; Hornu, 4.

Fevers. — Typhus and Typhoid \n London, 193; Liverpool
46 ; Glasgow, 26 ; Birmingham, 14 ; Manchester, 46 ; Dublin
74; Leeds, 13; Sheffield, 19; Edinburgh, 9; Bradford, 12
Belfast, 44 ; Bristol, 10 ; Hull, 7 ; Newcastle, 9 ; Amsterdam

20 ; Rotterdam, 2 ; Paris, 185 ; Lyons, 27 ; Marseilles, 89
Bordeaux, 40 ; Nantes, 20 ; Saint £tienne, 10 ; Havre, 82
Rouen, 24 ; Rheims, 7 ; Nancy, 5 ; Amiens, 10 ; Nice, 57
Berlin, 47 ; Hamburg, 54 ; Breslau, 9 ; Munich, 6 ; Dresden
6 ; Leipzig, 6 ; Cologne, 9 ; Magdeburg, 7 ; Frankfort, 4
Koenigsberg, 29 ; Hanover, 3 ; Dusseldorf, 6 ; Nuremberg
4 ; Bremen, 44 ; Chemnitz, 8 ; Dantzig, 7 ; Stuttgart, 4
Strasburg, 4 ; Elberfeld, 3 ; Altona, 10 ; Barmen, i ; Aix la
Chapelle, i ; Berne, 5 ; Lausanne, i ; Mayence, 3 ; Bale, 2
Vienna, 35 ; Pesth, 80 ; Prague, 17 ; Trieste, 2 ; Debreczin
12; Presburg, 6; Copenhagen, 12; Stockholm, 8; Chris
tiania, 2 ; Helsingfors, 3 ; Warsaw, 30 ; St. Petersburg, 135
Cracow, 16 ; Odessa, 32 ; Turin, 22 ; Venice, 8 ; Bucharest
62 ; Jassy, 7 ; Brussels, 22 ; AnVers, 14 ; Gand, 7 ; Liege, 11
Bruges, 3 ; Malines, 4 ; Verviers, 3 ; Louvain, 9 ; Tournay, i
Seraing, i ; Bergerhout, I ; Ostend, 3 ; Mons, 3 ; Jumet, 2
Alost, 5 ; Charleroi, i ; Lokeren, I ; Gilly, 4 ; Tumhout, i
Ypres, 2 ; Marchiennes au Pont, i ; Wasmes, i ; Boom, i
Grammont, 4 ; Vilvorde, 2 ; Morlanwels, i j Audenarde, 2.

Diphtheria and Croup in London, 595 ; Liverpool, 16 ; Glas-
gow, 108; Birmingham, 12; Manchester, 66; Dublin, 26;
Leeds, i ; Sheffield, $ ; Edinburgh, 31 ; Bradford, 2 ; Belfast,
12; Bristol, S; Hull, i; Newcastle, 13; Amsterdam, 66;
Rotterdam, 8 ; Hague, 5 ; Paris, 397 ; Lyons, 31 ; Marseilles*
113 ; Bordeaux, 47; Nantes, 5 ; Saint fitienne, 15 ; Havre,
17; Rouen, 9; Rheims, 15; Nancy, 11 ; Amiens, 14; Nice,
29 ; Berlin, 374 ; Hamburg, 161 ; Breslau, 193 ; Munich, 98 ;
Dresden, 105 ; Leipzig, 49 ; Cologne, 30 ; Magdeburg, 30 ;
Frankfort, 41 ; Koenigsberg, 42*, Hanover, 138 ; DUsseldorf,

21 ; Nuremberg, 40; Bremen, lo ; Chemnitz, 27; Dantzig,
40 ; Stuttgart, 18 ; Strasburg, 22 ; Elberfeld, 26 ; Altona, 20 ;
Barmen, 14 ; Aix-la-Chapelle, 6 ; Mayence, 7 ; Metz, 25 ;

Mitor'a Tahle. 177

Bale, 6 ; Lausanne, 5 ; Berne, 3 ; Vienna, 185 ; Pesth, 134 ;
Prague, 146 ; Trieste, 29 ; Debreczin, 16 ; Presburg, 16 ;
Copenhagen, 25 ; Stockholm, 40 ; Christiania, 92 ; Helsing^
fors, 5 ; St. Petersburg, 140 ; Cracow, 24 ; Odessa, 36 ; War-
saw, 151 ; Turin, 45 ; Bucharest, 23 ; Jassy, 18 ; Brussels,
27 ; Anvers, 19 ; Gand, 10 ; Liege, 13 ; Bruges, ii ; Malines,
7 ; Verviers, I ; Tournay, 11 ; Bergerhout, 6; Ostend, 22 ;
Mons, I ; Alost, 14; Roulers, 2 ; Jumet, 2 ; Quaregnon, i ;
Lierre, 3 ; Turnhout, 21 ; Marchiennes au Pont, i ; Hasselt,
6 ; Boom, 16 ; Wasmes, i ; Uccle, 3 ; Ledeberg, 3 ; Jamappes,
I ; Wetteren, 10 ; Grammont, 9 ; Vilvorde, 2 ; Iseghem, 3 ;
, Termonde, 3 ; Gossieles, i ; Hornu, i ; Ninove, 4 ; Wavre, 3 ;
Audenarde, 2 ; Forest, 2 ; Dinant, 2.

Whooping-cough in London, 223 ; Liverpool, 71 ; Glasgow,
70; Birmingham, 81 ; Manchester, 47; Dublin, 59; Leeds,
69 ; Sheffield, 29 ; Edinburgh, 9 ; Bradford, 19 ; Belfast, 8 ;
Bristol, 5 ; Hull, 6 ; Newcastle, 22 ; Amsterdam, 40 ; Rotter-
dam, 16; Hague, 7; Paris, 51; Lyons, 3; Marseilles, 21;
Nantes, l ; Bordeaux, 11 ;. Saint £tienne, 2 ; Havre, 3 ;
Rouen, 4 ; Berne, i ; Zurich, 3 ; Chaux-de-Fonds, 2 ; Nice,
9 ; Hamburg, 48 ; Breslau, 10 ; Munich, 17 ; Cologne, 16 ;
Vienna, 18 ; Bale, 5 ; Pesth, 5 ; Prague. 7 ; Trieste, 2 ; De-
breczin, 4 ; Cracow, i ; Copenhagen, 23 ; Stockholm, 8 ;
Christiania, 7 ; Helsingfors, 6 ; St. Petersburg, 60 ; Warsaw,
26 ; Odessa, 2 ; Bucharest, I2 ; Brussels, 20; Turin, 5 ; An-
vers, 8 ; Gand, 15 ; Liege, 19 ; Bruges, 7 ; Lierre, $ ; Tour-
nay, 6; Ypres, i ; Seraing, 7 ; Jumet, i ; Alost, ii ; Uccle,
I ; Jamappes, i ; Vilvorde, i ; Maldeghem, 11 ; Braine-le-
Comte, 3 ; Hornu, 2 ; Malines, 3 ; Verviers, 2 ; Borgerhout,
3 ; Ostend, i ; Herstal, i ; Ledeberg, 3 ; Ecloo, 2 ; Wet-
teren, I ; Iseghem, I ; Arlon, i ; Tougres, 3 ; Wavre, 8 ;
Audenarde, i ; Forest, 2 ; Dixmude, i ; Basel, 2.

For the third quarter, ending September 30th, 1888, the
number of deaths reported from small-poXy was in Lisle, 4 ;
Lemberg, 8 ; Moscow, 3 ; Milan, 137 ; Turin, i ; Genoa, 20 ;
Bologne, 16 ; Saragossa, 23 ; Morrice, 33 ; Carthagena, 76 ;
Lisbon, 52 ; Buenos Ayres, loi.

Death-rates in foreign cities during the fourth quarter, 1888,
as follows : London, 4,282,921, 18.8 ; Liverpool, 599.738,
22.2; Glasgow, 526,088, 20.6; Birmingham,. 447,912, 17,7;
12

178

Editor's TcMe.

Manchester, 378,164, 26.2; Dublin, 353,082, 24.6; Leeds,
351,210, 21.9; Sheffield, 321,711, 20.1 ; Edinburgh, 262,733,
15.4; Bradford, 229,721, 17.8; Belfast, 227,022, 21.7 ; Bris-
tol, 226,510, 16.7 ; Hull, 202,359, 16.3 ; Newcastle, 159,003,
22.7 ; Amsterdam, 389,916, 20.8-; Rotterdam, 193,658, 19.7 ;
Hague, 149,477, 18.7 ; Paris, 2,260,945, 21.5 ; Lyons, 401,930,
19.5; Marseilles, 376,143, 25.3; Bordeaux, 240,582, 23.7;
Nantes, 127,482, 21.3; St. fitienne, 117,875, 21.9; Havre,
1.12,074, 29.9; Rouen, 105,672, 29.5 ; Rheims, 97,903, 24.5 ;
Nancy, 81,593, 22.4; Amiens, 80,288, 25.3; Nice, 78,482,

26.2 ; Berlin, 1,414,980, 19.6 ; Hamburg, 543,670, 23.6 ; Bres-
lau, 313,451, 25.8 ; Munich, 275,000, 29.1 ; Dresden, 259,142,

18.6 ; Leipzig, 181,324, 17.2 ; Cologne, 175,200, 22.8 ; Magde-
burg, 171,086, 22.8 ; Frankfort-on-the*Main, 163,655, 16.4 ;
Koenigsberg, 156,441, 26.2 ; Hanover, 148,458, 19.7 ; Diissel-
dorf, 125,384, 24.4 ; Nuremberg, 122,832, 23.5 ; Bremen, 121,-
464, 17.4; Chemnitz, 118,926, 28.3; Dantzig, 118,037, 27.8
Stuttgart, 117,861, 17.4; Strasburg, 115,870, 23.1 ; Elberfeld
113,195, 18.8; Altona, 111,780, 21.9 ; Barmen, 106,749, 15.6
Aix-la-Chapelle, 100,982, 19.4; Mayence, 69,119, 21.3
Metz, 54,558, 22.1; Basle, 73,963, 15.8; Geneva, 52,516

13.3 ; Berne, 50,220, 19.8 ; Lausanne, 32,954, 19.3 ; Zurich
28.062, 13.8 ; Chaux-de-Fonds, 24,372, 16.6 ; Vienna, 800,
836, 23.2 ; Pesth, 442,787* 27.2 ; Prague, 295,857, 25.9
Trieste, 156,042, 25.6; Cracow, 67,000, 27,1 ; Debreczin, 56,
168, 26.6; Presburg, 49,003, 30.1; Copenhagen, 300,000

18.7 ; Stockholm, 221,549, 17.2 ; Christiania, 136,791, 18.7
Helsingfors, 51,515, 18.6; St. Petersburg, 988,016, 22.1
Warsaw, 439,174, 28.2 ; Odessa, 268,000, 24.1 ; Turin, 294,
826, 20.4; Bucharest, 206,000, 29.9; Yassy, 82,856,41.1
Brussels, 462,069, 20.7; Anvers, 220,123, 21.9; Gand, 147,
912, 22.2; Liege, 137,566, 17.9; Bruges, 51, 34^ 21.5
Malines, 48,971, 22.2 ; Verviers, 47,744, 15.8 ; Louvain, 39,
460, 19.5; Tournay, 36,536, i9-9 ; Seraing, 31,322, 16.1
Borgerhout, 28,781, 25.0; Mons, 25,755, 14.8; Jumet, 23,-
455, 14.7; Ostend, 24,500, 35.9; Alost, 23,399, 20.9; Char-
leroy, 21,490, 14.3 ; Roulers, 20,163, 24.8.

Populations and death-rates returned during tlu third quarter^
1888 : Utrecht, 81,334, 18.4; Groningen, 52,996, 18-7 ; Maes
tricht, 31,483, 23.8; Lille, 188,272,22.7; Roubaix, 100,456,

IMerary Notices. 179

25.7 ; St. Quentin, 46,746, 22.1 ; Bayonne, 27,289, 21.8 ; La
Rochelle, 16,616, 20.6; Lemberg, 120,127,30.2 ; Gratz, 105,-
274, 24.2 ; Briinn, 86,125, 34.5 ; Cracow, 70,084, 28.5 ; Mos-
cow, 753*469, 42*6; Rome. 382,973, 23.7; Milan, 373*352,
28.7 ; Turin, 294,826, 17.3 ; Genoa, 183,591, 21.0 ; Bologna,
133,789,22.3; Livourne, 101,722, 19.0; Saragossa, 87,922,
35.1 ; Murcia, 80,000, 56.0; Carthagena, 54,313, 57-9; Bada-
joz, 23,000,45.7 ; Lisbon, 242,297, 33.6 ; Algiers, 71,339, 28.5 ;
Bombay, 773,196, 30.3; Calcutta, 433,219, 21. i ; Madras,
398,777, 34.0; Buenos Ayres, 428,448, 26.5.

LITERARY NOTICES,

The Milroy Lectures: On Epidemic Influences; Epi-
demiological Aspects of Yellow. fever ; Epidemio-
logical Aspects of Cholera. By Robert Lawson,

LL.D., Inspector-General of Hospitals ; late President Epi-
demiological Society ; Fellow Statistical Society. London :
J. & A. Churchill.

The purport of these lectures is to show the relations of, if
not, indeed, the dependence of the prevalence of the diseases
treated of upon pandemic waves incidental to inappreciable,
or, at least, indescribable influences of the atmosphere at
particular periods. The progress of the pandemic waves is il-
lustrated with maps and charts of the regions over which they
have passed, coupled with historical data of the period, dura-
tion, and mortality. Numerous citations are made of the re-
lotion of local conditions and their limitations to the outbreaks
of epidemics of yellow-fever and cholera, and their dependence
when disassociated from their usual habitudes.

A New Mode of Treating and Disposing of Night
Soil. By S. t)E M. Aserappa, M.D., Edin., Sanitary Officer,
Municipality of Colombo, Ceylon, is a pamphlet of ten pages,
describing the advantages of coir-dust as an absorbent and
deodorant of excreta, and the subsequent incineration of the
mass, over the dry-earth system.

The incinerator consists of a brick chamber with an iron
flap-door at the top, divided by an iron grate into two horiv

180 LUerwry Noticea.

zontal compartments, and the lower. one also provided with
an iron grate as a fuel bed ; and each compartment with a side
opening for draught. The chamber is provided with a chimney
at one end carried to the height of an ordinary kitchen chim-
ney^ with draught flues adjusted to the grates. The faecal
compost is thrown down through the door on the top into a
chute so arranged as to have it fall on the lower grate, where
it is fired and spread. Meanwhile a fire is also kept up on the
upper grate. The object of this arrangement is to consume
the gases (all inflammable) evolved by the combustion of the
compost on the lower grate.

The process is a crude imitation of the Engle Cremator.
Obviously any other absorbent and deodorant ** dust" that is
readily inflammable would serve the same purpose as the coir-
dust — fibres of the cocoanut. The process is commendable.

Nervous Exhaustion — Neurasthenia : Its Hygiene,
Causes, Symptoms, and Treatment. By GEORGE M. Beard,
A.M., M.D., Formerly Lecturer on Nervous Diseases in the
University of the city of New York ; Fellow of the New York
Academy of Medicine, etc. Second edition revised and en-
larged by A. D. Rockwell, A.M., M.D., Professor of Elec-
tro-Therapeutics in the New York Post Graduate Medical
School and Hospital ; Fellow of the New York Academy of
Medicine, etc. Pp. 254. Price, $2.75. New York : E. B.
Treat.

The term neurasthenia^ which was first used by the author
of this book more than a dozen years ago, has at last gained
acceptance by the medical profession as the proper designa-
tion of the various forms of nervous disturbance hitherto com-
monly expressed under such terms as "general debility,"
** nervous prostration," "nervous debility," "nervous as-
thenia," "nervous strain," "nervous weakness," etc. But
the designation should not be regarded as a mere cloak of
convenience for an uncertain group of rational symptoms. On
the contrary, it is intended, in the mind of the medical practi-
tioner at least, to dispel such vague expressions as those
quoted, which are, for the most part, the mere expressions of
irregularities of living and indolence. Against all such the
work before us wisely discriminates ; they need not rest, more

LUerary Noticet. 181

food, and soothing treatment, but more mental and physical
activity and less engorgement.

Veritable neurasthenia, on the other hand, is commonly
traceable through a sequence of causes of a wholly different
character, and it requires wholly different treatment both hy-
gienic and medical.

This the work before us clearly points out ; and considering
the present general tendency of pursuits and diversions, few
books can be read by the medical practitioner with more benefit.

Favorite Prescriptions, of Distinguished Practi-
tioners, WITH Notes on Treatment. Compiled from the
Published Writings or Unpublished Records of Drs. Fordyce
Barker, Roberts Bartholow, Samuel D. Gross, Austin Flint,
Alonzo Clark, Alfred L. Loomis, F. J. Bumstead, T. G.
Thomas, H. C- Wood, William Goodell, A. Jacobi, J. M.
FothcrgilK N. S. Davis, J. Marion-Sims, William H. Byford,
L. A. Duhring, E. O. Janeway, J. M. Da Costa, J. Solis
Cohen, Meredith Clymer, J. Lewis Smith, W. H. Thomson,
C. E. Brown-Sequard, M. A. Fallen, George H. Fox, W. A.
Hammond, E. C. Spitzka, etc. By B. W. Palmer, A.M.,
M.D. New, Enlarged, and Revised Edition, with Blank
Pages interleaved in Its Several Departments for Registering
Formulae worth Preserving. Price, $2.75. New York : E. B.
Treat.

This is an interesting volume to students and young practi-
tioners to look over at odd times, but, like all mere prescription
books, to be avoided as a guide to practice. All such books
are dangerous to medical practitioners in proportion as they
are more or less likely to divert attention from painstaking
diagnosis, which, with such knowledge of indications and
therapeutics as all prescribers should be required to possess,
is the only true guide to correct practice.

Wood's Medical and Surgical Monographs : Consist-
ing of Original Treatises and of Complete Reproductions, in
English, of Books and Monographs Selected from the Latest
Literature of Foreign Countries, with all Illustrations, etc.
Published monthly. Price, $10 a year. Single copies, $1.

January and February numbers contain : (i) Pedigree of
Disease, by Jonathan Hutchinson, F.R.S. ; Common Dis-

182 Literary NoHce$.

eases of the Skin, by Robert M. Simon, M.D. ; Varieties and
Treatment of Bronchitis, by Dr. Ferrand, (2) Gonorrhceal In-
fection in Women, by William Japp Sinclair ; Giddiness, by
Thomas Grainger Stewart, M.D. ; Albuminuria in Bright's
Disease, by Dr. Pierre Jaenton.

A Cyclopaedia of the Diseases of Children, medical
and surgical, by American, British, and Canadian authors,
edited by JOHN M. KEATING, M.D., in four imperial octavo
volumes, to be sold by subscription only, is announced by
the Messrs. J. B. Lippincott Company. The first volume
will be issued early in April, and the subsequent volumes at
short intervals.

A thorough knowledge of the diseases of children is a mat-
ter of the greatest importance to most physicians, and as this
is the only work of the kind that has been published in Eng-
lish, it will be invaluable as a text-book and work of reference
for the busy practitioner.'

Hand-Book of Materia Medica, Pharmacy, and
Therapeutics. Compiled for the use of students preparing
for examination. By CUTHBERT BOWEN, M.D., B.A., Editor
of ** Notes on Practice." i2mo, pp. 366. Price, $1.40.
Philadelphia : F. A. Davis. A concise risumi of all that is
most valuable in this branch of medicine, and admirably well
adapted to its purpose.

Alden's Manifold CvcLOPiCDiA, second and third volumes,
now before us, fully maintains the good opinion we formed of
it in review of the first volume (August number, 1888). These
volumes cover the alphabet between the titles America- British,
and Baptisia, pages, respectively, 632,631. There seems little
doubt that it will become, as it deserves to, the most popular
cyclopaedia for a long time to come. The embodiment of an
Unabridged Dictionary of Language and a complete Cyclopaedia
of Universal Knowledge in one work, in excellent type, with
thousands of illustrations, and all for a price less than people
have been used to paying for a dictionary alone, is not only a
novelty in plan, but to the ordinary book-buyer, the fact is
equally astounding. The publisher, John B. Alden, 393 Pearl
Street, New York, or Clark and Adams streets, Chicago, will

Literary JVottces, 188

send specimen pages free to any applicant, or a specimen vol-
ume (-which may be returned if not wanted) in cloth for 50
cents, or half morocco, 6$ cents ; postage 10 cents extra.
The set of thirty volumes is offered at considerably reduced
price to early subscribers.

The Artesian Wells of Dakota are probably the most
remarkable for pressure, and the immense quantity of water
supplied^ of any ever opened. More than a hundred of such
wells, from 500 to 1600 feet deep, are to-day in successful
operation, distributed throughout twenty-nine counties, from
Yankton, in the extreme south, to Pembina, in the extreme
north, giving forth a constant, never- varying stream, which is
in no wise affected by the increased number of wells, and
showing a gauge pressure in some instances as high as 160,
170, 175, and 187 pounds to the square inch. This tremen-
dous power is utilized, in the more important towns, for water-
supply, fire protection, and the driving of machinery, at a
wonderful saving on the original cost of plant and maintenance,
when compared with steam. In the city of Yankton a forty-
horse-power turbine-wheel, operating a tow-mill by day and
an electric-light plant by night, is driven by the force of water
flowing from an artesian well, the cost of obtaining which was
no greater than would have been the cost of a steam-engine
developing the same power, not counting the continual outlay
necessary (had steam been employed) for fuel, repairs, and the
salaries of engineer and fireman. What has been accomplished
through the aid of natural gas and cheap fuel in building up
manufactories elsewhere, may some day be rivalled on the
prairies of Dakota by tapping the inexhaustible power stored
in nature's reservoirs beneath the surface. — P. F. McC/ure, in
Harper* s Magazine for February.

Why Women Get Short of Breath.— In order to ascer-
tain the influence of tight clothing upon the action of the
heart during exercise a dozen young women consented this
summer to run 540 yards in their loose gymnasium garments,
and then to run the same distance with corsets on. The run-
ning time was two minutes and thirty seconds for each person
at each trial, and in order that there should be no cardiac ex-

184 Literary Notices.

citement or depression following the first test, the second trial
was made the following day. Before beginning the running
the average heart impulse was 84 beats to the minute ; after
running the above-named distance the heart impulse was 152
beats to the minute ; the average natural waist girth being 25
inches. The next day corsets were worn during the exercise,
and the average girth of waist was reduced to 24 inches. The
same distance was run in the same time by all, and immedi-
ately afterward the average heart impulse was found to be 168
beats per minute. When I state that I should feel myself
justified in advising an athlete not to enter a running or row-
ing race whose heart impulse was 160 beats per minute after a
little exercise, even though there were not the slightest evi-
dence of disease, one can form some idea of the wear and tear
on this important organ, and the physiological loss entailed
upon the system in women who force it to labor for over half
their lives under such a disadvantage as the tight corset im-
poses.— From ** The Physical Development of Women,** by Dr.
D. A. Sargent, in the February Scribner's,

Editorial Change and a Life Tenure — Surgeon-Gen-
eral Hamilton at his Post Again. — In the Journal of the
American Medical Association of February 9th, Dr. John B.
Hamilton makes the following announcement :

"When the writer accepted the position as editor of the
Association Journal, although the Marine- Hospital Service Bill
was then pending, as it had been for the past ten years, he had
no certainty of its passage, but, on January 4th, it passed both
houses of Congress and became a law, which by prohibiting
any original appointments into the service except to the rank
of assistant-surgeon, has the effect of creating a life tenure in
the office of supervising surgeon-general. He therefore' ten-
dered his resignation as editor to the Board of Trustees, and it
was kindly accepted by them to take effect on a day named by
himself. His editorial connection with the Journal will there-
fore cease with the present number, and, until further notice,
the * Committee on General Management ' will take charge of
the affairs of the Journal, With the most sincere thanks to
those who have sent him kindly letters, his best wishes for the
continued success of the Journal, and the renewed prosperity
of the Association, the editor resumes his life-work in the
Marine-Hospital Service."

Medical ExoerpL 185

MEDICAL EXCERPT.

Medical Antisepsis. — From a lecture given at the Hos-
pital St. Andr6 by Dr. Artigalas, so competent on all micro-
biological questions, the following conclusions are noted :

1. The body normally manufactures ptomaines. They can
accumulate and produce some accident when the oxygen which
should destroy them is deficient, or the channels of elimination
are obstructed. From this the two great physiological princi-
ples of antisepsis are evolved : (a) to maintain normal oxy-
genation ; (p) to keep the secretions normal or to restore their
equilibrium.

2. According to the constitution of the microbian illness,
it is either local or general. The morbific element thrives in
certain regions, and causes there the formation of toxic prod-
ucts.

Therefore : {<i) the necessity to find a diffusible antiseptic,
as is sulphate of quinine in intermittent-fever ; ip) to change
the surroundings where the microbes flourish, as in the in-
testinal antisepsis of typhoid-fever ; ic) to make, as far as pos-
sible, secondary channels for elimination of the microbes and
ptomaines, as in nephritis of scarlatina and of cholera. — Revue
de Thirapeutique.

Anti-bacterial Action of Antipvrin.— By Dr. Nikolai
F. Keldysh (St. Petersburg, Russia). Dr. Keldysh has car-
ried out numerous bacteriological experiments for verifying
Neudoerfer's startling statement concerning the antiseptic
power of antipyrin. He inoculated dry pure cultures of the
staphylococcus aureus and albus and micrococcus prodigiosus
in a solid nutritious jelly containing 2.5, 5, and 10 per cent
antipyrin. In every one of the experiments ^n excellent
growth of the microbes was invariably obtained which did not
in any way whatever differ from that in a set of controlling
test-tubes containing a non-antipyrinized nutrient jelly. There
was not even any retardation in the bacterial growth ; hence
Dr. Keldysh goes still further than Dr. Lenevitch, and says

1S6 MedieaL Baoeerpt.

that antipyrin does not possess any antiseptic properties at
all. — Russkaia Meditzina^ No. 26, 1S88.

OXYCYANIDE OF MERCURY AS AN ANTISEPTIC— The com-
parative merits of oxycyanide of mercury and corrosive subli-
mate are to be summed up as follows : Its solution has a
slightly alkaline reaction, and precipitates albumen 6nly
slightly. It is less irritant than solutions of corrosive subli-
mate, and solutions of the chemical 1-1500 do not attack,
except slightly, the materials used in surgical instruments.
When tested by the power of preventing decomposition of
soup, its antiseptic power proved to be six times greater than
that of bichloride of mercury ; while tested as to its power to
destroy the micrococcus pyogenes aureus, the advantage lay
somewhat in favor of the sublimate, I~I4CX) of the former to
1-1300 of the latter. When employed on suppurating sur-
faces, or to render mucous surfaces antiseptic, it furnished
much better results than the bichloride, because of its much
greater tolerance by the tissues and of the small amount ab-
sorbed thereby (Comptes Rend, de la Soc. de Biol., July,
\%%%\— The Satellite.

Quinine and Antipyrine in Combination.— Dr. Dulon
adds 15 centigrammes of antipyrine to 25 centigrammes of
quinine and obtains an antipyretic effect equal to that from
75 centigrammes of quinine, without producing cinchonism or
disturbing the stomach. — Revue Ginirale de Clinique et de
Thirapeutique.

Of Terraline, a preparation of petroleum, in the treat*
ment of bronchial and pulmonary affections. Dr. C. S. Stroth-
ers, of Georgia, writes to the Medical and Surgical Reporter
as follows : " I have been prescribing this new remedial agent
for about a year, and the results have been so perfectly satis-
factory that I do not feel I would be doing my duty to the
profession were I to keep silent in regard to it. I have given
it in all forms of bronchial, pulmonary, and pharyngeal trou-
bles, and I am happy to bear record that in every instance its
effects have been to greatly relieve and palliate, if not to work
an entire cure. I have found it far superior to cod-liver oil in

Mediodl Easoerpt. 187

phthisis, as its effects have been not only to relieve the cough
and allay the extreme pulmonary irritation, but it improves
the appetite and overcomes the indifference and distaste for
food, increases the weight of the body, and begets a sense of
comfort which I have seen exhibited by none other of the
noted remedies usually given in these cases/' It may be ob-
tained from Hazard, Hazard & Co., New York.

Lanoxin and Boric Acid in the Skin Diseases of
Children. — The combination of lanolin and boric acid as an
ointment is said to have a most gratifying effect in certain skin
diseases in children, especially eczema of the head and face,
intertrigo, and seborrhea. In the case of eczema, for example,
with raw patches on the cheeks and yellowish crusts on the
head, the surface is first cleansed in the usual way, and then
dusted over with finely-powdered boric acid. On the follow-
ing day this washing and dusting over is repeated ; already the
inflammation will seem lessened. The process is then repeated
twice daily, the washing being always done gently, until the
skin is in a condition to bear an ointment containing thirty
per cent of lanolin and eight per cent of boric acid. In the
squamous form of eczema with considerable induration, olive
oil is well rubbed in and then removed with castile soap, and
an ointment containing one half, or one per cent of salicylic
acid, with thirty per cent of lanolin, is energetically applied
according to the degree of induration. This washing and ap-
plication are repeated twice daily. The strikingly beneficial
action of this course of treatment, which is less painful than
the use of strong alkalies, or oil of cade, is ascribed to the
penetrating properties of lanolin, which thus facilitates the
entrance of salicylic acid into the deeper layer of the epidermis.
Dr. Russel Sturgis, who advocates the above treatment, also
finds the lanolin a reliable means of alleviating the irritation
due to chronic uticaria. — Brit, Med, Jour,

Creoline and the Comma-bacillus.— Creoline is one of
the most recent of the many new antiseptic substances that
have of late years been brought to the notice of the profes*
sion. As is the case with most new remedies, the advocates
of this drug claim for it the advantage of great efficacy and

188 Medical £xeerpL

harmlessness to the animal organism ; but whether these claiins
will be substantiated by a more extended trial remains to be
seen. Some experimenters have already asserted that the
substance is capable of giving rise to toxic symptoms in even
moderate doses, and doubtless it will be found that care is
necessary in its administration as well as in that of other pow-
erful antiseptics.

Drs. Sirena and Alessi have made a series of experiments
with creoline to determine its action upon the comma-bacillus
of Koch, and have been led by the results obtained to place
great hopes upon it as an efficient remedy in cholera {La Ri^
forma Medtca^ Nos. 257 and 258, 1888). It is not necessary
to give the details of these experiments, which may be found
in the original article, and we will reproduce here merely the
following conclusions which the authors have reached, as a re-
sult of their labors :

They state that the addition of from eight to ten drops of a
three per cent aqueous solution of creoline is sufficient to com-
pletely sterilize, within five minutes, a pure culture in broth of
the comma-bacillus. From one to four drops of the same solu-
tion, added to ninety drops of a broth culture, will prevent the
development of the comma-bacillus. From one to three drops
of a one per cent solution retard the development of the
micro-organisms, and four drops or more prevent it completely.

The solutions of creoline are apt to lose their efficacy in
time, hence it is necessary to use fresh solutions whenever a
certain and speedy action is desired.

The authors regard creoline as an antiseptic of great value,
and recommend that it be employed in the treatment of chol-
era. They believe also — and this belief they hope to fortify
by experiments in the early future — that the remedy will be
found of great efficacy in the treatment of tuberculosis. — Med-
ical Record.

NiTRO-GLYCERIN IN CARDIAC AND RENAL DISEASES. — Dr.

L.-V. Hoist has employed nitro-glycerin in a number of acci-
dents consecutive to cardiac and renal diseases, such as dysp-
noea, angina, palpitation, etc., and the following are the con-
clusions which he draws from cases which he reports in detail
{Gazette Hebdomadaire des Sciences MidicaleSy Oct. 6/A, 1888) :

Medical JSccerpt 189

Nitro-glycerin is a remedy which is capable of affecting the
innervation of the heart in the most marked manner ; its
effects being especially marked in cases of weakening of the
cardiac muscles with implication of the valves. The best re-
sultSy however, are obtained in cases of angina, where it is
claimed that the symptoms are not only relieved, but that
the disease may be even cured. In cases of kidney trouble,
the author states that he has nearly always succeeded in ob-
taining good results from the use of nitro-glycerin, and even
in some cases its employment has led to the disappearance of
renal complications as a secondary effect to its regulating'
action on the heart. In cases of weakness of the heart it may
lead to the disappearance of serous effusions, its direct action
being cardiac in origin. The great obstacle to its employment
is its great poisonousness, and the difficulty of administration.
The author has employed a preparation of nitro-glycerin, of
which he gives one drop three times a day. If this dose is
too small, it may be gradually increased drop by drop, the
maximum dose being six drops daily.

HOMCEOPATHic THERAPEUTICS does not Consist in the dilu-
tion or size of the dose ; but *' the healing power of medicine
rests upon its faculty of producing symptoms similar to the
disease and superior to it in strength ; so that each individual
case of disease is most certainly, fundamentally, and rapidly
extinguished and cancelled by a drug which is more potent
than the disease, and capable of producing in the body symp-
toms most similar to and completely resembling the totality
of those of the disease ;" be it by the action of a dram of
the crude drug or by the one thousandth centesimal tritura-
tion.— W. Irving Thayer^ D.D.S., M.D.^ in Independent Prac-
titioner^ December^ 1888.

Vaseline Subcutaneous Injections, as shown by some

recent experiments, may occasionally prove decidedly injuri-
ous. Dr. G. Daremberg, of Dr. Grancher's laboratory, ob-
served that while guinea-pigs and rabbits may stand for a long
time daily injections of cod-liver, olive, cotton, and other vege-
table oils, they rapidly succumb under the administration of
crude petroleum, and the internal lesions will extend as far as

190 Medical JExcerpt.

the spleen, liver, and lungs. Dr. J. Roussel, the other day
commenting on Dr. Daremberg's experiments, remarked
before the Biological Society that he perfectly agreed with his
colleague's opinion, bis own observations on the human sub-
ject confirming the objections not only against petroleum, but
all the refined derivatives known as vaseline oils. He said,
" As they cannot be either saponified or emulsified within the
tissues, they are ipso facto rebellious to assimilation. When
things turn out for the best, the mineral oil will become en-
cysted in the conjunctive tissue, where it may be found several
weeks after the injection unaltered and still holding the medic-
ament absorbed. In the majority of cases the mineral oil
will cause a sharp and painful inflammation of the skin, and,
finally, purulent abscesses, which, on opening, will discharge
it out. With vegetable oils, fresh and sterilized, on the con-
trary, no trouble is experienced, their absorption being as
speedy as their assimilation." — Paris Correspondent, Thera-
peutic Gazette^ December 15/A, 1888.

A Simple Test for Blood, and easy of application, is
made by the addition of tincture of guaiac and ozonized ether
to a weak solutiqn of blood, when a bright blue color is pro-
duced. If a drop of blood be mixed with one half ounce of
distilled water, upon the addition of one or two drops of tinc-
ture of guaiac a cloudy precipitate of the resin appears, and
the solution has a faint tint. If to this solution one drop of
an ethereal solution of hydrogen peroxide is added, a blue tint
appears, which, upon a few minutes' exposure, gradually
deepens. This test is very valuable for minute quantities of
blood, and Dr. Day, of Geelong, succeeded in obtaining sixty
impressions from a stain upon cloth where the microscope
failed to show any blood. — ColL & Clin. Rec.

The Alleged Increase of Cancer.— Apart from the
purely surgical interest attaching to the Morton Lecture on
Cancer and Cancerous Diseases, delivered on the 26th ult., by
Sir Spencer Wells, before the Royal College of Surgeons, Lon-
don, the lecture contained in its opening remarks some im-
portant statistical information tending to prove that such dis-
eases are on the increase in this country. Thus, in England,

JfediaU Eadoerpt. 191

during the twenty-six years 1861-87, the mortality from
cancer has risen from 360 per 1,000,000 of the population to
606 — an increase which, Sir Spencer Wells truly remarked, is
far more than can be attributed to improved registration. In
Ireland, although the total mortality does not show so strik-
ing an increase, yet when this is corrected by reference to the
diminishing population of that country, the proportional in-
crease per 1,000,000 is almost as striking as that for England
— viz., from 1864 to 1880 an average annual rate of 676, and
from 1 88 1 to 1887 a rate of 873. In Scotland the proportion
of deaths from cancer is larger than in Ireland. A like in-
crease in mortality from cancer during the last decade is noted
in the United States. It is obvious that improved diagnosis
of malignant disease and greater accuracy in making returns do
not suffice to explain the rise in these figures. — Lancet ^ De-
cember 15/A, 1888.

A Case of Primitive Sarcoma of the Pancreas was
presented by Dr. Litten to the Medical Society of Rio de
Janeiro. The morbid growth was taken from a child four years
old, who within a few weeks had become extremely ema-
ciated ; but its abdomen became enlarged to such a degree
that, notwithstanding the emaciation, the weight increased ten
pounds.

The child had some diarrhoea and complained of slight
colic. The case was evidently an immense tumor in which
there was no fluctuation ; it was solid and evidently malignant.
As experience has shown that large abdominal tumors in chil-
dren arise most frequently from the kidneys, Litten diagnosed
ai primitive sarcoma of that organ ; but the autopsy showed
that this immense tumor was a primitive sarcoma of the pan-
creas, which almost completely filled the abdominal cavity and
pressed the intestines aside.

The case is unique ; no one has heretofore pointed out a
primitive sarcoma of the pancreas, and what m^akes it specially
interesting, is that the little patient had but little disturbance
of digestion compared with the immense size of tumor. —
Unids Medica, Rio de yaneiro.

An Ingenious Method of Forming a Sphincter after
Gastrostomy.— To avoid the usual unfortunate and almost

192^ Medical Exc&rpt.

inevitable leakage from the artificial opening in cases of gas-
trostomy, Girard recommends the following procedure :
Through a fifteen-centimetre vertical incision, the left rectus
muscle is divided in its upper portion in the median line. The
peritoneal cavity is then opened near the middle of the cut,
and a wedge-shaped portion of the fundus of the stomach
drawn out through the wound. A row of sutures is then in-
troduced, so as to include the posterior portion of the sheath
of the rectus, the edge of the peritoneum, and the stomach-
wall at the base of this protruding portion. These are to fix
the stomach in the wound. An incision ten centimetres long,
and parallel to the original wound, is now made on either side
of the latter, so that two bundles of muscle-tissue of the size
of a finger are formed. These bands are now crossed laterally,
and the stomach drawn out through the sphincter-like open-
ing thus made in the interval between them. The muscle-
bands and gastric pouch are now fastened in place by sutures,
after which the stomach is immediately opened. The author
thereby hopes to obtain a sphincteric action upon the stomach-
opening which shall be under muscular control, or, should the
muscle-structure disappear, that the cicatrix itself, being pulled
upon by the rectus, will accomplish the desideratum.

Girard performed this operation recently in a case, but as
the patient died before reacting from the operation, we can-
not yet be sure of its utility (Wiener Med. Presse, No. 25,
\%%%).— The Satellite.

Determination of Fat in Milk and Cream.— Place 5
cc. cream, or 10 cc. milk, carefully measured, into a test glass
of 50 cc. capacity, graduated into i-io cc. add 10 cc. concen-
trated hydrochloric acid, boil while rotating the liquid, and
agitate the cold dark-brown liquid with 30 cc. ether. After
this separates clearly, read ofT the volume of the ethereal layer,
remove 10 cc. with a pipette, allow to flow into a tarred porce-
lain crucible, evaporate on a water bath, dry in an air bath at
100° C, and weigh, calculating the weight for the volume read
off. This determination can be made in about 15 minutes,
and the results do not differ by o.i per cent from those ob-
tained by other quantitative methods. — Ztsch. An. Ch. {Am.
Jr. Ph.).

THE SANITARIAN.

MARCH, 1889.

Number 232.

THE VALUE OF MERCURIC CHLORIDE AS A

PRACTICAL DISINFECTANT.

By V. C. Vaugman, M.D., of Ann Arbor, Mich.

The report of the Committee of the American Public Health
Association on Disinfectants, together with the experimental
investigation of others, has given great prominence to the
employment of mercuric chloride as a germicide. Recently*
Dr. William B. Hills, of Cambridge, Mass., has criticised the
above-mentioned report so far as it recommends mercuric
chloride. As this is a matter of great practical importance, I
propose in Ihis paper to notice the points raised in this criti-
cism. Dr. Hills does not seem to have made any biological
or chemical tests himself, but founds his opinion upon what
he deems to be well-established facts. The critic uses severe
language with reference to the committee, and asserts that
** it is not creditable" that the committee should have made the
recommendations referred to upon the experimental evidence,
presented.

In the first place, Dr. Hills states that corrosive sublimatie
is rendered insoluble when brought in contact with organic
matter. He says: "It is, however, a well-known chemical
fact that the corrosive sublimate ts destroyed, or at least
undergoes chemical changes, when brought into contact with
organic matter. It is immediately converted by albumen to
the insoluble albuminate of mercury. For this reason, albu-
men is recognized as the most efficient antidote in cases of
poisoning by corrosive sublimate."

Now, let us inquire into the well-known chemical fact re-
ferred to by Dr. Hills. I endeavored to show in the report,

* Bost4m MuHcaland. Surgical Journal, August 25tb, 1888.
13

194 The Yalue of Mercuric Chloride.

which Dr. Hills criticises, that the albuminate of mercury is
soluble in solutions containing organic matter, and that it does
diffuse through such solutions ; but as Dr. Hills places his
opinion -against my experience, we will see what others say
upon this point. Merck,* of Darmstadt, says that the albu-
minate of mercury, which he manufactures according to the
formula of Schneider.f is readily soluble in blood-serum, meat-
broth, sodium chloride, etc. Every physician knows that the
albuminate of mercury is used hypodermically on account of
its ready solubility and non-irritating properties. For the
preparation of this compound either egg-albumen, blood-
serum, or peptone is used. Merck uses egg-albumen, while
FilehneJ recommends the following formula: ** 15 grams of
dry peptones, 10 grams of bichloride of mercury, 15 grams of
ammonia chloride, and enough water and glycerine so that
each cubic centimetre of the solution shall contain from two to
four milligrammes of mercuric chloride." Other formulae are
given by other authors. In one place Dr. Hills admits that
the albuminate of mercury is "slightly soluble," but he says
" the amount redissolved is very small." Filehne's solution
contains more than two and a half drams of the bichloride.
This amount would hardly be called "very small." When
Dr. Hills says that albumen is recognized as the most efficient
antidote in cases of poisoning by corrosive sublimate on account
of the insolubility of the albuminate of mercury^ he teaches a
doctrine which, I must admit, is wholly new to me. Mercuric
bichloride owes its corrosive properties to the avidity with
which it combines with proteids. In cases of poisoning by
this salt we give the albumen in order to supply a proteid with
which the poison can combine without injury to the walls of
ithe stomach, and then we liasten to give an emetic. What
would be the result if we should leave the albuminate of mer-
cury in the stomach ? If this compound is so insoluble, why
do we give the emetic ? The idea that the albuminate of
,mercury would not be readily absorbed by the stomach is, to use
some of Dr. Hills* vigorous English, " so absurd that it would
.not deserve serious notice were it not for the fact" that it has

* Merck's BulUHn, August, 1888.

t Pharm. Centralblatt, i888.

X Cloetca's '* Lehrbuch der Arzneimittellehre,** 1887, S. 134.

The Value of Mercuric Chloride. 195

been suggested by one so eminent in the profession. If mer-
cury forms an inert compound with albumen and other pro-
teidsy how is it that we get constitutional effects by the admin-
istration of the compounds of this base in the treatment of
disease? Are the contents of the stomach and intestines
always free from proteids when the medicine is administered ?
The truth is that the albuminate of mercury is insoluble in
water, but is freely soluble in excess of albumen, in blood-
serum, in meat-broth, in solution containing sodium chloride,
etc. Indeed, all the mercury given medicinally is said by
leading therapeutists and physiological chemists to be con-
verted into the albuminate before it is absorbed. Filehne says
concerning the absorption of mercury : ** The salts of mercury
soluble in water form first with albumen compounds which,
partly in excess of albumen, partly from the action of other
substances, as sodium chloride, hydrochloric acid, etc., are
soluble, so that the passage of these compounds into the blood
as soluble albuminates is undoubted. The compounds insolu-
ble in water are by the action of sodium chloride and hydro-
chloric acid converted into the sublimate, and this in turn into
the albuminate." Nothnagel and Rossbach* say that while
the albuminate of mercury is insoluble in water, it is freely
soluble in excess of albumen and in sodium chloride.

Dr. Hills again says : ** Sternberg, in the Medical Record lov
August 1st, 1885, affirms positively that the albuminate (of
mercury) is a potent germicide, but gives no facts in support
of this statement. Klein's experiments, however, suggest
that its germicide power is very slight at the most. Admit-
ting, however, that it has such power, the amount redissolved
is very small, and this is likely to be converted at once to the
inert sulphide by the sulphuretted hydrogen present."

I have italicized the assertion to which I desire to give im-
mediate attention. Here Dr. Hills is again wrong. Sulphu-
retted hydrogen does not decompose the albuminate of mer-
cury. Every toxicologist knows this, and destroys the organic
matter before he attempts to precipitate mercury from solu-
tions containing proteids. In the report of the committee,
where I show that the albuminate of mercury is soluble, I

* " Handbuch der Arzoeimittellehre," sechste Auflage, S. 194.

196 The Valvs of Mercwric ChlaHde.

state that the organic matter was destroyed by potassium
chlorate and hydrochloric acid, after which the mercury was
precipitated with sulphuretted hydrogen. Nothnagel and
Rossbach * say '* from the albuminate of mercury one cannot
precipitate the metal with sulphuretted hydrogen until the
organic matter has been destroyed. " If sulphuretted hydrogen
precipitate mercury from proteid solutions, the mercury so
precipitated is not combined with albumen, and the occur-
rence of such a precipitation shows that the mercury exists in
excess above that taken up in the formation of the albuminate.
The albuminate of mercury is not easily decomposed.

Again, Dr. Hills thinks that the alkalies formed in decom-
posing matter would precipitate the mercury. Nothnagel and
Rossbach f say: "If common salt be added to an alkaline
solution of albumen, mercuric chloride will then fail to pro-
duce any precipitate." No one will question the existence of
common salt in privy vaults.

It is true that Klein's experiments suggest that the germi-
cide power of mercuric albuminate is very slight at most. In-
deed, Klein asserts (or rather did assert) that a one per cent
solution of mercuric chloride is no more a germicide than is
vinegar. Certainly no one will now champion this statement,
although vinegar is not worthless as a germicide. Koch found
that the spores of the anthrax bacillus will not germinate in a
proteid solution if there be present one part of corrosive subli-
mate in three hundred thousand. And yet Dr. Hills, without
having made an experiment, condemns the committee for
recommending a solution of corrosive sublimate, one to five
hundred, for the disinfection of the liquid discharges of cholera,
typhoid-fever, etc.

Dr. Hills finds very strong language of condemnation for
the report of the committee in recommending that the amount
of bichloride found necessary to sterilize broken-down beef-tea
be multiplied by two, and used for the disinfection of the
liquid discharges from the bowels of patients with cholera,
typhoid-fever, advanced tuberculosis, septic diarrhoea, etc. As
he bases his condemnation upon the incompatibility (?) of
mercuric chloride with albumen, he must suppose that these

* L9€0 €itat0. f Lqcp eiiat^.

The Value of Mercurio Chloride. 197

stools contain a large amount of soluble proteids. In this he
is again wrong ; such discharges do not contain large amounts
of albumen or other soluble proteids. Simon * obtained the
following results from the analysis of the fsecal matters in
cholera :

Water 980.00

Solid matters 20.00

Fat 0.08

Extractive matter 4.80

Albumen and mucus o. 52

Chloride of sodium, lactate and acetate of

sodium, and alkaline phosphates 13*40

Phosphate of lime and magnesia 0.60

The blood contains, according to Hammerston, from 2.677
per cent (horse) to 4.436 per cent (rabbit) of serum albumen ;
and yet, according to Von Ermengen, mercuric chloride in
solution of I : 800 and i : 1000 sterilizes blood. With these
figures before us can we say that ''it is not creditable to a
committee of the leading sanitary association of this country'*
to recommend a solution of mercuric chloride i : 500 for the
disinfection of cholera stools.

Practically we know that mercuric chloride does efficiently
disinfect substances containing a hundred times as much pro-
teid as cholera stools contain. This is done many times every
day in bacteriological laboratories. Gelatine plates and tubes,
agar tubes, and blood-serum tubes, laden with all the known
germs, are disinfected with a solution of mercuric chloride
I : 1000. In Koch's laboratory this is the only disinfectant
used, and there has been no evidence of its failure. Plates
covered with colonies of the anthrax bacillus, the comma
bacillus, etc., are immersed in the solution with the certainty
that the sterilization will be complete. Old tube cultures are
treated in the same way, and with the same result, whether
they contain gelatine, agar, or blood-serum. Now, in the
gelatine, one litre of beef-tea contains 100 grams of gelatine,
10 grams of peptone, and 5 grams of sodium chloride. We
have seen that the albuminate of mercury is made with pep-
tone as well as with albumen, and there is nearly twenty times

* Becqaerel and Rodier'i " Pathological Chemistry/* p. 459.

}

198 The Value of Mercuric Chloride.

as much peptone in this mixture as there is albumen in cholera
stools, and nearly two hundred times as much gelatine besides.
Certainly no one will question the large amount of albumen in
blood-serum. Is it not strange, if the albuminate of mercury
is so " inert/' that the disinfection of these cultures should be
so successful ? Even the evacuations of infants with green
diarrhoea, containing a large amount of undigested food, do not
contain as much proteids as do gelatine cultures, as is shown
by the following analysis of Golding Bird :

Water 900.00

Biliverdin, alcoholic extracts, fat, cholesterine. 24. 50
Ptyalin, watery extract, colored with biliver-
din 1 1 25

Mucus, coagulated albumen, and hematin 56.00

Chloride of sodium, with traces of tribasic

phosphate of soda 5. 50

Tribasic phosphate of soda 1.75

Peroxide of iron i.oo

In the first report of the committee (1885) a solution of
chloride of lime was given the first place for the disinfection
of excreta in the sick-room, and a solution of mercuric chloride
of the strength of i : 500 the second place. In the latest re-
port (1888) carbolic acid has been given the second place, and
mercuric chloride has not been recommended for this purpose.
This change was made because the carbolic acid was believed
to be sufficient, and not because the mercuric chloride was
believed to be inefficient. In the light of the most recent
experiments in this country and abroad, we believe that mer-
curic chloride, in the proportion named, would be elTective in
the disinfection of the liquid discharges of patients suffering
from typhoid-fever or cholera, and that the recommendation
made in our first report was justified by the experimental data
then given, and not yet contradicted by any new evidence.

The committee called attention to the action of mercuric
chloride on lead pipes in its first report, and this influenced it
in substituting carbolic acid for mercuric chloride for disinfect-
ing the excreta in the sick-room.

To return to our critic, the broad statement is made that :
"An examination of the report of this committee fails, however,

Climate of Western North Carolina. 199

to bring to light the slightest particle of evidence upon which
such a recommendation could have been based/' viz., the
disinfection of excreta with mercuric chloride. Dr. Sternberg^
chairman of the committee, made extended researches upon
the germicide power of this agent several years before (1883)
the committee was appointed, and to those experiments refer-
ence is made in the first report. It is for this reason that
extended experimental researches were not made with this
agent in 1885. However, a number of experiments were
made and recorded in our report. These show that even the
solid or semi-fluid faeces of a healthy person may be sterilized
by the use of the solution recommended by the committee,
provided that they are broken up so as to be fairly exposed to
the action of the disinfecting agent. Moreover, the fact is
recorded that a certain amount of the mercurial salt remained
in solution at the end of twenty-four hours, as shown by a
deposit of mercury on a copper wire (exp. of September 8).
Yet our critic, without recording a single experimental obser-
vation of his own, states that there is not the slightest particle
of evidence upon which our recommendation could have been
based.

One who has given no special attention to chemistry may be
pardoned for not being acquainted with the chemical nature
of the albuminate of mercury, but certainly any one who had
read our report could not have made the sweeping assertion
which we find in Dr. Hills* criticism. — Boston Medical and
Surgical Journal, January 3, 1889.

THE CLIMATE AND SANITARY QUALITIES OF
WESTERN NORTH CAROLINA.

ABSTRACT OF A PAPER READ BEFORE THE INTERNATIONAL
MEDICAL CONGRESS, WASHINGTON, D. C, SEPTEMBER, 1 887.

By Henry O. Marcy» A.M., M.D., LL.D., of Boston, Mass.

The great Appalachian chain of mountains, in their south-
erly extent, present many features of scientific interest, chief
of which is found in the composition of the granite. The
decomposition of the rocks is most extraordinary, railroad

200 Climate of Wetiiem North Carolma.

cuts often extending fifty feet through the ledges, requiring
only the use of the pick and shovel. The explanation is found
in the fact that the feldspar is by far the largest factor of the
granite ; often it with the mica and quartz lie in separate
layers, and to this peculiarity is due the exceptional purity
and extent of the mica veins here found of greater size than
elsewhere in the world. To the decomposed feldspar, setting
free potash salts, is also due the marvellous tree growth which
covers this entire territory, nine tenths of which is yet the
primeval forest. These forests consist chiefly of deciduous trees
in great variety, oak and chestnut predominating. Under their
broad arches, spreading out in leafy shade, eighty to one hun-
dred feet above the traveller, one may ride on horseback
almost anywhere, except along the streams, which are thickly
hedged by an almost impenetrable jungle of kalmia and rhodo-
dendron, whose waxy leaves, in June and July, are almost
hidden by the great bunches of pink and white bloom.

Pearly streams of the purest water make laughing music
through every valley, and from the hill-sides gush forth in end-
less number cool springs, often impregnated with iron, sulphur,
and other minerals. In a few places lithia springs are reported
and claimed to possess much medicinal value.

The smaller streams abound in trout; the. larger game is
still found* in the forest depths, holding attractions for the
sportsman, while the seeming endless variety of plant growth
furnishes interest to the botanist, and the lover of nature never
tires of the kaleidoscopic pattern of landscape picture, on
every hand, domed by the clear blue vault of heaven, which
is itself often the panorama of cloud and storm rarely seen
outside these mountains.

The great variety of forest and plant growth is found in the
fact that these elevated ranges extend into a southern lati-
tude. In climbing the sides of some great mountain, the dif-
ferent tree growth of two thousand miles in latitude may be
met, until near the summit one wanders under the impene-
trable shade of the balsams and firs peculiar to the great
stretches north of Canada and to Northern Europe.

From the above description ready reference will be made of
a scant population, which is found, indeed, in a class of hardy
mountaineers, simple and uncultivated in taste and habit,

Climate of Western North Carolina. 201

whose chief wealth lies in broad acreage of small monetary
value, interspersed with little patches of corn and grain along
the larger streams, and also in herds of cattle, sometimes of
considerable size, which roam through the forest at will, and
are often found grazing upon the highest tops of the moun-
tains.

On account of the inaccessibility of this section until re-
cently, it has been less known to the outside world than per-
haps any other of equal size in the United States east of the
Rocky Mountains. Before the late war, a few of the more
wealthy planters upon the coast of the Carolinas and Georgia
took refuge upon the easterly and southern slopes from the
summer heat.

When first known to the whites, this region was the central
home of the Cherokee Indians, and in this tribe was found a
civilization superior to any other of the races east of the Mis-
sissippi. When visited by William Bartram in 1772 (see his
most interesting book published in London in 1778), he found
them dwelling in houses made of logs, much as now seen
occupied by the natives, and separated in families, living a
peaceful life, cultivating their corn and beans in well-kept
fields. He repeatedly expressed his wonderment at the phys-
ical strength and beauty of the natives.

Owing to the disasters following the recent conflict and the
engineering difficulties to be overcome, it is only very recently
that this territory has been rendered by any means fairly ac-
cessible to travel. The invalid seeking health in this region
has also been met with the extraordinary disadvantage of not
finding, even in moderate degree, the home comforts so essen-
tial to his welfare. However, the advantages offered to in-
valids, in considerable variety of disease, were so apparent
that many have braved the discomforts attending such evils,
and results have been attained of a character sufficiently marked
to warrant the further study of the climatic conditions of this
wide extent of country.

Asheville, the central metropolis of this region, has grown*
within a short period, from a small village to a city of about
nine thousand inhabitants. At first it was simply a summer
resort for the residents of the low country south, and, until
very recently, almost without winter visitors. Now a consid-

202 Climate of Western North Carolina.

erable percentage of the inhabitants consists of invalids from
the North, many of whom have found such marked improve-
ment that they have made it a place of permanent abode.
Some of the residences are homes of wealth and comfort, and
a number of excellent hotels offer good accommodation. The
largest are the Swannanoa and the Battery Park. The latter,
recently erected by Colonel Coxe, of Philadelphia, is a model
of excellence rarely surpassed anywhere. This was nearly as
full last winter as during the more fashionable summer season.
Dr. Battle, a resident of the hotel, who has had the oppor-
tunity of observing several hundred cases, assures me that he
has rarely seen a patient whom he thought had made a mis-
take in selecting Asheville as a health resort. I saw several
physicians who not only were enthusiastic in the belief that
this section was one of great healthfulness, especially to be
commended in pulmonary diseases, but said they themselves
were compelled by disease to leave other localities, while here
they were able to endure the fatigues of the active practice of
their profession. One who four years ago had had frequent
haemoptysis and a supposed cavity, was now nearly free from
cough, had been actively at work, and certainly gave every
appearance of recovery. From Dr. Watson we received a
confirmatory report in his exceptionally large and varied ex-
perience. I have sent about fifty patients to Asheville and
vicinity within a few years, and, for the most part, with very
satisfactory results.

The town has not been entirely free from diarrhoeal diseases
and typhoid, but great improvement has been made within
two years in the introduction of pure water from a distance,
and a system of good sewerage has been also inaugurated.
The location is excellent — upon a plateau, with a beautiful
outlook over an amphitheatre twenty miles in diameter, sur-
rounded by mountains, yet clothed, for the most part, by
forest.

Asheville is twenty-three hundred feet above the sea, and
from its southern location possesses advantages in climate
which, for mildness, is not unlike Southern France. From
observations now made for a number of years, the mean aver-
age temperature of Asheville is: Spring, 52.3°; summer,
71.3° ; autumn, 55. 3*" ; winter, 37.2° ; year, 55. 3"* F. During

Climate of Western North Cardi/na. 203

a period of eight years the thermometer but twice rose above
88"", and only three times fell below zero.

I here append a carefully kept record, tabulated by Mr.
D. S. Watson, of Asheville, for the first four months of 1886.
The cold wave of January will be remembered as havinjj passed
over the entire South, and was of a severity beyond that in
the experience of ** the oldest inhabitant."

I copy the following tables from a reprint of Dr. H. T.
Gatchell :

TABLE A.

Table of deaths from consumption in 10,000 of white popula-
tion, excepting in Western North Carolina, where the estimate
is for whites and blacks :

Four counties in Western North Carolina 6.5

Three counties in South Carolina, with Aiken as

central point 10.2

Minnesota 10.7

Four adjoining counties in Georgia, with Thomas-

ville as central point 11. 3

Peninsula of Florida 13.0

Mainland of Florida 18.0

Plains of Colorado (excluding Denver) 21.6

Maine 28.0

Los Angeles County, California 29.0

Massachusetts 29.0

New Orleans 30.0

District of Columbia 30.0

Charleston, South Carolina 3 1.4

TABLE B.

Table of deaths from pneumonia in 10,000 of white popu-
lation, excepting in Western North Carolina, where the esti-
mate is for whites and blacks :

Western North Carolina 4.5

Los Angeles County, California 5.3

Four counties in Georgia, with Thomasville as

central point 5.5

Florida 5.7

Minnesota 6.0

204 CUmate of Western North CaroUna.

Michigan 8.0

Charleston, South Carolina 9.0

Maine 9.0

New Orleans 9.3

District of Columbia lO.O

Massachusetts 14.0

Plains of Colorado (excluding Denver) 17.0

The late Dr. H. T. Gatchell, of Asheville, was a careful
student of the section of country adjacent to Asheville for
many years, and his observations, first published nearly twenty
years since, are of much value. His son. Dr. £. A. Gatchell,
writes me his experiences are confirmatory of those of his
father. The elder wrote : " In a series of nine years the mer-
cury did not rise about 90° F. any day in summer, the nights
are always cool, permitting refreshing sleep. In winter it is
seldom that a zero temperature is reached, while the air is
comfortable, dry, clear, and invigorating.

•' The following table gives the ratio of consumption in sev-
eral sections of the country. The figures indicate the number
of deaths from this disease in every thousand :

New England (nearly) 250

Minnesota and California 150

Kentucky and Tennessee 100

Western North Carolina 30

To any who seek entrance to the mountain region from the
east, Asheville will be the central point of interest, and, if
actuated by the restlessness of most of our countrymen, the
first stopping-place. There can be no doubt but many local-
ities upon the easterly and southerly slopes of the Blue Ridge
present great attractions for invalids. A number of my med-
ical correspondents write that some of these localities are
especially desirable because of the dryness of the atmosphere
and freedom from fog, which, at certain seasons of the year,
prevail to a considerable extent through the mountains.

Unfortunately, no records of temperature, sunshine, rainfall,
etc., from other localities have come under notice. The same
general features of the landscape and climate here prevail.
Along some of the southerly slopes the " no-frost line" is

Climate of Western North Carolina. 205

clearly perceptible, and sanitaria, well selected at such local-
ities, would offer certain marked advantages. It is greatly to
be regretted that careful observations have not been made at
some of these places as to the equability of heat, amount of
sunshine, rainfall, etc., as well as to the absence of severe
cold, a fact so abundantly substantiated that it cannot be
doubted, although a little distance away frost and ice are of
common occurrence.

On the Western North Carolina Railroad, at Morganton, is
located the State Asylum for the Insane, selected because of
the healthfulness and beauty of surroundings.

The Piedmont Springs, fifteen miles north of Morganton,
have been a favorite resort for a generation, and a long,
rambling hotel, venerable in service, offers attractions of quiet
and rest. The springs are sulphur, not unlike the White Sul-
phur of Virginia, and a short distance away is a fine chalyb-
eate spring, entirely free of sulphur. The surroundings are
wildly mountainous, picturesque, of a rugged Swiss type.

A few miles south of Marion, at Glen Alpine, is a large
hotel, long a favorite resort of the residents of the southeast.
Here are said to be good springs of iron and sulphur. Lithia
springs are reported at several places on the southeasterly
slopes of the Blue Ridge, but little, however, is known of the
medicinal value of the waters.

The railroad crossing the Blue Ridge is an engineering feat
worthy of modern science, and compares favorably with the
difficulties overcome in the famous Soemmering Pass of
Europe. To the north, in the range known as the Black,
towers Mount Mitchell, the highest peak of the entire region,
671 1 feet above the sea-level. In a broken, undulating line
runs the chain of the Blue Ridge to the Grandfather, fertile
farms dotting its slopes here and there ; a region intersected
by valley and mountain, picturesque, wild gorges, rippling
streams, tumbling cascades, forests, deep jungles of rhodo-
dendron, with a mean annual temperature of 45^ F., quite
similar to that of Vermont. From this point, the Grand-
father, diverges the Smoky Range, called by the Indians
Unaka or White, which forms the boundary line of Tennessee.
Its grandest representative is found at its very beginning, in
the Roan, 6390 feet in height, and the beautiful peak called

206 Glimate of Western North Carolvna.

the "Yellow/' a little less high than either, is the massive
gate forever locked between these magnificent representative
pillars of the splendid ranges of the Blue Ridge and Unaka
mountains. Near the top of the Roan a large and comfort-
able hotel has been erected by General John ?• Wilder as a
sanitarium, open during four months of the year. It is the
highest inhabitable spot east of the Rocky Mountains. The
difficulties encountered in the ascent make the journey a
severe one for the invalid, although the railroad from Johnson
City to Cranberry passes at the base of the mountain. The
station called Roan is the point of leaving the rail. There is
in contemplation the speedy completion of an elevated railway
to the top. The Signal Service station on the mountain has
furnished interesting and important data for climatic study.
The equability of the temperature has far exceeded expecta-
tion, and the electric phenomena are very interesting. It has
long been claimed that the Roan offered an asylum to the
victim of hay-fever unequalled, but the irony of Fate has in it
another illustration. Now that the recluse here can be sur-
rounded by the comforts of modern life, the old enemy con-
tinues in attendance, for hay-fever has been reported in the
entire locality the last two years, including also the region
about the Grandfather.

A new avenue has been opened through the mountains from
the south to Asheville, via Hendersonville from Spartansburg.
Ten miles south of Asheville, amid pleasant surroundings, is
the Arden Park Hotel, situated half way to Hendersonville ;
also a town with good hotels, and the entire section one of
beauty and interest. A little south from here is^ Cesar's
Head, an abrupt " fault" in the mountain on the South
Carolina border. Much is claimed for this locality on account
of its dryness, but I know of no reports of actual observations.
The landscape views are extremely varied and interesting.
The elevation is about 4000 feet. The hotel is well kept and
a popular resort in summer. The air is pure and bracing, and
many attractions are found in the immediate vicinity to inter-
est the invalid.

West is Cashier's Valley, a high table-land about 3400 feet
above the s6a. It is of repute as a resort for consumption.
Still farther west is the Highlands, a hamlet widely advertised

Climate of Western North Carolina, 20T

as a health resort. It is reached with great difficulty, indeed,
to the confirmed invalid, inaccessible, long distance from the
rail on either side, over roads of the worst sort. Here the
average rainfall has been found to be seventy inches annually,
and, judging from the configuration of the abrupt mountain
ranges bordering the lowlands lying south, it is presumable
the rainfall of the entire region is excessive.

Down the French Broad River one easily reaches, by rail,
the Hot Springs, which are becoming justly celebrated. The
hotel accommodations are modern and excellent, while the
baths are numerous and ample. The effect of the water
appears not unlike the famous Hot Springs of Arkansas.

Westward from Asheyille about thirty miles is the enter-
prising little town of Waynesville. In the Richland Valley,
one mile away, is situated the Hayward White Sulphur
Springs. The proprietor. Major W. W. Stringfield, is justly
popular, and his new hotel has been well filled with guests.
The elevation is over 2700 feet. The valley is very lovely,
and the view of the broad meadows and lofty mountain ranges,
as seen from the hotel, is beautiful beyond description. The
waters of the creek rush along with great rapidity over the
whitest pebbles, and their gentle murmuring is sweet music
to the troubled heart and weary brain. Much curative effect
is claimed for the sulphur water, which wells up pure and cool
into a marble basin at the edge of the valley. Westward from
Waynesville the railroad climbs the Balsam range to a height,
at the divide, of nearly thirty-five hundred feet. The dry,
pure, bracing air has attracted hither invalids, who reported
to me great benefit from a few weeks' residence, although the
hotel is limited and designed only as a station for dining pas-
sengers. Beyond lie the beautiful broad valleys of the Tucka-
seegee and Little Tennessee rivers, rapid streams of consider-
able size, only recently reached by rail ; still farther westward
tower the splendid ranges of the Cowee, Nantehaleh and
Valley River mountains, irregularly dividing the wide space
of the base of the triangle made by the Blue Ridge and Smoky
ranges. These are almost without exception clothed to the
very top with the primeval forest, which yet covers nine tenths
of the entire territory. The country beyond the iron ways is
of yet greater interest to the invalid able to " rough it" some-

908 Climate of Western North Carolina.

what. The roads are, of course, poor, the hotels intended as
hostelries only, but the quaint, old-time manners and customs
of a rude but always hospitable, honest people, are a never-
failing source of interest, and often of profit, to the student of
men as well as nature.

The valley of the Nantehaleh is of interest as a broad plateau
between the ranges, watered by the loveliest of rivers. Its
banks are thickly hedged with kalmia and rhododendrons
which in June present a mass of bloom never seen outside
these mountains. The delicate branches of the graceful
birches gently sway in the breeze, the music of the laughing
waters fills the air ; all else is the unbroken silence of the
primitive forest. Mr. L. R. Finch, who resides on a cattle
ranch in the Nantehaleh Valley, has sent me a daily record of
the weather during the past summer. The rainfall has been
large and the variations in temperature considerable. On
June 13th there was a frost and a temperature record of 30° F.
I found the two weeks which I spent here during August of
the present year very agreeable, although a fire morning and |

evening was a comfort. Frost was reported about the 20th
of the month.

The Valley River Valley surpasses all the others in beauty
and picturesqueness ; broad and fertile, a landscape rarely
equalled, set in a mountain frame of living green, of which the
eye never tires. The small hotel is ever full, and when proper
accommodations can be reached by rail it will become a popu-
lar resort.

Surrounded by a medium from which there is even momen-
tarily no escape, and which we must ever breathe, atmospheric
impurities must be of the first consideration in the climatic
elements. These are both chemical and atomic ; while the
relative amount of oxygen varies but little in a given weight of
air taken from sea or mountain, its changes, even in very slight
amount, are important. When deficient it is usually replaced
by carbonic acid. The last is undoubtedly deleterious ;
nausea and headache are common in close rooms containing
only one percentum of carbonic acid. These changes are also
important as indices of an atmospheric contamination in a
particular way by the presence of foreign material, chiefly 'of
a fermentative type. Since these are usually of the lowest

Climate of Western North Carolina. 209

origin of spore plant life, the general name of germ contami-
nation has been given to it.

The value of recent investigations upon this subject, as a
cause of disease, is one of the triumphs of modern science, and
invests the study of climate with new interest.

Since these minute growths develop under conditions of the
atmosphere usually marked by the lessening of the oxygen
and increase of carbonic acid, such changes assume an impor-
tance greater than earlier supposed.

The organic material exhaled with the breath is molecular^,
and is disseminated by atmospheric currents. The odor from
the decomposition of these organic elements is generally per-
ceptible when the carbonic acid reaches seven parts in ten
thousand, and is strong when it amounts to ten parts. One
of the chief causes of lung diseases in cities arises from the
atmospheric contamination by myriads of microscopic qell
growths.

One danger, by no means hypothetical, from the consump-
tive, lies in the material expectorated. This very commonly
dries where it is carelessly lodged, is pulverized and distributed
as dust. In the inspiration of the atmosphere thus infected,
the bacilli are lodged upon the mucous membrane of the air-
passages, and, if these are inflamed or broken, may find a suit-
able soil for generation. In this sense certainly consumption
is a contagious, or rather an infectious disease. Organic
material in the air is ever to be looked upon as injurious. We
can have no ^^^^tra/ test for discriminating between hurtful and
harmless organic matter, since the poisonous infection is vi^a/.

The mechanical admixture of water with the atmosphere in
the form of vapor is a constantly varying factor, dependent
upon a number of conditions, and although rarely entirely
absent is an element of itself comparatively unimportant ;
however, in combination with heat, albuminoids and the omni-
present microscopic cell plants, it renders possible changes of
the highest importance.

Atmospheric moisture has a marked influence upon the skin
and its glandular functions, as well as upon the respiratory
tract. Its presence also lessens, in a considerable degree, the
permeability of the atmosphere by the sun's rays, diminishing^
thereby the oxidizing power of sunlight.

14

SIO Climate of Western North Carolina.

, Ozone, although we know far too little of it as yet as an
agent, from its admitted powers, is an important atmospheric
factor in its bearing upon climate and health. It is an alio-
jt^'opic form of oxygen which has attained new properties of an
intensely active character, supposed to have been produced
chiefly by electricity.

; Ozone owes its great value as a disinfecting agent to its ex-
ceedingly powerful oxidizing qualities. The compounds of
ammonia, phosphorus and sulphur are acted upon with great
rapidity, and the odors resulting from decomposition are re-
moved instantly. It is probably destructive to all the minute
vegetable organisms. Under the direction of a committee
from the American Medical Association a series of continuous
studies in various sections of the country have been conducted
for a number of years to determine if any relation exists
between the development of acute epidemic diseases and
changes of atmospheric character.

Ozone tests are being continually and carefully made. It
exists in larger quantities in the atmosphere of mountains and
forest country than elsewhere, and is increased most of all
after severe thunder storms. To this, more than to any other
agent, is to be attributed the so-called ** clearing effect upon
the air" after a thunder shower, giving a delightful, exhila-
rating feeling in respiration never experienced after a long rain.

Temperature is an important climatic consideration. The
remarkable results obtained from a winter residence at elevated
localities in the Alps has demonstrated the possibility of great
gain, although the cold is intense. Under such conditions
the atmosphere is nearly free from moisture and impurities,
and the cold in the sunshine is seeming rather than real, since
the diathermancy of the air is so great at considerable eleva-
tions that the sun's rays make it comfortable to remain out of
doors when the ordinary thermometer registers a temperature
of 20° or 30*^ F. The experience in our own country, of in-
valids at elevated regions of the North in winter, has been
limited, and generally not favorable.

Patients have braved the winter in the Adirondacks, some
with good results ; but out-of-door exercise is limited, and the
elevation of 1000 feet too little to make the rarefaction of the
atmosphere important. This is also true in the White Hills

Climate of Western Norik CaroH/na. 211

of New Hampshire. A warmer climate^ with elevation, is im-
portant, and one of the great climatic advantages of the ele-
vated regions of Western North Carolina consists in the lati-
tude, which is south of 33° 53' and 36° 33'. The winter tem-
perature here is not unlike Southern France, while the eleva-
tion is from 2000 to 3000 feet. The invalid can comfortably
be out of doors in winter here most of the pleasant days.
One of the very best commendations of any climate is found
in the largest number of hours and days suitable for exercise
out of doors. This, of course, applies to rain and storm as
well as cold.

The barometric changes occurring in the great aerial ocea^
in which we live are of the greatest interest. From their
study, in large degree, has arisen the new science of ** Prob-
abilities" as to weather, which already governs so great a part
of the civilized world in its movements. Air currents are
created, with changes of temperature, moisture, etc., many
hundreds of miles in length.

In elevated localities broken by high mountains there is a
more or less fixed cloud region, where the chilling of the
moisture-laden atmosphere causes condensation ; especially is
this true during the summer months. During the day the
surface of the lower valleys is much heated, and the lower
atmospheric stratum becomes rarefied and rises along the
slopes, producing the breezes of the early part of the day.
After sunset the higher peaks and sides radiate the heat more
rapidly than the base^ and the cold, condensed air descends,
causing often an evening wind. These air currents vaiy
greatly with the configuration of the locality, and should be
studied in relation to the selection of sanitaria.

The formation of clouds about the mountain-tops is differ-
ent. The warm, damp winds blow across the ranges, the air
is suddenly cooled, and most of the moisture is precipitated
in the form of mist, rain, or snow. The air currents that cross
the summits sink in various directions, condense and become
warmer in descending. This modification of the temperature
of the air currents gives great variety to the cloud formation
and rainfall. Often the wind blowing steadily in one direction
will give abundant rain on the first range of mountains, while
beyond it is clear and dry. These influences greatly modify

213 Climate of Western North Carolina.

the climate of the valleys, which is widely variable^ according
as they are sheltered from the winds and open to the sunlight.
The extreme temperature between day and night is also more
marked in the valley. Upon the side toward the sun» under
the direct influence of its rays, the heat is increased by radia-
tion during the day and diminished during the night. On the
contrary, the differences in temperature between the heated
and cold seasons is less marked in the valleys. Locations for
residences in valleys should be selected that will furnish the
greatest number of hours of sunshine.

When the atmospheric humidity is considerable, the morning
and evening extremes of temperature in the valleys produce
condensation of the moisture in the form of mist or fog, while
the upper slopes may be entirely exempt from these.

An important climatic element of any country exists in the
character of its surface. Its ability to absorb and retain mois-
ture governs in large share its temperature, and the tempera-
ture of the soil in a marked degree governs the temperature
of the air. They are usually alike. A loose, porous soil
covered by a heavy tree growth furnishes the best surface for
equalization of evaporation and uniformity of temperature.
The earth's surface is charged with negative and the overlying
atmosphere with positive electricity. The latter is much
more marked in elevated regions broken in sharp mountain
ranges. This produces in regions of considerable elevation,
during the heated season, thunder storms of great intensity.

A mountain or elevated climate is advantageous to a variety
of diseases influenced by a change of circulation. The lessen-
ing of the atmospheric pressure causes the diminution of the
blood flow in the brain and central organs, and increases it in
the cutaneous surfaces. Imperfect nutrition, as exhibited in
anxmia, indigestion, loss of appetite, etc., is greatly benefited
by the pure, bracing air and exercise.

Neuralgia, nervous prostration, loss of sleep, headache,
hypochondria, etc., lessen under the stimulus of a better nerve
nutrition. The improved circulation and nutrition of the
respiratory organs give relief in most cases of asthma dependent
upon changes of the bronchial mucous membrane as well as
upon innervation. Bronchial inflammations are usually bene-
fited, and the increased respiratory function lessens the con-

Climate of Western North Carolina. 218

ditions favoring consumption ; and often the disease itself, in
its incipiency. is arrested.

The invah'd suffering from extreme weakness induced by
any cause had better not attempt a residence in an elevated
region unless by the advice of a competent physician, for
while an elevated cUmate is stimulating and has a powerful
therapeutic action on most functions, it requires a certain in-
tegrity and resisting power, which the patient may not possess.

Organic diseases of the heart and great vessels are, almost
without exception, made worse by the overwork demanded of
the circulatory apparatus.

Perhaps the most important of all conditions to be consid-
ered is that of the mental state of the invalid when directed to
any locality for the benefit of his health. They should not
only be guarded against extremes of exposure, exercise, care
as to diet, etc., but above all be given, as far as possible, a
bright, hopeful, happy state of mind. All these prerequisites
to improvement are so essential that the invalid does well to
place himself under the care of a resident physician. Occupa-
tion to direct the attention from self should, as far as possible,
be obtained. The sportsman finds recreative pleasure in the
rod and gun, the botanist in the wide diversification of plant
life* the geologist and mineralogist in the ever-interesting out-
cropping minerals about him. Indeed, Western North Caro-
lina abounds in mineral wealth. Here are found the richest
corundum mines of the world, rich ores of various kinds —
gold, iron, and copper — mica blocks, from six inches square to
two feet, and marbles of most exquisite beauty, from pure
white, pale flesh-color to coal black, variegated by seams and
stripes of every color.

" The bliss of a spirit is action," is the unwritten law of
life, and he who seeks the renewal of its pulses must come
under its universal requirement. To the invalid resting under
condemnation from the violation of nature's laws, a wise selec-
tion of residence in the mountain regions of the great Appa-
lachian chain holds out a hope often denied to the dweller in
the cities of the plain. Everywhere mountains and streams,
cliffs and valleys, gaps and glens, add charm to the scene and
inspire delight in the lover of the beautiful and sublime, and
while health is borne upon the breeze, beauty and grandeur
fill the soul.

214 Local CondiHons and YeUavo-Fever,

LOCAL CONDITIONS AND YELLOW-FEVER.

THE LATE JACKSON FEVER, AND PREVIOUS EPIDEMICS ELSE-
WHERE.

By E. H. Anderson, M.D., Jackson. Miss.

I PROPOSE in this article to treat of the recent fever that in-
vaded a limited area in Jackson, Miss., and compare it with
previous epidemics in Canton, Grenada, and Memphis ; and
endeavor to show that each and all were of local origin and
not from an imported germ.

In the last, the Jackson fever, it was my fortune to have
been a frequent visitor to the locality where it originated, and
from which it showed no disposition to spread. Previous to
the invasion, I had reviewed the ground, and from my medical
experience thought I saw abundant cause for the production
of some form of malarial-fever of pernicious type, at least.
An old depot building had been razed and a large new build-
ing erected, for the foundation of which much earth was neces-
sarily disturbed ; and, besides, a railroad bed had been dug
up, occasioning the upturning of soil for one hundred yards or
more. The building torn down was said to have been used as
a yellow-fever hospital in 1878, and two patients died there.
There were piles of upturned dirt along the track and heaps
of trash standing about the new building, in process of erec-
tion. All this was going on during the months of July,
August, and September, the fever making its appearance
about the 20th of the latter month.

This depot is situated in West Jackson on the lowest city
level, and through which a slough runs south emptying into
Pearl River. This may be called the paludal district of the
city. In the months of July and August there were frequent
heavy showers, which extended into September with less fre-
quency. The range of thermometer was high both in July
and August, but in the latter month interrupted by cool days
and especially cool nights and mornings, and this latter condi-

Local Conditions a/ad YeUow-Feoer. 216

tion prevailed through September. The range of thermom-
eter, however, was at no time as continuously high day oi*
night, with the exception of one night, as it had been in pre-
vious epidemics, according to my observation. There was an
effluvium about the depot very perceptible to the sense of
smell, and a closeness of atmosphere that rendered it very un-^
comfortable. In the progress of building the large depot;
there was necessarily an immense amount of painting material
used ; and owing to the limited space between the old and the
new depots, there was but little circulation of air. Add to
this the refuse material, incident to constant crowds of both
white and colored citizens and travellers, and you have thd
niateries morbid which only lacks heat and moisture to vitiate*
air and generate in the human system the worst form of malig-
nant fever. In the Jackson fever the cause seems to have
been operative upon those alone who were constantly subjected
to its influence, and though sick at home, away from the seat
of infection, did not propagate the disease. The inference
plainly is, that the contagium was not infectious beyond its
original seat. With these facts before me, and having seen'
on one or two occasions, while on the spot, every depressed'
surface full of water after showers, and the earth saturated,'
soon to be exposed to a hot sun, I ask, would not this condi-i
tion of things naturally suggest, as it did to me, chat the result
would be sickness of malarial form ? In my opinion an im-
ported germ was not at all necessary to produce the results
that have been realized.

Going back now to the epidemic invasion of Canton in 1855;
1 will remark that I was on the spot when the first case occurred
there, in the latter part of August. The court-house had been
razed to the ground a short time previously and there was a
great dearth of water, the quality generally bad. Before the
first case appeared there had been a few light showers, buf
during its progress a heavy rain fell at night, and rains con-
tinued thence on. There was much speculation as to thd
cause of the fever, and some were disposed to think it had
been brought in some blankets from Vicksburg some time
before.

A description of the topography of Canton will be necessary
to give a correct idea of the condition of things at that time.*

216 Local Conditions a^id YeUow-Fever.

The court-house stood on a square, in the centre of the busi-
ness portion of the town, upon an elevation sloping to the
west and also to the north and south, with residences extend-
ing in all directions along the streets, which run at right
angles. A slough runs on the north of the town, from east
to west, emptying into Bear Creek, a mile to the west. From
this sluggish creek many families procured their water supply.
The town was then generally in a bad sanitary condition, and
had always been subject to malarial and typhoid-fevers. The
pulling down of the court-house was simultaneous in this in-
stance with the invasion of the fever, which was supposed to
be yellow-fever. There was a barbecue and mass-meeting
held in the court-house yard while the first case was on hand.
The fever very gradually spread from this central point to
those more remote. The slough on the north side generally
contained a quantity of stagnant water, and stock were con-
stantly being watered there. The season was characterized by
high temperature, running continuously day and night. There
was another feature noticeable about it, which I emphasized at
the time, and has been coincident with every epidemic that has
prevailed in our State at different localities since 1855. This
is a stillness of atmosphere, or calm, observable about one
hour before sunset and continuing on to nine at night.. There
is no agitation of air whatever ; not the stir of a leaf ; all
nature seems to be in profound repose. The effect upon the
human system is that of oppression. As the night advances
the difference between the air without doors and within is
most marked ; that without feeling too chilly, while that
within feels oppressively hot. As this is the period at which
the earth is returning to the atmosphere, by radiation, the heat
which it has absorbed through the day, we may presume there
is a current established by which the emanations are carried
from the surface of the earth into the air, and until this ceases
and the vacuum is filled by fresh and pure air, our respiratory
organs are inhaling deleterious matter and a highly vitiated
air, especially in localities that abundantly furnish morbid
material.

I wish to emphasize this condition of atmosphere, as by
means of it, though having lived in an exempt region, I have
been enabled to predict, for years past, the advent of epidem-

Local CondUiona and Tdiow-Fever. 21Y

ics elsewhere. This condition has, in fact, been an infallible
harbinger of this dread disease. In this epidemic, I often
contrasted the condition of my country home, far away in the
hills, with those about Canton, and thought then, as I do now,
that the local conditions in the latter were sufficient, on known
medical principles, to account for the fever then prevailing
there, without looking up a mysterious and unknown imported
germ.

An accidental circumstance furnished me, in two of the
refugees who fled to my house, and were heartily welcomed,
the opportunity of seeing something of the character of the
disease. They were two young ladies. One of them was
quite sick the night of her arrival ; nausea and vomiting of
blood were the initial symptoms. This I attributed to fright
and natural causes. This patient, however, continued to have
fever for several days with slight remissions, apparently of
malarial character, with complexion of decided icteric hue.
She was treated as I usually treat our local fevers, and she was
soon convalescent. The other was attacked on the third day
with slight chill, followed by fever of same character, treated
in same way, and was soon convalescent. These patients
contracted their fever in the same locality where the first case
occurred in Canton. Had they remained at home they would
probably have had a virulent form of fever. My family con-
sisted of wife, self and two young children. The patients
occupied a room next to my own, and there was the freest
intercourse. No other sickness ensued. This would prove
the fever to be non-infectious and non-contagious when re-
moved from its original source.

I now pass to a consideration of the fever at Grenada, 1878,
also Memphis and Canton. That in Grenada was of unknown
origin, though there was much speculation on the subject and
many theories as to its source. Some supposed it to have
been brought in a lady's dress, made in New Orleans. If a
bacillus germ of a tangible shape had ever been identified in
connection with the fever, I would be willing to accept it as a
theory, and should conclude that there could be no yellow*
fever without this specific germ ; but in its absence, I shall
continue to look to recognizable and well-known local and
atmospheric conditions as the factors in its production. As

218 Local Conditions wnd YeUow-Fever,

will be remembered, the uncovering of a filthy slough in the
centre of the town had been perpetrated just previous to the
accession of the fever. This slough was said to haVe been the
receptacle of the filth of the place ; this too in midsummer,
when a hot sun is changing into putrid fermentation every
substance, vegetable or animal, that is susceptible of fermen-
tation. This was done in violation of one of the laws of nature,
and in opposition to all the well-established laws of hygiene,
and the victims of the fever were the atoning sacrifice. The
meteorological conditions prevailing at the time were similar
and almost identical with those of 1855.

That of Memphis in same year was of questionable origin.
At the time, as well as at this writing, I could not look out-
side of local causes for its appearance, under such propitious
circumstances as then existed. At that time, the drainage
system, since made so perfect, was in its incipiency, and the
condition of Bayou Gayoso was such as to make it a hot-bed
for breeding pestilential malaria. No medical mind could
have reviewed its topographical features then without the
conviction that it needed only suitable atmospheric conditions
to be afflicted by some malarial form of fever of malignant
grade. Those who reside in large cities, from habitude, be-
come so accustomed to their surroundings, as to utterly ignore
facts in reference to hygiene that have long since been estab-
lished ; and absorbed by their pecuniary interests, are prone
to neglect the more important matter of public health, until
suddenly and fearfully aroused by some outburst, the seeds of
which have long lain dormant in their daily walks. This re-
mark, howevef, is much more applicable to other cities than
to Memphis, as she has expended her means largely in meas-
ures for rendering herself salubrious. The fever of that year
was remarkable for its percentage of mortality. This by many
would be imputed to a want of skill on the part of the medical
staff. I think it unjust and illiberal to take this view, but
rather to look to the causes then in operation that gave type
and virulence to the disease. This view seems to be sustained
by its recuxrence the following year, when the type was milder
and they were well under way with their system of drainage ;
and since this latter has been made almost perfect, they have
enjoyed an exemption. Some may impute this exemption to

Local Conditions and YeUow-Fever. 219

non -importation of germs. Well, when they prove existence
I will surrender at discretion ; but until then will think, as
many of my confreres now do, that the germ is indigenous,
and will not leave its hidden haunts until called into active life
by neglect of proper hygienic measures and meteorological
causes. I shall perhaps have something more to say of the
germ before I close this paper.

At the time of the invasion of the fever in Canton in 1878,
its hygienic condition was bad and its topographical features
not very diderent from 1855. There had been many new
buildings erected in the ten or fifteen preceding years, and a
great influx of negro population. It was better supplied with
cistern water than formerly, but still had a scant supply, and
was dependent upon the season for that. There were no
unusual circumstances that could be connected with the out-
break except those incident to a town of its size and the char-
acter of its population and its surroundings. The atmospheric
conditions, however, were unusually favorable, and the fever
was confined to the most densely populated part of the town,
which was subjected also to the influence of the bayou on the
north. The drains were inadequate to carry of! rain water
rapidly ; there was no system of thorough drainage.

The opinion of the resident physicians was that the disease
was imported, and that the town was in good sanitary condi-
tion ; and so it would appear, thought the Jackson physicians
this year. If those of Canton will compare the present con-
dition of their city, and especially the condition of their bayou
on the north, which has since been cut off from public usage
and has been well drained, and the general condition of their
drainage system with what it was in 1878, they will see a vast
difference, and the effect has been manifested in the diminu-
tion of fever. This epidemic was preceded by an unusual
amount of malarial fever, and a high range of thermometer
prevailed from May on to September, with frequent rains, as
I am informed by one of their local physicians, who bore him-
self bravely through it ; and the season was considered by him
"an extremely sickly one" previous to the epidemic. On
tenable medical grounds, it appears to me that the latter and
severer form was due rather to the intensification of the same
causes producing a severer grade than to the supervention of

220 Local Conditions and Yellow-I^ever,

a new and different one. The death-ratcf amounted to about
ten per cent of all cases that were considered yellow-fever.
Dr. Beemis visited Canton as well as other points, after the
subsidence of the fever, looking up the germ. What the
result was I am not informed.

Now it is a well-known fact that, in all invasions of this
epidemic, it has been a difficult matter for experienced physi-
cians to decide the type of the disease in the formative stage
of the first cases. This was so to a greater extent this season
than usual, owing to the fact of the prevalence of yellow-fever
within the borders of the United States.

This difficulty arises from the fact that epidemics vary in
their mildness or virulence, and in the early stages may not
present the typical features characteristic of the disease ; and
may again so closely resemble bilious remittent, as not to be
distinguishable. They likewise are closely allied in features
to many forms of malarial-fevers, and their visitations are gen-
erally made to territory and localities where the malarial type
usually prevails.

In the Jackson fever of this year and that of Canton in 1855,
I think I see a similarity of causes, though differing in many
features. This difference was doubtless due to a larger area of
infectious atmosphere in the one case than in the other. The
house removed here was a small one, that of Canton a very
large one. The temperature in that at Canton ranged high,
and was for a longer period continuously high day and night.
As to contagiousness, neither seemed to possess that quality,
as only those in the infected locality had it. Its germ, if it
had one, did not seem to be portable. In this quality both
resemble malarial fever.

Yellow-fever being a tropical disease, our meteorological
conditions must approximate those of the tropics for its exist-
ence and especially for its prevalence. This condition of high
temperature combined with moisture, which is likewise that
most favorable to fermentation (thermometer ranging from 78^
to 88° F. day and night), has been a concomitant of all the
epidemics since 1855. In the most of them the daily range
of temperature, in the shade, was from 90° to 96° and occa-
sionally reaching 100°.

I would here venture the suggestion that a combination of

LooaL Conditions and YeUow^Fever. 221

external agents acting upon a system predisposed to sickness
through the enervating influences of season and surroundings
might be so disturbed in its physiological action, as to become
a prey to inflammatory processes that would soon transform
healthy into degenerative and destructive tissue, that would
soon lead to disorganization and death. The phenomena
manifested in yellow-fever, especially those of the stomach,
liver and spleen, would justify the conclusion if they do not
demonstrate the fact.

This h3q>othesis, when analyzed, will be found in accordance
with vital laws, and though opposed to the commonly accepted
germ theory, yet hath what might be termed a germ in it, if
metamorphosed tissue, the result of physical agents acting
from without, may be so termed. Dr. Lionel S. Beale, in his
work on Disease Germs, says " he thinks the original germ
came from the human body and is developed within man." I
regard what he calls the fever germ, in his illustrated plates,
drawn from microscopical observation, as a morbid product of
inflammatory action.

In commencing this paper, it was no part of my plan to dis-
cuss the germ theory, but collect some facts in regard to this
fever that would, when well considered, point out a way to
prevent its ravages. I have endeavored to show that in each
invasion referred to the. sanitary condition was bad and defec-
tive, and that in some cases the water supply was also deficient,
and in all, the meteorological conditions were favorable for
epidemic disease.

Now, the question arises, and it is a very important one, is
there any other mode of prevention besides quarantine ? I
think there is, and if it will not exclude, it will certainly
modify and render infinitely milder any form either of endemic
or epidemic disease. The remedy is proper drainage, sewerage
and the adoption of the best sanitary and hygienic measures
adapted to localities. Jackson has proved beyond all ques-
tion the impropriety and danger of disturbing surface soil
during the hot months of summer, and removing houses,
thereby exposing filthy material to be acted upon by a hot sun
and rains. This was done in defiance of all the laws of health,
and the perpetrators have immolated their employ6s as victims
for its violation. Had disinfectants been used as the work

222 LocciL Conditions and Yellow-I^ever.

progressed, there would probably have been no fever, or a
milder form only. Let the municipal authorities, who are the
conservators of the interest of the city and its welfare, see to
it that no violations of health laws shall occur again. Let
them put and keep their city in good sanitary condition in
advance of the sickly season ; then they may hope, with reason-
able expectation, founded on practical experience, that they
may escape these fearful and disastrous visitations ; and they
will then have the satisfaction at least of knowing the sin does
not lie at their door.

One word more in reference to the panic credited by the
announcement of this fever. That of this season exceeded in
alarm and consternation any preceding one, and so terrorized
the popular mind as to render it incapable of calm thought or
reasonable action. It illustrated how human nature " or man,
proud man, whose heaven- erected face the smiles of love
adorn," when dominated by fear, may ignore its or his better
instincts, and verify the couplet, " man's inhumanity to man
makes countless thousands mourn."

I foresaw the coming of the fever from local conditions
where it occurred, and hence it was no surprise. It was but
the natural result of natural causes. It so proved itself, for
its infection was strictly conjined to its breeding ground. It
affected no one not exposed to its influence. It was not
propagated by transportation.

There is no doubt in my mind that the newspaper reports
of the extension of the Florida fever to Decatur and elsewhere
occasioned the fright as to contagion. Reflection and investi-
gation would, I have no doubt, prove in every case, where
refugees had the fever and others were subsequently stricken
with it, that all the conditions were ripe for it, aided by the
paralyzing and weakening influence of fear.

In conclusion I now submit this paper, well knowing the
adverse criticism it may perchance elicit, but with the firm
conviction that should its suggestions be utilized, I will have
benefited my fellow-man. — Memphis Medical Monthly,

TTie North Carolina Sanitary Convention. 223

THE NORTH CAROLINA SANITARY CONVENTION.

Raleigh, N. C, February 8, 1889.

Editor of The Sanitarian :

The old North State has just taken a long step in advance
on matters relating to the sanitary question. The assembling
of a large number of the most advanced thinkers of the State,
to consider the vital questions of our public health, as affected
by the sanitary or unsanitary conditions of their various cities
and towns, means that hereafter there will be a body of trained
and earnest men ready to unite in solid column in support of
the best plans for the public welfare in this direction.

The original motion for the assembling of this convention
came from Dr. J. M. Baker, of Tarborough, Superintendent of
Health for Edgecombe County. The State Board of Health,
under the active guidance of Dr. T. F. Wood, of Wilmington,
the Secretary of the Board, took up the matter, and by their
influence and active work made the convention both practical
and successful. Very great credit is due to these gentlemen
in particular, but the effort was promptly seconded by the
hearty co-operation of the associate members of this most
efficient board and the leading physicians throughout the
State.

The first session of the convention was called to order by
Mayor Alfred A. Thompson, of Raleigh, in the mayor's office
at ten o'clock on February 7th.

An address of welcome was delivered by Governor Fowler,
who announced the coming Quarantine Convention to be held
at Montgomery, March 5th, and asked that this convention
designate delegates to that convention, to be commissioned by
the governor.

The objects of the convention were explained by Dr. R. H.
Lewis, of Raleigh, defining some of the leading questions to
come up : the duty of sanitarians to seek out and destroy the
disease germs ; to inquire into the best methods of getting rid
of the filth of cities ; to provide and preserve a sufficient sup-
ply of pure drinking-water ; to devise proper inland measures

224 The North Carolma Sanitary Convention.

against infectious diseases and epidemics, and to stimulate
public interest in all questions connected with sanitary science.

The convention then proceeded to the election of the tem-
porary officers, who were afterward made permanent, as fol-
lows : Mayor A. A. Thompson, President ; Mayor J. J. Fowler,
of Wilmington, First Vice-President ; W. E. Fountain, of Tar-
borough, Second Vice-President ; E. H. Neave, of Salisbury,
Third Vice President ; and Mr. J. C. Chase and Dr. Julian
M. Baker, Secretaries.

Committees on Ways and Means and for other purposes,
and an enrolment of the delegates present was made, showing
some seventy members present, as follows : N. M. Johnson
Superintendent Board of Health, Durham ; J. J. Summercll
Salisbury ; E. B. Neave, Mayor of Salisbury ; Dr. B. F
Dixon, Oxford ; Dr. A. J. Buflfaloe, Raleigh ; Dr. H. J
Bahnson, Superintendent Board of Health, Salem ; Dr
Thomas F. Wood, Secretary Board of Health, Wilmington
Dr. J. H. Tucker, Henderson ; Dr. H. W. Lewis, Superin
tendent Board of Health, Jackson ; Dr. L. L. Sasser, Smith
field ; Dr. J. M. Hays, Oxford ; Dr. W. P. Beall, Greens
borough ; Dr^ R. W. Tate, Greensborough ; John C. Chase, Hy-
draulic and Sanitary Engineer, Wilmington ; Dr. Eugene Gris-
som, Raleigh ; A. A. Thompson, Mayor, Raleigh ; Rev J. H.
Clewell, Salem ; Dr. John MacDonald, Washington ; Dr. W.
G. Curtis, Southport ; Dr. W. T. Ennett, Burgaw ; Dr. R.
F. Lewis, Superintendent Board of Health, Lumberton ; Dr.
H. B. Battle, State Chemist, Raleigh ; Dr. T, R. Flendersoa,
Henderson ; Dr. J. F. Crowell, President of Trinity College ;
Dr. Kemp P. Battle, President of the University ; Dr. J. W.
Jones, President State Board of Health, Tarborough ; Dr. A.
Cheatham, Henderson ; Dr. J. E. Malone, Louisburg ; W. E.
F6untain, Mayor of Tarborough ; J. L. Ludlow, Civil and Sani-
tary Engineer, Winston ; Dr. J. J. Mann, Superintendent
Board of Health, Nashville ; Drs. J. W. McGee and A. W.
Knox, Raleigh ; John J. Fowler, Mayor of Wilmington ; Mr.
Oscar Pearsall, Wilmington ; Dr. Julian M. Baker, Superinten-
dent Board of Health, Tarborough ; Dr. P. E. Hines, Raleigh ;
Dr. R. H. Lewis, Superintendent Board of Health, Raleigh ;
Dr. W. F. Morse, of the Eagle Sanitary and Cremation Com-
pany of New York ; Dr. F. T. Sutton, Raleigh ; Dr. S. H.

The North Carolina Sanitary Convention, 225

Rogers, Raleigh ; Dr. E. Burke Haywood, Raleigh ; Dr. W.
H. Wilson, Gastonia ; W. P. Mercer, M.D., Toisnot ; J. D.
Roberts, M.D., Durham ; C. J. O'Hagan, M.D., Greenville ;
F. P. Venable, Chapel Hill ; W. F. Beasley, Oxford ; G. W.
Hinshaw, Winston ; W. A. Blair, Winston ; Hubert Hay-
wood, M.D., W. I. Royster, M.D., Raleigh ; F. H. Fries,
Salem ; A. S. Halton, High Point ; T. B. Keogh, Greens-
borough ; N. M. Johnson, M.D., A. G. Carr, W. J. Vickers,
J. P. Monroe, J. D. Roberts, Durham ; E. B. Engelhard,
Raleigh ; J. A. Hodges, Fayette ville ; Dr. L. A. Hanks,
Pittsborough ; Dr. K. Battle, Jr., Dr. James McKee, Dr. R.
H. Lewis, Raleigh.

The first paper of the session was read by Dr. J. W. Jones,
of Tarborough, the President of the State Board of Health, on
** The Gains from Sanitation."

It was an able statement of the necessity of sanitary knowl-
edge, and an admirable presentation of the growth and spread
of beneficial results of such knowledge. This paper, with all
others read at the convention, was referred to the Committee
on Ways and Means for publication in the transactions of the
convention.

Dr. W. G. Curtis, the quarantine physician at Southport
(mouth of Cape Fear River), read a paper on ** Maritime
Quarantine," following which, on motion of Dr. Wood, the
convention put itself on record as favoring an appropriation
to rebuild and enlarge the quarantine station at the mouth of
Cape Fear River.

The paper of Dr. George G. Thomas, on " Inland Quar-
antine," was read in the absence of Dr. Thomas by Dr. Bahn-
son. This very able paper presented forcibly the difficulties
of enforcing the quarantine in inland towns, and suggested a
complete and practical plan for the solution of the same. It
abounded in practical suggestions of great value, and awakened
much interest.

At the evening session the first address was made by Dr. H.
T. Bahnson, of Salem, upon " The Water Supply of the Cities
and Towns of North Carolina."

This very elaborate and comprehensive essay was received
with the utmost interest by the convention. Dr. Bahnson
had devoted a year to the study of the question, and the re-
15

226 The North Carolina Sanitary Convention.

suits of his observations were in the highest degree valuable
and instructive.

Professor Venable, of the State University, read a paper on
"The Adulteration of Food and Drugs," which closed the
first day's proceedings.

At the second day's session, after some routine business,
Mr. J. L. Ludlow, Civil Engineer, read a paper on the dis-
posal of the refuse of towns, and gave many facts and figures
in support of his proposition.

Dr. T. F. Wood, Secretary of the State Board of Health,
read a short paper upon the disposal of the waste of cities by
cremation, and cited several striking examples of the evil
effects of the usual practice of depositing effete matter on un-
occupied ground. He gave a short account of various places
he had visited where cremating furnaces of different patterns
were in use ; and at the close of his remarks asked permission
to present to the convention Mr. W. F. Morse, representative
of the Engle Sanitary and Cremation Company, who was pres-
ent» for the purpose of explaining the Engle Furnace. At the
request of the convention, the President called upon Mr.
Morse, of New York, who explained at some length the con-
struction and operation of the Engle Cremator, for the destruc-
tion of all refuse of cities and towns.

The explanation was accompanied by the criticisms, testi-
inonials, and reports of practical tests and repeated trials of
the Engle process in many places where the furnaces are in
active use.

A paper was then read by Dr. J. H. Tucker, of Henderson,
•upon the duties and responsibilities of the superintendents of
health in the various counties.

The convention appointed a special committee to present
to the Legislature a bill for the protection of the water sources
and supply of the State. This committee comprised Drs.
McKee, Tucker, and Professor Venable.

At the close of the session the convention accepted an in-
vitation to call upon Governor Fowler, and afterward adjourned
sine die.

The assembling of upward of seventy-five men of the lead-
ing learned professions of the State, for the consideration of
the sanitary condition of the commonwealth, is certain to re-

Whete has 'Opkins Oonef 227

suit in a great increase of interest, both among the profes-
sional men, whose duties make it obligatory in a certain sense
to take note of these matters, and in the minds of the general
puUic, whose anxiety for the healthy condition of their respec-
tive cities is very noticeable at this time.

The personnel of the members of this first Sanitary Con-
vention of the State was the best possible guarantee for the
future success and prosperity of this new movement.

The officers of the convention (now made permanent under
the title the North Carolina Sanitary Association) are among
the most active and progressive men in their respective com-
munities, and the very great interest shown, the high charac-
ter of the papers read, and the eagerness with which all new
ideas and information was received, is indicative of the future
good work which will be done in the State.

Francis.

Where has 'Opkins gone?— The Hospital, of England,
states that nurses in hospitals are rather apt to lay too much
stress on the advantages received by the patients and their
duty of thankfulness. Witness the following true story :
Chaplain : So poor Hopkins is dead. I should have liked to
speak to him once again, and soothe his last moments ; why
didn't you call me ? Hospital orderly : I didn't think you
ought to be disturbed for 'Opkins, sir, so I just soothed him
as best I could myself. Chaplain : Why, what did you say to
him? Orderly: "'Opkins," sez I, "you're mortal bad."
•• I am," sez'e. " 'Opkins," sez I, " I don't think you'll get
better." "No," sez'e. "'Opkins," sez I, "you're going
fast." " Yes," sez'e. " 'Opkins," sez I, " I don't think you
can 'ope to go to 'eaven." " I don't think I can," sez'e.
" Well, then, 'Opkins," sez I. " you'll go to 'ell." " I sup-
pose so," sez'e. " 'Opkins," sez I, " you ought to be wery
grateful as there's a place perwided for you, and that you've
got somewhere to go." And I think 'e 'eard me, sir, ^nd
then 'e died.

228 Prophylaxis in Scarlatina.

PROPHYLAXIS IN SCARLATINA.

BiEUMLER {Munch, med. Wochenschr., 1888, No. 42, 703)
gives some statistics showing the high rate of mortality from
scarlet-fever, and reviews the complications which may occur.
Prominent among these is albuminuria, to which he calls espe-
cial attention. A careful distinction is to be drawn between
the albuminuria frequently occurring early in the disease, ac-
companying high fever, and lasting but a few days, and that
developing at the third or fourth week, which is often very
persistent and may be attended by all the evidences of a
severe nephritis, though the amount of albumin be small in
amount. Regarding the prophylaxis against scarlatina, the
two questions arise — whether this is possible, and whether it
is necessary. Though this disease is so much more dangerous
than measles, the disposition to get it is very much less.
Only in a few of the early years of childhood is there a really
considerable tendency to catch it from others, and this rapidly
grows less with advancing age. An important point, there-
fore, is that the longer the child can be protected from the
disease, the greater is the likelihood that it will escape it
entirely.

As is well known, the contagium of scarlatina is always de-
rived from some other case ; it possesses a very great vitality ;
it is active from the earliest beginning of the disease until far
into convalescence ; and it usually requires a very short period
for its incubation. The author reports cases to show that the
breath may carry the contagion before the appearance of any
eruption, though the chief danger is during the stage of des-
quamation. It is therefore absolutely necessary to isolate
patients as soon as possible. The clothes can be disinfected,
but it is virtually impossible to disinfect the epithelial cover-
ing. A fixed time during which the patient must be isolated
cannot, therefore, be named, but the child must remain away
from others until the shedding of the epithelium, especially
that of the palms and soles, is entirely completed. The author
has known this to require sixty-three days from the onset of

Prophylaxis in Scarlatina. 229

the disease, and a still larger number has been reported by
others. Desquamation can perhaps be hastened by bathing
with warm soap-water, and the dissemination of scales hin-
dered by inunctions. It is very important that the scalp be
treated in this way, as the scales of this part are fine and are
shed early. A convalescent room is of especial value for
those patients who feel well, but who cannot with safety
mingle with others.

Children who have come in contact with cases of scarlatina
should remain under observation ten or twelve days before
again joining other children. Those in attendance upon the
patients should wear some outside garment in the sick-room,
and change their clothes and wash their hands in carbolic
water on leaving it. The sick-room should be thoroughly
aired every day, with proper precautions that the patient take
no cold. All the linen used about the patient is, while still
in the sick-room, to be put in a three per cent carbolic acid
solution, and then boiled with a strong soap. Shoes are to
be disinfected with the carbolic water, and clothes treated
with steam. The walls of the sick-room, if painted or papered,
are to be rubbed down with bread after the patient has been
removed, the iron and wooden furniture and the floors washed
with a carbolic solution, and the curtains, mattresses, etc.,
subjected to steam. Special vehicles should be employed to
bring children with scarlatina to hospitals. Finally, precau-
tion should be observed against the carrying of the disease by
third persons, domestic animals, books, letters, milk, etc.

In connection with the above, a communication of A. Whit-
legge {Lancet, January 5th, 1889) is of interest. It seems to
him probable that a lull in the infectiousness of the disease
may occur about the end of the first week, at the time when
the acute symptoms are subsiding and desquamation has
hardly commenced. To determine this point, he analyzed
1700 cases, of which he had exact particulars, and found, in
fact, that the infectiousness suddenly decreased at about the
sixth day, and increased again about the twelfth day, reach-
ing its maximum by the sixteenth day. — American Journal vf
Medical Sciences.

230 Proposition to Improve Local Bocvrds of SedUh.

PROPOSITION TO IMPROVE THE ORGANIZATION
OF LOCAL BOARDS OF HEALTH, AND TO PRO-
MOTE THE SANITARY CONDITION OF PUBLIC
INSTITUTIONS.

REPORT OF THE COMMITTEE ON HYGIENE OF THE MEDICAL
SOCIETY OF THE STATE OF NEW YORK, AT THE ANNUAL
MEETING OF THE SOCIETY, ALBANY, FEBRUARY 6TH, 1 889.

Mr. President and Gentlemen of the Medical Society of the
State of New York :

Your Committee on Hygiene would respectfully report
that the line of observation followed in the year just com-
pleted has been in regard to the success in the working of the
present system of organization of the local boards of health in
this State, and also as to their efficiency of administration.

Through the efficient efforts of the State Board of Health
over 1200 local boards have been established during the past
eight years, and a consequent vast improvement in sanitary
conditions has been the result. ,

But in the experience of the State Board, as well as in local
organizations, constant failures to secure such a completeness
of administration as is reasonably expected are experienced.

Your committee has devoted considerable time and consid-
eration to the recognition of the causes of such failures, to
ascertain, if possible, means by which existing sources of em-
barrassment may be removed. Their idea has been so to ex-
amine the organization of the local health board as to learn in
what part of its structure possibility of imperfect administra-
tive work may commence.

They would present the result of their observations in three
statements :

First, as regards ^^ position and duties of the health officer.

Second, as to the composition of the board.

Third, as to the so-called unit of territory upon which the
organization is based.

First. The position of health officer is necessarily filled by

Proposition to Improve Local Boa/rds of Health. 231

a man of medical training. It is the medical profession which
must furnish the material for practical sanitation. Your com-
mittee, however, recognize the fact that while physicians make
the best sanitary teacherSy they do not necessarily make the
best sanitary administrators. Hence, the conclusion is reached
that a practising physician does not make the most successful
sanitary administrator. The lines of mental thought of the
sanitarian and practising physician are different, since the one
is wholly occupied with the prtitention of disease and the
means for its accomplishment, while the other is equally occu-
pied with the recognition of forms of disease and the means
of curing them. The practising physician cannot, as such,
have the necessary mental habits which the purely sanitary
administrator acquires, and which are vitally necessary for
successful working of the organization.

The sanitarian is also free from the element of professional
and personal embarrassment to which the practising physician
is subject to a great degree.. The inadequate salary paid the
health officer is another point noted, since the occupant of
such position cannot devote the time necessary, on account of
the insufficient compensation, to fully perform duties which
would require his entire time.

And last, but not least, the embarrassment arising from
political influences and control in sanitary matters, goes far to
destroy effectiveness of sanitary administration.

The second cause of imperfect administration is found in the
composition of the average health board. While the intent of
the law organizing them is in the direction of appointment of
fit persons, its effective working is not so clear. Political
considerations and influences are the chief disturbing factors.

Control by partisan combinations and failure to secure
capable commissioners of sanitary, legal, engineering, and
business qualifications, are the pregnant causes of inefficient
administration. With an organization so constituted, even
the ideal health officer must be thwarted in his best-conceived
efforts of administration, since the appointees of such a board,
being selected on a political and not a sanitary basis, must
fail to secure that perfection of detailed work so essential.

The third cause of failure noted lies in the so-called terri-
torial unit of organization.

232 Proposition to Improve Local Boa/rds of Health,

m

Under the present law this is the village, town, or city.

It has been a question of serious consideration with the
members of your committee whether this secures the greatest
efliciency of administration. With the existing difficulties,
connected with the positions of health officer and composition
of the board, the multiplication of small and loosely organized
boards, with small districts to cover, seems to comph'cate and
render more complex the insuring of generally efficient admin-
istration.

The work of our State Board is supervisory, not executive.

The present able Secretary of the State Board of Health,
Dr. Balch, in his report for 1887, calls attention to some of
these defects in the working of the local boards, and suggests
the advisability of such changes in the powers of the State
Board in emergencies as to, in part, relieve them by giving the
State Board the power, in such conditions of ineffective organ-
ization, to effect a proper organization.

It has seemed to your committee that a change in the unit
of territory might secure better results. That by establishing
the county as the unit, the number of health boards in the
State would be greatly reduced. The relation of the State
Board to the local boards would be greatly simplified and
more direct, and hence that greater efficiency and uniformity
of sanitary administration could be secured.

The economy of such a system is also apparent. The health
officer could be ensured a sufficient salary to devote his entire
time to the work, and also, which is very important, could be a
trained sanitarian, not a practising physician, and be continued
in office. The county seat would thus become the sanitary
centre of the district.

Your committee has aimed to present very briefly the results
and conclusions of the observations of the past year. They
believe this to be a very important subject for further consid-
eration by this society.

In interviews with sanitarians in other States, whose general
board is similarly organised with our own commonwealth for
sanitary work, the growth of similar views is apparent.

It is the object of your committee to present the subject to
this society, without any suggestions as to the character of the
changes or details of organization which they feel can be

Proposition to Improve Local Boa/rda of Health, 233

made. They do not think that it lies within their present
province to do more than forcibly emphasize the existence of
evils which may be remedied. They consider the subject of
so much importance, as thus far developed, as to lead them
to suggest that the Committee of Hygiene be instructed to
make this a special line of observation during the coming year,
and, at the next annual meeting, to report in a definite form
upon existing embarrassments in the administration of the
local health boards of the State, with suggestions for their
remedy looking to future legislative action.

From the assistance of the State Board of Health, in addi-
tion to the individual work of the Committee on Hygiene of
this Society, much can be accomplished.

They would invite special consideration of the question as
to the change from the village to the county^ as the unit of
territorial organization. This is not a new thought, but has
been for a time under consideration, though not generally
entertained and urged among the profession ; but we believe,
when fully comprehended, must recommend itself to those
acquainted with sanitary organization and interested in secur-
ing its efficiency.

During the past year no extensive prevalence of epidemic
disease has occurred within the State. Recently several out-
breaks of variola have occurred, but prompt resort to general
vaccination and isolation of the sick and exposed have proved
sufficient to place the disease within bounds and cause its
gradual disappearance in affected localities, though there still
exist in several parts of the State small groups of cases.

In the public institutions of the State sanitary conditions
are in general fairly maintained. Your committee would,
however, specially invite the attention of this Society to the
hygiene of the county insane asylums. A growing evil exists
which demands immediate action looking to radical reform.

The retention of the acute insane in many of the county
asylums, with the injurious conditions consequent of noise and
filth, calls for some action on the part of this Society.

The report recently made to the State Board of Charities
by its Standing Committee on the Insane, and by the State
Board adopted and transmitted to the Legislature, is a record
of facts, which are confirmed and in substance verified by the

231 TFi%.y he was so Lean.

experience and knowledge of general medical practitioners, as
well as of alienists and specialists, in the treatment of the
insane.

Your committee is so fully impressed with the importance
of this subject that they would offer the following resolution :

" Resolved^ That the detention of acute and chronic insane
in all of the county asylums, as shown by the report of the State
Board of Charities, is an evil which should' not be tolerated in
any case, whether pauper, indigent, or private patient, and
should be forthwith abated. That the recommendations of
said report for the regulation and restriction of county care
and for the radical reforms therein should be acted upon
affirmatively and immediately."

While the State Board of Charities may not be justified, by
their political or legal relations, in either affirming or denying
the expediency of exclusive State care of the insane, the
Medical Society of the State of New York is emphatic in
affirming the necessity for such exclusive State care.

Before closing this report your committee feel that they
must emphasize the importance of greater vigilance in the pre-
vention of diphtheria and typhoid-fever, and would refer again
to the reports of this committee on the subject at the meet-
ings of this society three and four years since.

E. V. Stoddard, M.D.,
A. N. Bell, M.D.,
William H. Bailey. M.D.,
J. P. Creveling, M.D., •
William C. Bailey, M.D.,

^ Committee.

Why he was so Lean. — A lean, misanthropic physician,
in a small hamlet, had as his only opponent a handsome robust
man. The strife between the two was violent. One day a
lady asked the first why he was continually in bad health,
whereas the other was so well all the time ? " You see, ma*
dame," he replied, '' the only man who can treat him I am,
the only physician whom I can get is he. ' * — Jour, de Medi.
de Paris, according U> The Scalpel.

The Medalsy JetanSj and Tokens UlustrcMve of Sanitation. 286

THE MEDALS, JETONS, AND TOKENS ILLUSTRA-
TIVE OF SANITATION.

By Dr. Horatio R. Storkr, Newport. R. I., Member of American Public Health

Association, etc.

X. Epidemics, Continued from page 145.

III. Small-pox.

y. Vaccination.

A. The United States. •

Dr. J. M. Toner, of Washington. " The Propriety and
Necessity of Compelling Vaccination.'* Philadelphia, 1865.
Already described under Section I.

B. England.

Dr. Edward Jenner (1749-1823). " Inquiry into the Causes
and Effects of the Variolae Vaccinae." 1798. " Continuation
of Facts and Observations Relating to the Variolae Vaccinae."
1800. " Address of the Royal Jennerian Society for the Ex-
termination of Small-pox." London, 1803, 8°. A copy of
this, in the Redwood Library at Newport, R. I., contains a
MS. letter by Dr. Jenner, and MS. notes by him.

926. Obverse. Apollo presents to Britannia, who is hold-
ing a civic crown bearing the name Jenner, a sailor who has
been preserved by vaccination. Legend : Alba Nautis Stella
Refulsit* 1801.

Reverse. An anchor. Above, Georgio Tertio Rege. Be-
low, Spencer Duce (Viscount Althorp, First Lord of the
Admiralty, and subsequently Earl Spencer). Grold.

SchlichtegroU, i., p. 156; Rudolphi, 1829, p. 81, No.
338 ; Kluyskens, ii., p. 68, No. i ; ibid.^ Numismatique Jen-
n6rienne. No. i ; Duisburg, p. 230, dcix., No. i ; P. and R.,
p. 139, No. 385.

2S6 The Medals, JetonSj and Tokens Illustrative of Sanitation.

Presented to Jenner by the Surgeons of the Royal Navy.
Its locality now unknown.

927. Obverse. Don. Soc. Med. London. Anno Salut.
1773. Institut. E. Jenner. M. — D. Socio Suo Eximio Ob Vac-
cinationem Exploratam. Reverse apparently plain. Gold.

Biog. Medic, v., p. 574 ; Rudolphi, 1829, p. 81, No. 339 ;
Kluyskens, ii., p. 68, No. 2 ; tbid.j Num. Jenn., No. 2 ; Duis-
burg, p. 230, dcix., 2 ; P. and R., p. 139, No. 386. Presented
by the Medical Society of London, March 4th, 1804. This
medal also is no longer to be traced.

928. Obverse. An infant with rose in its hands, between
a rose-bush and a cornucopia, points to its arm. Beneath the
bush, L(oos). Inscription : Eduard Jenner's Wohlthaetige
Entdeckung. Exergue : Vom 14 Mai | 1796.

. Reverse. Zum | Andenken [ An | Erhaltenen | Und | Mit-

getheilten | Schutz | | Gereicht Vom | Doctor Bremer j

In Berlin | 1803. Silver. 25 mm.

Rudolphi and Kluyskens add to reverse 8 L. 6 Gr., which
is upon the reverse of the following :

Rudolphi, p. 82, No. 340; Duisburg, p. 230, dcix., 3;
Kluyskens, ii., p. 68, No. 3 ; ibid,. Num. Jen., No. 5 ; P. and
R., p. 141, No. 393. In the Fisher collection. .

929. Obverse and reverse as preceding, save with the date
of 181 1, and the addition of 8 L. 6 Gr. Silver. 16 mm.

Rudolphi, 1829, p. 82; Kluyskens, Num. Jenn., No. 6;
Duisburg, p. 231, dcix., 3, note ; Bremer, Die Kuhpocken,
Berlin, 1804, fig. ; P. and R., p. 142, No. 394. This is in my
own collection. Reference will be made to these two medals
when speaking of Dr. Bremer of Berlin. They were struck
for distribution, as rewards to mothers who brought their
children to the Bremer Vaccination Institute at Berlin.

930. Obverse. Bust, to left. Beneath shoulder, F. Loos.
Inscription : Eduard Jenner Entdecker Der Schutzimpfung*
D-I4 Mai 1796.

Reverse. An angel from clouds garlanding a cow, around
which seven children are dancing. Legend : Ehre Sey Gott
— In Der Hohe (Hohe, Kluyskens). Exergue : Und Freude
I Auf Erden. Silver, bronze. 23. 36 mm.

Kluyskens in his figure omits the first dot in inscription of
obverse, and in that of reverse has Here instead of Ehre.

The Medals, Jetons^ mid Tokens lUustratvoe of Sanitation. 237

Rudolphi, 1829, p. 82, No. 341 ; Kluyskens, li., p. 69, No.
4; t'did.. Num. Jenn., No. 7; Duisburg, p. 231, dcix., No.
6; P. and R., p. 140, No. 387, fig. In the Lee and Fisher
collections.

931. Obverse as preceding.

Reverse. Hygeia, with serpent upon her right arm, defends
an infant against a demon by a shield which bears a cow.
Legend : Triumph ! Getilget 1st Des Scheusals Lange Wuth'
Silver, bronze. 28 mm.

Rudolphi, 1829, p. 82, No. 342 ; Kluyskens, ii., p. 69, No.
5 ; idid.f Num. Jenner., No. 13 ; Duisburg, p. 231, dcix.^ No.
7 ; P. and R., p. 140, No. 388. In the Lee and Fisher col-
lections.

932. Obverse. A child, between a rose-tree and the rising
sun, exhibits its arm. At its feet, a serpent. Legend : Dank
Der Giitigen Vorsehung. Exergue : Kriiger (either Fr. Hein-
rich or Chr. Jos. K,).

Reverse. Within a pearled octagon, Wohl | thatige | Ent-
deckung | Der | Schutz-pocken | Durch | Ed : Jenner. Silver.
30 mm.

Kluyskens has Vorsehung and Kruger, and on reverse Wohl-
thatige. Kluyskens, Num. Jenn6r., No. 8 ; Duisburg, p. 231,
dcix.. No. 8 ; P. and R., p. 142, No. 397. Unknown to
Rudolphi.

933. Obverse. Within palm branches, Jenner *s bust, fac-
ing. Beneath, 1749 (the date of Jenner's birth), and to left,
Hamel (Namel, Kluyskens) Et Lecompte (Lecomte, Kluys-
kens). Inscription : Edward Jenner.

Reverse. Between laurel branches, M6daille De Ire Classe.
Inscription : Comit^ Central De Vaccine Du D6partement Du
Nord. Silver. 40 mm.

Kluyskens has dots after each word on the reverse. Kluys-
kens, Num. Jenn6r., No. 9 ; P. and R., p. 145, No. 416.
Unknown to Rudolphi, Duisburg, and Ruppell.

934. Obverse similar to preceding.

Reverse. A laurel wreath, beneath which, M^daille de 2®
Classe. The field vacant, for the name of the recipient.
Silver. 36 mm.

P. and R., p. 146, No. 417. The obverse is figured. Un-
known to Rudolphi, Kluyskens, Duisburg, and Ruppell. I

238 The MedalSy JesUyM^ and Tokens lUustratioe of Sanitation.

presume that this and the preceding are French, as intimated
by P. and R., although it may prove that they are Belgian.
As to this, see under Dr. Demanet, a little further on.

935. Obverse, Portrait of Jenner upon an oval shield,
between two females holding a crown above. Beneath, an
elongated shield, upon which a cow, to right.

iRe verse plain. Plaster of Paris. 37 mm.

Designed by Charles Wiener, of Brussels. Unique. Alvin.
Revue beige de numismatique. April, 1888, p. 243. Unknown
to Kluyskens, Duisburg, Ruppell, and P. and R. Reference
is also made to Jenner upon both of the medals of Vraneken,
of Antwerp, and the two of Sacco, of Milan, to be described
in the present Section.

C. HOIXAND.

Dr. Phoebus Hitzer Themmen, of Amsterdam, President
of the Vaccine Society at Amsterdam.

936. * Obverse. Bust, to right. Beneath, Lageman F.
Inscription : Phoebus Hitzerus Themmen*M*D* Instituit

MDCCCIII.

Reverse. Laurel wreath, with field vacant for name of re-
cipient. Inscription : Het Amsterdamsch Koepokinentings
Genootschap' Silver. 35 mm.

Rudolphi, 1829, p. 158, No. 654; Kluyskens, ii., p. 496;
idui.f Num. Jenn6r., No. 25 ; Duisburg. p. 184, ccccxcvii. ;
P. and R., p. 146, No. 418. Dr. Jan le Francq Van Berkhey
(1729-1812). ** Vervolg op de natuurkundige Vergelijkingen
betreffende de zo veel gerugt maakende Koepokken," etc.
Leyden, 1801, 8°.

937. Obverse. Within beaded circle, bust very much re-
sembling that of B. Franklin, to right. No inscription.

Reverse. Hulde | Aan | *De Wetenschappelijke Verdiensten
I Van I • I Jan Le Francq Van Berkhey, | Med. Doct. En
Lector Der Nat. Historie | Aan De Hoogeschool. | Geb. Te
Leyden Den 23 Jun. 1729. | Overl. Den 13 Maart i8i2.
(Homage to the Scientific Merit of, etc.) Composition. 52.
80 mm.

Bom and Zoon Cat., p. 160, No. 2945.

In my collection. Unknown to Rudolphi, Kluyskens, and
Duisburg.

TJie JdedalSy JeionSy and Tokens lUvstrative of SanUdtion. 239

Dr. L. H. J. Vrancken, of Antwerp (1773-1853). Distin-
guished for his zeal in favor of vaccination.

938. Obverse. Bust of Napoleon I., to right.

Reverse. Inscription* engraved : Antvcrp : Civit : Doctor!.
Medico Domino Ludovico Henrico Josepho Vrancken Method!
Jennerianae Propagatione In Anno MDCCCVii Perillustrato.
Gold. 55 mm (65, Kluyskens).

Kluyskens, Num. Jcnn6r., No. 17; Mertens en Torfs,
Geschiedenis van Antwerpen, vii., p. 51, fig. ; P. and R.,
p. 146, No. 419.

D. Belgium.

Dr. Adolf Peter Burggraeve, of Ghent (1806- ). *' Le
Vaccin veng6." 1855. ** Monument a Edw. Jenner, ou His-
toire G6n6rale de la Vaccine," etc. Brussels, 1875, 4°-

His medal was described, No. 58, under Section I. He
will again be referred to in the present section under Cholera
and Syphilis, and in Section XII., Climate.

Dr. Guillaume Demanet, of Ghent (1747-1831). Founder
in 1800 of the Comit6 Central de Vaccine.

939. Obverse. Bust of Napoleon I., to right.

Reverse. Minist^re De L'lnt^rieur* — Soci6t6 G^n6rale de
Vaccine. — M. Demanet, Chirurgien A Gand. Silver. 35 mm.

Kluyskens, i., p. 245, No. i ; ibid.^ Num. Jenner., No. 18 ;
P. and R., p. 146, No. 420.

Unknown to Rudolph! and Duisburg. Curiously enough,
no mention whatever is made of this distinguished fellow-
countryman of his by Kluyskens in his subsequent publication,
the ** Numismatique M^dicale Beige."

940. Obverse. The sacred cow of the Hindoos, marked by
a star. Legend : Jupiter E Terra Genitam Mentitur Ut
Auctor

Desinat Inquiri. Poterat Non Vacca Videri. (Ovid. Meta-
noorphoses, !., 615.) •

Reverse plain. Silver, gilt. 40 mm. Engraved by L, De
Bast.

Kluyskens, 1., p. 245, No. 2 ; ibid,^ Num. Jenner., No. 19 ;
P. and R., p. 146. No. 421. Unknown to Rudolph! and
Duisburg. It was presented to Demanet at a banquet on July
22d, 1 82 1, and is unique.

240 The Medals^ JeionSj and Tokens Illustrative of Samtation.

Demanet was also the recipient of one of the Royal Belgian
Vaccine medals of gold, to be described hereafter. Dr.
Charles Kluyskens, of St. Gilles (1788-1858). Cantonal vac-
cine officer.

Dr. Kluyskens not only received one of the royal gold
medals last mentioned, but one from Willem I., and three
others from Leopold I. I have not as yet ascertained their
exact character. They were probably of the third of the types
mentioned hereafter, as Belgian premium medals for vaccina-
tion.

Dr. Joseph Francois Kluyskens, of Ghent (1771-1843).
** Verhandeling over de K^eypokjes." 1801, 8°.

941. Obverse. Lucina standing, with bouquet and torch.
Legend : Voto Parturientis Ades. Exergue ; Artis Obstet-
ritiae Praemium.

Reverse. S. P. Q. G. (Senatus Populusque Gandensis.)
Art. Obst : Prot. D. D. Josephus Franciscus Kluyskens 1791.
Gold, adorned with silver gilt. 44 mm. Engraved by
Tiberghien.

The second, word in exergue of obverse has tiae in Kluys-
kens* work of 1859, ^^^ ^>^ ^^ ^^^^^ of ^^^4 « ^^ h^s 3 ^^^ after
the second D of the reverse in the first, and not in the second.
When describing this medal in my paper upon the medals of
obstetrics and the diseases of women,* I pointed out that
Kluyskens* name should have been in the dative, not the
nominative case, as he was the recipient ; and at the same
time scarcely twenty years of age. The device of the obverse
is the same as that of a medal to Wedenberg, of Stockholm,
which I also described in the monograph mentioned above.
Kluyskens, ii., p. 109 ; ibid.^ Num. med. beige, p. 18.

942. Obverse. Bust, facing, in academic robes, seated at
table, with handkerchief and snuff-box.

Reverse. Joseph-Frangois | Kluyskens | N6 A Alost | Le
IX Sept. MDCCLXXI. j Mourut | A Gand Le XXIV Oct. |
MDCCCXLiii. Gold. 37 mm.

In both his descriptions Kluyskens differs from his figure in
having the dates in Roman numerals, and also Sept. and Oct.
In his work of 1859, ^^ ^^^ ^^^ Mort. In the two descrip-

♦ Netv England Medical Monthly t December, 1886.

The 3£edalsy JetonSy and Tokens lUustratwe of Sanitation, 241

tions he materially varies as to the size of the medals. Kluys-
kens, ii., p. no, fig. ; ibid.. Num. med. beige, p. 19.

943. Obverse. Bust, to right. Beneath, Barre F. In-
scription : Carolus Augustus Dux Saxonis (Saxe Weimar).

Reverse. Within a garland of flowers, Doctarum Frontiura
Praemia. Gold. 3$ mm. Kluyskens, i., p. no.

This medal was conferred upon Dr. Kluyskens in 1827, by
the Duke of Saxe Weimar, in acknowledgment of his work
upon Materia Medica. It is unmentioned in the " Numis-
matique medicate bdge/*

944. Obverse. Bust, facing, in official garb. Beneath,
Lemaire Gand. Inscription : Joseph-Frangois Kluyskens |
N^ A Alost Le 9 Septembre 1771. Mort A Gand Le 24
Octobre 1843.

Reverse. II Releva j Le Chirurgie | De Son 6tat D' Abjec-
tion j £t Contribua | Par Ses Lecons Cliniques | A J^tendre |
Les Progr6s | De Cette Science | En Belgique. Silver, bronze.
60 mm. Kluyskens, Num. med. beige, p. 19 ; RUppell, 1875,

p. 58.

E. France.

Dr. Jean Baptiste Bousquet. "Traite de la Vaccine,"

Paris, 1833, ^° \ *' Sur le cow-pox," etc., Paris, 1836, 8° ;

'* Nouveau traite de la vaccine," Paris, 1848, 8°.

945. Obverse. Bust. Beneath, engraved, Barre, 1829.
Inscription : I. B^*" Bousquet De L'Acad® Roy® De M6dec*.
Bronze. Duisburg, p. 73, cxc. Unknown to Kluyskens.

Frangois Alexandre Frederic, Due de Larochefoucault-
Liaincourt. President of the Comit6 de Vaccine.

946. Obverse. Bust, to right. Inscription : Laroche-
foucault De Liancourt N. 1747-

Reverse. Les Arts Et L'Humanit6 Honorent Sa M6moire.
— Mort Le 27 Mars 1827. Silver. Kluyskens, ii., p. 125.
Unknown to Duisburg.

Dr. A. A. Parmentier, of Paris. An ardent advocate of
vaccination.

His medal already described in Section I., and further refer-
ence made to him under Sections IV. and VI.

F. Germany.
Leopold, Graf von Berchthold. Induced extended vacci-
nation in Asia and Africa.
16

242 The Medals^ Jetons^ and Tokens lUustrcUtve of Sanitation.

His medal described previously, under Section X., The
Plague. Not mentioned by P. and R. in either edition (1880
and 1882) of their *' Pestilentia In Nummis," though' added
to a reprint from the former, without date, upon the medals
of inoculation and vaccination.

Dr. Johann Emmanuel Bremer, of Berlin (1745-1816).
'* Die Kuhpocken." Berlin, 1804, His two medals have
been described in the present Section, Nos. 926 and 927, with
those of Dr. Edward Jenner.

Dr. Friedrich Wllhelm Ludwig Hirt, of Zittau (1761- ).
Did much for the extension of vaccination.

947. Obverse. An infant, bending its knees, holds a flower
and points to its left arm. Inscription : Diess Erhaelt Mir
Leben, Gesundheit U. Wohlgestalt.

Reverse. Zum | Andenken | An Die | Schutz | Blattern.
Exergue : Von Dr. Hirt | In Zittau. Silver. 21 mm.

Duisburg has Diss. Rudolphi and Kluyskens have Und,
and D for Dr.

Rudolphi, 1829, p. 76, No. 318 ; Kluyskens, ii., p. 35 ;
Duisburg, p. 140, ccclxxvii. ; P. and R., p. 142, No. 395.

Dr. Johann Friedrich Stromeyer, of Gottingen (1749-1830).
Introduced vaccination into Germany.

948. Obverse. Minerva placing three crowns upon an
altar ; an owl at her feet. Inscription : Sollennib. Mvn. Pro-
fess. Qvinqvagenariis. Exergue : A. MDCCCXXVI. | G. Loos
D. Pfeuffer F.

Reverse. A crown of stars. Beneath, Triumviris | Joanni
Frid. Erico | Blumenbach | Jo. Fr. Stromeyer | Jo. Godefr.
Eichhorn | Grata | Georgia Aug. On rim of Kluyskens'
specimen. Ex ofiicina Monetaria G, Loos. D. Loos. Fil.
Berolin. Silver, bronze. 42 mm.

Ampach, 9931 ; Rudolphi, 1829, p. 21, No. 79; Kluyskens,
i., p. 136; Duisburg, p. 160, ccccxxviii., No. 2. In the
Fisher collection and my own.

F. Sweden.

Dr. Heinrich Callisen, of Copenhagen (1740-1824). Court
physician, he introduced vaccination throughout Denmark.

949. Obverse. Bust. Beneath, S. Jacobson F. Inscrip-

The MedalSy JeUms^ and Tokens Illustrative of Sanitation. 243

tion : Henr. Callisen, Med. Doct. Chirurg. Prof. Prim. Et
Direct. Gen. Nat. 1740. D. II Maii.

Reverse. A crown of oak leaves. Inscription : Senescent!
Doctori Discipulorum Pietas. Die 29 Martii 1805. Silver.
57 mm.

Kluyskens calls the crown, of laurel. Rudolphi, 1829, p.
30, No. 114; Kluyskens, 1., p. 175 ; Duisburg, p. 212, dlxiii.

G. Italy,

Dr. Ludovico Sacco, of Milan ( -1836). Introduced
vaccination into Italy.

950. Obverse. Bust, to left. Beneath, P(ietro)'T(adolini)*
F* Inscription : Aloysius'Sacco'Mediol'Med'Et'Chir'Prof'

Reverse. Within a wreath of oak leaves, tied below by a
serpent, Jenneri'Aemvlo' | Amici'Bononienses' | A*I*Ab'Ital-
Rep-Cons' Bronze, lead. 55 mm.

Kluyskens omits several of the dots, and in his larger work
has A.B. instead of Ab. Upon rim of his specimen, the word
Copie, engraved.

Millin, Suppl. hist. m6tall. Napol., pi. 64, No. 404 ; Bras-
seux ain6, Cat. des m6d. de THist. Num. de Nap., fig. ;
Rudolphi, 1829, p. 141, No. 587; Kluyskens, ii., p. 411;
idtd.. Num. Jennir., No. 3 ; Duisburg, p. 36, ciii.. No. i ;
P. and R., p. 140, No. 389.

This is in the Lee and Fisher collections and my own. It
was struck by Napoleon I.

951. Obverse. Hygeia, with serpent on her arm, and a
nude vaccinated boy are placing a wreath upon the bust of
Sacco, upon whose base a cow. Beneath, L. M(anfredini).
Legend : Sic Morbvs Morbo Cvratvr. Exergue : VIII Kal-
endas Mai I | Anno I Reip. Italics | MDCCCII.

Reverse, Aloysio* Sacco | Jennerianae* Insitionis | Primo'
In'Coenomani | Propagatori'Benemer j Municipium [ Grates
Bronze. 55 mm.

Rudolphi and Kluyskens omit the initials of the engraver.
They have Calend., and the date in Roman letters. They
omit Italicae, though Kluyskens gives it in his figure. Kluys-
kens has Grate in his description, but not in his figure. Duis-
burg has Calendas. Upon the rim of Kluyskens' specimen,
the word Copie. P. and R. have Coenomanis.

244 The Medals^ JetonSy and Tokens TQAtstTain/oe of Saniiaiion.

Millin, Suppl.y pi. 64, No. 405 ; Brasseuxain6, Cat., fig. ;
Rudolphi, 1829, p. 141, No. 588 ; Kluyskens, ii., p. 411, fig. ;
itui.j Num. Jenn^r., No. 4 ; Duisburg, p. 36, ciii., No. 2 ; P.
and R., p. 140, No. 390, fig. of obverse. Struck by Napo-
leon I.

H. Russia.

Mullah Hassan Daut, of Astrakhan.

952. Obverse. Beneath a crown, the irradiated monogram
of Alexander I. Below, five lines of Russian (for services
rendered to Mullah Hassan Daut, the son of Hadschi, 1805).

Reverse. Above, the Russian crown, irradiated. Beneath,
three lines of Tartar language (as above). Gold, bronze. 52
mm.

RUppell, 1875, p.'68 ; P. and R., p. 148, No. 431. For vac-
cination of the nomad tribes. Dr. Johann David Lange, of
Gorzda in Lithuania.

953. Obverse. A child pointing to its upper left arm ; in
that hand it has a rose. Before him a cornucopia ; to right
a rose-bush, beneath which, L(oos). Inscription : Donatum
A Doctore Med : Joh : David Lange. Exergue : Gorzda |
1811.

Reverse. Ad | Gloriam | Dei | Utilitatemqui (sic) { Magni
I Imperii | Russici | Silver. 26 mm.
Kluyskens, Num. Jenn6r., No. 11 ; P. and R., p. 149, No.

433.

The device of this is the same as of No. 926. Dr. Lange

was an earnest advocate of vaccination.

Premium medals for the encouragement of vaccination have

been instituted by several countries.

A. Belgium.

954. Obverse. A cow, with Fame holding a trumpet and
the staff of -^sculapius. Beneath, Fabriek H'D'Heus*
Legend : Volitat'Jam'Fama*Per-Orbem* Exergue : mek:ccix.

Reverse. Garland of oak leaves. Legend : Pro'Variol*
Vacc • Insit • Plus ' C(entuiii)'Civib(us)'Uno* Ann 'Gratis 'Ad-
ministr^ Gold. 40 mm.

Kluyskens omits several of the dots and the star, and has
Arabic numerals. In describing the Charles Kluyskens medal.

The MecUdsy Jetona^ and Tokens Ulvstraiive of Scmitation. 245

he has Fabrick and Anno. Kluyskens, i., p. 245, No. 3 ;
ilWrf., Num. Jennir., No. 20; P. and R., p. 147, No. 422.

Conferred by the King of the Belgians upon physicians who
had vaccinated at least one hundred times in a year. Un^
known to Rudolphi and Duisburg. The dies are at the Mint
at Utrecht.

I have already mentioned that this medal was given to Drs.
Demanet, of Ghent, and C. Kluyskens, of St. Gilles. In the
former case the inscription upon the field of the reverse was
Aan M. Demanet Te Gent. 1824, and in the latter Aan C.
Kluyskens Heelmeester Te St. Gilles Waas. 1825. They are
wrongly spoken of by previous authorities as different medals.

Kluyskens, ii., p. iii ; ibid.. Num. Jenn^r., No. 21 ; ibid..
Num. med. beige, p. 23 ; P. and R., p. 147, No. 422, note.

955. Obverse. Head of the King to left. Beneath,
Braemt F. Inscription : Leopold Premier — Roi des Beiges.

Reverse. A cow, to right ; under its head an open lancet.
Above, in two straight lines, Propagation | De La Vaccine.
Exergue : the staff of i£sculapius. Gold, bronze. 33 mm.

In P. and R.'s first edition, 1880, they have Propogation.

Kluyskens, Num. Jenn^r., No. 28 ; P. and R., p. 47, No,

423. In the Lee collection.

956. As preceding, save in exergue of reverse instead of
the staff : D'Apres E. Verboeckoren | Braemt F. Bronze.
33 mm.

Kluyskens, Num. Jenn6r., No. 27 ; P. and R., p. 147, No.

424. This is a pattern piece. It is in my collection.

957. Obverse. Head of the King, to left. Beneath,
S' Wiener* Inscription : Leopold II* Roi Des Beiges*

Reverse similar to that of the last but one. Gold. 33 mm.

Kluyskens, Num. Jenn^r., No. 29 ; P. and R., p. 147, No.
425.

This and the last but one were for the reward of public vac-
cinators of the poor, but were not conferred after 1868.

B. France.

The general " Central Vaccine Committee** seems to have
been founded in 1^00 at Paris. One with the same name, also
conferring medals, was instituted at Tours in 18 10. There

2i6 The Medals^ Jetons^ and Tokens IUu9t/ratvoe of ScmUaiian,

was also a *' General Vaccine Society" and a ** National Vac-
cine Society" dating from 1829, all of them apparently under
Government auspices. This diversity of name has created
much confusion.

958. Obverse. Laureated head of Napoleon^ to right.
Beneath, Andrieu F. Inscription : Napoleon — Emp. Et Roi,

Reverse. i£sculapius» leaning at right upon his staff, has
his left arm around the nude Venus de Medicis, who points to
her vaccinated arm. To the left a cow, and to right an open
lancet above a vaccine point. Below, to left, Andrieu F. To
right, Denon Dir. Exergue : La Vaccine | MDCCCiv. Silver,
bronze. 41 mm.

Laskey, Description of the Medals struck at the National
Mint by order of Napoleon Buonaparte, No. xlvii. ; P. and
R., p. 143, No. 400.

Laskey states that this was conferred by the Soci6t6 Cen-
trale de Vaccine. The dies are preserved at the French
National Mint.

959. Obverse as preceding, save Denon Dir* | Andrieu F',
and only the title Empereur.

Reverse as preceding. Silver, bronze. 41 mm.
; Ibid.,, p. 143, No. 399. The reverse is figured.

In the Lee and Fisher collections and my own. The dies
are at the National Mint at Paris.

960. Obverse. Device as preceding. Upon shoulder,
Droz Fecit' Beneath : Denon Direxi (?) | M-DCCC-vi- In-
scription : Napoleon — Emp'Et Roi*

Reverse, Two laurel branches. Field vacant for inscrip-
tion. In the descriptions by P. and R. the inscription is as
follows : Vaccine* | Mr. Bouriat | A Tours* | 1806 Et 1807'
Upon rim, Ministfere De L'lnt^rieur*** Silver. 40 mm.
Ibid.y p. 143, No. 401.

961. Obverse as preceding.

Reverse. E. Credet Ministre De L'lnt^rieur. Within,
Comit6 Central | De Vaccine | Form6 Le XI Mai | mdccc*
Below, MDCCCVlir Ampach, 3131 ; Hist. m6t. de Nap., pi.
Ixviii., No. 449* ; P. and R., p. 143, No. 402.

962. Obverse. A cow, to left. Above, a vaccine lancet
and point. Beneath, to left, De Paulis'F* Exergue : Ex
Insperato | Salus.

The Medals^ JetonSj wad Tokens lUttetrative cf Sanitation, 2:^7

Reverse. Within an oak wreath, | Vaccinations | Munic-
ipales I De Paris- | MDCCCXIV. | Silver. 32 mm.

Kluyskensy Num. Jenn6r., No. 16 ; P. and R., p. 144, No.
403.

In the Lee and Fisher collections.

03. As the last, but from different dies. Ibid.^ p. 144,
No. 404.

964. Obverse. Head of the King, to right. Under
shoulder, Gayrard F., and beneath this, De Puymaurin D.
Inscription : Louis XVIII Roi — De France Et De Nav

Reverse. Device like that of No. 956. Beneath, to left,
Andrieu ; to right. Fecit' De Puymaurin D. Exergue : La
Vaccine | — | MDCCCIV

Upon the rim of P. and R.'s specimen, engraved : Mr
Lombal, Oflicier-De-Sant6 A | Dombasle* 1820' 41 mm.
Ibid.y p. 144, No. 405.

965. Obverse. Head of King, to right. Beneath, Puy-
maurin D., and on shoulder, Andrieu F. Inscription : Louis
XVIir Roi De — France Et De Navarre.

Re\rerse as the last, save Di* for D. 41 mm. Ibid.^ p. 144,
No. 406.

966. Obverse as reverse of No. 962.

Reverse. A laurel wreath. The field vacant for inscription.
Kluyskens, Num. Jenn6r., No. 15 ; P. and R., p. 144, No.
407. This is in my collection.

967. Obverse. Bust, to right. Beneath, De Paulis F.
Inscription : Louis XVI 11 Roi De — France Et De Navarre.

Reverse. Ministere | De L'lnt^rieur | — | Comite Central
I De Vaccine | Form6 Le XI Mai. | mdccc. | —

P. and R. have dot after XVIII, and on reverse omit the
De and dot after Mai ; they have one after XI, and the date
in Arabic numerals. Silver. 42 mm.

Kluyskens, Num. Jenn6r., No. 22 ; P. and R., p. 144, No.
408.

This is in my collection.

968. Obverse as that of No. 962.

Reverse. Within a laurel wreath, Ministere De L'lnt^rieur.
Soci6t6 G6n6rale De Vaccine. 42 mm. Kluyskens, loc. cit.^
No. 23 ; P. and R., p. 144, No. 409.

969. Obverse. Head, to right. Beneath, De Paulis F. |

248 The MeddUy Jetons^ and Tokens lUugtrative of Sanitation.

De puymaurin-D" Inscription : Charles X Roi— De France
Et De Nav

Reverse like that of No. 956. 41 mm. /did., p. 145, No.
410. The dies are at the National Mint at Paris.

970. Obverse. Laureated head, to right. Beneath,
Caqu6 F* Inscription : Louis Phih'ppe I — Roi Des Fran^ais.

Reverse like that of No. 956. Upon edge of the Lee speci-
men, Mr. Thore Medecin A Sceaux (Dept. of the Seine) 1836.
Silver. 41 mm. Idid,^ p. 145, No. 411. In the Lee Collec-
tion.

971. Obverse as that of last.

Reverse. An oak wreath, with field vacant. Inscription :
Soci6t6 Nationale De Vaccine Fond6e En 1829" Kluyskens,
/oc. cit,, No. 26 ; P. and R., p. 145, No. 412.

972. Obverse. Device as that of No. 960.

Reverse. D^partement D'Indre Et Loire. Within, Comit6
I Central | De Vaccine | Fond6 A Tours | Le 23 Juin 1810 |
Et R6organis6 | Le 25 Juillet 1839. Silver. Octagonal. 30
mm. liid.y p. 145, No. 413.

973. Obverse. Female head, with diadem and wreath, to
right. Beneath, E. Rogat. Inscription : R6publique | Fran*
(aise.

Reverse like that of No. 956. I6id.^ p. 145, No. 414. The
dies arc preserved at the French National Mint.

974. Obverse. Laureated head, to right. Beneath, Barre.
Inscription: Napoleon III— Empereur.

Reverse like that of No. 956. I6id., p. 145, No. 415. The
dies are at the French National Mint.

975'. To Mr. Hauch, of Orchies. 1843. Bronze.
' Tarlier Cat., Paris, 1879, No. 421. This does not seem to
have been known to P. and R. It may have been of the
preceding group.

The medals of the Comit6 Centrale De Vaccine Du D^parte-
ment Du Nord have already been described arhong those of

Jenner, Nos. 933-34-

976. Obverse. Bust, to left. Inscription : Napoleon III
Empereur. Caqu6 Graveur d. s. m. L* Empereur.

Reverse. Conseil Central d'Hygifene et de Salubrity de la
Seine Inf6rieure. Vaccine k Mr. Legris Medecin — 1865 within
oak wreath. Lecomte k Rouen. Upon edge, Argent, Silver,

The Medah^ Jdons^ cmd Tokens IU\Mir<Ume of Sanitation. 2-(9

gilt, 28. Unknown to P. and R. It is in the Lee Collection,
and it is to Dr. Lee's courtesy that I am indebted for the
description,

C. Germany.

977. Obverse. Bust of King, to right, with cloak and
decoration. Beneath, Abramson. Inscription : Frid. Wil-
helmvs III Boruss* Rex Pater Patriae* *

Reverse. Hygeia, with patera and serpent, crossing the sea
upon a cow. Legend : In Te Svprema Salvs. Exergue :
Vaccinationis Praemivm. Gold, silver, tin. 65 mm. 44.
Kluyskens, loc, cit.^ No. 24 ; P. and R., p. 141, No. 391,
reverse figured.

In the Lee and Fisher collections. The dies are at the
Imperial Mint at Berlin.

978. Obverse. Head of King, to right. Beneath shoulder,
Goetze F. Inscription : Friedrich Wilhelm III* — Koenig
Von Preussen.

Reverse. A physician, seated, vaccinating two children
brought by their mother. To right, a third child. Behind,
a cow. Rauch Inv. — Goetze F. Legend: Dem Verdienste
Um Die Schutzimpfung. Silver. 53 mm. /J/rf.,p. 141, No.
392. The reverse is figured. The dies are at the Imperial
Mint at Berlin.

979. Obverse. An angel, upon whose shield is a cow,
overcomes a dragon. To the left, a kneeling woman and child.
Exergue : G'Loos Dir-L'Held'Fec"

Reverse. Fiir | Willige | Mittheilung | Des Impf- | Stoffes.
Silver. 25 mm. Kluyskens, lac. cit,. No. 10 ; P. and R., p.
142, No. 396. In the Lee Collection.

980. Obverse. A kneeling woman points to the arm of
her child. To the right, a vase with flowers, and shield bear-
ing a lion. Above, the All-Seeing Eye. Legend : Wir Dancken
Dir — Ftir Diese Wohlthaf Exergue : A. Guillemard f.

Reverse. The staff of iEsculapius, between wreaths of oak
leaves and roses. Legend : Gestalt Gesundheif— Leben
Geschiitzf Exergue : Schutz-pocken | Commission* | 1803.
27 mm.

Duisburg, p. 231, dcix., $ ; Kluyskens, Num. Jenn6r., No.

250 The Medals^ Jetons^ and Tokens Illustrative of Sanitation.

12 ; P. and R., p. 143, No. 398. Struck at Prague, for
Bohemia. In the Fisher Collection and my own.

The medals of the Bremer-Institut at Berlin have been
already described, Nos. 928-29.

D. Italy.

981. Obverse. Bust of the Pope, to right. Beneath, Giu'
Cerbara F. Inscription : Pivs Septimvs — Pon. Max. Anno
XXIII (1822).

Reverse. Within united oak boughs, De Salvt. Pvb | Bene-
menti Beneath, L*G" Silver. 41 mm. Hid., p. 147, No.
426.

982. Obverse. Bust of the Pope, to left. Beneath, Gir-
ometti'F' Inscription : Pivs Septimvs Ponf — Max'Anno
XXIV- (1823.)

Reverse as preceding. 42 mm. /did., p. 148, No. 427.

E. Sweden.

983. Obverse. Head of King, to right ; beneath, M.
Frumerie. Inscription : Carl XIII Sveriges G'Och V'Konung
(King of Sweden, the Goths and Vandals).

Reverse. Within an oak wreath : For Beframiad Vaccina-
tion (For encouraging V). Silver. 39 mm. Ampach, 4886 ;
P. and R., p. 149, No. 434.

984. Obverse. Head of King, to right ; beneath, L(ud-
wig)'P(ersson)-L(undgren)* Inscription : Carl XIV Johan
Sveriges Norriges G'Och V'Konung*

Reverse as preceding. 35 mm. Hid., p. 149, No. 435.

985. Obverse. The same device. Beneath, L'P-L'F*
Inscription: Oscar Sveriges Norr'G6th'0"Vend'Konung.

Reverse as preceding. 35 mm. Hid,, p. 149, No. 436.

986. Obverse. The same device. Beneath, L'A* In-
scription : Carl XV'Sveriges Norr*Goth'0*Vend*Konung.

Reverse as preceding. 35 mm. Hid,, p. 149, No. 437.

987. Obverse. The same device and initials. Inscription :
Oscar II"SverigesNorr-Goth*0"Vend*Konung* 35 mm. Hid,,
p. 150, No. 438.

The dies of all the above are preserved at the Royal Mint
at Stockholm.

Ths Birth of Man. 251

F. Russia.

988. Obverse. Bust, to left. Inscription, in Russian :
Ecatharina II, Czarina and Empress of Russia.

Reverse. Hygeia surrounded by seven naked children.
Upon her head, a star. Inscription, in Russian (For Vacci-
nation). Bronze. 66 mm. I6id., p. 148, No. 428.

989. Similar, with slight differences. Bronze. 40 mm.
liid.f p. 148, No. 429. The reverse is figured.

990. From still different dies, but in the main the same.
Bronze. 30 mm. Hid., p. 148, No. 430.

991. Obverse. Head, to right. Below shoulder, B*A'
Inscription : Nicolai I* Keisari'Kokovenaan Itsevalt'Suomen
Suuriruhtin' (Nicholas I., Emperor of Russia, Czar, Grand-
Duke of Finland.)

Reverse. Device as in the three preceding. Inscription :
Vaksinin Istuttamisen Edesta (For Vaccination). Bronze. 40
mm. I6td., p. 148, No. 432.

Struck for Finland. The dies are at the Imperial Mint at
St. Petersburg.

{To be continued.)

The Birth of Man. — The ethical question how far it is
pusillanimous and even religious to profit by the annihilation of
pain which anaesthesia affords under surgical operation and in
parturition has recently undergone discussion anew in some
of the French papers. The discussion is antiquated and out
of date in this country, and many of the stories told would
hardly bear repetition in this serious country. Sir James
Simpson long ago disposed of the argument, now revivified,
which charges the women who accept anaesthesia in childbirth
with evading the biblical injunction of pain. An indignant
Frenchwoman has revived an old argument with some flip-
pancy, but not without a reckless wit. "You quote," she
says, ** some verselets ift the Bible against us ; but let me re-
mind you that the only one of your sex who took his part in
the act of giving birth profited by anaesthesia ; for when
Adam gave up a rib toward the creation of Eve, he was thrown
into the deep sleep of insensibility." — British Medical Journal.

252 The Montgomery Qua/rantine Conference.

THE MONTGOMERY QUARANTINE CONFERENCE.

Editor of The Sanitarian :

Pursuant to the call issued by the Governor of Alabama,
as announced in your February issue, the representatives of the
Gulf and Mississippi Valley States assembled in the Hall of
the House of Representatives, Montgomery, at ten o'clock,
March 5th, 1889. There were pres'^nt, besides, Surgeon-
General John B. Hamilton, U. S. Marine Hospital Service ;
George M. Sternberg, Major and Surgeon U. S. Army ;
Daniel M. Burgess, Medical Officer to the Havana Consulate,
and Dr. William H. Van Bibber, of Maryland, who, by vote,
participated in the proceedings.

The conference was organized as follows :

President, Dr. C. B. Wilkinson, Louisiana ; Vice-Presidents,
Hon. D. B. Hadden, Tennessee ; Dr. T. George Simono,
South Carolina ; Mr. E. Berkley, Georgia ; Dr. William
Bailey, Kentucky ; Mr. J. C. Clark, Alabama ; Dr. Robert
Rutherford, Texas ; T. Y. Porter, Florida ; R. F. Gray, North
Carolina ; Dr. B. M. Griffith, Illinois ; Dr. J. M. Taylor, Mis-
sissippi ; Secretary, Dr. J. N. McCormack, Kentucky ; Assist-
ant Secretaries, Mr. J. N. Ludlow, North Carolina ; Dr. J. B.
Baird, Georgia.

The chair announced the following as the Committee on
Order of Business :

Drs. J. Cochran, Alabama ; R. P. Daniel, Florida ; W. D.
Bizzell, Georgia ; T. G. Simmons, South Carolina ; J. D.
Plunket, Tennessee ; R. Rutherford, Texas ; T. F. Wood,
North Carolina ; J. O. McReynold, Kentucky ; J. W. Du
Pree, Louisiana ; R. S. Toombs, Mississipi ; G. S. Sternberg,
U. S. Army ; J. B. Hamilton, U. S. Marine Hospital Service.

On motion, the chairman appointed a committee to whom
should be referred all papers on quarantine, as follows : Messrs.
Foster, of Georgia ; Conyngton, of Alabama ; Wall, of Flor-
ida ; Griffith, of Illinois ; Thompson, of Kentucky ; Smith,
of Louisiana ; Allen, of North Carolina ; Pires, of Texas ;
Van Bibber, of Maryland ; Horlbeck, of South Carolina ;

The Montgomery Quarantine Conference. 258

Thornton, of Tennessee ; Hyer, of Florida, and Hutton, of
the Marine Hospital Service.

Dr. Jerome Cochran read, by permission, propositions to be
submitted to the Conference. Dr. P. C. Wilkinson, of Louis-
iana, read a paper on the subject of disinfecting vessels arriving
in port, gave a detailed report of the methods followed in the
maritime quarantine at New Orleans, which was discussed
pending the report of committee. At the afternoon session
Colonel J. C. Clark, of the Mobile and Ohio Railroad, sub-
mitted a paper with propositions as a basis for action on matters
pertaining to inland quarantine, which after discussion was
referred to the Committee on Quarantine. Mr. Voyle, of
Florida, read a paper on the yellow- fever at Gainesville, Fla,
The evening session was devoted to the discussion of the
papers presented by the Business Committee. These topics
were selected from a lengthy series of questions and proposi-
tions submitted for the information and guidance of the Con-
ference, as read by Dr. Cochran at the morning session : by
Dr. A. N. Bell, of New York ; Dr. J. B. Hamilton, Surgeon-
General U. S. Marine Hospital Service ; Dr. J. McCormack,
Secretary Kentucky State Board of Health, and Dr. Jerome
Cochran, State Health Officer, Alabama. They covered the
whole question, Dr. Bell's being devoted to maritime quar-
antine ; Dr. Hamilton's eleven short questions covering each
point of dealing with a supposititious outbreak of fever, notifi-
cation, etc. Dr. MacCormack proposed four resolutions re-
garding co-operative work of health authorities, the closing of
ports, notification of fever, and importance of isolation. Dr.
Cochran's propositions were elaborate, on the quarantine of
railroads, comprising a complete schedule for proceeding
under all possible cases.

These propositions were digested and their substance sub-
mitted by the Business Committee to the Conference for action
in the form of a series of propositions, as follows :

I. What form of notification shall be adopted in case of
occurrence of yellow-fever ?

Resolved^ That this convention urges upon all health author-
ities of States represented in it the importance of strict com-
pliance with the argeement of inter-state notification adopted
by the National Conference of State Boards of Health and

254 The Montgomery Quarwntine Conference.

the Sanitary Council of the Mississippi Valley, in regard to all
communicable diseases, and especially in regard to yellow-
fever. Adopted.

II. Under what circumstances should an epidemic be de-
clared to exist ? After long discussion this was laid on the
table, no action being taken.

III. Should we advise depopulation in the event of the ap-
pearance of yellow-fever in any place, and if so, how soon ?
After lengthy discussion the following was substituted :

In the beginning of an outbreak of yellow-fever there is no
need of depopulation at all, except of infected houses or
infected districts ; but if people who are able to afford the ex-
pense desire to leave they should do so quietly and deliber-
ately, and no obstacles should be placed in their way ; and
those who leave healthful districts of the city or town should
go wherever they please, without let or hindrance.

Persons living in infected houses or in infected districts
should be encouraged to leave, but should be allowed to leave
only under such restrictions as will afford reasonable guar-
antees of safety to the communities in which they find asylum ;
and they should be sent only to such communities as are will-
ing to receive them.

In the depopulation of infected houses or of special infected
districts, the inhabitants should be removed into camps of
probation, or into vacant houses in the adjacent country.
After ten days* detention, if they remain well, and under proper
regulations, such as disinfection of baggage, they should be
considered free from danger, and allowed to go freely into any
community willing to receive them. Adopted.

This closed the first day's proceedings.

Preliminary to the business of the Conference, on the second
day, Col. W. F. Morse, of New York, described the methods of
the construction and operations of the Engle garbage cremater
for the final destruction by fire of garbage, night soil, refuse,
and offensive matter of all kinds. He gave a concise descrip-
tion of the furnace, exhibiting a diagram and giving estimates
of costs, proportioned to the size of each place and of the
matter to be destroyed. He showed that its use had been
adopted by many places with uniform success ; that this
method had been ordered by the city of Jacksonville, was

Ths Montgomery Quarantine Conference, 255

under consideration by Savannah, Charleston, Raleigh, Wil-
mington, and many other places. He stated that the Engle
Sanitary Company were prepared to make examination at any
place and submit estimates for furnaces of requisite size, to
erect same and put them into use, and guaranteeing the per-
fect operation before any payment could be made. The whole
question of cremation was one of the utmost interest and im-
portance, and of great value as concerning directly the whole
question of sanitation by the various towns and cities. Many
questions were asked and much interest was shown by the
members of the Conference.

The report of the Committee on Quarantine being ready,
the report following was adopted by the Conference, after a
lung discussion covering all the day.

A substitute for one section was offered by Colonel Fore-
man, of New Orleans, referring the whole question and man-
agement of quarantine to the General Government, both
maritime and inland, and providing for a board of commis-
sioners to inquire into the numerous epidemics which had been
prevalent in the country. He supported this by a strong
speech, and called for a vote by States. Under rules previ-
ously adopted, each State had ten votes, and his substitute was
lost by a vote of 97^ to 12^.

The following report of the committee, as amended, was
adopted as the voice of the Conference.

Section i. During the prevalence of yellow-fever epidemic,
passengers and freights should be brought from infected local-
ities only under such regulations and restrictions as may be
established by the State health authorities along the lines of
the roads concerned.

The regulations and restrictions governing railroad trans-
portation during yellow-fever epidemics should be of such
character as to afford all reasonable guarantees of protection
to the communities in danger of invasion by the disease, but
should not be more onerous than the circumstances warrant,
and should be framed with due consideration of the extent of
the danger in each particular case, and as affected by latitude
and seasons of the year, ind other qualifying conditions.

At all seasons of the year, and under all circumstances, the
simple passage of railroad trains should be allowed, without

256 The Montgomery Quarantine Conference.

obstruction, even when carrying sick refugees from infected
places to healthful localities willing to receive them.

Sec. 2. A well-digested quarantine formula, making and
promulgating the necessary rules and regulations for enforcing
the same, should be prepared ready to be put in force when
necessary to do so, at all points where it is necessary to put
quarantine in force. These rules should be published for gen*
eral information, to enable all persons to comply with the
same, and displayed by placard in every depot.

Sec. 3. At all quarantine stations, accommodations should
be provided for caring for such persons, if any, that may be
detained, or are not permitted to pass through such stations
while in transit until they can be disposed of.

Sec. 4. Only competent physicians who have had experi-
ence with contagious and infectious diseases should be made
inspectors of quarantine stations, whose duty it shall be to
inspect and examine the condition of passengers, baggage,
and express matter. All inspectors should have the power to
administer oaths and to remove from the trains at quarantine
stations and detain such passengers, baggage, or express matter
as may be found necessary to prevent the introduction or
spread of infectious or contagious diseases of any kind.

Sec. 5. State boards of health should be the powers author-
ized to put quarantine in force. They should determine when,
where, and for what length of time quarantines should be
maintained ; provide the means necessary for enforcing the
same, and promulgate rules and regulations for conducting
quarantines. Presidents and secretaries of State boards should
be required to visit and inspect all quarantine stations as often
as practicable during the existence of such quarantines, and to
make public over their signatures and ofBcial positions the
general condition of the public health at the points where
quarantines are established and the localities affected by such
quarantines. Local health officers, municipal or county
authorities may establish quarantine regulations, conferring
with the State board, if deemed necessary for co-operation.
The regulations for governing local quarantines should not
conflict with the rules and regulations adopted by the State
boards of health for enforcing quarantine regulations.

Sec, 6. The refugee stations as at present operated on the

The Montgotnery Quarantine Conference, 357

sea-coasts of the United States are, in the opinion of this
body, of infinite service, and we would recommend their con-
tinuance in a full equipment for all requirements.

Sec. io. Railroad agents at way stations should be required
to refuse to sell tickets to any persons who cannot show that
they have not in twelve days been exposed to any source of
infection, and conductors should be required by law to refuse
to transport passengers from way stations who are not supplied
with tickets.

Sec. II. Health certificates should be required from per-
sons whenever yellow-fever prevails in this country. They
should be issued only by the health official, under official seaK
or, in the absence of such seal, under the seal of the municipal
or county court where the certificate originated. In each cer-
tificate the person to whom it is issued should be so described
as to admit of his identification, and should state the facts of
the case fully and circumstantially. And to such certificates
full credence should be given by all health authorities. We
must have honesty and mutual confidence among those charged
with the protection of the public health.

Upon examination of Dr. Wilkinson's paper the committee
offers the following resolution :

Resolved^ That this Conference endorse the Holt quarantine
and disinfection system, as at present operated in New Or-
leans, as the best one known for the prevention of the intro-
duction of yellow-fever into the ports of the United States,
and recommend its uniform adoption.

After the adoption of the report the session adjourned until
three o'clock P.M.

On reconvening in the afternoon, consideration of the topics
on the various papers reported by the committee was continued:

IV. Is it practicable to cause depopulation of large cities P
Tabled.

V. Are probation camps desirable ? By whom should
they be managed and supported ? Tabled.

VI. On the occurrence of a case of yellow-fever, what im-
mediate measures of isolation are desirable ?

The following was substituted :

When one case or a few cases of yellow-fever occur in any
community, it does not follow of necessity that the disease
17

258 The Montgomery Qtmrantine Conference,

must spread and become epidemic. On the contrary, the ex-
perience of many countries through long periods of time shows
conclusively that in the majority of such instances and without
the observance of any special means of prophylaxis, the disease
fails to spread.

When one case or a few cases of yellow-fever occur in any
community, in the light of our present knowledge of the
habits and modes of propagation of the disease, it is generally
possible, by the employment of the proper prophylactic meas-
ures, to prevent the development of an epidemic.

•The golden rule for the preventicm of the spread of yellow-
fever is non-intercourse— isolation — the keeping of the well
away from the sick, away from infected things, and very
specially away from infected localities.

In the enforcement of this rule, non-intercourse, two prob-
lems present themselves for solution, {a) To keep the people
generally from coming into the infected houses and the in-
fected localities ; and {b) to keep doctors and nurses and other
attendants and the well members of sick families from
visiting and mingling with people outside of the infected
houses and localities. The solution of the first of these prob-
lems is comparatively easy. The solution of the second is
sufficien^tly difficult. But it is possible to solve them both.

In the densely settled sections of cities, guards may be use-
ful for the enforcement of non-intercourse. They are much
'less needed in sparsely settled towns. In villages and county
neighborhoods, as a rule, t'hey are not needed at all. In all
cases every intelligent family should be able to take care of
itself — should be able to keep all of its members away from
infected houses and localities, and to guard its own premises
from invasion by dangerous persons and things.

Non-intercourse may be practised in the very centre of an
infected district with considerable probability of escaping the
fever. Cloistered convents and prisons in infected cities, with
yellow-fever raging all around them, usually escape invasion ;
and there are numerous instances on record in which private
families in the midst of epidemics have passed the ordeal safely
by the vigorous enforcement of non-intercourse. Adopted.

VII. What means of disinfection should be adopted for
chambers and dwellings where cases of fever have occurred ?

The Montgomery Q%tara/fitine Conference. 259

** That this Conference recommends that all approved
methods of disinfection, ventilation, fumigation, or chemical
effusion of infected or suspected things should be used during
an epidemic or until danger of its spread shall have passed,
and that all places should be disinfected after the recovery
of the sick." Adopted.

VIII. What system of disinfection should be adopted for
the disinfection of personal baggage of persons fleeing from
an infected place ? No conclusion was reached on this topic.

The night session was devoted to the papers of Dr. G. M.
Sternberg, U. S. Army, on the ** Researches for the Bacilli of
the Yellow- fever," and by Dr. Vaughan, of Michigan, who
had written a paper, but, owing to the lateness of the hour,
gave only a brief r^sum^ of it. (Dr. Sternberg's will appear in
full in our pages hereafter.)

Third day. The Conference was called to order at 9.30 A.M.

The following committee, proposed by Colonel Clark's reso-
lution Wednesday night, was appointed by the president :
J. C. Clark, J. B. Baird, J. F. Porter, R. S. Starkweather,
William Bailey, H. B. Horlbeck, J. Black, R. Rutherford,
R. T. Gray, O. R. Earley, and C. M. Smith*.

Dr. Burgess read an interesting paper on yellow-fever, giving
in detail experience with the treatment of that disease on the
island of Cuba. The paper detailed fully the method of
issuing health certificates in Havana to outbound vessels.
Dr. Burgess, in concluding his paper, stated that the greatest
danger of the introduction of disease into this country from
Cuba was by means of smuggling schooners carrying on their
illegal traffic between that island and Florida.

A general discussion of this paper and description of the
method of inspection was given by Surgeon-General Hamilton.

Resolutions were adopted asking the United States Govern-
ment to break up the practice of smuggling from Cuba into
Florida, and for the appointment of sanitary inspectors in
foreign ports where infectious diseases are endemic.

Dr Van Bibber, of Maryland, read a' lengthy paper "On
the Quarantine of the Future." Dr. Gaston, of Georgia,
read a paper entitled ** A Plea for Yellow-fever Inoculation
as a Prophylactic Measure," which he closed with a resolution
that the theory of inoculation be thoroughly investigated.

860 Tlie Montgomery Qtuxrantine Conference.

To the question, When may refugees return to their homes ?
The following was adopted :
(i) After the occurrence of ice.

(2) After the occurrence of three killing frosts.

(3) After the occurrence of no case of fever for the period
of two weeks, and of the thorough disinfection and ventilation
of all localities infected, and bedding and such other articles
as are capable of carrying fever germs.

The following resolution was adopted :

Resolved^ That this Conference is of the opinion that it is a
duty devolving upon all nations to take measures to eradicate
any plague centre from its territory, and that the existence of
such plague centre is a menace to all other nations, and that
our State Department be requested to take measures through
proper diplomatic chambers for the conveyance of this opinion
to the governments deemed obnoxious to the opinion herein
expressed.

Dr. Baird, of Georgia, reported that the committee, consist-
ing of one from each State, appointed under Col. Clark*s reso-
lution, had appointed a sub-committee to prepare and promul-
gate rules and regulations to govern quarantines. The sub-
committee was composed of Colonel Clark, of Alabama, and
Dr. Baird, of Georgia ; the appointment was concurred in by
the convention, and the committee continued with instructions
to formulate rules, and report the same, to be published in the
report of the proceedings of the Conference. After votes of
thanks to the officers, the Conference adjourned sine die.

This Conference was remarkable for being the first organized
attempt to unite in one concerted action the Southern States
under uniform rules for the suppression of epidemics. The
Florida experience showed that some uniformity of procedure
was necessary for the safety of the community and protection
of business interests, and if the rules suggested by this Con-
ference be acted upon, there will result a uniform and universal
effort on the part of the local, the State, and the Government
officials, which will accomplish, as far as human agency can, the
suppression of the dread scourge.

The relative powers to be given to local. State, and munic-
ipal health officers was the subject which provoked most dis-

The " Wari/r^ System.'' 261

cussion, and one which was left in the most indefinite state.
The feeh'ngs of bitterness engendered by past encounters
sometimes found expression, and several times there were indi-
cations of a strong inclination to bring on a general battle,
but wiser measures prevailed, and the general harmony was
not disturbed except in one case.

The Mayor of Decatur made a passionate and forcible state-
ment of the grievances of that city in regard to the inattention
of the Health Officer of Alabama to the petitions of the citi-
zens for a thorough disinfection. It was met by the statement
of Dr. Cochran, that ** all the proof went to show that there
was not a particle of evidence that the infection still existed in
Decatur. The State had the money to do the work asked for,
and he had control of it, but he would cut oil his right hand
before he would do this. If the Conference granted the prayer
of Mayor Austjn, it would controvert the whole fever history
of the world."

It was the expressed opinion of Dr. Hyer, of Mississippi,
and Dr. Thornton, of Memphis, that the prayer of Decatur
should be answered, but the resolution of Mr. Hadden, of
Memphis, that the city of Decatur be disinfected by the proper
authorities, was lost, and the whole subject tabled.

To the scientific questions relating to the hibernation of the
germs of yellow-fever, the inoculation theory for the preven-
tion of the fever, no conclusion was formulated. The disposi-
tion of the Conference was eminently practical and business-
like, but little speculative or theoretical discussion being
allowed. A valuable fund of information as to observation
and treatment of the fever was brought out, and the general
result will do much to produce a harmonious system of quar-
antine, should the occasion arise hereafter. Francis.

The "Waring System. ' '—The San Diego City Council-
men last week unanimously voted not to approve a bill of
Colonel George E. Waring for $2,231.91, the balance of the
$20,000 he was to be paid as engineer of the sewer system.
It was held that the sewer system was not in successful oper-
ation. One trouble arises from the tide, which forces the
water back to the pipes and causes the sewer gas to burst the
smaller pipes. — Pacific Lumberman and Contractor^ December
13/A, 1888.

862 Editor's TaJUe.

EDITOR'S TABLE.

I^^All correspondence and exchanges and all publica-
tions for review should be addressed to the Editor, Dr. A. N.
Bell, 113A Second Place, Brooklyn, N. Y.

Subscribers will please conform to conditions of detachable
order on advertising page.

"defend yourselves from typhoid-fever.*'

Under this heading the Medical Record oi February 2d repeats
the words of Professor Carlo Ruata, of Perugia, in the striking
account he has recently given of the prevalence of typhoid -
fever in Italy. ** Every year/* he says, " this disease attacks
from 200,000 to 300,000 individuals, and causes a mortality of
27,700. One third of the persons in Italy who reach the age
of forty-five are attacked with typhoid-fever. In several dis-
tricts over three per cent of the inhabitants die from the dis-
ease annually."

** The extraordinary prevalence of typhoid- fever in Italy,"
the /?^r^rrf remarks, "can be better realized by a comparison
with the rates in this country. Massachusetts, with a popula-
tion of 2,000,000, has annually less than 1000 deaths from
typhoid-fever. Italy, with a population fourteen times as
great, has twenty-seven times more deaths from this disease.

** It is inexcusable that civilized States at the present day
should allow a disease relatively so controllable to make dev-
astations such as those in Italy. Well may Professor Ruata
exclaim, * Defend yourselves from typhoid- fever.* "

Apropos to this, the Berlin correspondent of the Medical
Press, March 28th, 1888, reports a persistent epidemic that
played havoc in a garrison artillery barracks, in Berlin, from
1873 to 1885, attributed to soiled clothing. A case of typhoid-
fever was imported in 1873, and from that date to the close of
the epidemic 146 cases occurred. Every possible source of
disease was looked into and everything kept in the best pos-
sible condition, but the disease baffled all inquiry. The clos-

Editor's Table. 268

ing of the barracks finally came up for consideration, but pre-
viously suspicion fell upon the bed linen and clothing, because
the vast majority of cases were furnished [by the men of one
battery alone. On close investigation, it was found that the
linings of the trousers were, almost without exception, soiled
by dry fecal matter. The clothing was submitted to renewed
careful treatment by means of chlorine and dry heat, from
which time (November i8th, 1885) no more cases of the dis-
ease occurred.

" Hygiene, however, is the direction in which the finger-
board of future glory seems to me to point," says Dr. S. S.
Turner, U, S. Army, in discussing the question, ** Is the
Practice of Medicine a Failure?" {Medical Record, February
2d, 1889.) ** Few people, relatively, require the art of the
surgeon. All are intensely interested in the causes which
develop disease, and the means of removing the causes or pre-
venting the development. Of course there are certain causes
inherent in the race which science cannot remove. It can
only point the way, and trust to the slow process of evolution
to make man master of his appetites, every one of which, in-
dulged to excess, becomes a source of disease. But man's
environment is more easily controlled, and there is reasonable
hope that the plagues and epidemics which have decimated
communities in the past will be substantially, if not literally,
banished. A widespread epidemic of yellow-fever, with a
percentage of death below the rate of most acute febrile dis-
eases, is certainly remarkable, and, in spite of Sternberg and
soda, it is too early to give the credit to therapeutics ; for did
not the negroes say that the colored people who sent for the
doctors died, while those who threw ' physic to the dogs ' got

well r

** The time is fast approaching," says the New York Medi-
cal Journal, of February 2d, 1888, ** when hygienic and pre-
ventive medicine must supersede in great degree the methods
of the old healing art. Less credit given to drugs results in
greater reliance on measures that render them unnecessary.
And thus a knowledge of limitation becomes an increase of
power. It is the physician alone who can lift to a higher level
puUic conceptions of life, death, and disease. In order to

2«4 Mitar's TcMe.

fulfil his high vocation of supreme educator — controlling the
relations of human life to the outer world — an exhaustive
knowledge of all the surroundings of man is essential, a sur-
vey of the whole of nature. Without it, the best-intentioned
must inevitably fail. To place medicine upon the plane of
biology is to give it the only foundation that accords with the
spirit of the times. Any effort in this direction deserves recog-
nition and encouragement. When man rises — by means of
modern medical instruction — to the momentous cognition that
be has power over his own destiny and that of his offspring,
Kfe for the masses will begin to be truly worth living.**

The Prevention of Diphtheria by sanitary work, in
many towns in Michigan, affords an example which other
communities should not fail to profit by. Dr. H. B. Baker,
Secretary of the State Board of Health, reports that —

" In those outbreaks of diphtheria in Michigan in 1887,
where the recommendations of the State Board of Health as
to isolation and disinfection were fully carried out there were
only about one fourth as many cases and deaths as in those
outbreaks where these measures were not taken. Compared
with those outbreaks in which either isolation or disinfection^
or both, were neglected, there was in the 78 outbreaks in
which isolation and disinfection were both enforced a saving
of 160 lives and 721 cases of diphtheria. Although this is a
record of a saving of human life of which those officers who
contributed to it should be proud, yet the saving of life in
Michigan during the year 1887 from this disease was un-
doubtedly much greater than is shown by such a comparison,
because, if in each of the 398 outbreaks reported there had
been as many cases and deaths as there were in each of the
118 outbreaks in which either isolation or disinfection, or
both, were neglected, there would have been 1079 deaths and
4692 cases. So that, without counting the saving which prob-
ably occurred in outbreaks in which only one of the essentials
(isolation and disinfection) was neglected, there is indicated a
saving in Michigan in 1887, from this one disease, diphtheria,
of 518 lives and 2371 cases of sickness.

'* The evidence of the experience in 1887 is all the stronger
because it is in harmony with the facts previously reported

mitar's TaMe. 206

relative to the year 1886. It is to be regretted that in 202
outbreaks the health officers* reports were not sufficiently
definite to make it certain just what was done ; but there is
cause for congratulation that the local work by those health
officers who made these imperfect reports was apparently
better than their reports ; because, if in each of these 202 out-
breaks there had been as many cases and deaths as in each of
the 118 outbreaks in which isolation or disinfection, or both,
were known to have been neglected, there would have been
357 more deaths and 1650 more cases than was reported to
have occurred."

Poisoning by Chrome Yellow Used as a Cake Dye is
the subject of two important contributions to the Medical
News (December 31st, 1887, and January 26th, 1889), by
David Dennison Stewart, M.D., reporting 79 cases with 8
deaths, and a large proportion of the other 71 irrecoverably
ill with the various phases of lead poisoning from this cause.
Lead, Dr. Dennison believes, is a more frequent cause of
chronic endocarditis than gout, syphilis, or alcoholism.

It may be that the general prevalence of heart disease, with
its relatively large proportion of deaths in the statistics of
mortality, generally, hitherto for the most part unaccounted
for, is due to this and other compounds of lead used for color-
ing candies as well as cakes, for glazing cooking utensils, and
for flesh powders and hair dyes.

•'The Old Oaken Bucket," as revised and edited by the
accomplished President of the Board of Health of New York,
which, since it was read by Dr. Edson at the Academy of
Medicine a few months ago has been going the rounds of the
press, was first published in The Sanitarian from the orig-
inal manuscript of the author, nearly ten years ago. Vol.
VIII., p. 38. But we are glad of its extended circulation.

•* Ex" AND "Sel" are the especially distinguished con-
tributors to several exchanges which come to our table ; par-
ticularly, we regret to say, to some new health journals : pub-
lications conducted by persons too contemptibly mean to
accredit the source of the material they use and who, instead.

266 Editor's TaUe.

commonly append one of these abbreviations. Sometimes
they append other signatures to pithy extracts which would
be tolerable enough if they did not, by extreme carelessness
with regard to printers* proof or ignorance of the gist of the
extracts they make, indicate the same purpose as ex and sel^
to divert attention from unqualified plagiarisms of the context.
The following are examples from a health journal less than a
year old, which claims a circulation of 5000 monthly :

** When a factory is blown up or a sloop sunk there is an
immediate cry for the punishment of some individual whose
selfishness or carelessness has led to the calamity, in order that
all men may be warned against the direliction of duty in time
to come. Yet, how few remember that besides these occa-
sional droppings, which so startle the year, there is a great
stream of death and misery holding its onward course, as to
which they have never asked the question whether or not the

bulk of its dark waters may be lessened.*'

•* Bell."

'* Cleanliness and refinement bear the same relation to each

other in the progress of civilization as do faith and moral un-

cleanness in the degradation of uncivilized communities ; and

the connection of cleanliness with civilization is everywhere

manifest in direct ratio with mental culture."

'•Ibid.'*

We have italicised the substitutes for ear and filth in these

extracts, and omit the name of the periodical from which they

are taken, with the hope that, considering the extraordinary

circulation of our youthful contemporary in so short a time,

its editor will appreciate the importance of the distinction,

and see his way clear at some future time how to explain it to

such of his numerous readers as may be like himself, too intent

on a wholly different purpose, to appreciate the importance of

correcting his proofs.

SANITARY AND ECONOMIC COOKING.

Garbled Abstract by the New York Herald.

Dr. Irving A. Watson, Secretary of the American Public
Health Association, has issued a circular letter to the public,
calling attention to the forfeited faith of the New York
Herald.

Mitor's Table. 267

It appears that soon after the Milwaukee meeting of the
American Public Health Association, ** Mr. Henry Lomb re-
ceived a telegram, signed by James Gordon Bennett, asking for
the Lomb Prize Essay entitled * Practical Sanitary and Eco-
nomic Cooking for Persons of Moderate and Small Means/
which had just been awarded the $500 prize, for publication
in the New York Herald, In response to this, Mr. Lomb and
the Secretary, believing that it would be a good medium
through which to present this very able and valuable essay to
the public, went to New York, and had an interview with Mr.
Bennett's representative.

** Almost the first question propounded* by the represen-
tative was, * What do you ask for the essay ? * He was in-
formed that it was not for sale at any price, but that if the
Herald would publish it in full, it should have the privilege of
first presenting it to the public. The representative critically
examined the manuscript, acknowledged its great value, ac-
cepted the proposition, and agreed to and did pay for a type-
written copy of the same. Mr. Lomb and the Secretary then
left, with the full understanding that the entire essay was to
appear in the Herald at its first convenience.

*' The Secretary ordered fifty copies of the Herald that was
to contain the essay. Our astonishment and disgust were un-
bounded, when, on January 31st, we received the fifty copies
containing a terribly mutilated and distorted article in place
of the complete essay."

The Herald was immediately written to by the Secretary,
properly characterizing ** the manner in which the Lomb Prize
Essay appeared in the Sunday Herald of the 27th inst. as an
insult to the Association, to the Committee of Award, to those
who competed for the prize, and to the public. . . .

** Your course reflects such a degree of mediocrity upon the
American Public Health Association that a statement of the
facts will be publicly made at once by the Association, unless
the Herald fully removes the gross misrepresentation it has
made. The fifty copies of the Herald^ sent in response to an
order for that number containing the Lomb Prize Essay, await
your order, since, not containing the same, the Association
has no use for them."

After waiting nearly a month, and receiving no reply, the

368 MiUn^s TakiU.

circular was issued. It particularly specifies a number of the
misleading sub-headings and vulgar qualifications of the Her-
ald^ s publication.

" The essay, which will soon be given to the public in an
authorized form, needs no defence. The concluding remarks
in the report of the Committee of Award show their appreci-
ation of it, after a critical examination :

** * The committee consider it a duty, in awarding the prize,
to emphasize the fact that of all the essays submitted the one
selected is not only pre-eminently the best, but that it is also,
intrinsically, an admirable treatise on the subject.'

" ' It is simple and lucid in statement, methodical in arrange-
ment, and well adapted to the practical wants of the classes to
which it is addressed.'

*• * Whoever may read it can have confidence in the sound-
ness of its teachings, and cannot fail to be instructed in the
art of cooking by its plain precepts, founded as they are upon
the correct application of the scientific principles of chemistry
and physiology to the proper preparation of food for man.

» f f

THE PROGRESS OF INFECTIOUS DISEASES AND MORTALITY
RATES AT THE MOST RECENT DATES, BASED UPON OFFICIAL
AND OTHER AUTHENTIC REPORTS.

Alabama. — Mobile^ 40,000 : Reports 64 deaths during Jan-
uary, of which 14 were under five years of age. Annual death-
rate, 19.2 per 1000. From zymotic diseases, 10, and from
consumption, 10.

California. — For the month of January, 1889, the Secre-
tary's abstract of the reports received from 66 cities and towns,
with an aggregate population of 700,850, the number of deaths
was 992. Annual rate, 16.92. Deaths from consumption
during the month, 165 — 16.62 per cent. From zymotic dis-
eases : Diphtheria and croup, 43 ; typhoid-fever, 29 ; typho-
malariaUfever, i ; remittent-fever, 3 ; cerebro-spinal fever, 1 1 ;
diarrhoeal diseases, ^ ; whooping-cough, 7 ; scarlatina, i ;
small-pox, 3.

San Francisco. — During the month of January, 1889, the
number of deaths was 517. From zymotic diseases, 33 ; 2 of

Mit07^'i Table. 369

which were from small-pox. From consumption, 90 — 17.4
per cent.

Los Angeles^ 80,000 :. 57 ; from zymotic diseases, 12 ; con-
sumption, 7.

Oakland, 55,000: 61 ; from zymotic diseases, 11 ; consump-
tion, 6,

San Diego, 32,000 : 19 ; from zymotic diseases, 2 ; con-
sumption, 4.

Sacramento, 35,000 : 30 ; from zymotic diseases, i ; con-
sumption, 5.

Connecticut.— The Secretary of the State Board of Health
reports for January, 1889, ^9^ deaths from 167 towns, com-
prising a population of 737,276, representing an annual death-
rate of 14.5. Deaths under five years of age, 178 — 24.0 per
cent. Deaths from zymotic diseases, 140 — 15.7 per cent.
From consumption, 112 — 12.5 per cent.

Florida. — The Legislature has passed the bill creating a
State Board of Health, which has received the signature of
the governor, and is now the law. The law contains all the
provisions insisted on by the friends of Florida. The Board is
given ample powers as to all sanitary matters, has a right to
call on the governor for any assistance that may be required
to enforce its orders, and is amply provided with funds,
$50,000 having been voted to carry out its orders. The Board
can restrict travel, and destroy, when it deems it necessary,
all infected property, to be paid for out of the special health
fund.

Iowa. — Monthly Bulletin for January, 1889, reports :

Keokuk, — Total deaths, 19. Consumption, 4.

Davenport. — Total deaths, 36. Diphtheria and croup, 13.
Death-rate, I2.8i,

Des Moifies, — Total deaths, 51. Consumption, 10; typhoid
fever, 2 ; diphtheria, 2.

Populations not reported.

Illinois. — Chicago, 830,000: Reports 1255 deaths during
January, of which 625 were under five years of age. Annual
death-rate, 18. 10 per 1000. From zymotic diseases, 282, and
from consumption, 112.

270 Mitor's TaMe.

Louisiana. — New Orleans^ 248,000 : Reports for four weeks
ending January 26th, 444 deaths, of which 87 were under five
years of age. Annual death-rate per 1000 among whites,
20.79; aniong colored, 30.13. From zymotic diseases there
were 44 deaths, and from consumption, 65.

A good deal of commotion has been excited in the city on
account of the governor's appointment of Dr. W. G. Austin,
Quarantine Officer, in the place of Dr. T. Y. Aby, who has so
successfully served for several years. Dr. Austin is a phy-
sician of excellent repute, and with the same aids as Dr. Aby
had — which he promises — there appears to us no reason to
fear an equally good service.

Maine. — The Secretary of the State Board says in the Sani-
tary Inspector : ** Maine stands alone among the New England
States in having no system of registration of vital statistics,
and consequently is like a ship at sea without a compass as
regards her knowledge of where she stands in the health scale.
We think we have good reasons for surmising that there is no
State in the Union with a lower general death rate. If this is
true, the proof of the fact would be worth something. If, on
the contrary, the local death-rates in some of our towns were
making the general death-rate higher than it ought to be, the
absolute demonstration of that fact might lead these towns to
remove their bad record.'*

Maryland. — Baltimore, 500,343 : Reports 612 deaths dur-
ing the four weeks ending January 26th, of which 194 were
under five years of age. Annual death-rate, 15.91 per 1000.
From zymotic diseases, 71, and from consumption, 100.

Massachusetts. — Boston^ 415,000: Reports 813 deaths
during January, of which 261 were under five years of age.
There were 120 deaths from zymotic diseases, and 132 from
consumption. Annual death-rate, 23.5 per 1000.

Michigan. — The Secretary reports that, for the month of
January, 1889, compared with the preceding month, the re-
ports indicate that scarlet-fever and neuralgia increased in
prevalence.

Editor's TaUe. 271

Compared with the preceding month, the temperature was
slightly lower, the absolute humidity was slightly less, the
relative humidity was slightly more, and the day and the night
ozone were less.

Compared with the average for the month of January in the
three years 1886-88, intermittent-fever, inflammation of kid-
ney, consumption of lungs, and pneumonia were less prev-
alent in January, 1889.

For the month of January, 1889, compared with the average
of corresponding months in the three years 1886-88, the tem-
perature was much higher, the absolute humidity was more,
the relative humidity was less, the day ozone and the night
ozone were more.

Including reports by regular observers and others, diphtheria
was reported present in Michigan in the month of January,
1889, at sixty places, scarlet-fever at ninety-four places,
typhoid- fever at thirty-eight places, measles at eleven places,
small-pox at eleven places.

Reports from all sources show diphtheria reported at eight
places more, scarlet-fever at thirty-seven places more, typhoid-
fever at eight places more, measles at seven places more, and
small-pox at five places more in the month of January, 1889,
than in the preceding month.

A part of the increased prevalence of communicable diseases
is doubtless only apparent, because a knowledge of a large
number of outbreaks, not otherwise reported, was obtained
from the annual reports of health officers and clerks sent to the
office of the Secretary during the month of January.

Detroit, 230, OCX) : Reports 284 deaths for January, of which
78 were under five years of age. Annual death-rate, 14.53
per 1000. From zymotic causes, 45, and from consumption,

Missouri. — St. Louis, 440,000 ; Reports for January 716
deaths, of which 274 were under five years of age. Annual
death-rate, 19.53 per 1000. From zymotic diseases there were
136 deaths, and from consumption, 76.

For the year 1888 there were reported 9015 deaths, of which
3659 were under five years of age. From zymotic diseases
there were 2133 deaths, and from consumption and pulmonary
tuberculosis, 800. Death-rate per 1000 for the year, 20.49.

272 Mitor's Table.

New Hampshire. — For the month of January there was
reported to the State Board of Health quite a prevalence of
diphtheria and scarlet- fever, although neither of these diseases
has assumed epidemic proportions. Diphtheria was reported
from Dover, Nashua, Somersworth, Wolfeborough, Rochester,
Bedford, Manchester, Langdon, Acworth, Epping, Concord.

Scarlet-fever was reported from Pittsfield, Dover, Nashua,
Jaffrey, Henniker, Farmington, Somersworth, Rochester,
Mount Vernon, Rye, Manchester, Claremont, Troy, Lebanon,
East Kingston.

The largest number of cases of diphtheria reported from
any one place was eight or ten in Bristol ; and the greatest
number of cases of scarlet-fever was nine, in Claremont, of a
mild type.

The character of both these diseases was usually non-malig-
nant. The action of local boards of health has undoubtedly
restricted the spread of these diseases in several localities. In
some towns the schools were closed ; in others, isolation and
disinfection were deemed sufficient.

No unusual prevalence of other diseases is reported.

New Jersey.— Hudson County, 282,254: Reports 565
deaths for January, of which 221 were under five years of age.
Annual death-rate, 24.0 per 1000. From zymotic diseases
there were 142 deaths, and from consumption, 69.

Paterson^ 80,000 : Reports 122 deaths during January, of
which 37 were under five years of age. Annual death-rate,
i8.2 per 1000. There were 16 deaths from zymotic diseases,
and 22 from consumption.

New York.— The number of reported deaths for January
is about the same as in December, and a little less than in
January, 1888. From a population of 3,980,000 there were
7100 deaths reported, which gives a death-rate per 1000 an-
nually of 21.40; this includes the cities and larger villages.
The infant death-rate is higher than in the preceding month.
Zymotic diseases caused 17.00 per cent of all deaths (17.90 in
December). A moderate increase in the prevalence of scarlet-
fever continues ; typhoid-fever is materially diminished ; diph-
theria is credited with causing fewer deaths than last month.

Editor's TaMe. 273

7.30 per cent of all deaths. From small-pox deaths are re-
ported from Lyons, Rome, Marengo in Wayne County, Mid-
dlebury in Wyoming County, and from the Onondaga County
alms-house. New localities for its development are the towns
of Burns, Allegany County, and Sheridan, Chautauqua County,
and a single mild case in Fort Plain. At Syracuse and Lyons,
previously reported, the outbreak is almost controlled. Con-
sumption caused 12.55 P^^* ^^^^ ^^ ^^^ deaths and 19.25 of
deaths over five years of age.

Maritime District. — New York City, 1,571,558, 25.28 ;
Brooklyn, 814,500, 22.93; Gravesend, 5000, 9.60; New
' Utrecht, 4742, 36.00 ; Long Island City, 21,000, 28.00 ; New-
town, 10,000, 38.40; Oyster Bay, 12,000, 22.00; Hempstead,
18,000, 12.00; North Hempstead, 8000, 18.00; Huntington,

8100, 19.26; Jamaica, 10,089, 5 Southold, 7267, 14.00;

Sag Harbor, 3000, 24.00 ; New Brighton, 15,000, ; Edge-
water, 12,000, ; Northfield, 7014, ; Westfield, 7000,

22.28; Yonkers, 30,000, 14.80; Westchester, 6900, 22.28;
Sing Sing, 6500, 16.62; New Rochelle, 5500, 26.18; Port
Chester, 4000, 9.00.

Hudson Valley District,— AlbsLny, 103,000, 20.97 ; Cohoes,
20,000, 12.00; Troy, 65,000, 23.26; West Troy, 13,000,
24.00 ; Hoosick Falls, 6000, 26.00 ; Lansingburg, 10,000,
20.40; Green Island, 5000, 7.20; Greenbush, 8000, 22.75;
Coxsackie, 4000, 18.00 ; Catskill, 4500, 10.67 ; Hudson, 10,000,
13.20; Kingston, 21,000, 16.60; Ellenville, 3000, 4.00; Mar-
bletown, 4000, 9.00; Esopus, 4736, 15.20; Saugerties, 4000,
12.00; Poughkeepsie, 20,200, 24.35 J Fishkill, 10,732, 17.88;
Wappinger Falls, 5000, 16.80 ; Newburg, 20,000, 24.60 ; Port
Jervis, 9500, 16.42 ; Middletown, 10,000, 33.60 ; Goshen,
4387, ; Ramapo, 5000, 12.00; Haverstraw, 7000, 25.70.

Adirondack and Northern District, — Greenwich, 3861, 27.50 ;
Argyle, 3700, 19.46; Salem, 3500, 20.58; Fort Ann, 4267,
11.50 ; Fort Edward, 4880, 12.30 ; Glens Falls, 10,000, 20.40 ;
Crown Point, 4287, 8.38; Malone, 9000, 16.00; Potsdam,
4000, 18.00; Ogdensburg, 11,000, 14.18; Gouverneur, 5500,
15.28; Plattsburg, 7000, 12.00; Watertown, 12,200, 19.75;
Lowville, 3188, 30.00; Clayton, 4314, 16.75; Ellisburgh,
481 1, .

Mohawk Valley District, — Schenectady, 20,000, 14.40 ;
18

874 MUar's TabU.

Schoharie, 3350, 21.50 ; Cobleskill, 3371, 15.00 ; Middleburgh,

8376, ; Amsterdam, 14,000, 6.00; Johnstown, 6000,

6.00; Gloversville, 10,000, 16.80; Little Falls, 7200, 20,00;
Herkimer, 3000, 8.00; Ilion, 4200, 50.71; Utica, 50,000,
16.08 ; Rome, 12,045, 21.00 ; Boonville, 4000, 21.00 ; Camden,
3400, 21.18; Waterford, 5400, 24.44; Ballston Spa, 3200,
18.75 \ Saratoga Springs, 10,000, 24.00.

Soutliern Tier District, — Binghamton, 30.000, 9,60 ; Owego,
6000, 12.00; Candor, 4323, 19.41; Waverly, 3000, 20.00;
Hornellsville, 10,000, ; Elmira, 25,000, 14.40 ; Horse-
heads, 3500, ; Bath, 3500, 20.57 \ Corning, 8000, i8.oo ;

Olean, 8000, 15.00; Salamanca, 6000, 8.00; Jamestown,
15,000, U.20; Westfield, 3000, .

East Central District. — Walton, 3540, 7.00 ; Delhi, 3000,
20.00; Cooperstown, 3000, 12.00; Oneonta, 7000, 8.57;
Worcester, 3000, 8.00; Cazenovia, 4363, 13.75; Brookfield,
3685, 16.25 ; Hamilton, 3912, 15.38 ; Baldwihsville, 3000,

4.00 ; Skaneateles, 4866, ; Syracuse, 80,000, 16.65 ;

Cortland, 9000, 12.00; Homer, 3000, 16.00.

West Central District. — Auburn, 26,000, 16.65 1 Ithaca,
10,000, 10.80; Groton, 3450, 24.35 \ Waterloo, 4500, 26.67 ;
Hector, 5000, 7.20 ; Manchester, 4000, 9.00 ; Phelps, 7000,
5.14; Canandaigua, 6300, 9.52; Geneva, 6000, 22.00; Penn
Yan, 4560, 16.00 ; Dansville, 3700, ; Batavia, 7000, .

Lake Ontario and Western District, — Oswego, 24,000, 10.50 ;
Richland, 4000, 12.00; Fulton, 4000, 15.00; Clyde, 3000,
16,00; Lyons, 6000, 20.00; Newark, 3500, 13.80; Palmyra,
4800, 22.50; Rochester, 110,000, 17.35; Brockport, 4500,
16.00; Medina, 4000, 12.00; Albion, 5000, I4.50; Buffalo,

230,000, 15.30; Tonawanda, 4900, ; Amherst, 4578,

15.50; Lockport, 15.000. 8.80.

New York City and Yellow- fei*er, — Last November, when
yellow-fever was prevailing in the South, the Dock Board,
with the assistance of the Health Department, started an in-
vestigation of the water front. Dr. Moreau Morris was de-
tailed by the Board of Health to make an examination. He
found that many of the old bulkheads were far inland, and
|hat when the tide receded a large area of the river bed was
left exposed. This area was covered with ** sewage-saturated
mud.*' The eddies in the slip kept objects revolving until

MUor'i TdUe. 275

they sank. Foul gases are constantly arising, and people who
work along the piers are subject to colic and typho-malarial-
fever. Dr. Morris was twice prostrated while he was pursuing
the investigation. He suggests that the sewers which now only
reach the bulkhead be extended to the end of the pier. He
thinks this *' sewage-saturated mud ** forms hotbeds for the
lodgment of yellow-fever, cholera, and other disease germs.

North Carolina. — In sixteen towns in the State, repre-
senting a population of 60,635 white, 50,165 colored (total,
110,800), there were 4 deaths from typhoid- fever, i from
scarlet- fever, 6 from malarial-fever, i from diphtheria, 24 from
pneumonia, 30 from consumption, 6 from brain disease, 11
from heart disease, 4 from neurotic diseases, 4 from diarrhceal
diseases, 43 from all other diseases, 3 from accident and vio-
lence, 2 from suicide, and 12 were still births. Tarborough,
Greensborough, and Statesville did not send in any mortuary
reports. Four more towns have been added to the list —
namely : Wilson, Hillsborough, Monroe, and Salem. Grad-
ually we are interesting other towns in the State in the neces-
sity and desirability of accurate mortuary statistics. Renewed
efforts are being made in this direction by this office.

Ohio. — Official Monthly Record of the Secretary reports
1248 deaths during the month of January, representing an
annual death-rate per 1000 population of 49 cities and town$
of 13.05. Deaths under five years of age, 393. From zymotic
diseases, 251 — chiefly croup and diphtheria, 107 ; typhoid*
fever, 43 ; scarlatina, 14; whooping-cough, 13. Deaths from
consumption, 182. Severally, the populations and death-rates
were as follows :

Akron, 30,000, 9.60; Alliance, 7000, 8.57; Ashtabula,
6500, 9.07; Bellaire, 12,000, 12.00; Bellevue, 3500, 10.28;
Canton, 25,000, 12.00; Chagrin Falls, 1400, 17.13; ChilU-
cothe, 14,000, 13.71 ; Cincinnati, 325,000, 16.51 ; Cleveland,
235,000, 14.25; Clyde, 3000, 12.00; Columbus, 101,000,
10.95 ; Conneaut, 1500, 32.00; Dayton, 52,000, 12.80; Defi-
ance, 7000, 8.57; Delaware, 9000, 10.64; East Liverpool,
10,000, 14.40; East Palestine, 1600, 15.00; Gallipolis, 5000,
12.00; Hamilton, 20,000, 11.40 ; Hudson, 1700, 35.28 ; Kent,

276 EcUU/r's TaOe.

3750, 6.85; Logan, 3700, 6.49; Mansfield, is.cxx), 5.60;
Marion, 8000, 16.50; Mechanicsburg, 2000, 18.00; Middle-
town, 7000, 13.50; Mt. Vernon, 6000, 16.00; Nelsonville,
5000, 7.20 ; New Straitsville, 3000, 8.00 ; New London, 1000,
24.00; Oberlin, 4000, 15.00; Oxford, 2000, 24.00; Piqua,
10,000, 16.80; Plymouth, 1500, 32.00; Portsmouth, 14,000,
15.43 ; Ravenna, 4000, 15.00 ; Rocky Ridge, 600, 40.00 ; St.
Mary's, 2500, 19.20; Toledo, 80,000, 15.45 ; Urbana, 8000,
16.50; Wadsworth, 2500, 24.00; Washington Court-House,
5200, 6.92 ; Wapakoneta, 3300, 21.21 ; Warren, 8000, 7.50;
Wooster, 8500, 12.71; Xenia, 10,000, 18.00; Youngstown,
24,300,17.78.

Pennsylvania. — Philadelphiay 1,040,245 : Reports for four
weeks ending January 26th, 1463 deaths, of which 445 were
under five years of age. Annual death-rate, 13.5 per 1000.
From zymotic diseases there were 162 deaths, and from con-
sumption, 198.

Pittsburgh^ 230,000 : Reports for four weeks ending January
26th, 341 deaths, of which 141 were under five years of age.
Annual death-rate, 19.25 per 1000. From zymotic diseases,
35, and from consumption, 24.

Rhode Island.— Reports show that a larger amount of
sickness prevailed throughout the State during the month of
December than in the previous month, but the accounts do
not make it appear that the general amount was larger than
the average for the corresponding month in previous years.

Bronchitis and pneumonia had a considerably larger mor-
tality than in any one of the seven months preceding. Diph-
theria was reported from two towns only besides Providence
City. In that city the disease had increased prevalence and
mortality. Croup, malarial diseases, and scarlatina had largely
diminished in numbers. Typhoid-fever had quite large prev-
alence in Providence City and surrounding towns. It had ob-
tained considerable prevalence during the last half of Novem-
ber and had largely subsided before the end of December.
In no other part of the State has any notice been given of its
occurrence in unusual number.

The number of deaths recorded in the different towns and

Mitar's TcMe. 277

cities, from which returns have been received, was 455, in an
estimated population of 284,152. Annual death-rate, 19.2
per I OCX).

Newport^ 22.000 : Reports 23 deaths during January, of
which 8 were under five years of age. Annual death-rate, 12.5
per 1000. Diphtheria caused 2 deaths, and consumption, 5.

Tennessee. — Official Bulletin reports for the month of Jan-
uary the principal diseases, named in the order of their greater
prevalence : Pneumonia, catarrhs, bronchitis, malarial-fever,
tonsillitis, consumption, erysipelas, rheumatism, pleurisy, and
dysentery.

In the chief cities the respective annual death-rates for the
month per 1000 of population are reported as follows :

Chattanooga, white, 4.00 ; colored, 26.76 : 11.40

Clarksville,

4.80 ;

' 20.00 : 10.50

Columbia,

12.00 ;

' 18.00 : 14.88

Knoxville,

8.83 ;

12.88 : 9.66

Memphis,

25.01 ;

31.34 : 27.89

Nashville,

14.62 ;

' 17.49 : 15.64

VflSCO^SW.— Milwaukee, 210,000: Reports for the month
of January 270 deaths, of which 69 were under five years of
age. Annual death-rate per 1000, 15.4. From zymotic dis-
eases there were 44 deaths, and from consumption, 19.

FOREIGN REPORTS AT THE MOST RECENT DATES.

Brusselles Report for the year ending October ist, 1888 :
Population (December 31st, 1887), 177,523. Births, 5058—
1449 or 29 percent illegitimate; deaths, 4139 — increase over
previous year 819, or a little more than 4 per 1000, but still
small as compared with other European cities, being 21.8 per
1000 of population ; and when computed for a series of fifteen
years shows a nearly uniform decrease.

The number of marriages was 1815 — i to 106; divorces, i
to every 35 marriages.

Vaccinations and revaccinations, 4779.

Cuba. — Havana^ 200,000 : Deaths reported for the month
of January, 497 ; under five years of age, 117. From consump-
tion, III — 22.33 P^*" cent of total mortality. 'From yellow-
fever, 19 ; other fevers, 28. Death-rate, 32.

278 Mitar's Table.

INFECTIOUS DISEASES ABROAD.

Small'pox in Italy, especially, has for a long time had free
sway, and the prospect of its early arrest is not encouraging.

The Lancet correspondent at Rome, under date of December
1st, 1888, writes :

** Vigilant, however, she must never fail to be, if the bad
traditions — the laxity, the negligence, the apathy bequeathed
by the old regime — are not sometimes to assert themselves dis-
astrously. Under the heading of * Delizie Ferroviarie ' (rail-
way delights), the Tribuna announces that a day or two ago,
while the up-train from Naples was stopping at Cecchina,
within some ten miles of Rome, five gentlemen got into a
second-class compartment from which, to their horror, three
peasants, all ill with small-pox, and one of them, indeed, very
seriously so, had just been taken. It was in vain that the in-
coming passengers protested to the guard against such an out-
rage on the travelling public. Their protestations were dis-
regarded, and they had td pursue their journey to Rome a
prey to the most disquieting anticipations. On reaching the
Roman terminus, they were subjected to a sanitary inspection,
and, this concluded, they lodged a strongly worded remon-
strance with the ' Direzione generale.' Certainly, such a
flagrant breech of good faith with the railway-faring com-
munity would not be tolerated in England, still less if the
management were vested, not in a company, but in the State.

'* . . . From all parts of Italy, but especially from the
southern provinces and the islands, comes an appeal for sys-
tematic vaccination under duly qualified medical surveillance.
Town councils have proved inadequate to the strain imposed
upon them by recent small-pox epidemics, and, indeed, some-
thing worse than mere incompetence is alleged of some of
them. The Tribuna^ an ably conducted and widely diffused
organ of the advanced liberal party, publishes, under the head-
ing * Vaiuolo e Camorra ' (Small-pox and the Camorra) some
scandalous details as to the mode in which the malady, still
unsubdued in Sicily, is sought to be combated. The public
health it seems is not sufficiently sacrosanct for the avaricious
contractor, and from the most sordid of motives the vaccine
lymph supplied to the municipalities (that of the Catina is

MiUyr'8 Table. 279

specified by the Tribund) is so largely adulterated with glycer-'
ine as to be worse than useless. Town Councillor De Felice^
according to the Tribuna, has tabled a series of charges incul^
pating certain prominent Catanese with this nefarious traffic
in the resources of sanitation, and the names of the leaders in
this Camorra or ring are to be made public in connection with
a criminal prosecution. We hope that a severe example will
be made of the culprits, and that erelong a well-ordered sys-
tem of State-controlled prophylaxis will put Italy on an equal
footing hygienically with Germany and France. Meanwhile,
there are symptoms that the small-pox epidemic has, for the
time, seen its worst in the Sicilian towns, Catania now record-
ing ten cases and Messina only two per diem.'*

Three months ago it was officially announced that an ** In-
stituto Vaccigeno," or depot for the supply of pure vaccinef
lymph, would at once be opened under the direction of the
Ministry of Health, in Rome, but its fruit has not yet become
apparent — six deaths reported during the week ending Feb-
ruary 1 2th. The reports from Rome are very irregular, this
being the only one received since that for the week ending
December 29th, during which there were reported two deaths
from small-pox.

But it also prevails extensively in other foreign cities besides
the Italian. According to the most recent reports at hand,
the number of deaths reported from it is as follows : During
four weeks ending February i6th : Paris, 10 ; Lyons, 8 ;
Amiens, 24 ; Ostend, 82 ; Wasmes, 2 ; Roulers, 2 ; Arlon, 13 ;
Tamise, 8 ; Trieste, 15. During the four weeks ending Feb-
ruary 9th : Prague, 75 ; Bucharest, 16 ; Venice, 5 ; Warsaw,
18. During the month of January: Marseilles, 11 ; Rouen,
5 ; Nice, 2. During the month of December : Milan, 23 ;
Bologne, 19 ; Madrid, 23 ; Saragossa, 5. During the month
of November : Carthagena, 52 ; Buenos-Ayres, 8 ; Rio de
Janeira, 12.

In India during the twenty years ending 1885, says Surgeon-
General G. Bidie, the deaths from small-pox averaged over
33,000 per annum, and for every death about ten persons had
the disease and suffered mutilation. In the Madras Presi-
dency the four great destroyers of human life are cholera^
small-jpox, fever, and bowel complaints, the average number

280 Literary Notioea.

of deaths from these diseases alone being about 339,000 every
year. In the fifty years ending 1886, the total losses to Eng-
land, France, Germany, and Austria on battle-fields amounted
to but 386,000, against the annual 339,000 of the Madras Presi-
dency from disease. The country is studded by towns and
villages that have been rendered terribly foul by the filth of
centuries.

Diphtlieria and scarlet-fever prevail far less extensively in
foreign cities, according to the most recent reports, than in
those of the United States.

Yellow-fever is prevailing extensively in Rio de Janeiro, the
number of deaths from it daily, according to the most recent
accounts, being about 20. By Surgeon-General Hamilton's
Weekly Abstract, March 8th, the total number of deaths reg-
istered in Rio during the week ending February 3d was 463 —
from yellow- fever, 127; typhus-fever, 26; enteric-fever, 11.

In Havana, during the month of February, deaths from
yellow- fever, 12.

In Panama the tribute of valuable lives paid to the insalu-
brity of the Panama Isthmus (says Engineering) has been very
heavy. M. A. Nicholas, who had the organization of the sani-
tary measures for the protection of the workmen, states that
among the European element there have been 5200 deaths
during a period of two years and three months, the burials
averaging about seven per day, and the death-rate being 98
per 1000. In one station, among 159 young men specially
selected for their physical vigor, 23 have died within twenty-
two months. Among the colored workmen the loss has not
been anything like so heavy, only 51 having died out of 2100
during the period considered.

LITERARY NOTICES.

Handbook of Histological and Geographical
Phthisiology, with Special Reference to the Distri-
bution OF Consumption in the United States. Com-
piled and arranged by Georce A. EVANS, M.D., Member of
the Medical Society of the County of Kings, N..Y. ; of Ameri-

Literary Notices. 281

can Medical Association ; formerly Physician to the Atlantic
Avenue, Bush wick, and East Brooklyn Dispensaries, etc.
i2ino, pp. 295. New York : D. Appleton & Co.

The chief originality of this work consists in such an arrange-
ment of the mortality statistics of consumption throughout
the United States as to show, so far as such statistics can, the
relation of that disease to climate, locality, and density of
population.

" It opens with a historical sketch of the subject, fortified
with citations of the most reliable authorities, ancient and
modern, and a concise statement of the recent investigations
of Koch and others in determining the existence and nature
of the tubercle-bacillus. This is followed by a short chapter
on the Geographical Distribution of Phthisis over the Globe,
condensed from Hirsch's Handbook of Geographical and His-
torical Pathology.

The topography and climate of the several States and Terri-
tories, cities and counties of 10,000 population and upward,
and groups of those with analogous conditions, are described,
and the number of deaths from consumption per 1000 inhabi-
tants on the last census year are given.

Other causes of death — as related to local and climatological
conditions — are taken into account, and numerous tables ad-
duced, showing not only the ratios of deaths from consump-
tion to populations in the different regions and localities, but
to other diseases, and, measurably, to density of population.

Next follows a series of meteorological tables giving the
monthly and annual means of Barometrical, Thermal, and
Hygrometrical observations at the chief stations of the United
States Signal Service.

The chapter on Etiology summarizes the views of the most
distinguished authorities on the special effects of the different
elements of climate and local conditions : temperature, mois-
ture of air and soil, altitude, etc. ; and the relative prevalence
of consumption among the different nationalities and races in
the United States.

Altogether, it is a good abstract of the best literature on the
most important subject that can engage the attention of the
medical practitioner — how to reduce the mortality from pul-
monary consumption.

282 Literary ^otieeB.

Electricity in the Diseases of Women, with Special
Reference to the Application of Strong Currents.
By G. Benton Massey, M.D., Physician to the Nervous De-
partment of Howard Hospital ; Late Electro-therapeutist to
the Philadelphia Orthopoedic Hospital and Infirmary for Ner-
vous Diseases ; Member of the American Neurological Asso-
ciation ; of the Philadelphia Neurological Society ; of the
Obstetrical Society of Philadelphia ; of the Medical Juris-
prudence Society ; of Franklin Institute, etc. i2mo, pp.
212. Philadelphia: F. A. Davis.

A thoroughly practical work, comprehending so much of the
laws of electricity and apparatus for utilizing it as are neces-
sary for its intelligent use in this branch of medicine and sur-
gery, and such a detail of illustrative cases in which it has
been successfully used as every medical practitioner ought to
be familiar with.

The Popular Science Monthly for April will contain a
scientific explanation of the power to ensnare the human mind
possessed by the leading delusion of the present day. The
article is by Professor Joseph Jastrow, and is entitled ** The
Psychology of Spiritualism." It contains accounts of the
manifestations by the Fox Sisters, Dr. Slade, Englinton, and
other mediums, all of which have been proved to be " gross
intentional fraud throughout."

The Vest-Pocket Anatomist. (Founded upon " Gray.")
By C. Henri Leonard, A.M.. M.D., Professor of the Medi-
cal and Surgical Diseases of Women and Clinical Gynaecology
in the Detroit College of Medicine. Fourteenth revised edi-
tion, containing one hundred and ninety-three illustrations,
** Dissection Hints" and '* Visceral Anatomy." Cloth, i2mo,
pp. 304. Price, $1. Illustrated Medical Journal Co., Pub-
lishers, Detroit, Mich.

The new fourteenth edition of this work has been increased
in size by the addition of over one hundred pages of text and
one hundred engravings ; the page of the book has also been
somewhat enlarged to accommodate better the engravings.
The Brain and its Membranes, the Eye, Ear, and Throat — in
fact, the entire Viscera and the Generative Organs of both
Sexes, form the new subject-matter in this edition.

Medical Eaoerpk d83

MEDICAL EXCERPT.

Diphtheria ; Topical Treatment with Insufflations
OF Finely Pulverized Sugar. — C. Loray, of Frankfurt am
Main {Deutsche med. IVocA., Nov. 15th, 1888), as the result
of more than eighty observations in children from one year
upward and in adults, in all gradations of the disease, finds
that the duration and extent of the deposit are much dimin-
ished, the fcetid odor quickly overcome, the membrane readily
detached under copious mucous secretion, and the cough
facilitated in many cases of involvement of the larynx. In
several cases of extensive ulceration, fatal by sepsis or by
pneumonia. Professor Weigert and his assistants found separa-
tion of the membrane in a much more advanced stage than in
similar cases which had been treated by other methods. Loray
neglects to state the frequency with which he makes the in-
sufflations.

Vinegar is highly recommended by Dr. Friedrich Engel-
mann, of Kreutznach (idem,), as the very best agent of a very
extensive detailed series with which he has made experimental
observations. — American Journal of Medical Sciences.

Borax in the Treatment of Diphtheria.— Dr. L. No€l,
of Noyers-Saint-Martin, has had considerable success with the
following treatment, practised by him for the last four years.

Starting with the belief that diphtheria is not a local but a
constitutional disease, he sought a remedy which could be
introduced into the system in quantities large enough, so to
speak, to ** crowd out," and not merely modify the action of
the poison. The author thus selected borax from all other
antiseptics, as bearing admini3tration in large doses without
danger to the patients.

In epidemics of diphtheria, the author administered nothing
but borax, with but three deaths out of sixty cases thus
treated.

The author claims that this agent produces a rapid and
abundant salivation ; and, in being eliminated by the salivary

284 Medical Excerpt.

and muciparous glands of the throat, it softens and detaches
the false membranes.

The dose is from 8 to 15 grains in an infant below one year
of age ; of from 1 5 to 22 grains for two to five years ; of 30
grains for five to ten years ; and from 45 to 75 grains for adults,
according to the strength of the patient and the severity of
the disease. No better results were obtained from 200 grains
or over than were obtained from 60 to 75 grains. The doses
are to be equally divided, and given hourly, except during
sleep.

In order not to disgust the patient, the correctives in which
this salt is given must be frequently changed, as the adminis-
tration of this medicament must be continued for some time
after all symptoms of the disease have passed off, the author
having administered it to two patients uninterruptedly for
four and six weeks. — Revue Thirapeutiquey December 15/A,
1888,

Application of Steam to the Throat.— The Medical
Times says : *' Apropos of the treatment of diphtheria by
eucalyptol inhalations, we note that a Scotch physician advo-
cates strongly the use of steam. The child, he says, should
live in an atmpsphere of steam ; with or without the addition
of sulphurous acid generated by burning sulphur in the room.
He states that since adopting this method he has not lost a
case."

In acute tonsillitis, especially the follicular variety, very few
remedies at our command give such prompt and decided relief
as the application of steam directly to the inflamed surfaces.
By using a small gas stove or oil stove on which to generate
the steam, it can be carried through three feet of tubing
directly into the patient's mouth, as hot as he can bear it. It
allays irritation, and relieves spasms of the laryngeal muscles.

A New Remedy for Cholera. —This remedy Dr. Loewen-
thal announces that he has found in salol^ the salicylate of
phenol, discovered in 1886 by Nencki, of Berne. This power-
ful antiseptic is decomposed in the organism by the pancreatic
juice, the same agent which renders toxic the cultures of the
cholera bacillus in the pancreatic paste. A multitude of ex-

Medical Excerpt. 285

periments have assured him that salol in presence of fresh
pancreatic juice is invariably fatal to the cholera bacilli in his
laboratory culture-tubes ; and he has determined the quantity
which is sure to effectually sterilize his cultures — namely, two
grammes of salol to every ten grammes of the paste ; a smaller
dose, however (as ten centigrammes), renders the bacilli inac^
tive.

It is known that salol can be taken in pretty large doses (as
much as ten to fifteen grammes a day) by man with compar-
ative impunity.

It must be added that the above interesting laboratory ex-
periments, conclusive as they seem to be to their author, who
has full faith that he has now found a sure specific for cholera,
still lack clinical confirmation, as well as that confirmation
which comes from a series of carefully conducted experiments
on animals. — Acad, des Sciences, Session, December, 1888. —
Boston Medical and Surgical Journal, February Jth, 1889,

Salol in Cystitis. — The results in the treatment of ca-
tarrhal cystitis by salol have been so satisfactory, says Dr. E.
L. Vansant, of Philadelphia, in a contribution to the Medical
Times, February ist, 1889, that it seems proper to draw further
attention to its use in this affection. Having used it in a
number of cases, the results in each one were surprisingly
rapid and beneficial.

The mode of administration followed was the same in each
case ; in pill form and given in five-grain doses every four
hours.

The results from this quantity were so satisfactory that
other sized doses were not tried. Whether one single large
dose will not perform the same work is, he thinks, worthy of
investigation.

Transfusion in Carbonic-oxide Poisoning. — A work-

man who had inhaled the vapor of burning coals was taken to
the Charite lately. All efforts to restore consciousness having
failed. Professor Leyden ordered the injection of two hundred
and fifty cubic centimetres of blood, taken from another
patient, into one of the veins of the right arm. The patient
showed signs of life five hours after the transfusion, then slept

286 Msdiocd JSeocerpt.

for about ten hours, and awoke in excellent spirits. His
further recovery was rapid, and he is now quite well. — Lancrt^
January 5M, 1889.

Cardiac Tonics. — Digitalis still holds its place as the most
powerful heart-tonic which we as yet possess, and the most
permanent in its effects. But there are good reasons for the
zealous efforts made of late years to find some other means of
strengthening the heart's action in cases of failure of compen-
sation.

Strophanthus has been on trial for over two years, and it is
difficult to decide in exactly what cases of cardiac disease it is
preferable to digitalis. Nearly all observers confirm Eraser's
original statements without adding any important new facts.
However, Guttmann maintains that it cannot compare, either
as a heart drug or as a diuretic, with digitalis. On the other
hand, it was used in Bamberger's clinic with success. — Dublin
Journal of Medical Science^ December ^ 1888.

COCOANUT AS A VERMIFUGE. — Professor Paresi, of Athens,
when he was in Abyssinia happened to discover that ordinary
cocoanut possesses vermifuge qualities in a high degree. He
took, one day, a quantity of the juice and pulp and shortly
afterward felt some amount of gastric disturbance, which,
however, passed off in a few hours. Subsequently he had
diarrhoea, and was surprised to find in the motion a complete
taenia, head and all, quite dead.

After returning to Athens, Professor Paresi made a number
of observations which were most satisfactory, the taenia being
always passed and quite dead. In only one case was the head
wanting. He orders the milk and the pulp of one cocoanut
to be taken early in the morning fasting, no purgative or con-
finement to the house being required. — Lancet, August, 1888.

A correspondent of the Tintes^ of India, writes that the
cocoanut has been used as a vermifuge in India for probably
forty generations by the beef -eaters of the country, and is so
well known there as a means of expelling the flat worm, that
he cannot conceive how information of the fact has not reached
England before. When properly prepared and intelligently
administered, so says the writer, the cocoanut is equally efli-

Medical Baeetpt. 287

cacious with male fern oil» kousso, pomegranate root, or tur-
pentine, while it is as pleasant to the palate as they are offen-
sive.— Pliarmaccutical Journal and Transactions^ November 3^,
1888.

The Alkaloids of Cod-liver Oil.— Gautier and Mour-
gues have found in cod-liver oil six toxic leucomaines ; butyla-
mine, hexylamine, amylamine hydro-dimethyl pyridine, asel-
line, and morrhuine.

Aselline is not abundant, and only acts in large doses, pro-
ducing stupor, fatigue, and dyspncea. Three milh'grammes
of the chloro-hydrate killed a green finch in fifteen minutes.

Morrhuine is quite abundant, as a teaspoonful of dark oil
contained two milligrammes. Given to guinea-pigs and to
birds, as a chloro-hydrate, it proved stimulant, diaphoretic,
and especially diuretic, a guinea-pig weighing 250 grammes
having lost 13.5 grammes in two hours, after taking 29 milli-
grammes of the alkaloid hypodermically. — Medical Titnes.

A Medico- LEGAL Question Decided. — On December 30th
last a woman twenty-five years of age was admitted to Braun's
Clinic for the removal of a foreign body from the uterus.

She pretended that she had used an injection in the morn-
ing, and that the canula remained in the vagina. This latter
was found to be empty, but the vaginal portion of the uterus
was softened and painful to the touch. On introducing a
sound into the cavity of the uterus a foreign body was dis-
covered, and after dilating the neck, removed.

It proved to be a small instrument, which she admitted she
was accustomed to use by the advice of a midwife, to swab
out the vagina after sexual intercourse, because she had four
children, and was unwilling to increase her family. To insure
success, a piece of cloth was wound around the instrument and
the parts thoroughly cleansed.

The easier to accomplish this, she placed herself in a squat
position, the buttocks against the heels, pressed down the
diaphragm and firmly contracted the muscles of the abdomen
in order to bring the mouth of the uterus within easy reach of
the instrument.

This case proves that a woman may, herself, introduce a

288 Medical Eccerpt

foreign body into the womb for the purpose of producing
abortion, etc. ; hence its great interest.

Hoffman, of Vienna, has reported two similar cases. — Soc.
de M^d. de Vienne, Janvier ii, 1889; Journal de M^decine de
Paris.

Phenacetin occurs in small slightly grayish white crystals
of a slightly aromatic odor. It is of value as a hypnotic in
neuralgia, cephalgia, migrain, and as a marked antipyretic. It
has not yet caused cardiac depression, and is best given in
doses of 5 to 12 grains in pill or capsule. It causes skin erup-
tions sometimes. — W. Dr, — Pharmaceutical Era.

Naphthaltn occurs in colorless, resplendent, scale-like crys-
tals of a tar-like odor and pungent taste. It is insoluble in
water, sparingly soluble in cold alcohol, readily in hot, or in
hot fatty oils. It is used as a local antiseptic, also in typhoid-
fever and gastro-intestinal catarrhs at all ages in two-grain doses
in powder. It can be advantageously combined with sugar of
milk and ground coffee. Its untoward effects are chiefly skin
eruptions and digestive disturbances. — Ibid.

Oleum Lan^E (copyrighted synonyms Agnine, Lanolin) is
derived from the wool of the sheep. It has been found of
great value as an ointment vehicle. It is quickly absorbed by
the skin, and should not be used in ointments intended for
local purposes. It is of value as a medium to secure endermic
medication in children. Combined with conium it produces
rapidly beneficial effects on rectal ulcers and fistulae. It is an
excellent means of securing mercury absorption in syphilis.
If unmixed with a small percentage of water it causes irrita-
tion of the skin when applied, by absorbing water therefrom.
—Ibid.

Paraldehyde is a colorless fluid of a pungent odor and
*' sickish" taste. It is used as an hypnotic. It is given in 30
to 60 grain doses. It is soluble in cold water (i to 10) and al-
cohol. It often deranges the digestion and produces urticaria.
It is best administered inbrandy orsyrup of orange peel mixed
with water. — Ibid.

THE SANITARIAN

APRIL, 1889.

Number 233.

WATER ANALYSIS.*

By Charles Smart, M.D., Sargeon U. S. A.

When a water is concentrated by evaporation and tested
by chemical reagents the inorganic substances dissolved in it
give notable and well-known reactions. Formerly these min-
eral matters were separated one from the other and weighed ;
and the report of the analysis gave a tabular view of their
quantity and supposed constitution when the various bases-
and acids were recombined on paper in accordance with known
chemical laws. This constituted the formal or scientific anal-
ysis of the water. The sanitary analysis of this period con-
sisted of an endeavor to find out, by some ready method, the
general character and approximate quantity of the dissolved
solids. The organic matter present was known only by its
odor, by the color which it gave to the residue after evapora-
tion, the blackening and loss of weight which the residue suf-
fered on ignition, and by some liquid reactions, as the decolor-
ation of permanganate solution, so indefinite in their indica-
tions as to be in reality little more than interesting laboratory
experiments. But as the progress of sanitary medicine de-
veloped the importance of the obscure organic matter in the
causation of disease, the time which was formerly spent in
formal analyses of the mineral ingredients became devoted to
inquiries into the organic constitution of the water. The*
weight lost by the residue on ignition was investigated, and
the error caused by the dissipation of carbonic acid was recog-
nized and eliminated. The residue was submitted to combus-

* Abstract (by permission from advance sheet) of article contributed to Refer-
ence Handbook of the Medical Sciences : William Wood & Co., New York.

19

290 Water Analysis.

tion by processes which revealed with more or less accuracy
the quantities of carbon, hydrogen-, nitrogen, and oxygen con-
tained in it. Easier methods of approximating to the quantity
of one or other of these elements were suggested and perfected
by patient work in the laboratory. Such, for instance, were
the approximation to the quantity of nitrogen by the estima-
tion of the ammonia produced from it, and the view presented
of the whole ot the elements by the amount of permanganate
of potash required to oxidize them. In a word, the analysis
of a potable water became the analysis of its organic constit-
uents, while the mineral matters, which received so much
attention at the hands of former analysts, came to be consid-
ered only in so far as they gave information concerning these
less known and more dangerous organic substances.

A good deal of feeling was displayed by the authors and
advocates of some of these processes, each contending that
his favorite method was superior, and all that was needful to
enable the operator to give an opinion on the quality of an
•examined water. Certain arbitrary limits of organic impurity
•were assigned within which waters were assumed to be whole-
some or allowable, and beyond which they were condemned
.as unwholesome or dangerous. But since it was asserted that
.instances had occurred where waters which were approved as
.^ure by one mode of analysis had been reported by another
anode as of doubtful or even dangerous quality, there was
fground for suspecting that not one of these processes was, in
all cases, of itself sufficient to warrant a positive opinion as to
ipurity, and still less as to wholesomeness or unwholesomeness.
Jn view of these differences of opinion the writer, before enter-
ing on an extended series of analyses in connection with the
,yellow-fever epidemics of 1878-79, decided that an official
opinion ought not to be given on the quality of the water-
^supply without a careful consideration of all the evidence pro-
<<:urable, and that the sanitary analysis of a water ought to
(Consist not of one process, but of

1. A determination of the total solids, for the purpose of
•ascertaining whether the sample comes within the limits of
:potability, with incidental observations on the general char*
^acter of the inorganic salts.

2. The loss suffered by the total solids on ignition, as afford-

Water Analysis. 291

ing a view of the organic matter in totOy and possibly a further
insight into the character of the sah'ne constituents.

3. An estimation of the quantity of oxygen necessary to oxi-
dise the oxidizable matters present in the water, as affording a
view, when taken in connection with other experiments, of
the organic matter on its carbonaceous side.

4. An estimation of the amount of ammonia which may be
obtained as the last stage of the destruction of the organic
matter present^ as giving a view of thcf said organic matter
from its nitrogenous side.

5. 6, and 7. Determinations of the ammonia, nitrous and
nitric acids, as indicating the amount of organic noatter which
may have been present in the water at a period more or less
remote^ and defining the period, wheo viewed in conjunction
with other considerations.

8. A determination of the chlorine present, as bearing on
sewage-contamination.

9. The examination of the sediment by the microscope^ as
yielding corroborative evidence as to grade and kind of
impurity.

10. A study of the source and surroundings of the water-
supply in connection with the results of the investigations
above enumerated, to furnish a proper appraisement of the
value of the said results.

There are, in addition, some preliminary points which re-
quire attention, such as the characters presented by the water
to the senses of sight, taste, and smell. The sample may be
turbid from a variety of suspended matters, and such a water
is always an impure water, but not necessarily an unwhole-
some one. The words pure and wholesome are occasionally
used without discrimination. The first is of chemical appli-
cation, and implies absence of all substances foreign to the
substance in question. The second is of sanitary application,
and implies the inability of any of the substances in the sub-
stance in question to produce evil effects on the human system.
A pure water may not be as wholesome as one that is chemi-
cally impure. Distilled or condensed water disagrees with
many people on account of its flat taste and the feeling of
oppression which it causes in the stomach. On the other
hand, a spring water which is notably impure from the pres-

292 Water Analysis.

ence of certain inorganic salts may be unobjectionable on the
score of yi^holesomeness.

A water» although it may be transparent and colorless, is
not of necessity either a pure or a wholesome water, for it
may contain saline, earthy, or organic substances which are
harmful. Graveyard-waters, which are noted for their clear
and sparkling appearance, are largely charged with nitrates,
and may not be free from suspicion of evil effects. Turbidity
may foe owing to minute particles of inorganic matter, as
sand, clay, soot, etc., to the debris of animal or vegetable
matter, or to the presence of microscopic forms ; it varies
from ^mple loss of lustre through all degrees of haziness and
cloudiness to well-defined turbidity from particles visible to
the unaided eye. Occasionally the question arises as to the
propriety of permitting a turbid water to settle before exam-
ining it. This should not be done in ordinary analyses. The
water-sample furnished for examination should represent the
supply as used, and should be examined without any prelim-
inary purification by sedimentation.

The presence of minute particles of suspended matter often-
times gives a color to a really colorless water. Thus rain-
waters may be darkened by minute carbon particles. But
color may be due to matters in solution. Dissolved vegetable
matters frequently give a yellow or dark tint to the water.
Some observers determine the color by looking down at a well-
lighted white surface through a long tube filled with the water.
Pure waters are generally bluish.

Odor, if faintly present, may be detected by shaking a
bottle half-filled with the water and testing by the sense of
smell the air which has been thus washed with the water.
Some well-waters which have lain in contact with a stratum of
clay have an unpleasant odor and taste, due to a decomposi-
tion of sulphides, but no injurious effects have been attributed
to their use ; and if the well is so frequently used that the
water is not permitted to stagnate, the odor ceases to taint
the supply.

Ready methods of determining the quality of a water are in
great request. A reagent which will strike a brilliant color in
an unwholesome water, while it leaves a wholesome water
clear and colorless, forms one of the unrealized dreams of the

Water Analysis. 293

amateur sanitarian. Hopes of this kind originated in the
decoloration of permanganate solutions by organic matter.
The ready methods appear from time to time in sanitary and
family journals, but none of them has the scientific value
which attaches to the easily performed experiment of evapo-
rating a small quantity of the water in a porcelain or platinum
capsule and igniting the residue. If there are no fumes nor
odor, and the slight darkening of the color of the film is im-
mediately dissipated^ the water may be approved as whole-
some with as much assurance as after a thorough investigation
by all the processes. On the other hand, if fumes are evolved,
and especially if these are nitrous or manifestly of animal
origin, while the carbon film is thick and oxidized with difHr
culty, the water may be condemned as likely to prove un-
wholesome, for certainly a more extended examination will
only give further demonstration of its undesirable qualities.
But between these extremes, comparative organic purity on
the one hand and great organic impurity on the other, in-
stances constantly occur where all the light which the proc-
esses of organic analysis are capable of throwing upon the
quantity and quality of the organic matter is needful to the
formation of an authoritative opinion.

In such cases, instead of igniting the organic residue in this
primitive manner, its combustion is effected with all the pre-
cautions which experience has suggested for the avoidance of
error, and the carbonic acid, nitrogen, and nitric oxide evolved
are collected and measured for the quantitative determination
of the carbon and nitrogen respectively. This constitutes the
process of Frankland and Armstrong, In it a certain quantity
of the water, depending on the probable amount of impurity
present, is evaporated to dryness. To prevent contamination
by atmospheric dust during the continuance of the slow evap-
oration, the capsule containing the water is covered by a bell-
glass which rests in a gutter, to convey away the condensed
moisture ; provision is made for the automatic feeding of the
capsule until the whole charge of water has been evaporated.
The ammonia present in the water is fixed, and nitrogen-salts
are destroyed by the addition of sulphurous acid. But as
there is, nevertheless, a loss of ammonia proportioned to its
total amount, its quantity has to be determined by a previous

294 Water Analysis.

experiment, that the necessary correction for this loss may be
applied when the process is finished ; and any errors in the
determination of the ammonia will be felt in the determination
of the organic nitrogen in the residue. The dry residue is
mixed with oxide of copper, and transferred to a combustion-
tube which is attached by an air-tight joint to a Sprengel
pump. After the air has been exhausted from the tube heat
is applied, and the gases evolved are withdrawn by the pump
and collected over mercury. They are then transferred to an
accurately graduated measuring apparatus, where the loss of
volume, after the introduction of a little potassic hydrate, indi-
cates quantitatively the carbonic acid yielded by the carbon of
the organic matter. Pyrogallic acid is then added to absorb
any oxygen which may have been liberated from the copper
oxide. If oxygen was present, the residual gas is nitrogen.
But in the absence of oxygen a few bubbles of this gas are
introduced to peroxidize any nitric oxide present, the resulting
peroxide being removed by the pyrogallate of potash ; after
which the nitrogen is measured. This nitrogen represents the
nitrogen of the organic matter and of the ammonia present in
the water, minus that of the ammonia lost during the evapo-
ration and plus that of organic matter adventitiously introduced
during the experiment. To determine this latter error, the
operator has to make several experiments on distilled water.
In Frankland's laboratory the control experiment on one litre
of pure water gives .05 milligramme of nitrogen, or .005 part
per 100,000 of the water.

The precautions taken in this process to prevent atmospheric
contact during the evaporation is an acknowledgment of the
liability to errors from this cause. It is claimed by some that
the evaporation of a water to dryness, without loss of the
organic elements, is an impossibility, especially in the pres-
ence of sulphuric acid oxidized from the sulphurous by the
destruction of nitrates. Many instances have occurred, to the
knowledge of the writer, in which volatile organic matter is
present in the water — in such cases the analysis of the residue
is of no value ; they will be more definitely specified in dis-
cussing the albuminoid-ammonia process.

The corrections applied to the nitrogen in this combustion-
process may in some instances be greater than the total of the

Water Analysis. 295

organic nitrogen present. Thus, in the first analysis given in
Dr. Frankland's book, where the nitrogen amounts to .007
part and the ammonia to .029 part, the correction for loss of
the latter during the evaporation is equal to .006 part of
nitrogen, while that for nitrogen adventitiously introduced is
.005 part, making .013 part of correction for error in dealing
with .007 part of material. Dr. Mallet concludes, with regard
to this process as conducted by Frankland, that it cannot be
considered as determining the carbon and nitrogen of organic
matter in water in a sense to justify the claim of absolute value
for its results. It is but a method of approximation involving
sundry errors, and in part a balance of errors. But even
allowing that it gives absolutely accurate results, the informa-
tion conveyed concerning the organic matter is of the most
general character, consisting only of the amounts of carbon
and of nitrogen contained in it. Of course, if a larger quantity
of each of these elements is obtained from the residue, the
water which it represents must have been polluted with a
larger quantity of organic matter, while a specimen which
yields low results may generally be accepted as correspond-
ingly pure.

. . . The analytical results may be similar, whether the
organic substances are harmless or hurtful. Inasmuch, how-
ever, as animal matters are conceded to be more dangerous
than vegetable substances, on account of their greater liability
to be associated with the germs or poisons of specific diseases,
it is claimed that a consideration of the ratio of carbon to
nitrogen will intimate the origin of the organic matter, and in
this way convey some idea of its possible qualities. The nitro-
genous proximate principles of animal life do not differ in
composition materially from those of the vegetable kingdom,
but the latter are usually associated with carbonaceous sub-
stances which modify the results obtained by the combustion.
Frankland says that if the ratio of carbon to nitrogen be as
low as 3 : I the organic matter is of animal origin, while if it
be as high as 8 : i it is chiefly, if not exclusively, of vegetable
origin. But in the majority of potable waters the ratio falls
between these extremes, and its value as an indication of
origin is lost. There are perhaps few natural waters polluted
solely by animal matters ; and the changes which take place

296 Watw Analysis.'

in 'decomposing animal or vegetable matters by which the ele-
ments are converted into carbonic acid and ammonia may alter
their ratio.

The care, time, manipulative tact, and constant practice
needful to secure trustworthy results by this method have led
analysts to seek for less difficult processes whicb will indicate
the relative position of waters on a scale of organic impurity.
One of these, known as the permanganate process^ has been
strongly advocated by Dr. Tidy. The organic. matter as it
exists in the water is oxidized by the permanganate, which
thereby loses its brilliant color, and the quantity of this salt
thus discolored gives a knowledge of the amount of oxygen
required for the oxidation of the organic and other oxidizable
matters present in the water. Tidy's process consists in
acidulating two given measures of the water-sample with sul-
phuric acid, adding an excess of the permanganate solution
and permitting the oxidation to go on without the application
of artificial heat, in one of the measures for one hour, and in
the other measure for three hours. At the expiration of the
proper period in each case, potassium iodide is added to the
specimen. The permanganate which has remained undecom-
posed by the organic matter liberates a proportionate quantity
of iodine from the iodide, the amount of which is determined
by a solution of sodium hyposulphite and the starch-test for
free iodine. A blank experiment on distilled water must be
conducted at the same time to ascertain the strength of the
hyposulphite solution. The sodium salt indicates the iodine,
the iodine the excess of permanganate, and when this is de-
ducted from the total of the permanganate solution originally
added to the water, the oxygen given up by that portion of it
which has been discharged by the organic matter may be cal-
culated. Dr. Tidy assumes that practically the whole of the
organic matter of the water will be oxidized in the experiment
which is continued for three hours, while the result of that
which is concluded at the end of one hour will give informa-
tion of value in determining the nature of the organic matter,
inasmuch as animal matters and those which are of a putres-
cent character are conceived to be more readily acted upon
than vegetable or non-putrescent substances. But Professor
Mallet has shown that the largest amount of oxygen consumed

Water Anah/sis. 297

in three hours by the organic matter of a series of waters ex-
amined with reference to this point was only seventy-five per
cent of that which was consumed by a more continued action,
and that the average amount used in the three hours consti-
tuted but fifty-seven per cent. His experiments also indicate
that while there is little difference in the rapidity of the oxi-
dation whether the organic matters are of animal or vegetable
origin, putrescent or non -putrescent, the proportionate con-
sumption of oxygen within the first hour is rather greater for
waters containing vegetable than for those containing animal
matters. But although the combustion effected by the per-
manganate' is usually imperfect and the oxygen only an ap-
proximate measure of the organic substances, waters contain-
ing the same kind of organic matter may be as accurately
graded by the use of this process as by the less readily applic-
able method of combustion. Dr. Frankland, in making
periodical examinations of water from the same source, found
a remarkable agreement between the results of the two proc-
esses ; and, in conjunction with Dr. Tidy, adopted the follow-
ing scale of classification as parallel to that formed for the
results of the combustion process.

Upland Surface-water. — Class I. Water of great organic
purity, absorbing from permanganate of potash not more than
O. I part of oxygen per 100,000 parts of water.

Class II. Water of medium purity, absorbing from o.i to
0.3 of oxygen per 100,000 parts of water.

Class III. Water of doubtful purity, absorbing from 0.3 to
0.4 parts per 100,000.

Class IV. Impure water, absorbing more than 0.4 part per
100,000.

Water other than Upland Surface. — Class I. Water of great
organic purity^ absorbing from permanganate of potash not
more than 0.05 part of oxygen per 100,000 parts of water.

Class II. Water of medium purity, absorbing from 0.05 to
0.15 part of oxygen per 100,000.

Class III. Water of doubtful purity, absorbing from 0.15 to
0.2 part of oxygen per 100,000.

Class IV. Impure water, absorbing more than 0.2 part of
oxygen per 100,000.

The process used by the writer is that of Kubel, in which

298 Water Analysis.

the oxidation is conducted at the boiling tennperature and the
excess of permanganate ascertained by the aid of an oxalic-
acid solution. The oxidation is carried further by this method
than by the action at ordinary temperatures ; but if volatile
organic matter is present the results are not reliable. There
is required a permanganate solution containing o. i milligramme
of available oxygen in each cubic centimetre. Were the salt
always chemically pure, the required solution would be obtained
by dissolving .395 gram in a litre of water ; but as it is not re-
liable in this respect, it is better to dissolve a few centigrammes
more than the theoretical weight, determine the exact strength
by means of metallic iron in sulphuric-acid solution, and dilute
to the required strength. The oxalic-acid solution, when con-
taining .790 gram of acid per litre, will decompose the per-
manganate solution volume for volume ; but it is not needful
that the two shall correspond exactl}^, as a blank experiment
on perfectly pure water has to be performed to determine the
relation between them. To insure purity on the part of the
water used in this standardizing experiment, distilled water
should be treated with permanganate and redistilled. Two
hundred cubic centimetres of this pure water are put in a flask
capable of holding nearly double the quantity, to which ten
cubic centimetres of a I : 3 dilution of sulphuric acid and four,
five, or six cubic centimetres of the permanganate test-liquid
are added. The contents of the flask are then boiled for ten
minutes, during which the brilliant color remains unaffected.
The flask is removed from the gas-flame, and ten centimetres
of the oxalic solution are added. Some effervescence takes
place, and the color of the liquid is discharged. Permanganate
is then dropped from a burette until a faint rose-tinge pervades
the liquid. The quantity of permanganate destroyed is a
measure of all the decomposing influences of the experiment
as performed on a water which is itself passive. The oxalic
acid is the principal of these influences, but there may be
others, as impurities in the sulphuric acid, the effects of the
boiling, etc. If, therefore, the relation between the solutions
is expressed as 10 c.c. oxalic = 10.5 c.c. permanganate, it is
understood that all decolorizing causes, as well as the drop or
two necessary to give the tinge of color indicative of the con-
clusion of the experiment, are included in the expenditure of

WaUr Anafyni. 299

10.5 c.c. If the experiment is repeated on an impure water,
while all the conditions remain as before, saving the different
character of the water, any increase in the quantity of per-
manganate required to produce a permanent tinge of color
after the boiling will be due to the intruded influence of the
impurity. If the impure water decolorize 16.5 c.c. of per
manganate when experimented on in this way, and 10 c.c.
oxalic = 10.5 permanganate, 4 c.c. of the test-solution will
have been destroyed by the organic matter of the water ; or,
in other words, .4 milligramme of oxygen will have been neces-
sary to its oxidation.

But potable waters submitted to examination by this test
sometimes contain other matters which act upon the per-
manganate, as nitrous acid, iron, and hydrogen sulphide. If
these be present their quantity must be ascertained and allow*
ance made for their influence, or, as suggested by De Chau-
mont, they may be dissipated or oxidized by boiling for twenty
minutes with sulphuric acid, which treatment does not affect
the organic matter of the water.

The quantity of oxygen which the organic impurity of a
water requires for its destruction by this method gives no inti-
mation as to the character of the organic matter. Indeed,
there are some substances, as urea, which are not affected by
the permanganate. An impure water may, therefore, by this
test be pronounced pure, while, on the other hand, a water
containing harmless carbon-particles, the product of fuel-com-
bustion, may stand high on the scale of impurity. It is only
when the permanganate results are considered in connection
with other testimony that their value can be determined.

Practically, the amount of permanganate destroyed is pro-
portioned to the blackening of the residue on ignition. Vary-
ing quantities of oxygen may be regarded as giving expression
to varying shades of blackening during combustion. A high
result indicates impurity ; but . if there is performed at the
same time on the water-sample an experiment which will give
an approximative view of the nitrogen contained in it, and if
this nitrogen is small as compared with the oxygen results, the
organic matter may be considered as of vegetable origin as
surely as if an 8 : i result by Frankland's process had author-
ized the opinion ; while, if the nitrogen is relatively large.

300 WcOer Analysis.

an animal derivation for the matter is as certainly indi-
cated.

The process by which the nitrogen is generally estimated is
that known as Wanklyn^s^ or the albuminotd'ammonia process.
In it the organic matter of the water is decomposed at the
boih'ng temperature by permanganate in the presence of an
alkali, and its nitrogen, evolved as ammonia, the so-called
organic or albuminoid ammonia, is collected and estimated.
Most natural waters contain minute quantities of free ammonia
which must be removed from them by boiling before this ex-
periment on the organic nitrogen is performed ; but as the free
ammonia, originating usually in the putrefactive destruction
of nitrogenous organic matter, gives in many instances impor-
tant testimony concerning the quality of a water, its quantity
is always determined in the process of preparing the water for
the experiment on its organic matter. Half a litre of the
water is placed in a retort capable of holding as much again.
A few cubic centimetres of a solution of recently ignited
sodium carbonate is added to the water, which is then dis-
tilled. The condenser, attached to the retort by clean black-
rubber connections, should be large and supplied with a con*
stant current of tap-water. The distillate is collected in cy-
lindrical glasses about i8 centimetres (7 inches) in height and
2.3 centimetres (.9 inch) in diameter. They contain about
70 cubic centimetres and have a mark at the fifty cubic centi-
metre level. When the distillate reaches this level the glass
is replaced by a second, and while the distillation proceeds the
ammonia which may be present in the first glass is estimated
by the Nessler reagent. This is made by dissolving 35 grams
of potassium iodide and 16 grams of mercuric chloride, each
in a small quantity of water, adding the mercuric solution to
that of the iodide until a permanent scarlet tinge shows the
presence of a slight excess. A solution of 160 grams of potas-
sium hydrate (or of 120 grams of sodium hydrate, the alkalinity
of which is relatively greater) in 800 cubic centimetres of water
is added to the mixture, which is then made up to one litre by
the addition of water. A few drops of a cold saturated solu-
tion of mercuric chloride is shaken up with the prepared liquid,
which, after becoming clear by sedimentation, is ready for
use. A small quantity of this reagent dropped into water
containing ammonia causes a coloration, the shado of which is

Water Analyms. 301

proportioned to the amount of ammonia present : .0025 milli-
gram of ammonia in 50 cubic centimetres of water gives a rec-
ognizable coloration, and o. i milligramme a deep sherry-brown
color, while notably larger amounts occasion a turbidity. But
to estimate accurately the quantity of ammonia present in the
50 cubic centimetres of the distillate, the color produced in it
by adding two cubic centimetres of the Nessler reagent is
compared with the color produced by the same means in sim-
ilar glasses containing known quantities of ammonia. Thus
the color of the ammoniacal distillate may be presented for
comparison with a series of test-glasses containing .01, .03,
.05, .07, .09 milligramme of ammonia, each in 50 cubic centi-
metres of ammonia-free water, and if no perfect agreement is
found with any of these standard tubes a fresh standard may
be prepared containing the quantity of ammonia which this
first comparison has indicated as likely to be present. By the
time this comparison is made the second iifty-cubic-centimetre
measure, or Nessler glass, has been filled by the progress of
the distillation and is ready for estimation in like manner.
The distillation is continued until a measure of 50 cubic centi-
metres is obtained which shows perfect freedom from ammonia
by giving no coloration with the reagent ; and when this
occurs the residual water in the retort, representing the orig-
inal half-litre, may be considered free from preformed am-
monia and ready for the experiment on its organic matter.
The first measure of the distillate contains the largest quantity
of ammonia, and it is a judicious precaution, lest it be so
strongly ammoniated as to cause a turbidity with the Nessler
solution, which would spoil the experiment by rendering
color-comparisons impossible, to wait for the second or third
measure, and decide from the quantity found in one or other
of these whether the first measure should be treated as a whole
or definitely diluted before attempting the colorimetric esti-
mation. The color struck by the Nessler reagent in ammonia-
cal waters requires from three to five minutes for its full de-
velopment. After this it remains unchanged for many hours.
The amounts of free ammonia found in each of the measures
distilled are added together and divided by 5, to express the
results in parts of 100,000 of the water, or multiplied by 2 to
express parts per million.
The permanganate solution for the destruction of the organic

302 Water Analyris.

matter must be prepared with care to insure its freedom from
ammonia, which would vitiate the experimental results. To
three-quarters of a litre of distilled water, which gives no am-
moniacal coloration with the Nessler reagent in a test-glass,
there are added one hundred grams of caustic potash and four
grams of permanganate, and the liquid is distilled from a retort
until reduced to one-half litre ; the last fifty cubic centimetres
of the distillate will be free from ammonia, and will thereby
indicate the freedom of the alkaline solution from ammoniacal
taint. It has been objected to Wanklyn's process that the
permanganate solution may contain traces of ammonia, but if
it does so the fault lies with the operator, not with the process.

To the residual water in the retort, from which the free
ammonia has been distilled and estimated, a measure of fifty
cubic centimetres of this alkaline permanganate solution is
added, and the distillation is continued as before, the distillate
being collected in the fifty-cubic-centimetre Nessler glasses,
and the ammonia therein estimated by colorimetry, testing the
second or third measure of the distillate, in the first instance,
in the case of an unknown or suspicious water, lest the am*
monia in the first measure should be so great as to occasion a
turbidity with the Nessler reagent. The process is continued
until a measure is obtained which is free from ammonia, or
until no more can be distilled without danger of fracturing the
retort.

The action of the permanganate in this process is allowed
by Wanklyn to be imperfect. The whole of the nitrogen of
the organic matter is not converted into ammonia ; but he
claims that as the albuminoids in water are of similar consti-
tution, and yield up a definite quantity of their nitrogen, the
results of the process in different instances are susceptible of
comparison, and enable the operator to rate a water on an
arbitrary scale of nitrogenous impurity. This scale he formu-
lates thus :

'' Drinking-water falls into three classes, according to the
degree of organic purity, as follows :

** Class I. — Water of extraordinary organic purity, yielding
from .00 up to .05 part of albuminoid ammonia per million.
This class comprises the most carefully prepared distilled
water and highly filtered waters, both natural {i.e. ^ deep-spring

Wat&r Analysis. 308

waters) and artificial (i,e.^ such water as has passed through a
silicated-carbon filter in good working order). Occasionally, a
river-water, in its unaltered condition, falls into this class.
Water of this class cannot be objected to organically.

** Class IL — Comprehends the general drinking-waters of
this country. It gives from .05 to .10 part of albuminoid am-
monia per million. I believe that any water falling into this
class is safe organically.

** Class III. — Comprehends the dirty waters, and is char-
acterized by yielding more than o.io part of albuminoid
ammonia per million."

But when the albuminoid ammonia amounts to .05 part p^r
million, he brings in the free ammonia as an element in the
detennination of quality, and is " inclined to regard with some
suspicion a water yielding a considerable quantity of free am-
monia along with more than 0.5 part of albuminoid ammonia
per million. Free ammonia, however, being absent or very
small, a water should not be condemned unless the albuminoid
ammonia reaches something like o. 10 per million. Albu-
minoid ammonia above o. 10 per million begins to be a very sus-
picious sign ; and over 0.15, it ought to condemn a water
absolutely."

Most rain-waters in the United States, collected in clean
dishes as they fall from the clouds, would be condemned by
Wanklyn's dictum. Most of our river-waters which are in
daily use would be condemned on similar grounds. In the
experience of the writer, while Wanklyn's limit of allowable
impurity may be accepted in the case of wells where the
danger of infiltration from privies is great, it should be ex-
tended to 0.20 in the case of our river and other surface-waters,
as it is not until the albuminoid ammonia reaches or exceeds
this quantity that a taint becomes developed in the water dur-
ing warm weather, and that diarrhoea, dysentery, or febrile
conditions are connected with its use.

But while the total amount of nitrogen obtained from the
organic matter of a water is the main object of the experiment,
a certain value attaches to the manner in which the ammonia
is evolved. Wanklyn observed that vegetable matter gave up
its nitrogen as ammonia slowly. The writer found, by ex-
amining his laboratory notes with reference to this point, that

304 Water Analysis.

in many instances where the organic matter was undoubtedly
of vegetable origin the albuminoid ammonia diminished by
one half in successive distillates of 50 c.c. Thus water from
the swamps near New Orleans yielded, in the first measure
distilled, .24 milligr. ; in the second, .12 milligr. ; in the
third, .06 milligr. ; and in the fourth, .03 milligr., equalling a
total of .45 milligr. in the 500 c.c. of the swamp-water dis-
tilled, or .90 part per million. But, from many experiments
on pure animal and vegetable albuminoids, it was found that
their tendency to change, or putrescent character, rather than
their derivation, influenced the manner of the evolution. A
gradual disengagement, as in the case of the swamp-water
given above, indicates the presence of organic matter, whether
animal or vegetable, in a fresh, or comparatively fresh, condi-
tion, while a more rapid evolution indicates that the organic
matter is in a putrescent or decomposing condition.

It has been suggested, as an objection to the albuminoid-
ammonia process, that after the distillation has been con-
cluded by the withdrawal of a measure which shows freedom
from ammonia, more ammonia may be obtained from the con-
tents of the retort on again resuming the distillation after
some hours. Many experiments were made by the writer,
not only on natural waters the nitrogen of which is usually
readily given up, but on artificial solutions of organic matter,
and in no instance was ammonia recovered from the retort,
even after the lapse of days, when the original experiment had
been carried far enough to show that the disengagement of
ammonia had ceased. The permanganate acts slowly on some
organic matters, and under the conditions of Wanklyn's ex-
periment, with only a certain quantity of liquid in the retort,
it may be impossible to carry the process far enough to show
the cessation of the evolution. The experiment may have to
be concluded by the exhaustion of the water in the retort
before all the organic matter has been decomposed, as in the
swamp-water above mentioned, and in such a case a renewal
of the distillation, with an addition of ammonia-free water,
would necessarily result in the evolution of more ammonia.
In such cases the time which is occupied in the distillation
affects the results obtained. Slow boiling with a lowered
flame will give more ammonia than a rapid ebullition, which

The Use of OUio StiU the Waves. 805

brings the experiment to a speedy termination by the exhaus-
tion of the water in the retort.

In view of these facts. Professor Mallet, in summing up the
results of an experimental investigation into the comparative
merits of the various processes by which the organic matter of
a water may be estimated, says of the albuminoid process,
that the value of its results depends more upon watching the
progress and rate of evolution of the ammonia than upon de-
termining its total amount. But he found a good deal of gen-
eral similarity between the figures for albuminoid ammonia
and those for organic nitrogen (by Frankland's process), al-
though there were frequent discrepancies of varying extent,
such as prevent the one. being taken as an accurate measure o£
the other.

{To bt continued^

The Use of Oil to Still the Waves.—** In June, 1885,
the British ship Slivemore took fire and had to be abandoned
when eight hundred miles northeast of the Seychelle Islands,
Indian Ocean. The people took to the boats and made for
Seychelle Islands. The third day after leaving the vessel a
cyclone came up, and no one believed that the boajts would
live through it. Before they left the ship the boats had been
supplied with oil for just such an emergency. Each boat got
out a drag made of spars and oars lashed together, for what is
known as a sea-anchor. Oakuiji saturated with parafline was
stuffed in long stockings hung over the bows of the boats.
Before the oil was used the boats had been several times-
nearly filled with water and the occupants had to bail for their
lives ; but when oil was applied no further trouble was experi-
enced. An oil-slick formed around the boats, which rode in^
perfect safety on tremendous swells which took the place of
the previously breaking seas. Little if any water came oveiv
the sides of the boats, and the occupants could lie down and
sleep. The boats eventually reached the islands, but every
soul would have perished except for the forethought of Cap-
tain Conby, the captain of the Slivemore." — Lieutenant Wl
//"• Beehler^ in the March Century.
20

806 HunUfig Ydhw-Fever Oerms.

HUNTING YELLOW-FEVER GERMS.

AN ADDRESS DELIVERED BY SPECIAL INVITATION BEFORE
THE QUARANTINE CONFERENCE, AT MONTGOMERY, ALA.,
MARCH 5TH, 1889.

By Gkokge M. Stkrnberg, M.D., Surgeon U. S. A.

Gentlemen : It would have been far more satisfactory to
you and to me if the subject of my address this evening could
have been announced as ** the Yellow-Fever Germ.** I need
hardly say that nothing would have given me greater pleasure
than, in the presence of the experts in the clinical and prophy-
lactic management of yellow-fever here assembled, to exhibit
microscopic preparations and pure cultures of the specific
infectious agent which I have been so long in search of. I
•shall show you presently upon the screen photo-micrographs
'of a variety of micro-organisms which I have encountered in
^the course of my researches, some of which are hitherto unde-
-scribed species, and among them some which have specially
^engaged my attention as possible yellow-fever germs. I shall
also show you cultures and photo^micrographs of the micro-
coccus presented to me by Dr. Domingos Friere, of Brazil, as
his microbe of yellow-fever ; of the tetragenus febris flavae
of Dr. Carlos Finlay, of Havana ; and of the bacillus of Dr.
Paul Gibier, of Paris.

But I must announce to you, in advance, that there is no
satisfactory evidence that any one of these micro-organisms is
the veritable infectious agent in the disease under consider-
.ation.

I at first hesitated to accept the invitation extended to me
^o address you on this occasion, inasmuch as my investigations
ihave not yet led to any definite result, and as they are still in
^progress and will be continued in Havana during the present
summer. But the importance of the occasion and the solicita-
tion of my good friend Dr. Cochran, the efficient Health
Officer of the State of Alabama, have induced me to come

HttfUing YeUoto-Fever Chrms. 807

here for the purpose of making a brief statement relating to
the present status of the investigation with which I am charged,
and especially for the purpose of demonstrating to you the
methods of research employed by bacteriologists in investiga-
tions of this nature.

I may say before going any further, that my faith in a living
infectious agent as the specific cause of this disease is by no
means diminished by my failure thus far to demonstrate the
exact form and nature of this hypothetical "germ." The
present state of knowledge with reference to the etiology of
infectious diseases in general, and well-known facts relating
to the origin and spread of yellow-fever epidemics, fully justify
such a belief. The it priori grounds for such faith I stated
as long ago as 1873, in a paper published in the American
Journal of the Medical Sciences (July, 1873) ; and the progress
of knowledge since that date has all been in the direction of
supporting this h priori reasoning. But yellow-fever is by no
means the only infectious disease in which satisfactory evi-
dence of the existence of a living infectious agent is still want-
ing. In the eruptive fevers generally no demonstration has
been made of the specific etiologcal agent — at least none
which has been accepted by competent pathologists and bac-
teriologists. Again, in the infectious disease of cattle known
as pleuro-pneumonia, notwithstanding very extended re-
searches by competent investigators in various parts of the
world, no satisfactory demonstration of the germ has been
made. The same is true of hydrophobia, in which disease we
are able to say with confidence the infectious agent is present
in the brain and spinal cord of animals which succumb to
rabies ; this infectious agent is destroyed by a temperature
which is fatal to known pathogenic micro-organisms (65^ C),
and by various germicide agents, yet all efforts to cultivate it
or to demonstrate its presence in the infectious material by
staining processes and microscopical examination have thus
far been unsuccessful.

You are aware that my first effort to solve the etiology of
yellow- fever was made ten years ago. As a member of the
Havana Yellow-fever Commission of the National Board of
Health, I had an opportunity to make researches which, in
advance of the effort, I fondly hoped might lead to demonstra-

808 Hwnting Tdlow-Fever Germs.

tion alike creditable to American science and useful as a basis
for preventive and curative measures in this pestilential malady,
which has destroyed the lives of so many of our fellow-citizens,
and has so largely interfered with the material progress of cer-
tain sections of the United States. I knew, from personal
experience, the malignant nature of the disease, and the futility
of the various modes of treatment which had been resorted to
in the effort to combat it. It was, therefore, with the deepest
interest as well as with strong hopes of success, that I went to
an endemic focus of the disease to search for the yellow-fever
germ. The recent (1873) demonstration of the spirillum of
relapsing fever in the blood of patients suffering from this dis-
ease, and the recognized facts relating to the etiology of
anthrax, considered in connection with the current notions
relating to the pathology of yellow-fever, led me to hope that
the discovery would prove an easy one. I was familiar with
the most approved methods of mounting and staining micro-
organisms, and was provided with the best high-power objec-
tives that could be procured, the one-twelfth and one-eigh-
jteenth homogeneous oil immersion objectives of Karl Zeiss,
of Jena, Germany. Not only did I feel that I was equipped
for the recognition of any micro-organism which might prove
to be present in the blood, but I was prepared to photograph
it, and thus to show to others what I might see in blood drawn
irom the circulation of yellow-fever patients. You know the
result of this investigation ; " ninety-eight specimens from
forty-one undoubted cases of yellow-fever were carefully
studied, and one hundred and five photographic negatives
were made, which showed satisfactorily everything demonstra-
ble by the microscope." But no micro-organism was discov-
ered. I shall presently show you upon the screen a photo-
micrograph of yellow-fever blood, made in Havana at the time
mentioned, so that you may judge of the performance of my
Zeiss one-eighteenth inch objective, and have ocular evidence
that no micro-organism demonstrable by this magnificent lens
was present in it. I may say here that my culture experi-
ments, made in Havana last spring, in which blood taken from
one of the cavities of the heart, as soon as possible after death,
was introduced into various nutritive media, gave a like nega-
tive result.

Hv/rUmg YeUow-Fever Germs. 309

Out of ten cases in which I made autopsies, in the military
hospital at Havana, a development of micro-organisms oc-
curred in two only. In the exceptional cases I obtained a
bacillus which subsequent researches showed to be identical
with a bacillus constantly found in the alimentary canal of
healthy persons — the bacterium coli commune of Escherich.

The absence of micro-organisms from blood drawn from the
finger during life, or from the heart after death, cannot, how-
ever, be accepted as evidence that there are no parasitic organ-
isms anywhere in the tissues. The bacillus of typhoid-fever,
for example, is rarely found in the circulating fluid, although
it must be transported in the blood current to the various
organs in which foci of growth are found which contain numer-
ous bacilli. Such foci are especially abundant in the spleen,
but even in this organ many thin sections may be made before
a single focus of development is encountered.

Having failed to find the yellow*fever germ in the blood,
we may still admit that, as in typhoid, it is perhaps only to be
found in the organs principally involved in the morbid process.
This reasoning has led me to give special attention to an ex-
amination of the liver and kidney, both by the culture method
and by the examination of thin sections. Both methods have
given me positive results, so far as the occasional presence of
micro-organisms is concerned, but both are in accord in failing
to demonstrate the constant presence of any particular organ-
ism. In my culture experiments, made in Havana last year,
the micro-organism most frequently encountered was my bacil-
lus a^ already referred to as found in two out of ten cases in
cultures from blood drawn from the heart. Naturally, I have
given much attention to this bacillus, and it was only after an
extended series of comparative experiments that I gave up the
hope that it might be concerned in the etiology of the disease
under consideration. These comparative experiments forced
me to the conclusion that this is the same bacillus as was
found by Emmerich in cholera cadavers at Naples, and that it
corresponds with the bacterium coli commune of Escherich.

In my researches by the method of staining thin sections of
the tissues hardened in alcohol, I have encountered several
different micro-organisms ; but no one of these has been found
in a series of cases. One, the bacillus of Lacerda and Babes,

310 Hunting Ydtow-F&oer Oerms.

I have found only in material brought from Dr. Lacerda's
laboratory in Brazil, and in two only out of nine cases repre-
sented by material from this source. In one of my Havana
cases, in which the material was collected by my friend, Dr.
Burgess, in 1887, a long bacillus was found in the kidney, for
the most part in the glomeruli. In a case in which I made the
autopsy in Havana last spring a micrococcus, grouped in fours,
was found in the kidney.

Evidently, if any one of these micro-organisms was found in
a considerable series of cases, the fact would be decidedly
significant, and would afford presumptive evidence that the
parasitic organism found bore some relation to the morbid
process. But, even if one and the same micro-organism was
found in every case, the final proof of its etiological import
would depend upon its isolation in pure cultures, and the pro-
duction of the characteristic phenomena of the disease in one
of the lower animals, or, in the absence of a susceptible
animal, in man himself.

The method of cultivation is by far the most reliable for the
demonstration of micro- organisms which will grow in our cul-
ture media, for isolated cocci or bacilli might easily escape
observation when present in small numbers but would serve to
start a culture. Thus the bacillus of typhoid-fever, which, as
stated, is not as a rule found in the blood of the general circu-
lation, and is only found in the spleen in scattered clumps,
may be obtained from this organ in pure cultures, almost with-
out fail, by introducing a small quantity of splenic pulp into a
suitable nutritive medium.

Moreover, this method enables us to differentiate micro-
organisms which look alike, and which by microscopic exami-
nation alone it would be impossible to distinguish one from
another. This is a fact now well recognized by bacteriologists,
but not generally appreciated by microscopists whose researches
have been limited to the staining and mounting of sections.

Both methods require skill and practice in the execution and
great caution in drawing conclusions, for there are a thousand
traps lying in wait for the explorer, in this field of investiga-
tion. It is for this reason that pseudo-discoveries ar« so
numerous.

Especial care is required in the microscopical examination
of stained preparations of yellow-fever tissues. One encoun-

Sunting YMow-Fever Genna. 811

ters in the urinary tubules, mingled with the dibris of the
desquamated epithelium, stained masses of various forms which
often closely resemble cocci or bacilli. These I believe to be
fragments of nuclear material. The same material is often
massed in the urinary tubules in the form of plugs, which are
deeply stained by the aniline dyes.

Again, fragmentation of the nuclei of cells still in position
may give the impression of a cell containing cocci ; and the
karyiokinetic figures found in the cells, especially in the liver,
aften resemble bacilli so closely that it is difficult to convince
any one not familiar with them that they are not micro-
organisms.

The " plasma cells" of Ehrlich, also, seem to have as their
chief function the rdU of deluding amateur microscopists into
the idea that they have made a discovery. They are often
very abundant in the liver and in the kidney of yellow-fever
cases, and so closely resemble zoogloea masses of micrococci
that experienced pathologists have been deceived by them.

In addition to these objects which resemble micro-organisms
there are dangers from the post-mortem invasion of the tissues
when the autopsy has been delayed beyond an hour or two,
in the warm climates where yellow-fever prevails ; or even in
the preserving medium, or during the process of staining.

My experiments made in 1883 showed that "exposure to
ninety- five per cent alcohol for forty -eight hours did not kill
the bacteria in broken-down beef-tea (old stock)," and pathol-
ogists are familiar with the picture presented by the post-
mortem invasion of tissues which have been left in alcohol
which was not strong enough to preserve them.

Finally, inasmuch as my culture experiments with material
collected soon after death, from the liver and kidney, gave a
positive result in a certain proportion of the cases, it is evident
that the micro-organism most frequently found by this method
— my bacillus a — should occasionally be encountered in stained
preparations.

The possibility remains that by some method of staining
not hitherto employed, the specific infectious agent may yet
be demonstrated in the tissues ; but the fact that my culture
experiments with material from the liver and kidney of ten
cases failed to demonstrate any such specific microbe is op-
posed to this view. We may, of course, suppose that the

812 Hv/nimg Tdhw-Fever Oerma.

yellow-fever germ not only requires special methods, yet un-
discovered, for its demonstration in the tissues, but that it will
not grow in the culture media which I have employed in my
researches. I would say in reply to this hypothesis that all
known pathogenic micro-organisms may be demonstrated by
the staining methods employed, and that, inasmuch as the
yellow-fever germ appears to find a favorable nidus in filth
beds external to the body, I have been inclined to believe
that, like the bacillus of typhoid-fever and cholera, it is not
especially nice as to the character of the mediunt in which it
may develop. However, this may be a mistaken idea, and I
propose in my future researches to make use of various culture
media not yet employed, and especially to make cultures from
the tissues and the excreta in an atmosphere from which
oxygen has been excluded ; for it may be that, like the bacil-
lus of malignant oedema and the bacillus of tetanus, the yellow-
fever microbe is anae'robic.

While, then, I admit that by some special method of stain-
ing, or by a modification of the culture methods heretofore
employed, the specific infectious agent we are in search of
may yet be found in the tissues of yellow-fever patients, I
feel justified in saying that no such demonstration has yet
been made. The negative results attending my researches in
this direction have led me to turn my attention to the micro-
organisms present in the alimentary canal, for the possibility
suggests itself that this may be after all the habitat of the
deadly yellow-fever microbe, which is capable of destroying
life within two or three days, and that the phenomena of the
disease are not directly due to its presence in the body, but
result from the absorption of a poisonous ptomaine produced
by it, as appears to be the case in cholera.

The famous English hygienist Parkes, from the considera-
tion of evidence relating to the prevalence of yellow-fever dur-
ing a series of years among English troops stationed in Jamaica
and elsewhere within the *' yellow- fever zone," in connection
with the sanitary condition of their barracks, arrived at the
conclusion that yellow-fever is a "fecal disease," and there
are many facts relating to the origin and extension of epi-
demics which seem to support this view — that is, the belief that
the germ finds a proper nidus in fecal ix\atter external to the

Simtmg YeUow-Feoer Oerma. 813

body. If in yellow-fever, as in cholera, the infectious agent
is located in the alimentary canal of those who fall sick with
the disease, we can readily understand bow it is that new cen-
tres of infection are developed, when external conditions are
favorable, in the localities where imported cases have occurred,
or as a result of the introduction to such localities of fomites.

This view also accords with the demonstrated fact that
yellow-fever is not directly communicated by the sick to those
in attendance upon them. Pathogenic germs which multiply
in the intestine no more endanger those who are associated
with the infected individual than the same micro-organisms
cultivated in a suitable medium in a test tube endanger the
bacteriologist who is engaged in their study.

The possibility that the infectious agent in yellow-fever may
have its habitat in the alintentary canal, occurred to me sev-
eral years ago, and I determined, in advance of my visit to
Havana last spring, to give special attention to a bacteriologi-
cal study of the intestinal contents.

It is well known that the <excreta of healthy persons con-
tain a vast number of micro-organisms of various species, and
that while some of these appear to be constant, others are
occasional, and, we may say, accidental tenants of the human
intestine, being introduced, no doubt, with the ingesta, and
especially in drinking-water.

Notwithstanding the researches of Brieger, of Bienstock, of
Escherich, of Vignal, and others, this bacterial flora of the
healthy intestine is still imperfectly known. The attempt,
therefore, to explore this field for the purpose of finding a
specific microbe in any particular disease, is attended with
very great difficulties, unless, as in cholera, this specific
microbe occupies the field to the exclusion of the ordinary
bacteria found in the intestinal contents. Koch found his
'* comma-bacillus" almost in pure cultures in the characteristic
rice-water discharges of cholera patients, and other bacteriolo-
gists, following his methods, have had no difficulty in verifying
the presence of the same micro-oi^anism in cases of cholera
occurring in various parts of the world. On the other hand,
extended comparative researches, including my own investi-
gations made in Havana and in Decatur, show that the
*' comma-bacillus," or rather spirillum, is not found in the

814 Huntiaig YMow-Femr Germs.

alvine discharges of healthy persons, or in other diseases than
cholera. If in yellow-fever, as in cholera, there was a micro-
organism in pure cultures, or in relatively great abundance,
capable of growing in the culture media which are suitable for
the development of a majority of the known pathogenic organ-
isms, I ought to be able, to-night, to exhibit to you cultures
and photo-micrographs of this micro-organism. But my re-
searches show that the micro-organism which is by far the
most abundant, and, so far as my investigations go, the only
constant form found in the excreta of yellow-fever cases^ is
the bacterium coli commune of Escherich, which is also the
most constant and abundant form found in the excreta of
healthy persons.

In Havana my cultures were made from material from the
stomach and intestine of fatal cases obtained at the time of
making the autopsy. My researches did not show that any of
the micro-organisms encountered was constantly present, with
the exception of the bacterium coli commune — my bacillus a.
Having excluded this bacillus by comparative researches,
there was nothing to point to any one of the micro-organisms
present in my cultures as the^probable infectious agent I was
in search of.

The bacillus of Dr. Paul Gibier I only encountered in three
cases out of ten, and in these it was not present in very great
abundance, compared with the colon-bacillus for example.

My time in Havana, limited by my orders, was too brief to
enable me to make an exhaustive research. The epidemic in
Florida and Alabama during the past summer gave me an
opportunity to continue the investigation, and, at my request,
I was directed to proceed to the infected district for this pur-
pose. The presence of my friend, Dr. Jerome Cochran, State
Health Officer, at Decatur, decided me to locate my laboratory
in that place, where I found abundant material for the re-
searches I had in view. Having made a considerable number of
autopsies in Havana, I determined while in Decatur to devote
my attention especially to a bacteriological study of the alvine
discharges collected during the different stages of the disease.

Evidently, if the infectious agent multiplies in the intestine,
it should be found in the excreta during the earlier stages of
the attack.

Huntmg Tellow^ener Oermjs. 815

The cause must be present in advance of the development
of the morbid phenomena which characterize the disease. But
it is quite possible that during its later stages the etiological
agent has perished, and, therefore, would not appear in cul-
tures made from material obtained post-mortem.

While in Decatur, and after my return to Baltimore, I
examined by bacteriolc^ical methods — Esmarch tubes — the
excreta of 39 cases of yellow-fever, and for comparison of 9
convalescents and of 19 healthy individuals. A detailed ac-
count of the results reached will be given in my final report.
As was to have been expected, I have encountered a variety
of micro-organism. Many of these I have isolated in pure
cultures, and the biological and pathogenic characters of sev-
eral have been carefully studied by cultivation in various
media and by inoculation experiments in the lower animals.
It would be premature for me to attempt to give you the re-
sults of these researches even if time permitted me to do so.
But I may repeat what I said at the outset that the germ of
yellow-fever has not yet been demonstrated. It is possible,
however, that one or the other of the micro-organisms which
I have isolated is the long-sought germ, although I have no
satisfactory evidence upon which to base a claim that this is
the case.

My attention has been especially directed to the liquefying
organisms found in the excreta of the 39 cases examined. In
a majority of these cases the presence of liquefying bacilli was
demonstrated, but liquefying colonies were not numerous as
compared with the non-liquefying, among which the colon-
bacillus of Escherich was by far the most abundant. In a
series of Esmarch tubes No. i would show numerous liquefy*
ing centres, usually within twenty-four hours, very often No.
3 would contain a few liqactying colonies, while, as a rule.
No. 3, although containing numerous isolated colonies of the
colon-bacillus, did not contain any liquefying colonies.
Further, I found that several different liquefying organisms
were present in different casea, or were associated in the same
case. I shall presently show you cultures and photo-micro-
graphs of these liquefying bacilli. The one most frequently
present, my bacillus 0, I have since found in cultures from
another source, and am oU^ed to exclude it as the possible

316 JBunMng YeUow^I^ever Germs.

specific etiological agent of yellow-fever. It has also been
isolated by Dr. Booker, of Baltimore, from the discharges of
one or more infants suffering from summer diarrhoea. The
bacillus of Gibier I have only isolated from three cases, and
in these it was not present in considerable numbers. I have
made extensive experiments upon the lower animals, which
show that this bacillus has interesting pathogenic properties,
but give no special support to the view that it is the specific
germ of yellow-fever. I have never observed in my cultures
the black pigment which, according to Gibier, is produced
during the development of this bacillus, and am at a loss to
understand this discrepancy in our observations.

So far as the pigment in black vomit is concerned, I have
no doubt that it is of hsemic origin. I have never failed to
demonstrate, by a microscopic examination, the abundant
presence of red blood-corpuscles in the numerous specimens
of black vomit which I have examined. The little black floc-
culi are, in fact, made up of agglomerated corpuscles which
have lost their pigment and appear as pale disks, often more
or less swollen and distorted ; while the brownish pigment,
which has been changed by the acid secretions of the stomach,
remains in their vicinity in the form of granules or amorphous
masses. The idea that there is something specific about this
pigment, or that it is the secretion of a specific microbe, as
has been maintained by Freire and by Gibier, appears to me
to be untenable. In a majority of the non- fatal cases of
yellow-fever and in a certain proportion of the fatal cases there
is no passive hemorrhage into the stomach, and consequently no
black vomit, yet these cases must result from the action of the
same etiological agent as those in which this symptom is present.

I have found by experiment that the bacillus of Gibier, the
micrococcus of Freire, and the tetragenus of Finlay, all grow
after being exposed for an hour to a temperature of — 15® C.
(S° F.). Exposure outside of the laboratory in Baltimore for
five days in the month of January failed also to destroy the
vitality of these micro-organisms, although the temperature,
during the greater part of the time at least, was below the
freezing-point.

Having thus given you a brief account of the present status
of the investigation in which I am engaged, I propose to de-

The Microbe as a Factor in Disease. 817

vote the remainder of the time at my disposal to a practical
demonstration of the methods of research employed, and to
an exhibition upon the screen of the various micro-organisms
to which I have referred. — Medical News ^ March <^hy 1889.

The Microbe as a Factor in Disease. — The prevailing
opinion now seems to be that the microbe is not the all-impor-
tant factor in disease, but that the substances elaborated by it
do the harm. It is certain that in some cultivations the bodies
evolved cause a cessation of the growth of the microbe, and
this fact is now taken as a starting-point for a new theory of
inoculation against disease. Professor Bouchard has said in
his lectures that there ought to be a careful separation of the
soluble matters secreted by the micro-organism from the toxic
substances which might exist in connection with them. The
former only were suitable for inoculation. It is possible, he
thought, that they might come into use for internal medica-
tion to arrest .the progress of a disease which had already
begun, rather than for inoculation. Thus it might be that the
substances that arrest the development of micro-organisms in
cultivations could be used to combat their growth in the body,
and thus to put an end to the disease the micro-organism had
caused. Professor Peter said that he never had believed that
the microbes themselves did any harm, but that their presence
gave rise to the formation of poisonous alkaloids. Professor
Bouchard was of the opinion that inoculated matter was not
retained within the tissues to act as certain substances did
which were put into cultivation to prevent the growth of micro-
organisms, but that it modified cell-nutrition to such an extent
that the cells became permanently, or at least for a long period,
incapable of being again affected by the substance which had
modified them originally. The inoculations practised by him
of the urine of animals suffering from various diseases had
appeared to confer immunity from the disease affecting the
animal from which the urine had been taken. This would
seem to indicate that a modification of the virus, similar to
the attenuation produced artificially, as in the case of anthrax,
had occurred spontaneously in the system. — Paris Letter^ New
York Medical Journal^ March 2^, 1889.

818 Shaking Sands vnth a Swuce^n.

SHAKING HANDS WITH A SAUCEPAN.

If ever we are seized with a desire to understand what
manner of women our grandmothers and great-grandmothers
' were, let us not disdain the information which may be obtained
by studying the cookery-books of eighty or a hundred years
ago. Our great-grandmothers themselves studied little else.
Some of them sighed and wept over the sorrows of Clarissa,
liked to linger with Harriet Byron in her cedar parlor, were
not quite sure what they thought of Pamela, got much garni-
ture for mind and body out of the Belle Assembl6e ; but, for
the most part, little enough reading did they do. Mrs. Glass,
Mrs. Raffald, and certain well-informed persons who sheltered
themselves behind the appellation of " A Lady," were quite
enough for them ; and these writers knew it, and, while teach-
ing the noble art of cookery, almost always benevolently added
a number of miscellaneous observations on life and conduct
likely to be useful to girls whose " ornamental education had
commenced before impressions of duty had been made."

These old cookery-books seem to bring us much nearer to
our dead and gone progenitresses, and show us that, though
they did not read much, and could do mighty little in the way
of spelling, they were simpler, and perhaps sweeter, women
than their granddaughters. They could scarcely fail to be so,
for the mere exercise of the one art which they practised as an
art brought them hour by hour in the most intimate relations
with nature and her bounties. In the season when green
things flourished hardly a day can have passed without these
good ladies themselves going into their gardens to seek the
fagot of sweet herbs which was to impart flavor and fragrance
to their '* ragoos" and savories ; or the marigolds which poor
Charles Lamb hated so much when they floated on his mess
of Charter House pottage, but which Simple Susan's enemy
Barbara found so tempting. The greater part of our grand-
mothers* lives must have been spent in culling simples, ex-
pressing juices, gathering fruits, and spying out things to
pickle. This was not done haphazard. Solomon tells us that
there is a time for all things, and Mrs. Raffald and her sisters

4€

Shaking Hands with a Saucepan. 819

tell us the time to gather fruit, and many a thing besides.
Gather your currants while the sun is hot upon them/'
Pick your clary- leaves in the dry," " Pick * something else '
in the cool. ' * It was therefore with our grandmothers a con-
stant round of watchfulness and duty, and it seems strange
that it is only recorded of one woman that she was married
when she went out into the garden to pick parsley, or that
little Mary in Grimm's "" Household Tales" is the only one
said to have found a husband when she went to cut cabbages ;
for lovers, and would-be lovers, ought to have known where
women were likely to be found during canonical hours.

What was there — was there anything that the women of a
hundred years ago did not pickle or preserve ? They pickled
parsley green to cheat grim winter of some of its terrors ; they
pickled " nasturtions" — and a very excellent pickle they make.
They pickled the large shoots of elder to imitate '* the Indian
bamboe." " They put out in the middle of May, and the
middle shoots are the most tender," They pickled green wal-
nuts ** when they will bear a pin to go into them" — which
also is done to this day. They were aware that " the clusters
of elder-flowers makes (sic) a delicate pickle before it opens,"
and that to effect this it was only necessary to pour vinegar
over them. They also knew that the seeds of elder should be
pickled while still green, as a substitute for capers, and that
" large cucumbers of the kind called green turley, prepared as
mangoes, are excellent, and come sooner into eating." They
pickled radish-pods, young artichokes, horse-radish, samphire,
marigold flowers, and more things than can well be enumer-
ated. Having pickled nearly every green shoot, stalk, pod,
and seed, they began to do the same by plums, apricots,
peaches, currants, and gjapes. When they set about making
jams no fruit escaped them — they even attacked vegetables.
When they made cakes it was the same. Parsnips, raspberries,
etc., were made into cakes, and red beetroot, potatoes, and
oranges into biscuits. The recipe for violet cakes reads de-
lightfully : " Take the finest violets you can get, pick off the
leaves, beat the violets fine in a mortar with the juice of a
lemon, beat and sift twice their weight of double-refined sugar,
put your sugar and violets into a silver saucepan or tankard,
set it over a slow fire, keep stirring it gently until all your

_wl

320 Shdhmg Hcmds wUh a Saucepan.

sugar is dissolved ; if you let it boil it will discolor your vio-
lets ; drop them in china plates ; when you take them off put
them in a box, with paper between every layer," Can any-
thing be more charming and ethereal than this ? The only
point at which it seems to touch common earth is the sugar,
and that is to be double refined. The china plates doubtless
were such as would now make the joy of a collector and
madden his wife by their price. Would that the time when
women found healthy excitement in turning this mixture out
of the pan, with the color of the violets undisturbed by the
rude, passionate act of boiling, were back again ; it was a time
when Satan must surely have found fewer idle hands to do his
work. For our own part, we never take up a paper and read
some horrible story of woman's guilt or folly without wishing
that the days of silver saucepans and delicate confections were
once more with us ; it is more than probable that the women
who err so greatly have, as Dr. Kitchener says, *' never shaken
hands with a saucepan in their lives." But to return to our
great-grandmothers. Even after their pickles and preserves
were made, flowers, fruit, and vegetables had other missions
to fulfil. Tarts were made of sorrel, cucumbers were " farced,*'
not with pearls, as in the " Arabian Nights," but with more
savory compounds, and the garden supplied many a dainty
dish besides.

Wine-making, too, was then a recognized branch of female
industry, and every fruit in turn was chosen as a basis, and
some flowers and vegetables — notably cowslips and parsnips —
were promoted to the same dignity. There is a very pretty
recipe for cowslip mead, made of honey, lemons, seven pecks
of cowslip pips, and a handful of sweetbriar. The sweetbriar
is a delicious ingredient, but think of picking seven pecks of
pips ! A recipe is given for making elder-flower wine " from
the tree which bears white berries." We are confidingly told
that " it drinks very like Frontiniac." Wine of black elder-
berries is said to be equal to the best Hermitage claret ; and
another recipe instructs us how to make wine of white elder-
berries, "which is so like the fine rich wine brought home
from Cyprus, in its color and flavor, that it has deceived the
best judges." So says one of our grandmothers' books ; but
we cannot but think of Mrs. Browning, and fear that, if " Old

Shaking HandB wiik a Scmcepwn,. 321

Bacchus were the speaker, he would tell us with a sigh," that
this elder-flower wine was never **soft as the Muses' string,
tawny as Rhea's lion, bright as Pdphia's eyes, or sweet as the
honey made by the brown bees of Hymettus." Such as it
was, it was made in days gone by, and so was Clary wine.
Or sycamore, birch, walnut, blackberry, or balm wines — all
these were once made by fair and dainty housewives, and now
are made no more. And, then there was shrub, wherein to
one gallon of new milk flavored with lemons and Seville
oranges was added two quarts of red wine, two gallons of rum,
and one of brandy. Sweet dishes, also, were generally made
by the ladies of the family, and there is much play of fancy in
the naming of them. In turning over the pages we find direc-
tions how to spin gold and silver webs for dessert, to spin
birds' nests, to make a Chinese temple or obelisk, a fishpond
with silver and gold fishes, a hen's nest, with strips of lemon
for straw, and eggs filled with flummery, a hen and chickens
in jelly, a desert island. *' Take a lump of paste and form it
into a rock three inches broad at the top, set it in the middle
of a deep china dish, and set a cast figure on it with a crown
on its he^d and a knot of sugar candy at its feet,*' etc. '* If
this dish is for a wedding-supper, put two figures instead of
one," so the desert island is not so much of a desert after all.
Next comes a *' Rocky Island," and then a ** Floating Island,"
with sheep, swans, "or you may put in snakes, or any wild
animals of the same sort." Moonshine is another dish with a
pretty name, and there is likewise a recipe for " Moon and
Stars in Jelly," a half moon with seven stars shining out of
flummery colored with cochineal and chocolate to imitate the
color of the sky. We still have numbers of people among us
whose eye for color is as fine as that of the inventor of this ;.
but who now makes moon and stars in jelly? "Solomon's
Temple in flummery" is a yet finer flight of the imagination..
A recipe for making an amulet takes our fancy, but loses its.
attraction when we find it is only Mrs. Raffald's way of spell*
ing omelet.

Who can say how much the construction of some of these
quaintly-named and delicately-compounded dishes may have*
been to our grandmothers ? Perhaps it was their poetry, their
sphere of art, their one escape from the monotony of their

31

822 Shahmg Scmds with a Saucepcm.

quiet lives. The fancy of cooks of a hundred years ago played
lightly about " Solids and Savories," too, and they also
have taking names. We learn how " To make a Porcupine of
a Breast of Veal and to Surprise a Shoulder of Mutton."
Every joint, by the way, was liable to be surprised, and many
were liable to be dressed to look like a hen and chickens.
Veal was bombarded, pigeons were transmogrified. There are
directions to Florendine a Hare (probably a bad attempt at
Florentine), and also to make a Solomon Gundy, " To make
an artificial Turtle," and " To Barbecue a Pig." We will not,
however, enter on the more important branch of cookery ; all
that now concerns us is the part in which our grandmothers
were most actively interested. What a pity it is that so few
women now care for it sufficiently to make them overcome
their fear of entering their own kitchens at odd times I What
a pity that the class spoken of as those who have never shaken
hands with a stewpan is now so large, and the number of those
who possess a silver saucepan so infinitesimally small ! The
sight of a dear, white-haired lady measuring out one wineglass-
ful of port wine, and two of what she called " fair spring
water," into a bright silver saucepan, with sugar, and cinna-
'mon and other spices from her own spice-box, when we had a
'Cold, is something never to be forgotten. How many ladies
now possess a spice-box, or could enumerate the spices which
•it ought to contain ? and what lady could promptly answer if
asked which are the four cold seeds ? With the changed lives
•of our women, changes have taken place in our gardens too.
Where are many of the old vegetables, and what has become
of so many of the " pot-herbs and small salladings?" Who
now, as a matter of course, grows basil, hyssop, rue, burnet,
'balm, " tragopogon," purslane, sorrel, tansy, or sweet cicely?
Who goes out to seek these or other " sprigs of summer," or
rosemary, or handfuls of sweetbriar for flavoring, or myrtle to
»put in the bills of pigeons ? What careful housewife gathers
»hop shoots to eat in the place of asparagus ? Such knowledge
'is now known no longer, and much that was pleasant and good
has gone with it. Time was when women ought to have been
as poetical as landscape painters, whose almanac is forever
.before their eyes in the diurnal changes of nature. — The Sat-
urday Review.

The Charity Instii/uMons of Paris. 823

THE CHARITY INSTITUTIONS OF PARIS— NURS-
ING INFANTS WITH ASSES' MILK.

In recent years, in France, conscientious efforts have been
made to ascertain the principal causes of the loss of popula-
tion, and it has been demonstrated by numerous facts that
one of these causes consists in the physical degeneration in-
duced by deficiency of alimentation in infancy ; and the most
eminent physicians of Paris, and the Director of Public Assist-
ance, have endeavored to modify and improve the system of
nutrition in the public charitable institutions, providing for re-
cently born children lactation adequate to the necessities of
the temperament and constitution.

In the Hospital for Infants' Diseases, situated in Sabres
Street, there exists a section for rickety boys and girls, whose
miserable aspect produces an iftipression of pain upon the
mind — unfortunate beings who have inherited the organic
vices of their parents, and who suffer from anaemia's cruel
tortures.

The administration of the hospital is arranged in two sepa-
rated pavilions, where there is much ventilation, with large
windows that look out upon a garden, and whose walls have
double rows of willow cradles perfectly equipped. The newly
bom receive here the personal care of the establishment,
beginning with being weighed in the balance the same day
they make their appearance, the operation being frequently
repeated almost every month in order to determine with exact-
ness the development of the child. The little one is subjected
to an especially nutritious diet of the most tonic kind, if it had
been previously fed from a refractory goat liable to convey
contagious germs, it having been found by experiment that
the milk of this animal, although possessing nutritive principles
of the most salutary kind, presents the Inconvenience of com-
municating by absorption the effects of those nervous accidents
to which the goat is subject.

The public charities of Paris, advised by the wise doctors of
medicine, have substituted for the milk of goats that of the

324 7X« Ckariiy Institutioru t»f Paris.

Prevention of JRahies hy Pasteurian Inoculation. 325

ass, and have installed an ample yard near the pavilion of the
rickety and scrofulous children, which is only separated by a
short covered passage-way. Nothing is more picturesque than
the spectacle of the lactation of the babes in this inclosure
every morning, as graphically represented in our engraving,
from a drawing by M, De Haenen.

The nurses, dressed in dark gowns with white caps and
aprons, each carrying a child on the right arm and a little seat
in the left hand, present themselves in exact turn to the women
who have charge of the animals, and they hold the child,
applying its lips to the teats of the docite animal. The chil-
dren suck with avidity the liquid nutriment, which is fresh and
of agreeable taste.

The Administration of Public Assistance of Paris has calcu-
lated that one young ass is able to lactate abundantly for a
space of nine or ten months, and when this period has passed
they are sold and replaced by others. It is well known that
the milk of asses, by its vivifying qualities and its nutritious
principles, assimilates in a great degree the milk of the nurse,
and these disinherited and sick children, enjoying its beneficial
effects by its permanent and methodical use, are restored little
by little to health and vigor. — La Ilustracian Espa^iola.

Prevention of Rabies by Pasteurian Inoculation.—

From a return issued by the Local Government Board, it
appears that 85 British subjects have been treated by Pasteur
during the past two years. In 24 cases the dc^ was proved to
have been rabid by the experimental test ; in 44, the dog was
recognized to be rabid by the veterinary surgeon ; s^nd in the
remaining cases (17) the dog was only suspected of being
rabid. In 4 cases the patient afterward died of rabies, and in
I case died of rabies while under treatment. Professor Hors-
ley, in a communication just made to the Epidemiological
Society, states that the death-rate among persons bitten by
dogs undoubtedly rabid averages fifteen per cent, and points
out that in the same class of patients Pasteur has obtained a
death-rate of only 1.36 per cent. Professor Horsley therefore
regards the success of Pasteur's treatment as assured. — London
Letter^ Medical Record^ March 9/A, 1889.

326 LigJU Without Eeat.^

LIGHT WITHOUT HEAT.

Some investigations recently published by Professor Oliver
J. Lodge, on the subject of artificial light, are worthy the at-
tentive consideration of all concerned in the supply of gas or
of electric light. The professor arrives at the conclusion that
light is an electrical disturbance, and that light waves are ex-
cited by electrical oscillations, and goes on to remark that our
present systems of generating artificial light are both wasteful
and ineffective. The requirement is a certain range of oscil-
lation, which may extend from 4000 to 7000 billions vibrations
per second. Anything out of these limits is of no use, as it
has no effect on the retina. Ordinary matter cannot be made
to furnish such rapid vibrations by mechanical means. The
strings used in musical instruments only give 1000 vibrations
per second, or less. So it is necessary to fall back on atoms,
and the most convenient way of getting vibrations of the
necessary rapidity is the application of heat. But the vibra-
tions thus obtained are infinite in number and mode, and only
a very small proportion out of the whole come within the
range above named. There is no known method of separating
out the useful vibrations from the great majority, and hence it
is that light cannot be produced without heat. In the case of
ordinary combustion only a small percentage of the energy
evolved is obtained in the form of light ; and with the electric
light, the energy for which first originates in the combustion
of the fuel under the boiler, it necessarily follows that but a
small proportion of the original energy can be realized in the
form of light in the lamps. If we expose a carbon filament or
a piece of quicklime to heat, as the temperature rises higher
and higher, rates of vibration of the atoms are obtained until
at last such rates as the retina is constructed to perceive are
reached. But the low rates are not transmuted into the
higher ; there is simply a superposing of a comparatively
small number of vibrations coming within the range above
named upon the lower ones. A small range of rapid vibra-

JSkamining and Orammmg. 327

tions is required, and we know of no better plan than to make
the whole series leading up to them, as though in order to get
the sound of some one shrill note upon an organ we were
obh'ged to depress every key and every pedal. What is wanted
is how to produce the shrill note by itself, and Professor
Lodge holds out the production of light waves without any
others as the problem of the future. These considerations
render it evident that there is a large ground to be worked in
the way of increasing the proportion of light rays in the total
energy produced by any artificial sources of light. — N. H.
Humphreys y in American Gas- Light Journal.

Examining and Cramming. — Every teacher knows by ex-
perience that, when he has to take his place in the examina-
tion curriculum, he has to submit to the system, and he does
his best to practise the examining "art." And when, as
every teacher nowadays must, he has to turn crammer, he tries
to acquire the crammer's art — omnes eodem cogimur. Teachers,
examiners, crammers, and students, all have to take their
place in the vast examining machine, which, like the Prussian
military system, grinds out a uniform pattern. The huge ex-
amining mill grinds continually, and grinds very fast — unlike
the mills of the gods — but the grain it casts aside ; it is
designed to grind out the husk.

I do not say that we can do without examinations : nor do
I object to all examinations, under any condition. My com-
plaint is confined to the incessant frequency of examinations,
the growth of the practice into a highly artificial system, the
creation of a profession of examining, and its correlative the
profession of cramming, the wholesale, mechanical, and hurried
way in which the examinations are held, and the subjection of
teaching to examining. In sum, I complain that the trick,
the easily acquired and cheaply purchasable trick, of answer-
ing printed questions, should now so largely take the place of
solid knowledge and be officially held out as the end of study.
— From " Comments on the Sacrifice of Education,'* by Frederic
Harrison^ in the Popular Science Monthly for February.

328 The Medals^ Jetona^ and Tokens Illustrative of Samtation.

THE MEDALS, JETONS, AND TOKENS ILLUSTRA-
TIVE OF SANITATION.

By Dr. Horatio R. Storkr, Newport, R. I. , Member of American Public Health

Association, etc.

X. EpicUmui, Continued from page 251.*

IV. Cholera.
A. The United States.

Dr. N. S. Davis, of Chicago. " How Far do the Facts Ac-
companying the Prevalence of Epidemic Cholera in Chicago
During the Summer and Autumn of 1866 Throw Light on the
Etiology of the Disease." Chicago, 1867, 8*^.

The medal of the American Medical Association, com-
memorating Dr. Davis as its founder in 1846, was described
under Section VIII., No. 377. He is also mentioned upon
the larger medal of the International Medical Congress of
1887, No. 906 of the present series, and he will again be men-
tioned when speaking of typhus, surgical-fever, and diphtheria,
and in Section XII., climate.

Dr. J. M. Toner, of Washington. " The Portability of
Cholera, and Necessity of Quarantine." New York, 1866.

(With Professor C. A. Lee.) ** Facts and Conclusions Bear-
ing upon the Question of the Infectious Character and Por-
tability of Asiatic Cholera." New York, 1876.

* The previous portions of this paper will be found in The Sanitarian for
May, July, August, October, 1887 ; February, April, July, August, November,
1S88 ; February and March, 1889.

With reference to having mentioned the medals of St. Charles Borromeo
when spealcing of The Plague (Sanitarian, November, 1888), I may sute that
sjnce that portion of my paper appeared, I have received descriptions of three
additional and hitherto unpublished medals of the Saint from Mr. A. de Witte
of Brussels, the dies of which are preserved at the Royal Mint of that city.
One of them, the following, definitely settles the claim of St. Charles to be
commemorated in this connection.

865a. Obverse. Bust of the Saint, in biretta, to right. Beneath, R(oettiers)
Legend : Ora Pro— Liberanda Peste.

Reverse plain. Oval. 23x25 mm.

This was unknown to Pfeiffer and Ruland.

The Medals f JetonSy aaid Tokens lUustraUve of 8(mitalion. 329

Dr. Toner has been mentioned under Section I., repeatedly
in the present Section, and will be again alluded to hereafter.

B. England.

Dr. E. A. Parkes. ** Pathology and Treatment of Asiatic
Cholera." 8^

This medal was briefly described under Section I., No. 57.
I have as yet been unable to obtain full particulars of it. Dr.
De Chaumont, his successor at the Netley Hospital, who had
promised to procure them for me, has since then deceased.

C. Holland.

Dr. J. L. H. Haerten, of Utrecht. ** Djssertatio exhibens
historiam Cholerae Asiaticae annis 1848-49." Utrecht, 1850,
8^

992. Obverse. Within a beaded circle, bust to left, with-
out inscription. Upon: shoulder, J. P.M. Menger. F.

Reverse. J.L.H.Haerten | Medico. Doctissimo. | Hoc.

Amicitiae. I Et. Grati. Animi. Pignus. | J.G.Putman | Arch-

iepisco. Ultra! | A. Consil. Et. Decan. | Civit. IncidL Curavit

I A.R.S. MDCCCLXXIIL (Rosette.) Bronze. Rilppell, 1876.

p. 14.

Gerard Jan Mulder, of Utrecht (1802-80). '* De scheikr
undige middelen der Nederlandsche regering tegen de ver-
spreiding der cholera." Rotterdam, 1866, 8°.

*' De natuurkundige methode en de verspreiding der chol-
era." Rotterdam, 1866, 8°. (With F. Vander Paut.) " De
Cholera in Rotterdam." Rotterdam, 1832, 8°.

993. Obverse. Bust, to left. Beneath, D.V.d.Kellen F.
Inscription : Gerardus Johannes Mulder.

Reverse. Within a laurel wreath, Praeceptori | Carissimo |
Grati | Discipuli mdcccxi^mdccclxv. Bronze. Riippell,
1876, p. 12. Unknown to Duisburg.

Dr. Bernhard Francis Suerman, of Utrecht. Distinguished
for his services during the cholera of 1831-32.

994. In 1833 a gold medal was conferred upon Dr. Suerman
for devotion during the preceding cholera epidemic. I have
not yet seen its description. Volcker Cat., Amsterdam, 9-13
April, 1888, no. 1925.

380 The Medals y Jetona^ and Tokens Illustrative of SaniiaUan^

995. Obverse. Bust to left, with military orders. Beneath,
D. Van Der Kellen F. Legend : Laborantibus Praesidivm —
Consvlentibvs Lvmen.

Reverse. Within heavy oak branches tied by ribbon : Bern.
Franc. Suerman | Per X Lvstra | Medicinae Professori | Doc-
trina Arte Sapientia | De Academia £t De Patria | Optime
Merito | Senatvs Academiae | Rheno Trajectinae | D. IX
Octobris | MDCCCLIX. Bronze. 58 mm. RUppell, 1877, p.
12. In my collection. Unknown to Duisburg.

D. Belgium.

Charles De Brouckere, of Brussels. While burgomaster,
zealous to check two epidemics of cholera.

996. Obverse. Bust to right. Inscription : Charles De
Brouckere Burgomastre De Bruxelles Braemt F.

Reverse. An angel in armor striking down a triple-headed
monster, with a flaming sword. A spade and coffin, with
skull and crossed femora upon the latter. The city in the
background. Inscription : Au Magistrat D6vou6 Les Habi-
tans De La Capitale Reconnaissants. Souscription Ouverte
Par Le Cercle Artistique Et Litteraire. Zele Infatigable
Pendant L'Invasion Du Cholera 1849 & 1^54* Silver, bronze.
54. Dugniolle Cat., 1885, Nos. 280 and 288. In the Lee col-
lection. Unknown to Kluyskens, Duisburg, and P. and R.

Dr. Adolphe Pierre Buggraeve (1806- ). " Le Chol6ra
Indien." Ghent, 1855, 8^

This medal has been described in Section I., and Dr. Bug-
graeve again referred to under Vaccination. He will also be
mentioned in the present Section under Syphilis, and in Sec-
tion XII., Climate. While preparing the present Section for
the press, I have learned of a second medal to Burggraeve
that has quite recently been struck. I take the description
from advance sheets of a valuable work that has been sent to
me by its author, Mr. A. de Witte, of Brussels.

997. Obverse. Bust, to left. Beneath shoulder, Ch.
Wiener. Inscription : Dr. Burggraeve — Anno Aetatis LXXXII

Reverse. Branches of laurel tied by ribbon. Above their
junction, a burning antique lamp. Within field : La | Mede-
cine I Hippocratique | Restaur6e | — Above, Medicine Dosi-
metrique. Below, 1872- 1887. Edges pearled. Bronze.

The MeddUy JetanSy and Tokens IHuatratwe of SamtaMon. 331

Alvin, Revue beige de numismatique^ 1888, p. 590 ; De Witte
Medailles Historiques De Belgique, p. 194, No. 95, pL
LXXVII.

Dr. J. F. Kluyskens, of Ghent. " Quelques reflexions sur
la nature et le traitement du chol6ra-morbus 6pid6mique de
rinde." 1833, 8\ Already described under Vaccination, in
the present Section.

E. France.

Dr. Mathieu Maxence Audouard (1776-1856). ** Histoire
du choI6ra-morbus qui a regn6 dans l'arm6e frangaise au nord
de r Afrique." Paris, 1836, 8^

His medal, which was given conjointly to Mazet and tliree
others, will be described hereafter, when considering those of
Yellow-fever.

Dr. Francois Victor Bally (1775-1866). *' Etudes sur la
choladr6e lymphatique ou chol6ra indien," etc. Paris, 1833-
35, 8°. The medal to this physician is the same as that last
mentioned, and will be described a little later on.

Dr. Jean Baptiste Bouillaud (1796- [this date not given in
the Index of Cat. S. G. O.]). " Trait6 clinique et statistique
du chol6ra." Paris, 1832, 8''.

998. Obverse. Within laurel branches tied by ribbon, Au
I Professeur | J. Bouillaud | Ses El^ves | Reconnaissants | —

Juin 1836. Outside, Hdpital De LaCharit6 — Clinique Interne
(rosette).

Reverse. Within laurel branches tied by a long ribbon,
Fi&vres | Encephalite | Philosophic M6dicale | Rhumatisme
Articul* I Maladies Du Coeur | &.&.&. Externally, Science
(rosette) Progrfes.

Duisburg has dots before and after Juin, omits the dash,
and has a dot after Charit6 ; and on reverse, has four dots
after words in the field, and omits the three &*s. Duisburg,
Supplement (I.), 1863, p. 4. Unknown to Kluyskens. It is
in my collection.

999. Obverse. Head, to right. Beneath, Caqu^ F. In-
scription : J. Bouillaud N6 A — Gavat 16 Septembre 1796.

Reverse. A jointed circle. In field, Au Chef | De La
M^decine | Exacte | — | A6ut 1838. Inscription : *Hom-
mage Au G6nie De L'Observation* | Clinique Interne De

332 The MedcbUy JetonSy amd Tokens lUnatratvoe qf Sanitation,

La Charit6. Bronze. 40 mm. Kluyskens, 1. , p. 146, fig. ;
Duisburg, p. 74, cxciii.

Dr. J. B. Bousquet. ** Lettre sur le Chol6ra-morbus."
Paris, 1 83 1, 8^ Already described in this Section, under
Vaccination.

Dr. Fran5ois Joseph Victor Broussais (1772-1838). ** Le
chol^ra-morbus 6pid6mique." Paris, 1832, 8°. Two clinical
lectures on d®. Translated by John S(tephen). Bartlett,
N. Y., 1832, 8^

1000. Obverse. Bust. Beneath, Michaud. Inscription :
F.J.Victor Broussais.

Reverse. M6decine | Phisiologique. | 1814. Duisburg,
Supplement IL, 1868, p. 7. Unknown to Rudolphi and
Kluyskens.

looi. Obverse. Naked bust. At base, an order with its
ribbon and three medalets. Beneath, Michaud. Inscription :
F. J. V. Broussais, N6 A St.Malo Le 17 Decern. Ann^e 1772.

Reverse. In fourteen lines : A L'lUustre Auteur De La
M6decine Physiologique Et Du Cours De Phrenologie. Mem-
bre De L'Institut De France Officier De La Legion D'Hon-
neur.Prof.De La. Facul. De M^d. De Paris. M6decin En
Chef De L'Hopital Milit. Du Val De Grace, etc., Ses Dis-
ciples Reconnaissans 1836. Bronze. 32. Duisbui^, p. 69,
clxxvii. Unknown to Kluyskens. It is in the Lee collection.

Guillaume Dupuytren, of Paris (1778 [according to the
medal ; 1777, Thomas, Biographical Dictionary ]--i835).
** Lettre sur le si6ge, etc., du Chol6ra-morbus.'* Paris, 1832,
8°.

1002. Obverse. Nude bust to right. Beneath, to left,
Caunois F. Inscription : Guillaume — Dupuytren.

Reverse. N6 A Pierre Buffi^re "I Haute Vienne | Le 5
Octobre 1778 | — | M^dailler. | Fran9ais C61febres. | XIX
Siecle. 182 1 . Silver, bronze. 40 mm. Rudolphi has Frangois.
Rudolphi, 1829, p. 43, no. 170 ; Kluyskens, p» 269, No. i ;
Duisburg, p. 68, clxxii.. No. i.

1003. Obverse as preceding.

Reverse also the same, save with addition of Mort A Paris

I Le 8 Fevrier 1835., ^^^ ^ith omission of the final 1821.

Bronze, silvered do. 42 mm. Kluyskens, p. 269, No. 2,

fig. ; Duisburg, p. 68, clxxiL, No. 2. Unknown to Rudolphi.

Tlie Medals y Jetons^ and TcJcena lUugtratvoe of Sanitation. 883
Dr. F6rat, of Bourbonnc, will be mentioned a little later on,

No. IOI2.

Baron Dr. Jean Dominique de Larrey (1776-1842). " Notice
sur l'6pid6mic du chol6ra-morbus indien," etc. Paris, 1835,

4°.

1004. Obverse. Head to right, with long hair. Beneath,
Petit D'Aprfes R.J.David. Inscription : J. D. Larrey N6 A
Beudeau (H***' Pyrenees) Le 8 J^ 1766, Mort Le 22 J* 1842*

Reverse. A group of four persons. In midst a figure with
sword and cloak holds the hand of a kneeh'ng woman, upon
whose lap a dying child is lying, and extends the staff of
i£sculapius toward a soldier with sword and shield. Exergue :
MDCCCXXXXVII. Beneath, Petit Fecit. Bronze. Ruppell,
1876, p. 25. Unknown to Kluyskens and Duisburg,

Dr. J. A. A. Legay. Distinguished for personal services
during the epidemic of 1849.

1005. Obverse. Bust of Liberty. Beneath, Borrel. In-
scription : R6publique Frangaise.

Reverse. A M' J.A.A.Legay Chirur". Major Du 41® De
Ligne. En T6moignage De Son D^vouement. — Cholera.
1849. O" edge, Ministfere De L' Agriculture Et Du Com-
merce. Bronze. Duisburg, p. 73, clxxxix. Unknown to
Kluyskens and to P. and R.

F. Germany.

Christian Gottfried Ehrenberg, of Berlin (1795-1876). *' Er-
fahrungen iiber die Pest in Orient," etc. Berlin, 183 1, 8°.

1006. Obverse. Head to right. Beneath, J. Weigand
Berlin.

Reverse. Christiano Godofredo | Ehrenberg | Medicinae
Per L Annos Doctofi | Naturae Investigatori | Sagacissimo |
Latentium Indagatori | Admirabili | Die V Mens. | Nov. |
MDCCCLXViii. Bronze. RUppell, 1875, p. 50. In the Lee
collection.

Carl von Pfeuffer, of Munich (1806-69). For services in
cholera epidemic of 1854.

1007. Obverse. Bust to right Beneath, C.Voigt. In-
scription : Doctori Carolo Pfeuffer.

Reverse, The staff of iEsculapius, between branches of
laurel. Inscription : In Memorlam Anni 1854 Medici Bavariae.

384 The Medals^ JeUms^ <md Tokens Illustrate of SanitcUion.

Silver, bronze. 42 mm. Kluyskens has Pfeufer. Kluyskens,
ii., p. 312 ; Duisburgy p. 172, cccclxiv. Unknown to P. and R.

icx)8. Obverse, Bust. Beneath, C.Voigt. Inscription :
Carl V. Pfeuffer. Prof. D. Heilkunde,

Reverse plain. Bronze. Duisburg, Supplement (I.), 1863,
p. 9. Unknown to Kluyskens.

G. Italy.

Dr. Giuseppe Ferrario, of Milan. " Istruzione al popolo
per curarsi del colera asiatico." Milan, 1854, 8**.

** Cenni storico-statistici sul pestilenziale colera-morbus
asiatico negli anni 1836, 1849 ^ iS54-" Milan, 1855, 8^.
•' I6td. per I'anno 1855." Milan (1856), 8^

** Avvertimento al popolo sui mezzi di distruggere, etc., del
cholera-morbus." Milan, i860, 8°. Already described in the
present Section, under The Plague.

H. Russia.

Dr. Ernst August Kupffer (1797-1867). Prominent in arrest-
ing the cholera of 183 1.

1009. Obverse, Inscription : In Sommer 183 1 Schwebte
Ueber Goldingen Der (here, as device, a figure of Death with
his sickle, flying, toward right). At left, Lange.

Reverse. Inscription : Da | Gab Uns Gott | in RV (Raths-
Verwandte) Schmidt [ Und Dr. Kupffer Heifer | In Der Noth.
I Das Erkennen Dankbare | Biirger. 35 mm. Duisburg has
Med. Dr., and Kupfer. Koehne, Zeitschrift^ vi., p. 26 ; Duis-
burg, p. 194, dxxii. ; P. and R., p. 155, No. 442. Unknown
to Kluyskens.

The other medals of cholera are the following :

A. Canada.

In a series of papers that I am now publishing in the Ameri-
can Journal of Numistnatics upon the medals, etc., illustrative
of medicine, generally considered, I shall fully discuss the
question whether there exist any medals struck in Canada
with reference to cholera. The following seem to be of this

The Medals J JetonSj and Tokens lUvstratvoe of Sanitation. 335

character, although at the date of their issue the epidemic of
1832 had not yet occurred. A little later, when speaking of
the similar tokens of Paris, I shall explain this seeming dis-
crepancy.

loio. Obverse. The Blessed Virgin standing upon the
globe, her hands irradiated. Inscription : O Marie Congue
Sans P6ch6 Priez Pour Nous I Qui Avons Recours A Vous
Exergue : 1830

Reverse. M surmounted by a cross (the monogram of
Maria). Beneath, a heart pierced by a sword. Around,
twelve stars. Exergue : Grothe. Oval. 20 x 25.

Upon this class of medals both the Sacred Hearts, of Jesus
and Mary, are usually represented, instead of the former of
them, as here. McLachlan, American Journal of Numismatics^
July, 1881, p. 9, ccii. ; ibid.^ Canadian Numismatics, Mon-
treal, 1886, p. 51.

Mr. McLachlan states that " Grothe, whose name appears
on this medal, had at that time an extensive silversmith's
establishment (in Montreal). The dies are said to have been
engraved by Beaume. We may therefore class it as the earli-
est medal of purely Canadian workmanship."-

loii. Obverse. Device as in preceding. Inscription:
Marie Congue Sans — P6ch6 Priez Pour Nous.

Reverse. The monogram as in preceding; but both the
Sacred Hearts. The stars and name as above. Oval. 10x12.

Le Roux, le Medailleur Du Canada, 1888, No. 634, fig. .
This is much smaller than the preceding, the date is absent,
and the inscription upon the obverse is greatly abbreviated.
McLachlan thinks that there exists only the former of the two,
and that he possesses the only specimen. The latter of them
is admitted here solely upon the authority of Dr. Le Roux.
They are both unknown to P. and R.

B. Holland.

a. Amsterdam {^%i2y 1866?).

1012. Obverse. The Arms of Amsterdam ; two Uons,
erect, upholding a crown. Inscription : Cholera-Commissie
Te Amsterdam' Exergue : MDCCCXXXli. | TP-Schonberg F

Reverse. Blijk Van Erkentenis* | Aan' followed by the

336 The MedalSy JeUms^ and Tokens lUustraivve of Sanitation.

name of the recipient. In P, and R/s specimen this was Dr.
J. B. Klonstrup, Jr. ; in that of Durand, Dr. G. J. Stork, and
in that of Dr. Fisher, H. | Meijer Hz" Durand, p. 194 ; P,
and R., p. 158, No. 448. In the Fisher collection.

1013. There is another cholera medal of Amsterdam, of
which I have only the following description :

** Eerepenning van wege de regeering voor onverplicht
dienstbetoon aan cholera-lijders of hunne betrekkingen. In
18(66).** (Medal of honor conferred by the Government for
voluntary attention to cholera patients and their surround-
ings.) Dies by J. Elion. Bronze. 58 mm. Bom and Son
Cat., Amsterdam, 3 Nov., 1884, No. 4271, Unknown to P.

and R.

6. Grontngen,

1014. By D. VanderKellen. 60 mm. Conferred by the
Town Council, for special official services during the cholera.
Gold, silver, bronze. Ibid,, No. 4255. Unknown to P. and
R. There were struck in all thirty of these medals ; one in
gold, twenty-seven in silver, and two in bronze.

c. Utrecht.

Reference has been previously made to the medal given to
Dr. B. F. Suerman of this city, No, 994,

C. Belgium.

a. Brussels (1832, 1849, 1866).

1015. Obverse. Head to left, encircled with oak leaves.
Inscription : Leopold Premier — Roi Des Beiges. Beneath,
Braemt F.

Reverse. Beneath a wreath, Reconnaissance Publique* In-
scription : Services Rendus Pendant Le Chol6ra*i832* Gold ;
bronze. 37 mm. Guioth, p. 142, pi. 18, No. 151 ; Kluys-
kens, i., p. 297 ; P. and R., p. 158, No. 449.

1016. • As preceding, but smaller. Silver. 16 mm. Guioth,
p. 142, pi. 18, No. 152 ; Kluyskens, i., p. 297. In the Fisher
collection. Unmentioned by P. and R.

1017. Obverse. Bust to left. Hart Fecit. Inscription :
Leopold Premier Roi Des Beiges.

The Medals J Jekma^ and Tokens lUvstraiive of Sanitation. 837

Reverse. A female figure with couchant lion, distributing
laurel wreaths to two sitting figures ; one of whom, a male,
represents Science, and the other, a female, clasps two infants
in her arms. In background, figures bearing a patient.
Legend: Recompense Nati'onale. Exergue: Cholera — 1849.
Hart.F. Silver. 37, In the Lee collection. Unknown to
P. and R. I owe its description to Surgeon J. S. Billings,
U.S.A.

Concerning the next in sequence I am as yet without exact
information, but I insert it here at the suggestion of Dr.
William Lee, of Washington.

1018. A female holding branch over another who kneels
beside a stricken youth. In background, a statue of Hygieia
— 1849. Bronze. 36. Cogan sale March i6th-i8th, 1883,
No. 986. Unknown to P. and R.

The epidemic of 1849 ^^^ ^^^^ ^^ ^^54 ^^^ ^'^^ referred to
upon No. 996, the medal of De Brouckere.

1019. Obverse. A female, with masonic emblems, a twig
in her raised right hand and a wreath in her dependent left,
stands near an altar, against which two oval shields are lean-
ing. To left a B, a circle, etc. Two pediments : upon the
left one the letter J, and beneath, a twig ; upon the right, B.
At their base a branch of roses. Inscription: R. •-□ Des.
Amis Philanthropes. Exergue: Or.'.De Bruxelles

Reverse. Beneath two branches bound by ribbon, La | □
.-.Au T.-.C.-.F.\ I Jules Anspach | Son V6n.-.M.-. I Pour Sa
Conduite | Vraiment Mag.*. | Pendant L'fipid6mic | De L'An
De La | V.".L.'. | 5866* (1866). Bronze. 48 mm. Marvin
has Ven., and La for Sa. Marvin, Medals of the Masonic
Fraternity, p. 88, No. CCX. ; P. and R., p. 167, No. 477.

D. France.
a. Bourbonne (1832).

1020. Obverse. Inscription : £pid6mic Du Cholera 1832^
Reverse. Within a crown of oak and laurel : Au Docteur

F6rat La Ville De Bourbonne Exergue : A. Caqu£ F. Sil-
vered bronze. 31 mm. Duisburg inserts a dot before the
date. Kluyskens, i., p. 297 ; Duisburg. p. 74, dxciv. Un-
known to P. and R,

29

338 The Medals^ Jetana^ cmd Tokens lUustroMoe of Somiiation.

b, ' Chateauroux (183 2).

1021. Obverse, i^sculapius (HippocrateSt Lee) warding
death with his scythe from a sick woman. A corpse at left.
Attendants with disinfectants, and grieving friends. At right,
E. Rogat 1832. Exergue : Invasion Du Cholera | En 1832'

Reverse. Within oak wreath an old chateau with two lateral
towers. Inscription : Ville De Chateauroux Reconnaissante
31 Mai An 15, 7*'*- Bronze. 84 mm. 53.

This obverse is the same as that of No. 102 1, which is fig-
ured by P. and R. In the Lee Collection. Unknown to P.
andR.

c. Douau

1022. La Ville De Douai Au Corps M6dical A L'Occasion
Du Cholera. Bronze. Minart Cat., Paris, 1880, No. 3762.
Unknown to P. and R.

d. Paris (1832, 1848).

1023. Obverse as that of the last but one.

Reverse. A thick oak wreath. Field vacant for name of
recipient. Bronze. 84 mm. Kluyskens, i., p. 297 ; P. and
.R., p. 159, No. 450, fig. of obverse.

Either this or No. 1021 is in the U. S. Mint Collection.
.Snowden mentions it in his " Miscellaneous Medals" (Medallic
Memorials of Washington in the U. S. Mint, p. 128, No. 41),
and calls ^sculapius " the Good Samaritan.'*

1024. Obverse. iEsculapius attending a patient with
vcholera, whom a female (the city of Paris) sustains. Above,

the Genius of Pestilence. Legend : G6nerosit6 — D6vouement
.Exergue : 1832 | J'Vatinelle InvEt F*

Reverse. Within an oak (P. and R. ; laurel, Kluyskens)
wreath : Louis — Philippe | R6gnant | La Ville De Paris | A |
iF-Mouillef I Le C- D'Argout Ministre | Le C^' De Bondy |
Pr6fet' Bronze. 69 mm.

Kluyskens*s specimen was a proof, and instead of a recipient's
mame, it had Essai engraved. He also gave C*** Kluyskens,
J., p. 298 ; P. and R., p. 159, No. 451.

1025. Obverse. Bust, to right. Beneath, Gayrard'F-
•Inscription : Hyacintvs — Lvd* De Qvelen* Archiepiscopvs*
Parisiensis*

The Meddlsy Jetons^ amd Tokens lUuetrative of Sanitation. 339

Reverse. " St, Francis De Paula" (5/. Vincent De Paul ?)
seated, with nuns and children at his feet. Legend : Orphano'
Tv — Eris — Adjvtor Exergue : Cholera'Morbo | Ingravescente
I MDCCCXXXir Mr. Frossard (Cat. of ninetieth sale, March
I2th-I3th, 1889, No. 801) calls the saint "the praying arch-
bishop." Bronze. 37 mm. 24. /iti/., p, 159, p. 452.

1026. Obverse. The saint, kneeling. Inscription : St
Roch Priez — Pour Nous*

Reverse. *S* Roch | Pr6servez | Nous | Du Cholera Oval.
Bronze. 23 x 19 mm. Itid.^ p. 159, No. 453 ; Die deutschen
Pestamulete, p. 492.

Mr. Edouard Frossard, of New York, in his eighty-ninth
Sale Catalogue (Hart collection, December 26th-28th, 1888,
No. 567), speaks of this medal as having been struck specially
for the parish of St. Roque, Quebec. He is doubtless in error,
and it is not mentioned as Canadian by either McLachlan or
Le Roux.

1027. Obverse. The saint, kneeling. Inscription : S*
Roch Pr6servez Nous De La Peste.

Reverse. St. Hubert, kneeling before the miraculous stag.
Inscription : S* Hubert Priez Pour Nous Oval. Bronze.
18 X 14 mm. P. and R., p. 159, No. 454 ; Die deutschen
Pestamulete, p. 492.

1028. As belonging to this same epidemic of 1832, P. and
R. class the many French medals, sometimes styled " miracu-
lous," consecrated to the Immaculate Virgin, with a serpent,
here not merely the personification of original sin, but of pesti-
lence, beneath her feet. Most of these bear upon the reverse
the Sacred Hearts of Jesus and of Mary, with monogram and
a cross, irradiated or not, and surrounded by stars. Of these
I possess no less than nine varieties. There are others in my
collection with the same obverse, but apparently unknown to
P. and R., which have the following reverses : St. Louis De
Gonzague, St. Ignace De Loyola Priez Pour Nous, Sta. Anne
M6re De Marie with the same invocation. Souvenir Du JubiI6
1 85 1, and Ecce Panis Angelorum ; the last but one of which
shows how an old die is often misled with a more modern one.

Of a similar character, and probably issued for the same pur-
pose, are medals bearing an English inscription, but whether
struck in England^ Canada, or the United States, or in all of

340 TTie Medals^ JetonSy omd Tokens Illustrative of Sanitation.

these countries, I have not yet ascertained. The device of
their obverse is as just described, and the legend, O Holy
Mary Ever Virgin And Conceived Without Sin | Pray For Us
Who Implore Thy Aid ; or, as in some of them. For Us Who
Have Recourse To You. Of these, of the Sacred Hearts'
type, irradiated and not, I have sixteen varieties, and six
others with the same obverse and the following reverses : Ecce
Panis Angelorum (a large and very beautiful medal of the
Adoration of the Blessed Sacrament), St. Patrick Pray For
Us, Congregation of the Children of Mary, D**. of the Holy
Child Jesus, and Remembrance of The Holy Mission (from
three sets of dies). To the German issues, of the same type,
I shall subsequently refer.

Some of these medals bear the date of 1830, and would at
first seem excluded from the cholera classification in point of
time. As, however, the epidemic in question started from
India in 1827, and reached Orenburg in 1829, and Astrakhan
in 1830, although it did not arrive in Germany till 183 1, and
in France till 1832, it is probable that these medals were struck
in the hope that prayers through the Divine Mother might
arrest the threatening scourge.* Especially does this seem to
be the case in view of the history of the following :

1029. Obverse. The Mother of God, upon the globe. In
the field, stars ; above, sunbeams. Inscription : Medaille
Anti Chol6rique. Beneath, very small, 1848.

Reverse. Around a star, Anti | Chol6rique Beneath, very
small, Gamier A Paris. Inscription'*: M6tal Compost *Pr^-
servatif* Beneath, very small, D6pos6.' 18 mm. P. and R.,
p. 163, No. 464 ; Die deutschen Pestamulete, p. 492. Al-
though this was issued in 1848, evidently in the endeavor to
ward off the approaching epidemic, it was not till 1849 ^^^^
the cholera reached Calais and Dunkirk, and then Paris. The
medal was followed by that next described.

1030. Obverse. The Phrygian cap between two skulls and
cross-bones. Above, Republique ; beneath, Frangaise.

Reverse. Medaille \ AntichoUrique. Beneath, 1849 between

* The religioui medal of St Martial, with the date of 1830, I have mentioned
under Small Pox, with the intimation that it may have been stnicit at Limogei
during the prevalence of that disease, although it may prove npon further in*
vestigation to have been another cholera medal, lilce those above.

l%e MedalSj JetonSy and. Tokens HktstnUive of Sanitation. 841

a cross and an anchor. Legend : Saint Roch Priez Pour Nous
Octagonal. Tin. 34 x 45 mm. P. and R., Die deutschen
Pestamulete, p. 492.

e. Marseilles (1835, 1849, 1854).

103 1. Obverse. The arms of the city.

Reverse. Within an oak wreath : Chol6ra | 1835 | Marseille
Reconnaissante' 56 mm. P. and R., p. 160, No. 455.

1032. Obverse. The arms of the city.

Reverse. Within an oak wreath : Marseille | Reconnais-
sante | Chol6ra | 1849' Beneath, small, Robineau. Silver.
28 mm. /did., p. 163, No. 465.

1033. Obverse as preceding.

Reverse as in the last but one, save 1854. 56 mm. Idid.^
p. 163, No. 466.

/. Toulon {iS6s).

1034. Obverse. The City Arms. Inscription : Epid6mie
De 1865 — La Ville De Toulon Reconnaissante.

Reverse. A laurel wreath, with space for name of recipic^nt.
Idid.y p. 167, No. 476.

D. Germany.

a. Berlin {iS^i-^z).

1035. Obverse. Within a circle, the angel of pestilence
with flaming sword and cup of poison threatens a seated and
shrinking female wearing a mural crown, who leans upon a
shield bearing the arms of the city. To right, CPfeuffer F.
Inscription : Demiithiget Euch Nun Unter Die Gewaltige
Hand Gottes* Exergue : Berlin Von Der Asiaf | Cholera
Erreicht | D*3i Aug- 1831*

Reverse. A similarly crowned female kneels in thanksgiving
before an armorial shield resting against a tree. Beneath, to
left, G*Loos D* Inscription : Bei Dem Herm 1st Gnade Und
Viel Erldsung* Exergue : Von Der Plage Erl5set | D*30
Januar | 1832. Silver, bronze. 37 mm. Kluyskens has De
Muthiget, and P. and R. in their edition of 1880 have Peuffer.
Kluyskens, i., p. 298 ; P. and R., p. 155, No. 443, obv. fig-
ured. In the Fisher collection and my own.

342 The MeddUy Jetons^ and Tokens IlkuitraUve of SaaiitaUon.

b. Breslau {i%ii-i2).

1036. Both obverse and reverse as in preceding, save that
the shield bears the arms of Breslau, and that the dates in the
two exergues are different. In that of the obverse, there is
29 Sept., and in that of reverse 4 Januar.

1037. Obverse. The epidemic as a female, flying before
Hygieia. In background, the city. Inscription : 1st Den Die
Hand Des Herm Verldirzt? 4 Mos* 11, 23, Exergue : An-
fang D Choler- | D-29, T-Sepf | 1831

Reverse. A person rendering thanks at an altar. Beneath,
small, Less(e)r Inscription : Der Herr Giebt Mich — Dem
Tode Nicht Psal* 118, 18 Exergue: Dankfest Nach D- |
Cholera, Bresl* | D 22 -Jan 1832 Silver. 32 mm. P. and R.,
p. 157, No. 446.

c. Hamburg {i^ii-ii).

1038. Both obverse and reverse as in No. 1030, save that
on obverse the date is 8 Oct., and on reverse 22 Januar. Ibid.^
p. 158, No. 447.

d. Munich {iZz6, 1854-55).

1039. Obverse. The Arms of Munich ; a monk upon a
heart-shaped shield. At the sides, in Gothic letters, S(uppen)
A(nstalt)

Reverse plain. Both oval and four-cornered. White metal.
Neumann, No. 6, 872 ; Num* Zeitung^ 185 1, s. 99 ; P. and
R., p. 162, No. 460.
Soup ticket, during the epidemic of 1836.

1040. Obverse. Inscription : Talisman | Gegen Die |
Cholera

Reverse. Diese Medaille Wird In Der | Magengegend
I Auf Dem | Blosenleibe | Getragen* Copper. 32 mm.

In their " Pestilentia in nummis," 1882, P. and R. have
Gegfn. P. and R., p. 162, No. 462 ; Die deutschen Pestamu-
lete, p. 491. Worn during the cholera of 1836.

1041. P. and R., following Von Eyb (Miinzen und MedaiK
len der Stadt Munchen, No. 220), here include the heart-
shaped medalet, with the Immaculate Virgin, within an oval,
upon obverse, and the Sacred Hearts upon reverse, similar to
those already mentioned. The inscription is : O Maria Ohne

Ths Medals J Jetons^ a/nd Tokens lUustraiwe of Sanuation. 343

Siinde Empfangen | Du Unsre Zuflucht Bitt Fiir Uns. P. and
R., p. 162, No. 461 ; Die deutschen Pestamulete, p. 491 ;
Walter, Medallic Amulets and Talismans, Proceedings of Ameri-
can Numismatic and Arcfueological Society of New Yorky 1886,

P- 39-

1042. Obverse. Head, to right. Inscription : Maximilian

II — Koenig V'Bayem Beneath, C'Voigt*

Reverse. The Blessed Virgin standing upon a pillar, the
crescent beneath heir feet. Inscription : Patro | na — Bava |
riae'Zur Erinnerung An — Die Wicderherstellung | | Der
Mariens^ule — In Miinchen 1855* Upon rim, Zwey Gulden.
Silver. 36 mm. 23. P. and R., p. 165, No. 472. In the
collection of Mr. Robert Shiells, of Neenah, Wis.

1043. Obverse. The Blessed Virgin, with The Child, a
crescent under her feet. Beneath, T— B. At the sides :
Heilige | Maria — Mutter \ Gottes Exergue : Bitt Fiir | Uns
(Pray for us).

Reverse. Gedenke | Der | Gottes | Gnade, | Mariens [ Fiir-
bitte Und [ Schutzes* (Believe in the mercy of God, and
Mary's intercession and protection) | Anno | 1854-55' P. and
R. in their " Pestamulete" have Fiiebitte. Rhomboid in
shape. Brass. 36x24 mm. Ibid.^ p. 166, No. 475 ; Die
deutschen Pestamulete, p. 492.

1044. As the last, save that the die- cutter's initials are
absent. Ibid.^ p. 492.

1045-47. P. and R. also give three medals of the Blessed
Virgin, two of which are heart-shaped and the other oval, as
struck during this epidemic, which are without date and
closely resemble those already mentioned of 1830. They are
P. and R., pp. 165-66, Nos. 473-74 ; Die deutschen Pestamu-
lete, pp. 491-92.

Of interest in connection with the cholera of 1854-55, is the
medal conferred upon Dr. Pfeuffer, of Munich, by the phy-
sicians of Bavaria. This I have already described, No. 1004.

E. Austria.

a. Vienna {iSii-iZ).

1048. Obverse. The city of Vienna, over which hovers an
angel with sword and cup of poison. To the left a weeping

844 The Medals y JetonSy and Tokens Illustrative of SanUation.

woman, with mural crown, who leans against a pedestal.
Upon this : Wien | Von Der | Cholera | Erreicht | D:4:Sep:
I 1831- I ][Legend : Herr Dein Wille Geschehe

Reverse. A woman, erect, with thankful mien, before a
flaming altar, upon which : Erlost | D*i "April | 1832* At
left, over a hill, the rising sun, and at right, in background,
the city of Vienna, Legend : Bei Dem Herm 1st Gnade*
Exergue : Wien Bey F'Machts* Silver, 44 mm. P. and
R,, p. 156, No. 444.

F. Italy.

a. Brescia (1836).

1049. Obverse. The genius of Religion with a large cross
supports a sinking female, behind whom is an armorial trophy
with shield. In background, to right, a distant city. Inscrip-
tion : Deo'Praestiti' — Sospitatori Exergue : Zapparelli.

Reverse. A two-barred cross, beneath which : MDCCCXXXVI*
Inscription : Brixia Cholera Morbo Tentata Pristinae Reddita
Sanitati* Bronze. 52' mm. litd., p. 161, No. 458, fig. pf
obverse.

1050. Obverse. Inscription : Sacro Presidio Di Brescia*
Within field : Nel | Cholera | Del | 1836.

Reverse. A two-barred cross upon a pedestal. Inscription :
Voto — Publico. Copper. 21 mm. Idid., p. 161, No. 459.

6. Chtavari, near Genoa (1837).

105 1. Obverse. The Madonna and Child, before a curtain.
Legend : Hortus Conclusus Maria Patrona Incomparabilis.

Reverse. The fagade of a church. Inscription : Clavar-
enses A Diro Cholera Servati Vivebant. Exei^e : H. Lo*
renz F. Anno Domini 1837. Bronze. 31. In the Lee Collec-
tion. Unknown to P. and R.

c. Leghorn (1835).

1052. Obverse. Inscription : La Ven*A'C'Della Miseri-
cordia Di Livorno Within olive and cypress branches, tied
by ribbon : Ai | Capiguardia | Flagellante | II | Cholera | 1835
Beneath, small, G(iorgio)*N(esti)*

Reverse. Iddio | AH* Opera Procellosa | Sortilli \ Per Fare

Ths Medals^ Jetana^ a/nd Tokens Illustrative of Sanitation, 345

Prodigio | Di' Misericordia | Salvandoli. Bronze. 52 mm.
P. and R., p. 161, No. 457,

d. Parma (1855).

1053. Ooverse. The busts of the Grand Duke and Duchess,
to left. Inscription : Roberto TD-Di Parma Ecc-Luisa
M"Di-Borb'Regg' Upon neck : Bentelli.

Reverse. Within a wreath of oak and laurel : Alia | Carita
I Coraggiosa | 1855. Copper. 24 mm. Ibid.y p. 165, No.

471-

e. Turin (1835-36).

1054. Obverse. The Madonna upon a pedestal. To the
lefty a female with mural crown and a child bearing a shield,
upon which is a rampant bull, are making a votive offering.
To the right, ai man is supporting a sick woman who tries to
touch the Virgin's mantle. Beneath, to left, Galazzi F. Ex-
ergue : MDCCCXXXVI

Reverse. Matri'A'Consolatione | Ob'Aerumnam-Morbi'
Asiatici | Mire'Lemtam'Mox'Svblatam | Tantae'Sospitatricis*
Ope I Ordo*Dec'Pro*Popvlo | Votvm'Solvens-Qvod'Vovit |
An'M'DCCC'XXXV Bronze. 54 mm. 35. /Sw?., p. 160, No.
456, fig. of obverse. In the Lee Collection.

As to the following I am somewhat doubtful.

1055. Obverse. A Suor Cristina Pasquier Per Viril Lenno
Per Carita Intelligente Operosa Instancabile Angelica In XXX
Anni Di Governo E Nelle Piu Tremende Epidemie Segnal-
latissime (To the Reverend Sister C. P., etc.).

Reverse. La Direzione Del Manicomio Di Torino Inter-
prete Delia Publica Riconoscenza mdccclx (The Directors
of the Lunatic Hospital at Turin acting as interpreters of the
public gratitude). Bronze. 32 mm. In the Lee Collection.
I have not seen this medal and owe its description to Dr. Lee.
Whether or no the " tremendous epidemics*' that it chronicles
were of cholera, I am still uncertain. Unmentioned by P.
and R.

G. The Stateis of the Church.
a. JRxmu (1854).

1056. Obverse. Bust of the Pope, to right. Inscription :
Pivs IX'Pontifex-Maximvs Anno X* Beneath, P'Girometti F*

346 The Medals y Jetons, and Tokens lUAistrcUme of Somitation.

Reverse. The Holy Father, attended by two priests and
an officer, blesses a sick person upon a bed. At its side, a
third priest, kneeling. Exergue : Ad Sancti Spiritvs Lve
Laborantes | Invisit XI Kal'Sepf | A'MDCCCLIV. — 44 mm.
Ibid.^ p. 164, No, 467, fig. of obverse.

1057. Obverse. Within a heavy wreath of oak and laurel,
the bust of the Pope, to left. Inscription : Pivs IX* — Ponf
Max' Beneath, NicCerbara F.

Reverse. Pivs IX'Pont'Max* | Pater Indvlgentissimvs |
Senatori Et Conservatoribvs Vrbis | Anno 'Rep 'Sal •MDCCCLIIII
Lve Asiana In Vrbem Grassante | De Civium Incolvmitate
Praeclare Meritis | (here follow the names of the nine offi-
cials who are honored). Bronze. 82 mm. Ibid.^ p. 164, No.
468. :

1058. Obverse. The Madonna. Legend : Prima Vrbis
Et Orbis Tvtela.

Reverse. Maria Labis Nescia Qvod Pio IX P*M*Vbertatem
Vrbi Impetravit Lvem Asiaticam LenivifA'Chr'MDCCCLIV
37 mm. Ibid.^ p. 164, No. 469.

There is a medal of Pope Leo XII. blessing a sick person in
bed, with the legend Infirmus Eram Et Visitatis Me, which is
known as a hospital piece, and is often mentioned as com-
memorating cholera. This is undoubtedly, however, an error,
as the pestilence was not then in Europe, and upon the other
hand, the pontiff in question was noted for his great fidelity in
personally visiting and investigating the condition of all the
public institutions within the domains of the Church.

H. Spain.
a. Barcelona (1854).

1059. Obverse. The arms of Catalonia. Beneath, Car^
rasco. Inscription : A'D'Pascual Madoz Los Catalanes Resi-
dentes En Madrid*

Reverse. Colera Morbo, Agitacion Politica, Crisis Indus-
trial Afligieron A Barcelona Durante El Mando De Madoz.
Desde 10 Agosto A 20 Octobre De 1854. Su Abnegazion Y
Civismo Amenguaron La Intensidad De Estas Calamidades.
Bronze. 59 mm. Ibid.^ p. 165, No. 470.

To Young Physicians. 847

■ aii.i. ■! • I II I. , , m.

I. Poland.

a. Warsaw (1831).

1060. Obverse. An old man, with bat-like wings, holding
a vase before him, flies toward the right, where there is a
withered tree. Beneath, St.

Reverse. Pierwsze | Ziawienie Sie | Cholery | W Wars-
zawie (The First Appearance of Cholera in Warsaw) [ 183 !•
Silver. 23 mm. Hid., p. 154, No. 441.

J. Russia.

a. Goldingen (183 1).

This medal has already been described, No. 1006, when
speaking of Dr. E. A. Kupffer.

b. Odessa (1837).

1061. Obverse. The monogram of the Czar Nicholas I.
beneath a crown.

Reverse. In four lines of Russian (For the arrest of the
pestilence in Odessa). 1837. Bronze. 28 mm. Ibid., p.
162, No. 463.

1062. In addition to the above there appears to exist a
large oval " anti-cholera copper plaque" of 183 1. If such is
the case, it was unknown to P. and R., unless there be an
error in the date, in which it may prove one of those of Mu<^
nich in 1836.

Frossard sixty-fifth sale, February 19th, 1887, No. 175.

{To he conHnuid.)

To Young Physicians.— There is said to be a barber's
sign near the Palais Royal, Paris, bearing the following legend
in the vernacular : " Callileucocapillaire water which colors
the hair white. For the use of young physicians and magis-
trates."

848 Sitka.

SITKA.*

By Passed Assistant Sorgeon C. W. Rush, U. S. Navy.

The inhabitants of Sitka are chiefly Russians and Indians,
there being but few Americans. The number of Indians
varies with the season, as during the summer most of them are
absent hunting or fishing for their winter supply of food.
They return to Sitka usually about November 1st, but the in-
creasing attractions of Juneau, with its dance-houses and
theatre, have mfaterially reduced the population of the ranch.
At present there are about five hundred, while during the last
winter there were between twelve and fifteen hundred. Phthisis
and the various forms of scrofula are rapidly diminishing their
number. In spite of the influences of civilization they adhere
so strongly to their old customs that any attempts at medical
treatment from the whites, if not refused, are submitted to
with reluctance, and as a result, particularly in the case of
children, the mortality is very high.

During the past winter erysipelas has prevailed to an alarming
extent throughout the ranch, and maily deaths have occurred
from its cause.

Bronchitis and catarrhal pneumonia among the children are
common, and in many cases are fatal because of neglect and
the lack of proper treatment. Rheumatism in a subacute or
chronic form is common among the males, and the peculiar
deformities resulting therefrom are especially noticeable among
the Sitka tribe. While on the summer cruise all Indians who
applied for treatment were furnished with medicines by per-
mission of the commanding oflficer. At Chilcat and a small
village at the head of Taiya Inlet many cases of purulent
ophthalmia in children were presented for treatment. Those
who came regularly and followed directions faithfully were
soon relieved, but the majority made but one visit to the ship.
This disease I believe to be a prominent cause of blindness,

* From Report of the Chief of the Bureau of Medichie and Surgery, U. S.
Navy, i888.

SUka. 349

which is by no means uncommon among the Indians, both
adult and children. As a rule the Indians from the northward
and the interior are far superior physically to those of Sitka.
They are taller, more robust and muscular, and present fewer
evidences of chronic disease, but syphilis is everywhere present.

When we consider the exposure to which they are subjected,
and the primitive attempts at either relief or cure of disease,
it is not surprising that the mortality among these Indians is
so great. The primary results of civilization among such a
people are never encouraging. The white man's vices are far
more attractive to the Siwash than his virtues, and time alone
can bring about the avoidance of the former and the adoption
of the latter. When we think of the Siwash " doctor," with
his hideous masks and his doleful incantations, it is not strange
that impressions such as they must have produced are not
easily removed ; and we can hardly expect the average Indian
to have much faith in the white man's treatment. The posi-
tion of " medicine man'' was so lucrative, and at the same
time commanded so much respect from the Indians, that
attempts to abolish his practices have met with great oppo-
sition, both by the *' doctor" himself and those of the tribe
who were impressed with his wonderful abilities. But the
prompt arrest and punishment of the offenders has made the
distinction an undesirable one, and it is only in places that are
rarely visited by the whites that a " Siwash doctor" can now
be found.

Their treatment of young girls is» perhaps, as fair an illus-
tration as can be found of their brutality and cruelty. Upon
the appearance of the menses the girl was taken and confined
at some distance from the camp, in a small hut or tent, only
large enough to admit her in the most cramped position.
Here she was kept, for a period varying from a few months to
a year, entirely shut oflf from every one, her food being passed
into the hut, and she was regarded by all the tribe as unclean
and unBt to associate with them. While on the cruise several
of these unfortunates were discovered and released by the
commanding officer, and speedy punishment promised for a
repetition of the offence.

Southeastern Alaska is noted for its mineral springs, and
there is scarcely an island but has one or more. On BaranofT

350 The Microbe of Malaria.

Island there are four, the most important of which is situated
on the western shore, about eighteen miles south from Sitka.
These springs, both hot and cold, are strongly impregnated
with sulphur, iron, or magnesia, and some contain various pro-
portions of each. During the Russian occupation of th^
country a hospital under the charge of the army was located
at this place, and not only were soldiers treated there, but
citizens were allowed free use of the waters. The medical
officer stationed at Sitka made semi-weekly trips to the springs,
and it is said that in most cases no medicine other than the
waters was used. People from all parts of the Territory went
there for treatment, and wonderful cures are related by men
whose word is beyond question. The place is still resorted to
by patients afflicted with rheumatism and venereal disease,
and, from my own observation, I am forced to believe that
benefit results from the use of these waters.

An enterprising trader has erected several houses at the
place and charges visitors at the rate of $i per day for the use
of bath-tubs which he has built. During the summer there
are always from six to a dozen patients there, and in the
♦majority of cases they return greatly improved if not wholly
cured.

It would be interesting to know whether or not cases orig-
inating under my own observation would be equally benefited,
and if the permission of the department to send patients there
could be obtained sufficient data might be accumulated to
form an opinion as to their curative value.

The Microbe of Malaria. — At a recent meeting of the
Academy of Sciences, Professor Bouchard presented, in the
name of Professor Laveran, of Val de Gr&ce, a memoir on the
parasite of impaludism. The parasite brought to notice by
the author in 1879 ^^ considered as being incontestably that
which produces intermittent-fever. Everywhere where cases
of fever were examined the same organism was found, and
that not only in France, but also in Germany, in Italy, in
Russia, in Algiers, in Madagascar, etc. M. Bouchard, there-
fore, considers it as demonstrated that intermittent-fever is
due to the parasite discovered by Dr. Laveran. — The Lancet,

Editor's TabU. 861

EDITOR'S TABLE.

fe^ALL correspondence and exchanges and all publica>
tions for review should be addressed to the Editor, Dr. A. N.
Bell, 113A Second Place, Brooklyn, N. Y.

Subscribers will please conform to conditions of detachable
order on advertising page.

The Disinfection with Steam Advised for the * * Bos-
ton."— We regret that a strong impression created by conver-
sation with one of the members of the Board of Medical
Officers of the Navy, who recommended the use of steam at a
temperature of 220° F. for the disinfection of the ** Boston,"
and negligence to refer to the report in our January number,
when we recalled the subject editorially in February, led us
into a misrepresentation of the intent of the board. It did
not recommend the application for two hours — did not desig-
nate the time at all ! But we are now informed that the board
never contemplated more than ten minutes' exposure at that
temperature ; and in a subsequent explanatory note (when it
was found that the Bureau of Construction objected to the use
of steam on account of its injury to the lining woodwork),
reported that two hours' exposure to steam of 150° F. would
probably accomplish the same result.

The Happiest of Nations— France ?— It has been said
that the happiest nation is that in which the proportion of
men and women is most nearly equal, in which the number of
illegitimate births is least, which contains the greatest number
of healthy adults, in which the average life is longest, and in
which the proportion of people beyond sixty years of age is
the highest. According to the Paris Temps^ France is the
country in which all these conditions are most fully met.
While in Great Britain there are 750,000, and in Germany
1,000,000 more women than men, in France the excess is only
92,000. Between the years 1825 and 1867 the illegitimate

352 Miiar's TdUe.

births varied in the different countries of the Continent from
8.2 to 25 per cent, but in France they were only 7.2 per cent.
The mortah'ty in England is 31, in Germany 38, and in France
23.8. The proportion of inhabitants between fifteen and
sixty years of age isgreater in France than in any other coun-
try, and the same favorable showing is made for the average
duration of life and for the number of vigorous old people.

Investigations by M. Chervin, published in a recent number
of the Gazette Hebdomedaire des Sciences Medicales de Bordeaux^
show that, of 10,425,321 families in France, 2,073,205, or
twenty per cent, are childless ; 2,546,611, or twenty-four per
cent, have but one child each; 2,265, 3i7,or twenty-two per
cent, have two children each ; 1,512,054, or fifteen per cent,
have three children each ; 936,853, or nine per cent, have four
children each ; 549,633, or five per cent, have five children
each ; 313,400, or three per cent, have six children each ; and
232,188, or two per cent, have seven children each.

Excluding the 2,073,205 families that have no children,
there are only 8,352,116 that contribute to the increase of the
population. This gives an average of 259 children for every
100 families, but if those having no children are included the
average will be but 207 for each 100 families, or a little more
than two children in each household. Those having no chil-
dren, the families being unrepresented, drop entirely out of
existence in time. Of those having only one child there is
only one representative for father and mother, and such
families, unless by alliances with others, would disappear.

Families having two children would barely be represented if
sickness, wars, epidemics, and other causes did not reduce the
number thus left. Only 3,544,188 families, representing
thirty- four per cent^ contribute to maintain the population ;
while 6,881,133, or sixty-six per cent, contribute nothing.
This small increase explains the almost imperceptible increase
of the population in France.

The departments having the least increase are those in the
northeast, the northwest, the southeast and the southwest.
In these the average number of children for 100 families is
from 200 to 228.

The departments having the greatest increase are Brittany
and Poitou on one side and Savoy, Auvergne, etc. In the

EcUtar'B TcMe. 863

north, Flanders and Loire scattered, which give an average of
285 to 340 children in the household.

The interest of the State in the conservation of infantile
health and life may be appreciated by reference to the illus-
trated article under the head of " Charity Institutions of
Paris," on preceding pages.

The Journal Offi^iel, recently issued, reports the vital statis-
tics for the last year as follows : 278,056 marriages, 899,33^
births, and 842,797 deaths, showing an increase in the popula-
tion of 56,536 individuals, or 3920 more than during the pie-
ceding year. In spite of the increase, however slight, it is
noteworthy that there is a steady decrease (12,808 annually)
in the births during the last seven years. Of the total number
of births registered during the year, 73,854 were illegitimate,
giving a proportion of over 8 per cent of the whole. In the
department of the Seine (Paris) the percentage reached the
high figure of 25, while in that of Finisterre it sank to 2. The
average number of deaths per 1000 for the year was 22.

The total number of suicides was 7572. Of these, one fifth
were in and around Paris. Poverty appears to have caused
only 483 suicides throughout France, and this number includes
a morbid fear of impending misery without actual privation.
To mental aberration 1975 cases were traced, and 1228 to
physical suffering. Among the moral causes domestic trouble
comes first, and alcoholism next. Disappointed love and.
jealousy caused respectively 200 and 27 cases ; dislike of military
service, 25. The suicidal month of the year is July, and it is
noteworthy that since the establishment of ihefite on the
14th, suicides have increased.

The Medical Society of the State of New York

held its eighty.third annual session in Albany, February* 5th-
7th inclusive. The number of papers on the programme was
so large — and for the most part excellent — as to require a
division of the society into sections for their proper dis-
posal.

The opening address of the President, Dr. Samuel B. Ward,
of Albany, besides citing some of the prominent evidences of
professional advancement during the year since the society
last met, and stating the necessity for division into sections,

23

854 miUyr'B TaUe.

invited special attention to a recent judicial decision on What
Constitutes Insanity? "Within the past year, two of our
professional brethren, here in Albany, have been placed in a
somewhat novel and disagreeable position, as the result of ex-
amining a man whose actions had been such as to raise a doubt
concerning his mental soundness. It is a matter of no little
importance to us all, for any two of us might easily have found
ourselves in the same unpleasant predicament. Examination,
cautiously and properly conducted, showed the man to be the
subject of the delusion that his wife and daughter were con-
spiring to poison him — a perfectly unfounded suspicion. The
usual papers were made out, signed and sworn to, and he was
transferred from the jail to the insane asylum. He brought
suit through his attorneys to recover his liberty, and the case
came before Judge Learned, of the Supreme Court, who vir-
tually decided that no man could be judged insane and sent
to an asylum on the certificate of two physicians, in the way
usually followed, unless he had shown that he. was dangerous
to himself or others. Before this court and jury the man was
judged sane, though it was shown that he was laboring under
delusions. He then commenced action against the Recorder
and the two physicians to recover several thousand dollars
•damages. The defendants put in a demurrer, on the ground
that even if all the facts were as stated there was no cause for
■action, and the demurrer was sustained by Justice Mayham.
Appeal being taken to the General Term, a decision handed
down last December sustained the demurrer as to the Re-
'Corder, on the ground that he was a public official, but over-
ruled it as to the two physicians. It appears, then, that in
^accordance with the latest decision of the Supreme Court of
this State any two of us who express the opinion that a man
lis insane, on any other ground than that he is dangerous to
'himself or others, become thereby liable to the annoyance of
•a suit for damages.*'

Medical Expert Testimony^ the subject of Dr. Ward's anni-
versary address, we purpose to give entire hereafter.

Of other papers, viewed from The Sanitarian's standpoint,
the most notable was by Dr. George M. Sternberg, U. S.
Army, on ** The Etiology of Croupous Pneumonia," conclu-
sively demonstrating its microbic origin and the particular

Mitar'9 TabU. 365

microbe causing it that which was discovered by the author of
the paper in 1880, which he named after Pasteur.

Dr. Charles Storer, of Amsterdam, read a paper on " The
Municipal Control of Diphtheria/* in which he described the
excellent results of active sanitary measures against impure
water, surface filth, and foul ground air.

Dr. Stephen S. Burt, of New York, read a paper on ** The
Prevention and Treatment of Typhoid-fever," attributing its
prevalence in New York and other places to foul water, and
urging more attention to general cleanliness and drainage ;
and where these measures are not accomplished, to the im-
portance of boiling the drinking water as the most effectual
means for rendering it harmless.

" Purulent Conjunctivitis of Infants, and Blindness in the
State of New York," and " The Report of the Committee on
Blindness," by Dr. Lucian Howe, of Buffalo, were replete
with statistics and other information on the prevalence of eye
diseases, contagious and otherwise, and suggestions for pre-
vention and treatment. Blindness in the State was shown to
be rapidly on the . increase ; chiefly from neglect of purulent
conjunctivitis in infancy, largely spread by immigrants, espe-
cially the lower order of the Irish.

The " Report of the Committee on Quarantine Control"
was in favor of " home rule" as against the Marine Hospital
Service.

The " Report of the Committee on Hygiene" is given in full
on other pages.

Officers elected for the ensuing year : President, Daniel
Lewis, of New York ; Vice-President, Alfred Mercer, of Syra-
cuse ; Secretary, F. C. Curtis, of Albany ; Treasurer, C. H.
Porter, of Albany.

How Do Germs Induce Disease ?— Professor Victor C.
Vaughan, M.D., of Ann Arbor, in the American Lancet^
believes that the symptoms of disease are due to chemical
poisons. This admits of three explanations : i. Are the
germs poisonous ? No, for they may be injected in large
quantity, and death will occur no more quickly than if a small
quantity be injected, and chemical analysis has shown they
contain no poisonous element. 2. Do the germs produce a

856 Editor's TabU.

chemical ferment ? No, for it has been proven that the fluid
in which they resided will cause no disease if the germ be
filtered out. 3. Is it by splitting up the proteids producing
ptomaines ? This theory thus far seems tenable, and we have
evidence that every characteristic germ is capable of producing
its own characteristic ptomaine.

Hence, we may formulate a definition for an infectious dis-
ease. An infectious disease arises when a specific pathogenic
micro-organism, having gained admission to the body, and
having found conditions suitable for its development, grows
and develops, and in so doing produces a poison, which, being
absorbed, causes the characteristic disturbances.

We will take note that the germ must be specific, must pos-
sess the same characteristics at all times. The germ of one
specific disease cannot cause another disease. And it must
find a suitable soil for development, or it will not develop.
Koch found that the cholera bacillus would not develop in a
normally acid gastric juice, but when sodium carbonate was
added the germ developed. Typhoid- fever develops a pto-
maine that if isolated and injected into a healthy being will
produce the fever. So also of anthrax, cholera, tetanus, etc.

A ptomaine is a substance, basic in character, produced by
the action of germ proteids.

Of what practical value is all this is often asked.

1. If it be the truth all truth is worth knowing.

2. Knowing the truth must always be of service to us,
sooner or later.

HoT-AiR Inhaijltion as a Cure for Phthisis.— At the

meeting of the Section in Theory and Practice of Medicine
of the New York Academy, February 19th, 1889, Dr. A. L.
Stearne exhibited and described the apparatus recently devised
by Weigert for heating air for inhalation, and gave an account
of the results which followed the use of air so heated by con-
sumptives. The apparatus consists of a stand supporting a
double cylinder covered with asbestos. The interior of the
inner cylinder is heated by means of a Bunsen burner, so that
air drawn in between the two cylinders is heated while it is at
the same time disinfected — if it contains any impurities — by
Itieat. At the outset of treatment by this means the patients

Editor's TcMe. 357

were made to inhale air at a temperature of 212° F. for thirty
minutes. Gradually the sitting was prolonged to two hours,
both morning and evening, and the temperature of the air was
slowly increased to the highest point each patient could en-
dure without discomfort ; the maximum reached in any case
had been 482^.

The chief results were the following : I. The pulse, at first
faster, became slower as the inspirations continued, and the
respirations became deeper. 2. The body temperature rose
at first one or two degrees, but in the course of an hour sank
to normal, the exhaled air having a minimum temperature of
113® F. 3. While the general health remained undisturbed,
the difficulty in breathing was at once removed ; there was
lessening and finally cessation of cough, fever, and night-
sweats, and the appetite and strength improved. The disease
in time came to an end in fact, the hemorrhages, catarrhal
lesions, infiltrations, and the dilatations of the bronchi all
being put a stop to ; cavities underwent cicatrization ; the
weight increased rapidly, especially where emaciation had
been extreme ; and the bacilli slowly disappeared from the
sputa, sometimes in as short a time as fourteen months.

Phthisis prom House Sweepings.— The Munchener Me^

dicinsche Wochenschrift^ No. 308, reports that Carnet has ex-
perimented with the dust obtained from the walls and floors of
various dwellings in which tuberculous patients have been,
inoculating guinea pigs with it, and carefully excluding all
possibility of infection from outside sources. In this way,
twenty-one rooms of seven Berlin hospitals were examined,
and bacilli found to have been present in the dust from most
of them. Positive results were also obtained with the dust
from insane asylums and penitentiaries.

The dwellings of fifty-three tubercular patients were investi-
gated in the same way, and the dust in the neighborhood of
twenty patients found to be virulent. It was the case, with
absolute regularity, that the dust was always virulent when
the patient had been in the habit of spitting on the floor, or
in a handkerchief, while it was never so when a spit-cup had
been employed.

358 MUar's Table.

A •* Cremator " Cremated.— By the New York press tele-
graphic reports of March 2ythf 1889, we learn that the cremator
erected by Chicago for the burning of the city's garbage was
burned to the ground by an incendiary fire the day before ;
and that citizens in the neighborhood have been indignantly
remonstrating against its use for some time, alleging that it
created an unbearable stench.

This is understood to be the " Distillery Crematory" — ^the
Mann patent — ^which was so enthusiastically urged by its
patrons at the Milwaukee meeting of the American Public
Health Association in November last. As at that time in
operation in Buffalo, it was said that the entire running ex-
penses could be defrayed by the lubricating oils extracted
from, and the residual manure of, the garbage " cremated ;"
and that the process was entirely free from offensive odors.
The one at Buffalo has since been reported a nuisance, and
that at Chicago as above. It is to be hoped that rendering'
apparatus, such as this appears to be, will not detract from or
prove to be an obstacle in the way of the growing interest in
garbage cremation, and the adoption of such cremators as will
effect the purpose without nuisance.

Dried Potatoes. — In the Voenfto-Sanitarnoie Delo, Dr.
Jakov M. Shmulevitch emphatically draws attention to dried
potato as an important food article, possessing some very
valuable advantages in comparison with the vegetable in fresh
state. The advantages claimed for the article are these :
(i) While fresh potatoes easily rot, blacken, and sprout, dried
potatoes, when kept duly protected from moisture, remain in the
best condition for a very long time ; and (2), being by-far lighter
and less bulky than fresh potatoes, are by far more convenient
for preservation and transportation, which point has a great
practical importance, especially in time of war. To be fit for
culinary use, the article requires a preliminary maceration in
water for ten or twelve hours.

Aged 109 Years. — The longevity of Chesley Heal, a resi-
dent of Searsmont, Me., who died in October last, at the ad-
vanced age of one hundred and nine years, ten months and
twenty days, is ascribable to his simple life, which was that of

Editor's TcMe. 859

an agriculturist, unbroken by worry or excitement of any kind.
He retired and rose with the sun ; had a good appetite and
freely indulged it, meat being an important part of his diet ;
and he was a tobacco chewer from boyhood. His education,
or rather his lack of it — for he could neither read nor write,
and consequently the excitement of the daily papers was un-
known to him, and he bad never put foot on car or steamboat
— was a bar to the most harassing incidents of progressive
civilization. His perverse fondness of meat and tobacco were
apparently the only elements which should have militated
against his longevity ; but they did not, unless we assume
that he might have been still living if he had been more
abstemious.

Intoxication.— The Medical Register sdiys that it is claimed
that half a teaspoonful of chloride of ammonium in a goblet
of water will almost immediately restore his faculties and
powers of locomotion to a man who is helplessly intoxicated.

The Number of Immigrants landed at Castle Garden
during the year 1888, reported by the Commissioners of Emi-
gration, was 370,822, of whom 237,856 were males, and 132,966
females. The nationalities chiefly represented were : Irish,
44,300; English, 38,355 ; German, 78,145 ; Russian, 33,052 ;
Swedish, 37,934 ; Italian, 43,927.

THE PROGRESS OF INFECTIOUS DISEASES AND MORTALITY
RATES AT THE MOST RECENT DATES, BASED UPON OFFICIAL
AND OTHER AUTHENTIC REPORTS.

Alabama. — Mobile, 40,000 : Reports 61 deaths during Feb-
ruary, of which 12 were under five years of age. Annual
death-rate, 18.3 per 1000. From zymotic diseases, 2, and
from consumption, 12.

California. — For the month of February, 1889, the Sec-
retary's abstract of the reports received from 67 cities and
towns, with an aggregate population of 665,700, the number
of deaths was 859. Annual rate, 15.48. Deaths from con-
sumption during the month, 165—19.20 per cent. From
zymotic diseases : Diphtheria and croup, 43 ; typhoid- fever,

860 Editor's TahU.

21 ; typho-malartal- fever, i ; remittent- fever, i ; cerebro-
spinal-fever, 14 ; diarrhoeal diseases, 9 ; whooping-cough, i ;
scarlatina, i ; small-pox, i.

San Francisco, — During the month of February, 1889, the
number of deaths was 484. From zymotic diseases, 53. From
consumption, 93.

Los Angelesy 80,000 : 54 ; from zymotic disease, 9 ; con-
sumption, 10.

Oakland^ 55»ooo : 74 ; from zymotic diseases, 9 ; consump-
tion, 10.

San DUgOy 32,000 : 19 ; from zymotic diseases, i ; con-
sumption, 6.

Sacramento^ 35>ooo : 26 ; from zymotic diseases, 3 ; con-
sumption, 4.

Connecticut. — The Secretary of the State Board of Health
reports for February, 1889, 922 deaths from 165 towns^ com-
prising a population of 731,851, representing an annual death-
rate of 15.0. Deaths under five years of age, 215. Deaths
from zythotic diseases, 136. From consumption, 12$.

Florida. — Pensacola, I5,CCX) : Reports 14 deaths in four
weeks ending February 28fh, 1889, of which 6 were under five
years of age. Annual death-rate, 12.06 per looo. From
zymotic disease there were 2 deaths, and from consumption, 2.

Iowa. — The State Board Bulletin for February reports since
previous issue :

Small'poXy two cases, at Ainsworth.

Diphtlieria at Alden, Sabula, Delta, Lake City, Clear Lake
township, Cambridge, Marne, Center Grove, Audubon, Doug-
las and Leroy townships, Mechanicsville, Orange City, Plain-
field, and Thor.

Scarlet-fever at Story City, Solon, Tama, Lake City, Paul-
Isna, Toledo, Marne, Shelby, Anita, Lohrville, Parnell, San-
born, Decorah, Kingsley, Lucas, Webster township, Polk
County, Woodward, New Sharon, Lone Tree, and Hedrick.

Illinois. — Chicago^ 830,000 : Reports 1072 deaths during
February, of which 524 were under five years of age. Annual

MUar's TahU. 361

death-rate, 15.50 per 1000. From zymotic diseases, 197, and
from consumption, 112.

Louisiana. — New Orleans^ 248,000 : Reports for four
weeks ending February 23d, 425 deaths, of which 97 were
under five years of age. Annual death-rate per 1000 among
whites, 18.04; among colored, 32.84. From zymotic diseases
there were 35 deaths^ and from consumption, 68.

Maryland.— AzZ/iw^^, 500,343 : Reports 632 deaths dur-
ing the four weeks ending February 23d, of which 216 were
under five years of age. Annual death-rate, 16.43 per 1000.
From consumption, 95.

Massachusetts. — Boston, 415,000: Reports 750 deaths
during February, of which 233 were under five years of age.
There were 106 deaths from zymotic diseases, and 118 from
consumption. Annual death-rate, 21.68 per 1000.

Michigan. — ^The Secretary reports that for the month of
February, 1889, compared With the preceding month, the re-
turns indicate a marked increase in the prevalence of pneu-
monia.

Compared with the average for the month of February in the
three years 1886-88, measles, intermittent-fever, consumption
of lungs, diarrhoea, bronchitis, and inflammation of bowels were
less prevalent in February, 1889.

Including reports by regular observers and others, diphtheria
was reported present in Michigan in the month of February,
1889, 21* thirty-one places, scarlet-fever at fifty-two places,
typhoid-fever at eleven places, measles at seven places, and
small-pox at ten places.

Detroit, 230,000 : Reports 259 deaths for February, of which
71 were under five years of age. Annual death-rate, 14.67 per
1000. From zymotic causes, 42, and from consumption, 20.

Minnesota. — Official report of infectious diseases for the
month of January, 1889 : Diphtheria, 143 cases, 45 deaths ;
scarlatina, 73 cases, 1 death. SmalUpox, a case of varioloid
in a woman, was reported in Minneapolis by Dr. Kilvington,

862 moot's Table.

under date of January 14th. " She had been in the city three
months. January 7th, went to a Scandinavian hotel on Thir-
teenth Avenue. Got sick there, and on the 27th went to a
friend's house. She was placed in bed with two children, in
a small unventilated room, and in same room with the father
and mother bf the children, there being no space between the
bed and the wall. Eleven other persons were exposed in this
house, beside one who had gone out of the city. She was
sent for and the whole number isolated and vaccinated. Six-
teen boarders and thirteen visitors at the hotel were vaccinated
and quarantined. One from the hotel was in the lockup. He
was released, vaccinated, and returned to the hotel, and fifty-
seven tramps in lockup vaccinated." It is by such vigorous
treatment that small-pox and other infectious diseases, as well,
may usually be stamped out.

Diseases of animals : Cases of glanders remaining isolated or
not accounted for, 15 ; reported during the month, 14 ; killed,
9 ; released, 9 ; isolated, 8. Remaining February ist, isolated
or not accounted for, 11.

Saint Paul, — Henry F. Hoyt, M.D., Commissioner of
Health, reports for the year 1888 : Population, 175,000 ;
deaths, 2078; death-rate, 11.80 — 1 171, or 56.34 per cent of
the deaths were of children under five years ; 549, or 26.4 per
cent of all, were caused by zymotic diseases. There were 358
cases of diphtheria, 281 of scarlet-fever, and 7 of small-pox.

The especially remarkable feature of these statistics is the
large ratios of infantile mortality, and from zymotic diseases
in conjunction with so low a death-rate in the aggregate.

Bad water, bad plumbing, and bad surface drainage are
urged as the chief conditions promotive of zymotic diseases,
and requiring municipal attention. During the month of Feb-
ruary, 1889, there were 141 deaths, of which 73 were under
five years of age. Annual death-rate, 9,40 per 1000. From
zymotic diseases there were 30 deaths, and from consump-
tion, 8.

Missouri. — St. Louis^ 440,000 : Reports for February 671
deaths, of which 288 were under five years of age. Annual
death-rate, 18.3 per looo. From zymotic diseases there were
158 deaths, and from consumption, 52.

Miior's TaUe. 363

New Hampshire.— Official organ of the State Board re-
ports for the month of February : Diphtheria in Somersworth,
Wolfeborough, Stratham. Dover, East Kingston, Manchester,
Lancaster, Moultonborough, Canaan, Rochester, Fittsfield,
Conway, Campton, and Henniker. The largest number re-
ported from one place was four at Stratham. No epidemic
of diphtheria exists in the State.

Scarlet-fever in Keene, Dover, Rye, Laconia, Manchester,
Claremont, Rochester, Pittsfield, Jafifrey, Wakefield, and
Goffstown. Dover reported the largest number, 13 cases ;
Wakefield, 7, and Claremont, 5 cases.

Typhoid-fever was reported from Nashua, Manchester,
Rochester, and Weare.

New Jersey. — Hudson County y 282,254: Reports 514
deaths for February, of which 244 were under five years of
age. Annual death-rate, 21.8 per 1000. From zymotic dis-
eases there were 117 deaths, and from consumption, 51.

Patersony 80,000 : Reports 135 deaths during February, of
which 43 were under five years of age. Annual death-rate,
20.0 per 1000. There were 10 deaths from zymotic diseases,
and 21 from consumption.

Newark^ 180,245 : Reports 346 deaths during February, of
which 127 were under five years of age. Annual death-rate,
23.06 per 1000. From zymotic diseases there were 55 deaths,
and from consumption, 43.

New York. — The number of reported deaths during Feb-
ruary is less than in January and less than in February, 1888 ;
not only for the entire State but for each sanitary district.
The proportion of deaths under five years of age is nearly the
same as in January, but higher than of a year ago. The same
is true of zymotic diseases, which for the last two months
caused 170 deaths in each 1000 deaths, and but 154 in Febru-
ary, 1888. The increase is mainly in scarlet- fever, and this is
limited to the Maritime and Hudson Valley districts, other
parts of the State showing no increase. Measles and whoop-
ing-cough are also more prevalent than a year ago, as shown
by their mortality. On the other hand, there is a considerable
diminution in the mortality from diphtheria. There were nine

864 Mitor's Table.

deaths from small-pox, seven of them occurring in the Onon-
daga County Poor House, one in Lyons, and one in Canas-
seraga, Allegany County ; cases are reported from Dansville
and Hannibal. Consumption caused 11.57 per cent of all
deaths, and 15.15 of deaths over five years of age.

New York, 1,571,558 : Total deaths, 3327 ; under five years
of age, 1441 ; annual rate, 27.50. Zymotic, 702; consump-
tion, 430.

Brooklyn^ 814,500: Total deaths, 1422; under five years
of age, 614 ; annual rate, 22.75. Zymotic, 295 ; consump-
tion, 153.

Buffalo, 230,000 : Total deaths for four weeks ending Feb-
ruary 23d, 320 ; under five years of age, 139 ; annual rate,
18.10. Zymotic, 40; consumption, 36.

Rochester J 1 10,000 : Total deaths, 207 ; under five years of
age, 49 ; annual rate, 22.58* Zymotic, 17 ; consumption, 29.

Albany, 103,000 : Total deaths, 166 ; under five years of
age, 44 ; annual rate, 19.34. Zymotic, 22 ; consumption, 20.

Syracuse, 80,000 : Total deaths, 93 ; under five years of age,
27 ; annual rate, 13.95. Zymotic, 10 ; consumption, 18.

The five cities or towns reporting the highest rates of mor-
tality are : Catskill, 34.67 ; Goshen, 30.00 ; Lyons, 30.00 ;
Newtown, 27.60 ; New York, 27.50.

The five lowest mortalities are : Worcester, 4.00 ; Clayton,
5.60; Ilion, 5.75 ; Hoosick Falls, 6.00 ; Marbletown, 6,00.

North Carolina. — In twenty-two towns in the State, rep-
resenting a population of 68,828 whites, 56,328 colored, total,
120,156. There were 5 deaths from malarial-fever; i from
whooping-cough; i from measles; 15 from pneumonia; 24
from consumption ; 8 from brain diseases ; 3 from neurotic
diseases ; 5 from heart diseases ; 6 from diarrhoeal diseases ;
33 from all other diseases ; 5 from accident and violence, and
7 were still births. Total number of deaths among the whites,
46 ; temporary annual death-rate, 7.2 ; the total number of
deaths among the colored was 67, temporary annual death-
rate, 13.2 ; total number of deaths, both races, 113 ; tempo-
rary annual death-rate, 9.6.

Ohio. — Official Monthly Record of the Secretary reports
13 17 deaths during the month of February, representing an

Edikn^'B T<AU. 865

annual death-rate per looo population of 53 cities and towns
of 13.84. Deaths under five years of age, 496. From zymotic
diseases, 224 ; croup and diphtheria, 78 ; typhoid-fever, 41 ;
scarlatina, 11 ; whooping-cough, 10 ; cerebro-spinal meningitis,
15. Deaths from consumption, 194.

Cincinnati^ 325,000 : Total deaths, 430 ; under five years of
age, 232 ; annual rate, 15.50. Zymotic, 58 ; consumption, 56.

Cleveland J 235,000 : Total deaths, 302 ; under five years of
AgCy 115 ; annual rate, 15.42. Zymotic, 68 ; consumption, 28.

Columbus^ 101,000: Total deaths, 99; under five years of
age, 23 ; annual rate, 10.77. Zymotic, 18 ; consumption, 19.

Toledo^ 80,000 : Total deaths, 80 ; under five years of age,
26 ; annual rate, 12.00. Zymotic, 9 ; consumption, 13.

Dayton, 60,000 : Total deaths, 51 ; under five years of age,
17 ; annual rate, 10.20. Zymotic, 7 ; consumption, 9.

Pennsylvania. — Philadelphia, 1,040,245 : Reports for four
weeks ending February 23d, 1871 deaths, of which 496 were
under five years of age. Annual death-rate, 23.3 per 1000.
From zymotic diseases there were 188 deaths, and from con-
sumption, 195.

Rhode Island. — The number of deaths recorded in the
different towns and cities, from which returns have been re-
ceived, was 474, in an estimated population of 281,053.

The annual death-rate upon the estimate given is 16.6 in
every thousand of the population. The death-rate is some-
what smaller than for the previous month. The general sick-
ness throughout the State, although reported as large during
February, as in the month of January, was less fatal.

Tennessee. — The State Board Bulletin for March reports
the principal diseases named in the order of their greater prev-
alence, in the State for February were pneumonia, bronchitis,
catarrhs, tonsilitis, consumption, and rheumatism.

Typhoid-fever is reported in the counties of Bledsoe, Camp-
bell, Cannon, Davidson, Franklin, Grundy, Hamilton, Han-
cock, Hawkins, Knox, Lincoln, Maury, Rhea, Shelby, and
Sumner. Measles in Cannon, Franklin, Gibson, Grundy, Hen-
derson, Humphreys, Lawrence, Lincoln, and Maury. Mumps

366 Mitor's Table.

in Bledsoe, Campbell, Gibson, Lawrence, Montgomery,
Moore, Overton, and Robertson. Whooping-cough in Cum-
berland, Gibson, Hamilton, Houston, Humphreys, and Maury.
Scarlet-fever in Dyer, Gibson, Montgomery, Robertson, and
Shelby. Croup in Davidspn, Maury, Robertson, and Sullivan.
Varicella in Bledsoe, Grundy, and Rutherford. Diphtheria in
Hamilton and Shelby. Roseola in Gibson and Smith. Ery-
sipelas in Gibson and Robertson. Cerebro-spinal-fever in Han-
cock. Meningitis in Overton.

In the chief cities the respective annual death-rates for the
month per looo of population are reported as follows :

Chattanooga, \

vhite

J, o.oo ; col<

3red, 24.00 :

12.30

Clarksville,

<•

9.60 ;

36.00

: 19.50

Columbia,

1 <

12.00;

*' 6.00

: 9.60

Knoxville,

<«

8.47;

32.95 :

: 13-47

Memphis,

«•

19.05 ;

26.59

: 22.48

Nashville,

•<

12.32 ;

21.09 '

: 15.46

Wisconsin. — Mi/waukee, 210,000 : Reports for the month
of February 255 deaths, of which 80 were under five years of
age. Annual death-rate per 1000, 14.6. From zymotic dis-
eases there were 44 deaths, and from consumption, 20.

Cuba. — Havana^ 200,000 : Deaths reported for the month
of February, 411 ; under five years of age, 117. From con-
sumption, 92 — 22. 1 1 per cent of total mortality. From yellow-
fever y 4 ; other fevers, 17 ; small-pox, i ; diphtheria, 6.
Death-rate, 26.66.

Small'pox^ according to the most recent reports from abroad,
continues prevalent in Ostend, Milan, Bologne, Madrid, Barce-
lona, Prague, Marseilles, Amiens, Rouen, Lyons, and Paris.

Yellow-fever^ by report of United States Consul, Weekly
Abstract of Sanitary Reports, February 13th, 1889, is more
prevalent in Rio de Janeiro than ever before known at the
same season. The number of deaths during the month of
January was 171 3, and was so large up to February loth as to
indicate about one-third more for that than for the preceding
month.

Literary Notices. 867

LITERARY NOTICES.

The Insane in Foreign Countries. By William P.

Letchworth, President of the New York State Board of
Charities. 8vo, pp. 386. Adequately illustrated. New York
and London : G. P. Putnam's Sons.

No work hitherto published, to our knowledge, gives such a
full and clear account of the oversight of the insane abroad,
past and present, as this. The author of it is so extensively
and favorably known for his many years' devotion to the duties
of his ofHce, it appears but a natural trend of his mind and
intensification of his thoughts to contemplate especially the
most pitiful and the most needful of all the subjects of his
care— the insane poor.

To all devoted students the magnitude and importance of
the object in pursuit incresLses, pari passu^ with a knowledge of
it ; and it would be difficult to find a better illustration of this
general truth than in the author of the work before us. Pain*
fully familiar with all the relations of his subject in the United
States, but still realizing a lack of practical knowledge for
ameliorating the deplorable condition of the insane poor, he
pursued the subject abroad ; and for the purpose of securing
fulness of detail as well as accuracy, his work comprises sten-
ographic notes of visitations and interviews with many distin-
guished specialists in this field of inquiry ; his aim through*
out being to ascertain, from a practical point of view, what are
the most advanced, the most humane, and the most economi-
cal methods of caring for the insane.

The work opens with an introductory and retrospective
chapter on the insane in foreign countries, and a sketch of the
initial treatment of them in this country. Next follows the
history of the treatment of the insane in England, Scotland,
and Ireland, and in Continental countries from a little more
than three centuries ago to the present time. It would be
difficult to furnish a better illustration of the triumph of sci-
entific knowledge over superstition, though slowly acquired,
than the recognition of insanity as a disease and its treat-

8ft8 Liiterary NoUoes.

tnent accordingly, so admirably sketched in these chapters — a
triumph in which physicians may take reasonable pride, not-
withstanding the unjust reproach of infidelity because of their
belief in brains diseased instead of *' devil- possessed."

The most approved methods of treatment are presented in
the descriptions of the colonies of Gheel, Fitz-James, Alt-
Scherbitz, and other institutions, with illustrations of the build-
ings and grounds in detail. And the whole is summed up
under a general r/sum^ of the subject and such practical de*
ductions as no one whose duty it is to provide for the insane
can well afford to do without. We heartily commend the
work to all such not only, but to all physicians and other per-
sons interested — and who is not ?— in the treatment of the
insane.

Atlas of Venereal and Skin Diseases. By Prince

A. Morrow, A.M., M.D., Clinical Professor of Venereal Dis-
eases, formerly Clinical Lecturer on Dermatology, in the Uni-
versity of the City of New York ; Sui^eon to Charity Hos-
pital, etc. Imperial folio atlas to consist of fifteen parts, con-
taining seventy-five chromo-lithographic plates, containing
several hundred figures, many of them of life-size, in flesh tints
and colors, together with descriptive text for each plate, and
from sixteen to twenty folio pages of a practical treatise upon
venereal and skin diseases, the whole to form one volume. In
the composition of the work, besides Professor Morrow, many
of the most distinguished authorities on the subjects treated
of have been secured as contributors : M. Kaposi and I. Neu*
mann, of Vienna ; Hutchinson, Fournier, and Hardy, of Lon-
don ; Ricord, CuUerrier, Besnier, and Vidal, of Paris ; Leloir,
of Lille ; Keyes, Otis, and Henry G. Piffard, of New York ;
Hyde, of Chicago, and others. Fasciculi X., XL, and XII. of
this superb work are now before us, and fully maintain the high
standard of those which have preceded and have been before
reviewed. The plates are (F. X.) : Eczema of Palm, Psoriasis
of Palm, Eczema rubrum ; Eczema seborrhoicum, dry, scaly,
and moist forms ; Impetigo Figurata, Contagiosa ; Dermatitis
Exfoliativa, Pityriasis rubra ; Dermatitis medicamentosa.
Eruptions from Iodide and Bromide of Potassium. (F. XL) :
Herpes Zoster, Ferbrilis, Progenitalis ; Herpes Zoster ; Der-

Literary Notices. 369

matitis herpetiformis ; Pemphigus Vulgaris, foliaceus ; Pur-
pura simplex, thrombotica. (F. XII.) : Psoriasis of body,
hand, and arm ; Lichen planus ; Lichen ruber, ruber monili-
formis ; Acne vulgaris, rosacea ; Moluscum epitheliale, Veruca
Senilis.

The descriptive text of these several subjects— etiology,
pathology, and treatment — is full in all respects.

The Psychic Life of Micro-Organisms : A Study in
Experimental Psychology. By Alfred Binet. Trans-
lated from the French by Thomas McCormack, with a pref-
ace by the author written especially for the American edition.
Chicago, 1889 • The Open Court Publishing Company. Cloth,
75 cents ; paper, 50 cents.

The subject of this book is little known, as the data of this
department of natural science lie scattered for the most part
in isolated reports and publications, and this is the first attempt
made to collate and present them in a systematized form.

Especial use has been made of the investigations of Balbiani,
ClaparMe and Lachmann, Maupas, Ribot, Engelmann,
Pouchet, Weber, Pfefifer, Kent, Dujardin, Gruber, Nussbaum,
BUtschli, Lieberkiihn. The cuts, eighteen in number, are illus-
trative of the movements, nutrition, digestion, nuclear phe-
nomena and fecundation of proto-organisms. The researches
and conclusions of the author show " that psychological phe-
nomena begin among the very lowest classes of beings ; they
are met with in every form of life from the simplest cell to the
most complicated organism."

Merck's Index of Pine Chemicals and Drugs for the
Materia Medica and the Arts. E. Merck : New York,
London, and Darmstadt. An evidently useful catalogue to
chemists, druggists, and apothecaries, for whom it is intended ;
embracing upward of 4000 different articles, with their trade
prices. The make-up of the book is neat and substantial.
Price, $1.

Alden's Manifold CYCLOPiEDiA, Vol. IV., Baptism to
Bilberry, 637 pages, is at hand, distinguished by the excellent
characteristics which have already. been pointed out in our

24

870 JMerary Notices^.

notice of preceding volumes. Handsome cloth binding, 50
cents ; half morocco, 65 cents. This is truly bringing knowl-
edge within reach of millions. John B. Alden, Publisher, 393
Pearl Street, New York.

Wood's Medical and Surgical Monographs for

March contains Neurasthenia and its Treatment, Dr. H.
Von Ziemssen ; Antipyresis and Antipyretic Methods of Treat-
ment, ibid; The Tongue as an Indicator of Disease, Dr. W.
H. Diclcinson ; Treatment of Cystic Goitre, T. M. Hovel,
F.R.C.S. ; New Remedies, 1878 to 1888, Dr. C. Canquil.
Ten dollars a year ; $1 a number. New York : William Wood
&Co.

Report of the Commissioner of Education for 1886-87,
Nathaniel H. R. Dawson. Pp. 1170, Washington : Gov-
ernment Printing Office. It is the misfortune of this office to
be so inadequately equipped as to forfeit much of the interest
that would otherwise attach to the publication of its reports
by reason of their tardy appearance. The Commissioner fully
recognizes this misfortune, and has done a good deal in his
effort to overcome it, though as yet the desired result is not
manifest. The volume before us contains a large amount of
useful information to all who take interest in the status of
education and the means for sustaining it throughout the
country, but its want of freshness relegates it to the book-case
instead of the table.

The Commissioner states that the Bureau has undertaken
to investigate the history of American education from its
earliest beginnings : good encyclopedic work and entertain-
ing to the student ; but considering the restricted force of
the Bureau — the reasons for, the how and the means of infus-
ing more educational spirit among the people of the present
generation, appear to us to.be the objects which should ani-^
mate the Bureau before and above all things else. If these
objects can be spurred into greater activity by the excellent
monographs and ** Contributions to American Educational
History" as now seem to be given the foremost place, it is
well, and they should be pushed to the fullest extent, but
otherwise not. Monograph3 of William and Mary College

LiieTwry Notices. 871

and the University of Virginia, with sketches of other Vir-
ginian colleges, have been prepared, and others are in progress,
comprehending all sections of the country, to be treated of in
State groups.

The volume is replete with information on the status of
public education throughout the country, at the time of its
going to press, and contains an index and list of the publica-
tions of the Bureau from 1868 to 1887.

Contributions to American Educational History,

edited by Henry B. Adams. Bureau of Education, Circular
of Information, No. 2, 1888 : The History of Education in
North Carolina. By CHARLES Lee Smith, Fellow in History
and Politics, Johns Hopkins University.

This is an adequately illustrated pamphlet of 180 pages,
comprehending the pioneer work of education in colonial times
and all the way up to the present educational outlook, which
was never before so complete and encouraging. ** Since the
revival of the University in 1875 there has been manifest
progress in every department of education. The public schools
have been made more efficient ; the graded school system has
been introduced in the principal towns ; the endowments of
several of the denominational colleges have been largely in-
creased, their curricula made more thorough, and their stand-
ard of graduation raised ; normal schools and teachers' insti-
tutes are conducted at convenient points, the State and coun-
ties making provision for their maintenance ; and at. the last
session of the Legislature (1886-87) provision was made for
the immediate establishment of a college of agriculture and
the mechanic arts, to which the State, besides granting the
interest from the land-scrip fund, amounting to $7500 per an-
num, guarantees a liberal income from certain specified taxes..
All the young men of the State who can successfully pass the:
entrance examination will receive free tuition. This college -
has been established at Raleigh, and it is expected that the:
work of instruction will begin in the fall of 1889. 1*^^ interest
now samanifest in all that pertains to the intellectual advance-
ment of the Old North State promises grand results for the:
future."

872 lAterary JS/otiees.

Industrial Education in the South. By Rev. A. D.
Mayo. Circular of Information, No, 5, 1888. Bureau of
Education, Washington, D. C. A paniphlet of 86 pages,
composed by one who has been for the past eight years en-
gaged in the ministry of education through all the Southern
States. It consists of a plain statement of the reasons for the
growing interest in industrial education in the country gen-
erally, and the special needs of this type of education in the
Southern States in particular, together with a brief account of
the principal institutions that have already undertaken this
work in that section. It contains a large amount of useful and
practical information, well calculated to correct erroneous opin-
ions entertained for the want of knowledge, and should be ex-
tensively circulated.

Proceedings of the Department of Superintendence
of the Nationai, Educational Association, Washing-
ton, February I4th-i6th, 1888. Circular of Information, No.
6, 1888. Bureau of Education, Washington, D. C.

A pamphlet of 165 pages, containing essays on Manual
Training, County Institutes, Elocution, Qualifi.cations of
Teachers, Normal Schools, Moral Training, Can School Pro-
grammes be Shortened and Enriched? Alaska, Superintendents
and Teachers, National Aid to Education, and the discussions
thereon, by a number of the most accomplished school officers
.and educators in the country.

The Century for April is largely devoted to celebrating
^the Centennial of the Inauguration of Washington in New
York, April 30th, 1789. The contents of the number include :
" The Inauguration of Washington," by Clarence W. Bowen,
illustrated with views of New York in 1789, the reception at
Trenton, portraits, etc. ; " Washington at Mt. Vernon after
>the Revolution," by Mrs. Burton N. Harrison, with a number
of interesting illustrations, and " Washington in New York in
fi789,*' by the same author ; " Original Portraits of Washing-
ton," by Charles Henry Hart, and " A Century of Constitu-
vtional Interpretation," by Professor John Bach McMaster.
Mrs. Harrison's articles are devoted to the social aspect of the
subject and describe New York society at the time of the first
President. Profusely illustrated.

Liiera/ry Notioea. 378

How TO BE Successful on the Road as a Commercial
Traveller. By an Old Drummer. 96 pp., paper, price
20 cents. New York: Fowler & Wells Co., 775 Broadway.
Is a condensation of the experience and observation of an old
and successful commercial traveller. He puts a deal of com-
mon sense into his advice, and shows how a good knowledge
of human nature is the potent instrumentality in dealing with
business men and the road to success. In this connection he
naturally dwells upon the influence of personal appearance,
dress, language, manners, and tact generally.

An appendix is bound in with the book containing about
250 places and hotels arranged in the most approved mannen

Selection of Lives for Insurance, by Edgar Holden,

M.D., Ph.D., is an instructive pamphlet of thirty-one pages,
showing the indications of diatheses, parental longevity, occu-
pation, physical condition, and habits as illustrated by the
statistics of life insurance companies.

pamphlet reprints, reports, etc.

" Partial Syllabic Lists of the Chemical Morphologies of the
Blood, Sputum, Faeces, Skin, Urine, Vomitus, Foods, Includ-
ing Potable Waters, Ice and the Air, and the Clothing." By
Ephraim Cutter, M.D., A.M., LL.D., F.R.S., etc. New
York : The Author.

" Transactions of the American Association of Obstetricians
and Gynaecologists," Washington, September, 1888.

" Primary and Secondary Action of Drugs.*' By Boardman
Reed, M.D., Atlantic City, N. J.

" History of Abdominal Section in Albany, with a Report
of Seventy-five Cases." By Albert Van der Veer, M.D., Pro-
fessor of Surgery in the Albany Medical College, etc., Albany.

** Prophylactic and Therapeutic Resources of Mankind."
By Henry G. Hanchett, M.D., Member of New York Acad-
emy of Anthropology, etc.. New York.

"Cocaine Doses and Cocaine Addiction." By J. B. Mat-
tison, M.D., Brooklyn.

" Intestinal Surgery, with Special Reference to the Treat-
ment of Intestinal Obstruction." By Nicholas Senn, M.D.,
Ph.D., Milwaukee.

1

374 Literary NoUoes.

*' Electrolytic Treatment of Stricture." ByG. C. H. Meier,
M.D. New York : E. P. Coby & Co.

"Gaseous Enemata — Experimental Demonstrations/* etc.
By R. Harvey Reed, M.D., Mansfield, O.

"Treatment of Peritonitis by Abdmninal Section." By
L. S. McMurtry, A.M., M.D., Danville, Ky.

** Hydrophobia, Report on." By Charles W. Dulles, M.D.,
Philadelphia.

"Recent Advances in State Medicine." By Henry B.
Baker, M.D., Secretary of State Board of Health of Michi-
gan, Lansing.

"The Human Nature Library — The Servant Question."
By H. S. Drayton. New York : Fowler & Wells Co.

" Effects of Food Preservatives on the Action of Diastase,
Pancreatic Extract and Pepsin." By Henry Leffman, M.D.,
and William Beam, M. A. Philadelphia : William F. Fell & Co.

" Medical Expert Testimony." By F. H. Darby, M.D.,
Morrow, O.

" Pleurisy as a Predisposing Cause of Phthisis Pulmonah's."
By B. F. Westbrook, M.D., Brooklyn, N. Y.

"The Ischiatic Crutch." By A. B. Judson, M.D., New
York.

" Orthopedic Treatment of Paralysis of the Anterior Muscles
of the Thigh." By A. B. Judson, M.D., New York.

" Uses of Adhesive Plaster in Orthopedic Surgery." By
A. B. Judson, M.D., New York.

" Vegetable Parasitic Diseases of the Skin — New Method
of Treatment." By Henry J. Reynolds, M.D., Chicago, 111.

" Rectal Insufflation of Hydrogen Gas — ^An Infallible Test
In the Diagnosis of Visceral Injury of the Gastro-Intestinal
Canal in Penetrating Wounds of the Abdomen. " By N. Senn ,
M.D., Ph.D., Milwaukee.

" Uterine Myoma — Two Cases of Removal of." By Mary
A. Dixon Jones, M.D., Surgeon of the Woman's Hospital^
Brooklyn, N. Y.

" Suggestions Regarding the Shortcomings and Misconcep-
tions in Medical Education — Inaugural Address." By C. B.
Kinyon, M.D., President of Illinois State Homoeopathic Med-
ical Society, Rock Island, 111.

" Heredity." By James Thomas Searcy, Tuscaloosa, Ala.

LUerary Nctioes. 375

" Some of the Advantages of the Union of Medical School
and University." By WilUam H. Welch, M.D., Professor of
Pathology in Johns Hopkins University, Baltimore, Md.

Cornell University College of Agriculture :

1. " Insectory of Cornell University."

2. " Preventing the Ravages of Wire Worms."

3. " Destruction of the Peum Curculio by Poisons." Cor-
nell University, Ithaca, N. Y.

" Writing-Machines for Doctors." By John Aulde, M.D.
Philadelphia : Records, McMullen & Co.

'* Success and Failure of Electrolysis In Urethral Strictures,
Especially Dr. Keys's Method Reviewed," By Robert New-
man, M.D., Surgeon to the Northwestern Dispensary, New
York.

"Aseptic Climates without Altitude." By W. H. Ged-
dings, M.D., Aiken, S. C.

" Gynaecology : Presidential Address to the American Gynae-
cological Society." By Robert Battey, M.D., Rome, Ga,

*' Manual Training in Elementary Schools for Boys." By
A. Sluys, Director of Normal School, Brussels, Belgium.
New York : Industrial Education Association.

" Suggestions Regarding the Management of Phthisical Pa-
tients at Health Resorts." By Isaac Hull Piatt, M.D., Lake-
wood, N. J.

*' Diseases of the Nose and Pharynx and their Treatment.'*
By W. Cheatham, M.D., Lecturer on Diseases of the Eye,
Ear, Throat, and Nose in the University of Louisville, Ky.

" The Means of Effecting the Unity of the Medical Profes-
sion, being the Anniversary Discourse Delivered before the
New York Academy of Medicine, November 15th, 1888." By
D. B. St. John Roosa, M.D., LL.D., New York.

"Treatment of Epithelioma with Mild Caustics." By
Daniel Lewis, M.D., Surgeon to New York Skin and Cancer
Hospital, New York.

" Pulmonary Consumption Considered as a Neurosis." By
Thomas J. Mays, M.D., Professor of Diseases of the Chest in
the Philadelphia Polyclinic, Philadelphia.

" Plumbing — Sewer-Gas — Disease." By James A. Camp-
bell, M.D., St. Louis, Mo.

" How Far Can Legislation Aid in Maintaining a Proper

376 IMerary Notices.

Standard of Medical Education ?" By W. A. Purrington,
Counsel of the Medical Society of the county of New York.
New York.

'' Relation of Menstruation to the Sexual Functions." By
William M. McLaury, M.D., New York.

** The Social Evil : Its Cause and Cure." By Charles H.
Kitchell, Esq., New York.

"The Pneumatic Cabinet in Lung Disease." By Sidney
Allan Fox, M.D., Brooklyn, N. Y.

" Extent and Distribution of Consumption in New Hamp-
shire." By Irving A. Watson, M.D., Secretary of New
Hampshire State Board of Health, Concord, N. H.

" Inflation of the Stomach with Hydrogen Gas in the Diag-
nosis of Wounds and Perforations of this Organ." By E.
Senn, M.D., Attending Surgeon to the Milwaukee Hospital,
Professor of the Principles and Practice of Surgery and Surgi-
cal Pathology in the Rush Medical College, Chicago, 111. ;
Milwaukee, Wis.

" Gun-shot Wounds of the Abdomen Illustrating the Use
of Rectal Insufflation with Hydrogen Gas, as a Diagnostic
Measure." By N. Senn, M.D,, Milwaukee, Wis.

The Seguin Physiological School for Feeble-Minded Chil-
dren, 260 West Fifty-fourth Street, New York.

" Placental Development." By Henry O. Marcy, A.M.,
M.D., LL.D., Boston, Mass.

" History and Surgical Treatment of Uterine Myoma." By
Henry O. Marcy, A.M., M.D., LL.D., Boston, Mass.

" The Climate of the Southern Appalachians." By Henry
O. Marcy, A.M., M.D., LL.D., Boston, Mass.

Seventy-first Annual Report on the State of the Asylum
for the Relief of Persons Deprived of the Use of their Reason*
Philadelphia.

"Pott's Disease of the Spine." By A. B. Judson, M.D.,
New York. Pamphlet reprint from New York Med. JournaL

** Angina and Pneumonia Before 1857 and Since, with the
Pathology of Diphtheria in its Various Phases." By William
Henry Thayer, M.D., Brooklyn, N. Y. New York Medico/
yournal, January 26th, 1889.

Medical JStoerpt. 877

MEDICAL EXCERPT,

. Tobacco Amblyopia. — Dr. St. Clair Buxton finds the fol-
lowing formula uniformly successful in curing tobacco ambly-
opia : Liq. hydrarg. perchlor. (B. P.), half a drachm ; potassii
iod., twelve grains ; aquae destil, one ounce.

To the above he adds for simultaneous administration the
following pill : Ext. nucis vomic, half a grain ; ext. hyoscy-
ami, one grain ; ft. pil. no. i. The pill of this strength is
given three times a day, and with the solution. — Lancet.

The Nail-Brush as a Source of Infection.— The ^ri/-

ish Medical Journal has made quite a savage and wanton at-
tack upon the nail-brush. This esteemed article of the toilet
is thought by the Journal to be a dangerous and dirty thing.
Such condemnation applies, of course, only to common and
strange nail-brushes used in the hospitals. These may, it is
thought, be carriers of infection. The question could be eas-
ily settled by inoculating pure cultures with tainted nail-
brushes or washings from the same. It is but reasonable to
assume at any rate that it would be safer if each surgeon should
have his own nail-brush.

The Disinfection and Tempering of Rubber Drains.

— The proper disinfection of rubber drain-tubes is of great im-
portance ; the hiore so, as its accomplishment is attended with
considerable difficulty. Javaro shows that tubes are usually
so affected by the usual processes of preparation as to be very
much injured, and then fail to realize their intended purpose.
To avoid softening (more especially of the red varieties), he
advises that for five minutes they be immersed in concentrated
sulphurous acid. He urges that the red variety should always
be used in preference to the white kinds, as being more suited
to withstand injury during his process. In the acid, the tubes
assume a dark chestnut color, and become hardened. Then
they are to be washed in alcohol, seventy-five per cent, and
finally to belaid away in antiseptic preserving fluid — either five

S78 M^dieal Bkeerpl.

per cent carbolic acid solution or 1-200 bichloride solution.
Tubes so prepared will not collapse under even very consider-
able pressure. If they have become too hard, by working them
between the fingers they can be much softened. After being
treated in the acid, they are unaltered in any way further by
preservation in antiseptic fluids. These tubes have now for a
long time in his hands entirely replaced all other kinds, and
he utilizes them for every possible purpose. They maintain
their lumen even when placed between the ribs, and will not
readily kink or become obstructed, yet are not so resistant as
to exert dangerous pressure (Centralblatt fiir Chir., August
l8th, 1888).— 7X^ Satellite.

Weil's Disease. — E. Lanphear {Kansas City Medical Index ^
November, 1888) describes a febrile disorder now prevailing
at Kansas City, which he is inclined to believe may be identi-
cal with Weil's disease. He has seen sev^n cases of it, one of
which ended fatally. The disease begins suddenly, usually
with a severe chill ; there is a sudden and alarming rise of
temperature, persistent headache, moist and clean tongue, and
a decided tendency to vomiting without much nausea. There
are tenderness and some enlargement of the liver, and some
jaundice is apt to be present. The urine is dark, strongly
ammoniacal, and contains, in some cases, a slight amount of
albumen. Herpes and purpuric spots occasionally appear.
The characteristic feature of the disease is the severe and dis-
tressing pain which may develop in any of the muscles, but is
most frequently confined to those of the back and calves.
The fever is peculiar in that it begins with 104^ to 106° F.,
and gradually diminishes in intensity without much remission ;
while the pulse keeps but 80 or 90, soft, and compressible,
like the pulse of shock, and indicating a profound disturbance
of the vasomotor centres.

The author considers the disease infectious. An autopsy
on one of his cases revealed nothing characteristic. He dis-
cusses its diagnosis, showing that it has little in common with
either typhoid or malarial-fever, and is readily to be distin-
guished from cerebro- spinal meningitis. He obtained the
best results therapeutically with aconite or gelsemium for the
fever, or with salicylate of sodium, or with injections of sul-

Medical EaooerpU 879

phate of codeia into the body of the muscle to relieve the pain.
— American youmal of Medical Sciences.

Common Salt in Nervous Affections of the Stomach.

-T—Dr. Batrom has lately employed common cooking salt in the
treatment of migraine, and Dr. Nothnagel has recommended
the same in the treatment of epilepsy. Dr. Cern^ attributes
his success in the treatment of the first affection with this
remedy^ to an increase of the hydro-chloric acid of the gastric
juice. In a case of gastralg^a and migraine, in which the treat-
ment simply consisted in augmenting the quantity of salt in
the food, he noticed that the dyspeptic symptoms and sto-
machal pains disappeared entirely. — La Normandie nUdicale.
Revue Tk&apeutique, December IS/A, 1888.

The Treatment of Rickets should be by food rather
than by drugs. Raw meat is of more value than iron, and
cream or fresh milk than cod-liver oih The diet must be care-
fully examined to see that it contains a due proportion of fat,
proteids, and salts. A sufficiently close estimate is easily
made, since the composition of milk and of all foods used for
children is accurately known. The amount of animal fat in a
rickety child's food must equal at least one fourth of the total
solids taken ; proteids and carbo-hydrates about one third,
and salts about one tenth. Such a diet will cure rickets with-
out drugs. Iron is often a useful adjunct. The salts of lime
may be added in the form of lactophosphate. Potent aids are
sunlight, fresh air, and warm clothing. — Lancet.

Incompatible Antiseptics. — The youmal de Mtdecine
directs attention to the following incompatibilities : Corrosive
sublimate and iodine ; corrosive sublimate and soap ; soap
and iodine ; carbolic acid and iodine ; carbolic acid and per-
manganate of potassium ; salicylic acid and soap ; salicylic
acid and permanganate of potassium ; permanganate of potas-
sium and oils, soap, or glycerine.

Surgery Run Wild.— Professor Von Nussbaum has been
instructing and perhaps regaling the young generation of Ger«
man surgeons by a brave pamphlet on " Surgical Mishaps."

380 Medical Enooerpt.

Among the instances is the following case of a peasant who
many years ago was taken to the clinics of a great medical
centre in order to be treated for multiple ulcers of both legs.
On being examined on the operating-table, the right leg was
pronounced to be curable, while the left was declared to be
incurable and to require amputation. The amputation had
scarcely been performed when the surgeons found, to their
great horror, that they had amputated the wrong leg ! Their
chagrin was still increased when the right leg, which by acci-
dent had been saved, healed in a short time spontaneously.—
Boston Medical and Surgical Jour-ncU.

Forceps and Idiocy. —In a recent paper in the London
Lancet^ Drs. Winkler and Ballaan contend that instrumental
delivery of the child is in a few cases the direct cause of idiocy.
Dr. Langdon Down points out the fallacy of the above con-
clusion. In his experience of idiocy, he found that in only
three per cent were the forceps employed. In only a small
fractional percentage could he arrive at the conclusion that
the use of the forceps was the principal cause of the calamity.
In every case of idiocy where they had been employed, the
friends of the child believed that the use of instruments alone
was the cause of the disaster, while in the great majority of
the cases he was able to find in the family history a sufficient
cause.

Treatment of Anal Fistula without Operation. —

Fistulae which do not cause pain should not be operated upon.
The clothing should be soft and smooth, and extreme cleanli-
ness should be observed, the general condition of the patient
should be attended to, and of systemic remedies a mixture of
the bromides and iron is especially valuable. The following
is an excellent remedy : Bromide of potash, lo grams ; citrate
of iron, ammoniated, \ gram ; syrup of bitter orange peel, 190
grams. Tablespoon ful should be taken morning and evening.
Topical appliances should be made after each st6ol. Here
is a good formula for suppositories : Iodoform, -^ gram ; ex-
tract of belladonna, ^^ gram ; cocoa butter, q.s. This should
be applied after each defecation and on going to bed. — Profes*
sor Guyoiy journal de Midecine.

Medical EaBcerpt. 881

Milk Jelly. — As a variation in milk diet, the following is
recommended by Professor Liebreich :

Heat one quart of milk with one pound of sugar, and when
the sugar is dissolved continue the heat, at a boiling temper-
ature, for about ten minutes. Now cool it well, and then add
— slowly stirring — a solution of one ounce of gelatin in a cup-
ful of water. Next add the juice of three or four lemons and
three wineglassfuls of wine, brandy, or other liquor. Set the
glasses containing the mixture in a cold place, so that the
contents may gelatinize. It is necessary to have the milk
quite cold before the other ingredients are added, as it would
otherwise curdle. — Medical Science.

Cocaine and Lanolin for Burns. — Dr. Wende recom-
mends a preparation made of these substances. It excludes
the air and quiets the pain. The cocaine should be pure and
the mixture freshly prepared. — J. de M^d. de Paris.

Calomel as a Diuretic. — R. Stintzing, in a paper entitled
'' Clinical Observations upon Calomel as a Diuretic and flydra-
gogue" {Deutsch. Arch, f. klin, Med.^ xliii., Abstr. in Fortsch.
d. Med. J 1888, No. 24), arrives at the following conclusions :
I. Calomel is a diuretic of more powerful action than any
other known drug. Its diuretic property may be seen to a
slight extent in the non-dropsical, and in a great degree in
certain forms of dropsy when it is combined with an anthy-
dropic action. 2. Its diuretic action is best seen in cardiac
dropsy, whether secondary to valvular or to muscular disease.
It does not act, or but imperfectly, when the cardiac inability
is extreme, but then other remedies are also inoperative.
3. Dropsy from other causes is less amenable to calomel treat-
ment. This is the case with perial obstruction, but especially
with renal dropsy. 4. In combined renal and cardiac disease,
calomel acts in proportion as the latter predominates. 5. In
diminishing cardiac dropsy, the drug acts not only by exciting
diuresis, but also by increasing the flux from the intestines ;
the best results being obtained when diuresis predominates.
If the reverse holds good, there may be loss of weight, but
not much general improvement. 6. When calomel acts as a
prompt hydragogue, it acts favorably on the general condition

S82 Medical MoeerpL

— on appetite, sleep, and strength. 7. In exudative processes
(as pleurisy and pericarditis) calomel has no action, or only an
insufficient one. 8. Mercurialism does not occur in cases
where polyuria is established ; but if there be no diuresis,
then mercurialism is apt to arise. 9. Although a more power-
ful diuretic than digitalis, it is not a cardiac tonic. The com-
bination of the two drugs in cardiac dropsy is most useful.
Calomel probably acts directly on the secreting structure of
the kidney. — TAe Lancet.

Tincture of Mustard.— It is now recognized that the
emetic qualities of ground mustard seeds are dependent for
their exciting cause upon the minute particles enveloping, or
having adherent to them, particles of the acrid and volatile
principles of mustard, which act, mechanically, as local irri-
tants to the mucous membrane of the stomach, and thus cause
a revulsive action, and that it is not due to any centric influ-
ence.

Believing, then, that mustard in the form of a tincture
would possess valuable stimulating properties, the writer pre-
pared, over a year ago, an alcoholic preparation of this drug
and urged its medicinal employment, especially in those con*
ditions which are graphically expressed by the term " drunk-
cases." It was found to answer admirably. Possessing the
aromatic qualities of ginger and the sharply stimulating prop-
erties of capsicum, it combined in one the excellencies of both,
without the local irritant feature so characteristic of capsicum.
It was found to be stronger than tincture of ginger and less
active than tincture of capsicum ; standing, apparently, mid-
way in medicinal activity between the two.

In the preparation of the tincture, the ground commercial
black mustard seed which has had the larger portion of its
20-25 per cent fixed oil removed by pressure, has been used*
The formula is as follows :

Take of

Ground black mustard 8 troy ounces.

Water 2 fluid ounces.

Alcohol q. s. ad I qt.

Moisten the mustard with the water, added in small quanti-
ties at a time, in a porcelain evaporating dish or other non-

Noticee. S88

metallic receptacle, and admix thoroughly. Cover well and
leave stand for twenty-four hours. Remove and pack in a glass
funnel or percolator ; add one pint of alcohol and macerate for
forty-eight hours. Then allow percolation to proceed, keep
adding alcohol until the percolate measures one quart.

The finished liquid is a clear, transparent, yellow fluid, hav*
ing a strong characteristic odor and a warm pungent taste.
Mixed with water it becomes slightly opalescent or milky from
the precipitation of a small quantity of fixed oil. Its dose is
from J-i-i teaspoonful well diluted with water. — Joseph W.
England^ Ph. G.y American Journal of Pharmacy , vol. 19, No. 3.

LiSTERlNE is recommended by Dr. I. N. Love, of St. Louis,
as a gargle and spray in diphtheria and scarlet-fever. He also
has his scarlatinal patients sponged with it daily. By this pro-
cedure, he says, the question of contagion is almost eliminated
during the desquamation. — Southern California Practitioner.

NOTICES.

AMERICAN MEDICAL ASSOCIATION — NOTICE TO EXHIBITORS.

Exhibits at the next meeting of the American Medical
Association, at Newport, R. I., June 25th-28th, 1889, will be
provided for as follows :

1. Medical books and stationery, charts and diagrams, busts,
portraits, engravings, photographs, etc.

2. Hospital and ambulance plans and models.

3. Surgical instruments and supplies, general and special
(gynaecic, obstetric, orthopedic, laryngeal, otic, ophthalmic,
dental, etc.).

4. Microscopes, analysis outfits, and electro-galvanic appa-
ratus.

5. Pharmaceutic products.

6. Rubber goods applicable to medicine and surgery.

7. Invalid furniture.

8. Invalid foods.

384 Notices.

9. Sanitary appliances, as ventilators, filters, water-closet
basins, traps, and similar necessities, and disinfectants.

Applicants should state the character of their proposed
exhibits, that they may be assigned to their respective groups.

As a large attendance is probable, while the space available
for exhibits is comparatively limited, the advantage of early
application will be perceived.

Choice of space will be given in accordance with the date
of application.

Intending exhibitors should address Dr. Charles A. Brackett,
Chairman Sub- Committee upon Exhibits, American Medical
Association, Newport, R. I.

The American International Congress of Medical
Jurisprudence, to which we called attention in September
last, will convene in New York on the first Tuesday in June^
1889.

Persons who propose to contribute papers are requested to
forward their names and the titles of their papers for proper
placement on the programme as early as possible, to the presi-
dent, Clark Bell, Esq., 57 Broadway, New York.

The Convention for the Revision and Publication

OF THE PHARMACOPCEIA OF THE UNITED STATES OF AMERICA

will assemble in Washington, D. C, at noon of May 7th, 1890,
for the purpose of providing for a revision and publication of
the pharmacopoeia of the United States of America ; and all
incorporated medical or pharmacal colleges, associations, or
societies desiring to be represented in the convention are re-
quested to send to ROBERT Amory, President, their corpora-
tive titles and lists of officers for engrossment and publication,
addressed to the care of

Dr. Edwin H. Brigham, Assistant Librarian of the Boston
Medical Library, 19 Boylston Place, Boston, Mass.

THE SANITARIAN

MAY, 1889.

Number 234.

SIR EDWIN CHADWICK, K.C.B.,

AND THE

PRESENT CONDITION OF SANITARY SCIENCE.

The sixth annual dinner of the Association of Public San-
itary Inspectors of Great Britain was celebrated at the First
Avenue Hotel, Holborn, on March 2d, 1889. The event
was further intended to mark the attainment of his nine-
tieth year by their President, Sir Edwin Chadwick, K.C.B. ;
and, by a happy coincidence, on the previous day Her Majesty
was graciously pleased to gazette the President, hitherto
C.B., to the higher honor. There was not room for all those
who had expressed a desire to be present on the occasion. Dr.
B. W. Richardson, F.R.S., presided, and among the company
present were the Earl of Aberdeen, Earl Fortescue, the Hon.
D. F. Fortescue, Sir Lyon Play fair, M.P., Sir Richard Owen,
Sir Robert Rawlinson, Sir Spencer Wells, Sir Douglas Galton,
Dr. Cameron, M.P., Dr. Farquharson, M.P., the Mayor of
Hastings, the Mayor of Chelmsford, Dr. Alfred Carpenter,
Professor Corfield, Dr. Buchanan (Chief of the Medical De-
partment of the Local Government Board), Colonel Tulloch,
R.E. (Chief Engineer of the Local Government Board), Osbert
Chadwick, Esq., C.M.G., Dr. Marshall, Dr. Dudfield, Major-
General Graham, Wyke Baylis, Esq., H. Alexander, Esq.
(Chairman of the Council of the Association), etc.

Letters excusing absence, and cordially congratulating Sir
Edwin Chadwick, were read from the Duke of Westminster,
the Duke of Bedford, the Earl of Meath, Lord Chelmsford,
Sir James Paget, General Sir L. Simmons, Dr. Adler (Chief
Rabbi), and Mr. J. B. Firth. The Duke of Westminster
wrote as follows :

25

386 TJie Present Cm^dition of Sanitary Science.

Gkosvenor House, February 25.

** I regret exceedingly that a previous engagement prevents
me from attending to do honor to one to whom it is pre-emi-
nently due. If better health, greater happiness of life and
length of days are objects to be desired for and by a nation,
and if our country has been able to secure a larger measure of
these, then gratitude and recognition are largely owing to Mr.
Chadwick, who has happily lived to see some tangible results
of his long-continued endeavors in the direction of sanitary
reform for the good of our countrymen. The debt we owe
him is a heavy one ! That every good wish may be realized
for him in the evening of his days is the prayer of

*' Westminster."

The following address was presented to Sir Edwin Chad-
wick, K.C.B. :

** We, whose names are appended to this simple but earnest
Memorial, beg, on behalf of the members of the Association
of Public Sanitary Inspectors of Great Britain, over whom you
have so generously and ably presided since the foundation of
the society in 1883, and of your many friends and fellow- workers
in sanitary science at home and abroad, to tender to you our sin<-
cerest congratulations upon your entry into the ninetieth year
of your life, and the seventieth of your active public career.

" We should consider it an event historical in character for
any one of our friends and contemporaries to have distinguished
himself during so long a period in the promotion of any work
of public utility ; but when we recall the labors which you
have performed, and the objects of those labors — namely, the
health of this nation and of other nations, and therewith the
happiness, prosperity, and advancing civilization of peoples
everywhere, for all future generations — our pleasure is the
greater, not only that one so gifted as yourself should have la-
bored toward the accomplishment of such extensive and lasting
goodness, but that we who have witnessed your efforts should
have had the opportunity of testKying to the industry, cour-
age, and enthusiasm, continued to the present hour, by which
your efforts have been characterized, and which, from oppo-
nents as well as from friends and allies, have long commanded
the respect and admiration which are ever accorded to those

The Present Condition of 8omiia/ry Science. 387

in whom genius for original observation and suggestion is com-
bined with earnestness of purpose and consistency of action.

** We consider that on your early labors in sanitation, espe-
cially your report on the sanitary condition of the laboring
classes, and your introduction of the half-time system of edu-
cation, the present advanced state of sanitation largely rests.
And in thanking you for all you have done in the past for the
health and happiness of mankind, we pray that your own
health, hitherto so conspicuous an example of good sanitation,
in its fullest strength and activity, may still long be preserved
with every happiness that should to the last attend so honor-
able, honored, and useful a life."

The address was signed by a large number of noblemen and
gentlemen, to the number of ninety or a hundred in all.

At the request of the Chairman, Lord Fortescue read a part
of Sir Edwin's Address, of which the following is a complete
copy :

Sir Edwin Chadwick*s reply was as follows :

" My dear Chairman, my Lords and Gentlemen, Mem-
bers OF THE Association of Sanitary Inspectors of
Great Britain : I presume that I may accept the great kind-
ness bestowed on me ori the present occasion, partly as having
regard to the unusually advanced age of the body, and partly
as to the extent of the occupation of the mind, for the promo-
tion of our science during that unusually long period. On
the bodily account, it is due to those here, who are practically
engaged in sanitary work to state that it will be found on ex-
amination that the risks of death and wounds, especially in
withstanding epidemics, are fully as great as those sustained
by officers of the naval and in the military service. I have
myself participated in those common risks, and although I
probably owe the duration of such working ability as may yet
remain to me, to exceptional hereditariness — for my father died
at the age of eighty-four, my grandfather at ninety-five, and
my two great -great-grand fathers as centenarians — these facts
do not interfere with the point I have named, that men who
have to fight for sanitation have sometimes to Bght for life also.

" Turning from this topic, let me now briefly state the chief
present conditions to which we have advanced in the practical

388 The Present Condition of 8anita/ry Science,

applications of our science, which are as yet very imperfectly
known. I beg to premise that I state nothing upon hypothesis
— nothing but well-examined experiences.

" It has been objected that if it were possible to amend com-
munities by Utopias, Utopias would long since have been in-
troduced. Our proceedings — assumed to be Utopian — which
I have to recite, are not, however, based upon Utopian ideals,
but on ' experiences ' carefully and separately examined —
separately examined as to their assumed and strict application
to common conditions. It is no Utopia that death-rates in
towns under the separate system of drainage have been reduced
by one half through the work of the sanitary engineer alone.
It is no Utopia that the death-rate at Rugby, for example,
which was one of the towns first treated by our first General
Board of Health, was then 24 in a 1000, and is now only 12.
It is no Utopia that at Salisbury the old death-rate, which at
the beginning of the century was as high as 40 in a 1000, is
now about 16 ; or that at Croydon and a number of other
places, death-rates of 24 in a 1000 now average 15. These re-
ductions have been effected by the system of ' circulation versus
stagnation,' which is yet to be made generally understood, to
be by constant and direct supplies of water, by the removal of
the fouled water through self-cleansing house-drains and self-
cleansing sewers, and by the removal of the refuse — fresh and
undecom posed, and un wasted — on to the land.

" On the examination of incipient experiences, and on long
and careful examination, the application of this system was
proposed for the metropolis, but it was opposed by what is
called * Vestralization, ' and by strong interests inexpensive
works, in the House of Commons, by which the Government,
at a morning sitting, were put in a minority. An opposite
system was adopted, which has since been examined and con-
demned by Lord Bram well's Commission as ' a disgrace to
the metropolis and to civilization. ' Our measure was carefully
examined by German sanitary engineers, who proposed it for
application to Berlin. It has been applied theie, though not
yet so completely as I consider it might be, and it has recently
been re-examined by a deputation from the French Govern-
ment, and it is now adopted on that examination for the relief
of the sanitary condition of Paris. I greatly lament the loss.

The Present Condition of Sanitanry Science. 889

by death, of M. Durand Claye, the inginieur-enchef oi Paris,
a firm sanitary disciple of mine, but I hope that loss may not
imperil the economical execution of the work.

"Various experiences in this country, by these factors
alone, have established with such certainty that a contractor
may contract with safety for the attainment of sanitary results,
and. by them the general death-rate, may yet be reduced by lo
in a looo. Beyond the reduction of the annual death-rate
from the work of the sanitary engineer, nothing is yet com-
monly expected or sought for. I had, however, early antici-
pated that the reduction of the annual death-rate would be
accompanied by an advance of the life-rate, and I have recently
obtained from the Registrar-General examples of what that
advance may be.

" I find that at Rugby the life-rate has been extended to all
living there, of every class, by eight years, or from thirty-three
to forty-one years. At Hastings the duration of life has been
advanced for males an average of five years and five months,
but for females of eight years and one month ; at Leek it has
been extended by ten years ; at Croydon and Salisbury, and
other places, the extension has been from six to seven years,
females, as a rule, obtaining, by our science, the greatest share
— that is to say, some eight years more of life-rate, more of
painless life, more of health, and strength, and beauty. These
extensions of the life-rates, as yet little known and regarded,
belong, however, to all classes, both to the well-to-do and to
the lowest. Of the wage classes, whose life-rate is largely the
lowest, the extension will be found to be the greatest. To
them the greatest gain developed is by the house alone, the
'model dwelling,* the work of the sanitary architect, giving
ten years more of life and working ability, a result cheap to
pay for by extra rents, and which would be still further im-
provable by the removal of surrounding deteriorating condi-
tions, especially bad schools and ill-conditioned places of work.

" As against extant evils, there is yet to be provided the
due exercise of the functions of medical officers of health and
the aid of the sanitary inspectors in the inspection of work-
shops and schools, and chiefly the half-time schools. As Com.-
missioners of inquiry into the labor of young persons in
factories in 1833, it was the recommendation of myself

390 The Present Condition of Samtary Science.

and my colleagues that the factory inspector should be essen-
tially a sanitary inspector. Under our first General Board of
Health we made an effort to extend these functions in our
regulation of the duties of the local officer of health to a
weekly inspection conducted at the places of work. On the
detection of the premonitory symptoms of disease — chiefly the
eruptive diseases—the health officer would, to prevent them
spreading, intrust the removal of the patient to the sanitary
inspector, who would be ordered to see to the fitness of the
habitation for recovery or else to provide a proper place. It
is a mark of our progress that such official sanitary qualifica-
tions as now abound, which qualifications it is economical to
pay for, did not then exist, or were to be obtained in a few
instances only, such as that of Dr. Neil Arnott, at such salaries
as we could induce a Chancellor of the Exchequer to pay for
them.

" The greatest and the grandest advance in the power of
sanitation made in my time is, it appears to me, that for the
extinction of the chief children's diseases, measles, scarlatina,
typhus, and diphtheria — an advance carefully and efficiently
tested and ascertained in the chief district half-time schools,
where the death-rate, among the children who come into those
institutions with no developed disease upon them, is reduced
to less than 3 in a 1000, or less than one third of the death-
rate prevalent among the general population. Such reduction
is coincident with the reduction of the death-rates in the
prisons, the former seats of epidemics, where among the persons
who enter without developed disease upon them, the epidemics
are entirely expelled, and the death-rates reduced below 3 in
a 1000, or to less than a third of the death-rates prevalent
among the unprotected population outside.

" Physicians are beginning to declare that a large amount of
the crime for which punishment is inflicted is due to insanity,
and that insanity is due to low physical condition, which sani-
tation by early physical training would remove. There are
experiences to show that this is the fact. Dr. Ashe and others
conversant with the lunatic asylum declare that, as a class,
lunatics are of low physical condition, and that that low con-
dition is reducible by sanitation and early physical training ;
an important matter, for eighty thousand lunatics are now

V

>

The Present Condition of Sanitary Science. 391

burdening the rates. Of thirty thousand blind persons, the
late Dr. Rolph declared that two thirds might have been saved
by early sanitation. There are experiences, too long to par-
ticularize on this occasion, which sustain these several con-
clusions.

*' These experiences are also of vital importance in their ap-
plication to prison life. But there is another part of our na-
tional life and strength which yields the same results. I refer
to the latest manifestation of the power of our science for the
maintenance of the force of our army. At the Congress of
Social Science, held at Liverpool in October, 1858, 1 proposed
that the science which had saved the second army of the
Crimea should be applied to the protection of our excessively
death-rated army in India, and after much persistent labor of
representation, a Commission of Army Sanitary Inquiry was
appointed at the instance of Lord Stanley, now the Earl of
Derby, in May, 1859, ^^^ ^^^ change which has since taken
place is surprising, even to stolid minds. The old death-rate
in the Indian army was 6"/ in a 1000. In the last decade it has
been reduced to 20 in a 1000. The saving of life in India in
that decade was in men, 28,130; in sickness, 25,000. This
was affirmed, on examination, by Sir Louis Mallet, on a claim
for due recognitions, when he was secretary to the India Board.
The services of the Army Sanitary Commission, which com-
prised those of Dr. John Sutherland, and of Sir Robert Raw-
linson — the remaining officers of the Crimean Sanitary Com-
mission— were extended over the whole army, and the aggre-
gate saving of life, as returned by the late lamented Professor
de Chaumont, of the Army Statistical Department of Netley,
has been 4058 men per annum, and for the decade, 40,500
men ; or in money, at £100 per man, ;f40,053 ; and in sick-
ness, ;^4i,68o, an equivalent sum of ;^ioo per man. The sav-
ing in life by sanitation is immensely greater than the losses of
life by war.

" At this time a further reduction has been made from the
26 per 1000 of the last decade to about 14 per 1000, and fur-
ther advances may yet be made in the sanitation of the Indian
army. A strong party has been formed in India to obtain the
application of the experiences of the successful sanitation in
the army to the relief of the civil population of India, and.

»

392 The Present Condition of Sanitwry Science,

moreover, to apply those experiences to large tracts of unoc-
cupied but fertile land, capable of permanent military settle-
ment, or of the civil settlements of a population much greater
than the present population of all India. My aid by exposi-
tion of sanitary and administrative principle has been besought
for this movement.

** So much for our own empire ; but a still greater advance
in army sanitation has been made in the German army, where
the death-rate has been reduced to 6, and even to 5, in a 1000,
with an increased value of 30 per cent for civil work after three
)'ears of military service. We have not yet attained to that
increased value of labor, although I have been informed of the
value of the labor of the volunteers being increased by five
shillings a week by the aptitude imparted by the drill. The
foremost sanitation of the German army is largely advanced
by a factor which is new to us, but which is extensively avail-
able for the civil as well as the military population. Mr. David
Grove, the eminent sanitary engineer of Berlin, applied a
means of washing constantly half a million of soldiers, with
tepid water, at the cost of a shilling for every two hundred
men. But I find that we now improve upon that sanitation,
and can effect it better for ninepence per two hundred men.
Now, also, in our schools and district institutions about ten
children can be washed with tepid water for about a penny,
soap and towel included, at a rate of time of three minutes per
head — much more cheaply and effectually than they can be
washed at home. Trained nurses devoted to the care of pa-
tients with the most infectious diseases, have long protected
themselves by a double washing, head to foot, daily, with tepid
water and a change of clothes, and experienced sanitary oflficers
use the same precautions on the occurrence of extraordinary
visitations of epidemics. Populations may now be trained to
do the same.

** Let me state one large gain in sanitation, which I now be-
lieve to be attainable for the satisfactory ventilation of public
buildings, and of large schools and workshops.

" I hiave for a long time collected observations of the height
of attacks of epidemics on the population of tall buildings, and
have found the attacks to be generally confined to the cellar
dwellings or the lower floors, while the occupants of the upper
floors have been distinctly exempted from them, that is to say,

The Present Condition of Scmitary Science, 398

the occupants of dwellings above the range of the visible fogs,
made up of the heavier, low-lying, and visible fogs. Mr.
Glaisher, the experienced aeronaut, gives me his testimony
that the visible fogs are low and close lying to the land. From
the height at Highgate or Hampstead, fogs are seen covering
London like a level white blanket, out of which the upper and
bright portion of the dome of St. Paul's Cathedral is seen
bright and clear above it. By tubular arrangements (largely
economical in result) intakes may now be opened into the
purest superior strata of air, and it may be pumped down and
delivered, at a rate required, into public edifices, into the larger
schools and workshops, warmed in cold weather, and cooled in
hot weather. Had this new means of sanitation been under-
stood at the time of the erection of the new public offices, two
sets of officers might have been enabled to work well, where
one now works ill, and not with comfort, above half a day, in
the large, ill-ventilated rooms, which are reservoirs of impu-
rity, from which Ministers of State have declarlsd that they
have been driven to work at home. From India I have col-
lected experiences where the fog just covered the infantry, but
where the cavalry were seated above it ; and another experi-
ence also where a foot messenger could not pass, but where a
messenger on an elephant might. In such places, by shorter
tubular arrangements, the fresher air may be reached at an
expense less than that of the punkha, and healthy rest ob-
tained free from the torment of mosquitoes.

" Experiments may be required to determine the height for
a tubular intake (which may be of copper sheathing) to be
raised above the clock tower, to avoid the discharges of the
high chimneys of bone boilers and others (which themselves
require correction), and to insure for the Houses of Parliament
and the new public offices air of complete purity for their ven-
tilation.

** Let me do justice to the intellectual by referring to some
of the experiences of the working of the half-time school princi-
ple. At the half-time District School of Anerley, and of others
of them, excluding absolute idiots, full 90 per cent are got ' to
the good ' — that is to say, to wages when they leave of 8^.,
lar., and 12^. per week, or nearly the former wages of adults.
When I last visited the half-time school of Manchester, at
Swinton, the head-mistress there asked what need they had of

394: The PreMfU Condition of Sanitary Science.

emigration when they had three applications for every girl as
soon as she was fitted for a 'place. When the Dowager Em-
press of Germany visited the half-time school of Norwood, the
head-mistress declared that she had the greatest difficulty in
meeting the pressing applications for girls for good places.
And there can be no doubt that many will be carried from
them who would have been left with the helpless insane. The
late distinguished inspector of schools in Ireland, Sir John
Lentaigne, declared that the system, if duly applied, would
beneficially change the character of a nation. Lord Shaftes-
bury has put it on record that the mothers of the factory chil-
dren in Lancashire had declared to him that the half-time sys-
tem of school and work had made their children as of another
race to them. And this, too, is practicable at a reduced
charge from often using the same school buildings for double
sets the same day to accommodate industry, as they are find-
ing out they may do in the colonies. And this may be done
for £i los. per head, with a superior physical training, as
against £2 ^s, per head, the charge of the long time board
schooling. School teachers have declared that if they were
left to their own devices as to classification, they would save
three years of school life to every child, and that with a su-
perior physical training which can be got at no time afterward.
This will effect the abolition of the ' snaiPs pace,' and will
make the school the happy assemblage of the millions of chil-
dren during the first days of their life.

" What may be further attained, by a combination of more
effective work of the sanitary architect, with better sanitary
inspection of schools and places of work, by the local health
officer, with the aid of the sanitary inspector, would, it appears
to me, be ascertained by what I have called a close clinical ex-
amination, carried out by a competent specialist, as was done
with great advantage for Brighton.

** The selection of emigrants is now a subject of much con-
sideration, but it maybesubmitted that one great object would
be to ascertain the sanitary fitness of the locality to which it is
proposed to send the emigrant, as, for example, that it is not
one where the chances of death from phthisis are doubled, or
one where, of the children born, more than half will be in their
graves before their fifth year— common conditions in some
places to which emigrants and their families are now sent.

The Present Condition of Sanitaay Science. 895

" The orphan children in the district half-time schools are,
in a large proportion, the children of hereditary vagrants,
mendicants, and delinquents. Our experiences now display a
considerable reduction from them of juvenile delinquency, and
enable us to declare that if the children of these classes were
given to us from very infancy they need be vagrants and de-
linquents no longer, but honest and productive citizens.

" To those who are unacquainted with the subject in detail
in principle — the popular test of central legislation and of local
administration, of either political party, may be deemed ex-
travagant ; yet on due examination it will be found that the
wastefulness of ignorance, of bad central legislation, and of
bad local administration, causing sickness and premature mor-
tality, may actually be tested by the nose — now by the odors
of stagnation and of putrefaction, now by the gases of stagna-
tion, by putrefaction in rooms, defective supplies of water, by
stagnant cisternage which absorbs foul gases, by the odors of
putrefaction from sewers of deposit, by the odors of putrefac-
tion from ill-formed and ill-cleansed streets, and by the eye
indeed, as well as the nose, in unwashed children and unwashed
workpeople in the byways and the highways.

" In a sentence, low sanitary conditions of populations are
everywhere the sources of irritations, of despair, of disorder ;
while high sanitary conditions are the sources of satisfaction,
of political security, prosperity, order, and peace.

*' Mr. Chairman, lords and gentlemen, 1 thank you most
sincerely for the consolation and happy assurance of the great
future which your testimonial conveys to me. Looking further
back than perhaps any one here present can look, I do see, I
confess, in the progress of the past, an augury for the future
which fills me with all the delight that can fill with the bright-
ness of hope a human heart that has beat so long as mine. I
see in the happier, because healthier children that are being
nurtured, what may fitly be called the new birth of health that
is in promise for the world. My satisfaction may not be equal
to my thankfulness, but it is sufficient in this respect, that it is
a richer satisfaction than has fallen to the lot of most men who
have devoted all their energies to the work of national reform,
in matters that lie nearest to the most vital of all that is na-
tional, the vitality of the nation and its power for strength and
endurance in the career of nations."

396 The Sanitary Condition of India and its Teachings.

THE SANITARY CONDITION OF INDIA AND ITS

TEACHINGS.*

By Dr. J. A. S. Gra»t-Bey, of Cairo. Egypt.

In our last article we gave an account of an eye-witness of
the sanitary normal state of a native hamlet in the suburbs of
Calcutta while no epidemic was raging.

We now purpose to lay before our readers an account of a
visit in December, 1887, to a native cholera-stricken village,
also in the suburbs of Calcutta, in order that we may profit by
the lessons taught us by the sad narrative.

The epidemic here described is only part of that cholera
epidemic which has been spreading over the length and
breadth of India since last year, and which is now raging in
all its intensity in, the Punjab. As all our readers know, India
is the hot-bed of cholera, where it is always present in its en-
demic form, and where every three or four years it assumes the
epidemic character, when it threatens to spread not only over
India, but to every port having communication with that
country.

** The destroying angel passing over the land of the Pharaohs
and smiting the first-born in every Egyptian household can-
not have produced a more heartrending scene than the one
now presented on a smaller scale at Hathibagan, a suburban
village not more than a quarter of a mile from the centre of
Calcutta. There, within an area of small compass, more than
twenty families are each bewailing the death of some member
or members of their family. The sound of the dirge and
lament is heard at nearly every door, for within the last few
days cholera has visited house after house, carrying with it
sorrow and ruin and panic. People are hurrying their dead to
the burial and burning-grounds, while others are fleeing for
safety from the place.

* Copy of paper written for the Arabic medical journal. Al SAifa, Septem-
ber, 1888.

Ths Scmitwry Condition of India and its Teaehings. 397

" Among the refugees there are not a few who have fled too
late, only to be struck down on the roadside.

" Custom and apathy have so ordered that no pitying eye
takes note of these things — no helping hand stretches forth
succor to the suffering people in their aflliction.

'' Hopelessly left to shift for themselves, they die in all the
horrors and pangs of a cholera death.

'*But this is not all. The moral insensibility which distin-
guishes the authorities in their attitude toward the sufferings
of the inhabitants is only surpassed by their supineness in per-
mitting the causes of the pestilence to remain unremoved.

'* The sanitary condition of the village has, out of India, no
parallel in the civilized world.

** There are tanks supplying the inhabitants with drinking-
water, and at the same time receiving the contents of their
latrines ; ditches full of the blackest and most putrid of mire ;
the soil soaked with the foulest and most noxious of filth,
while the air is laden with impurities and redolent with stinks.
Literally, the place is a vast cesspool — air, water, soil are all
alike poisoned. Here the external and most potent causes of
disease are in full play, and grim and ghastly indeed are the
effects.

** Cholera, the child of filth, revels in its home, gaining in
strength and vitality, until conditions arise that will give it an
opportunity of leaving its native soil and visiting other places
and countries congenial to its tastes.

" Doubtless the authorities will declare that the endemic or
epidemic is due to seasonal influences, and that the deaths are
not more than usual.

'' This apology has ever and at all seasons been a convenient
cloak for inaction ; but how long is the truth to be suppressed
for the ease of the authorities ? Seasonal causes are myths of
a bygone day, and must give way to the irresistibly large ac-
cumulation of facts which evidence that polluted soil, polluted
air, and polluted water are alone the means of nurturing this
fell disease, and that the removal of this pollution is alone the
remedy. How long are the inhabitants to be deprived of a
pure water-supply, of drainage, and of measures of cleansing
which are among the ordinary necessaries of healthy aggregate
life ? It is idle to speak of the filthy habits of the people,

398 The Sanita/ry Condition of India and its Teachings.

when the ordinary means whereby they can be clean are not
placed within their reach.

** If municipal commissioners will not supply these three
wants to their constituents, no amount of education or lecturing
will ever effect a change. The change must come from those
who are in municipal power — that is, from those who are in
authority.

'* At the present time the unsanitary condition of the suburbs
of Calcutta is an outrage on humanity, a satire on civilization,
and a disgrace to all concerned." *

The closing words of the above report are even more trench-
ant than we dare use toward our authorities, however much
tempted to do so.

. Now what can we Egyptians learn from this picture of the
unsanitary condition of our neighbors ?

What about the air we breathe ? What about the state of
the soil on which our habitations are built ? What about our
drinking-water supply ?

True, we have not cholera to deal with unless when it is im-
ported, but we have other death-producing diseases always
present that are equally dependent for their existence and
propagation on what feeds cholera and other contagious dis-
eases. Is it not true that the air in and about the majority of
our dwellings is pestilential ? And have we not evidence
enough that the soil is saturated with Blth and is becoming
more and more so every day ?

As to our drinking-water, if we have no means of storing
the high Nile water, then, for about three months in the year,
we have to drink what may be truthfully designated sewage-
water, while during the other months of the year the river is
only comparatively pure by reason of the abundance of water,
which helps to nullify the bad effects of the organic matter
thoughtlessly thrown into it by the natives ; for there is no
sacredness attached now to old Father Nilus to force the
natives to keep the river undeBled.

The wisdom of the ancient Egyptians is proverbial, but, un-
fortunately for us, wisdom is not hereditary ; besides the ac-
quiring of it is by far too laborious and irksome for a race

* Journal of the Health Society for Calcutta and its Suburbs^ vol. Iv., Pt. I.,
1888.

The Sanitary Condition of India and its Teachings, 399

whose nerve power is concentrated elsewhere than in the
brain.

We have heard a great deal lately about the excessive death-
rate throughout Egypt, but more especially in Cairo, and it
may well attract our attention and draw out our concern.

What are the best means for lowering it, and are they being
used ?

In other departments of the government we hear of great
projects proposed and attempted at a great cost to the State,
but the Public Health Department is in many respects like
that of India— left almost out of count, although disease and
death threaten the very existence of such a small nation as
this is. India, with its population of 300,000,000, can afford
to be well purged of its extra population from time to time by
keeping up its unsanitary condition, but this is not the case
with Egypt, which is at this moment suffering from scarcity of
tillers of the soil. There is no lack of immigrants pouring into
Egypt, but none of them can replace tYi^ fellaheen. The culti-
vation of laborers ought then, one would think, to demand
the serious study of our political economists as much, if not
more so, than the cultivation of cotton and sugar>cane.

We question very much whether this is the case, but the
shoe will pinch more tightly erelong if intelligent and well-
digested sanitary methods are not speedily adopted and faith-
fully carried out. There is a remarkable similarity between
Egypt and India in their unsanitary conditions and in the
apathy of the authorities as to sanitary questions that involve
the health and stability of the native population.

One has only to walk through our cities and villages to be
sensibly assured of the pollution of the air and soil ; and in
nine cases out of ten that pollution is far more intense inside
the dens and houses of the natives than it is in the open
streets. Even the European houses are not exempt from un-
sanitary stinks that might easily, by proper ventilation, be
carried off and disinfected in the open air instead of being
allowed to permeate through the rooms, thereby destroying
the health and stamina of the inmates. We read of the filthy
water-supply in India and of its deleterious effects on those
who are obliged to drink it, and we are not astonished to find
that an impure water-supply in Egypt is accompanied by a

400 The Scmitary Condition of India and its Teachings,

high death-rate. Just look at those green, stagnant pools at
low Nile, which surround the Egyptian villages and receive the
filth and washings of the people, while at the same time they
serve as a water-supply for man and beast.

Can it be wondered at that the native population is dying
out by a slow process of blood-poisoning? Here in Egypt
there is no lack of polluted air, polluted soil, polluted water-
supply ; these, combined with the excessive heat of summer,
ignorance, and crime, make our demographic statistics simply
deplorable. The present unsanitary condition of India has
been designated an outrage on humanity. This may equally
be said of the unsanitary state of Egypt. Surely things are
not going to remain as they are.

It becomes more and more evident every day that a Min-
ister of Public Health is urgently needed in the Council of
Ministers. There is no lack of sanitary measures to be passed ;
but as they are not well understood by a non -professional and
non-scientific ministry, and as they are not immediately re-
munerative, they are pigeon-holed, and thus remain a dead
letter.

We have raised our feeble voice in the cause of sanitary
reform, and we have pointed out some of the ways by which
the health of the people might be improved, and we are glad
to find that sometimes our suggestions occupy the serious
attention of the Sanitary Department ; but as this department
is discredited at the Ministry, its proposed sanitary measures
are generally sent back for further study, as they are con-
sidered both ill-digested and impracticable. As far as the
climate of Egypt is concerned, little need be said further than
that it is excellent.

The heat of summer is, no doubt, sometimes excessive, and
children suffer from the effect it has upon their milk-food, and
many of them die from summer diarrhoea. This could be con-
trolled somewhat if the people were less ignorant and knew
more about the proper preparation of food for the delicate
stomachs of their offspring.

The cold of winter does not last long, so that chest disease
is not common among the natives ; but we have seen many
cases that would have better health if they had more clothing.
We are sure that a little more education would enable the

Sewage Irrigation and Salubrity. 4()1

natives to intelligently combat the evils arising from the
climate.

We consider that it is the duty of the government to take
the advice of the Sanitary Department as to the laying out of
towns and villages, and as to the construction of individual
houses, so as to secure a pure air for the people to breathe.

Many of the wild beasts have better dens to live in than the
Egyptians have houses.

The honeycomb principle on which the houses of the villages .
are built is entirely wrong in a sanitary point of view. This
could easily be rectified, as they are but crude brick huts at
best. The government is certainly responsible for a pure
water-supply for man and beast all the year round, and it
would be wise in fulfilling this duty to make arrangements
beforehand for carrying off the waste. This has been effect-
ually frustrated at Cairo by the destruction of all the sewers.

Cairo is now supplied with an abundance of water, and occa-
sionally during the winter there is a considerable downfall of
rain ; but without a single sewer this must inevitably lead ta
flooded streets, if to nothing worse.

The Public Instruction and Sanitary Departments could not
have a better field than Egypt for distinguishing themselves
in, there is so much that needs to be done.

We are, therefore, very anxious to see both these depart*
ments in a more flourishing condition.

SEWAGE IRRIGATION AND SALUBRITY.

The Paris correspondent of the Lancet, December 26th, 1888,
writes that,

Concerning the disposal of the sewage of Paris, the first
reading of the report of Dr. Cornil has been favorably received
at the Senate. In concluding his report. Dr. Cornil made the
following statement : " Our hospitals are the great centres
where are accumulated patients affected with contagious or
microbian affections. The dangerous matters, such as the
sputa of phthisical subjects, the dejections of patients affected
26

402 Sewage Irrigation and Salubrity.

with intestinal ulcerations or simply of general maladies, the
linen of dressings, everything which proceeds from wounds or
suppurations, etc., should be disinfected on the spot, before
leaving the hospital, by chemical procedures or by well-known
heating measures." In connection with this subject I may
here give the substance of a very remarkable article published
a short time ago in the Temps, in which Dr. Cornil relates two
conversations which he had with Professor Koch, of Berlin,
when on a visit to that city. In the first Professor Koch de-
clared that it was not correct to say that the use of the waters
of the drains by the inhabitants of the city was interdicted.
Everybody, he said, drinks this water, and finds it good.
The municipal functionaries who occupy domains in the city,
have drunk this water for several years without experiencing
the least inconvenience. The contamination of small streams
by the effluent waters of the drains is not admitted by M.
Koch. This water, he says, does not contain organic matters
non-nitrified ; the inhabitants of the villages situated on their
banks contaminate these streams a great deal more than the
drains which open below them. He recognizes, moreover,
that the soil of the domains where Paris proposes to practice
irrigation with sewage water, is much more favorable than that
of Berlin, as it is very permeable. Moreover, at Paris there
are two hundred and fifty litres of water per inhabitant, in-
stead of sixty or seventy as at Berlin. To the question as to
whether there would be any fear of a progressive saturation of
the soil, M. Koch replied that there was none. If the period-
ical quantity is properly regulated, as is done in Berlin, one
can obtain the complete transformation of the organic matters
without any modification whatever of the soil. The facts ob-
served, he added, at Breslau, Dantzic, and Berlin, are alto-
gether conclusive, and he considers it as demonstrated and
certain that the irrigation may be continued indefinitely. At
the second interview the eminent professor of hygiene at Ber-
lin recalled that the bacteriological researches have demon-
strated that in the sewers the air is extremely poor in microbes.
The confirmatory results of the an^alysis of the air of the sew-
ers of London and of those of Paris by M. Marie-Davy were
foreseen ; for, firstly, the air is always but little charged with
microbes ; and, secondly, humidity fixes them. M. Maze,

The Weight of the Smoke Cloud. 403

who was present at the interview, asked whether purification
was best effected with absolutely pure sand, or with sand a
little argillaceous. M. Koch replied that the second mode
appeared to him preferable, as the filtration is then much
slower, and consequently better. The soil is, moreover, a
perfect purifier ; it is thus that at Berlin the sheet of water
does not contain any germs. In conclusion, to an observation
made by M. Maze as to the disagreeableness which would re-
sult to the localities of the neighborhood of the irrigation, M.
Koch replied that in his office of physician he interested him-
self a great deal more in the salubrity of Paris than in the
agreeableness of the localities of its outskirts. Great cities, so
much exposed to diseases, should be salubrious in order that
the environs might be also. As to the proposal to convey the
sewage by means of a canal to the sea, M. Koch considers
this impracticable, whereas the purification of the waters by
the soil should succeed even better than at Berlin.

The Weight of the Smoke Cloud which daily hangs
over London has been estimated by Professor Chandler Rob-
erts, says the Engineering Times^ to amount to about 50 tons
of solid carbon and 250 tons of carbon in the form of hydro-
carbon and carbonic-oxide gases. Calculated from the actual
result of tests made by the Smoke Abatement Committee, the
value of coal wasted in smoke from domestic grates amounts,
upon the annual consumption of 5,000,000 of^people, to £2,-
256,500. The cost of cartage on this wasted A)al is calculated
to be ;f268,750, while the unnecessary passage of about 1,500,-
000 horses through the streets in drawing it, adds seriously to
the cost of street cleaning and repairing. Then there is the
cost of taking away the extra ashes, ;f43,ooo per year. Sum-
ming it all up, the direct and indirect cost of waste coal may
be set down at £2^600^000, plus the additional loss from the
damage done to property caused by the smoky atmosphere,
estimated by Mr. Chadwick at ;^2, 000,000, the whole aggre-
gating, ;C4»6oo,ooo.

"Hello, Moses! Wot's the matter wid ye?" "Indi-
gestion." "How's dat?" "Hain't had nothing to digest
lately."

404 Water Analysis.

WATER ANALYSIS.*

By Charles Smart, M.D., Surgeon U. S. Army.

A NUMBER of experiments on the decomposition of urea
showed that while the amount of the ammonia collected in the
later measures of the distillate might be made to vary by rais-
ing or lowering the gas-flame, and so altering the time occupied
in the distillation of the measure, it was a constant quantity
where the rate of ebullition did not vary, and under similar
conditions the quantity given by the alkaline permanganate
was always as large again as that obtained by simple distilla-
tion. Dilutions of fresh and decomposing urine in tap-water
gave similar results. This peculiarity in the behavior of urea
is of importance, as by it not only may the presence of this
substance in the water be diagnosticated, but an approximate
estimate may be made of its quantity. Laboratory notes giv-
ing the details of the evolution of ammonia from ox^anic chem-
icals and composite organic solutions, the waste-products of
manufactories, etc., were examined, but not one was found
presenting reactions by which it could be confounded with
urea. Thus, while some gave a persistent and equable evolu-
tion of albuminoid ammonia, no free ammonia was liberated.
Among those acting in this way were potassium cyanide, po-
tassium and silver cyanide, sodium nitroprusside, alloxan, and
some of the alkaloids. In several instances factory-drainings
gave a persisting evolution of both free and albuminoid am-
monia, but not in the ratio i : 2, as furnished by the decom-
position of urea. The details of the analysis of a large num-
ber of waters were examined with reference to this point, and
in all cases where the evolution had occurred in the manner
stated urea was known to have been present, or its presence
was probable in view of the known origin of the sample. The
writer is therefore of the opinion that where this peculiarity is
found in treating a water-sample by the Wanklyn process, the
presence of liquid sewage amounts to more than a probability.

* Contiaued from page 305.

Water Analysis. 405

It is true, in some of the analytical notes examined, the evo-
lution was not recorded as having taken place in this peculiar
manner, although sewage was probably, or, indeed, known to
be, present ; but as in these instances many days had elapsed
between the collection of the sample and its analysis, urea
might have disappeared in the meantime by the natural fer-
mentative process.

Moreover, the process is approximatively quantitative ; for
since i milligram of urea in 500 c.c. of water gives a persisting
and equable evolution of .01 milligram of ammonia when dis-
tilled alone or with sodium carbonate, and an evolution of .02
milligram when subsequently treated with the alkaline per-
manganate, a water-sample which gives such results must have
contained urine equivalent to at least i milligram of urea in
each half-litre. The urea in urine is, of course, a variable
quantity ; but experiments on a number of samples of fresh
urine, \^ ^, ^, and i c.c. in the half-litre, gave an average evo-
lution of .01 milligram of free ammonia in the third and fourth
measures of the distillate, and of .02 milligram of albuminoid
ammonia when the water contained i part of urine in 15,000
parts of water. For example, one half cubic centimetre of
urine in 500 c.c. of water, equalling i part in 1000, gave .47,
•25, .15, and .15 of free ammonia, respectively, in the four
measures of 50 c.c. each, and .54, .34, .32, and .32 of albuminoid
ammonia in the four measures distilled from the alkaline per-
manganate.

This method of detecting the presence of sewage in water
was put to practical use in an examination of the wells and
cisterns of Nahant. One of these, known to the writer only
by its number in a series, showed black rings and islets, with
sooty fumes and foul odors on ignition, and gave .19 part of
free and .53 part of albuminoid ammonia per million. This of
necessity condemned it as an organically foul water, but as the
ammonias were evolved in the manner indicated as peculiar to
urea, and as, moreover, the water, known from its general
characters to be a cistern-water, contained a larger proportion
of chlorine than is normal to cistern-waters, the writer had no
hesitation in reporting it as contaminated with a certain pro-
portion of urinous admixture. One month later another of
the Nahant series of waters, known to the analyst only by its

406 Water Analysis,

number, was reported on analysis as a satisfactory cistern-water.
Thereupon the following history was communicated : Typhoid-
fever had appeared in a cottage built by a gentleman as a sum-
mer residence on the sea-shore. The water was suspected as
having to do with the causation, and a sample analyzed by
Professor E. S. Wood, of Harvard, was pronounced unfit for
use. The proprietor, dissatisfied with this report, sent a speci-
men to another chemist, who returned a similar verdict. A
physician inspected the premises and suggested that sewer-
gases might have been condensed on the roof from the venti-
lating pipe of the water-closet. Thereupon means were adopt-
ed to remedy the evil ; and the cistern was pumped out,
cleaned, relined with cement, and put in what was conceived
to be perfect condition. When filled, the sample was collected
which on examination was reported as polluted with urine.
This naturally shocked the proprietor, after all his efforts to
obtain a pure rain-water, and he felt more inclined to deny
credit to water-analysis than to pronounce his cistern guilty.
But Mr. Bowditch, of Boston, who was conducting the sanitary
survey of Nahant, conceived that further investigation was
imperatively demanded. There was a possibility of leakage
into the cistern from certain drains which carried off kitchen-
waste, but this would not account for the urea unless the ser-
vants were in the habit of putting this system to an unauthor-
ized use, and the proprietor, though willing to concede that
some servants might act in this manner, would not allow that
his could be guilty of such a practice. However, it appears
that the drains had no connection with the cistern. But Mr.
Bowditch, in his examination, discovered that there were three
apertures into the cistern while only two conductors from the
roof entered it. It was then remembered that two years be-
fore, in adding a wing to the building, a conductor had been
disused, but what had been done with it was not known. The
old conductor was then uncovered by Mr. Bowditch, and its
distal end was found open under the surface near the piazza
where grew some vines which were sometimes nourished with
chamber-slops. It was further found to be the custom of the
house to collect all such slops in pails, which were emptied
through a water-closet on the first floor and then placed on the
roof of the piazza to air. The old conductor was removed and

Water Analysis. 407

its cistern-aperture sealed, and the connection was cut between
the cistern and the roof of the piazza, the roof of the house
thus becoming the only contributing surface. When the cis-
tern was again filled after these changes the analysis authorized
a favorable opinion on the contained water. This appears to
be a satisfactory illustration of the value of attending to the
manner in which the ammonias come over during the distilla-
tions of the Wanklyn process.

The information which may be gathered concerning the
character of a water by a comparison of the results of the
Wanklyn and Kubel processes may be formulated as follows :

A water yielding up the nitrogen of its organic constituents
slowly as albuminoid ammonia contains recent organic matter /

Of animal derivation, if a small quantity of oxygen be re-
quired to oxidize it by the Kubel or Tidy process ;

Of vegetable derivation, if a large quantity of oxygen be re-
quired.

A water yielding up the nitrogen of its organic constituents
more rapidly contains decomposing organic matter ;

Of animal derivation, if a small quantity of oxygen be re-
quired to oxidize it, and if there be no interference with the
development of the true ammonia-coloration during Nessleri-
zation ;

Of vegetable derivation, if a large quantity of oxygen be re-
quired, and if a yellow coloration be developed in the water on
the addition of sodium carbonate and agreenish color interfere
with the estimation, particularly of the free ammonia, by Ness-
ler's method.

The nitrates in a water are of much importance, as being the
inorganic or skeletal remains of formerly existing nitrogenous
organic matter. In themselves they are harmless ; but the
water which contains them must at one timQ have been con-
taminated with organic substances.

Wanklyn says that the nitrates offer no data of any value in
judging of the organic quality of a water. But as the nitrates
are always derived from organic matter, and very generally
from recent matter, Frankland gives greater weight to their
presence, and makes them, with the nitrites and ammonia, the
basis of a calculation showing what he calls the previous sew-
age-contamination of the water. Ekin goes further, and claims,

408 Water Analyeis.

from an experience which has found nitrates in waters which
had undoubtedly caused typhoid -fever and yet were free from
any unusual amount of recent organic matter, that nitrates in
excess of 0.5 or 0.6 part in 100, o<X) point significantly to dan-
gerous pollution. This is an extreme view. A water which
contains the nitrified remains of organic matter should have its
surroundings minutely inspected, and if there is a possibility
that the nitrates are derived from any neighboring polluting
source liable to infection with typhoid excreta, suspicion as to
the wholesomeness of the water may be entertained, for some
change in the circulation of the percolating current may at any
time bring unoxidized organic matter into the water, and,
moreover, there is great probability that the specific fever-
poison may persist notwithstanding a filtration which destroys
ordinary or non-specific sewage.

Nitrates are conveniently detected by means of Sprengel's
solution, which consists of one part of carbolic acid dissolved
in four parts of sulphuric acid, and subsequently diluted with
two parts of water. It forms a faintly reddish solution when
seen in mass, but is almost colorless when dropped on a white
porcelain surface. The water to be tested is evaporated to
dryness in a porcelain capsule. A few drops of the test-liquid
are permitted to fall on the residue and are trailed over its sur-
face by tilting the c^Lpsule. If nitrates are present in notable
quantity a dark blood-red color is developed on the trail of the
test-drops. If traces only are present the color is fainter — so
faint, perhaps, that it may be difficult to decide if the original
color of the drops has been really deepened. Besides this, the
darkening produced in some organic residues by the acid of
the test obscures the reaction with minute traces of nitrates,
but, nevertheless, the test is of value.

Frankland has called the nitrates the skeleton of sewage ;
but these salts may have their origin in the nitrogen of vege-
table organic matter as well as in that of animal matter. If
any one salt is especially characteristic of animal life it is sodium
cMoride. It is an essential component of the animal tissues,
and is therefore present in the excretions. Chlorine in a water
associates the sample with a pre-existing animal matter. If
ammonia is present in unusual quantity the proximity of the
polluting source whence the chlorine was derived may be con-

Water Analysis. 409

sidered certain. If nitrates, and especially nitrites, are pres-
ent, the chlorine may also be referred to a recent pollution.
These various substances, found on analysis, support each
other's testimony and give greater value to the analytical re-
sults. Rain-water contains minute traces of chlorine, especially
in showers falling near the sea-coast. Cistern-waters collected
from foul roofs may contain a fraction of a part per million.
River-waters usually contain up to five parts per million, and
well and spring- waters more than this. The more extensive
the contact with the soil the greater usually is the amount of
chlorides present.

Chlorine is detected by the action of silver nitrate on its so-
lutions. This test should be applied to a few cubic centimetres
of a water under examination, not to manifest the presence of
the chlorine, for that may be taken for granted, but to give a
rough estimate of its quantity, that the analyst may know
what volume of water will be convenient or necessary for the
exact determination of quantity. When a dense cloud or
curdy precipitate appears in this preliminary experiment, the
chlorine may be estimated in the unconcentrated water ; but
when the silver salt gives only a faint haze, it will be advisable
to evaporate lOO c.c. to a small bulk for the quantitative ex-
periment ; and if the silver gives little or no reaction, as much
as 400 c.c. may be required.

The estimation of the chlorine concludes the organic analysis
of clear waters, but it is always advisable to supplement the
chemical methods by microscopic examination and bacterio-
scopic investigations, as they may furnish points of informa-
tion bearing on the character of the organic matter. Although
the sediment to the unaided eye may appear as nily or as the
merest film upon the bottom of the containing vessel, the
microscope may reveal in it an infinite variety of vitalized
forms, few of which, however, have been associated with in-
jurious qualities of the water. Thus the symmetrical forms of
the desmids and diatoms are found in the sediment of almost
every natural water. Their presence is therefore deprived of
any special sanitary value, except where it constitutes the char-
acteristic of the microscopic field, as in cases of pure well or
spring-waters. Impurity in the water develops other forms of
life which withdraw the attention of the observer from the oc-

410 Water Analysis.

casional diatoms. The filamentous oscillatoriacex and nostocs,
with their transverse markings and constrictions, and the other
confervoid genera in which the colored endochrome becomes
converted into motile zoospores, as in zygnema, spirogyra,
zygogonium, conferva, oedogonium, and choetophora, are so
generally found in water that it is only when they become
prominent as a sediment that excess of organic impurity may
be suspected. Of the animals, rotifer and hydatina among the
rotifers, cypris, cyclops, and daphnia among the entomostraca,
and macrobiotus and hydrachna among the arachnids, occur
frequently in waters which analysis has shown to be pure, and
experience to be destitute of any unwholesome qualities ; while
the tentacled infusoria, such as euglena and peranema, and the
ciliated acomia, enchelys, and alyscum are also to be found in
waters which give good results chemically. Pure waters have
generally but little sediment. Impure waters, although fre-
quently depositing a sediment which swarms with vital forms,
may give a microscopical field which is as devoid of living
forms as that furnished by a pure spring-water. This result
may be obtained after water has been thoroughly sedimented
in the well or cistern whence it has been withdrawn for exam-
ination. But if the sedimentation has been less perfect, so
that some particles of vegetable d/6rts are left floating in the
water, these particles will be seen to swarm with living forms
if the water is impure ; while, if it is pure, any vegetable debris
thus accidentally present will not be found to be the centre of
a vital settlement. In some instances an organically impure
water has presented a perfectly dead field when the amount of
saline matter in solution was large.

The discovery of the comma bacillus by Koch, with the ex-
pectation of further developments from his methods of biolog-
ical research, has for some time past made the sanitary analysts
feel as if there would speedily be no more use for their chem-
ical knowledge and experience of the constitution of water-
supplies. The medical profession, and even the general pub-
lic, became fascinated with the views and possibilities opened
up by the German method of growing invisible germs on solid
gelatine plates until the colonies of each reached a magnitude
that brought them within the ken even of the naked eye. The
original germinal spots could be counted, to demonstrate the

Water Analysis. 411

number of individuals that had existed in the water under ex-
amination. Differences could be observed in the appearance
of the various colonies. Transplantation could be effected and
pure cultivations of each could be obtained for further micro-
scopic and biologic study. It seemed as if the end had been
reached, and that the question of the wholesomeness or un-
wholesomeness of a water was at last susceptible of solution
by laboratory methods. But the progress of experimental
work is slow. The anticipations of the enthusiasts, onlookers
chiefly, may be reached ultimately ; but in the meantime it
may be safely asserted that the new method has only succeeded
in developing the difficulties by which it is surrounded and in
casting doubt on its own results as a gauge of the quality of a
water-supply.

In Koch's method a given quantity of the water is mixed
with a sterile peptonized meat-jelly, which is then distributed
evenly on a glass plate, where it solidifies. The plate is placed
in a moist and properly protected apparatus and kept at a
temperature of about 20° C, which is that most favorable to
germination and growth. After a few days the colonies ap-
pear. They vary in size and shape, some minute, some larger
and spreading, some round or oval, smooth, fibrillated or tuber-
culated, and some liquefying the jelly which is their nidus.

Among the first of the facts demonstrated by this new
method of study was the universality of bacterial germs in
water. It was difficult to find a water which would not yield
a few colonies ; even distilled water from the laboratory of the
chemist was sometimes charged with them. The question
arose. Does the number of colonies developed from a water
have any bearing on wholesomeness irrespective of the charac-
ter of the individual colonies ? To this Bischof (** Trans. Soc.
Medical Officers of Health," 1885-86, p. no) has given a de-
cided reply. It was recognized that a water which, when
freshly drawn, gave rise to but few colonies, would yield very
different results after storage for a few days, on account of the
rapid multiplication of germs in the stored water, and it was
also recognized that this multiplication depended less on the
number of bacteria originally present or the organic pabulum
at their disposal than on such accidents as temperature and
exposure to, or deprivation of, light, oxygen, etc. But not-

412 Water Analysis.

withstanding the development of these germs a wholesome
water does not become unwholesome, as is well authenticated
by the use of such stored waters. A sample of New River
water, concerning the purity of which there could be no ques-
tion, as it yielded dnly fifty-three colonies per cubic centimetre,
was found after a storage of six days to yield no less than seven
hundred and seventy thousand colonies, a number seventeen
times in excess of that derived from the Thames water at Lon-
don Bridge ; yet there was not the slightest evidence to show
that the water in which this immense number had been devel-
oped was not a wholesome water. A water might be as free
from bacteria as that of Loch Katrine, or it might contain as
many as this stored sample of New River water, without
aspersion on its wholesomeness. Of what value, then, the
intermediate hundreds or thousands — particularly as these
numbers may be obtained from the same water on one day or
another? If seven hundred and seventy thousand be consist-
ent with wholesomeness, where is the line to be drawn ? We
know by experience that sewage or animal excretions consti-
tute a dangerous element in water supplies, but the number
of colonies throws no light upon this element, for Bischof
added sewage to a sample of the New River water, and after
storing it for six days, as in the parallel experiment with the
pure water from the river, he found that the bacteria in the
latter exceeded those in the tainted sample almost twenty
times.

But supposing the number of the colonies to be an indica-
tion of value, several important objections are urged against
the accuracy of the results yielded by the gelatine method.
Zoogloea masses and chains are not broken up by the agita-
tion in the tube, so that a mass may give origin merely to a
simple colony. From analogy, as well as direct experiment,
we know that different kinds of bacteria require different kinds
of food. The addition of a little phosphate of soda to an or-
dinary water will greatly increase the colonies in the gelatine.
Some organisms that do not flourish on the meat-jelly will do
so on potatoes, Iceland moss, bread-paste, and other vegetable
nutrient substances. The water-supply of Antwerp, which
was stated by a commission of experts to be completely sterile
to Koch's test, gave evidence of abundant life when potato

Water Analysis. 418

was used as the field of cultivation. Remembering these de-
fects in the gelatine process^ and recaUing the fact that num-
ber means nothing, what remains to be done ? To study the
colonies— to transfer to gelatine, blood-serum, potatoes, etc.,
in order to obtain pure cultivations. To examine these mi-
croscopically and study their characters, which are simple
enough, yet complex in their simplicity. The bacteria are
thick or thin, straight or curved, oval, round, or square-cut at
their ends, long and filamentous, or so short as to merge into
the torula or coccus, the cocci presenting every form of aggre-
gation from single to zooglcea, and the whole, perhaps, mixed
with mycelial threads, shreds of mucor, spores, etc. Every
water has a variety of forms, though in some the cocci, in
others the bacteria may predominate. Which are harmless ?
Which are harmful ? Nobody knows. In fact, the difficulties
of the microscopic field are so great that few observers have
attempted to state the number of different kinds of organisms
present, and fewer still to isolate by pure cultures and inves-
tigate by subsequent experimentation.

The gelatine culture-test is valuable only for its promise of
the future. At present it gives little information, and that lit-
tle is assailed on all sides by interrogation points. Chemical
analysis gives a definite statement of the quantity of the or-
ganic matter present and throws light upon its character, but
the results of the culture-field vary for the same water accord-
ing as it is examined on one day or another.

But to return from these culture-tests to the ordinary course
of sanitary analysis. If the water is turbid the substances
causing the turbidity may require to be investigated by both
chemical and microscopical methods. The total amount of
the sediment may be determined by evaporating a given quan-
tity of the water after it has thoroughly sedimented, drying
the residue and weighing, when its weight deducted from that
obtained by a similar experiment performed on the unsedi-
mented water gives that of the sediment present. If the ex-
periments already described in this article as performed on the
natural or unsedimented water are repeated on the thoroughly
filtered or sedimented specimen, a comparison of the results
will manifestly discover the special inorganic or organic char-
acters of the sediment. But a formal examination of this kind

414 fTater Analysis.

is seldom necessary, as the microscope usually sufHces to de-
termine the quality of the sedimented matters. The micro-
scopic appearances are extremely complex when examined in
detail, but each sediment presents certain characteristics which
may be seen at a glance with ordinary powers, and on which
the quality of the water may frequently be predicated. The
matters are mineral, organic, and vitalized.

The organic matters in suspension are various in character.
They are easily discriminated when fresh, but in the progress
of disintegration and decay their histological characteristics
become lost, and their origin is of necessity obscured. Their
organic derivation may, however, be generally determined by
their difference from the usual forms of inorganic matter and
by the activity of the organic life in their neighborhood. Those
most frequently occurring are fragments of woody tissue from
the roof in cistern-waters, and from the wood-work in well-
waters — the pitted tissues showing their derivation from
cypress or pine — straw, starch-cells, pollen grains, as also the
cellular tissue, stomata, veinlets, etc., of broken up leaves.
Dark- colored masses of woody tissue from the roots of trees,
when present in a well-water, lead to the expectation of vege-
table impurity in the water. Cotton fibres are often found in
the cistern-waters and in many of the wells of the Southern
States ; but their prevalence in the atmosphere deprives their
presence in the water of any sinister meaning. Wool and linen
fibres may also be washed from the roof into cisterns, but when
they are found in well-waters inflow from the surface may be
suspected. Fragments of human hair and epidermic scales
suggest a direct surface-leakage of a dangerous character, or an
equally dangerous carelessness in protecting the water after it
has been drawn. Insect remains, such as the legs, antennae,
abdominal shell, and wing-scales may be present in cisterns,
indicating a corresponding degree of impurity in the water and
affording evidence of inefficient filtration, or of insufficient
protection in the case of well-water.

The germs of vitality are so generally diffused that, where
there is food, development, growth, and reproduction will
ensue under ordinary circumstances. Temperature retards or
accelerates these changes ; but the same temperature which
promotes the growth of microscopic organisms induces, in

Water Analysis. 415

devitalized substances, the development of the putrefactive
changes which transform their albuminoids from wholesome to
unwholesome, as regards their action on the human system.
The growth of these microscopic organisms may therefore be
considered, in many cases, as measuring the harmfulness of a
water-supply. Bacteria, on the microscopic field, show a
putrefactive tendency in the organic matter of waters. Of the
tentacled infusoria, oxytricha, kerona, and euplotes are found
in waters which do not give a satisfactory response to the
chemical tests. The flat worms, the anguillula, and the regu-
larly ciliated paramecia, of which that most commonly met is
the oblong compressed Paramecium, with its oblique fold, the
elongated amphileptus, and the flask-shaped lacrymaria, with
its long neck and ciliated mouth, coincide with waters which
would be condemned on chemical grounds. Sluggish amoe-
boids and the more active protoplasmic masses, such as monas,
cyclidium, cercomonas, etc., and a profusion of vorticellae in
an active or encysted condition, are certainly characteristic of
an impure water.

The question sometimes arises as to the presence of injuri-
ous quantities of certain metals in water. Lead^ derived from
service pipes or tanks, is usually the suspected metal, but it
may be copper from boilers. These, when present, may be
detected by the method recommended by Professor Wanklyn.

Rain-water is modified by the character of the roof which
sheds it — that from a clean slate roof may not differ materially
from the specimens collected in clean dishes ; while rotting
shingles, foul conductors, and equally foul cisterns may im-
press their characters upon the analytical results.

If the storage cistern is a wooden tank, the free and albu-
minoid ammonias may continue present in large quantities for a
long time after the inflow of a fresh rainfall. These, with a
large oxygen figure due to carbon washed from the roof, con-
stitute analytical results which would condemn any water save
that with this particular history. If the history of the water
is unknown, the small amount of the solids and of the chlorine
indicates with certainty that the water has not come in contact
with mineral matters, and that it is probably a rain water from
a wooden tank.

During the hot season putrefactive changes take place in the

416 WaiieT AncUysis.

albuminoids of waters thus stored. The water may even be-
come so tainted that the senses may take cognizance of its
impurity. It is therefore especially desirable, when wooden
tanks are used, that the impure portions of the rain-shower be
rejected by a cut-off, and that the water used for drinking pur-
poses be subjected to filtration.

If the rain-water is contained in a brick cistern, the carbonic
acid which it holds in solution enables it to dissolve a small
portion of lime from the lining of the cistern. The total solids
are therefore increased in quantity to lo, 12, or even 16 parts
per 100,000 of the water. The presence of the lime is readily
demonstrated ; and the absence of chlorine, save in quantities
normal to rain-water, shows that the alkaline earth is not de-
rived by sipage from the soil in which the cistern is built. In
waters thus stored a remarkable change takes place in a very
few hours. Although the rainfall on entering may have con-
tained .050 free ammonia and .030 albuminoid ammonia, the
former may disappear completely and the latter be reduced to
less than .010 part, constituting, according to the opinion of
most analysts, a record indicative of a pure and probably
wholesome water. The purification which is experienced by
rain-water when stored in an underground cistern, so notable
in contrast with the continued impurity of that contained in
wooden tanks, was at first attributed by the writer to condi-
tions, as of exclusion from light and heat, pertaining to the
underground position. But the speedy purification is now
known to be owing to a process of nitrification, the earthy lin-
ing of the cistern appearing to furnish the germs of the organic
ferment. This knowledge explains certain anomalous results
which were puzzling to the writer when dealing with the tank-
waters of New Orleans, La. Of two cisterns, one of which
was new or newly cleaned, and the other many years old and
perhaps never cleaned, the latter in most instances furnished
the purer water. Many such cases maybe found in his report
in the *' Annual Report of the National Board of Health" for
1880, Nitrification was effected in the old cisterns by germs
in the sediment which had gradually accumulated as the result
of roof-washing. But if the shedding surface was very foul
and the sediment largely charged with organic matter, the
water by prolonged digestion, especially at summer tempera-

Water Analyaia. 417

tureSy became contaminated by the sediment rather than puri-
fied by the organisms which it contained. Hence the old and
uncleaned cistern did not in every instance furnish a purer
water than the new or recently cleaned cistern. The lesson
taught by these facts is the introduction of the nitrification
ferment by a cleaner and surer medium than the accumulated
sediment. If a layer of sand or gravel be placed in the bot-
tom of a clean wooden tank, nitrification will progress in its
contained water as certainly as in that of the underground
brick cistern. And if the sediment in a tank which yields a
comparatively pure water be removed and replaced by sand or
gravel, the purification of the water will be more rapidly and
thoroughly effected.

Rain-water shed from the surface of the ground and collect-
ed in low-lying situations with an impervious subsoil layer
constituting swamps, ditches, or ponds, gives an increase in the
total solids over that proper to cistern-water, even when the
lining of the cistern has been attacked. The chlorine is usually
augmented to .5, i.o. or more parts per 100.000 of the water.
Such waters may become impure by passing over an unclean
surface ; but even if uncontaminated in their progress to the
lower level, their subsequent stagnation in or on the highly
organic surface soil affords opportunity for the solution of de-
caying vegetable matter, and they become impure, as their
volume is small compared with the mass of organic matter
which underlies them. The conditions in these instances ap-
pear similar to those in a cistern with a low water-level and a
large and foul organic sediment. In fact, the analyst may be
in some cases at a loss to determine whether he is dealing with
a swamp-water or with a foul cistern-water. The influence of
nitrification is lost in the continued absorption of ammonia and
solution of albuminoids from decomposing tissues, so that the
water yields to the Wanklyn process high figures of free and
albuminoid ammonia ; as much as .050 of the former and from
.040 to .090 of the latter. The swamp-water of New Orleans
yielded .050 free and .090 albuminoid ammonia, and its organic
matter required as much as 1.345 part of oxygen from perman-
ganate for its oxidation.

Foul pond-waters are sometimes used as public supplies, al-
though they manifestly should not be so used. The water of
27

418 Waier Analysis.

Easton's pond constitutes, for example, the city supply of
Newport, R. I. It was repeatedly examined by the writer in
connection with a sanitary survey of the city, and its organic
constitution, as developed by the analysis, did not differ from
that of swamp-water. On one occasion it yielded as much as
.105 part of albuminoid ammonia per 100,000, and required
.840 part of oxygen from permanganate. It might be sup-
posed that, if the use of such a water was specially dangerous,
the health reports of the city of Newport would bear testimony
of the fact ; but, as Bowditch says in his report on Summer
Resorts : ** It is questionable, however, whether the health of
the city is known to any one ; with the exception of a few of
the citizens it is undoubtedly so, and it would be entirely safe
to assert that neither the local board of health nor their officer
know at any time the actual health of the community or any-
thing approaching it, while the records show nothing. " When
necessity requires the use of these impure surface-waters, they
should be purified by systematic filtration, for although the
quantity or quality of the organic matter may not suffice to
cause a notable endemic of diarrhoeal disease, and although
the germs of specific disease may not be present, the tendency
to the former, and the probability of the presence of the lat-
ter, must be acknowledged to be greater in a supply which has
much organic impurity than in one which has little or none.
The microscopic characters of such waters are usually distinc-
tive, consisting of bacteria in the zooglea form, amcebae and
other sluggish protoplasmic masses, and a profusion of active
and encysted vorticles.

Lake-waters, resting on bed-rock, and having their volume
incomparably greater than the small marginal zone of organic
decay, are usually pure. They are analogous in organic con-
stitution to rain-water in a clean and sound underground cis-
tern. After a heavy rainfall on the water-shed the free and
albuminoid ammonia maybe slightly increased for a few hours,
but the active progress of nitrification soon effects a return to
the normal constitution. Naturally, the total solids show a
slight increase over those of cistern-water, and the chlorine
participates in this increase. If the level of the lake is pre-
served less by direct outflow than by surface evaporation, the
consequent concentration may give a marked increase to the

Water Analysis. 419

various mineral matters, an exaggerated instance of which may
be seen in the Great Salt Lake of Utah Territory.

The total solids in river- waters range from lo to 25 or 30
parts in the 100,000. With a small amount of dissolved solids
the water is usually soft ; with a larger amount there may be a
certain degree of hardness from lime-salts. Chlorine is pres-
ent, but it is seldom in excess of i part in the 100,000. A
trace of nitrites may be present ; nitrates are also found as a
result of the transformation of free ammonia and the albu-
minoids ; but if they exceed 0.5 part, an unusual amount of or-
ganic matter has been washed into the stream. The free am-
monia varies from .001 to .020, and the albuminoid ammonia
from .010 to .025 ; while the oxygen from permanganate re-
quired to oxidize the organic matter ranges from .1 to .4 part.
River-water is so liable to change in its quality from temporary
disturbing causes, that its general character cannot be deter-
mined from a single examination. If a heavy rainfall has in-
creased the volume of the stream just before the sample was
collected, the free and albuminoid ammonias may be as high
as the maximum quantities above mentioned. On the other
hand, if no rain has fallen for some time before the collection
of the specimen, the free ammonia and albuminoids may be
present only in comparatively small quantities. Moreover,
there are seasonal changes in the quality of river- water. Heavy
rains and snow-meltings carry into the stream the sewage of the
atmosphere. The former, especially, erode the surface-soil and
diffuse its organic constituents in the running water, while the
increased flow prevents the deposition of suspended matters
and the consequent purification which occurs under other con-
ditions. On account of these normal variations in quality, th^
water of one stream may not be compared in its analytical re-
sults with that of another. The mean annual quality of each
must be known.

This varying constitution of a river-water renders it difficult
to detect sewage in it by chemical means, unless the contam-
ination is very gross indeed— in which case analysis will prove
nothing that may not be determined by an inspection of the
water-shed. Even when a large inflow of sewage is known to
take place at a given point, the analysis of samples collected
above this point, and a few miles below it, may not show any

420 Water Analysis.

marked differences in organic quality. The presence of the
sewage becomes marked only by a slight increase in the quan-
tity of nitric acid, and a corresponding increase in the quantity
of the chlorides.

The quantity of dissolved oxygen present in a water has
been suggested as a measure of organic impurity. Professor
Leeds says : " Pure natural water, such, for instance, as that
of the Passaic in the upland hill country of New Jersey, con-
tains in solution the maximum amount of oxygen which water
can dissolve at natural temperatures and under ordinary at-
mospheric pressure. This amount is not far from 6.5 c.c. of
oxygen in a litre. On coming into contact with decomposing
organic matter, a portion of this dissolved oxygen is used up
in processes of oxidation. The amount of oxygen held in so-
lution becomes, therefore, an index of the degree to which the
water is contaminated by decomposable organic substances."
It is true that a large quantity of oxygen in a water is in-
consistent with the presence of a large quantity of organic
matter, since the latter, in its decomposition, forms transition
products which are susceptible of oxidation by the dissolved
oxygen ; but as the oxidation of organic matter does not pro-
gress quickly, the presence of oxygen in a water may mean
either that there is no accompanying organic matter, or that
the two have not been associated long enough for the oxida-
tion to be completed. If Professor Leeds's analyses are com-
pared with some of those published by Professor Mallet in the
•' Annual Report of the National Board of Health" for 1882,
it will be seen, for instance, that the stagnant water of the old
Basin Canal at New Orleans, La., containing as it did 5.2 c.c.
of dissolved oxygen, even after the many days which elapsed
between its collection and analysis, does not differ much in
this respect from the Passaic River supply ; and yet it yielded
i.o part of free, and .83 part of albuminoid ammonia per mill-
ion, and no one would think of using it as a potable supply.
In fact, as already explained, the self-puriiication of water is
not dependent on a chemical oxidation, but on a vital process,
some of the products of which are susceptible of oxidation.

The dissolved solids in well or spring-water may be so large
as to cast doubt on the wholesomeness of the supply. But,
even when these are not present in such excess as to interfere

Water Anaiy^. 421

with potability by the saline character or hardness which they
give to the water, they usually contain a much larger propor-
tion of chlorides than the solid residues of pond or river-
waters. Nevertheless, this increase in the quantity of the
chlorides need not be viewed with suspicion, unless the water
of the well under examination contains more than is found in
the organically pure well-waters of the district. When the ex-
cess is due to local causes, the character of these and their
bearing on the quality of the water must be studied. Similar-
ly, in the case of nitrates, their presence in larger quantity
than in the unquestionably pure waters of the same section
calls for a demonstration of the absence of polluting sources
from the area of drainage. Such sources are usually privies,
sinks, cesspools, leaky house-drains, stables, pigsties, manured
lands, grave>yards, and the contaminated condition of the soil
which results from the accumulated filth of many years of oc-
cupation. The organic matters from these reach the well by
inflow from the surface, by subterranean channels which may
have been formed in the soil, or by a failure on the part of the
soil to effect purification during the percolation of the water
into the well, such failure occurring when the soil has become
permeated by impurity. Subterranean communications be-
tween a well and a polluting source in its vicinity may some-
times be detected by pouring on or into the latter a solution
of some chemical foreign to the constitution of the well-water,
and testing at intervals for its appearance in the well. The
communication which occasioned the typhoid poisoning of the
Lausen Spring (see infra) vras thus detected by means of com-
mon salt ; and in the case published by Dr. Janeway, of New
York {in/ra), chloride of lithium was employed to demonstrate
the connection between the drain and the well-water. If the
contaminating source is near, the nitrates may not be in excess,
but the results of the distillations from alkaline permanganate
will indicate its influence on the quality of the water. The
organic matter may be of a harmless quality, but it is not so
in all cases ; and prudence dictates the disuse of the water
which contains it. . The danger arises from the fact that
organic matter reaches the water by some channel ; for, where
harmless organic matter enters, harmful organic matter, if
placed in the are^ of drainage, will also enter. If the polluting

422 Water Analysis.

source is distant, and especially if the soil in the drainage area
is not surcharged with organic matter, the absence of free and
albuminoid ammonia may indicate a water organically pure. A
water of this kind is generally wholesome, but it is not so always.
Typhoid-fever may be disseminated by well-waters which con-
tain only traces of free ammonia and the albuminoids, but in
these instances the nitrates and chlorides are usually in excess.

If a well-water is contaminated by undecomposed sewage, its
presence may be determined by the peculiar manner in which
urea evolves its nitrogen as ammonia when treated by the
Wanklyn process.

The well-waters of cities usually contain large quantities of
nitrates and chlorides, and in many instances the coexistence
of organic matter indicates that these salts are of recent forma-
tion, and the well correspondingly dangerous ; not perhaps dan-
gerous from the sewage or other foul matters which enter
them, for ordinary or non-specific matter is not necessarily
dangerous ; but at all times threatening the consumers with
an epidemic of typhoid-fever or cholera, should the sewage
which enters the wells become infected with the poison of
either of these diseases — for a well which contains nitrates may
admit the specific poison in full potency, although other and
ordinary organic matters have been destroyed in transit.

When the analyst has completed his work, he is able to state
that the examined water does or does not contain a certain
quantity of the elements of organic matter. He is able also
to state whether the water at one time contained more than
this quantity ; and sometimes he may indicate that this in-
creased quantity had a recent or remote existence. He may
be able to say that the organic matter was of an animal or
vegetable nature, and fresh or decomposing in condition. He
may even determine the presence and the approximate quan-
tity of sewage matters in the water. But tlie important ques-
tion— Is the water wholesome or unwholesome ?— cannot re-
ceive a positive answer from the records of the analysis. The
nitrogen which enters into the composition of the albuminoid
ammonia, distilled from a water which the analyst would char-
acterize as foul, unfit for use, or dangerous, may come from
an organic matter which is perfectly harmless, or from one
which is a deadly poison.

Rdation of Drinhmg - WcUer to Infeciiou% Diseases. 423

The extensive investigations into the methods of water
analysis undertaken by Professor Mallet for the National
Board of Health, and published in the Report of that Board
for the year 1882, had for one object the determination of the
Value of the processes, as furnishing indications of the whole-
someness or unwholesomeness of a water. From a careful
study of the analytical reports on a number of samples, the full
history of which was known to him, although unknown to the
analysts who investigated their character by the various
methods. Professor Mallet concluded that, " It is not possible
to decide absolutely upon the wholesomeness or unwholesome-
ness of a drinking-water by the mere use of any of the proc-
esses examined for the estimation of organic matter or its con*
stituents.*' But, as has been advanced in these pages as the
result of an extensive experience in water analysis, and its
bearing on the question of wholesomeness, a study of the
analytical record, combined with a careful inquiry into the
source and surroundings of the water, will frequently enable
an opinion to be given which will have value as indicating the
probability of dangerous qualities. In the future, culture ex-
periments and the microscope may be used for the detection
of the living particles which give a morbific quality to water,
but until a greater advance has been made in this direction
than at present, the chemical processes above outlined afford,
in connection with a close inquiry into the natural history of
the water, the only trustworthy data for the formation of an
opinion as to the potable quality of any given sample.

{To be cofUinuid.)

THE RELATION OF DRINKING-WATER TO SOxME

INFECTIOUS DISEASES.

By Theobald Smith, M.D., Washington, D.C.

In discussing problems of public health, the student of
hygiene may have to face two classes of readers. One class
consists of those who are timid and nervous about most ques*
tions concerning health, and who are easily alarmed by any
disclosures which reveal possible dangers in their habits

424 Hdatian of Drinking - Wafer to Infectious Diseases.

of life and environment. Another class, representing the
other extreme, encouraged by the fact that nothing serious
has happened thus far under prevaih'ng conditions, display an
assurance amounting to indifference and even gross negligence.
The investigator is looked upon by such as an alarmist, who
substitutes theory for experience, and who sounds the tocsin
at the approach of spectres, the creatures of his own imagina-
tion. But the advances made and the means suggested for
the protection of human life should not be looked at from
either of these standpoints. They can, at best, proceed but
slowly, and if they succeed in saving only a few lives each
year from premature death, the compensation for labor and
outlay is ample enough. It is from this middle point of view
that the following remarks are made.

The immense but still infantile strides which have been
made within the last eight or ten years in the field of infec-
tious or communicable diseases have demonstrated that a con-
siderable number of such maladies are directly due to the in-
vasion of the body by specific bacteria. Quite naturally it
became necessary to examine our surroundings in order to
learn whether any of these micro- parasites may be found
among the numberless harmless bacteria that live in the water
and the soil, on the surface of the body, in the mouth and the
digestive tract of man and animals. In general the results of
numerous patient unbiassed observations have thus far proved
negative. Disease germs do not exist in our environment in
numbers sufficient to be detected by the methods of bacteri-
ological research. The few that are constantly present in the
soil, and which are presumably the agents producing certain
forms of suppuration, septicaemia, and tetanus, are little to be
feared, excepting by the surgeon during operations, judging
from the comparative infrequency of these diseases. On the
other hand, typhoid- fever germs have been found a number of
times, within recent years, by carefully searching suspected
drinking-water during and immediately after epidemics, Koch
found during his researches in Calcutta, in 1884, cholera
spirilla in the water of a tank which was, at that time, the
centre of a localized cholera epidemic.

The scrupulous care which we exercise in the selection and
preparation of our food contrasts strongly with the indifference

Relation of Drmhmg - Waiter to Infectiovs Diseases, 425

which IS exhibited with regard to the water we drink. Many
of our large cities are supplied with river water which not only
represents mere surface drainage, but also the diluted sewage
of large communities and the refuse of manufactories. We
do not hesitate to consume this in its rawest state, though we
have learned to apply heat to most other foods, not merely as
a preliminary aid to digestion, but also to destroy any deleteri-
ous matter which may be attached to or incorporated with
them. It has now become generally accepted among author-
ities in hygiene, that water containing a large number of bac-
teria should not be used as a beverage unless previously boiled
or filtered. The bacteria are evidence that the water repre-
sents surface drainage, or filters through a very porous soil
more or less impregnated with organic matter and living bac-
teria. These, it is now known, live in the largest numbers
near the surface of the soil. At a depth of from nine to twelve
feet they are either entirely absent or present in very small
numbers.

We must assume, then, that water which in its flow over or
through the soil becomes loaded with a large number of or-
ganisms may, under certain circumstances, gather up disease
germs and thus act as a vehicle for a short time, especially
during epidemics. The disease germs may be widely distrib-
uted before they perish. The maladies which are now known
to be chiefly transmitted in this way are Asiatic cholera,
typhoid- fever, and dysenteric affections. The localization of
these diseases in the digestive tract makes it extremely prob-
able, even if bacteriological evidence were wanting, that the
specific bacteria are introduced by way of the mouth with food
and drink. In Asiatic cholera the spirilla, now generally ac-
cepted as the cause, are found in the intestines only. In
typhoid- fever* they are not only present in the intestines, but
penetrate thence into the internal organs, notably the spleen.
Dysenteric diseases have not yet been thoroughly studied, so
that positive facts are not at hand, but they also are, without
doubt, caused by micro-organisms introduced with the food
and drink. Of these, cholera need not claim our attention,
since it is to be hoped that it will not gain a foothold in our
own country. Whatever shall be said in this article concern-
ing the relation of drinking-water to disease, will apply with

436 Helation of Drinkmg - Water to Irfectiovs Dimases.

even greater force to this malady should it appear in our
midst.

Typhoid-fever, being endemic over the greater part of the
civilized world, has received considerable attention of late.
The specific microbe (bacillus) was first distinctly recognized
in 1882, and its peculiar characters and constant presence in
the body during the disease confirmed by a host of observers
since that date. It is transmitted very probably in the fol-
lowing way : The stools of patients, which contain the specific
bacilli, are thrown upon the soil, whence the rain washes them
into streams, which serve as sources of drinking-water for com-
munities farther down, or they are thrown into vaults, whence
they may contaminate wells, either by filtering through a v^ry
porous soil, or else by being carried through communicating
fissures. The proximity of cesspools to wells and cisterns,
and the ease with which surface water may find its way into
the latter, are facts too frequently observed in small towns and
villages to need any comment.

Numerous experiments have been made to determine the
length of time during which typhoid bacilli may live in water.
This is a very important problem, for we need to know how
long these microbes may remain alive after the soil or water
has been infected. Such experiments have shown that typhoid
and cholera bacteria do not increase in number in drinking-
water of average quality. Not only is the temperature too
low, but the quantity of available organic matter present is
below the minimum limit at which multiplication begins.
Moreover, there is a gradual destruction going on which finally
rids the water of its infectious elements. Experiments have
shown that typhoid bacilli may remain alive a month, perhaps
somewhat longer. Water may therefore become the means
of transmitting typhoid bacilli from one person to another,
but this capacity is limited, and future observations must be
invoked to determine how long it may last, and whether the
period assigned by laboratory experiments be correct.

In the actual examination of suspected water, two difficul-
ties arise, (i) The bacilli resemble harmless bacteria present
in water and other media very closely, and grow so much less
rapidly than many saprophytes also present, that detection is
rendered very difficult with methods now in use. (2) Water

Hdatian of Drinking - Waiter to Infectious Diseases. 427

is rarely examined until some time after an epidemic has ap-
peared— that is, not less than from four to six weeks after it
has been contaminated. After what has been said of the rapid
destruction of these bacteria in water, the chances of finding
them are very poor. Still, they have been found recently in a
number of epidemics.

But there are other lines of evidence that gradually lead up
to the occasional conviction of drinking-water. I have dwelt
upon the bacteriological evidence as, perhaps, the simplest
and most direct. Other evidence, more complex, may be ad-
duced from the mode 'of origin and distribution of epidemics.
Perhaps one of the best illustrations is furnished by Mosny in
the Revue d* Hygiene for January, 1888, in describing the
water-supply of Vienna. This sketch deserves our attention,
as the statistics have been carefully compiled. Before 1874,
Vienna received nearly all its water from the Danube. Since
that date, large reservoirs built in the. mountains near the city
have been in use to collect spring water, so that in 1886, about
88 per cent of all the city houses were provided with pure
water. Dysentery has now become quite unknown, as the fol-
lowing figures show : In 1869, 1870, and 1871, there were
about 100 fatal cases of this disease ; in 1872, 38 ; in 1873, 53 ;
in i874and 1875, 32 ; in 1877 and 1878, 17 ; in 1880, 11. Since
that time none have occurred. Typhoid-fever has also well-
nigh disappeared. Professor Nothnagel had occasion to say,
recently, that when a case entered the hospital he quickly an-
nounced the fact by a bulletin, so that the students might see
this malady which was dying out in the city. In the decade
of 1850 to i860, the mortality from this disease was about two
for every 1000 inhabitants. In 1871 an epidemic appeared in
which the mortality rose to 4.5. After 1874 it began to fall,
until it has now reached the low figure of .11. In the winter
of 1877 the reservoir of spring water had become frozen, and
to supply the demand four districts of the city were provided
with water from the Danube until February loth. An epi-
demic of typhoid thereupon appeared in March, in which
twenty-nine out of every 100,000 inhabitants succumbed ; of
every 100 sick, twenty-five died. The distribution of the dis-
ease showed that the number of deaths was in inverse ratio to
the number of houses in each district provided with spring

428 Relation of Drinking - Water to Infectious Dieeaeee.

water. In those districts in which no Danube water had been
distributed the mortality rose but sh'ghtly above the usual
rate. Of every lOO houses, the disease invaded 25.2 provided
with river water, 3.4 provided with well water, and 2.7 pro-
vided with spring water. To present the same facts in an-
other form, out of every 10,000 inhabitants, 21.5 were attacked
in the districts supplied with Danube water, 3.8 in those dis-
tricts not receiving it. In the garrison, 15 per cent were at-
tacked in the barracks receiving spring water, 2.69 per cent in
those using river water. These statistics should be committed
to memory in every municipality, especially by the authorities
of those that are being supplied with uniiltered, filthy river
water which receives and dilutes the offal of communities and
again distributes them whence they came to make the rounds
through the digestive tract of the inhabitants.

During the past two years several localized epidemics in
France have been carefully studied and reported by the comity
consultatif (f hygiene publique. I select the two following as of
considerable interest. Of 24 persons who had come from
Paris and Versailles to spend the summer of 1886 at Pierre-
fonds, 20 were attacked with typhoid. One of the three houses
occupied by them had been a focus of this disease in the past,
for it had appeared five times, usually in August and Septem-
ber, between the years 1874 and 1883. The investigation
brought out the fact that a leaky cesspool, which also receives
rain water from the roofs, is directly in the path of the ground
water as it flows from the hills on its way to feed the well
which supplies the houses with water, and farther on to join a
small stream. The great porosity of the superficial layers of
the soil may have permitted the microbes of typhoid-fever to
be carried from the cesspool to the well 20 metres away. At
any rate the specific bacilli were found in the well in October,
the disease having appeared at the end of August and contin-
uing during September. Another very formidable epidemic
appeared in Clermont-Ferrand, from September to December,
1886. Over 250 persons were attacked. During the investi-
gation the important fact was revealed that several families in
the infected district, whose members drank either boiled or
mineral water, remained well. A careful examination of the
water-supply showed that there was every opportunity afforded

Hdation of Drinking - WcUer to Infecdoics Diseases, 429

for the contamination of the source at another village, which
was located some distance up the stream furnishing the water.
The public lavoir, or place for washing clothes, was a grotto
only ten feet from the mouth of the conduit. This, which was
defective in several places, passed the lavoir at a distance of
only five feet. A few cases of typhoid had appeared in this
village several weeks before the outbreak of the epidemic at
Clermont. The chemical analysis of the water indicated fecal
contamination. The specific bacilli are reported to have been
found in the reservoir of one of the houses at Clermont in-
vaded by the disease.

Epidemics like the foregoing have been frequently observed,
and cases could be cited ad libitum. No doubt one or more
recur to the mind of every experienced physician. The severe
epidemic at Plymouth, Pa., which occurred several years ago,
needs only to be mentioned here. It is true that in all such
investigations there is still much to be desired to make the
demonstration absolute. When evidence, however, is cumu-
lative and invariably points in one direction, its warning should
be heeded. In our own country all localized epidemics should
be studied with reference to the topography and geology of
the water-supply and other possible factors. Bacteriological
examinations should be made in all cases and with the utmost
care, for there is no branch of hygiene in which hasty conclu-
sions, based on insufficient evidence or faulty methods and
want of skill, are more likely to go utterly wrong than in
bacteriology.

If the water we drink may become a prominent factor in the
dissemination of typhoid-fever when contaminated with the
bacteria of that disease, we must not overlook our ice supply.
Dr. Prudden has shown that typhoid bacilli may resist contin-
uous freezing for several months, and that, in general, bad
water yields bad ice. An Italian observer states that 90 per
cent of all bacteria in water are destroyed by freezing, the re-
mainder live in the ice till summer. We must not forget that
the milk we drink needs attention. The water used in cleans-
ing the receptacles may at any moment become contaminated
from cases of typhoid. When we bear in mind that typhoid
bacilli multiply very rapidly in milk at a summer temperature,
we will realize the importance of knowing whether the milk

430 Relation of DrinJcing - Water to Infectious Diseases.

supply of our large cities is subject to any careful sanitary in-
spection or not.

Every summer there is a vast emigration from the densely-
populated centres to the open country. Here there is apt to
be much carelessness and indifference in sanitary matters. A
vague notion seems to take hold of the traveller and the sum-
mer boarder that the country is safe, and that pure air is an
antidote for all illness. Yet this migration very frequently
carries the same diseases that threaten us in the crowded cities
into the country where the general unsanitary conditions are
often more favorable to their dissemination than in the city. In
all cases it is best not to drink any water the source of which we
do not know or have not inspected, unless boiled. Nor should
we rely upon so-called filtered water, as most of the filters in
the market are not to be trusted. The same rule applies in
travelling. A recent collection of medical ** don'ts" suggests
that we should not forget our drinking-cups. Why not in-
clude what we drink as of more importance ?

At the last International Congress of Hygiene and Dem-
ography held at Vienna in September of the past year, the re-
lation which drinking-water bears to cholera and typhoid was
quite thoroughly discussed. There was a general agreement
as to the propagation of typhoid-fever by drinking-water, al-
though there were not wanting voices who objected to too
dogmatic assertions, since the proof was not yet absolute.
The following proposition^ was adopted, by a large majority,
as representing the position of the Congress : ** The possibil-
ity of the propagation of infectious disease by contaminated
drinking-water being proved, one of the most important pre-
scriptions of public hygiene should be to supply communities
with water absolutely pure." After an eloquent address made
by Dr. Brouardel of the French comiti consultif (T hygihie pub-^
lique on this subject, he concluded with the following words :

" Experience has taught us that it is the large cities which
perpetuate the epidemics of typhoid-fever and from which the
transmissions of this disease radiate. It may be burdensome
to obtain pure water and distribute it to a community, but it
is possible. Has it not been said repeatedly that nothing
costs so dearly as an epidemic ? Is it not true that a malady
which kills one or two thousand persons every year strikes,

TJie Medicinal Valtce of Color. 431

from an economic point of view, a population more cruelly
than the taxes, which might have spared the lives of several
thousand from 15 to 25 years old, cut down at an age at which
they have cost so much and returned so little to their state ?
If we share these views, we should make an energetic effort in
every country, proclaim the good fight, the preservation of hu-
man life. Our proofs are sufficient. The authorities need only
to be convinced. They hesitate because they find dissidents
among physicians. Is there one among you who dares main-
tain an adverse view, or who has opposing beliefs vigorous
enough to say, * No, the water into which the stools of typhoid-
fever are poured does not produce typhoid ? ' Let him arise
and assume before our successors the responsibility of the
deaths which his resistance will have entailed." — Albany Med-
teal Annals.

The Medicinal Value of Color. — At a time when fog
is prevalent, any mention of the remedial value of color and
brightness appears extremely tantalizing, although from per-
sonal experiences of the depressing influences of darkness and
gloom it is probable that every one will rate the contrasts
more highly than at any other time in the whole year. Color
treatment has been suggested for various forms of mental
derangement — bright crimson surroundings for melancholia,
soft blue for maniacal excitement, and so on. The report
which has reached us leaves much to be desired from a scien-
tific standpoint ; meanwhile there is very little room for doubt
that a prolonged period of darkness largely influences the
mental attitude, and, by hope deferred, favors a general feel-
ing of misanthropy. Pessimism flourishes in the autumnal
and winter seasons, optimism in spring and summer, even
though the statistics of deaths from suicide show an increase
in bright weather. To restate a belief in the remedial value
of color is merely to insist upon the therapeutic effects of
change, since, in advising change of scene, brightness and in-
terest are always the objects sought. No one would recom-
mend a course of fogs as an alternative for sunshine. In other
words, stimulants, as a rule, are more valuable than depress*
ants. — Lancet.

432 Causation of Fewr in the State of New York,

MALARIA, AND THE CAUSATION OF FEVER IN

THE STATE OF NEW YORK.* J

. By A. N. Bell, A.M., M.D.

It may be premised at the outset that, in this State, as
throughout the United States, the most numerous of all dis-
eases, after the communicable diseases common to childhood,
are those attributable to malaria, but owing to the relatively
low rate of mortality in this class of diseases, as a whole, in
this latitude, and to the almost total neglect of morbility sta-
tistics, it is impracticable to give even an approximate esti-
mate of the number of cases. Moreover, as the cause of fever,
though secondary in its etiological relations but primary in its
importance, no conditions which give rise to disease of any
kind have been so long recognized and continuously urged by
the physicians of the State as preventable, as those which give
rise to malaria and, consecutively, to malarial fevers. Not-
withstanding, the same relative prevalence, and well-nigh the
same generally recognized conditions which give rise to malaria
continue to obtain now as they did at the beginning of scien-
tific inquiry into the causes of disease in this State fully three
quarters of a century ago.

It would be a comparatively easy matter to make a volume
of nq mean dimensions out of the reports of committees and
other contributions to the Transactions of the Medical Society
of the State of New York from 1807 to the present time, con-
taining material which would compare favorably with the best
literature of the subject anywhere to be found. For example :

John R. B. Rodgers, M.D., President of Society in 18 14 in
his annual address of that year remarks that intermittent and
remittent fevers ** arise from a change made in the qualities of
the air, or the production of new materials in the atmosphere,
arising from the application of long-continued heat on animal
and vegetable matter in a state of . decomposition." + The

* Read in the Section on State Medicine at the Thirty-ninth Annual Meeting
of the American Medical Association, Cincinnati, May, 1888.

t Transactions of the Medical Society of the State of New York, 1807^31,
p. 61.

Cavsatian of Fever in the State of New York, 438

** new materials" of Dr. Rodgers are now called germs. And,
as a description of the conditions which give rise to malaiia,
we know of nothing more perspicuous, more in accord with
the present state of knowledge on the same subject, or more
worthy of being proclaimed from the house-tops than the fol-
lowing extract from the annual address of Alexander Coventry,
M.D., President of the Society in 1824. He remarks :

" On my arrival in New York, in 1785, I found the whole
space between the east side of Broadway and the river was
vacant ; it was a sandy soil with a gradual descent to the west,,
at whose foot the tide washed a sand and gravel beach ; this
shore, when fanned with the exhilarating westerly breeze which
had swept the surface of the noble Hudson, might have been
selected by Hygiea as her chosen abode. The citizens of New
York at that time bore in their faces the bloom of health, and
no signs of endemic disease were discernible in their looks.

" Ten years afterward my business called me to the capital,
but the change I found in the looks of the citizens astonished
me. Those living near the docks and wharves, indeed along
most of the streets along the East River, had the pale, sallow
look, the yellow skin and muddy eyes with which I had be-
come familiar in the lake country during the preceding four
years. The inhabitants bore the marks of endemic disease,
and on inquiry I found that the disorder that raged in the city
had been accompanied with the same symptoms as that which
prevailed in the country. A most intimate friend then resided
in the lower part of Pearl Street ; he had lost a son and
daughter and barely survived himself, while his eldest daughter
who had nursed her relations had escaped the fever.

" Although there was neither swamp nor marsh, yet sources
of disease were not wanting where vessels formerly lay. I
found spacious streets and elegant houses, slips and basins filled
up, and many acres gained from the sea and converted, as I
was informed, not into dry land, but a mass of putrefiablestufT
with which the most noxious swamp in Genesee could not
compare. The North River side, where encroachment had not
commenced, still remained healthy, and proved a safe retreat
for the afflicted citizens.

'' In the spring of 1820 1 was again in the city, and witnessed
the improvements going on on the west side, the consequences
a8

434 Causation of Feoer in the State of New York.

of which became visible in 1822. Had the bank of the North
River been left as it was originally the tide would have re-
moved all the filth brought down the cross streets and all the
sugar boxes ever brought from Havana would never have in-
fected a spot large enough for a mosquito to alight on.

** In the country it often requires years, ^sometimes ages to
conquer the source of disease, for vegetation annually supplies
the pabulum. In cities, provided their location be favorable,
it is man who works his own destruction, first by his improvi-
dence, next by his negligence. . . •

'' The records of medicine abound with the most indubitable
facts of the dreadful effects arising from the decomposition of
animal substance. The wise Romans preserved the ashes of
their ancestors in beautiful urns, and perhaps this was a mode
preferable to resigning their remains as a prey to the worm
and a poison to the living. The delicate Hindoo ascends the
funeral pyre of her husband. Custom is everything. The
Chinese find the most valuable manure in what with us is a
great nuisance. The formation of poudrette, as practised in
France, would fertilize our fields and be a valuable relief to
the inhabitants of cities. Pure and good water from a distance
would be a grand desideratum. The filterings used in the city
are extremely offensive, especially to the stomach of a stranger.
One ounce of prevention is better than a pound of cure. Prob-
ably before the commencement of another century the island
of Manhattan will be thickly covered with human inhabitants.
He whose patriotic endeavors would insure health to such a
number of fellow-creatures would be more worthy of a monu-
ment than the proudest hero of the age, ay, if we may be-
lieve the Roman orator, he would approach nearer the divine
nature, Homines enim ad DeoSy nulla re, proprius accedunt^
quant Salutem hominibus dando.** *

Such observations have not been improved upon during the
sixty-four years that have intervened, but all along during the
period the medical topography of the State and the conditions
of endemic fevers have been among the most constant subjects
of investigation and report by the members of the State Med-
ical Society, yet never more completely than twenty-eight
years ago, by the late Joseph M. Smith, M.D., in his ** Report

* Opus Cit., pp. 270, 271.

Otmsation of Feoer in the State of New York. 435

on the Medical Topog^raphy and Epidemics of the State of New
York," to the American Medical Association. (Vol. XIII., pp.
83-269.)

On the organization of the State Board of Health, in 1880,
** Malaria and Preventive Measures Against It," was one of the
first subjects to engage the attention of the then Secretary, the
late Elisha Harris, M.D., who remarks in his first report :

"The reports and various. complaints concerning malaria
and the local sources of miasmatic diseases outnumber all
others received at the office of this Board. The local condi-
tions which are accused as the immediate causes of the evils
thus complained of may be summed up as consisting of un-
drained wet grounds, stagnant pools and partially dried
swamps and ponds and unsewered or badly sewered premises.
The most obvious fact is that drainage and sewerage for health
do not yet appear to be the first object which local authorities
have in view in this class of public works, and the rules and
regulations they enforce concerning them. This is true alike
in cities, villages, and the rural districts." (P. 20). In his
third annual report (1883, P* 4^)* he remarks :

'* The localities of paludal malaria, and the extent to which
miasmatic diseases prevail cannot be ascertained from the
records of death, but from reports of sickness ; yet the total
mortality from the miasmatic fevers and other kinds of disease
from the same class of causes is considerable. The special
sources of these diseases abound in the large cities as well as
in the regions of drying swamps and stagnant ponds, or un-
drained basins and water-soaked grounds. The local suffering
from malaria is often found to exceed even that which, from
other causes, is attended by great mortality. In some in-
stances the increase and persistence of malaria breaks down
the health of many families, discourages enterprise, and drives
the thrifty classes and their business to more healthful lo-
calities."

The foregoing quotations are made, not because they con-
tain anything new, but because the truths which they express
continue to be the most important subjects which sanitarians
and health authorities can urge upon the civic authorities for
the prevention of disease. "During the last four or five years
considerable headway has been made in the State, under the

436 CauscMon of Fever in the State of New York.

auspices of the State Board of Health, in arousing the atten-
tion of local authorities to the importance of sanitary econo-
my, and there is reasonable ground for hope for continued and
increasing progress in this direction.

" Just what groups of signs and symptoms are accepted as
evidence of the influence of malaria," it is somewhat diflicult
to define, but, in general terms : most fevers caused by malaria
are in their types intermitting, or paroxysmal, and remitting
or exacerbating, and hence are properly designated periodicaL
But the exceptions to this definition are by no means rare.

From somewhat extensive observation in regions exception-
ally prolific in periodical fevers, I have sufficiently often wit-
nessed the prevalence of endemic pneumonia of a peculiarly
acute and fatal type to satisfy me of its malarial dependence.
Such cases are usually ushered in with a severe chill, intense
headache, delirium, rapid pulse, high temperature, overwhelm-
ing pulmonary engorgement and fatal termination within four
days — and sometimes within forty-eight hours — without any
remission. Moreover, I have observed cases of approximately
similar character in relation with domiciliary conditions and
localities, especially foul cellans and cellars exposed to gaseous
emanations from foul soil surroundings, in so much as to be
fully satisfied in my own mind that a very large percentage
of the numerous deaths from pneumonia in the winter time,
among children and other persons mostly confined to indoors,
in the colder regions of the United States — in the country as
well as in cities — is due to malaria and preventable by sanitary
measures.

Other exceptions are found in persistent chronic congestions
of the liver and spleen, resulting in dropsies, and congestion
of the spinal meninges, giving rise to the persistent pains,
aches, and neuralgias common to the inhabitants of most
malarial regions and domiciliary abodes, such as those indi-
cated, and more or less proportional with the extent of the
conditions.

Dengue^ too, may be mentioned as a generally recognized
distinct type of malarial fever, with exceptional symptoms,
mostly limited to regions where the conditions which give rise
to malaria exist in greatest intensity.

With regard to your final propositions — *' What is malaria"

Naphtha- Poisoning in Rubber Factories. 437

-

and *' what evidence is there for or against a malarial germ ?" —
the correct reply is yet to be discovered.

The practical conclusions deducible from the foregoing
summary are :

1. Malaria is coincident with accumulations of organic mat-
ter in process of putrefaction in alluvial bottoms, on the mar-
gins of sluggish streams, low humid borders of stagnant ponds
and lakes, the marshy borders of the sea-shore, and circum-
scribed local conditions^ chiefly artificial, comprehending more
or less the same relations to vegetable d6bris and other or-
ganic matter in process of decay as the outlying conditions
mentioned in this connection.

2. While it is not possible in the present state of our knowl-
edge to determine the special relations existing between ma-
larial diseases and the geological, thermal, hygrometrical and
barometrical conditions under which they occur, those thermal
and hygrometrical conditions most promotive of putrefaction
coincident with the absence of sunlight are in the highest de-
gree promotive of malarial poison. — youmal of the American
Medical Association.

NAPHTHA-POISONING IN RUBBER FACTORIES.

In several large factories in Germany, especially in india-
rubber factories and establishments for cleaning india-rubber,
peculiar morbid symptoms have lately been observed. The
faces of many of the girls, who had not left the factory during
the day, became flushed and swollen in the evening, and they
could not walk steadily. An examination of their clothes and
of the work-rooms for brandy, opium, etc., yielded no result,
till an accident led to the solution of the mystery. In these
factories naphtha is used in large quantities, and kept in special
boilers closed against the air. The girls had succeeded in
getting keys to the boiler valves, and, soon learning the in-
toxicating effect of naphtha, were in the habit of slinking un-
observed to the reservoirs to inhale the poison, which threw
them into a state of happy forgetfulness and conjured up a
thousand sweet dreams of wealth, splendor, happiness, etc.
The secret was revealed by a novice, who made too deep an
inhalation and fell into hysterical convulsions. — Lancet.

438 Medical £cpert Testimony.

MEDICAL EXPERT TESTIMONY.

ANNIVERSARY ADDRESS BEFORE THE MEDICAL SOCIETY OF
THE STATE OF NEW YORK, FEBRUARY 6tH, 1889.

By Samubl B. Ward, M.D., of Albany, President.

The laws of this country and the practice in our criminal
courts differ in some fundamental respects and in many details
from those existing under other civilized governments. With
us the accused man is entitled to, and, in a vast majority of
cases, secures every possible opportunity for defence. He
cannot be compelled to give evidence which would tend in the
remotest degree to criminate himself ; his wife may not give
evidence against him ; his physician and his legal adviser are
not permitted to divulge any information which they may
have received in their respective professional capacities ; he
himself is always supposed to be innocent until he is proved
guilty ; and the jury are charged to give the prisoner the
benefit of every reasonable doubt. If the accused has means,
he can employ what legal counsel he may select ; should he
be penniless, the court assigns to some lawyer the duty of de-
fending him.

Undoubtedly the practice of having counsel for the defence
originated in the manly desire in our race that no injustice
should be done to a man ignorant of the law. At the present
day it is not considered at all dishonorable for most eminent
counsel to espouse the cause of a prisoner whom they know
to be guilty ; and by carefully concealing evidence of the ex-
istence of which they are perfectly aware ; by confusing and
embarrassing witnesses; by taking advantage of every legal,
technicality ; by the weight of their erudition and personal
character ; and by their persuasive eloquence with the jury
they frequently succeed in making the worse the better cause
appear. Their position is far different from the witness on
the stand, who is supposed to tell the truth, the whole truth,
and nothing but the truth. All this procedure may or may

Medical JSkpert Testimony. 489

not be in strict accordance with the highest code of morals —
may or may not, in the long run, be productive of the great-
est good 'to the greatest number. It is certain that we as
medical men have no more interest in it than any other body
of reputable citizens.

But in a majority of criminal cases questions arise which no
layman can answer — questions about which even members of
our profession may differ in opinion ; the lawyers on both
sides take counsel with the doctors, and the physician called
to the stand to express a professional opinion becomes known
as a medical expert.

There are other classes of cases, it is true, in which expert
evidence becomes necessary, as in determining the strength of
material used in constructing a bridge, a ship, or a piece of
machinery. But every science is exact just in proportion as
mathematics can be applied in working out or demonstrating
its results ; and, unfortunately for us, with the single excep-
tion of errors of refraction, mathematics does not come to our
assistance in any degree worth mentioning. The capacity of
a piece of Bessemer steel to resist a strain, longitudinal, lateral,
or by torsion, is known with perfect accuracy within certain
pretty narrow limits ; it can be accurately expressed in figures ;
and it is not possible for truthful experts to make statements
concerning it greatly at variance with each other. But the
phenomena with which we are called upon to deal are of an
entirely different order ; can rarely become the subject of ex-
periment ; are extremely complex in their nature — so complex
that to isolate the component elements and prove how much
influence is to be ascribed to each, is, up to the present time,
simply impossible ; it remains a matter of judgment and opin-
ion. Nor is this condition of things the result of any lack of
diligence on our part, or want of native ability on the part of
those who have in all the past ages applied their best energies
to the study of medicine. It is simply inherent in the com-
plex nature of the problems presented to us for solution.
Hence it is that medical experts may honestly differ from each
other more widely than those inmost other professions.

If, however, questions of law or theology could be submitted
to the expert on the stand, as those in medicine are, it would
be easy for counsel to procure opinions more radically at vari-

440 Mediml JBxpert Testimony.

ance than those expressed by members of our own profession.
The opprobrium cast upon us is, to a certain extent, at least,
undeserved and unjust. In support of this statement we have
only to note how counsel wrangle with each other over many
points of law arising in every case that is argued ; how the
decision of the lower court is on appeal alternately reversed
and affirmed in each succeeding higher one until the court of
last resort is reached ; and how even the highest courts in the
land have at different periods rendered decisions incompatible
with each other. Or imagine for a moment the divergence of
opinion which would become apparent if a Materialist, a Uni-
tarian, a Methodist, and a Roman Catholic were called upon
the stand to express their views concerning justification by
faith, the divinity of our Saviour, the doctrine of eternal pun-
ishment, or even the existence of a future state at all. And
yet it is a matter of history that these men have had such pro-
found faith in the eternal righteousness of their convictions
that they would rather burn at the stake than abate one iota
thereof. We can safely promise entire unanimity of opinion
on all points as soon as this blissful state is attained by either
the lawyers or the theologians.

The lawyer engaged on one side or the other of a criminal
suit finds that medical points are necessarily to be raised, or
thinks that they may be raised with advantage to his cause.
We all know that almost every important case occurring in
our daily practice presents some one or more features that are
unusual, are rare, are sometimes almost inexplicable, and
criminal cases are no exception to the rule. Counsel therefore
looks about for some one of our profession to assist him. He
presents his statement to a medical man and finds that his
opinion is not of a nature to serve the purpose he has in mind.
He goes to another, and another, until finally he finds one who
entertains opinions to suit him, or approximating thereto, and
this one he engages to appear on the stand as an expert. One
defect in the present law is that this man may be subpoenaed
to appear in court at an inconvenient hour and distance, to
the disappointment of his own patients, to the neglect of any
or every other professional engagement, and kept waiting there
an indefinite period of time for the paltry remuneration of fifty
cents a day and eight cents a mile for travelling expenses.

Medical Expert Testimony. 441

Such instances are, of course, exceedingly rare, and, as a rule,
the medical expert is fairly compensated. In some cases the
fee is agreed upon beforehand ; in a few an effort is made to
have it dependent upon the issue of the case — a condition
which cannot be too strongly reprehended.

I believe that medical men, almost without exception, when
they go into a case, fully intend and mentally resolve not to
take sides ; that they will make every effort when on the
stand to live up to their oath and to be as impartial as the
judge upon the bench. But even the judge does not always
succeed in not taking sides, and the doctor, like the judge, is
but human. Moreover, he, unlike the judge, has, in private
at least, expressed an opinion, and he certainly wants to see
that opinion prevail, primarily because he believes it to be the
correct one, secondarily because it is his. In all callings, from
religion to politics, every man innately rejoices in convincing
others of the correctness of his views. Moreover, the lawyer
is, collaterally, at least, and in many cases primarily, working
to win because his client is paying him. Had he been paid
by the prosecution instead of the defence he would have taken
an entirely different view of the case. He would not in either
event tell an untruth ; but he would under different circum-
stances attach very different values to the same item in evi*
dence ; would entertain very different opinions as to the cred-
ibility of witnesses ; would cite another set of authorities and
of precedents ; would express to the jury an exactly opposite
opinion, and call upon them as good men and true to render
a diametrically opposite verdict. The unfortunate medical
expert is also human, subject to like temptations and influ-
ences as other men. He knows the public puts him on a differ-
ent plane from the counsel, and expects him to tell what he
believes to be the exact truth, no matter whom it may help
or hurt. But then, there are many points about which a man
may be in doubt ; about which he may entertain one belief at
one time in his life and another at another — I had almost said
that he may believe as he chooses to believe — points that are
not matters of fact, capable of demonstration, but absolutely
and wholly matters of opinion. And he knows that as the
case now stands the side from which he accepts payment ex-
pects him to believe and express opinions tending in a certain
direction.

442 Medical Expert TeeUmony.

Moreover, it is certainly true that there are a few men in
our profession who entertain opinions differing widely from
those of the large majority. These opinions, expressed in
private conversation or in medical meetings, result in very lit-
tle harm, because they are estimated at once at their true
value. But the holders of such opinions are precisely the
men whom the counsel in a desperate case is desirous of re-
taining. By them he can show to the jury how uncertain and
divergent medical opinions are» and throw doubt upon the
reliability of the evidence produced by the other side. For
instance, in a rural community I have heard a physician, whose
fine personal appearance, army experience, large and success-
ful private practice, and gray hairs gave weight in the minds
of the jur>'' to every word he uttered — every man on the jury
knew him by sight and reputation, and a majority of them
personally — I have heard this physician say that, in his opin-
ion, " any man who used any splint in the treatment of any
form of fracture was guilty of malpractice." Such monu-
mental nonsense as this, is, of course, very rare ; but the in-
cident serves well to illustrate the abuses to which the present
system of obtaining and using expert evidence is liable.

The physician selected as an expert considers his case care-
fully ; he reads up the various authorities, paying, of course,
considerable attention to those whose views agree with his
own, and mentally remarking what sensible men they were,
while the impression formed of those who differ from him is
not nearly so complimentary. He looks up the records of
similar cases in medical journals, and finally goes on the stand
well prepared to answer truthfully the questions previously
arranged to be asked him on the direct examination. During
this investigation of the case it is sometimes curious to observe
how the expert's opinions will become strengthened in the
direction of the side which he has espoused. Without any
real additional arguments having been brought to light he will
incline to give more and more weight to facts which seem to
favor his view, and become more and more inclined to make
light of, or even to ridicule, facts or opinions which militate
against him. He often ends by being honestly persuaded that
there ought to be no manner of doubt on points which are in
reality very doubtful and which at the outset he willingly ad-
mitted so to be.

J

Medical JExfpert I'egtimony. 443

When the expert goes on the stand he is first questioned by
the lawyer on whose behalf he appears. The questions are
hypothetical ones, supposed to be based on the facts proven
on the trial. As a rule this is fairly done, and the expert has
no difficulty in giving honest, straightforward answers.

The direct examination completed, the counsel for the other
side takes the expert in hand and his trials begin. In some
cases, in the majority of cases perhaps, he receives perfectly
fair treatment. The cross-examiner simply endeavors to bring
out all the weak points in his view of the case, to show how
very weak they may be ; that they are matters of opinion and
not of fact ; that other honest men may take a different view
of the case, and that an entirely different theory may not be
wholly without foundation. Even though the treatment he
receives be perfectly courteous the ordeal is a trying and dis-
agreeable one. While he is honest and frank in his answers
he must be very cautious in the wording employed, resting
assured that every slip will be taken advantage of, and every
response stretched to its utmost limit of construction, even if
it be not entirely twisted out of its original meaning, when
the case comes to be summed up before the jury.

At other times, and especially if the counsel is conscious of
having a bad case, the expert may be treated very differently.
Instead of its being assumed that he is a gentleman who has
taken the stand for the sole purpose of giving information of
a technical character and telling the exact truth, it is assumed
that he is there for the purpose of aiding the side which called
him, and sometimes it appears to be further assumed that he
IS scarcely hampered by the ownership of a conscience ; he is
treated as though it was known that he was lying, and every
effort must be made to catch him at it. Questions are asked
which cannot be answered truthfully without conveying an
entirely erroneous impression to the jury ; a categorical answer
is insisted upon, when such an answer without an explanation
is virtually a falsehood ; questions are asked which are capable
of several different subsequent explanations ; others which
have, in the form in which they are put, absolutely no mean-
ing at all. On one occasion I recollect a lawyer's laboriously
going over all the organs and tissues of the body from the
scalp to the toe-nails, and being informed by the medical ex-

444 Medical JSapert Testimony.

pert that, in his opinion, no one of the organs was the subject
of pathological change. He then inquired if this man was
sound from head to foot what ground he had to claim dam-
ages. The answer was that the functions of the nervous cen-
tres were so deranged as to prevent the claimant from pursu-
ing his vocation and supporting his family. The expert was
then requested to state to the intelligent jury precisely where
these * 'functions'* were located and what they looked like.
By this time the expert was so thoroughly annoyed, angry,
and disgusted that he declined, for the moment, to answer any
more ** stupid " questions — and woe betide the expert who for
a single moment loses his temper.

Sometimes the "stupid" questions are put for the very
purpose which was reached in the instance quoted, of confus-
ing, annoying, and angering the expert, or of catching him in
apparent contradictions, the explanation of which, to the aver-
age layman on the jury, is always tedious and often impossi-
ble. At other times the questions are not intentionally
** stupid,*' but are so simply by reason of a lack of medical
knowledge on the part of the counsel propounding them.
Your president last year, in his inaugural address, speaking of
medical experts, said: "Their testimony is often of little
value, on both the direct and cross-examination, from the fact
that the questions which they are called upon to answer are
formulated by lawyers who have little medical knowledge ; or
if, as sometimes happens, a physician is employed to assist a
lawyer, the lawyer not understanding the real import of the
questions which his Mentor may suggest, perplexes the wit-
ness, and too often places his assistant in an undignified posi-
tion, so that medical-expert testimony often disgraces our pro-
fession." When a lawyer is asking questions prepared for
him by his medical expert for use in the examination, it is
not uncommon to see a well-laid train of reasoning entirely
destroyed by a single unexpected answer, when, in point ol
fact, the answer given is more favorable to his view than his
medical friend had dared to expect or hope for, and the only
trouble is that the counsel, not knowing enough of medicine
to take advantage of it, abandons his argument just when suc-
cess is within his grasp.

While medical experts are, as a rule, men of large experience

Medical Eepert Testimony. 445

in the practice of their profession, each of them must, on some
occasion, have gone on the stand for the first time. The po-
sition is then to him novel and embarrassing. He is unfamiliar
with the rules of the court, the audience is a strange one, and
the counsel is not averse, if it suits his purpose, to take ad-
vantage of these circumstances. Sometimes the lawyer will
undertake the process of brow-beating the witness, repeatedly
reminding him that he is under oath ; cautioning him to be
careful about his statements ; gesticulating violently ; and
sometimes succeeds in getting the young man, if he is at all
bashful, in such a condition of mind that it is impossible for him
to recollect facts with which he is perfectly familiar, or to couch
his answers in appropriate language. A favorite device with
some is to ask the expert concerning all the possibilities of the
case, not taking at all into account the probabilities. The
timid expert is, perhaps, unwilling to admit a possibility, fear-
ing that his admission will be afterward misrepresented to the
jury as expressing his opinion of what was a probability.
Under such circumstances I have repeatedly heard good,
honest, careful men deny the possibility of an occurrence
which, in their cooler moments, and when they did not fear
that their meaning would be misinterpreted and misapplied,
they would freely admit. Indeed, since it is a matter of record
that an iron tamping-rod, five feet long and three-quarters of
an inch in diameter, has passed vertically through a man's
skull, scattering his brain more or less extensively over a forty-
acre lot, the patient living more than twenty-five years after-
ward, and the accident resulting in no great permanent disabil-
ity other than the loss of sight of one eye, it is difficult to
swear that anything is impossible ; and yet an infinity of pos-
sibilities are not in the slightest degree probable.

One of the most unfortunate results of this condition of
things is, that it is frequently impossible to get the most sub-
stantial and reliable men among us to go on the stand under
any circumstances, or for any consideration, and their places
are sometimes taken by ambitious men, with more assurance
than mental balance or experience, who see an easy way of
attaining a notoriety which they mistake for well-founded
fame, and whose main object is to be on the winning side, if
that end can be obtained without stretching their consciences
beyond the breaking-point.

446 Medical Expert Testimony.

If the present system of obtaining medical expert evidence
resulted simply in the annoyance occasioned to medical men,
or the disgrace brought upon the profession by an apparent
or real difference of opinion expressed on the stand, there
would be great cause for complaint on our part, though we
could not expect much sympathy from others. But it is re-
spectfully submitted that, above and beyond this, the present
system does not tend to bring out the truth in the shortest
and clearest manner ; in fact, in many instances is believed to
have resulted in a miscarriage of justice. Almost any lawyer
of large experience in the conduct of criminal cases will tell
you that he has been sometimes ashamed of the use which he
has made of expert testimony, or else will gleefully chuckle
over it. This matter was brought to the attention of this So-
ciety as long ago as 1879, when, in his anniversary address. Dr.
Roosa so eloquently spoke of the evils attendant upon the
present system.

Many remedies have been proposed, but up to the present
time no action has been taken toward applying them. Dn
Loomis last year proposed that the questions to the expert
should be framed by a medical man employed or appointed
for that purpose. This would undoubtedly help matters to a
certain extent, but would, after all, fall far short of accomplish-
ing all that might be wished for.

A well-known judge of the Supreme Court has suggested
that in each judicial district, a physician of eminence should
be appointed by the court, whose duty it would be to appear
as expert in ev^ry case where his services were required. This
man would, upon the stand, be free from all the bias which
arises from the fact that he is paid by one side or the other,
and a great advantage would, without doubt, be gained. But
he would be subjected to all the annoyances and vexations of
the examination, and the plan would be manifestly impracti-
cable on account of the varied acquirements demanded of the
expert in different classes of cases. The same man can scarcely
be expected to be an expert in chemistry, surgery, medicine,
and obstetrics, and, while the expert would be free from par-
tiality toward either side, his evidence would probably be en-
tirely satisfactory in only some one class of cases. Moreover,
there are few medical men who would be willing to be placed

Some Poptdar Medical Superstitions. 447

in a position where the expression of their individual opinion
virtually results in the imprisonment of a fellow-being for a
term of years, or launches him into eternity. It is scarcely
probable, again, that this plan would meet with the approba-
tion of the legal profession, who would, naturally, desire that
the views of each side should be presented in their best
light.

In most cases where medical expert evidence is required, at
least two physicians are called to the stand, and in many cases
a half-dozen. The remedy which we would suggest would be
that, under such circumstances, a board of three experts should
be appointed by the court ; one on the suggestion of the
counsel for the defence, one nominated by the counsel for the
prosecution, and a third by the court itself ; that these experts
should be paid by the court and the charge divided equally be*
tween the two sides ; that to this board of experts should be
submitted in writing the questions involving medical matter ;
that the answers should be submitted in writing and sworn to,
and that medical witnesses should not be required to go upon
the stand. In the event of the failure of the board to entirely
agree, a minority report might be admitted, and if each side
desired to be represented by two or three experts instead of a
single one, there would be no objection to such a course.

The adoption of this method would certainly result in obtain-
ing from medical experts opinions free from the bias which
arises from the expectation of pecuniary reward from either
side, the unseemly antagonisms between the expert on the
stand and the cross-examining counsel would be avoided, and
the ends of justice be more speedily and surely attained.

Some Popular Medical Superstitions.— In a book en-
titled •• A Bird's-eye View of France in the Middle Ages,"
M. Challemel refers to a number of superstitions which were
current at that time, many of which have not yet died out.
There were several means of warding off fevers. One was to
eat neither meat nor eggs at Easter and on other solemn fes-
tivals ; another to carry about on the person a piece of a
human bone ; and still another to pluck and eat the first daisy

1

448 India- Rubber Pamtment.

found in the field. In order to cure a fever the sufferer would
rise early in the morning and go out into the field, walking
backward all the time, pluck a handful of herbs, and without
looking at it, throw it behind him, and then return quickly to
the house. The fever then forsook him and fastened itself
upon the devil. The Bretons preserved their children from
all evils by putting on them a damp shirt. A knife with a
white handle was a sure preservative against colic. The tooth-
ache was quickly relieved by touching the painful part with a
dead man's tooth. Running here and there, without particu-
lar aim, through a church, was sufficient to ward off pleurisy.
The formation of gall-stones was rendered impossible by roll-
ing one's self naked in a field of oats. Spitting in the mouth
of a live frog was a very efficacious remedy for a cough. Ear-
ache was cured by touching the ear with the hand of a skele-
ton, and headache was quickly relieved by binding the temples
with a cord by which some one had been hung. — Journal €U
Midecine et de Chirurgie Pratiques y October y 1888.

India-Rubber Pavement. — The latest innovation is pav-
ing streets with india-rubber, which material threatens to enter
into competition with asphalte. The new pavement is an in-
vention of Herr Busse, of Linden, who has introduced it in
Hanover. He used it first in the summer of last year for pav-
ing the Goethe Bridge, which has a surface of about 1000
square metres, or 10,764 square feet. The new pavement, it
is stated, proved so satisfactory that 1500 square metres (i6,-
146 square feet) of ordinary carriage-way in the city were
paved with it last summer. The Berlin corporation, being
favorably impressed with the new pavement, has had a large
area on the Lutzow-Ufer paved with india-rubber as an experi-
ment, and the magistracy of Hamburg is likewise trying the
pavement. It is asserted that the new pavement combines the
elasticity of india-rubber with the resistance of granite. It is
said to be perfectly noiseless, and unaffected either by heat or
cold. It is not so slippery as asphalt, and is more durable
than the latter. As a covering for bridges, it ought to prove
excellent, as it reduces vibration ; but a question maybe asked
as to its cost. The expense must be heavier than that of any
known pavement. — Iron.

Editor's TcMe. 449

EDITOR'S TABLE.

^^*All correspondence and exchanges and all publica-
tions for revieiv should be addressed to the Editor, Dr. A. N.
Bell, 113A Second Place, Brooklyn, N. Y.

Subscribers will please conform to conditions of detachable
order on advertising page.

The New York Quarantine Establishment, we are

gratified to learn from the Annual Report for 1888 of Dr.
William M. Smith, Health Officer, is sufficiently advanced in
the process of repair to warrant the conclusion that it will be
equal to the demands of the service during the coming season
of special activity and public concern ; although it is yet far
from being complete, according to the original design and the
suggested necessities of advancing practical knowledge of pre-
ventive measures against portable diseases, and for which ad-
ditional appropriations are required. The magnitude of the
work of the New York quarantine service is measurably indi-
cated by the following extract from the Health Officer's re-
port :

" The number of vessels inspected during the year 1888 was
6344. Of this number 5291 were from foreign ports, and 1053
were vessels from domestic ports subject to quarantine.

" The number of vessels from foreign ports in 1880, the first
year of the present Health Officer's administration, was 7827.
There were 2536 vessels less in 1888 from such ports than in
1880, and 637 less in 1888 than in the previous year. It will
be seen that the number of arrivals is progressively less each
year.

** The number of inspections of vessels from domestic ports
during the past year was 1035. The number given pratique in
1888 was much less than the previous year.

*' The decrease is in great degree owing to the effect of the
law passed March 22d, 1888, ' To amend section fifty-three of
29

450 MUar'e Table.

chapter three hundred and fifty-eight of the Laws of 1863,
entitled " An Act establishing a quarantine and defining the
qualifications, duties, and powers of the Health Officer for the
harbor and port of New York." '

"The inspection of domestic vessels from ports south of
Cape Henry commenced June ist, last.

" The bill which subsequently became a law» whose title is
referred to above, when introduced, provided that all coast-
wise vessels south of Cape Henlopen should be inspected be-
tween May and November in each year. The bill was un-
wisely amended, so that the inspections were not allowed to
commence until June ist ; a further amendment exempted
from inspection all vessels from ports north of Cape Henry.

" Vessels from all Southern ports should be inspected after
May 1st. Yellow-fever is liable to develop at any port in the
South by the first of May, if the infection hibernates in the
extreme South, as there is good reason to believe it did during
the winter of 1887-88, or, if the infection is imported from the
West Indies and secures, as it frequently does, an early lodg-
ment in the South. . • .

" During the past year 383,59$ steerage passengers were
inspected by the medical officers of this department, making
a total since January ist, 1880, of 31323,580."

It is remarkable that only last year — simultaneously with
.the threatening recurrence of yellow-fever northward — the
Legislature of New York should have come to the conclusion
that the time had been so long since the coasting vessels from
ports north of Cape Henry have been required to keep clean,
under the operation of the law of 1863, that they might now
be permitted to return to their filthy habits of former times at
the risk of former results. Fortunately, however, the law of
1863 has a saving clause which was not repealed, making it
the duty of the Health Officer to take the responsibility of
applying such additional measures to the letter of the law as
may be deemed indispensable for the protection of the public
health. While, therefore, he is ^stified by the Legislature in
neglecting needful precautions, he is left to the exercise of his
judgment independently of legislative shortsightedness.

The report before us shows a painstaking watchfulness of
the Health Officer throughout in the exercise of his office.

J

MiU/r's Table. 451

Carefully drawn-up instructions and rules for the prevention
of infectious diseases, and, in case of their recurrence notwith-
standing, the proper care of them on board emigrant vessels,
have been issued in several languages and distributed to the
masters and medical officers. By such and other means the
sanitary service on board emigrant vessels has been greatly
improved. Small-pox, especially by the restrictions against
the freedom of unvaccinated persons, has been almost wholly
excluded — the rare cases which occasionally crop out, attrib-
utable to immigrants, being the result of undiscoverable in-
fected baggage.

The cases of the United States naval ships Boston and Yantic,
infected with yellow-fever, are reported in detail, essentially
the same as before published in our January number from
official sources.

In concluding his report, the Health Officer makes gratify-
ing reference to the successful administration of his office in
arresting cholera at the port in 1887, to its final disappearance
from Europe, and to the non-fulfilment of the prophecies so
generally entertained of its certain and speedy invasion of the
United States.

The report i > altogether alike creditable to the service and
to its author, and should be largely circulated.

THE PROGRESS OF INFECTIOUS DISEASES AND MORTALITY
RATES AT THE MOST RECENT DATES, BASED UPON OFFICIAL
AND OTHER AUTHENTIC REPORTS.

Alabama. — Mobile ^ 40,000 : Reports 64 deaths during
March, of which 14 were under five years of age. Annual
death-rate, 19.2 per 1000. From zymotic diseases, 8, and from
consumption, 5.

California. — For the month of March, 1889, the Secretary's
abstract of the reports received from 74 cities and towns, with
an aggregate population of 741,500, the number of deaths was
907. Annual rate, 14.88. Deaths from consumption during
the month, 157. From zymotic diseases: Diphtheria and
croup, 30 ; typhoid-fever, 18 ; typho-malarial- fever, 2 ; cere-
bro*spinal-fever, 4 ; diarrhoeal diseases, 7 ; whooping-cough,
4 ; scarlatina, 8.

452 mitar'9 Table.

San Francisco, 3CX>,ooo : During the month of March the
number of deaths was 479. From zymotic diseases, 37.
From consumption, 78.

Los Angeles, 80,000 : 54 ; from zymotic diseases, 5 ; con-
sumption, 5.

Oakland, 55,000 : 74 ; from zymotic diseases, 16 ; con-
sumption, 10.

San Diego, 32,000 : 19 ; from zymotic diseases, i ; consump-
tion, I.

Sacramento, 35,000 : 26 ; from zymotic diseases, i ; con*
sumption, 5.

Connecticut.— The Secretary of the State Board of Health
reports for March, 1889, 1049 deaths from 167 towns, compris-
ing a population of 7^8,662, representing an annual death-rate
of 16.5. Deaths under five years of age, 230. Deaths from
zymotic diseases, 161. From consumption, 125.

New Haven, 85,000 : total deaths, 127. From zymotic dis-
eases, 15 ; consumption, 13.

Hartford, 52,000 : total deaths, 88. From zymotic diseases,
17 ; consumption, 15.

Bridgeport, 46,000 : total deaths, 65. From zymotic dis-
eases, 16; consumption, 15.

Waterbury, 34,000 : total deaths, (?). From zymotic dis-
eases, 3 ; consumption, 9.

District of Columbia.— Report of the Health Officer for
the year 1888 : Population — ^white, 150,000 ; colored, 75,000 :
225,000. Deaths — whites, 2778 ; colored, 2262 : 5040 — ex-
clusive of 458, or 12.4 per cent, still born. Death-rates per 1000,
respectively, 18.52 ; 30.16 : 22.40. Mean average death-rate
of the total population for the thirteen years ending June 30th,
1888, 23.88. Of the white population for the same period,
18.77 ; colored, 34.00.

The ratios of deaths from zymotic diseases for 1888 are given
as 4.26 per 1000 for whites ; 6.45 for colored : 4.99. " About
57 per cent of the white population of this class, and 68 per
cent of the colored were of children under five years of age.
The causes of death in which the whites furnish a higher rate
as compared to the colored, are scarlet-fever, diphtheria.

Miior's TaMe. 453

croup, and alcoholism ; in which the colored are to be noticed
for^ preponderance — typhoid-fever, malaria- fevers, diarrhoeal
diseases, congenital syphilis, and inanition ; 1935 of the deaths
were of children under five years of age, and of these 70 per
cent were under one year, 15.10 per cent of the mortality of
the white, and 18.08 of the colored population — 16.59 in the
aggregate — were caused by consumption."

The report is, altogether, remarkable for its statistical com-
pleteness, even to the daily mortalities and meteorological ob-
servations, and taken in connection with the diagrams and
charts with which it is abundantly illustrated affords an unus-
ually valuable fund of practical knowledge on vital statistics.

Florida. — Pensacola^ 15,000: Reports 19 deaths in four
weeks ending March, 23d, 1889, of which 2 were under five
years of age. Annual death-rate, 16.4 per 1000. From zy-
motic diseases there was i death, and from consumption, 3.

•* Be it resolved by the Board of Health of the county of
Escambia, State of Florida :

'" First. That from and after the ist day of May> a.d. 1889,
and until the 30th day of November, A.D. 1889, no vessel ar-
riving at the port of Pensacola between the ist day of May
and the 30th day of November, 1889, from any port or place
where yellow-fever or other malignant disease prevails, shall be
permitted to discharge ballast or cai^o or load cargo in the
bay of Pensacola ; and that all other vessels arriving in said
bay, between said dates, shall immediately upon crossing the
bar proceed to the Quarantine Station designated by a yellow
flag, to be inspected, and, if deemed necessary by the quaran-
tine physician, discharge ballast or cargo and be submitted
to a cleansing and disinfecting process.''

" Sanford (Press dispatch), April 24. — Mrs. C. Demont
died at ten o'clock Monday night, and was buried yesterday.
Dr. R. P. Daniel, President of the State Board of Health, was
present and pronounced it a sporadic case of yellow-fever.
Dr. Caldwell and President of the State Board of Health
Daniel held a post-mortem examination over the body of Mrs.
Demont who died yesterday, and they say it was unmistakably
a case of yellow-fever. We do not apprehend any further
trouble. Every step is taken to protect against an infection

454 Mitar'9 TabU.

spreading." No additional case has been reported up to the
time of this writing. May 5th.

Iowa. — The State Board Bulletin for March reports :

Keokuk. — February — No deaths from contagious diseases.
Total deaths, 12. Death-rate, 18.0. March — Consumption,
3 ; diphtheria, I ; pneumonia, 3. Total deaths, 14. Death-
rate, 10.56.

Davenport. — February — Diphtheria, 14 ; measles, i ; con-
sumption, 3 ; pneumonia, 2. Total deaths, 33. Monthly
death-rate, 12. March — Croup, i ; membranous croup, i ;
diphtheria, 4 ; consumption, 6 ; pneumonia, i. Total deaths,
31. Death-rate, 11.2.

Des Moines. — March — Consumption, 9; pneumonia, 7;
diphtheria, 3 ; whooping-cough, 2. Total deaths, 44. Death-
rate, 10.56.

Illinois. — Ninth Annual Report of the State Board, for
the year 1886, with appendix, pages 362. The quarterly sum-
maries, and the special subjects of this report, State Sanitary
Survey, Vital Statistics and Coroners' Inquests, and State
Medicine, have already been commented upon, and in part
republished in our pages.

Preliminary Report on the Water Supplies of Illinois and the
Pollution of its Streams is a pamphlet of one hundred and fif-
teen pages, hastily prepared " to meet the inquiries of the Gen-
eral Assembly for information concerning certain subjects of
pending legislation." The subject is well known to have en-
gaged the attention of the Secretary of the Board for more
than ten years ; hence it is that this " hurried preparation,"
in excuse for its " incomplete appearance/' is, notwithstand-
ing, one of the most cogent of statements of the importance of
prompt legislative measures for the protection of the water
supplies of Illinois. The investigations embrace the data of
more than one thousand chemical analyses of various water
supplies, comprehending most of the important cities and
towns of the State, and of all the State institutions, in conjunc-
tion with a very thorough presentation of the general physical
characteristics of the Illinois and Lake Michigan basins and
their tributaries. It is said to be a current opinion among
those who have observed the results of surface drainage con-

Editar'B TabU. 455

tinually going on in the general tiling of the heavier soils, that
the ditching out of the sloughs, bogs, and prairies, and the
wholesale reclamation of the great marsh areas by drainage
districts, destroy most of the natural reservoirs for the equal-
ization of flow to the streams. Hence it seems impracticable
to determine at present what will be the result to the water^
courses and the supplies in the future if wholly left to the
natural trend of the conditions involved.

The liability to sewage pollution of the water supplies, and
the relations gf such water to the propagation of disease,
under the present conditions, is clearly and forcibly presented,
and it is difficult to believe that the Legislature of Illinois,
supplied with the knowledge which this report conveys, will
fail to appreciate the importance of promptly making the need*
ful appropriations to complete this most important work of the
State Board of Health, to provide an abundant water-supply
to all the people, of the State under the best practical safe*
guards against every species of pollution.

Chicago^ 830,000: Reports 1260 deaths during March, of
which 585 were under five years of age. Annual death-rate,
18.22 per 1000. From zymotic diseases, 252, and from con*
sumption, 134.

Louisiana. — In accordance with resolutions adopted by the
State Board of Health, the Governor has issued his annual
proclamation of quarantine at all the seaports of Louisiana,
from and after May ist, instant.

Special suggestions to owners^ agents^ masters of vessels, and
passengers.

The Louisiana State Board of Health recommends the fol-
lowing suggestions to agents, owners, masters of vessels, and
passengers, for the purpose of facilitating the work of quaran-
tine officers and reducing the period of detention to a mini-
mum :

1. That vessels should be stripped during the quarantine
seasons of all woollen hangings, carpets, curtains, and such
like materials, and upholstered furniture as far as practicable.
Hair or moss mattresses to be replaced by wire or wicker beds.

2. That as far as possible vessels trading with tropical ports
should be manned with acclimated crews.

456 Editor's Table.

3. Masters of vessels, ship and consular agents are earnestly
requested to instruct passengers from quarantinable ports to
dispense, as far as possible, with baggage which may be injured
by wetting, in case of pestilential outbreak on board, while
undergoing disinfection. Such passengers are especially warned
against bringing silks, laces, velvets, and other fabrics of deli*
cate texture, as they will be compelled to assume all risks of
injury.

4. While in ports infected with yellow-fever, vessels should
be anchored out in the harbor, when this is possible, and the
crew prohibited from going ashore, especially at night.

5. When practicable, cargoes should be loaded in such a
manner as to allow access to the pumps, and also to enable the
quarantine officials to pump out and wash the bilge.

6. Special attention should be given to cleanliness of vessels
and persons, and provision should be made for all possible
ventilation of the entire vessel. The best disinfectants and
instructions for using same can be obtained by application to
the Board of Health or any of its officers.

7. Masters should, before arrival, see that the bilge is thor-
oughly pumped out and cleansed, and that the entire vessel
be put in such good sanitary condition as to permit of the
least possible detention. Fruit-vessels, particularly, should
be kept thoroughly cleansed for the purpose of avoiding delay
at the quarantine station.

8. Vessels observing the above recommendations will re-
ceive special consideration at the quarantine station, detention
and cost of cleaning, disinfecting, etc., being materially les-
sened thereby.

*' Maine," observes the Sanitary Inspector ^ *' still stands
alone in the sisterhood of New England States with no pro-
vision whatever for the collection and recording of vital sta-
tistics. And yet public health officers, physicians, local histo-
rians, political economists, have hundreds of questions, not
trivial or unimportant, which can be answered only by means
of the data which a record of births, marriages, and deaths
would furnish. This long-continued negligence by the State
of Maine of a work now held to be of very great value by al-
most all modern State and National governments, has caused

JSditor's Table. 467

the finger of depreciation to be pointed at us. Not simply to
remove the stigma from our State, but because there is a strong
need of this work, three independent moves were made to get
a vital statistics bill ready for the Legislature which has just
gone home — by the State Board of Health, by the Maine
Genealogical Society, and by F. W. Hovey, Esq., of Pittsfield,
Member of the House. Curiously, each I>ad made the New
Hampshire law the basis of its proposed bill. The bill which
was presented to the Legislature needed but very slight changes
to meet the approval of all who were interested in the matter,
and the result was — we are grateful to the committee which
had it in charge for referring it to the next Legislature.*'

MARYLA.^B.'—BaUipnore — Annual Report of the Health De-
partment for 1888 : Population — white, 423,782 ; colored, 76,-
561 — 500,343. Marriages, 4390 ; rate per 1000, 8.78. Births
— white, 7500; rate, 17.45 ; colored, 1225 ; rate, 15.91 ; com-
bined birth rate, 17.45 ; still- births, 694. Deaths (exclusive
of still-born) — whites, 6894 ; colored, 2042. Death-rate —
white, 16.26; colored, 26.50 : 17.87.

" The reduction of the annual mortality from zymotic dis-
eases since the enforcement of the ' Plumbing Ordinances,'
January ist, 1884, has been very remarkable. The percentage
of deaths from zymotic diseases to the total mortality from all
causes, during a period of forty-eight years, 1836-83, was 28.08 ;
during the five years, 1884-88, 22.00."

Scarlet-fever, during the period of fifty-four years, 1830-83,
caused an annual average mortality of 226 ; for the five years,
1884-88, 57. In 1830, with a population of 81,000, the
number of deaths from this cause was 149 ; in 1888, with a
population of 500,000, the number was 44.

Typhoid-fever, during the period of twenty-four years, i860-
83, caused an annual average mortality of 190 ; during the
last five years, the average number has been 55.

Diphtheria, during the last seven years previous to the
Plumbing Ordinance, 1877-83, caused an average of 469
deaths annually ; during the five years since, 1884-88, the
average number from this cause has been 143. In 1882 the
number was 707. ** This," these results in the aggregate, the
Commissioner of Health justly remarks, " may well be claimed

458 JEditar's TaUe.

as a triumph in sanitation, demonstrating the value of good
laws, diligently and strictly enforced." And to this added an
important additional illustration, " there has not occurred
more than five cases of small-pox in the city during the last
five years (all imported), and not more than two deaths. This
is due to vaccination carefully and persistently practised by
the excellent corps of vaccine physicians, added to the watch*
fulness and diligence of our able quarantine physician.'*

The several subordinate reports of the detail of the health
service are in keeping with the foregoing excellent results.

During the five weeks ending March 30th, there were 800
deaths, of which 244 were under five years of age. Annual
rate, 16.63. From zymotic diseases there were 75 deaths, and
from consumption, 125.

Massachusetts. — Bostons Annual Report of the Board of
Health for the year 1888 : Population, 415,000; deaths, 10,-
197; death-rate, 24.57. Deaths from zymotic diseases, 1841
— 18 per cent of the mortality from all causes ; 3598, or 35.2
per cent of the deaths from all causes, were of children under
five years of age — the lowest percentage since 1871.

The number of deaths from zymotic diseases were 2221, 21.7
of the total mortality ; but the only one that assumed an un-
interrupted prevalence throughout the year was diphtheria,
from which (and croup) the number of deaths was 589 — 5.77
per cent of the deaths from all causes. From typhoid-fever,
170 — 1464, or 14.34 per cent of the total mortality, was caused
by consumption.

The public school-houses were all inspected once during the
year, and better ventilation is urged as the common necessity.
The average proportion of carbonic acid gas of all the rooms in
the best house examined was 8.3 volumes to 10,000 volumes of
air ; and the poorest one, the average amount of impurity was
18.1 to 10,000.

Michigan. — The Secretary reports that for the month of
March, 1889, compared with the preceding month, the reports
indicate that influenza and pleuritis increased, and that scarlet-
fever decreased in prevalence.

Compared with the average in the month of March, in the
three years, 1886-88, measles, intermittent-fever, tonsilitis.

Miiar's Table. 459

inflammation of bowels, consumption of lungs, and rheuma-
tism were less prevalent in March, 1889.

Including reports by regular observers and others, diphtheria
was reported present in Michigan in the month of March,
1889, at twenty-nine places, scarlet-fever at thirty-two places,
typhoid -fever at eight places, measles at twelve places, and
small-pox at five places.

Reports from all sources show diphtheria reported at two
places less, scarlet-fever at twenty places less, typhoid-fever at
three places less, measles at five places more, and small-pox at
five places less in the month of March, 1889, than in the pre-
ceding month.

Detroity 230,000 : Reports 284 deaths for March, of which
61 were under five years of age. Annual death-rate, 14.53 P^i*
1000. From zymotic causes, 37, and from consumption, 29.

Minnesota. — Official report of infectious diseases for the
month of February, 1889 : Diphtheria, 91 cases, 16 deaths ;
scarlatina, 69 cases, 3 deaths.

Diseases of animals : Cases of glanders remaining isolated
or not accounted for, 11 ; reported during the month, 8 ; killed,
6 ; released, 3 ; isolated, 4 ; remaining March ist, isolated or
not accounted for, 10.

" Meat and Meat Inspection. — A very small proportion of the
cattle killed for public consumption are sufferers from infec-
tious or contagious disease. The most common and danger-
ous of these diseases, as respects the use of the meat for human
food, is tuberculosis. It affects in far the largest proportion
dairy stock — domestic cows. Professor James Law informs
the writer : ' Cannot give accurate statistics. Have seen eight
per cent in State (New York) steers, more on plains than
Texas steers, and always much more in dairy stock than in
steers. Have seen thirty, fifty, and even eighty per cent in
some dairy herds.' And Dr. Salmon, Chief of the Bureau of
Animal Industry, informs me that, ' There are no accurate
date as to proportion of different kinds of cattle affected with
tuberculosis in this county ; it is generally admitted that milch
cows are most affected ; thoroughbred breeding stock, next ;
native steers, least. ' They state the opinion of the most ex-
perienced observers.

460 JEditor's Table.

•* In order of danger from this source, dairy stock and all
cows are by far the most to be feared, and should invariably
be subjected to rigid inspection before, and after slaughter.
Next comes domestic steers ; then western stock, and lastly
Texas steers.

** The liabih'ty to the disease increases as the stock are re-
moved from natural conditions of living and food, and, in
cows, their exclusive use for milk sppply is a strong provoca-
tion, if conjoined to artificial feed, close quarters, and general
unsanitary condition.

'' There are other infectious (and some parasitic) diseases
of cattle, but none which affect this question at present.

" But there are other conditions of health which affect tJu
value of beef as food than infectious disease. Those of most
common occurrence are bad conditions^ ill^defined sickness^
fatigue^ overheat. It is for these that inspection of domestic
stock is very important. Any of them may cover tuberculosis,
and fatigue, excitement, over-heating, and injuries, particu-
larly in the warmer months, do seriously affect the healthful-
ness of their meat as food. This is the testimony of butchers,
who often complain that they are compelled to buy such meat,
and after what seemed reasonable care, iind the meat lacking
in brightness, sweetness, dryness, and keeping qualities. I
believe it not unlikely that such meat is the occasion of many
bowel troubles and obscure fevers commonly attributed to
more apparent causes."

Minneapolis. — Annual Report of the Board of Health for the
year ending March 31st, 1889, opens with a vigorous sketch
on the tardiness of civic authorities in the application of meas-
ures for the prevention of disease, and the inexactness of
physicians in reporting it, no less applicable to other commu-
nities than to that of Minneapolis. The reckless reliance upon
the natural advantage of situation and sunshine to counteract
the equally natural results of filth storage, foul water, and bad
plumbing ; and certificates of death from ** lack of vitality,"
** weakness," "stomach trouble," "heart failure," " prema-
ture birth," "still-born," "peritonitis," "septicaemia," etc.?
to shield criminal mortality, are unfortunately common con-
ditions throughout the country, to which health authorities
generally would do well to give more earnest heed.

Editor's Talle. 461

The tables of the report are based upon an estimated popu-
lation of 200,000. Deaths, 2689 ; death-rate, 13.4. Deaths
under five years of age, 1488 — 55.33 per cent ; from zymotic
diseases, 979 — 36.4 per cent. These ratios are so unusually
large in conjunction with so low a death-rate as to lead to the
inference of some defect ; probably, in an overestimate of
population, for under such excellent executive management
as appears to obtain, the registration is supposabiy complete.
The especially prevalent zymotic diseases were, as indicated
by the number of deaths therefrom, as follows : Diphtheria,
^59 » typhoid-fever, 134; measles, 36; scarlet- fever, 24.
Deaths from pulmonary consumption, 218 — 12.2 per cent of
the deaths from all causes.

St. Paul^ 180,000 : Reports for March 160 deaths, of which
82 were under five years of age. Death-rate, 10.66 per 1000.
From zymotic diseases there were 24 deaths, and from con-
sumption, II.

Missouri. — St. Louis^ 440,000 : Reports for March 722
deaths, of which 274 were under five years of age. Annual
death-rate, 19.69 per 1000. From zymotic diseases there were
136 deaths, and from consumption, 67.

New Hampshire. — OfBcial organ of the State Board re-
ports for the month of March : Diphtheria in Manchester,
Bridgewater, Nashua, Concord, Newport, Dover, Hooksett,
East Kingston, New London, and Jaffrey. The largest num-
ber of cases for the month reported from any town or city was
five in Nashua. No epidemic of the disease exists in the State.

Scarlet-fever was reported for the same period from Man-
chester, Nashua, Chichester, Pittsfield, Concord, Dover, New
London, and Jaffrey. The largest number of cases was four
in Pittsfield. No epidemic of the disease prevails.

Typhoid-fever was reported from Manchester and Nashua.

New Jersey. — Hudson County^ 282,254 : Reports 634
deaths for March, of which 259 were under five years of age.
Annual death-rate, 26.9 per 1000. From zymotic diseases
there were 135 deaths, and from consumption, 6o.

Paterson, 80,000 : Reports 145 deaths during March, of

462 Editor's TabU.

which 38 were under five years of age. Annual death-rate,
21.75 P^^ 1000. There were 12 deaths from zymotic diseases,
and 25 from consumption.

Newark t 181,351 : Reports 364 deaths during March, of
which 140 were under five years of age. Annual death-rate,
25.45 per 1000. From zymotic diseases there were 59 deaths,
and from consumption, 52.

New York. — The number of deaths reported during March
is almost identical with that of March, 1888. Of zymotic dis-
eases, a considerably larger number of deaths occurred from
scarlet-fever, measles, and whooping-cough than a year ago ;
from diphtheria and all other zymotic diseases, a smaller num-
ber. Other diseases do not show a material variation. The
chief increase in scarlet-fever is in New York City, Troy,
Albany, Middletown, and Goshen. Whooping-cough and
measles are chiefly reported from New York and Brooklyn.
Diphtheria is not specially prevalent in any locality. But one
death from small-pox occurred during the month ; Geneva is
the only new locality, it having been carried thence from
Lyons. In each 1000 deaths, 167.50 were from z)niiotic dis-
eases (147.37 in March, 1888); and the percentage of infant
mortality is higher than a year ago. From consumption,
129.60 per 1000 deaths occurred, and nearly 200 per 1000
deaths above five years. The proportion of deaths from zy-
motic diseases as a class and separately is a little less than it
was in February.

New York, 1,571,558 : Total deaths, 3778 ; under five years
of age, 1634; annual rate, 28.30. Zymotic, 803; consump-
tion, 485.

Brooklyn, 821,525 : Total deaths, 1686 ; under five years of
age, 725; annual rate, 24.17. Zymotic, 315; consumption,
181.

Buffalo, 230,000 : Total deaths for five weeks ending March
30th, 373; under five years of age, 158; annual rate, 17.30.
Zymotic, 50 ; consumption, 47.

Rochester, 110,000: Total deaths, 177; under five years of
dgc> 52 ; annuiil rate, 19.31. Zymotic, 26 ; consumption, 22.

Albany, 103,000: Total deaths, 211 ; under five years of
age, 73 ; annual rate, 24.58. Zymotic, 35 ; consumption, 29.

Editor's Tahle. 468

Syracuse^ 8o,ooo : Total deaths, 127 ; under five years of
^g^» 31 I annual rate, 19.50. Zymotic, 14; consumption, 25.

The five cities or towns reporting the highest rates of mor-
tality are : Saugerties, 39.00 ; Newburgh, 36.60 ; Waterford,
35.55 ; Goshen, 32.75 ; Greenwich, 30.75.

The five lowest mortalities are : Brockport, 2.4 ; Coopers-
town, 4.00 ; Herkimer, 4.00 ; Ellenville, 4.00 ; Salamanca,
6.00.

North Carolina. — In sixteen towns in the State, repre-
senting a population of 101,144, there were in the month of
March 6 deaths from zymotic diseases and 3 from consump-
tion. Total deaths, 125, of which 36 were under five years of
age. Annual rate of mortality, 14.8 per 1000 of population.

Ohio. — Cincinnati, 325,000 : Total deaths, 533 ; under five
years of age, 185 ; annual rate, 19.68. Zymotic, 82 ; con-
sumption, 66.

Columbus y 101,000 : Total deaths, 102 ; under five years of
age, 28 ; annual rate, 12.00. Zymotic, 19 ; consumption, i6.

Toledo, 80,000 : Total deaths, too ; under five years of age,
29; annual rate, 15.00. Zymotic, 15 ; consumption, I2.

Pennsylvania. — Philadelphia, 1,040,245 : Reports for five
weeks ending March 30th, 2066 deaths, of which 628 were
under five years of age. Annual death-rate, 19.84 per looo.
From zymotic diseases there were 211 deaths, and from con-
sumption, 280.

Pittsburgh, 224,660 : Reports for March 394 deaths, of which
163 were under five years of age. From zymotic diseases there
were 63 deaths out of 209 cases reported, and 1 1 deaths from
whooping-cough and 18 from measles, which are not by law
required to be reported. From diseases of the respiratory
system there were 100 deaths. Annual death-rate, 20.6.

Reading. — Report of the Board of Health for the year 1888 :
Population, 57,750 ; marriages, 622 ; births, 1628 ; deaths (ex-
clusive of 128 premature and still-born), 823. Death-rate, 14.2
— \. 1 3 less than the average of the four years preceding. Deaths
from zymotic diseases, 200 — 32.1 per cent ; an unusually large
percentage, considering the low death-rate. Moreover, 288

464 Editor's TaUe.

— 59.3 per cent of the deaths were of children under five years
of age ; also an unusually large proportion, indicative of un-
healthful conditions generally. And so, indeed, they are
made to appear. C. P. Bassett, C.E., E.M., having been
employed to prepare plans for the disposal of sewage, reports
'* the method now in vogue within the city for the disposing
of household filth, especially human excrement, consists in
pouring it into excavations in the ground preferably deep
enough to reach to open crevices in the limestone, and walled
up with loose stone work, open jointed. Twenty feet is the
depth usually attempted for these vaults. Where the ground
water stands nearer the surface, or difficulty is encountered in
removing rock a less depth, greater than six feet is considered
satisfactory."

Taken all together, the report is suggestive of possible
omissions in the registration or an overestimated population.

Rhode Island. — The number of deaths recorded in the
different towns and cities, from which returns have been re-
ceived, was 533, in an estimated population of 315,800.

The annual d^^Xh-tdX^ upon the estimate given is 19.3 in
every thousand of the population. The death-rate is some-
what larger than for the previous month. The general sick-
ness throughout the State was reported greater during March
than in February.

Newport's Board of Health Annual Report for the year
1888: Permanent population, 22,000; deaths, 315; death-
rate, 14.31. Deaths of children under five years of age, 99 —
31.4 percent of total number of deaths. Deaths from zymotic
diseases, 68 — 21.6 per cent of total ; the chief and the num-
ber of deaths from which were : Cholera infantum, 19 ; diph-
theria (and croup), 17 ; typhoid-fever, 7 ; scarlet- fever, 4.
Deaths from consumption, 25 — 8 per cent, probably the low-
est rate of any equal city population in New England.

Tennessee.— The State Board Bulletin for March reports
the principal diseases, named in the order of their greater pre-
valence, in the State for March, were pneumonia, malarial-
fever, consumption, bronchitis, catarrhs, rheumatism, and
tonsilitis.

Editor's TaUe. 466

Typhoid-fever is reported in the counties of Davidson, De-
catur, Fayette, Franklin, Grundy, Hamilton, Hardin, Haw-
kins, Humphreys, Knox, Lincoln, Maury, and Shelby.
Mumps in Chester, Decatur, Dyer, Fayette, Gibson, Grundy,
Hardin, Henry, Lake, Lawrence, Madison, Shelby, and Wil-
liamson. Whooping-cough in Davidson, Decatur, Dyer,
Franklin, Gibson, Grundy, Hamilton, Henry, Lincoln, Maury,
and Shelby. Measles in Chester, Fayette, Franklin, Gibson,
Henry, Humphreys, Lawrence, Lincoln, and Madison. Scar-
let-fever in Davidson, Dyer, Lake, Montgomery, and Shelby.
Diphtheria in Davidson, Decatur, Hamilton, Montgomery, and
Shelby. Cerebro-spinal meningitis in Franklin, Maury, and
Shelby. Erysipelas in Bledsoe, Decatur, and Maury. Crop in
Knox, Robertson, and Shelby. Meningitis in Shelby. Ratheln
in Gibson. Varicella in Robertson. Roseola in Stewart.

In the chief cities the respective annual death-rates for the
month per looo of population are reported as follows :

Chattanooga, white, 11.55 ; colored, 30.46 : 17.70
Clarksville, *' 21.60; " 28.00:24.80

Columbia, " 16.00; " 24.00:19.20

Knoxville, *• 15.10; " 18.61:15.81

Memphis, " 18.26; •* 33.24:25.08

Nashville, " 12.03 ; " 22.64 : 15.82

Wisconsin. — Milwaukei, 210,000: Reports for the month
of March 273 deaths, of which 57 were under five years of age.
Annual death-rate per lOOO, 15.6. From zymotic diseases
there were 39 deaths, and from consumption, 31.

England. — The 28 large towns dealt with by the Registrar-
General, which have an estimated population of upward of 28,-
500,000, during the four weeks ending March 30th, returned
24,157 births and 15,198 deaths. Birth-rate in London, 32.6
per 1000 ; average in the other 27 towns, 33.3. Death-rate in
London, 18.9 ; average in the whole 28 towns, 20.8. The
lowest death-rate was in Derby, 15.5 ; the highest in Black-
bum, 30.9. Of the 15,198 deaths from all causes in the 28
towns, 709 resulted from measles, 436 from whooping-cough,
189 from scarlet-fever, 171 from diphtheria, 133 from diarrhoea,
115 from ** fever" (principally enteric), and 2 from small-pox.

30

466 Mitor'8 Table.

Cuba. — Havana, 200,000 : Deaths reported for the month
of March, 514 ; under five years of age, 149. From consump-
tion, 1 16—22.58 percent of total mortality. 'From yellow- fever ^
7 ; small-pox, i ; diphtheria, 10. Death-rate, 30.26.

Small- POX. — The number of deaths from this disease in
foreign cities, according to the most recent reports received,
has been as follows : During the four weeks ending April 4th,
1889, in Bruges, 4 ; Ostend, 125 ; Roulers, 2 ; Wasmes, 2 ;
Dour, 5 ; Boussu, i ; Arlon, 10; Fumes, i ; Paris, 18 ; Nancy,
6 ; Havre, 9. During the four weeks ending March 30th :
Lyons, 19 ; Amiens, 19 ; Marseilles, 16 ; Vienna, i ; Prague,
84 ; Lemberg, 8 ; Trieste. 6 ; Brunn, 2 ; Warsaw, 22 ; Odessa,
6 ; Venice, 14 ; Bucharest, 3 ; Cairo, 16. During the month
of February : Moscow, 4 ; Genoa, 7 ; Bologne, 8 ; Madrid, 10 ;
Algiers, 23 ; Bombay, 43.

Yellow-fever in Rio de Janeiro, according to the most
recent consular reports, as summarized in the Weekly Abstract
by Surgeon General Hamilton, shows some abatement. The
number of deaths reported for the six weeks ending consecu-
tively : February 17th, 136 ; 24th, loi ; March 3d, 107 ; loth,
126 ; 17th, 81 ; 24th, 68.

The Mortality Among Seamen and Soldiers in the
French Colonies is the subject of an interesting report re-
cently made to the Acad^mie de M^decine by Dr. Lagneau, as
follows :

** In France the yearly mortality varies between 9 and 11
per 1000 of the effective force, while the proportion in young
men in civil life, between 20 and 30 years of age, is from 8 to
10 per 1000.

" In Algiers, in 1848, the mortality in the army was yy per
1000 men in service, now it averages 11 to 12.

" In Tunis, in like manner, the death-rate has fallen from
61 in 1881, to 12 in 1887.

" In the French possessions in Oceania, the death-rate is re-
markably low. It is only 8 to 9 in Tahite.

'* In the French possessions in the West Indies, except dur-
ing the prevalence of epidemics of yellow-fever, the mortality

EdiUyr's Table. 467

has greatly diminished, and is now only about twice as great
as in France.

" In French Guiana the mortality is enormous during the
prevalence of epidemics of yellow- fever. That of 1885 carried
off nearly one fourth of the effective force.

" In the East Indies the mortality is great ; at Pondichery
the average is 37 per 1000.

'' In Cochin China the mortality during the first years of
French occupation was very great. In 1861 it was 115 per
1000, but it has progressively fallen, so that now it is about
double that of France.

"It is difficult to fix the death-rate in Tonquin, even ap-
proximately. The excessive fatigue imposed on the soldiers,
in consequence of the great diminution of the army of occu-
pation and the frequent epidemics of cholera morbus, have
raised the mortality to more than 40 per icoo.

" In the island of R6union the mortality among the seamen
and soldiers would not be excessive if the hospitals did not
receive the sick from Madagascar and the adjacent islands.

** Senegal has the reputation of being the most unhealthful
of the French colonies. The average mortality, from 1832 to
1837, was 148 per 1000 ; but now, in consequence of the fre-
quent changes among the men and the order to send each year
150 of the sick to France, for every 1000 men in the service,
the mortality has been reduced to 73 per 1000 of those who
remain. Unfortunately, the epidemics of yellow-fever fre-
quently carry off more than half the Europeans."

From the facts in his report. Dr. Lagneau draws the follow-
ing conclusions :

"To lessen the sickness and lower the death rate among
our native troops in the colonies, it is necessary not only to
shorten the term of service abroad, to send the sick to suitable
health resorts at altitudes more or less elevated above the sea
level, and to islands where they may be refreshed with health-
ful air, but to send the convalescents and the sick who are able
to undertake the journey to their native country, and, above
all, it will be necessary to supply with native troops the place
of Europeans, who are acclimated with such difficulty. The
army in the colonies should be recruited only from among
those who volunteer for such service.

468 Mitor'B Table.

'* In establishing colonies abroad, France not only increases
her political importance and extends her commeicial relations^
but she favors emigration, which, by draining the population,
t^nds to increase the birth-rate, which is now so low. Let her
cast a^ide that dangerous optimism which has too long pre-
vailed in official circles, and, following the example of other
nations, as England, publish official reports showing the
amount of sickness and the death-rate among her soldiers and
sailors in the colonies, especially the ratio of the deaths to the
number of men in the service.

'" The nation which supplies the men ; the Parliament which
decides the question of peace or war ; the Government which
determines to take possession of territories in certain localities ;
the generals and the admirals who direct the expeditions into
distant parts, or who govern established colonies are inter-
ested to know the death-rate in each war, in each campaign,
or in each of the territories occupied.

" In our country, far more rich than populous, it is neces*
sary to be economical of human life ; it is necessary that a pre-
cise estimate of the amount of sickness and the deaths enable
us constantly and fully to' apply the hygienic measures neces-
sary to limit their proportions ; it is necessary that, for colonial
troops, the volunteer system take the place of conscription,
that the natives and the metis, better able to resist epidemics
and endemic diseases in the tropics, should gradually but
steadily take the place of Europeans, who are so severely tried
in tropical countries ; it is also necessary that the danger-
ous service rendered by our soldiers in the colonies should
be better appreciated, and both soldiers and sailors should
be compensated in proportion to the dangers they encoun-
tered in maintaining the authority of France in distant coun-
tries.'

That is certainly a very reasonable programme for the guard-
ians of the health of our soldiers. It remains to be seen if it will
be put in force with greater care when formulated by a mem-
ber of the Acad6mie de M6decine than it has been hitherto
when formulated by experienced hygienists, of whom, speaking
de visu et de experientia, the medical corps of the navy has
reason to be proud. — Dr, de Foumis, in Journal d* Hygiene.
— T. P. C.

MiUyr'8 Table. 469

The Hungarian Public Health Association, which
meets at Buda-Pesth, held during the year 1888 twenty general
sessions and eighteen meetings of special commissions, at
which one hundred and eighty-five questions relating to scien-
tific and administrative business were considered. Among the
questions considered and adopted were the following :

Revision of the second edition of the Hungarian Pharma-
copoeia, which is published in both Hungarian and Latin^ in
one volume.

Removal of the tax on medicines, ordered by the council.

Instructions for supervising and regulating the sale of meats,
and such modifications as experience has suggested have been
introduced.

The manufacturers of siphons for seltzer having presented
objections to the law proscribing the use of more than one per
cent of lead in their manufacture, the council instituted a new
series of investigations, and concluded to continue the existing
restrictions in full force.

Being asked to decide whether the sale of artificial (mar*
garine) butter, and saccharine, a common addition to other
adulterants of sugar, should be permitted, the ** Conseil Gen-
eral " decided that these substances should be prohibited in
Hungary for the following reasons :

Margarine is digested with great difficulty, and causes dis-
ease of the stomach. Besides, it is difficult to insure its pu-
rity, and therefore permission to make and sell it would only
encourage the fraud.

Saccharine has no nutritive value whatever, and is not al-
ways well tolerated by the human system ; therefore it should
not be used as a substitute for sugar. Moreover, innumerable
other frauds would result from its use, and their detection
would be rendered more difficult.

At the request of the Secretary of the Interior, the *' Conseil
General," after a careful study of the fever prevailing at Cairo,
reported that the disease is not contagious, and that it does
not for that reason need to be quarantined. — Journal d' Hy-
giene.— T. P. C.

470 Medical Eoooerpi.

MEDICAL EXCERPT.

Cerebral Localization.— P6an, Gibbert Ballet, and G61U
neau have sent a communication to the Academy of Medicine
announcing the success of their experiments in the localization
of the cerebral regions and its application to the successful
treatment of epilepsy. The diagnosis was made of a tumor in
the motar tract in a patient who suffered from frequent attacks
of epilepsy, and, by means of the topographical description of
the brain, the skull was opened exactly over the point occupied
by the tumor, which was successfully removed. The epileptic
attacks had the following characteristic features : First, they
began with painful spasm of the great toe of the right foot,
followed by stiffness of the lower limb of the same side ; tonic,
followed by clonic spasms, which extended to the arm and the
face also on the same side. Loss of consciousness did not follow
every attack ; when it occurred it was only at an advanced
stage of the seizure. It never occurred at the beginning. In
the interval between the attacks, which followed one another
quite rapidly, a partial paralysis of the lower limb was very
marked on the right side.

The operation was performed by Dr. P6an, after the method
described by Dr. Lucas Championi^re, over the motar tract of
the lower limb, near the upper extremity of the fissure of Ro-
lando. Crucial incisions were made in the integuments, which
were then dissected back together with the periosteum, and a
piece of bone about the size of a twenty-five cent piece was
removed ; the dura mater and the pia mater were then divided.

Beneath the pia mater was found embedded in the substance
of the brain, a small tumor, which was removed in pieces, pro-
ceeding from the centre to the periphery ; it was a fibro-Hpoma.

A drainage tube was placed in the cavity left by the tumor ;
the divided portions of the dura mater were united with catgut
and the scalp with hair sutures, and the whole covered with
an antiseptic dressing.

Eight days after the operation the sutures and the drainage
tube were removed ; the tenth day the cicatrization was com-
plete.

Some slight convulsions occurred a few days after the opera-

Medical Eaooerpt 471

tion, but the attacks soon disappeared entirely, and the cure
remains complete at the end of two months* According to
the authors of this communication, the operation and its im-
mediate results show :

First. The absence of danger in opening the skull when care
is taken to use efficient antiseptic applications.

Second. The value of the recent discoveries in cerebro-
motor localizations and in cerebro-cranial topography. With
these facts in view it is possible to locate with surprising ac-
curacy, as in the case described, the seat of certain tumors,
and we are enabled to go directly to these abnormal growths.

Third. The importance of the results obtained in the case
described, which seems to prove that surgical interference is
destined to render valuable service in some cases of tumors in
the brain. — Gazette Heb. des Scie7tces M^d.— T. P. C.

Facial Paralysis in Infants is found in at least three
forms :

First. Paralysis caused by the application of the forceps.

Second. Paralysis caused by slow labor resulting from mal-
formation of the pelvis, or from internal pel\ric tumor.

Third. General paralysis accompanied with defect of hear-
ing, which are really congenital.

The Brst and second admit of a favorable prognosis regard-
ing the final result, while the last is incurable. The functional
troubles which follow are not great, because the individual
soon learns to adapt himself to the conditions, as he never
knew the normal action of the paralyzed side. If at birth the
paralysis result from the use of the forceps, it will recover ; if
from pressure, probably, if it be congenital, it will remain dur-
ing life. — Ibid. — T. P. C.

Intestinal Occlusions.— Goltdammer, who has studied
the treatment of intestinal occlusions at great length, rejects
the use of purgatives, and puts his patients on strict diet and
opium in large doses — seven grains a day.

Simultaneously with this treatment the stomach may be
washed ; and injections, or the insufflation of air into the in-
testines may be employed. Laparotomy is always dangerous
in these diseases, because the peritoneum is generally in a state
of hyperaemia.

472 MedioaL ExoerpU

Laparotomy may be performed when the diagnosis of invag-
ination can be arrived at with more or less certainty and when
the following conditions exist : youth in the patient ; rapid
invasion of the disease ; absence of meteorism ; bloody stools,
tenesmus, and especially if on palpation a tumor is found.

It should be performed when, notwithstanding the free ad-
ministration of opium, there is fear of compression of the in-
testine.

It ought to be performed when, after temporary relief, a
relapse occurs accompanied with rapid loss of strength on the
part of the patient. If a hernia is supposed to exist, the same
means should be resorted to promptly. — Gazette Hebdomadaire
de Bordeaux. — T. P. C.

Cocaine Injections have recently been introduced as a new
treatment in inflammatory and spasmodic contraction of the
joints. The operator uses a long needle, and with the usual
antiseptic precautions, injects .05 to .10 of a gramme of a ten
per cent solution of cocaine. In coxitis the needle is intro-
duced at the posterior surface of the joint, just above the ex-
tremity of the trochanter, in the direction of the neck of the
femur into the articulation. The pain ceases instantly, and
the contracted limb is easily straightened ; but extension
should be made with care.

This treatment has been employed a score of times in cases
of coxalgia in the service of Professor Albert. — Ibid. — T. P. C.

Fluoric Acid in Phthisis.— At a meeting of the " Soci-
6t6 de M6decine Pratique," M. L6on-Petit, speaking of hydro-
fluoric acid in phthisis, said : " The question of phthisis is in-
finitely more complex than the chemists and micrographists
seem to believe. It must not be forgotten that tuberculosts,
although having a single origin, is extremely variable in its
manifestations. For my part I have for a long time used
hydro-fluoric acid in the treatment of phthisis, and I am forced
to admit the fact that with some temporary improvements I
have had very many complete failures. Moreover, I do not
think it possible that a single article will ever be found to cure
phthisis. It must not be forgotten that along with the bacillus
we have the patient, besides the researches in the laboratory
we have the clinical study, and the facts obtained by the prac-
titioner who is in immediate contact with the disease very often

Medical' EccerpU 478

disprove what seem to be the best theories. " — Journal deM^d-
ecim de Paris. — T. P. C.

Bromidia as a HYPNOTIC—Edward Warren-Bey, M.D.,
CM., LL.D., Chevallier of the Legion of Honor, thus refers
to the remarkable success which bromidia has achieved in
France. " The French, as a nation, are remarkably conserva-
tive in everything, save their politics, adhering tenaciously to
the ideas and objects with which they are familiar, and regard-
ing with corresponding suspicion all novelties and innovations,
especially those coming from abroad. Hence it is that the
materia medica of France has not ra^xc^^A pari passu with that
of its neighbors. The bromidia (Battle) at once attracted the
attention of the French physicians, and their experience with
it so developed their confidence in it as a prompt, reliable, and
harmless hypnotic that, in utter disregard of all that they had
been taug^ht and believed respecting the danger and unrelia-
bility of alien products, they promptly accorded it a place in
their repertoire of remedial agents, and are now using it as
freely as any medicinal preparation included in the codex.
In no other country, in fact, does it enjoy a larger measure
of popularity than in France, and so great is the demand for it
that it has been found necessary to manufacture it here in large
quantities in an establishment especially arranged and organ-
ized for that purpose.

** As no extraneous influences have been brought to bear in
its favor, it has had to make its own way in the face of oppo*
sition and prejudice of the most formidable character, upon
the strength alone of its virtues as a remedy for insomnia and
other corresponding disturbances of the nervous system, the
conclusion is legitimate that it really possesses the therapeuti-
cal properties claimed for it, that it is ^^hy^noXXz par excellence^
and without a rival.

"To those familiar with the use of bromidia (Battle) no
argument like this is necessary, for it speaks for itself by ful-
filling the indications for which it is administered with a cer-
tainty, efficiency, and harmlessness which elicit at once the
delight of the prescriber, and give to the profession the assur-
ance of possessing one remedy at least which approximates so
near to infallibility of action as to justify the title of specific.''
— Medical Press and Circular, March 2jth, 1889.

474 LUerary Notices.

LITERARY NOTICES.

American Resorts ; with Notes upon their Climate.
By BusHROD W. James, A.M., M.D., Member of the Amer-
ican Association for the Advancement of Science ; the Amer-
ican Public Health Association ; the Pennsylvania Historical
Society ; the Franklin Institute, and the Academy of Natural
Sciences, Philadelphia ; the Society of Alaskan Natural His-
tory and Ethnology, Sitka, Alaska, etc. With a translation
from the German by Mr. S. Kauffmann of those chapters of
*' Die Klimate der Erde," written by Dr. A. Woeikof, of St.
Petersburg, Russia, that relate to North and South America
and the islands and oceans contiguous thereto. Intended far
invalids and those wfio desire to preserve good health in a suitable
climate. 8vo, pp. 300. Price, $2. Philadelphia and Lon-
don : F. A. Davis.

" This book," the author says prefatorily, * * does not aim
at a scientific consideration of the subject of climatology, but
has been prepared in the hope that it maybe of some practical
service to numerous health-seekers in search of information
regarding our climate and health resorts." To this end he has
summarized a long category of reputed health resorts through-
out the country, which may and ought to challenge the scrutiny
of " health-seekers." It begins with a <short chapter on and
a good definition of medical climatology in general terms,
which may be usefully applied as a basis of inquiry with regard
to the promised healthful conditions of a multitude of diverse
localities. But the misfortune is that these are without data,
and must therefore be judged of by their relations to such known
conditions as may be accessible independently of the descrip-
tions herein given, because these are evidently, for the most
part, derived from *' health resort " manuals, railway induce-
ments to travel, and proprietary advertisements generally.

The special chapter on the therapeutics of climate, as com-
pared with the rest, is excellent for its precautionary sugges-
tions in the selection of climates and local conditions, with
reference to known pathological indications and constitutional
predispositions.

IMerary Notices. 475

The Preventive Treatment of Calculous Disease,
AND THE Use of Solvent Remedies, by Sir Henry
Thompson, F.R.C.S., M.B., Lond. ; and Sprains : Their
Consequences and Treatment, by C. W. Mansell
MOULLIN, M.A., M.D,, Oxon., F.R.C.S., Eng.,are the espe-
cially valuable essays in the current number of Wood's Medical
and Surgical Monographs.

Sir Henry Thompson is well known to be the most eminent
authority on the subject of which his essay treats in this num-
ber. His consideration of the subject is concise, though full
and eminently practical, and will doubtless afford a revelation
to many practitioners regarding the amenability of this affec«
tion to medical treatment.

Dr. Moullin*s monograph is on an equally important subject —
one which every medical practitioner is more or less frequently
called upon to treat, primarily, or as the result of neglected
slight injury resulting in chronic and frequently by ordinary
methods of treatment in permanent disability. The subject is
here treated of in all its aspects, and it is one which no physi-
cian can afford to be unacquainted with. Monthly, $io a year ;
single copies, $i. New York : William Wood & Co.

A Hand-Book FOR the Hospital Corps of the United
States Army and State Military Forces, by Major
Charles Smart, U.S.A., is announced by Messrs. William
Wood & Co. to appear at an early date. It may be safely
said in advance that this work will be replete with the best
knowledge upon the subjects of which it treats.

Manual of Dietetics for Physicians, Mothers, and
Nurses. By W. B. Pritchard, M.D. Price. 25 cents.
The Dietetic Publishing Co,, 115 Fulton Street, New York.

This is a pamphlet of eighty-eight pages, containing a great
deal of useful and practical information on food for and feed-
ing of the sick.

Report of the Dairy Commissioner, William K. New-
ton, M.D., of the State of New Jersey, 1888, pp. 1 56, com-
prehends a great deal of useful work to the people of the State
on one of the most important subjects that can engage their

476 Literary Notices.

attention — healthful foods. During the year 623 articles of
food were analyzed, and of these 303, or 48.64 per cent, were
found to be more or less adulterated. The leading articles in
the degree of impurity were : Ground spices, ground coffee, lard,
butter and oleomargarine, milk, and imported canned goods.
Of ten samples of extracted honey, five were adulterated with
glucose ; of nine of maple sugar, four ; of seven samples of
pickles, two contained copper. Under the head of Drugs :
Of ninety samples of cream of tartar analyzed, forty-nine were
impure ; of fifteen samples of iodide of potassium exam-
ined, four only were equal to the requirements of the United
States Pharmacopoeia ; of nine samples of carbolic acid, two
only were of the purity demanded by the Pharmacopoeia ; of
twenty-eight seidlitz powders, sixteen were deficient in quan*
tity or quality, and so on to the end of the chapter.

Brandy, whiskey, and gin : Of forty-three samples, pur-
chased at drug-stores, six only answered to the tests of purity
and quality given in the Pharmacopoeia. The price paid for
the samples varied from $4 to $20 a gallon, yet this was no
indication of the quality.

The report is eminently worthy of extensive circulation.

Transactions of the Medical and Chirurgical Fac-
ulty OF Maryland, Nineteenth Annual Session, 1888.
Pp. 250. G. Lane Taneyhill, M.D., Secretary, Baltimore.
Besides the Address by the President, J. E. Atkinson, M.D.,
the reports of the sections on the different departments, and
several special papers on curative medicine, of interest to all
medical practitioners, the two papers of the section on Sani-
tary Science — ** Practical Measures for the Restriction of Con-
tagious and Infectious Diseases,*' by George H. Roh6, M.D.,
and " Insanitary Agents in Common Use — Trees, Refrigera-
tors, Ice-Boxes, Filters," by John Morris, M.D. ; and ** In-
ebriety as a Disease," by Charles G. Hill, M.D., are more
particularly allied with preventive medicine, and deserve the
attention of practical sanitarians. Dr. Roh6 invites attention
to the large percentage of mortality from infectious diseases
in Baltimore, and strenuously urges notification^ isolation^ and
disinfection as special measures of prevention which should be
enforced by the health authorities with the co-operation of all

LUera/ry NoUce%. 477

medical practitioners, and supports his argument by citations
of the best authorities. Dr. Morris, except his misnomer of
i/fsanitary, as a designation of inanimate things, concisely but
lucidly describes the healthfulness of shade trees ; the danger
of uncleanly ice>boxes, and the contaminating effects of stor-
ing milk and butter in the same apartments with other food,
particularly with meats ; and points out the special importance
of ventilation to ice-boxes and refrigerators of all kinds. His
description of the unreliability of filters as means of removing
the most dangerous impurities of water, and the consequent
danger of relying upon them, is worthy of special heed.

Dr. Hill refers to the dogmatical assumptions and specula-
tive theories commonly entertained by moralists and others
who have, from commendable motives, crystallized themselves
into various reformatory movements, as reason sufficient for
more assiduous attention to inebriety in all its phases by med-
ical men generally than has hitherto obtained. He concludes
with a quotation from Dr. Clouston that, ** What we want is
an island where whiskey is unknown ; guardianship, combining
authority, firmness, attractiveness, and a high bracing moral
tone ; work in the open air ; a simple, natural life ; a return
to mother-earth and to nature ; a diet of joints, vegetables,
bread, milk, egg^, and fish. No opportunity for one case to
corrupt another, and suitable punishments and deprivations
against the rules of life laid down. All this continued for sev-
eral years in each case, and the legal power to send cases to
this Utopia for as long as medical authority determines, with
or without their consent. This would be the ideal mode of
treatment."

" But this," he says, " is too Utopian for practical consid-
eration here. What we want, first, is a State inebriate asylum,
or, in lieu of this, a ward in the State Insane Asylum set apart
for this purpose. And, most important of all, we should have
the power of commitment so simplified that the testimony of
two or more physicians, as is done in cases of insanity, would
be sufficient to commit any inebriate, nolens volens^ to such an
institution for a sufficient time to guarantee a thorough trial
of the efficacy of treatment, and if he persists in returning to
his old habit on being released, for the sake of himself and his
family, for the sake of society, for the sake of humanity, let

478 Literary Notices.

him be detained there throughout the term of his natural life,
rather than have him propagate a race of neurotics who would
probably become drunkards like himself, and after setting a
terrible example and wasting his means and impoverishing his
family, go down at last into a drunkard's grave."

Transactions of the Medical Association of Mis-
souri, Thirty-first Annual Session, 1888, pp. 462. L.
J. Matthews, M.D., Carthage, Secretary. A volume of nu-
merous and, for the most part, excellent papers on curative med-
icine ; and besides contains the following contributions to
State medicine and practical sanitation : ** The Ounce of Pre-
vention," and ** What has been done and What has not been
done by the State Board of Health of Missouri," by George
Homan, M.D. ; ** Pneumonia-Malaria the Probable Cause of
the Large Mortality," by W. B. Lucas, M.D. ; " Report on
the Recent Outbreak of Small-pox in Schuyler and Adair
Counties," by G. A. Goben, M.D. ; " Laws and Appropria-
tions of the Federal and State Governments in the Interest of
the Public Health," by G. Hurt, M.D. These papers, col-
lectively, are especially important and timely to the people of
Missouri, and well would it be for them and the purpose for
which the papers were written, if they were unlocked from
this report and its limited circulation, and scattered broadcast
over the State. Such an act might have the effect of rousing
the people to a recognition of the importance of State medi-
cine as an essential subject of public economy. " What has
not been done by the State Board of Health," by reason of the
ignorance and indifference of the legislators — so well shown
by Dr. Homan — doubtless reflects the sense of the people to
the same degree, and until this is reached legislators are likely
to continue obtuse and obdurate. Staid volumes of State
Medical Society Transactions are a means of filing away such
papers without benefit to the people.

Jean Francois Millet.— The Century Magazine -w^s the
first to publish the " Life of Jean Frangois Millet " — this was
even before its appearance in France. The May number con-
tains still further recollections of him — " With Some Account
of his Diawings for his Children and Grandchildren," by

Literary Notices. 479

Wyatt Eaton, the well-known American artist, who lived in
Barbizon and was intimate with the famous painter. The
article is illustrated not only by many of the drawings referred
to, but also with a portrait of Millet made by Mr. Eaton from
various sources, including his own remembrance of the orig-
inal. There is also a full-length portrait of Millet, at the age
of forty, from a photograph taken in his garden. A picture
of the interior of his studio, taken soon after Millet's death,
is also given.

Wonders of the Camera. — The peculiar rhythmical
effects which accompany discharges of powder and of nitro-
glycerine compounds have been elaborately investigated by the
aid of photography. It has also been suggested that careful
photographs, taken of steel and timber just at the point of
rupture under a breaking load, would conduce to our knowl-
edge of the complicated subject of elasticity.

The lightning flash can be investigated. Dr. Koenig, in a
recent communication to the Physical Society of Berlin, states
that he has photographed a cannon-ball which was moving at a
rate of 1200 feet per second. The ball was projected in front
of a white screen and occupied one fortieth of a second in its
passage. Marey has photographed the motions of limping peo-
ple, and has thus given surgeons the materials for a study of
lameness. It is said, moreover, that photography often reveals
incipient eruptive diseases which are not visible to the eye.
Photographs taken by flash-powders of the human eye, show-
ing it dilated in the dark, give the oculist a new method of
studying the enlarged pupil. — Professor John Trowbridge^ in
the May Scribners.

The Extermination of the Buffalo.— At the present
time, outside of the National Park, where about two hundred
and sixty buffaloes are now harbored, there are not over three
hundred, probably not as many, left in the whole United
States. The survivors of this magnificent race of animals are
scattered in little bunches in several localities. There are
about one hundred in Montana, or at least there were a year
ago, some at the head of Dry Creek, and the remainder at the
head of Porcupine Creek. In Wyoming there are a few strag-

480 Literary Notices.

glers from the National Park, which, when chased, run back
there for protection. In the mountains of Colorado last sum-
mer there were two bunches of mountain bison, one of twenty-
five head and the other of eleven. These have probably been
killed. There are none in Dakota, though eighteen months
ago thirty were known to be there. It was estimated in 1887
that there were twenty-seven in Nebraska, and about fifty
more scattered in the western part of the Indian Territory and
Kansas. Those in Nebraska have since been killed by the
Sioux. Of the thousands that once inhabited Texas, only two
small bunches remain. Thirty-two head are near the Ratons,
in the northwestern part of the Panhandle, and eight in the
sand-hills on the Staked Plains north of the Pecos River.
These were seen and counted on April ist of last year.
This estimate of the remnant of a great race is believed to be
essentially correct. It was obtained from reliable and well-
informed persons throughout the West, and in part from per-
sonal observation during the past years. — Franklin Satterth-
waite^ in Harper s Magazine for May.

PAMPHLET REPRINTS, REPORTS, ETC.

** Physical Condition of the Police Force of St. Louis." By
George Homan, M.D.

** The Relation of the Abdominal Surgeon to the Obstetri-
cian and Gynaecologist." By A. Vander Veer, M.D., Albany,
N. Y.

** Sixty- fourth Annual Report of the Retreat for the Insane,"
Hartford, Conn.

Suicide and Legislation." By Clark Bell, Esq., New York.
Annual Report of the Murdock Free Hospital for Wom-
en," Boston.

'' Nineteenth Annual Report of the Manhattan Eye and
Ear Hospital," New York.

" Twenty-ninth Annual Report of the Medical Superintend-
ent of the State Asylum for Insane Criminals," Auburn, N.Y.

" First Annual Report of the Methodist Episcopal Hos-
pital," Brooklyn, N. Y.

" Thirty-eighth Annual Report of the State Lunatic Hos-
pital," Harrisburg, Pa.

• <

THE SANITARIAN

JUNE, 1889.

Number 235.

PULMONARY CONSUMPTION, AND ONE OF ITS

CAUSES.

Pulmonary consumption is more to be feared in every
community than any other disease that affects mankind. It
is the great placid ocean of mortality, compared to which the
occasional epidemics that terrify the public mind are but tur*
bulent inland lakes. Cholera* yellow-fever, and small-pox^
diseases that paralyze with fright entire States, provinces, and
countries, are exceedingly limited in their results in compari-*
son with the steady, silent, and awful slaughter of consump*
tion.

Last year Florida was panic-stricken from the havoc of
yellow-fever ; but during the same year consumption destroyed
more than twice as many lives in the little State of New
Hampshire, and not a tremor ran through the body corporate.
The average annual death-rate in this country, from cholera,
yellow-fever, small-pox, typhoid-fever, diphtheria, and scarfet-
fever, all combined, does not reach the enormous total of
deaths from consumption.

It is time that some determined and systematic effort be
made to lessen this disease, which the most eminent pathol-
ogists and sanitarians now regard as preventable. Its com-
municability by contagion and infection has been proven, and
its natural history is so well known that much may be done to
limit its prevalence.

Among the general sources of infection there is one, at
least, that should be removed, or, if not wholly removed,
greatly lessened by legal action, and that is the sale of tuber-
culous food products. Such foods, chiefly in the form of
tuberculous meat and milk, particularly the latter, are un-
doubtedly extensively sold to unsuspecting consumers ; and

31

482 Pulmonary Consumptmij a/nd One of its Causes.

that the results are not infrequently lamentable, no sanitarian
doubts. Pulmonary consumption is a very prevalent disease
among the cattle of this country ; and since the general gov-
ernment has taken no measures to restrict the malady, it be-
comes the duty of the individual States to inaugurate some
course that will reduce the danger to the public therefrom.

To illustrate, we will give one instance in this State very
recently investigated by the Board of Cattle Commissioners :
Complaint was made to the Board that some disease existed
in a herd of thirty cows, in a certain town of the State ; and
under the assumption that the disease might be pleuro-pneu-
monia, the Government, upon notification, sent a competent
veterinary surgeon to inspect the herd. The inspector imme-
diately diagnosed tuberculosis, had an infected cow killed, and
the post-mortem examination revealed tubercles in nearly every
organ of the body, including the udder. The inspector re-
ported that about seventy-five per cent of the herd was already
infected. All, or nearly all the cows were being milked, and
the product being sold daily to a milk dealer for distribution
among his customers. The dairyman, ignorant of the char-
acter of the disease, was bringing up a baby upon the milk of
a single cow in which the disease had advanced nearly to its
iatal termination.

This is only one case, but there are many others ; and when,
-as a result, consumption appears in the human subject, the
^unfortunate victim and the friends accept the edict as wholly
(Unavoidable and perhaps inexplicable. It is time that this
.great danger be taken in hand by every State, as it can be,
with every probability of lessening in a marked degree the
annual death-rate of this terribly insidious and fatal disease.

Under our present laws, neither the Board of Cattle Com-
missioners nor the State Board of Health has any authority to
deal with tuberculosis in cattle in a way necessary to restrict
its spread among other herds, or to prevent the appalling
dangers to which it subjects the human family. The next
Legislature should enact a law that will require the Board of
^Cattle Commissioners to stamp out the disease wherever found
'by destroying the animals infected, and for which the State
rshould, in some measure at leasts reimburse the farmer for his
ios9.-^.Sanitarjf Volunteer.

WcUer Analym. 483

WATER ANALYSIS,

SANITARY ASPECTS.*

By Charlbs Smart, M.D., Surgeon U. S. A.

Water exercises a sanitary influence as a climatic factor, by
its geographical distribution and the quantity present as vapor
in the atmosphere ; it has a potent influence on the human
race by its presence in soils, causing disease as well when the
temperature is low as when it is high ; it is an essential in the
sanitary police of individuals, families, and communities ; but
it is only as a supply for the physiological necessities of the
human organism that we propose now to consider it.

Natural waters have been variously classified, for con-
venience in discussion, by their source, into rain, snow, ice,
river, lake, 'spring, well, sea-water, etc. ; by their prominent
inorganic impurities, into saline, chalybeate, sulphurous, cal-
careous, magnesian, etc. ; by their abstergent qualities, into
hard and soft. For sanitary purposes no system of classifica-
tion appears to be needful or of value, for we can rarely gen-
'eralize when a water-supply is in question, or predicate of one
from the known qualities of another. Every specimen must
be analyzed, its history carefully examined, and an opinion
formed upon the results independent of its source from well,
river, or lake, or of its hardness, softness, or mineral character-
istics. But there is a marked difference in the results of the
analysis of certain naturally pure waters, and to give expres-
sion to this difference, which will be explained hereafter,
waters may be divided into surface waters and percolated
waters. These classes are frequently found in natural supplies
to be mixed one with the other. Rain-water stored in sound
cisterns may be taken as an illustrative specimen of the one,
deep well-water of the other, while river-water consists of
varying proportions of both.

Rain-water is generally regarded as a pure water. It con-
tains but minute traces of the mineral salts which are found in

* Continued from page 413.

484 Water AnalyHa.

well-waters. The solid residue left on its evaporation is small
as compared with that of the average well-water ; but it can-
not on that account be considered as correspondingly pure,
for it contains other matters which are characterized by chem-
ical reactions as marked after their kind as the mineral films
and crusts, or crystalline residues, which can be seen, handled,
and weighed.

It is by means of the rainfall that the atmosphere is purified
after long periods of drought. The detritus — mineral, vege-
table, and animal — of the earth is swept up into the air, where
it becomes diffused, and may accumulate so as to dim the out-
lines of distant views. If in the air, there are miasmatic ex-
halations and volatile poisons which are unsusceptible of de-
structive oxidation by atmospheric influences, spores of bacilli
or fungi capable of instituting a fermentative action in organic
substances under congenial conditions ; these, although undis-
coverable, or as yet undiscovered by the microscope, will be
washed down by the falling rain as certainly as the pollen and
starch grains, carbon particles, fibres, filaments, and mineral
dust which may always be detected in the sediment of a rain-
water. In times of epidemic prevalence of disease, as of
cholera or yellow-fever, it is possible that the rain-washed im-
purity from the air may contain the essence of the prevailing,
disease. When the exhalations from extensive malarious
tracts rise into colder strata of the atmosphere, it is probable
that the disease cause is carried thence with them, where it is
condensed and falls as a constituent of the rain. When, dur-
ing the warm days of summer, the atmosphere stagnates in
the streets of a city and becomes so saturated with the foul
issues from sewer ventilation, half-dried gutters, unremoved
garbage, and a generally impure soil, that a putrefactive ten-
dency is established, it is probable that the falling shower^ in
purifying the atmosphere, becomes itself exceedingly impure
and the source of subsequent diarrhceal, choleraic, dysenteric,
or typhoid troubles, if used as a drinking-water. The rain is
the sewage of the atmosphere, and it is hardly to be supposed
that spores, germs, bacilli, ferments, poisons, or other dele-
terious organic substances which have resisted the atmospheric
oxidizing agencies, will become destroyed or rendered inert
by their transference from an atrial to an aqueous medium.

Waier Andh/ais. 485

The ammonia which is evolved during the putrefactive proc-
ess escapes into the air and is diffused therein ; the bacteria,
the cause of this putrefactive change in oi^anic matter, also
pervade the atmosphere. The presence of the one may be
shown by chemical means, that of the other by culture experi-
ments. But the presence of both may be in like manner
demonstrated in the rain which has washed them down from
the atmosphere. Since these bacteria and the products which
accompany them as exhalations from fermenting organic
matters may be found in the rain, it seems within the limits
of probability that a malarial germ or microphyte, or a prod-
uct of its growth during the fermentative change in oi^anic
matter which is connected with paroxysmal fevers, may be
exhaled into the atmosphere, and be found thereafter in the
rain or snow ; or that a choleraic germ may in like manner be
present in the rain during the epidemic prevalence of the
disease.

Moreover, rain-water is liable to be contaminated by im-
purities on the collecting surface. The cleanest of roofs be-
come covered with dust in dry seasons, and this dust, although
largely mineral in character^ contains a percentage of organic
matter which requires only moisture for the inception of fer-
mentative change and the development and growth of organic
forms. The germ, essence, or poison of specific disease,
which may be air-borne, must thus, of necessity, be also sus-
ceptible of transmission to the system by means of a rain-
water supply ; for it may be either carried down by the falling
rain, or be washed into the reservoir from the collecting sur-
face on which it may have been condensed or deposited.

Nevertheless, rain-water, as will be shown hereafter, is one
of the purest sources of water-supply. By rejecting all short
summer storms and the first part of the fall of continued rains,
thus excluding from the reservoir the atmospheric impurities and
the washings from the water-shed, a water may be obtained
which, although containing traces of ammonia and of organic
matter, must, from its natural history, be considered as a per-
fectly wholesome supply.

. When the rainfall reaches the ground it is disposed of in
one or other of two ways. It runs off by surface channels or
it penetrates. Its disposition is determined by the rapidity of

486 Water Analyns.

the fall, the superficial characteristics of the receiving surface,
its porosity, and the permeability or impermeability and dip
of the underlying strata. That which runs off by surface
channels into ponds, lakes, or river-bottoms, is practically a
rain-water which has become somewhat changed in its char*
acter by its contact with the ground forming the water-shed.
It has lost some of its impurities which it washed from the
atmosphere, but it has gathered more in its course over the
surface ; and the alteration in its quality depends upon the
nature of these fresh acquisitions. Running over the rocky
ground of an unpeopled country, it acquires only a few grains
of mineral matter per gallon ; sweeping over the foul streets
of a city, it may become converted into veritable sewage.

The rainfall which penetrates the surface soil percolates un-
til it joins some body of subsoil or subterranean water. This
(nay be immediately below the surface, as when the g^round-
water is upheld by an impervious layer underlying a shallow
stratum of superficial soil. In river bottoms the subsoil water
is usually found close to the surface, upheld in this position
by the bed-rock. In some situations, as in the mesas of
Arizona and New Mexico, the impervious layer is at such a
depth under porous sand and g^ravel that there is practically
no subsoil water. In other localities, as where the rainfall
penetrates the uplands of a river-valley, the water, on reach-
ing the impervious stratum, may have to percolate along its
slope for a long distance before it reaches the general body of
subsoil water in the river-bottom. In its passage along this
slope it may return to the surface as a spring at some point
where a rift or erosion of the surface-soil has exposed the bed-
rock of the water-shed.

Where the rainfall is absorbed on ground which forms the
outcrop of a porous stratum underlying an impervious layer,
it may have to percolate for great distances before it reaches
the subterranean basin where its level is temporarily found.
Here it may be tapped by deep wells, or it may issue by
natural crevices in the form of springs. The water which per-
colates the soil becomes altered in character by the penetra-
tion, and the extent of the alteration depends on the solubility
of the mineral matter through which it passes and its freedom
from, or saturation with, organic substances in a decomposing

WaAer AfuUysts. 487

state. If the distance traversed is great the inorganic con^-
stituents of the water may be increased, but the organic will
probably be diminished ; for the chances of encountering solu-
ble mineral matters are augmented and time is afforded for the
progress of changes which transform organic matter into inor-
ganic salts. The mineral matters which a percolated water
takes up do not usually come up for consideration in ques*
tions as to wholesomeness or usefulness as a domestic supply*
When they are large enough to be unwholesome the taste of
the water generally interferes with its use as a potable supply,
and its hardness with its use for domestic and economic pur*
poses. When they are not in sufficient amount to be percepti*
ble to the taste, they are usually neither unwholesome nor in-
jurious in other ways. Organic matter dissolved in water,
such as that carried down in the rainfall and that gathered by
contact with an impure receiving surface, becomes transformed
into ammonia and nitric acid during its percolation. This
was formerly considered to be an oxidation of the organic
nitrogen by the air in the pores of soil. The explanations
given were theoretical and obscure so long as chemical laws
only were conceived to be involved in the process. It is now
well known that the retrograde metamorphosis of organic
matter which fits it for absorption by living vegetation is due
to the action of micro-organisms. Bacteria are recognized as
the agents which reduce the organic nitrogen to the ammo*
niacal condition, and the experiments of Schloesing, Waring-
ton, and many others following them, have shown that the
formation of nitrates from this ammonia is likewise due to
actions of a similar character, although the living ferment has
not been identified.

The influence of percolation through the soil has thus a
purifying tendency. As an offset to the comparatively harm->
less mineral additions, the subtle organic matter and the com^
plex and unstable substances formed during its decomposition
are transformed into innocent inorganic salts. Even some of
the germs which are washed from the air by the falling rain
or collected from an impure surface may be removed by this
natural process of filtration, if we assume the essence of ma*
larial diseases to reside in a minute organism ; for while such
diseases have been frequently referred to the use of surface-

488 Water Analysis.

waters, no instance has been recorded which throws suspicion
on percolated waters. On the contrary, the testimony is
strong as to the efficiency of filtration in removing the malarial
germ ; for the purer water-supply which, in all countries, has
succeeded the use of surface-collections, and which has been
coincident with the diminished prevalence of malarial diseases,
has been in the first instance derived from wells and springs ;
in other words, a percolated water. But this favorable change,
exercised by percolation in the case of the malarial germ, is,
unfortunately, exceptional. The experiments of Pumpelly
and Smythe for the National Board of Health, and those more
recently recorded by P. F. Frankland ( Van NostraruTs En^
gineering Magazine^ xxxv., p. 315, 1886), warrant the asser*
tion that bacteria are not completely removed from water by
any process of filtration. The history of certain outbreaks of
typhoid-fever and cholera give full assurance that percolation
does not purify water from the essence of these diseases. So
it is probably with the causes of other specific diseases, as
scarlet-fever, diphtheria, small-pox, yellow- fever, etc., which
may be washed from a contaminated atmosphere.

But it is not so much from the air as after its contact with
the soil that rain-water becomes impregnated with specific-
disease poisons. The germs of typhoid-fever and cholera find
their way to the soil with the excretions of individuals suffer-
ing from these diseases, and are taken up by and accompany
the percolating water. The dead organic matter which may
be dissolved at the same time may afterward disappear by
nitrification ; but there is no assurance that any modifying
influence is exerted on the living matter.

The purity of water depends on the purity of the substances
with which it comes in contact. Rain-water shed from a well-
washed slate roof into a clean cistern is a pure supply, but
collected in a tank, ditch, pond, or lake, it will be pure or im*
pure according to the condition of the water-shed and the re-
ceiving basin. Subsoil water may be rain-water purified by
filtration, as in springs or wells in a clean sand, or it may be
so altered by the addition of organic matter from a foul soil
as to be unfit for use, as in the shallow wells of most localities
which have been occupied for some time. Subterranean
springs or deep well-waters are usually organically pure, and

WcUer Analyeis. 489

wholesome if not excessively charged with mineral salts, but
even these have occasionally been the source of epidemic dis-
eases. River-waters have their quality determined by the
characters of the water-shed and soil-drainage, and especially by
the presence or absence of masses of population on their banks.

TAe effects of impure water vary according to the impurity.
Where the mineral matter does not exceed 30 parts per 100,000
(17.5 grains per U. S. gallon, or 21 grains per imperial gallon),
and does not give a taste to the water, it may be accepted as
wholesome without inquiry into the special constitution of
the inorganic salts. It has been suggested that mineral salts
in the drinking-water may supply certain wants in the econ-
omy, as, for instance, lime for the bones of the growing child ;
but as every article of food contains its percentage of such
matters, it would seem that ample provision has been made
by nature without requiring their introduction by means of
the water-supply. Moreover, as water is, so far as we know,
intended for the solution of fresh nutritive materials and the
removal of the products of tissue-change, its freedom from
dissolved solids would seem desirable.

Where the mineral salts are in excess of 30 parts per 100,000
of the water, yet do not give a taste to it, some doubt as to
its qualities may be entertained, for it is well known that cer-
tain waters induce relaxation of the bowels or affect the kid-
neys through the agency of their mineral constituents. These
doubts are usually settled, not by chemical analyses, but by
the test of experience.

If the water contains more than 100 parts of salts in the
100,000 it is evidently unsuited for a potable supply^ The
sense of taste objects to many lime, magnesian, and alkaline
waters even before this limit is reached. Iron in compar-
atively minute quantities may be recognized, but when it is so
the Water containing it is thereby removed from the potable
to the list of mineral waters.

As water is frequently distributed by leaden pipes and some-
times stored in lead-lined cisterns, the possibility of the solu-
tion of poisonous quantities of the metal must be held in view.
Such instances are of rare occurrence ; but it is possible that
noxious effects from lead may have been overlooked in some
instances and attributed to other causes.

490 Water Analysis.

Where lead is used for service-pipes the water which has
stood in the pipes during the night should be run to waste
before drawing a supply for use. The contact with the metal
of the service-pipes during daily use is so slight that lead is
seldom found in such quantities as to be harmful. But the
use of lead for cisterns is of doubtful propriety. Where metal
is used iron should be employed, protected, as Professor
Nichols recommends, by a coating of asphalt paint or black
varnish.

Zinc is also acted upon by most waters, and may be detected
in those which have been stored in galvanized-iron tanks.
The corrosion is especially active if the coating is imperfect.
Dr. Downes, of Chelmsford, England, who studied this sub«
ject, remarked with truth that if the zinc were seriously injuri-
ous we should have more cases of poisoning on record, for a
great number of people must be in the habit of drinking water
more or less contaminated with the metal. Dr. Boardman, of
Boston, came to the conclusion, as the result of his own ex*
periments and of an examination of the literature of the sub*
ject, that if all the zinc found in water existed in the form of
chloride, which is known to be the most actively poisonous of
the zinc salts, the amount would be insufficient to endanger
health.

Decomposing vegetabU matter in water is well known to be
the cause of diarrhoeas ; and in tropical countries, or where
the water is unusually foul, dysentery has been attributed to
its use. Many of our medical officers, during the war, referred
certain attacks of diarrhoea, which occurred in their commands,
to vegetable impurity in the drinking-water. The minute
organisms that are associated with, and live upon, the decay
of vegetable matter in water have in no instance been con*
victed of causing injurious effects on the human system.
Their presence is sometimes of value as an indication of an
impurity that experience has shown to be harmful ; but there
is no evidence to show that they are themselves pathogenic
agents. Sluggish amoeboid masses are characteristic of foul^
stagnant, or swamp-waters that are almost certain to occasion
diarrhoea! troubles. Those that contain a profusion of vor*
ticellce are also dangerous. Many organisms, such as oxy-
tricha, kerona, euplotes, anguillula, and paramecia, have their

Water Analysis. 491

habitat in waters that do not give satisfactory results on
chemical examination. Others, such as acomia, enchelys,
alyscum, euglena, peranema» rotifers, and entomostraca, occur
frequently in supplies which both experience and chemical ex-
amination show to be not unwholesome. The palmellaceous
algae, desmids, diatoms, and confervoid general have usually
no value as an indication of impurity. Sometimes, however,
the minute algae which grow in vast numbers in some lake-
waters become the cause of a tainted and unwholesome con-
dition of the supply, as when, from some temperature-change
or variation in the depth of the water inconsistent with their
vitality, death overtakes them in mass and their decomposi-
tion renders the water impure. Thus the waters of certain
ponds become affected occasionally with what has been called
a pig-pen odor from the sudden death and decomposition of
an abundant growth of nostocs.

At the present time, however, the bacteria in water-supplies
occupy the attention of all students of water-organisms. That
many of these microphytes, particularly those connected with
decomposing fragments in the sediment, are concerned in the
reduction of organic matter is now an accepted doctrine ; but
waters which seem perfectly free from all putrefactive ten-
dencies may be shown, by Koch's process of cultivation on
gelatine, to contain extraordinary numbers of bacteria. What
are these ? Whence do they come, and what is their object
in the economy of nature? Nothing certain is known, but
meanwhile there is much speculation. Following Buchner and
Naegele, some fear that by a transformation of species there
is danger in all of these bacteria — harmless they may be under
ordinary conditions, but capable, on account of their rapid
succession of generations, of becoming developed into patho-<
genie organisms. Others consider that where there are many
individuals and, particularly, many varieties, there is an in-
creased likelihood of danger. Others, again, remembering
Koch's opinion, that the bacteria of putrefaction may exter-
minate the comma bacillus, conceive that the presence of a
large number decreases the likelihood of the coexistence of a
pathogenic variety. Fortunately, in this incertitude there is
one thing certain, and that is, that the majority of water-
bacteria are harmless.

492 WaJUr AnalystB.

But the writer, without indulging in speculation, would go
a step further than this, and maintain that the majority of
these organisms are not only harmless but that they are en-
gaged in an important and beneficent work. It is now an
accepted and well-known fact that the organisms which co-
operate with the bacteria of putrefaction and transform into
nitric acid the ammonia which these evolve in the destruction
of organic matter have their habitat in the surface-layers of
the soil. Warington's latest researches have shown that they
are confined to within one or two feet of the surface.

Among the germs in a natural water there may be patho-
genic organisms. Typhoid-fever and other diseases are propa-
gated by water ; the comma bacillus of cholera has been found
in it, and the spirochapte of Obermeyer and the tubercle and
anthrax bacilli may be present ; but, as T. Mitchell Prudden
expresses it : " If we can be certain that the water from our
city-supplies cannot contain sewage or human or animal excre-
tions of any kind, we are pretty safe, so far as our present
knowledge goes, in giving ourselves little concern about the
number of bacteria which it may contain."

Decomposing animal matters are likewise productive of
diarrhoea, and gastric disturbance with much prostration fre-
quently accompanies the flux. Yet the quantity of either
animal or vegetable organic matter required to produce evil
effects is generally such that its presence cannot be overlooked,
as it is manifest to the senses of taste and smell.

The water of wells slightly contaminated by privy-drainage
has been known to be used for years without producing any
apparent harmful effects. And it has been frequently in-
stanced that the water of rivers subject to sewage-inflow is
daily used by immense numbers of people without any evil
results ; but this argument is of no value, as it assumes what
has to be proved — that the fevers, diarrhoeas, etc., which pre-
vail among the people who drink the water are endemic among
them and do not depend for cause upon the water-supply.
Much has been said on the self-purification of rivers in connec-
tion with this subject.

The English Rivers-pollution Commission paid much atten-
tion to the claim that running water becomes purified in its
flow, and the result of many experimental investigations con-

Waier Analysis. 493

strained its members to report that there was no river in the
United Kingdom long enough to secure the oxidation and
destruction of any sewage which might be discharged into it
even at its source.

It is true that sedimentation, oxidation, nitrification, and,
particularly, dilution tend to obliterate the chemical tracks of
sewage in a running stream, and may even give it the reputa-
tion of a better quality below than above the point of sewage-
inflow, just as in wells which are exposed to privy-drainings
the water, after percolation through the soil and admission
Into the well, may give better results on analysis than it gave
as rain-water before its pollution by the privy. But in both
instances the purification, so far as is known, affects only the
dead and decomposing organic matter, which is productive of
no evil effects on the system unless in amounts rendering it
more or less objectionable to the senses. A favorite idea of
many bacteriologists is that the common water-bacteria which
are engaged in the destruction of organic matter displace and
destroy the specific organisms in the struggle for existence,
and thus prevent the occurrence of typhoid and other epi-
demics from sewage-tainted water ; but this is no more than
a pleasing optimistic romance which must be set aside when
we turn to the cold facts of medical experience. There are
many instances on record in which comparatively pure, chem-
ically speaking, well-waters with privy-connections have been
associated with the spread of typhoid-fever ; and if such a
record does not appear in the case of the comparatively pure
water of a self-purified sewage-contaminated stream, it is
probably because of the difficulty of obtaining the necessary
conditions for manifesting the results of its use. To demon-
strate the wholesomeness of a river- water which has been con-
taminated with sewage it is not enough to show by analysis
that it contains but a small proportion of oi^anic matter ; it
should be shown at the same time that none of the diseases
which are generally recognized as transmissible by the water-
supply prevail in the districts where the water in question is
used. There are many difficulties in the way of effecting this
demonstration, but chief among them is the well-attested fact
that certain of these diseases frequently do prevail in the dis-
tricts in question. Usually there is no difficulty in showing

494 Water Analysis.

that a disease — typhoid-fever, for example — ^prevails among a
population which uses a sewage-tainted water ; but it is often
extremely difficult to prove the charge of causation against the
water. When an epidemic outbreak is sudden and virulent,
as at Plymouth, Pa., coming like a visitation of Providence or
a pestilence of the olden time, and stirring up the health
authorities to careful investigations because the ej-es of the
scientific world will scrutinize their methods and conclusions,
the water-supply is convicted by an unbroken chain of evi*
dence ; but when the cases are isolated or scattered in a com*
munity — when they are merely every-day occurrences in the
routine practice of the profession — the testimony that convicts
the water on the epidemic charge seems to be forgotten, and
all sorts of unsanitary predisposing conditions are brought for-
ward in explanation of the existence of the so-called sporadic
disease. When it is known that a large quantity of an in«
fected sewage in a water-supply will spread a disease with
epidemic virulence, it is not inconsistent with our knowledge
of the essence of such diseases to infer that a small quantity,
even though diffused through an immense volume of flowing
water, wjU strike its victim when the glass of water which
contains the essential particles is ingested.

The writer, in a discussion of the subject of wholesome
water at the Philadelphia Sanitary Convention of 1886, grave
full expression to the facts and arguments which expose the
danger of the belief in the doctrine of the self-purification of
a running stream and the consequent assumed harmlessness
of a sewage-inflow. Among these he pointed out that the
sporadic prevalence of typhoid- fever is in a great measure
proportioned to the sewage-pollution of the water-supply.
The water used by Brooklyn, L. I., is perhaps less contami*
i\ated with sewage than that of any large city in this countiy.
In 1885 23 persons died of typhoid-fever in every 100,000 of
the population ; and this was not an accidentally small rate
due to the absence of so-called epidemic influences during
that year, for the average annual rate of the previous decade
was only a little over 15 per 100,000. The water of New
York is guarded with care, but it is derived from a more ex-
tensive area than the Brooklyn supply ; the typhoid rate in
the year mentioned was 21, and the average annual rate for

Water Analysis. 495

the decade 26. A constant supervision is exercised over the
supply of London, England ; and the corresponding typhoid
rates were 17 and 28. These rates, varying from 15 to 28 per
lOOyOOO of the population, may .be regarded as standards of
comparison for the rates of other cities. Notwithstanding a
careful superintendence by the health authorities, the water-
supply of Boston is kno\Vn to have a certain amount of sewage*
inflow ; correspondingly, we find the mortality-rate to be
higher than those already instanced — 38 for 1885, ^"^ 45 ^^^
the decade. Cincinnati, supplied by the Ohio River, with
many large settlements on its upper waters, had higher
typhoid rates — ^44 for the year specified, and an average of 63
for the decade ; and Philadelphia, supplied chiefly from the
Schuylkill, which is acknowledged to be in foul condition,
recorded 64 deaths for the year and 66 as the average of the
previous ten years. Looking at these figures in their consoli-
dated proportions, the sporadic typhoid cases of Philadelphia
— and of other cities similarly situated as regards water-supply
— assume the proportions of a continued epidemic, for they
mean that during the decade there died of t)^hoid-fever 4400
persons who would not have died had the Brooklyn rates pre-
vailed ; and that over 50,000 people suffered from a dangerous
and debilitating illness who would have escaped attack had
their water-supply been derived from a purer source than the
sewage-tainted SchuylkilL

Let the health records of any city be examined, and it will
be found that a notable improvement has invariably followed
the introduction of a water-supply that is free from sewage.
But it may be claimed that this improvement is due to the
system of sewerage, which is usually a coincident sanitary
work ; and, in fact, the removal of the filth by water-carriage
constitutes so important a change in the sanitation of the
municipality that the influence of the water-supply is generally
regarded only in so far as it has contributed to that end. For-
tunately, the city of New Orleans is able to give important
testimony on this point. It has no sewers ; its liquid filth
flows sluggishly in open channels by the sidewalks, flushed
from time to time in recent years by water from the Missis-
sippi ; its more solid refuse is collected in boxes in closets and
out-houses, in confined areas, whence it is carried to the cur-

496 Water Analysis.

rent of the river ; the subsoil water which is found within a
few feet of the surface is so impregnated with drainage as to
be unfit for use ; and the exhalations from the sluggish drains,
the closets, and out-houses not infrequently taint the air in
many parts of the city. Here are conditions as to subsoil and
surface which would be regarded as accounting sufficiently
for the extensive prevalence of typhoid, were it found to be
present. Certainly they must be considered as more condu-
cive to the spread of zymotic disease than the corresponding
conditions of the subsoil and surface in Philadelphia, for the
genera] results of modem sanitation show a sewered city to be
a more healthful abode than one that is not sewered. But
this city of New Orleans has a water-supply that is free from
sewage-inflow. The Mississippi water is pumped up mainly
for use in flushing the streets and drains, while the domestic
supply consists of rain-water, collected and stored in cypress-
wood cisterns which are raised above the suspicion of contam-
ination by sewage. And the typhoid mortality, i6 during
1885, and 25.6 as the average of the previous ten years, is as
low as the standard rates furnished by the cities of New York
and London.

The latest testimony bearing on the influence of a pure
water-supply on the diminution of typhoid-fever comes from
Europe, and in this instance the complicating influence of
sewerage is eliminated. M. Mosny {Revue d* Hygitne^ January
20th, 1888) compares the history of the water-supply of Vienna
with that of its typhoid -fever. From 185 1 to 1874 well-water
of an impure character was used to a large extent, in addition
to a systematic supply from the Danube. During this period
the deaths from typhoid- fever ranged from 100 to 340 an-
nually per 100,000 of the population. In the last-mentioned
year a spring-water was introduced, and the typhoid rate fell
immediately to 50. Since then, by the disuse of impure wells
and the extension of the new supply, the rate for the past
three years has fallen to 1 1 ; and inasmuch as the sewerage
system was in existence during the period of high rates, the
low rates since 1874 are necessarily referred to the use of
water that is free from sewage. The fall in the typhoid rate
experienced an interruption in 1877 when, owing to the freez-
ing of some of the sources of the spring-supply, the water of

Water Analysis. 497

the Danube had to be pumped into certain of the mains ; and
it is of interest to observe that the sections of the city that
were chiefly affected by this epidemic were those in which the
Danube water was distributed. According to Professor Noth-
nagel : ** Typhoid-fever has become such a rarity since we have
had spring-water that, when by chance a case appears at the
hospital, I show it to the students as one of unusual interest ;
and I should add that the larger proportion of the cases now
3cen come from outside the city."

The close investigation into the organic matter in water
which has of late years been prosecuted has indicated certain
specific micro-organisms or disease-germs as the special danger
in connection with a potable water-supply, the decomposing
organic matter being of importance only in its relation to
these as furnishing a pabulum for their growth and multiplica-
tion, or as indicating to some extent the possibility or likeli-
hood of their presence in certain instances. The specific
micro-organisms which are of interest are those containing the
essence of miasmatic diseases, as malarial-fevers and dysentery,
on the one hand, and miasmatic contagious diseases, as
typhoid-fever and cholera, on the other.

Miasmatic exhalations when disseminated in water may be
expected, from the known natural history of the malarial
miasm, to be accompanied by the soluble organic substances,
chiefly of a vegetable nature, which are taken up by the water
from the soil whence the exhalation is evolved. The germs
of typhoid- fever and cholera are, on the contrary, connected
with organic matter of an animal character by the multiplica-
tion of the disease-germs in the intestines of the affected sub-
ject and their discharge with the excreta. Vegetable organic
matter in water points, therefore, to malarial or dysenteric
possibilities, and animal matters to such specific poisons as
those of typhoid-fever and cholera. Not that the organic
matter in any quantity gives in either of the cases an assurance
of the presence of the germs of specific disease, but that a
water which contains much of the generally associated organic
matter is more likely to be contaminated by the specific dis-
ease than one which contains little or none.

Malaria is believed to be exhaled from the decomposition
of organic matter in the soil. A certain amount of moisture
32

498 Water AndtyHs.

with a high summer heat increases the activity of the fermen-
tative processes and the consequent exhalation. The miasm
has been traced by its effects to a distance from its source,
wafted thither by light winds. It rises into the air and is dis-
sipated or lost by dilution in the aerial ocean. But it has been
known to reappear by its manifestations in the mists and fogs
that sometimes settle on mountain-slopes. We must infer
that the aqueous vapor in its condensation has concentrated
the previously diluted miasm. If the condensation of the
watery vapor reaches the point at which precipitation takes
place a malarious water will fall, to be taken into the system
in the water-supply, instead of a veil of mist producing its
toxic effects more slowly by cutaneous or pulmonary absorp*
tion. The vast extent of the malarious districts of our country,
and the constant exhalation produced therefrom during the
hot season, suffice to account for an accumulated malarial
miasm in the air, and a corresponding impurity in the rainfall
when the air becomes purified by nature's processes. If in
the rainfall of a certain region the pollen grains of plants which
grow in distant parts of the country are detected, it is evident
that they must have been swept up from their native soil,
transported, and precipitated. It is readily understood how
an infinitely less ponderable body, the malarial miasm, may
diave been similarly transported.

Diarrhoea and dysentery, as has been already indicated, are
igenerally acknowledged as resulting from decomposing organic
matters in water. Arising from this cause, the flux is regarded
as the result of a local irritation similar to that produced by
any other dietetic error. It is an effort of nature to eliminate
the offending substance, and terminates spontaneously in a
speedy return to health unless the action of the cause is suffi-
ciently powerful or prolonged to institute inflammatory action.
But in epidemic dysentery a specific cause is generally recog-
nized, a terrestrial miasm evolved in localities where the soil
has been turned up for agricultural purposes or in the progress
•of extensive engineering works. That this miasm may enter
the system through the medium of the water-supply is ac-
knowledged by most writers. But to the infection of the
water contact with the miasmatic soil is needful. It seems
probable, also, that the specific poison of the epidemic disease

Water Anah/ds. 499

may be communicated by water which has been contaminated
with the excreta of dysenteric patients.

There are so many Instances on record of the propagation
of typhoid-fever by an infected water that it is almost needless
to do more in this connection than mention some well-known
outbreaks which have been traced by competent observers to
a contaminated supply.

One of the most interesting' illustrations of the propagation
of typhoid-fever through the medium of the water-supply is
found in the history of the epidemic in Lausen, Switzerland,
in 1872. Isolated cases had occurred in this village from the
time of the Napoleonic wars, but for the seven years preced-
ing the epidemic no case had been recorded. The village had
a population of about eight hundred inhabitants, and was sup-
plied with water by a spring which rose at the foot of a neigh-
boring mountain. The water was stored in a covered reser-
voir, whence it was distributed to four public fountains. Six
of the houses in the village had an independent supply. Sud-
denly typhoid-fever^broke out in this settlement. On August
7th ten of the inhabitants, living in as many different houses,
were seized, and in a short time one hundred and thirty per*
sons were attacked, the only houses which escaped visitation
being the six which had a private water-supply.

During the investigation into the origin of this outbreak it
was shown that a subterranean communication existed between
a stream on the other side of the mountain and the spring
which supplied Lausen. It was known that when the waters
of this stream were used in irrigating the meadows the flow in
the Lausen spring was greatly augmented ; and on one occa-
sion, when a break occurred on the surface and the waters of
the stream sank, the flow in the spring became correspondingly
increased. The subsequent filling in of the hole permitted the
stream to resume its surface-course. Three typhoid-fever
cases had occurred on its banks during the summer of 1872,
and the privies in which the typhoid excreta were deposited
drained into it. In July the meadows bordering the stream
were irrigated with its waters for the second hay-crop, and
three weeks later the outbreak occurred at Lausen. To prove
the communication between the stream and the springs a large
quantity of salt was thrown into the former, and next day the

500 Water AnalysU.

salt was found in the Lausen waters. But when wheat-flour
was mixed with the waters on the one side the spring on the
other remained perfectly clear and gave no reaction with the
tests for starchy showing that while a subterranean communi-
cation existed it was not of the nature of an open channel,
but of a porous filter capable of removing granules as minute
as those of the wheaten starch.

In urging the disposal of sewage by irrigation on farms or |

by downward intermittent filtration » sanitary engineers have
instanced the purity of the water from the efterents and the
absence of all danger to health from the flushing of the surface
with the sewage. It has been stated , for instance, that while
cholera prevailed in Edinburgh no cases occurred in the neigh-
borhood of the meadows which received the sewage of the
city. But, in view of the experience of Lausen, it would
seem that the outflowing water should be regarded with sus-
picion, notwithstanding satisfactory results yielded by chem-
ical analysis ; for the germ or poison of typhoid-fever may be
present in a water which might not be suspected to be un-
wholesome from an examination of the report of its analysis.

The typhoid epidemic at Pl)nmouth, Pa., in 1885, ^^ ^^^ ^^
the most instructive on record, inasmuch as the facts relating
to its causation and spread are accurately known. At the
time stated Pljonouth was a coal-mining town of eight thou-
sand inhabitants, situated on the Susquehanna River about
two and a half miles below the city of Wilkesbarre, which
threw the greater part of its drainage and about one half of
the sewage of its thirty thousand people into the river. There
were always a few scattered cases of typhoid-fever in Plym-
outh, but up to April loth nothing uncommon was noted in
the prevalence of the disease. On that day, however, about
fifty persons were seized, and the fever spread so rapidly that
within a month 1200 persons were or had been ill, and 130
deaths had taken place. Post-mortem observations revealed
the characteristic intestinal ulcerations. A board of local
physicians investigated the causation of the fever, and their
report was subsequently confirmed by Drs. French and Shake-
speare, who were sent by the Mayor of Philadelphia as a com-
mittee of experts. These reports show that the water-supply
was derived from a mountain-brook which was dammed at

Water AndlyHs, 501

four different elevations just beyond the western edge of the
town. From the lowest and smallest of these reservoirs the
water was distributed by a main which speedily divided into
two branches, one supplying the higher levels back from the
river, the other the main street and other low levels on the
Susquehanna front. About fourteen or fifteen days before the
sudden outbreak of the epidemic this supply became infected
by the discharges from a single typhoid-fever patient, an inmate
of a house situated on a declivity not eighty feet from the brook,
and just below the highest of the dams. This patient had
suffered from January, and during the progress of the case the
evacuations passed at night were carried out of the house and
thrown on the snow covering the ground on the slope toward
the stream. The long-continued frosts of winter had mean-
while bound up the sources of the brook so that the supply in
the reservoirs became almost exhausted, and recourse was had
to the Susquehanna water, which was pumped directly into
the mains for the use of the town. On March 25th a general
thaw began, followed by light rains, and next day the super-
intendent of the water company, finding the two upper reser-
voirs to be full, caused the waters of the third to be let down
to the lowest or distributing reservoir ; and, that evening,
pumping from the Susquehanna was discontinued and the
town was supplied with the water of the mountain-brook
charged with the thawed-out dejecta that had been deposited
on the snow. To exonerate the water pumped from the
Susquehanna from the suspicion of having caused this sudden
and disastrous outbreak, Plymouth had fortunately two sub-
urbs which were not supplied from the company's reservoirs :
one, Broadway, containing forty families, averaging five per-
sons each ; the other, Ridge Row, containing twenty families.
In the former no case of the fever was found ; in the latter,
one or two cases occurred among persons who had frequented
the town and made use of the water from the hydrants. The
water-supply of these settlements was from the Susquehanna,
through the pumps and water-mains of the Delaware and Hud-
son Coal Company.

The contamination of drinking-water by the germ or poison
of cholera is also now very generally accepted. Instances are
numerous where local outbreaks of the disease have been sup-

502 Water AncUysis.

posed to be due, as in the case of typhoid-fever, to an infec-
tion of the water by the alvine discharges of affected indi-
viduals. In many cases, also, immunity from the disease has
been conferred upon a locality by the introduction of a pure
water-supply. In India many illustrations of the connection
between the disease and the water have been recorded. Dr.
Macnamara mentions, as one of the characteristics of cholera,
that the more explicit the examination the clearer the fact
appears that the disease, in the majority of cases, spreads
from one human being to another by means of the cholera-
fomites finding their way into drinking-water, and thus into
the intestines of other people.

Analogy leads to the supposition that an investigation into
the cause of yellow-fever would probably manifest its propa-
gation by means of water. But no strong evidence has been
recorded in favor of this view. In fact, the testimony given
by the last great epidemic (1879) ^^ ^^^^ country seems to ex-
clude the water-supply from any participation in the extension
of the disease. It prevailed in New Orleans, where rain-water
is stored in wooden tanks raised above the surface of the
ground and susceptible of contamination only by the air ; and
while some of the cistern-waters in the localities where the
disease prevailed were not good, others were of excellent
quality. It prevailed extensively in Memphis, Tenn., where
the rain-water was collected in underground brick cisterns,
many of which were sound and clean, containing a water free
from contamination by matters in the soil, while others were
impure and impregnated with privy-drainage. It prevailed,
also, in 1878, in Grenada and Holly Springs, Miss., where the
wells and cisterns generally yielded a pure supply, and in
Brownsville, Tenn., where a large proportion of the wells
were found to be contaminated by sewage.

While.it seems probable that other specific diseases, such as
diphtheria and scarlet-fever, may be occasionally communi-
cated by an infected water, there is no evidence on record to
establish the point.

Ice. — In the progress of the development of the methods of
water-analysis in this country the character of the ice-supply
naturally received some attention from the sanitary analysts.
The extensive use of ice-water in summer rendered the purity

1

WaUr Andhfds. 508

of the ice a matter of the first importance. In a recent article
on its growth, harvesting, storage, and distribution {Popular
Science Monthly^ March, 1888), T. Mitchell Prudden states
that twenty to twenty-five million tons are annually harvested
in the United States, and that not far from fifty million dollars
are invested in the business. The greater part of this supply
may fortunately be considered as of fair quality. Formerly,
under the assumption that water became purified in freezing,
less care was given to the purity of the source from which the
ice-harvest was gathered. Thus Nichols, in 1875, examined
ice which was supposed to have caused sickness. This ice
had been cut from a brackish pond into which a small brook
brought a quantity of sawdust from several sawmills. At that
time ice was often cut in winter from shallow ponds which for
a considerable portion of the year had no existence, or existed
merely as stagnant pools. Even at the present time ice is fre-
quently gathered from waters that are known to be impure,
the claim being made that the ice is not intended as a potable
supply, but for commercial purposes, for which a high standard
of purity is not essential. Ice furnished by the Health Officer
of St. Paul, Minn., was examined by the writer in 1886, and
found to be in reality solidified sewage, two melted specimens
giving respectively .100 and .074 of free ammonia, and .069
and .084 of albuminoid ammonia, while samples of the river-
water collected just below the sewage-inflow gave .321 and
.241 free ammonia and .066 and .056 albuminoid in 100,000
parts (see ** Public Health in Minnesota," vol. ii.. No. 12).
Manifestly the harvesting of ice from impure sources should
be interdicted, because the uses to which such ice may be ap-
plied cannot always be controlled.

Pengra, of Michigan (" State Board of Health Report,"
1882), investigated the influence of freezing in removing cer-
tain saline and albuminoid matters from water. About fifty
per cent of the crystalloids were cast out and only about
twenty per cent of the colloids. He therefore denounced the
use of ice from impure sources, " even if used for no other
purpose than that so common of packing poultry or any fresh
meats," and urged the State health authorities to warn the
people that pure ice can come only from pure water. Two
years later he published the results of experiments on the

604 WoUt Analysis.

freezing of water which contained bacteria and certain infu*
sorial animalcules, showing the casting out of about ninety
per cent of these orgranisms. Good ice should be as free
from organic matter as a pure spring-water.

Artificial ice is usually good, as distilled water or water of
known wholesomeness is selected as its basis. No sample ex-
amined by the writer has been of a questionable character.

Storage and Purification of Water. — The storage of a water--
supply on a small scale, with its protection from avoidable
defilement, and its purification when needful and possible,
lies with the householder or consumer. Spring-water merely
requires protection. If a pure distilled water be collected in
a receiver which is half-filled with decaying vegetation, it will
immediately cease to present the characters of a pure water ;
if the reservoir of a spring be similarly lined, the water that
comes from the seam of the rock will be similarly changed.
The basin should be kept free from all organic accumulations,
and its edge and sides should prevent the inflow of surface
washings. Wells which penetrate an impervious stratum to
reach the water-supply should be carefully lined to exclude
surface-drainage. Wells should not be sunk in the vicinity of
large trees, as their roots may penetrate the clay and form
channels which permit of inflow from the surface. The
writer has met many instances of foul water in wells situated
in richly manured gardens bearing many fruit or shade-trees,
the soil a porous sand, but the tree-roots extending below
this through the clay to the water-bearing stratum. Of
course, no matter how carefully the well may be lined, it
should be at a proper distance from privy-pits, stables, and
other sources of impurity. The dangers attaching to the use
of wells in cities and other closely-built settlements is now
fully recognized by health officers, who, in many municipal-
ities provided with a public supply, have directed their disuse
and closure.

Rain-water is usually stored in brick cisterns or cypress-wood
tanks, the former generally underground, the latter raised
above the surface. The raised tanks are only used in situa*
tions where the high level of the ground-water denies a favor-
able site to the underground reservoir. The purity of the
water depends, in the first instance, on the cleanliness of the

Water Analyns. 505

shedding surfaces and conduits. The first part of the fall,
particularly after seasons of continued drought, should be cast
aside as the impure washings of roofs and pipes. Many in-
genious contrivances to effect this have been invented, under
the title of automatic cut-offs ; but, as a rule, the whole of the
rainfall enters the cistern unless the careful householder gives
his personal attention to the collection of the water-supply.
Sometimes, instead of a cut-off or other means of rejecting the
first falls, the whole of the rainfall is received into the cistern,
which acts as a sedimenting reservoir, and feeds a second or
distributing cistern by its overflow. In every case the con-
duits from the roof should enter at a low level, that the sediment
may not be stirred up by every rainfall. The underground
cistern is, from its position, frequently exposed to all the
dangers of a well. Its water always contains more lime than
that which entered from the roof, showing that its cement
lining is becoming gradually destroyed. Hence follows either
loss of water or contamination by inflow of surface-drainage.
Of 558 cisterns examined by the writer at Memphis in 1879,
167 were undoubtedly leaky and tainted with soil impurities,
177 were apparently sound, and the remainder on the border-
line— one half probably sound, and the other half probably
siping. That many of these were found to contain water con-
taminated with animal excretions may easily be understood
when it is recalled that of 4744 cisterns and wells in the city
mentioned, 369 were built under the basements of houses and
within ten feet of privy-vaults, the contents of which had
often a higher level than the water in the cistern ; 3039 were
between ten and fifty feet from the privy, and 1336 over fifty
feet from accumulations of organic matter.

The raised cistern is protected from dangers of this kind ;
but in the hot weather of summer, when the sediment bears a
large, proportion to the overlying water, the latter is prone to
become tainted by the fermentation of organic matter. The
purification which takes place in underground cisterns and the
method of effecting a similar purification in wooden tanks have
already been referred to.

The ground-water forms a dangerous source of supply in
localities that have been occupied for some time. The ac-
cumulated filth of continued settlement drains through the

506 Water Analysis.

surface-layers and enters into the constitution of the water-
supply. The percolation may destroy the dead and decaying
organic matter, so that the water may be reported by analysis
as comparatively pure ; but if there be specific infection asso-
ciated with any of the excreta, the well may become the focus
of an epidemic outbreak. Sanitary authorities are united in
condemning the use of these shallow wells.

On the other hand, the ground-water in certain localities
forms one of the purest sources of supply. When the sur-
face-layers consist of clean gravel and sand the subsoil water
is a rain-water purified by natural filtration, and stored or
retained in position by the conformation of the underlying
clay. When there is an extensive filtering area of this char-
acter, water may be obtained on a large scale by digging
wells or basins as storage-reservoirs. Brooklyn is mainly sup-
plied by this sand-filtered rain-water; Filtering galleries are
sometimes built for the collection of the water. That at
Lowell, Mass., is a Ipng tunnel with heavy masonry sides sup-
porting a water-tight semi-circular brick arch ; the water rises
through the gravel and sand at the bottom of the tunnel. At
Columbus, O., and Taunton, Mass., the water is drawn from
the gravel by long circular tunnels of pervious brickwork. At
Dresden, Hanover, and other German cities the water is
drained off by perforated pipes of iron or clay into suitable
reservoirs, from which it is pumped for distribution. In this
country wells or filtering galleries are sometimes constructed
by the edge of a river, the impression being quite general that
the water is derived by filtration from the bed of the stream,
when, on the contrary, it consists of the drainage of the higher
levels toward that bed. At Winona, Minn., for instance, the
general water-supply, although supposed to be Mississippi
River water filtered into the reservoir, consists really of the
same character of water that percolates into the wells in other
parts of the city (" Public Health in Minnesota," January^
1887).

The character of the water from driven wells depends in
part on the depth of the well. If the tube be sunk merely
into the pervious superficial strata, the water is pure or danger*
ous according to the sanitary condition of the area of drain-
age. If it be sunk through layers of clay and other imper-

Water Analysis. 507

meable strata to some water-bearing sand, the water procured
is usually of good quality. One of the purest natural waters
examined by the writer was obtained from wells in the city of
Memphis, Tenn. Organically it was pure as distilled water ;
it contained no more organic substances in solution than a
cistern-water ; even the chlorine was scarcely in larger quan-
tity than in a good cistern-water, and this* with the absence
of nitrates, showed that the water was. no percolation from
the overlying surface-soil but drawn from another and distant
source.

Very deep or artesian wells give a water which is free from
all taint of recent organic matter ; but the mineral substances
held in solution are frequently of such a character as to inter-
fere with potability.

As the natural filtration in the case of springs and wells
usually effects the purification of the water, the only questions
that arise are those relating to quantity and distribution ; but
in the case of surface-waters methods of purification become
of the first importance. Rains and snow-meltings carry much
of the organic detritus of the surface into the streams and
ponds, rendering them turbid and impure, irrespective of the
sewage and manufacturing waste that are cast into them from
every settlement.

The claim as to the self-purification of a stream has already
been discussed. Dilution, sedimentation, aeration, and nitri-
fication have been shown to so dissipate the vegetable matter
of the uplands and swamps, and even the sewage of cities, that
the chemist may have difficulty in recognizing the continued
existence of some particular polluting substance in the general
organic impurity of a stream. This general impurity, in view
of many of its known elements, calls for treatment. In Eng-
land sedimentation and filtration are the methods adopted ;
in this country, sedimentation alone. The water is taken
from a tank or pond which forms a natural sedimenting basin ;
dams are thrown across the bed of a stream to impound its
waters^ or the water is pumped from the stream into storage
and distributing reservoirs. Primarily these basins were in-
tended merely for storage, but, if they are large enough, the
turbid waters of the stream become clear and give better re-
sults on analysis. There are now at St. Louis four settling-

508 Water Analyns.

basins holding eighteen millions of gallons each. The floors
are paved with brick on edge, and slope toward the centre
and the river-side. The sediment is floated off from the floor
of each basin once in about four months, the quantity removed
annually amounting nearly to two hundred thousand cubic
yards. The wants of the city permit the water to settle only
from eight to eighteen hours, while a period of thirty hours is
required for a satisfactory subsidence. On this account the
extension of the works is at present contemplated. Surveys
have been made and land purchased for larger settling-basins
and conduits to carry the water to the present high service or
clear-water pumping plant. The estimated cost of these im-
provements is three and a half million dollars.

But although stored waters undergo a purification by the
subsidence of their suspended matters, they are prone to be-
come affected, particularly in summer, with a vegetable taint
which has sometimes occasioned diarrhoeal troubles. In
August, 1859, the bad taste and smell of the Croton reservoirs
caused much anxiety. In 1876 Professor Lattimer investigated
and reported on the fishy taste which affected the pond-water
supply of Rochester, N. Y. In 188 1 the disagreeable odor
and taste of the Boston supply was referred by Professor
Remsen to the presence of a large quantity of a spongiUa or
fresh-water sponge in a more or less decayed condition. The
Boston water-supply has also suffered from the decomposition
of certain algae of the nostoc family, species of ccelospherium,
clathrocystis, and anaboena, which float as minute greenish
filaments in the water or gather as a scum on its leeward sur-
face. The sudden death of large masses of these in a reser-
voir, from such causes as changes of temperature or of the
depth of water, communicates an offensive taste and odor to
the supply. Professor Leeds attributes their death and decay
to a want of aeration of the water resulting from stagnation
and high temperature ; and, in the case of the Hoboken sup-
ply, he has succeeded in removing the odor and taste, and the
green scum of oscillaris which caused them, by pumping air
under pressure into the water-mains.

Filtration. — ^As the storage-reservoirs and sedimenting
basins of this country fail to give a clear water at all times, a
very general demand has arisen for small or domestic filters.

\

Water Analysis. 509

Those that are furnished for application to the tap or faucet
are vahieless* The filtering area is so small that, if it act
efficiently, the flow is necessarily by drops. Rapidity of flow
is gained at the expense of efiiciency» and when attained, the
so-called filter becomes a mere strainer, retaining only the
grosser particles ; and these have usually been removed already
by partial sedimentation. Household or domestic filters gen-
erally combine with the filter a storage-chamber from which
filtered water may be drawn off as required. Gravel, sand,
charcoal, spongy iron, and blocks or beds of various porous
materials are used as the filtering medium. If the water flow
freely, and give satisfaction to the eye, the filtration may be
accepted as efficient, for with the removal of the fine particles
of clay and other inorganic substances which cloud the natural
water, organic matter in a state of fine division is also re-
moved, and processes of oxidation and nitrification diminish
the quantity of dissolved organic matters. If the filtering
medium become clogged or cracked, the necessity for interfer-
ence will be manifested in the one case by the inadequate flow,
in the other by the cloudiness of the filtered water. The fine
clay in many of our streams will choke an ordinary filter after
twenty-four hours' use by forming an impermeable layer on
the surface of the filtering material ; this has brought into
existence filters which may be cleaned from time to time by
breaking up the layer by means of a reverse current, and float-
ing off the turbid and impure washings.

The profession and, indeed, the general public of this coun-
try are aware that the filtration of a turbid water does more
than effect an improvement in the appearance of the water.
They understand that there is an associated improvement in
its quality ; but it is by no means generally understood that
the prevalence of malarial-fevers may be lessened by avoiding
the use of unfiltered surface-waters. In no instance has
malarial disease been traced to the use of well-water untainted
by a direct inflow from the surface. Dangerous malarial
waters, from marshes and other soils rich in vegetable decay,
leave their noxious constituents behind them in percolating
through the soil, and appear in the well as pure and non-
malarious waters.

Filtration is therefore capable of removing from a surface-

610 Water Analysts*

water the essence of the remittent fevers that may be present
in it. The great prevalence of these paroxysmal fevers in
many sections of this country calls for the adoption of every
means which may offer a prospect of diminishing the evil.
Surface-water, whether collected from the roof in the domestic
cistern or supplied by the municipality from rain-fed ponds
or running streams, should be filtered before being used as a
supply for drinking. Yet with us filtration on the large scale
has not extended beyond the experimental stage, while in
England and in Continental Europe it is an accepted method
of purification. In England the first filter on the large scale
was constructed by the Chelsea Water Company as long ago
as 1829. A Royal Commission had reported that the Thames
water, when free from extraneous substances, was a water of
considerable purity, but that as it approached the metropolis
it became loaded with much filth, from which, however, it
was perfectly possible to purify it by filtration through sand,
and this with all requisite rapidity and within reasonable limits
of expense. In experimenting with a view to carrying out the
suggestions of the commission, the water companies found
that a filtering-bed of sand speedily became choked by the
mass of fine matter removed from the water ; but thitif the
water was permitted to stand for some hours in a settling-
basin, to rid it of its heavier and grosser particle^, the sand-
filter would afterward give satisfactory results. iThe experi-
mental filter of the Chelsea Company had an area of one acre,
and as it proved a success, it led to the general adoption of
filtration ^as a means of purifying the surface water-supply of
England. According to Professor Leeds, who has recently
visited the works of the London companies (Sanitarian, xix*.
p. 25), the average daily supply to the 5,274,542 inhabitants
of the metropolis for the month of May, 1886, was 160,388,316
gallons. Of this more than half, or 82,366,466 gallons, came
from the Thames, and the remainder from the River Lee,
from certain chalk springs in the valleys of the Lee and
Thames, and from twenty-one deep wells sunk into the chalk
formation north and south of London. There are fifty- four
subsiding reservoirs for unfiltered water, with an area of four
hundred and sixty-five acres and an available capacity of
1,290,100,000 gallons, and fifty-three covered reservoirs, with

Water Andlysia.. 611

a capacity of 160,002,000 gallons, for the storage of water after
filtration. The number of filter-beds is ninety-nine, with an
area of ninety-eight acres ; of this surface ninety-two acres
were cleaned during the month stated.

Filtering basins have the sides of solid masonry and the
floors of brick, laid in hydraulic cement, with channel-ways for
the collection of the filtered water. The filtering medium
consists of several layers of broken stone, screened gravel, and
sand— the coarser materials at the bottom, the finer on top.
The thickness of these layers varies in different beds, but the
sand always forms a considerable proportion of the whole, as
it in fact constitutes the intercepting layer. The Chelsea
Company filters through four feet six inches of sand, the West
Middlesex through three feet three inches, the Southwark and
Lambeth through three feet, and the Grand Junction through
two feet six inches. The rate of filtration depends upon the
pressure or head of water, the porosity of the filter, and the
freedom of the unfiltered water from suspended matters. The
maximum permissible rate of filtration is two gallons per hour
per square foot of surface ; but, as a matter of fact, the actual
rate is generally much smaller than this, many of the filters
passing only one and one-third gallon. When the surface-
layers of the sand become choked, the water is drawn off and
the filter-bed cleaned by removing as much of the sand as has
become fouled by use.

Poughkeepsie, on the Hudson, was the first city in this
country to construct filter-beds for the improvement of the
water-supply. As originally built these works consisted of a
settling-basin 60 X 25 X 12 feet, and two filter-beds, each
200 X 73i feet, and 12 feet deep, one half of which was occu-
pied by the filtering materials. These consisted, from below
upward, of two feet of four to eight-inch broken stone, and
six inches each of two-inch stone and one-inch, one-half -inch,
and one-fourth-inch gravel, topped with two feet of sand.
The expense of running such filter-beds, variously estimated-
at from $2.50 to $5 per million gallons, exclusive of the cost
and interest of the plant, has prevented their general adoption
in this country.

The English Rivers-pollution Commission concluded, with
regard to sand-filtration as carried out in water-works, that it

512 Watei' Analysis.

'* not only clarifies the water by removing suspended impuri-
ties, but also diminishes the proportion of organic matter in
solution to an extent dependent upon the thickness of the
filtering medium and the rate at which the water passes
through that medium." This conclusion has been verified by
all who have since investigated the subject ; indeed, the con-
stant watch kept upon the condition of the London supply
furnishes all the testimony needful in this connection. Re-
cently, however, fresh evidence of the efficiency of sand-filtra-
tion has been placed on record by P. F. Prankland (" Trans*
actions Sanitary Institute of Great Britain," viii., p. 276).
He made a continued series of observations on the quality of
the unfiltered Thames water, and of the same water as filtered
for delivery by the various metropolitan water companies.
Taking, for instance, the averages of the month of March,
1886, the unfiltered water at Hampton gave evidence of the
presence of 11,415 microbes in each cubic centimetre, while a
striking reduction was found in all the filtered waters. The
West Middlesex Company gave 175 ; the Lambeth, 287 ;
Chelsea, 299; Grand Junction, 379; and Southwark, 1526.
The influences which determined the efficiency of the filtration
by the various companies were : i. The storage-capacity for
unfiltered water, inasmuch as extensive basins obviated the
necessity for taking in water from the river when it was impure
and turbid from floods ; 2. The thickness of fine sand used in
filtering ; 3. The rate of filtration ; and 4. The care taken in
cleaning and renewing the filter-beds.

Frankland's experiments extended to other filtering ma-
terials than sand and to other modes of purification than filtra-
tion. Most of the filtering media that were tested — ferrugi-
nous sand, animal charcoal, iron sponge, brick-dust, coke,
vegetable charcoal, etc. — were efficient at first, but afterward
the organisms passed through, although in reduced numbers.
It was found also that substances which, like vegetable carbon,
exercised but little chemical action, were nevertheless highly
efficient in removing the microphytes. Their separation was
effected mechanically, for the greater the rapidity of the flow
the less efficient was the filtration. Sponge-iron, charcoal,
and coke gave the best results. Sedimentation, after agita-
tion with such substances as china clay, brick-dust, plaster of

Water Analysia. 613

Paris, and oxide of manganese, was of no value, but when
porous substances, as coke and charcoal, whether animal or
vegetable, were used, the number of microbes became greatly
reduced. In these experiments the fact was recognized that
the greatest improvement in the sedimented water was shown
when it was examined immediately after it had become clear,,
for the multiplication and growth of the unremoved organisms
speedily altered the character of the sample as developed on
the bacterial culture-field. Sometimes, indeed, this multipli-
cation more than offset the purification effected by the sub-
sidence. On one occasion a water which gave 3000 colonies
was agitated with coke, and when subsidence was completed,
at the end of twenty-six hours, the microbes had increased to
20,000 per cubic centimetre. Precipitation by lime, in the
case of hard water, was also efficient in reducing the number
of colonies derived from a water. Water softened on the
large scale at Colne Valley Water-works showed only four
colonies when examined after two days of subsidence, although
previous to treatment it had yielded 322. Some of the labor-
atory experiments in this process of precipitation are of in-
terest as placing on record the varying qualities of the same
water at different times. Thus a water which contained 85
microbes per cubic centimetre was in one bottle precipitated
by lime, and in another permitted to stand untreated for
future comparisons. At the end of eighteen hours, when sub-
sidence was completed, the treated water yielded 42 colonies,
while the 85 of the untreated water had become augmented to
1922. The principal conclusions drawn from his experiments
are tabulated by Frankland as follows :

1. That the complete removal of micro-organisms from wa-
ter by filtration is unattainable without frequent renewal of the
best filtering materials, and duly restricting the rate of filtration.

2. That a very great reduction in the amount of organized
matter in water may be accomplished by filtering materials
which have hitherto been generally regarded as almost in-
effectual.

3. That organized matter is to a large extent, and some-
times to a most remarkable extent, removable from water by
agitation with suitable solids in a fine state of division, but
that such methods of purification are unreliable.

33

514 Water Analysis.

4. That chemical precipitation is attended with a large re-
duction in the number of micro-organisms present in the water
in which the precipitate is made to form and allowed to sub-
side.

5« That if subsidence, either with agitation or after precipi-
tation, be continued too long, the organisms first carried down
may again become redistributed throughout the water.

About ten years ago a filter known as the Newark filter was
found to answer well for household, hotel, and factory pur-
poses, in localities where the public water-supply was turbid
from clay or fine silicious particles which choked the ordinary
filter. The water-pipes connected with this filter were so
arranged that when needful a current could be sent through
the filtering materials in the reverse direction, to clean them
by dislodging and floating off the intercepted accumulations.
From this as a beginning, that which is now known as the
Hyatt system was developed— a system in which the filtration
takes place in a strong iron cylinder under considerable press-
ure, the filtering bed being cleaned from time to time by a
reversal of the current. Coagulants, as alum, iron, lime, etc.,
are used to facilitate the removal of the suspended matters.
The general supply of several cities, among which may be
mentioned Somerville and Brunswick, N. J., Charleston,
W. Va., and Belleville, 111., are now filtered by this system,
which is favorably regarded by many sanitary engineers and
others interested in public water-supplies.

The addition of alum, iron, permanganate of potash, and
^other substances has often been suggested and employed in
-special cases for the purification of impure water. Waters
fturbid from fine clay particles, which take a long time to
settle, are frequently cleared satisfactorily by the use of alum ;
hydrate of alumina is precipitated, carrying down with it the
suspended matters. A similar action takes place when a solu-
vtion of perchloride of iron is used, the precipitated hydrate
clearing the water and at the same time removing some of the
albuminoids. Lime-water throws down lime carbonate from
bicarbonated waters, softening them and improving their or-
.ganic quality. The readiness with which permanganate of
potash parts with its oxygen renders it of use in oxidizing
»those matters which, being in a putrescent or transition state,

Water Analysis. 515

give an unpleasant odor or taste to the water. It has little
influence on recent organic matter, and, so far as known,
none whatever on the dangerous elements derived from an
infected sewage. It is added in solution, in small quantities
at a time, until the faintly pink tint which is produced re-
mains visible for five or ten minutes. Boiling the water, if it
be hard, precipitates excess of lime and removes albuminoids,
particularly if a little tannin be introduced, in the form, for
instance, of tea-leaves. But boiling has a more important in-
fluence on the purification of water on the domestic scale, in-
asmuch as it destroys the infection of specific diseases. Ac-
cording to the Committee on Disinfectants of the American
Public Health Association, Report 1885, boiling in water for
one hour does not destroy the spores of bacillus subtilis, but
is effective for the destruction of the spores of the anthrax
bacillus and of all known pathogenic organisms. Distillation
gives a pure water, except in occasional cases, in which the
original water is tainted with the volatile products of decom-
position.

Iron as a precipitating or filtering agent has been used in
various forms, to a considerable extent on the large scale, as
a water-purifier. L. H. Gardner, of New Orleans, La., re-
cently made inquiry, through the Belgian consul in his city,
concerning the cost and success of these works at Antwerp,
and received in reply the following (Scientific American, Sup-
plement, October loth, x886), which was signed by E. Devon-
shire, Engineer of the Antwerp Water-works, and approved
by the city authorities : ** The motive power required to turn
the apparatus is trifling. The cost of cleaning is really noth-
ing, from the fact that the particles of iron are kept clean by
reciprocal friction. All oxidized matters are removed by the
current of water and deposited on the sand filters. The quan-
tity of iron used in the Anderson apparatus does not exceed
one tenth of a grain per gallon, or about 15 lbs. per million
gallons. The filings of qast iron that can be employed for the
purification would cost perhaps los. per ton, making the cost
of iron employed amount to about |d. per million gallons.
The cost of cleaning the sand filters averages 12s. per million
of filtered gallons, including the cost of purified water em-
ployed to wash the sand. In our works at Waelham we have

516 Water Analysis.

established three Anderson puriiicators No. lo, which can
together purify 2,200,000 gallons of water per day. The value
of these three machines is jf'isso, and the cost of their instal-
lation, including the building in which they are located, was
about ;f 300. The water retains no trace of iron after being
filtered through sand. The daily consumption of water at
Antwerp at this time of the year [July] is about 2,000,000
gallons, and it is all subjected to this process of iron purifica-
tion."

Mr. Gardner, in the journal cited, makes a strong plea on
behalf of iron for the purification of the surface-waters of this
country. He reviews the attempts to carry out the English
system of filter-beds, and condemns them on the score of ex-
pense. He claims that, speaking generally as regards our
Western waters, filtration on the large scale accomplishes only
what a twenty-four hours' rest in a reservoir would effect, and
that by the addition of a solution of iron their clarification can
be promptly secured. The European methods for purification
by iron contemplate actual contact with natural or prepared
ore, or with cast-iron borings or turnings, with a subsequent
sand filtration for eliminating the excess of iron. Mr. Gard-
ner's suggestion is the introduction of a solution of iron in
such a quantity as experiment may have demonstrated to be
needful for the desired purpose, and no more. He tried a
solution of red haematite ore in hydrochloric acid, on Missis-
sippi water, at the New Orleans Water-works, and the clarified
water gave satisfactory results to Professor Chandler, of New
York, and other chemists. Later, he treated a body of thir-
teen million gallons in the sedimenting basins at St. Louis,
Mo. The solution used, the water in various stages of pre-
cipitation, and the colorless resultant water met with favor-
able reports from the analysts. The action is chemical and
mechanical. In the water of the Mississippi there exist car-
bonates of lime and ms^nesia. Contact of the chlorine of the
iron solution forms chloride of calcium, and coincident there-
with is the formation of the hydrated oxide of iron. The
latter settles rapidly, carrying with it all suspended matters
and leaving the water clear. The use of a solution of 1.60 sp.
gr. in the proportion of one part to 20,000, clarifies the mud-
diest water, neither hardening it nor leaving in it any excess

1

Water Analysis. 517

of the iron. The Mississippi water at New Orleans is clarified
by a rest of eight hours in a reservoir, at a maximum cost of
one cent per looo gallons of the water. The present writer
has a practical knowledge of the sedimentation of the Missis-
sippi River water at New Orleans and elsewhere, and if the
addition of iron gives, as claimed, a crystal-clear water after
eight hours' subsidence, the advantage of its use needs no
lengthened argument.

The lime process, that patented in 1844 by Professor Clark,
of Aberdeen, has also been used on the large scale as a softener
and purifier of hard water. In this process lime is removed
from the water by the addition of lime. If a water which
contains carbonate of lime, dissolved by the agency of free
carbonic acid, has that free acid neutralized by the addition
of caustic lime, the original carbonate will be rendered insolu-
ble by the loss of its free acid, and the carbonate, formed by
combination with the added lime, will also fall in an insoluble
state. The precipitated lime-salt carries down with it all the
suspended matters, organic or inorganic, which may be pres-
ent, and, to a certain extent, purifies as well as softens the
water. Professor Frankland's recent experiments at the Colne
Valley Water-works have demonstrated the efficacy of this
process in removing bacteria from the water.

All the processes of purification that have been mentioned
remove suspended matters and more or less of the dissolved
saline and organic substances that are present in the water ;
but, with the exception of boiling and distillation, none of
them can lay a well-defined claim to the removal or destruction
of the causative agencies of the acute infectious diseases that
are known to be propagated by the water-supply. The con-
clusions of the English Rivers Commission remain unaltered
by recent additions to our knowledge concerning the impurities
in water : " i. The existence of specific poisons, capable of
producing cholera and typhoid-fever, is attested by evidence
so abundant and strong as to be practically irresistible. These
poisons are contained in the dischai^es from the bowels of
persons suffering from these diseases. 2. The admixture of
even a small quantity of these infected discharges with a large
volume of drinking-water is sufficient for the propagation of
those diseases among persons using such water. 3. The most

518 Water Analysis.

eflicient artificial filtration leaves, in water, much invisible
matter in suspension, and constitutes no effective safeguard
against the propagation of these epidemics by polluted water."
Boiling the water is the only sure disinfectant, and this can
only be effected on the small or domestic scale. At present
the object of sanitary legislation in England is not to pre-
serve the rivers as a source of water-supply, but to prevent
them from becoming a nuisance in their character of open
sewers. It is desired to permit the inflow of water into their
channels only when it contains less than a stated maximum of
organic impurity ; to treat sewage chemically for the removal
of its filth, so that its water may flow in a clear and compar-
atively pure condition into the streams ; or to effect the same
result by filtration through the soil. The advocates of sewage-
irrigation become enthusiastic over the clearness and purity of
the water from their under-drains, and suggest that the gen-
eral use of their system would reclaim the polluted streams
and permit them to be again used with safety for household
purposes. But the purifying factor in sewage-irrigation is
filtration, and filtration through a notoriously polluted soil.
The unwholesomeness of water that has percolated into a well
through a soil saturated with sewage has been so often illus-
trated, that we may well be excused for showing some hesi-
tancy in accepting the effluent water of sewage-farms as a
general household supply. The adoption of this system of
irrigation would certainly improve the appearance and quality
of the river-water ; but so long as we know that at Lausen,
not sewage, but a sewage-tainted mountain stream, used for
irrigating purposes in one valley, occasioned a general out-
break of virulent typhoid among the inhabitants of another
valley who used th6 clear water of the effluent, we must ac-
knowledge that filtration cannot be trusted to render an in-
fected water safe. The English Commissioners gave positive
expression to this view: "Of all the processes which have
been proposed for the purification of sewage, or of water pol-
luted by excrementitious matters, there is not one which is
sufficiently effective to warrant the use, for dietetic purposes,
of water which has been so contaminated. In our opinion,
therefore, rivers which have received sewage, even if that
sewage has been purified before its discharge, are not safe

The InjhAence of a Better Water-Sv^ly. 619

sources of potable water." It is often urged that sewage is
harmless, as evidenced by the long-continued use of sews^e-
polluted wells ; and that, even were it harmful, the natural
processes taking place in the running stream effect its destruc-
tion. The fallacy of these arguments may easily be under-
stood from what has been already stated* It is not the ex-
creta of health that are dangerous, but those that contain the
contagion or germs of disease ; and although the former may
be deposited or decomposed in their passage down stream,
there is no evidence that the germs of typhoid-fever are de-
stroyed in this manner ; but, on the contrary, positive evi-
dence that they are not. Moreover, a river-water that con-
tains sewage must always be regarded as infected. The
contributors to the sewage of a river are so numerous, and
typhoid-fever so continually and extensively prevalent, that
the outflow of sewage from a populous city cannot safely be
assumed to be uninfected. Below the point where sewage
enters there should be no more thought of using the waters as
a potable supply. The stream should be left, to fulfil its part
in the economy of nature as an open drain for the water-car-
riage of surface-swept impurities. River water-supplies should
be taken from above all points of sewage entrance, and the
drainage area placed under the control of the sanitary author-
ities for its better protection from contamination. In this
way only, so far as our present knowledge extends, can a truly
wholesome water be obtained. Sedimentation and filtration,
with or without chemical additions for promoting their action,
will improve the quality of the water when this is needful, but
only by avoiding the presence of animal excretions can we
avoid the unnecessary propagation of certain dangerous dis-
eases by the water-supply.

The influence of a better water-supply upon the
HEALTH OF A COMMUNITY is remarkably illustrated in the ex-
perience of the town of Havre de Grace, Md. In times
past the only available water-supply was from wells within the
town limits, and for many years the town had been notorious
for the prevalence of malarial diseases, usually ascribed to the
situation of the town on the banks of the Susquehanna River,
and to the fact that it lies within a so-called malarial district.

520 The DeM Cast Out hf Science.

In 1883-84 water-works were built and the supply taken from
the Susquehanna River, and the use of well-water was aban-
doned. As an immediate consequence, for which he can in
no otherwise account than by the change from well to river-
water, Dr. Cochran, the leading physician of Havre de Grace,
reports that whereas three years ago he usually treated about
seventy-five cases of shaking chills daily, he now has scarcely
a single case. The town site is certainly the same, and the
river, tide-water, and surrounding natural conditions remain
unchanged ; but the one change is that this town of several
thousand inhabitants has suddenly, upon the introduction of
a better water-supply, become singularly free from the one
special disease which was so lately and for so long a time pre*
viously prevalent. Account for it as you please, the results
at Havre de Grace are well worth noting by other towns in the
United States which now experience what that town did in
the past, and by a similar remedy they may meet with similar
relief. — Engineering News.

The Devil Cast out by Science.— Conscientious men
still linger on who find comfort in holding fast to some shred
of the old belief in diabolic possession. The sturdy declara-
tion in the last century by John Wesley, that " giving up
witchcraft is giving up the Bible," is echoed feebly in the
latter half of this century by the eminent Catholic ecclesiastic
in France who declares that ** to deny possession by devils is
to charge Jesus and his apostles with imposture," and asks,
" How can the testimony of apostles, fathers of the Church,
and saints who saw the possessed, and so declared, be denied ?"
And a still fainter echo lingers in Protestant England.

But despite this conscientious opposition, science has in
these latter days steadily wrought hapd-in-hand with Christian
charity in this field, to evolve a better future for humanity.
The thoughtful physician and the devoted clergyman are -now
constantly seen working together ; and it is not too much to
expect that Satan, having been cast out of the insane asylums,
will erelong disappear from monasteries and camp-meetings,
even in the most unenlightened regions of Christendom. —
From " Diabolism and Hysteria,'* by Dr. Andrew D. White ^ in
the Popular Science Monthly for June.

The MedalSy Jetons^ a/nd Tokens lUuetra^ive of Sanitation. 521

THE MEDALS, JETONS, AND TOKENS ILLUSTRA-
TIVE OF SANITATION.

By Dr. Horatio R. Storer, Newport, R. L, Member of American Public Health

Association, etc.

X. epidemics. Continued from page 847.*

V. Yellow-fever.
A. The United States.

Dr. Jean Charles Paget, of New Orleans (1818- ).
" Medical Reflections (etc.), and a Short Account of a Paludal
Endemic Disease of Catarrhal Form, which Prevailed at New
Orleans During the Epidemic of Yellow Fever in 1858." New
Orleans, 1859, 8° ; " M6moires et Lettres sur la Fifevre Idune
et la Fifevre Palud6enne." 1861 ; " The Type and Specificity
of Yellow Fever Established with the Aid of the Watch and
Thermometer/' New Orleans Medical and Surgical Journal^
1873, i., N. S., p. 145 ; tbid.^ Paris and New Orleans, 1875, 8°.

1063. Obverse. i£sculapius facing, with the cock in his
right hand, and his staff in the left. Beneath, upon a bifid
band : Et Prudens Et Vigil. Inscription : Soci6t6 De M6de-
cine De Caen.

* The previous portions of this paper will be found in Thb Sanitarian for
May, July, August, October, 1887 : February, April, July, August, November,
188S ; February, Much, dind April, 1889.

Since my chapter upon the medals of The Plague, in Thb Sanitarian for
November last, I have received from Signor Francesco Gnecchi, of Milan, im-
pressions of another plague medal of that city, unknown to Pfeiffer and Ruland,
and apparently as yet unpublished.

867 *. Obverse. Bust to right, with collar and coat of mail. Inscription :
Phillippvs'IIir Hispaniarvm. Ret Exergue : 1630

Reverse. View of Milan. Above, an angel, in clouds, with flaming sword.
In front, many dead persons. Legend * Et Inde Salvs-Vive Mediol.

The reverse is the same as of No. 867. The obverse of that was of the Emperor
Charles V., and was without date. It presumably commemorated the epidemic
of 1576 (made famous by the devotion of St. Charles Borromeo), though the
Emperor had then been dead for eighteen years. In 1630 The Plague raged
again in Lombardy ; in Venice and its surroundings nearly a hundred thousand
persons died of it.

Silver. 44 mm. In the collection of Signor Gnecchi.

522 The Medals^ Jetona^ and Tokens Ilhis^raHve of Sanitaiion,

line

"I

Reverse. A wreath of flowers. Within, engraved : 2
Prix Exceptionnel Decern^ A Mr le Dr Paget 1853. Gold. 24.

For a description and impressions of this medal, conferred
upon the late Dr. Paget by the profession of Caen, Prance. I
am indebted to his daughter, Mile. H61^ne Paget, of New
Orleans.

Df. James Prancis^ Harrison, of Vit^inia (1822- ),

The medals conferred by the Prench Government and the
city of Portsmouth, Va., upon this gentleman will be described
in another connection, in the present Section.

Dr. David Hosack, of New York. On Yellow- fever. 1830.

Already mentioned in Section I., and will be subsequently
again referred to in the present Section under Typhoid.

Dr. Robert W. Mitchell, of Memphis, Tenn.

The medal upon which Dr. Mitchell's name appears in an
official capacity, that of the Howard Association of Memphis,
will be described a little later.

Dr. John Morris, of Baltimore (1824- ), " Prison Physi-
cians, Their Duties and Influence." An Address before the
National Prison Congress at Atlanta, Ga. Maryland Medical
Journal^ November 27th, 1886.

Dr. Morris is one of the gallant band of medical men who
hazarded their lives during the epidemic of 1855 at Norfolk,
Va. The medal, that of the Howard Association of that city,
will be described subsequently.

Dr. Benjamin Rush, of Philadelphia (1745-1813). ** An
Account of the Bilious Yellow Pever as it Appeared in Phila*
delphia in 1793." Philadelphia, 1794, 8° ; and of each succes-
sive year till 1805 ; " Pacts Intended to Prove the Yellow
Pever not to be Contagious." 1803, 8°.

During the epidemic of 1793, Dr. Rush rendered extra-
ordinary services. For these he received gold medals from
the King of Prussia in 1805, ^"^ ^^ Queen of Etruria in 1807,
and a diamond ring from the Czar of Russia in 181 1.

1064. Obverse. Bust, with queue, to left ; a neckcloth
under the collar. Beneath shoulder : P. Inscription : Ben-
jamin Rush M:D: Of Philadelphia v

Reverse. A river, flowing forward. In background, the
setting sun, with clouds and mountains. Large trees in fore-
ground, to right. To the left, Sydenham. In front, a block

The Medals J JetonSy a/iid Tokens IWustrati/oe of Sanitation. 523

of stone, on which : Read | Think | Observe Upon this, an
open book. Beneath, to right, M. Furst Fee, Exergue :

a(NNO). MDCCCVIII.

As regards the name upon the reverse, Dr. Rush has been
called " The American Sydenham." The legend is from one
of his lectures. Silver (?), bronze, lead. 41 mm. 27.

In the Lee Collection. I also have it« both in bronze and
lead. It is very rare, and seems unknown to all numismatic
writers. The engraver, Fiirst, was Chief Engraver at the
United States Mint, where this was struck, and of which Dr.
Rush was Treasurer for fourteen years. There are said to ex*
ist two specimens in silver, but I have endeavored in vain to
trace them.

1065. Obverse as in preceding.

Reverse. An altar, upon which rests an open book. In
front, upon an oval panel, a bust of i£sculapius, with staff and
serpent. In another, at right, an urn. Beneath, to right,
M. Furst Fee. Exergue : A. MDCCCVIII. Bronze, gilt bronze,
41 mm. 27, The size is given as 20 in the Wood Catalogue,
February 25th-29th, 1884, No. 2372.

Unknown to all writers upon medals. Still rarer than the
preceding. It is in the Lee Collection and my own.

Dn Rush has already been referred to under Section VIII.,
Diet. He will be again mentioned in the present Section, and
under Section XL, Military Hygiene,

Dr. J. M. Toner, of Washington. "Contributions to the
Study of Yellow Fever in the United States ; Its Distribution,
with Weather Maps. " Washington, 1874, 8*.

Several medals of Dr. Toner have already been mentioned,
but since their publication I have learned of anolher that has
been conferred upon this distinguished physician.

1066. Obverse. Laureated head of the Emperor Wilhelm,
to right. Exergue : J. Tautenhayn.

Reverse. Three persons, with distaff, wreath, and cornu-
copia. In background, a plough. Inscription : Weltausstell-
ung 1873 Wien Exergue : Dem | Verdienste.

This, the ** medal for merit" of the Vienna Exposition of
1873, was given to Dr. Toner for the collection of the reports
of medical institutions, hospitals, etc., then contributed by
him.

524 The MeddU^ JeUynSy and Tokens lUustrati/oe of SanUaiAon.

Dr. Thomas H. Williamson, U. S, N.
This medal from the French Government, like that of Dr.
Harrison, will be described hereafter.

B. England.

Dr. Frederick Rose, Assistant Surgeon, R. N.

The two American medals to Surgeon Rose will be described
in their more appropriate connection, later on in the present
Section.

C. France.

Dr. Matthieu F. Maxence Audouard (1776-1856). " Lettre
sur la contagion de la Fifevre jaune."* Paris, 1821, 8° ; " Re-
lation historique et m6dicale de la fi^vre jaune qui a regn6 k
Barcelone en 1821." Paris, 1822, 8® ; " Typhus Nautique ou
Fi^vre Jaune." 1825, 8^

1067. Obverse. A recumbent figure, with civic crown and
armorial shield. Upon her, a flying spirit of evil pours from
a vase. To her aid, come Faith and Hygeia. In the back*
ground, the city walls. Legend : Pietas — Gallica Exergue :
Saevlente In Barcinonam | Pestilentia | mdcccxxi To left,
Gayrard Inv.

Reverse. In field : V* (the five) Viri'Medici' ] Qvorvm*
Primvs Occvbvif | Mazet* | Parisef | Bally | Frangois* |
Audouard* | iSancti-Moniales'II* | Sancto*Camillo*Devotae* |
Lvdovici-XVIII- | Regni | Ann-XXVIII- At left, a laurel,
and at right, a palm branch. Legend : Morte*Venalem*Petiere*
Palmam* Silver, bronze. 48 mm.

Rudolphi, Kluyskens, and Duisburg have the dates in
Roman. Rudolphi has a dot after Medici, and Duisburg both
here and after Regni. Rudolphi does not mention the
branches upon the reverse. Kluyskens calls the second of
them olive instead of palm.

Rudolphi, 1829, p. 105, No. 440 ; Kluyskens, ii., p. 203 ;
Duisburg, p. 64, clxi. ; P. and R., p. 152, No. 439, fig. of
obv. In the Lee and Fisher collections.

Dr. Francois Victor Bally (i 775-1 866). " Opinion sur la
contagion de la fifevre jaune." Paris, 1810, 8° ; (with Dr,
Pariset) " Fi^vre jaune." 1 821.

His medal is conjoint with that of Mazet, Audouard, and

The Medals J Jstona, and Tokens lUu^lraime of SanUaMon. 525

others just described. He has already been referred to under
Cholera.

Baron Dr. R. N. D. Desgenettes, of Paris (i 762-1 837).
" Discours relatif a la fifevre jaune." Paris* 1827, 8°.

This medal has been described under Section I.

Dr. Guillaume Dupuytren, of Paris. " Rapport etc. sur
repid6mie qui ravage a Barcelone en 182 1." Paris, 1828, 4^.

Described in this Section, under Cholera.

Dr. Andr6 Francois (i775[?]-i84o). ** Sur la fifevre jaune a
Saint Domingue." Paris, 1804, 4^

His medal, conjoint with that of Mazet and others, has
just been described.

Baron Dr. J. D. Larrey. " Considerations sur la fi^vre
jaune." Paris, 182 1, 8°.

Described under Cholera, in the present Section.

Dr. Andr6 Mazet (1793-1821). '* Relation abreg6e du voy-
age fait en Andalousie pendant Tepidemie de 1819." Paris,
8° ; (with Dr. Pariset) ** Observations sur la fifevre jaune faites
a Cadiz en 18 19,*' etc. Paris, 1820, fol.

His conjoined medal, as the first of the five French physi-
cians investigating yellow- fever at Barcelona in 182 1, to die
a victim to the epidemic, has already been described.

1068. Obverse. At the right, sick persons for whom phy-
sicians and religious sisters are caring. At left, Death with a
sickle removes the lid of a tomb, upon which : lis Me Les
Ravissent. Behind, a cypress, and a pyramid bearing : Mazet.
Upon its summit an angel places a crown. Above, a head
encircled by rays. Below, to left. Morel F. Exergue :
Devouement Des M^decins Frangais A Barcelone 1821.

Reverse plain. Bronze. 73 mm. Kluyskens, ii., p. 204.
Unknown to Rudolphi, Duisburg, RUppell, and P. and R.

Dr. ^tienne Pariset (i 770-1 847). " Rapports sur la fifevre
jaune de Cadix et de Barcelone ;" and with Drs. Bally and
Mazet, already mentioned.

1069. Obverse. Bust. Beneath, L. Dubour F. Inscrip-
tion : ^tienne Pariset.

Reverse. Inscription : Cadix. 18 19. Barcelone. 1821. In
field : Ire. Obviam. Cadentibus. Miseris. Aegris. Bronze. 40
mm.

Kluyskens has no dot after Cadix. Rudolphi, 1829, No.

526 The Medals^ Jetona^ and Tokens Illustrative of Sanitation.

500 ; Kluyskens, ii., p. 295 ; Duisburg, p. 71, clxxxii.. No. i.
Unknown to P. and R.

The two other medals of Pariset have already been de-
scribed. The one conjointly with that of Mazet and others, is
in this Section under Audouard, and the other, to himself
from his friends, is also in this Section, under the subdivi-
sion of The Plague.

The medals conferred \^y the French Government upon Drs.
James F. Harrison and Thomas H. Williamson, of Virginia,
for their services in an outbreak of yellow-fever upon the ship-
of-war " La Chimfere" in the summer of 1854, will be shortly
described.

D, Sweden.

Dr. Pehr (Peter) Dubb, of Gothenburg (1750-1834).
Distineruished for his practical knowledge of yellow-fever.

1070. Obverse. Bust. Beneath, C. E(nhoeming). In-
scription : Doctor Per Dubb Admiralit. Medicus Ridd. Af K.
W. O.

Reverse. Erk&nsla Af Gotheborgs Stad Hwars Fattigvard
Inv&ttad Efter Hans Fdrslag Vann Verkst^llighet Genom
Hans Drift. Exergue: Pa Stadens Aldstes Bekostnad. 1806.
Silver.

Rudolphi has dot after Per, and Kluyskens has Pet instead.
Both have Amiralit.

Sackl6n, p. 281 ; Silfverstolpe, p. 825, No. 31 ; Rudolphi,
1829, p. 43, No. 168 ; Kluyskens, i., p. 262, No. i ; Duisburg,
p. 213, dlxviii., No. i.

1071. Obverse. Till Tacksamhet For Ytterligare Tio Ars
Moda At Directorerne Pehr Dubb Och Johan Wohlfahrt Af
V9,nfaste Broder D. 19 Nov. 1799.

Reverse. A spreading oak, to whose shelter birds are fly-
ing. Exergue : Sorgtslltigt Vardad J 20 Ar.

Silfverstolpe, p. 804, No. 15 ; Rudolphi, 1829, p. 43, No.
169 ; Kluyskens, i., p. 262, No. 2 ; Duisburg, p. 213, dlxviii..
No. 2.

Dr. A. H. Florman, of Lund (1761-1840). " De febre
biliosa anno 1788 nautas afHciente.'* Lund, 1789, 4^

1072. Obverse. Bust, to right. Under shoulder, P. H.
L(undgren). Inscription : A. H. Florman. Anat. Et Chir.
Prof. Lund. Below : Nat. 1761. Den. 1840.

The MeddUj Jetons^ and Tokens lUvstrative of SanUdUcn. 527

Reverse. A statue of Hygeia before an altar, and a priest
sacrificing thereat. Legend : Arcana Deae Scrvtatvs In Extis.
Exergue : Socio Svo Meritiss. R. Acad. Scient. Svec. A.
MDCCCLI. Silver. 20.

Duisburgy Supplement II., 1868, p. 22. In the Lee Collec-
tion.

E. Germany.

Johann Heinrich von Chaufepi6, of Hamburg (1773-1856).
" Historia febris flavae Americanae." Halae, 1794, 8®.

1073. Obverse. Head, to left. Beneath, F. Alsing F,
Inscription : Jean Henry De Chaufepi6 Med & Chir. D'.

Reverse. Inscription : Preismedaille Des Arztlichen Ver-
eins. In field : Dem Geehrten | Kunstgenossen | Zur FUnfzig-
j&hrigen | Jubelfeier | Der Arztliche Verein | Hamburg D.
4 Oct. 1844. Gold, silver, bronze. 21. Duisburg has Et for
&. G^dechens, Die Neueren Hamb. Miinzen und Med. St. 5,
p. 221 ; Duisburg, p. 167, No. ccccli. In the Lee and Fisher
collections and my own. Unknown to Kluyskens.

1074. Obverse as preceding.

Reverse blank, for name of recipient. Riippell, 1875, p. 46.

This is a premium medal of the Medical Society of Ham-
burg, as was the last. It was unknown to Duisburg, Kluys-
kens, and Gadechens.

There exist several medals commemorative of yellow-fever,
other than those already mentioned. They are, save one,
American, and all but that have been unknown to foreign
writers.

A. The United States.
a. Norfolk, Va. (1855).

1075. Obverse. Faith, Hope, and Charity, In back-
ground at left, an altar ; in foreground, an anchor^ and at
right, a lamb. Above, the AU-seeing Eye, and stars, irradi-
ated. Beneath, W. N. Dunnell, N. Y. Inscription, within
a double circle : Presented By The Howard Association of
Norfolk, Va. | 1855.

Reverse. The Good Samaritan. Legend, within a double
circle : I Was Sick And You Visited Me. | Matt.xxv.xxxvi.
Chased at the edges. Gold, bronze. 22. Snowden, miscel-
laneous medals, in his Medallic Memorials of Washington in

528 The MeddU^ Jetons^ and Tokens lUustraivoe of Sanitation.

the United States Mint, p. 112, No. 23. Very rare. In the
Lee Collection and that of the United States Mint.

I owe to Dr. John Morris, of Baltimore, impressions of the
gold medal that he received from the Norfolk Association, and
to Dr. Herbert M. Nash, of Norfolk, the following history of
the medal, which he was so kind as to send me at the request
of Professor James L. Cabell, President of the National Board
of Health.

" I had no idea that I should have so much difficulty in
getting the information desired. The records of the Howard
Association were carried off by the Federal troops, who took
possession of them. None of the gold medals are now in the
city. They were presented by the Howard Association only
to volunteer physicians from abroad, who tendered their ser-
vices, and performed them, during the epidemic. The follow-
ing physicians received these gold medals : Warren Stone,
E. D. Fenner, C. Beard, Thomas Penniston, William P. Will-
iams, J. S. McFarlane, and S. D. Campbell, New Orleans ;
James B. Read, Thomas J. Charlton, S. T. McFarland, R. J.
Nunn, James E. Godfrey, and W. S. Donaldson, Savannah,
Ga. ; A. F. Bignon, Augusta, Ga. ; St. Julien Ravenel, W.
H. Huger, T. C. Skrine, J. B. Holmes, and A. B. Williman,
Charleston, S. C. ; William (John) Morris, Baltimore ; WilU
iam H. Freeman, Philadelphia ; W. Horwitz, New York ;
John T. Hai^ove, Richmond, Va., and J. E. Marsh, New
Jersey.

" None of these medals were given to the local physicians."

b. Portsmouth, Va. (1854-55).

In the summer of 1854 the French steamship " La Chim^re"
arrived in the harbor of Portsmouth, Va., with her crew ill
with yellow-fever. The sick were removed to the United
States Naval Hospital, frequently spoken of as at Norfolk, al-
though upon the Portsmouth side of the Elizabeth River, and
were cared for by Sui^eon Thomas H. Williamson, U. S. N.,
and his assistant. Dr. James F. Harrison, now of the Uni-
versity of Virginia. Gold medals were presented to each of
these gentlemen by the French Government, in appreciation
of their services. Dr. Williamson is now, I believe, dead, but

The Medaisy JetonSj and Tokens lUtMtnUive of Sanitation. 529

from Dr. Harrison I have received impressions of his medal.
Its description is as follows :

1076. Obverse. Head of the Emperor, to left. Inscrip-
tion : Napoleon III — Empereur Beneath, Caqu6y F.

keverse. Within an oval, flanked by allegorical figures :
Ministfere j De La Marine | Et Des Colonies | — | Au D* |
Harrison | (James F.) | M6decin A L'Hop'* | De Norfolk
I = I Soins Donn6s | A L' Equipage | De La Chim&re | 1855.
Gold. 24.

Dr. Harrison writes me that Dr. Williamson's medal was
the same as his own, save a trifle larger. The following cer-
tificate accompanied the Harrison medal :

The

Imperial

' • Marine Coat of Arms et Colonies

of France.
" Le Ministre Secretaire d'etat au d6partement de la Marine
et des Colonies,

" Certifie que, par un d6cret du 17 Janvier 1855 TEmpereur
a d6cern6 une M6daille d'honneur en Or k M. le Docteur
James Harrison, m6decin a Thopital de la Marine k Norfolk
(£tats Unis) pour les soins qu'il a donn6s a I'^quipage de
rariso a vapeur de la marine imp^riale la Chim^re.

•* Paris, le 17 Avril 1855.
" P Le Ministre de la Marine et des Colonies et par son
ordre. Le Conseiller d'£tat Directeur du Personnel.

" (Signed) Layly.

'•(SealoQ
Le Ministere
de la Marine
et des Colonies
" P Le Conseiller d'£tat Directeur du Personnel, LeChef
du Bureau de T Inscription Maritime. V* S* C.

" (Signed) A. Hennequin.''
The following^ known as the " Portsmouth medaU'* was also
struck to commemorate the epidemic of 1855.

1077. Obverse. The naval hospital, facing, surmounted by
the United States flag (five stars and two stripes). Legend,
upon a band : Palmam Qui Meruit Ferat. Exergue : A
trophy ; % scrolled escutcheon with oval shield bearing the ser-

34

530 The Medals^ Jetons^ and Tokens lUual/rative of Sanitation.

pent-staff of i£sculapius. At sides, banners, a mast, cannon,
trident, anchor, and dolphins.

Reverse. Oak and laurel boughs tied by ribbon. Field
vacant for name of recipient. Inscription : Presented By The
Council Of The Town Of Portsmouth Virginia Exergue :
F. N. Mitchell Sc. Gold, bronze. 40.

In the catalogue of the Wood sale, February 25th-29th, 1884,
No. 175 1 > the engraver's name was given as Mitchel, and the
il^ stated to be the Confederate. The latter error was cor-
rected by Dr. William Lee, of Washington, in a note ta the
American Journal of Numismatics (July, 1885, p. 22). Fros-
sard erroneously speaks of the medal having been given for
services in 1858 or 1859.

Snowden, loc. cit.^ p. 188, No. 8.

This is in the United States Mint Collection, that of Dr.
Lee, and in my own. I owe my specimen to the kindness of
my good friend. Dr. James L. Cabell, of the University of
Virginia. Through the courtesy of Dr. Harrison, of whom I
have already spoken, I am enabled to complete the inscription
of the medal as given to himself. Upon the impressions sent
to me by that gentleman, it is as follows : Presented (etc.,
etc.) To James F. Harrison | Of Virginia | Passed Assistant
Surgeon, U. S. Navy, | For His Professional Services, | During
The Epidemic | Of Pestilential Yellow Fever | In | 1855.

Through the thoughtf ulness of Professor Cabell I have re-
ceived from Judge Legh R. Watts, of Portsmouth, the fol-
lowing copy of the minutes of the Common Council of that
city, giving the full history of this medal.

*' At a meeting of the Common Council (of Portsmouth,
Va.), held February 5th, 1856, the following resolutions were
adopted :

'* Resolved^ That our grateful acknowledgments are tendered
to Lewis W. Minor, Surgeon of the United States Naval
Hospital, and to his able and humane assistants, Thomas B.
Steele, James F. Harrison, Randolph Harrison, John C. Cole-
man, and F. A. Walke. These excellent men and skilful
physicians were, in season and out of season, at the beds of
our sick and dying people, ministering to their necessities and
smoothing their pillows in the solemn hour of death. Their
kindness to the sick, and their urbanity to all, during the try-

The MedaJSy Jetons^ amd Tokens IUt£8trativ& of Sanitation. 531

ing times when their labors were so accumulated, ennobled
their positions and dignified their honorable profession.

" Resolvedy That as a memorial of them and a testimonial
of the public appreciation of their valued services, a committee
be appointed, with instructions to have executed six gold
medals with suitable inscriptions and devices, and that one be
presented to each of these physicians, together with a copy of
this and the foregoing resolution.

" At a regular meeting of the Common Council of the Town
of Portsmouth, held at Literary Hall on Tuesday evening,
March 4th, 1856, G. W. Peete, chairman of the committee
appointed to carry out the spirit of the resolution of thanks,
adopted at the meeting of the Board, held February 5th, and
to devise suitable medals, reported progress, whereupon, on
motion of Mr. Niemeyer, it was

" Resolved^ That the sum of fifteen hundred dollars be, and
the same is hereby appropriated out of any moneys in the
hands of the Treasurer, to liquidate the expense of having
executed six gold medals, to be presented one to each of the
aforementioned United States naval surgeons attached to the
hospital of this station, during the late epidemic.

" At an adjourned meeting of the Common Council of the
Town of Portsmouth, held at the office of the Clerk of the
Council, on Wednesday evening, November 5th, 1856 ;

" The Committee on Medals, appointed under a resolution
of the Common Council, adopted February 5th, 1856, sub-
mitted the following report, which on motion was received :

" ' Portsmouth, Va., October 28, 1856.

" * To THE Common Council : Gentlemen, under a reso-
lution of the 5th February, 1856, the undersigned were ap-
pointed a committee to procure and present to Surgeon L.
W. Minor, Assistant Surgeons J. F. and R. Harrison, Cole-
man, Walke, and Steele suitable medals for services rendered
to this community during the pestilence of 1855. We have
performed the duties assigned in the following manner : We
have made presentation to Surgeon Minor and Assistant
Walke, and their letters of acceptance accompany this report.
Not knowing where to find Messrs. J. and R. Harrison, Steele,
and Coleman, we have forwarded them to the Hon. Secretary

632 The MedalSy Jeftons^ and Tokens Ilhuftratwe of Sanitation.

^ - n -^ ^1—

of the Navy, and requested him to give them their proper
direction. There were struck off twelve bronze medals, five
of which we send. We enclose herewith an account of the
cost, together with the necessary vouchers, all of which is
respectfully submitted.

'* '(Signed) George Peete, H. V. Niemeyer, J. H. Porter,
Committee.'"

The following was the letter of presentation :

•' * Portsmouth, Va., October i, 1856.

" * My DEAR Sir : You will perceive from the accompany-
ing resolutions, that we are assigned the pleasing duty of pre-
senting to you this medal. We ask that you will accept it in
the name of the people of Portsmouth, as an inadequate but
willing expression of their gratitude for important services in
behalf of her suffering people. We know, sir, that in all the
future, wherever the duties of a diversified life may lead you,
you can never be called upon to exert more cool heroism and
disinterested humanity.

'* ' In this memorial Humanity acknowledges her indebted-
ness to you, and we hope, sir, that you may never cease to
enjoy that happiness which ever attends the remembrance of
duties well performed, and of virtues strongly illustrated.

*' * Signed : G. W. Peete, H. V. Niemeyer, J. H. Porter,
Committee.' "

The Portsmouth medal is extremely rare.

c. By vote of Congress (1857).

1078. Obverse. Bust of the President, with hair erect, to
right. Beneath shoulder, Paquet F. Inscription : James
Buchanan, President Of The United States.

Reverse. iGsculapius, with patera and serpent, stands
between Death, with hour-glass and scythe and two sick men,
one of whom clings to his robe. Beneath, to right, Paquet
F. Inscription : To Dr. Frederick Rose, Assistant Surgeon,
Royal Navy, G. B. Exergue : For Kindness And Humanity
I To Officers And Crew | Of The U. ^. Steamer | Susque-
hanna. Gold, bronze. 48. Loubat, " Medallic History of
the United States of America," i., p. 362 ; ii., pi. LXXI.

l%e MeddUy JetonSj cmd Tokens lUtutraiive of SamtaHon. 58S

The ship was at Port Royal, Jamaica, completely disabled.
Surgeon Rose returned with it to New York. This medal is
in the Lee and Fisher collections, and my own.

The following belongs here, though the medal was pre-
sented to Surgeon Rose by the survivors upon the infected
ship.

1079. Obverse. Presented To Ass* Surg" Frederick Rose,
R. N., By The Remnant Of The Crew Of The United States
Steam Frigate Susquehanna, Who Returned To The United
States In Said Ship In Good Health, As A Mark Of Their
Appreciation Of His Generously Volunteered Professional
Services Rendered Their Shipmates Who Were Afflicted With
Yellow Fever. April, 1857.

Reverse. The Steamship. Bound on edge, as by a cable.
Bronze. 47. In the Lee Collection.

d. Chicago (1873).

io8o. Obverse. View of Exposition building, surmounted
by flags. Beneath, at right, J.S.Weber. Exergue : 1873 I *

Reverse. The face of a watch. Upon it, Elgin Watch,
between the two lines. Contribution To 1873 I Yellow Fever
Sufferers. Marginal inscription : Made By The National
Elgin Watch Co | « In Exposition Building* White metal.
19. In my collection. Very rare,

«

e. Savannah^ Ga. (1876).

108 1 . Obverse. The Geneva Cross. Savannah Benevolent
Association. 1876.

Reverse. The Good Samaritan. Legend : I Was Sick
And You Visited Me. Matt, xxv-xxxvi. R. L. Auten-
heimer. Gold, bronze. 22. Very rare. In collection of
the Boston Numismatic Society and that of Dr. Lee.

/. Memphis, Tenn. (1878).

1082. Obverse. Within a heavy laurel wreath : Howard
I Medical Corps. | (with flourishes).

Reverse. Awarded | for services | during the Yellow Fever

I epidemic in | Memphis | 1878. j A. D. Langstaff | Pres*

Howard Assoc" | R. W. Mitchell, [ Medical Director. | (with

flourishes). Heavy scroll-work above and below, with pin

584 Ths Medals^ Jetons^ and Tokens lUvstratd/oe of Sanitation.

attached above, upon which the name of the recipient* Gold.
21. In the Lee Collection.

For the opportunity of inspecting this very beautiful medal
I am indebted to Dr. Mitchell, of Memphis. To this gentle-
man I also owe a copy of Keating's '* Yellow Fever Epidemic
of 1878 in Memphis, Tenn./' from which I am enabled to
give the following list of the physicians who were entitled to
the medal. It was awarded. Dr. Mitchell writes me, only to
non-residents. ** No resident of the city or its suburbs re-
ceived one." Drs. J. S. Bankson, Stevenson, Ala. ; O. D.
Bartholemew, Nashville, Tenn. ; Charles Baskerville, Horn
Lake, Miss. ; W. F. Besancny, Jonestown, Miss. ; B. A.
Bobo, Thomasville, Ga. ; T. W. Bond, Brownsville, Tenn. ;
Samuel Boyle, Baltimore, Md. ; Robert Burcham, Columbus,
O. ; L. A. Bryan, Houston, Tex. ; G. D. Bradford, Long-
point, Tex. ; W. A. Carswell, Americus, Ga. ; L. A. Chevis,
Savannah, Ga. ; L. B. Childs, Fisherville, Ky. ; W. L. Cole-
man, San Antonio, Tex. ; S. H. Collins, Cincinnati, O. ; J.
G. Davis, Lincoln, Neb. ; J. R. Dale, Arkadelphia, Ark. ;
E. F. De Graffenried, Columbus, Ga. ; P. G. De Saussure,
Charleston, S. C. ; Gordon De Hulin, New York ; William
Duncan, Savannah, Ga. ; Greenville Dowell, Galveston, Tex. ;
Thomas Easton, New York ; N. J. Fogarty, Columbus, Ga. ;
H. F. Force, Hot Springs, Ark. ; J. G. Forbes, Round Rock,
Tex. ; T. L. Gilzer, Mobile, Ala. ; G. H. Gray, Denison,
Tex. ; J. G. O. Gorrell, Wayne, Ind. ; R. P. Hall, Mobile,
Ala. ; L. B. Harlan, Hot Springs, Ark. ; J. B. Hicks, Mur-
freesborough, Tenn. ; R. R. Hunter, Kansas City, Mo. ;
August Kenhue, Dayton, O. ; M. T. Keating, New York ;
J. Cecil Legar6, New Orleans, La. ; H. T. Lowry, Cincinnati,
O. ; J. Luppo, Los Angeles, Cal. ; W. C. Meade, Hopefield,
Ark. ; T. W. Menees, Nashville, Tenn. ; B. R. Montgomery,
Chattanooga, Tenn. ; S. H. McCormick, Terre Haute, Ind. ;
W. A. McCuUy, Independence, Kan. ; T. H. McGregor,
Tipton Co., Tenn. ; J. W. McKim, St. Louis, Mo. ; J. T.
McFarland, Savannah, Ga. ; P. C. Nugent, St. Louis, Mo. ;
J. G. Orr, Cincinnati, O. ; G. W. Overall, Murfreesborough,
Tenn. ; J. D. Palmer, Fernandina, Fla. ; H. M. Pearce, Cincin-
nati, O. ; Maurice Pritchard, Virginia City, Mo. ; J. G. Ren*
ner, Indianapolis, Ind. ; C. S. Roberts, Sulphur Springs, Ky. ;

The Medals J JetonSy and Tokens lUttstrative of Sanitation. 535

G. F. Sample, Austin, Miss. ; H. C. Sauv6, Hot Springs,
Ark. ; Benjamin Sheftall, Savannah, Ga. ; T. G. Simons,
Charleston, S. C. ; T. M. Smith, Rockport, Ind. ; T. O.
Somers, Nashville, Tenn. ; A. K. Spencer, Charleston, S. C. ;
T. C. St. Clair, Vaiden, Miss. ; R. H. Tate, Cincinnati, O. ;
W. A. Tyron, Houston, Tex. ; P. Tuerke, Cincinnati, O. ;
G. W. Tucker, Dallas, Tex. ; A. G. Wendall, Minneapolis,
Minn. ; J. L. Westbrook, Newborn, Tenn. ; E. P. White,
Detroit, Mich. ; R. B. Williams, Woodbum, Ky. ; T. E.
Williams, Sherman, Tex. ; A. B. Wilks, Lebanon, Tenn. ;
R. F. Woolfolk, Orange Co., Va. ; J. Yates, Charleston,
S. C. ; S. O. Young, Houston, Tex. ; Easton Younge, Savan-
nah, Ga. ; E. T. Easley, Little Rock, Ark. ; F. Heady, Sher-
man, Tex. ; T. D. Manning, Austin, Tex. ; J. E. McGrew,
Terre Haute, Ind. ; J. C. Logan, New Orleans, La. ; J. M. White,
Atlanta, Ga. Of these eighty-two gentlemen, no less than
twenty-four, or nearly one third, died during the epidemic, in
the discharge of their self-assumed duty. May they rest in
peace. Dr. Mitchell well writes me of the survivors, " Only
those who have earned the medal can realize how greatly the
little souvenir is valued." Each medal was accompanied by
an appropriate diploma, signed by the Medical Director and
Secretary of the Howard Association, in additional testimony
of its appreciation of the services rendered to .the people of
Memphis during the epidemic. A copy of this I also owe to
the courtesy of Dr. Mitchell.

B. Spain.
a. Barcelona (1870).

1083. Obverse. An urn, upon which : R.LP. (Requies-
cat In Pace.) Upon this, a female, representing the city,
rests her left arm, and with the other holds on high a wreath.
At her feet, a cross, armorial shield, and extinguished torch.
Legend : Barcelona Agradecida.

Reverse. Within a laurel wreath : A Los | Eminentes
Servicios | Prestados En La Epidemie | De La | Fiebre Ama-
rilla I De 1870. Silver. 45 mm. Memorial Num. Espafiol,
1873, P- 62 ; P. and R., p. 152, No. 440.

The medal commemorative of the epidemic at Barcelona in
182 1 has already been described, No. 1067.

(To he continued,)

586 Ths Lea%on of a Lang Ltfe.

THE LESSON OF A LONG LIFE.

Michel Eugene Chevreul, the distinguished French
chemist who died in Paris, April Qth, 1889, at the age of one
hundred and two years^ seven months and nine days^ was the
child of healthy parents, and appears to have observed and
used the means most conducive to old age throughout his long
life. He married young, and his conjugal life is said to have
been a very happy one, but his wife died twenty-five years
ago, leaving but one child, a son, who rose to some distinction
and died recently, a retired magistrate.

Chevreul devoted himself to science from his earliest man-
hood. A catalogue, alone, of his public works would be a
considerable volume in itself. The two subjects which he
above all others did most to develop, are the chemistry of
fatty substances, giving the processes of obtaining stearine,
glycerine, etc., and the theory of complementary colors ; by
the application of his methods in the treatment of these sub-
jects alone human industry has been benefited to the amount
of many millions.

In an account of him in the Lancet^ a few years ago, it is
said : " He is generally lightly clad, and wears no hat unless
under circumstances in which he is obliged to appear in one ;
indeed, he hardly needs a hat, as he has most luxuriant hair.
He is constantly at work, allowing only ten minutes for each
of his meals, of which he has but two a day. He breakfasts
at seven, the repast consisting of a plate of meat and another
of vegetables, which he eats together, the whole being washed
down with two tumblers of water. . He is said to have never
drunk a glass of wine in his life. He dines at seven in the
evening, and takes nothing between the two meals except a
small loaf at noon, which he eats standing and by the side of
his alembics. The writer who relates this states that on a visit
to M. Chevreul he found him in the attitude just described.

The Zeisan of n Zong Life. 687

and on expressing his surprise at the frugal manner in which
he lived, M. Chevreul observed, ' I am very old * (this was in
1874), ' and I have yet a great deal to do, so I do not wish to
lose my time in eating.' In his work he is said to follow a
motto that he has chosen from a maxim by Malebranche, and
which is regarded by Nature as affording a true key to his life,
his works, and his discoveries : ' Chercher toujours Tinfailli-
bilit6, sans avoir pr6tention de I'atteindre jamais ' (' Always
to seek infallibility, without having the pretension of ever
reaching it ')."

In a sketch of him at a hundred, in the Popular Science
Monthly (Vol. XXX., p. 37), it is said : ** He drinks nothing
but water and beer, except that, by the special request of
Minister Goblet, he for the first time in his life departed from
his abstinence to drink a glass of champagne in response to
the sentiment, * Vive la France I ' at his century banquet ;
and to his temperance, with his robust constitution and his
prudent, regular, and industrious life, he doubtless owes his
survival to so high an age. ...

" The lesson has been drawn from M. Chevreul's life of what
one writer styles ' the physical wholesomeness of sustained
labor. * Cases of extreme longevity are usually found either
among persons who live in almost complete inactivity of mind,
and are thus subject to no wear whatever from their nervous
and intellectual faculties, or else among those who spend their
lives in constant, vigorous thought. Persons of the class
between these, who learn and pursue some business which in
time becomes largely a matter of routine, and ceases to call
out exertion of the powers, usually die early, or at moderate
old age. Hence, the wonderful brightness and activity which
we sometimes admire among very old persons is not so won-
derful, after all, but is a part of their old age, and one of the
causes that have enabled them to enjoy it. And the general
rule is sustained in the case of M. Chevreul, as in the case of
numerous other men who have served the world or are serving
it at ages far beyond three score and ten, that ' the harmoni-
ous development of all the many-sided aspects of man is the
most conducive to the health of the individual, and that the
training of the brain may be as valuable as the training of the
muscles.

try

Crystal Brook.

CRYSTAL BROOK.

This picture represents in part a new summer resort founded
on strictly sanitary principles.

The "backbone" of Long Island, the highlands of the
north shore, which form the southern boundary of Long Island
Sound, has long been known as a region of remarkable salu.
brity. There are all along it numerous picturesque recesses
among the well-shaded hills, reaching down to the placid
waters of miniature bays and coves, with the cleanest and safest
of shores for still-water bathing. Among them are a consider-
able number of the most delightful summer retreats of the
well-to-do of New York and Brooklyn, who have the best ap-
preciation of healthful conditions. But many still remain,
clothed with unsurpassable natural beauty. And of such, in
part at least, is the one hitherto known as Mount Sinai, so
named by the first European settlers two centuries ago, doubt-
less from an appreciation of the relative beauty of the situation
at that time, without any reference to the laws of health now
to be proclaimed therefrom and practised roundabout.

Crystal Brook. 639

Crystal Brook is a chosen tract on Mount Sinai, compris-
ing a commodious house and one hundred acres of land, taking
in the shore, with a beautiful beach for still-water bathing and
a boat landing. About one half of the area is well shaded and
at once available for its intended purpose — a Sanitary Resort
to meet the needs of nursing mothers and children who would
escape the dangers of city life in hot weather and keep well ;
and equally as a recruiting retreat for the enfeebled by wear
and tear, or by protracted illness, who would avail themselves
of the best advantages to regain health and strength ; and no
less for puny children— in short, foe all who need and would
take rest in a pure atmosphere with pure surroundings, and a
general utilization of the best natural resources, in conjunc-
tion with such artificial arrangements and competent supervi-
sion as are best calculated to promote comfort and health.

While the house is commodious and well appointed for the
accommodation of guests, it is but a small part of the sanitary
arrangements. The beautifully shaded hills are available to
an almost unlimited extent for the erection of tents and portable
houses. With the advantages of tents, as compared with close
dwellings for summer occupancy, all sanitarians are familiar ;
but knowledge of portable houses is far from being so general.
They are built in sections for facility of transportation, and so
constructed as to be erected and taken down with great facil-
ity, even by unskilled workmen. They are of various sizes,
of from one to three rooms, and may be procured at moderate
prices by guests, or provided by the proprietor.

The facilities for still salt-water bathing have already been
referred to. There is besides an abundance of the purest
spring-water, pure fresh milk, eggs, fruits, and vegetables and
other edibles suitable alike for capricious or good appetites.

Careful provision has been made for the sanitary administra-
tion of the place in all respects.

Dr. Jerome Walker, the proprietor of this institution, is
well known in Brooklyn as a medical practitioner, where he
has devoted special attention to the needs of children, and
as physician- in-chief for ten or twelve years to the Brooklyn
Sea-side Home for Children at Coney Island. He may be
relied upon as being specially competent to conduct the enter*
prise which he has undertaken, and it is sincerely to be hoped

540 Mischief 'Maher9 in Milk.

that those who most need it may be alive to its importance,
and the first to avail themselves of its benefits.

No persons are received with contagious diseases. Corre-
spondents should address Dr. Jerome Walker, No. 8 Seventh

Avenue, Brooklyn.

A. N. Bell.

Mischief-makers in Milk. — According to Professor
Vaughan, tyrotoxicon does not develop below 6o® Fahr., and
is anaerobic — grows when air is excluded. Some very simple
measures, then, are preventive :

1. Scrupulous cleanliness. A little dry milk on the rim of
a can or vessel may breed the germ which will find a culture-
ground in fresh milk.

2. A low temperature — below 6o^ Fahr.

3. Ventilation in an untainted atmosphere.

It is but just to say that these precautions are generally ob-
served by careful dairymen and cream manufacturers. There
is grave reason to fear, however, that they are not generally
observed after the milk reaches the consumer's hands. Also,
the slightest carelessness may affect seriously that class of the
community which does not speak for itself — the very youngest.

Statistics prove with increasing testimony that all artificial
feeding is not only unnatural but hazardous, and to be success-
ful requires the most intelligent attention. However, if all
mothers and nurses could learn that milk exposed to foul or
warm air for any length of time may not only sour, but be-
come the vehicle of a virulent poison, perhaps the summer
months would bear a better health record.

One word of warning may not be amiss. Whenever a young
child is fed upon cow's milk, and this causes symptoms of
disagreement, the diet should be changed at once either to
meat or rice ; for if the chief mischief-maker be at work, the
best milk will only furnish it with the medium in which it
flourishes, and, deprived of this, it will inevitably perish. — By
Alice B, Tweedy f in the Popular Science Monthly for June.

The Ideal Physician. 541

THE IDEAL PHYSICIAN.

EXTRACT FROM THE ADDRESS OF DR. LUTHUFL SEXTON,
PRESIDENT OF MISSISSIPPI STATE MEDICAL ASSOCIATION,
JACKSON, MISS., APRIL I/, 1 889.

Every ideal physician should be a Christian gentleman. It
is no compliment to any profession to be the hotbed of in-
fidelity and agnosticism. The principles of immortality and
the consolations of religion are beyond the reach of the
scalpel, but not beyond human experience. Others as learned
as we have found consolation in these doctrines, and no one
has greater need of such assistance, or a better opportunity to
teach to greater advantage the principles inculcated by the
meek and lowly Nazarene.

Leaving now those matters to which I have referred, as
being in common with the ideal man of every profession, let
us direct our attention to that peculiar characteristic which, in
my judgment, will be the crowning glory of the ideal phy-
sician of Jthe nineteenth century.

Never before, within the history of our profession, have
public hygiene and preventive medicine received the absorb-
ing attention of the profession and the laity which they do in
our day.

The superstitious expectation of our forefathers of the dis-
covery of a panacea for all ills, a veritable elixir vits, has van-
ished with other myths of the Dark Ages. And as we grow
older and wiser in our profession we realize the fact that the
bounds of specific medicine are very restricted. But being
thus forced to abandon some of our old routine practice does
not leave us empty-handed or with nothing to do.

The want of interest shown by physicians in this branch of
medicine has compelled members of other professions to band
together into Howard and sanitary associations and boards of
health, assuming to a large extent the duties and responsibil-
ities rightfully belonging to our chosen profession.

No one else is so obviously interested in the prevention of

542 ITie Ideal Physician.

disease as the physician himself. This may seem paradoxical
to some, who will say that " the treatment of disease is the
doctor's legitimate business ; that is what he is paid to attend
to, and it would be suicidal for him to occupy his time trying
to prevent the very thing which gives him employment and
maintenance."

Dr. Bowditch estimates that in the United States the an-
nual death-rate from preventable diseases is 250,000. I think
this estimate far too low. But if we estimate the actual value
of these lives unnecessarily lost at $750 each, as our political
economists do, our figures reach the frightful proportions of
$187,500,000. To these millions of dollars add the vast array
of doctors', nurses', and undertakers' bills, the pain and the
anguish of the unfortunate patients, the weary night watches
and heartaches of friends and relatives, the homeless widows
and destitute orphans, and you have not an overdrawn picture
of the result of the criminal negligence of the physicians and
citizens of the United States of America.

The painful fact is that we only comprehend or even appre-
hend these losses when they come as the result of decimating
pestilences or in epidemic forms. But day by day, hour by
hour, minute by minute, throughout the year, miasmatic or
morbific influences are assailing the vitals of the inhabitants of
this country, creating an annual loss, as just stated, of almost,
if not quite, $200,000,000 by sickness and death, which might
have been prevented, if physicians and other citizens had done
their duty.

Should some sudden calamity come upon our grain or cotton
crop, entailing such financial loss, every avenue of intelligence
would be crowded with discussions of expedients to retard the
waste or to prevent the recurrence of such destruction. Never-
theless this waste of human life and energy continues steadily
as the sand in the hour-glass, and we hear hardly a word of
sanitary warning from those who should be sanitary authorities,
and insult our Creator by attributing to his mysterious provi-
dence, or to his malevolence, evils due to our filthiness and
negligence.

It is a matter for which the profession may justly feel proud
that in every emergency there have been men in the profession
who, " when weighed in the balance, were not found wanting."

Infection h/ Books. 543

As late as 1888, when that dreaded pestilence " that walketh
in the darkness and wasteth at noonday, whose muffled foot-
steps give no warning of approach, and whose mysterious
pathway is traced by the desolation it has wrought," swept
like some dreaded simoom over our beautiful Southland, and
brooded like a nightmare over many lovely cities, knights of
the profession stood like faithful sentinels on the outpost of
duty, with a firmness and devotion unequalled in the annals of
history. Some laid down their lives as the cost, in the pres-
ence of the dread demon's " courts of death ;" others more
fortunate were restored again to home and friends, full of
honor, without a single blotch upon their bright escutcheons,
and their names are sung by the million of voices of every
smitten bower and glen, and from every sun-kissed floral vale.

He who can buckle oa bis sword
To meet the enemy of his land and race,

Content if but their health shall be restored.
To end life's journey on the battle place,

Is worthy of as bright a crown
As history can jewel for his pallid brow.

Is worthy of all honor and renown
The world concedes, and we concede it now.

Infection by Books. — In many of the European cities
extensive investigations are making to prove or disprove the
infectiousness of books handled by the sick, such as must of
necessity frequently occur in large circulating libraries. The
editor of the Christiania (Norway) Sanitary Journal^ in com-
menting on the subject, remarks that it is the universal pastime
of invalids and convalescents to read or look over books, which
if not procurable at home are brought from some library.
Even children are fond of looking at picture books, and the
editor relates the following personal experience :

" In 1846 an eight-year-old brother of my wife was taken down
with scarlet-fever and died. During his illness he frequently
amused himself by looking over a large picture book. This,
together with several other of his useful playthings, was packed
away in a chest after his death. Twenty-six years afterward,
in 1872, a sister-in-law of mine journeyed across the Channel
to England, where I was then residing, and with her came the
chest and the picture book. On the second day the chest was

544 Parasites in Aimatio Paste.

opened and the book presented to my two-year-old son.
Within the next two weeks the little fellow was taken down
with scarlet- fever. The doctors who were called in consulta-
tion wondered how the disease was contracted, as there had
been no scarlet-fever in the town for years. The circum-
stances of the book were called to mind, and the indications
were clearly that the twenty-six-year-old book had retained
the poison and communicated it to the child."

The process of disinfection now in use in Denmark and Nor-
way in many of the circulating libraries and book-stores is a
good one, and it is claimed to disinfect the books without
damaging them in the least. It consists in placing the books
fully opened out in a suitable compartment and subjecting
them to dry hot steam at a temperature of over loo^ C. for
several hours. — Winshw Anderson^ M.D.^ Pacific Medical
Journal.

Parasites in Annatto Paste. — In a recent number of
the Pharmaceutische Zeitung i^zxiMZxy 26'0^^ 1889), J. Schirmer
gives some further facts in regard to the trichina-like parasitic
worms discovered by him in annatto paste. He says : " I
have been induced to give this subject further consideration
since I have been able to prove the existence of these para-
sites in greater or smaller numbers in every sample of annatto
which I have examined. The worm is colorless, without
prominent annular markings, with blunt head and long needle-
pointed tail. It is of various sizes and keeps up a lively move-
ment under the microscope. If immersed in glycerine it is at
once killed, or at least it becomes motionless.

" This worm belongs to the order of so-called round or
thread-like worms (Nematodes). To the same group belong
also Vinegar eels (Anguellula aceti), Ascarides (human intes-
tinal worms), and Trichina spiralis. Most of these species live
in moistsoil and putrefying substances. They undergo in these
their full development. The first stage is the embryonic,
then, after encysting, the larval, and finally the sexually per-
fect creature. Almost always these latter begin to migrate
after a few days, during which they produce eggs, or living
young, which follow their parents, and in turn undergo the
same cycle of changes. ' '

Hypnotism Extraordinary. 545

Now, since, as is well known, annatto is often moistened
with urine in order to prevent drying, and since, further, the
pulp of which the annatto is made is prone to ferment, the
occurrence of these worms should not astonish us. It would,
however, be interesting to determine whether they get into
the annatto in the tropics or only after it reaches Europe.

The above observations are of interest in connection with
the fact that annatto paste has been in use for the manufac-

_ ■

ture of " Milkman's Benefit," an article which has had exten-
sive use in the milk trade to impart to skimmed and watered
milk the appearance of rich whole milk. — Boston Medical and
Surgical Journal y April \%tky 1889.

Hypnotism Extraordinary. — M. Clovis Hughes relates
in La France AUd. a case which is perhaps the most successful
example of the apph'cation of hypnotism so far recorded. A
young lady was attacked six months ago with a nervous ail-
ment which completely deprived her of the use of her voice.
Electricity was tried, and with a certain amount of success at
first, but it lost its effect after a time, and it was at length
abandoned in despair. As a last resource, her friends applied
to Dr. Berillon, the hypnotic specialist, and, after a consulta-
tion with Charcot, he decided to undertake the case. After
having brought on the mesmeric trance by the usual means,
he suggested to the patient to say " I am twenty" as soon as
she awoke. A minute afterward she opened her eyes, and at
once uttered the words without the least trace of an effort ; but
there her powers of articulation ended. The next day the
suggestion was that she should converse with the doctor, and
this she did w^ith ease, though she could not exchange a single
remark with any one else present. Finally, at the third seance.
Dr. Berillon ordered her to speak whenever and with whom-
soever she pleased thenceforward. Since that time she has
been able to use her tongue freely, and her voice is as clear
and distinct as it was before. — N. Y. Medical Times.

35

546 EdUor'9 TahU.

EDITOR'S TABLE.

I^^All correspondeifce and exchanges and all publications
for review should be addressed to the Editor, Dr. A. N. BELL,
X13A Second Place, Brooklyn, N. Y.

Subscribers will please conform to conditions of detachable
order on advertising page.

The New York Health Department's new president,
Mr. Charles G. Wilson, is said to be everything that is required
of him by the terms of the law creating thS office. That is to
say, " The Health Department shall consist of the President
of the Board of Police, the Health Officer of the Port, and
two officers to be called ' Commissioners of Health,' one of
whom shall have been a practising physician for not less than
five years preceding his appointment. The Commissioner of
Health, who is not a physician, shall be the President of the
Board, and shall be so designated in his appointment. These
several officers shall together constitute a Board "^Vx^ shall
be the headoi the Health Department.'' The italics of this
quotation are ours.

; The efficiency of the Board depends upon the competency
and co-operation of all its members, the president being in no
respect superior to his colleagues except in the dignity of
being the presiding officer. That Mr. James C. Bayles has
been superseded in this office is no reflection upon him ; his
term had expired. That he has been an accomplished and
efficient officer is conceded by all who have watched the prog-
ress of the Board during his term of service. The tenement-
house laws and regulations have been more strictly enforced,
plumbers have been required to use better material and to do
better work, the arrangements for dealing with infectious dis-
eases and the process of disinfection have been rendered more
complete, and the medical profession is believed to have more
heartily co-operated with the purposes of the Board than ever
before. These improvements are doubtless measurably due

mitar'9 TdhU. 647

to Mr. Bayles. But his contemporary, Dr. Joseph D. Bryant,
the Medical Commissioner, from former service as a sanitary
inspector was familiar with the most important department
of the practical work — that of sanitary inspection ; and this de-
partment is believed to have undergone a greater improve-
ment than any other, although yet far from being as perfect
as it should be in searching out the causes of disease in ad-
vance of their reported results*

Mr. Wilson, the new appointee, is favorably known in com-
mercial circles as President of the Consolidated Stock and
Petroleum Exchange ; has a quick comprehension of measures
before him, and a profound appreciation of the importance of
the duties of his new office, which are eminently worthy of his
best e£Forts. That the Board will be any less efficient by
reason of the change we have no reason to expec(.

A Prize for Cleanliness.— Mr. John G. Borden, a winter
resident of Florida, has offered a prize of $1000 to the city
within that State that shall be found in the most cleanly con-
dition on July 1st. It is sincerely to be hoped that the con-
testants may be numerous.

Pieces of Toilet Soap that have become too small for
convenient handling may be utilized by making a small flannel
bag, leaving the top open, and into this putting the pieces of
soap as they accumulate. When it is full sew it up and you
have a nice accessory for your bath-tub.

But for washing flannels^ of which we are reminded,

Pyle's Pearline is the best of all soap. It is readily and
thoroughly soluble in boiling or even warm water, and is con-
sequently no less adaptable to thorough cleansing than of
being thoroughly cleansed from the substance to which it has
been applied after all dirt is removed.

For cleansing flannels, it should go without saying that
they should never be rubbed or rung, but swayed about in a
moderately hot solution of Pearline until all the dirt is re-
moved, and subsequently in perfectly clean, warm water.
Then squeeze the water out by passing them under the roller
of a ** clothes ringer" or by other pressure without twisting,
which is apt to spoil the texture.

548 EMUyr'M Table.

For house-cleaning purposes Pearline is also especially ex-
cellenty because after using it in the removal of dirt of every
kind, all surfaces to which it has been applied may be thor-
oughly cleansed with pure water, without leaving behind the
sticky, insoluble deposits common to other soaps, some of
which leave more dirt than they take away. Indeed, insolu-
ble soap, which deposits the dibris of the impure and putrid
fats of which it is not unfrequently in part composed, is not
only in itself filthy, but when used in scrubbing floors, particu-
larly, is a means of accumulating other and additionally dan-
gerous filth. The use of pure soap is an essential condition to
thorough cleanliness.

Offensive Odor of the Breath due to bad teeth or
other causes may be overcome, or at the least greatly abated,
by the habitual use of Listerine. Add ateaspoonful to a tum-
blerful of water for a mouth-wash and gargle, and if a little is
swallowed, so much the better. Indeed, a bad breath is not
unfrequently caused by the gaseous eructations of indigestion,
and for this also Listerine is an excellent remedy, in doses of
twenty to thirty drops in a little water.

Ice in the Sick-room.— A saucerful of shaved ice may
be preserved for twenty-four hours with the thermometer in
the room at 90° F., if the following precautions are observed :
Put the saucer containing the ice in a soup plate and cover it
with another. Place the soup plates thus arranged on a good,
heavy pillow, and cover it with another pillow, pressing the
pillows so that the plates are completely embedded in them.
An old jack-plane set deep is a most excellent thing with
which to shave ice. It should be turned bottom upward, and
the ice shoved backward and forward over the cutter.

American Climatological Association.— The next an-
nual meeting of this Association will be held in Boston, June
24th and 25th, 1889, i"st prior to the meeting of the Ameri-
can Medical Association at Newport. Dr. V. Y. Bowditch,
of Boston, President. An interesting series of papers have
been secured, and the meeting promises to be a very successful
one.

Mitar'9 Table. 549

THE PROGRESS OF INFECTIOUS DISEASES AND MORTALITY
RATES AT THE MOST RECENT DATES, BASED UPON OFFICIAL
AND OTHER AUTHENTIC REPORTS.

Alabama. — Mobile, 40,000 : Reports 69 deaths during April,
o{ which 21 were under five years of age. Annual death-rate,
20.7 per looa From zymotic diseases, 9, and from con-
sumption, 10.

California. —For the month of April, 1889, the Secretary's
abstract of the reports received from 72 cities and towns, with
an aggregate population of 701,950, the number of deaths was
835. Annual rate, 14.16. Deaths from consumption during
the month, 138. From zymotic diseases : Diphtheria and
croup, 25 ; typhoid-fever, 23 ; typho-malarial-fever, 2 ; cere-
bro-spinal- fever, 9 ; diarrhceal diseases, 23 ; whooping-cough,
6 ; scarlatina, 4.

San Francisco^ 300,000 : During the month of April the
number of deaths was 478. From zymotic diseases, 39.
From consumption, 72.

Los Angeles^ 80.000 : 46 ; from zymotic diseases, 8 ; con-
sumption, lO.

Oakland f 55>ooo : 61 ; from zymotic diseases, 11 ; consump-
tion, 6.

San Diego f 32,000 : 12 ; from zymotic diseases, 3 ; con-
sumption, I.

Sacramento^ 3S,ooo : 26 ; from zymotic diseases, 4 ; con-
sumption, 3.

Connecticut.— The Secretary of the State Board of Health
reports for April, 1889, 1073 deaths from 166 towns, compris-
ing a population of 756,522, representing an annual death-rate
of 16.9. Deaths under five years of age, 253. Deaths from
zymotic diseases, 144. Prom consumption, 134.

Hartford^ 52,000 : total deaths, 106. From zymotic dis-
eases, 31 ; consumption, 12.

Bridgeport^ 46,000 : total deaths, 61. From zymotic dis-
eases, 10 ; consumption, 3.

Waterbury^ 34.000 : total deaths, 52. From zymotic dis^
eases, 7 ; consumption, 8.

550 Mitcr'B TaUe.

New Havetiy 85,cxx> : total deaths, 145. From zymotic dis-
eases, 15 ; consumption, 20.

Sixteenth Annual Report for 1888 : Population, 84,000 ;
marriages, 825 ; births, 2467 ; deaths, exclusive of 107 still
born, 1594; death-rate, 19.44. Three hundred and ninety-
six, or 21.7 per cent of the deaths, were caused by zymotic
diseases. Two hundred and seventeen, or 13.6 per cent,
were caused by consumption. But Professor William H.
Brewer, President of the Board, remarks, in submitting the
Report to the Common Council :

" As a member of the Board of Health since its organization
in August, 1872, I have watched the great growth and pros-
perity of the city during that period. The population of the
town was then estimated at 55,000, and the death-rate that
year was 22.34 per thousand population, or one death to each
44.7 inhabitants.

" The population in 1888 is estimated at 84,000, a gain of
58 per cent during the period, and the death-rate of the year
is 19, or one death to each 52.8 inhabitants. This is higher
than it has been since 1881, yet there were 279 fewer deaths
than would have occurred had the death-rate remained what
it was the first year of organization of the board. It is more
fair, however, to compare averages of several years, rather
than the rate of any two special years. The average death-
rate for the three years previous to the organization of the
board (1869, 1870, and 1871) was 22.7 per thousand inhabi-
tants ; for the last three years (1886, 1887, and 1888) it has
been 18. This means a saving of 394 lives per year in a popu-
lation of 84,000." Such is the result of practical sanitation —
of cleanliness : the prompt removal of all surface filth, drainage,
and sewerage ; the prompt notification and isolation of infectious
diseases, and the disinfection of things. There is room for still
further improvement in New Haven, but few cities have a
better record.

Florida. — Pensacola^ 15,000: Reports 12 deaths in four
weeks ending April 27th, 1889, of which 3 were under five
years of age. Annual death-rate, 11.26 per 1000. From
zymotic diseases there were 5 deaths.

Mitor's Talle. 551

Illinois. — Report on Medical Education, Medical Colleges,
and the Regulation of the Practice of Medicine in the United
States and Canada, 1765-1889, by John H. Rauch, M.D.,
Secretary of Illinois State Board of Health, a pamphlet of one
hundred and sixty-two pages, is the latest revise of the impor*
tant subject of which it treats. It embraces an historical
sketch of State legislation on the practice of medicine and
medical education in the United States and Canada, a Schedule
of Minimum Requirements, Summary of Institutions and
Students, together with a brief account of the efforts that
have been made and the degree of progress attained in improve
ing the standard of medical education and weeding out quack-
ery under the special direction of the author, who has accom-
plished more in this much-needed reform than any other
person.

ChicagOy 830,000: Reports 11 59 deaths during April, of
which 474 were under five years of age. Annual death-rate,
16.76 per 1000. There were 227 deaths from zymotic diseases,
and 117 from consumption.

Louisiana. — New Orleans^ 254,000 : Reports for four weeks
ending April 27th, 422 deaths, 150 of which were among the
colored population. There were 100 deaths under five years
of age. Annual death<rates per 1000, white, 19.22 ; colored,
28.65. There were 74 deaths from consumption.

Maryland. — Baltimore^ 500»343 • During the four weeks
ending April 27th there were 596 deaths, of which 195 were
under five years of age. Annual death-rate, 15.49 per 1000.
There were 47 deaths from zymotic diseases, and 86 from
consumption.

Massachusetts. — Boston, 415,000 : There were 874 deaths
during April, of which 287 were under five years of age. An-
nual death-rate, 25.27 per 1000. From zymotic diseases there
were 112 deaths, and from consumption, 138.

Michigan. — The Secretary of the State Board of Health
has just issued his sixteenth annual report for the fiscal year
ending June 30th, 1888. The first part of the report consists
of a compilation of meteorological conditions, and a contribu-

562 Mitor'9 TdhU.

tion to the study of the causes of sickness, based on weekly
reports of sickness by physicians in the State.

The most important article in the report is a paper by Dr.
Baker, in which reports of sickness and meteorological condi-
tions are so grouped as to show the relation of certain meteo*
rological conditions to diseases of the lungs and air passages.
This paper not only presents evidence concerning these dis-
eases in Michigan, but also in the United States armies, in the
native troops of India, and in London, England, for a period
of thirty years. These statistics seem to show that influenza,
tonsillitis, bronchitis, and pneumonia have one controlling
cause — the inhalation of cold, dry air. The paper explains
the order of succession of the cold-weather diseases from a
simple coryza, or common cold, to pneumonia.

Tables and diagrams are also presented showing that a few
of the communicable diseases, which, as a rule, gain access to
the body through the air passages, are quantitatively related
to the atmospheric temperature, almost invariably rising after
the temperature falls and falling after the temperature rises.
Dr. Baker's explanation of this is that the albuminous exuda-
tions which result from the inhalation of air colder than usual
supply a place favorable for the reception and reproduction of
the specific germs of these diseases.

Other articles in the report deserving special mention are a
document giving rules concerning the prevention and restric-
tion of small-pox, a report on alleged nuisances in Michigan,
and especially a paper on communicable diseases in Michigan
during the year. The reports compiled in this last article show
that in those outbreaks of scarlet-fever and diphtheria in
Michigan in which isolation and disinfection (as recommended
by the State Board) were neglected there were four to five
times as many cases and deaths as in those outbreaks where
these precautions were taken. This evidence is all the stronger
because it is in harmony with the facts collected during the
previous year. Together they indicate a saving during the
two years of 1 1, i8o cases and 1685 lives by restrictive measures
in these two diseases.

At the regular quarterly meeting of the Board, January 8th,
1889, the Secretary reported his having taken action on 85
outbreaks of diphtheria, ^7 of scarlet-fever, 48 of typhoid-

MUar's Table. 55S

fever, and one of typhus-fever during the three months ending
with December.

Compared with the preceding quarter (July, August, and
September), reports received from all sources show diphtheria
to have increased by an average of 15 places per month, scar-
let-fever to have increased by an average of 21 places per
month, typhoid-fever to have increased by an average of 6
places per month, small-pox to have increased by an average
of 4 places per months and measles to have decreased by an
average of 4 places per month.

A comparison of the meteorological conditions of the fourth
quarter of 1888 with the average of correspopding quarters in
the two years, 1886-87, shows that in 1888 the temperature
was slightly higher, the absolute humidity was slightly more,
the relative humidity and the day and the night ozone were
less in the fourth quarter of 1888.

T/ie Smead System of Disposing of Excreta was the subject of
a special communication from G. R. Brandt, principal of the
public school at Bancroft, describing the very imperfect and
offensive method, even when the greatest care is exercised by
keeping a fire in the ventilating shaft heater and opening the
basement windows. The rest will go without saying*

A toy called " Kezoo^^* and designed to be put in the mouth,
was exhibited by the Secretary, which had caused sickness in
Lansing. The part which came in contact with the mouth
was found to be covered with green arsenical paper. The
Secretary stated that frequently boxes made of arsenical card-
board were received at the office. Poisonous card-board is
not unfrequently used for tickets.

Tyrotoxicon in Oysters was reported by Dr. Kellogg. A
boy in a printing office in Battle Creek* took an oyster stew at
a restaurant at eleven o'clock at night. The stew was very
slightly warmed. In a few hours he was taken very sick with
vomiting and purging, and was sick all the next day. Dr.
Kellogg sent for some of the oysters, and obtained a good test
for tyrotoxicon. A few days afterward he sent for some more
oysters from the same restaurant, from which also he obtained
tyrotoxicon. He thought the probable reason why there
were not more frequent cases of poisoning by eating oysters
was that the tyrotoxicon was destroyed by heat in cooking.

654 Editor's TcMb.

The oysters had been received in kegs and kept open, thus
giving a good opportunity for the tyrotoxicon to develop.

For the month of April, 1889, compared with the preceding
month, the reports indicate that intermittent-fever, rheuma-
tism, and remittent-fever increased, and that influenza, pleu-
ritisy and pneumonia decreased in prevalence.

Compared with the average for the month of April in the
three years, i886-88> measles and inflammation of kidney were
less prevalent in April, 1889.

Including reports by regular observers and others, diphtheria
was reported present in Michigan during the month of Aprils
1889, at 23 places, scarlet-fever at 43 places, typhoid-fever at
5 places, measles at 14 places, and small-pox at one place.

Reports from all sources show diphtheria reported at 6
places less, scarlet-fever at 1 1 places more, typhoid-fever at 3
places less, measles at 2 places more, and small-pox at 4
places less in the month of April, 1889, than in the preceding
month.

Detroit^ 230,000 : Reports 256 deaths for April, of which
47 were under Ave years of age. Annual death-rate, 13.54
per 1000. From zymotic causes, 26, and from consumption,

31-

Minnesota. — ^Official report of infectious diseases for the
month of April, 1889 : Diphtheria, 85 cases, 26 deaths ;
scarlatina, 138 cases, 14 deaths.

Diseases of animals : Cases of glanders remaining isolated or
not accounted for, 12 ; reported during the month, 9 ; killed*
2 ; released, i ; isolated, 6 ; remaining April ist, isolated of
not accounted for, 18.

Sanitary Organtgatiou in Minnesota. — The State contains 76
organized counties, 218 cities, villages, and boroughs, 1298
townships. (These figures are constantly changing by the
organization of new villages and towns.) Of the 218 villages,
cities, and boroughs, 212 have filed notice of the oi^ranization
of a local board of health ; of 1298 townships, 1181 have filed
notice of the Board elected, March 12th, 1889, leaving 117
which, though organized, have yet to make such report.
These are reporting daily, so that all will have complied with
the law in a few days more.

MUar's IcMe. 666

St. Paul, 180,000 : Reports for April 125 deaths, of which
59 were under five years of age. Death-rate, 8.33 per looo.
From zymotic diseases there were 27 deaths, and from con-
sumption, 13.

Missouri. — St. Louis, 440,000 : Reports for April 660
deaths, of which 224 were under five years of age. Annual
death-rate, 19.17 per 1000. From zymotic diseases there were
126 deaths, and from consumption, 56.

New Hampshire. — For the month of April diphtheria was
reported to the State Board of Health from Portsmouth,
Keene, Canaan, Exeter, Laconia, Fremont, Nashua, Clare-
mont, and Manchester. Four cases, with three deaths, in
Portsmouth. No epidemic of the disease in the State.

Scarlet-fever was reported from Rochester, Rye, Nashua,
Claremont, Wakefield, Pittsfield, Manchester, and Ports-
mouth, there being six cases in the latter city. No epidemic
of the disease reported.

Typhoid-fever was reported from Rye, Amherst, Concord,
Nashua, Wakefield, Pittsburg^ and Rochester.

Measles were reported from Wakefield, and as epidemic in
Walpole.

New Jersey.— Twelfth Annual Report of the Board of
Health and Vital Statistics, 1888, pp. 503. '' The year has
been marked by no special epidemic or endemic, except that
in a few instances diphtheria has proved a serious endemic in
some localities. Even in these cases the people have seen,
when in part too late, how the closing of schools, the prohibi-
tion of public funerals and strict isolation, cleanliness, and dis-
infection would have saved many a life."

A prominent feature of the year has been the more com-
plete organization of local boards of health, and a general in-
crease of interest in the health service ; but there is still much
lacking in the equipment for dealing with infectious diseases
and facilities for their prevention — hospitals for contagious
diseases, disinfecting apparatus, facilities for bathing, garbage
destructors, etc.

Impure water supplies continue to be urged, as they have

556 Editar^B TahU,

been in previous reports, as among the most prolific sources
of preventable diseases. And relying upon the statements of
the engineers, chemists, and sanitarians of the State, certain
restrictions are recommended for the abatement and prevention
of all water-supply systems which do not comprehend stated
conditions preventive of impurity.

The relation of human and animal diseases is dwelt upon at
considerable length, suggestive of more diligent observation
in this field of inquiry than has hitherto obtained.

Under *' Laws as to Adulteration of Foods and Drugs," the
Secretary quotes approvingly a letter from President Bayles,
of the New York Board of Health, to Mayor Hewitt, nearly
two years ago, that " the adulterations usuilly encountered
are made in the interest of bulk and cheapness, and the mate-
rials used for this purpose are seldom in any other respect hurt-
ful than that they are likely to be indigestible. In the case of
liquors, even of imitation of wines into which no grape juice
enters, it has been found that if the alcohol is eliminated, only
the fruit syrups of the soda fountain remain. . . . That it is
difficult, if not impossible, to find on sale in New York a sample
of confectionery with poisonous coloring or flavoring," notwith-
standing the frequent cropping out of such cases, as the one
which has occurred within a few weeks in Brooklyn, where
about sixty persons were poisoned by eating ice-cream colored
with poisonous aniline ; and that even toys and paper tickets,
liable to being put in the mouth, as just above noticed in
the proceeding of the Michigan Board of Health, are colored
with arsenical dies. True it is there has been great improve-
ment in the quality of milk by the mere exclusion of water,
and that alcohol is undoubtedly the most mischievous ingredi-
ent of all fermented liquors ; but these truths should in no
sense detract from the importance of constant vigilance against
the use of dangerous coloring matters by both ignorant and
fraudulent users of them in a great variety of ways.

The charitable and penal institutions of the State are re-
ported upon in detail, showing considerable improvement as
compared with previous reports, but still, as common in other
States, some conditions disgraceful in the extreme — due to
such town, board, and political control as is alike devoid of
competency and principle. All such institutions should be by

EdiUyt'a TabU. 667

the aid, if not, indeed, under the sole control, of the health
authorities.

A number of excellent papers read before the State Sanitary
Association are added :

The Report on Vital Statistics is unusually full, preceded
by chapters on " Perils of Population," " How to Reckon as
to the Real or Comparative Healthfulness of Communities,"
and "Climatology," which summarizes the conditions of the
variable health of communities.

Population (census of 1885), 1,278,033 ; marriages, 16,025 ;
births, 20,074; deaths, 27,173. Ten thousand five hundred
and eight (exclusive of 1739 still born), or 38.63 per cent of the
deaths, swere of children under five years.

Deaths from consumption, 3358. From zymotic diseases :
Remittent-fever, 264 ; typhoid-fever, 620 ; small-pox, 5 ;
scarlet-fever, 574 ; measles, 74 ; whooping-cough, 161 ; diph-
theria (and " croup*'), 2036 ; erysipelas, 128 ; diarrhoeal dis*
eases, 3508 ; puerperal diseases, 271 : 8640, or 31.8 per cent.

" Of the 10,508 that died under five years, 7455 died in the
larger cities. Total death-rate from consumption for the
State, as compared with the total death-rates, 12.44, the
deaths being 2236 in cities, 1122 outside. Rates for short
periods, or which deal with small numbers, are only approx-
imate, since temporary causes may have been in operation,
and small numbers do not eliminate or balance errors which
practically disappear in large aggregates. The number of
deaths before twenty, in proportion to the rest, is much more
informatory as to local causes affecting health than the total
deaths.

"... Valuable contrasts can be drawn between such cities
as Jersey City and Plainfield, or Newark and Orange. No
one can study these statistics, as recorded from year to year,
without seeing how artificial is the shortening of human life.
A death-rate of 26.82 in Hudson County and of 11.65 ^^ Sus-
sex County means something more than mere location."

Hudson County^ 282,254 : Reports 544 deaths for April, of
which 236 were under five years of age. Annual death-rate,
23.1 per 1000. From zymotic diseases there were loi deaths,
and from consumption, 60.

Pater son^ 80,000 : Reports 126 deaths during April, of which

S58 MUor'9 TtMe.

49 were under five years of age. Annual death-rate, 18.9 per
icxx>. There were 13 deaths from zymotic diseases, and 18
from consumption.

Newark^ 182,457 : Reports 371 deaths during April, of
which 146 were under five years of age. Annual death-rate,
24.46 per 1000. From zymotic diseases there were 59 deaths*
and from consumption, 39.

New York. — The reported mortality was considerably less
in April than in March, which was also the case in 1888. The
rate of infant mortality is less than in March, but still con-
tinues higher than that of last year. The differences are
mainly due to scarlet- fever, measles, and whooping-cough, the
mortality from which is relatively about the same as reported
upon in the last issue, both in proportion and distribution.
Two deaths occurred from small-pox, both in Geneva ; it has
been reported from no new locality, and has, probably, ceased
to exist in all heretofore reported. The proportion of deaths
from all zymotic diseases is a little higher than in March and
the average for the preceding quarter. From . consumption
there were 120 deaths in each 1000 deaths from all causes
(twelve percent), and 183 in each 1000 deaths above five years
of age.

New Yarky 1,571,558 : Total deaths, 3593 ; under five years
of age, 1544; annual rate, 27.80. Zymotic, 816; consump-
tion, 426.

Brooklyn^ 821,525 : Total deaths, 1517 ; under five years of
age, 667 ; annual rate, 22.47. Zymotic, 301 ; consumption, 187.

Buffalo^ 230,000 : Total deaths for four weeks ending April
27th, 344; under five years of age, 134; annual rate, 19.50.
Zymotic, 45 ; consumption, 43.

Rochester^ 110,000: Total deaths, 175 ; under five years of
age, 60; annual rate, 19.10. Zymotic, 30; consumption, 17.

Albany^ 103,000 : Total deaths, 194 ; under five years of
<^gCt 51 t annual rate, 22.60. Zymotic, 34 ; consumption, 23.

Syriuuse^ 80,000 : Total deaths, 124 ; under five years of
age, 30; annual rate, 18.72. Zymotic, 14; consumption, 18.

The five cities or towns reporting the highest mortalities
are : New Utrecht, 51.20 ; Newtown, 42.0 ; Marbletown, 42.0 ;
Sag Harbor, 36.0 ; Clyde, 36.0.

E&Uor'9 TcMe. 559

The five lowest mortalities are : Phelps, 3.42 ; Canandaigua»
3.8 ; Salamanca, 6.0 ; Lockport, 6.4 ; Cortland, 6.67.

North Carolina. — Second Biennial Report of the Board
of Health, 1887-88^ is a volume of 191 pages. The work of
the Board is still confessedly confined to elementary princi-
ples, but by persistent effort much progress has been made
during the last year, particularly in securing the co-operation
of physicians and educating the people throughout the State
on the importance of practical sanitation. The number of
counties reporting has increased from 42 in April, 1887, to 58
in January, 1888, and the number is still slowly increasing.
No epidemics have prevailed extensively, and such as have, to
a limited degree, have been accounted of in our monthly ab-
stracts from the Bulletin^ as also of the account of the disturb-
ance created in travel and trade created by the Florida epi-
demic of yellow- fever. The report endorses and urges the im-
portance of prompt notification and isolation of persons and
disinfection of premises, as the only safe methods in dealing
with all pestilential diseases. Appropriation for the better
equipment of the maritime station for the prevention of the
introduction of pestilential disease at the mouth of the harbor
of Wilmington, especially for the erection of the hospital for
the care of the sick and disinfecting apparatus for the treat-
ment of vessels, is urged as a commercial necessity against
otherwise heedless and dangerous detention of both persons
and vessels. Hygienic teaching in the public schools and im-
provement in the sanitary condition of State and county pub-
lic buildings, poor-houses, jails, asylums, etc., have engaged
the constant attention of the Board, with encouraging results.
Considerable attention has been given to the disposal of gar-
bage in the more densely populated districts, and cremation
is especially recommended as the best means. A good de-
scription, with illustrations, is given of the Engle Crematory,
which is said to be in successful use in Des Moines, Minne-
apolis, and several other places. Appended are several special
contributions by members of the Board and others : *' Prelim-
inary Inquiry into the Causes of Death in North Carolina, and
some Suggestions about the Future of Prevention/' by
Thomas F. Wood, M.D., Secretary of the Board; "The

660 Editor's Table.

Contamination of Foods with Metallic Poisons," by F. P.
Venable, Ph. D., F.C.S. ; " The Sewerage of Cities and
Towns," by J. L. Ludlow, C.E., M.S.

During the month of April, 1889, in fifteen cities and
towns, aggregating a population of 83,650, there were 133
deaths, 37 of which were under five years of age. Annual
death-rate, 19.07 per 1000. Deaths from typhoid-fever, 2 ;
malarial-fever, 4 ; diphtheria, i ; measles, i ; diarrhceal, 6 ;
consumption, 10.

Wilmington, 23,000 : Reports for April 29 deaths — 1 1 under
five years of age. Death-rate, 14.4 per 1000.

Raleigh, 15,000 : Reports for April 22 deaths — 5 under five
years of age. Death-rate, 16.8 per 1000.

Ohio. — Fifty-five cities and towns, with an aggregate popu-
lation of 1,146,100, report 1577 deaths during the month of
March, of which number 497 were under five years of age.
Annual death-rate per 1000 was 16.52. From zymotic dis-
eases there were 246 deaths, and from consumption, 200.

Cincinnati, 325,000 : Total deaths, 520 ; under five years of
age, 185 ; annual rate, 19.20. Zymotic, 82 ; consumption, 66.

Cleveland, 235,000 : Total deaths, 383 ; under five years of
age, 145 ; annual rate, 18.70. Zymotic, 57 ; consumption, 43.

Columbus, 101,000: Total deaths, 102; under five years of
age, 28 ; annual rate, 12.08. Zymotic, 19 ; consumption, 16.

Toledo, 80,000 : Annual Report for 1888 : Total deaths,
1095 ; death-rate, 13.69. Deaths from zymotic diseases, 238
— 21.73 P^"* c^^^ o^ total; from consumption, 126 — 11 per
cent of total. These figures are evidence of excellent practical
work.

For the month of March : Total deaths, 100 ; under five years
of age, 29 ; annual rate, 15.00. Zymotic, 15 ; consumption, I2.

Dayton, 60,000 : Total deaths, 58 ; under five years of age,
II ; annual rate, 11.6. Zymotic, 4; consumption, 12.

PE^iiSYLVASlA.—PAiladelpAia, 1,040,245 : Reports for four
weeks ending April 27th, 161 1 deaths, of which 389 were under
five years of age. Annual death-rate, 20.13 per looo. From
zymotic diseases there were 136 deaths, and from consump-
tion, 218.

MiUyr's Table, 561

Rhode Island. — The number of deaths recorded in the
different to^vns and cities, from which returns have been re-
ceived, was 465 y in an estimated population of 306,263.

The annual death-rate upon the estimate given is 17.4 in
every thousand of the population. The death-rate is some-
what smaller than for the previous month. The general sickr
ness throughout the State was reported less during April than
in March.

Providence. — Annual Report, 1888 : Population, 123,000 ;
deaths, 2608 ; death-rate, 21.48. The number of deaths from
consumption, 359, or 13.3 per cent of the whole number. Two
hundred and seventy-one, or 10.3^ per cent of all deaths, were
caused by diarrhoeal diseases, though " the number of deaths
among children under one year of age was less than for several
years — 16.71 per cent against an average of 19.61 for an aver-
age for thirty-three years. Deaths respectively from diph-
theria, 98 ; scarlet-fever, 80 ; typhoid-fever, 103. The num-
ber of deaths from typhoid-fever in December was 47 — the
largest number in any month since November, 1882, when
there were 70. It was attributed to the pollution of the
Pawtuxet at Natick, where there had been two or three cases of
typhoid-fever in the valley of the river during the autumn
months, three and one quarter to three and one half miles
above the pumping station. " The city engineer estimates
• that during high water, when the water is flowing over the
dams, the flow must be nearly 600,000,000 gallons daily. It
is certain that during the rains of November it must have
been fully this amount.

*' It has been objected that it is utterly incredible that such
a very small amount of infecting material could have contam-
inated such a large body of water. And it must be confessed
that it does not on the face of it look at all probable. It is
also objected that if the polluted water was the cause of the
fever more persons should have suffered from it, there being,
to put it in round numbers, scarcely 300 cases in 100,000 per-
sons. But it seems to me that these objections counterbalance
and explain each other. The reason that so few were attacked
was owing to the enormous dilution of the poison. The
poison, if it had once entered the water, would not be lost, no
matter how great the dilution (though it would probably be
36

562 MUor'a TahU.

destroyed after the lapse of a certain time). The more dilute
it was the smaller would be the number of persons affected by
it."

Newport^ 22,000 : Reports for the month of April 28 deaths,
9 under five years of age. From zymotic diseases, 3, and from
consumption, 3. Annual rate, 15.27. Number of cases of
contagious diseases reported, 5.

Tennessee. — The State Board Bulletin for April reports
the principal diseases, named in the order of their greater prev-
alence, in the State for the month of April were pneumonia*
malarial-fever, tonsillitis, catarrhs, rheumatism, bronchitis,
consumption, pleurisy, dysentery, and diarrhoea.

Mumps is reported in the counties of Carroll, Gibson, Har-
din, Henderson, Madison, Montgomery, Robertson, Shelby,
Stewart, Wayne, and Williamson. Typhoid-fever in David-
son, Franklin, Knox, Maury, Pickett, Robertson, Sequatchie,
Shelby, and Sullivan. Erysipelas in Carroll, Hamilton, Henry,
Houston, Maury, Washington, and Williamson. Measles in
Gibson, Henderson, Henry, Madison, Sequatchie, and Wayne.
Scarlet-fever in Davidson, Knox, Robertson, Shelby, and
Tipton. Whooping-cough in Davidson, Gibson, Houston,
and Maury. Diphtheria in Davidson, Hamilton, Shelby, and
Williamson. Croup in Knox, Shelby, and Sullivan. Men-
ingitis in Hardeman and Shelby. Chicken-pox in Hamilton.
Cerebro- spinal meningitis in Maury.

In the chief cities the respective annual death-rates for the
month per 1000 of population are reported as follows :

Chattanooga, \

vhitc

?, 7.1 1 ; coli

3red, 21.23 : 11.70

Clarksville,

9.60;

*' 16.00 : 12.00

Columbia,

20.00 ;

12.00 : 16.80

Knoxville,

8.83;

22.90 : 1 1. 71

Memphis,

17.46 ;

30.39 : 23.34

Nashville,

9.46;

18.51 : 12.70

Memphis. — Dr. G. B. Thornton, President of the Board of
Health, reports for 1888 : Population, white, 30,277 ; colored,
25,267: 55,494. Deaths, white, 745; colored, 795: 1540.
Death-rates, white, 24.64; colored, 31.46: 27.75. Three
hundred and sixty-nine — 175 white and 194 colored, or a little

Mitor's Table. 563

less than 24 per cent of the total, were caused by zymotic dis-
eases ; of which there were from diarrhoeal diseases, 125 ;
malarial-fever, 93 ; typhoid- fever, 45 ; diphtheria, 23. Deaths
from consumption, white, 86 ; colored, 122 : 11.54 per cent of
the deaths from all causes of the white population, and 15.72
per cent of the deaths from all causes of the colored.

Much gratification is expressed at the recent solution of the
long-pending question with regard to the public water supply,
by the sufficiency and purity of that which is now obtained
from artesian wells. " Secretary Cameron, of the Water Com-
pany, states that there are thirteen wells now in use and six
more in process of being sunk. That the daily output of the
company is 8,000,000 gallons, with no perceptible impression
on these wells. The quality oi the water, after analysis made
by Dr. Charles Smart, U. S. A., and Professor Mallet, of the
University of Virginia, is pronounced exceptionally good, and
in every respect suitable for a public water supply."

Important modifications in the sewerage system are urged
before additional extensions are made, and if possible before
the recurrence of warm weather. The report states that some
of the mains and submain lines are too small, and conse-
quently overcharged the year round.

Garbage disposal is now an animated question, but negotia-
tions are in progress for its early solution by the erection of a
cremator.

Sanitarians generally will regret to learn that with this re-
port Dr. Thornton retires from the field of sanitary work. He
has declined to be any longer the executive, or a member of
the Board of Health of Memphis, has resigned from the State
Board of Health, and has declared his purpose to devote his
time hereafter exclusively to curative medicine. But to him
more than to any other one person is due the now compara-
tively uneventful life of the medical practitioner in Memphis.
From 1878 to the close of his work, both as medical practi-
tioner and as practical sanitarian. Dr. Thornton has stood
among the foremost in the battle for the redemption of Mem-
phis. In the first place, in his contention against the most
devastating and relentless of foes ; and, secondly, in persist-
ently urging to a successful issue the application of such sani-
tary measures as have raised Memphis from a bed of death

564 Editor's Table.

and placed her in the front rank of progressive cities. It may
be truly said that, with such a record, Dr. Thornton can afford
to retire. But whether Memphis can afford to do without him
depends upon how well those who succeed him may maintain
and continue to promote the good works now so full of
promise. ,

Wisconsin. — Milwaukee^ 210,000 : Reports for the month
of April 270 deaths, of which 66 were under five years of age.
Annual death-rate per 1000, 15.4. From zymotic diseases
there were 43 deaths, and from consumption, 19.

Small-pox. — The number of deaths reported from small-
pox in foreign cities during the three months ending March
31st, 1889, according to the returns before us, was as follows
Bradford, i ; Paris, 42 ; Lyons, 38 ; Marseilles, 34 ; Bordeaux
2 ; Havre, 27 ; Rouen, 10 ; Nancy, 8 ; Nice, 2 ; Limoges, 5
Besangon, i ; Gand, 3 ; Liege, 4 ; Bruges, 4 ; Tournai, i
Ostend, 283 ; Boulers, 9 ; Ypres, i ; Montigny, 4 ; Boone, 3
Quaregnon, 11 ; Iseghem, i ; Boussu, i ; Hornu, 3 ; Arlon
44 ; Furnes, 2 ; Dixmude, 4 ; Vienna, 4 ; Prague, 220
Trieste, 29 ; St. Petersburg, 3 ; Warsaw, 1 1 ; Odessa, 1 1
Venice, 31 ; Bucharest, 31 ; Jassy, i ; Cairo, 19 ; Alexandria, 5.

Cholera. — During the four weeks ending April 19th, the
number of deaths reported from cholera was 7 ; in Madras,
during the three weeks ending March 15th, 19; in Calcutta,
during the week ending March i6th, 23.

Yellow-fever. — Havana : The number of deaths reported
from this disease during the month of April was 18 ; the num-
ber of deaths from all causes was 493.

Rio de Janeiro (from Surgeon-General Hamilton's Weekly
Abstract) : During the week ending March 31st, 26 ; the num-
ber of deaths from all causes was 423.

Carthagena: During the week ending March 23d, 2.

Literary Notices. 566

LITERARY NOTICES.

TRANSACTgONS OF THE CONGRESS OF AMERICAN PHY-
SICIANS AND Surgeons. First Triennial Session, held at
Washington, D. C, September i8th-2oth, 1888. 8vo,
pp. 432. Published by the Congress. William H. Carmalt,
M.D., Secretary. New Haven, Conn.

This is a volume of unusual excellence both in the selection
and the treatment of the subjects which it embraces. It opens
with a brief historical sketch of the union of the following
special associations, as the basis of the organization of the
Congress : American Surgical, Ophthalmological, Otological,
Neurological, Laryngological, Gynecological, Dermatological,
Climatological, and Clinical and Pathological Associations, to
meet triennially at the same time and place jointly.

It is gratifying to observe in the introduction that the
allegation which was somewhat extensively circulated at about
the time the movement for this organization was initiated,
that it was antagonistic to another, is wholly disclaimed.

The work of this first Congress was chiefly confined to two
comprehensive subjects, as follows :

" The Diagnosis and Medical Treatment of Acute Intestinal
Obstruction," by Reginald H. Fitz, M.D., of Boston; " The
Surgical Treatment of Intestinal Obstruction," by N. Senn,
M.D., Ph.D., of Milwaukee, and the discussions thereon by
several of the most distinguished medical and surgical practi-
tioners of the United States and from abroad, comprising
about half the volume, in which is presented the most com-
plete analysis and treatment of this important subject hitherto
published.

" Cerebral Localization and its Practical Relation," by
Charles K. Mills, M.D., of Philadelphia; "Surgery of the
Brain, Based on the Principles of Cerebral Localization," by
Roswell Park, A.M., M.D., of Buffalo, and the discussions
thereon, which take up most of the remainder of the volume,
of scarcely less importance than the preceding. Next follows

566 LUermry Notices.

the Address of the President, John S. Billings, M.D., Surgeon
U. S. A., " On Medical Museums, with Special Reference to
the Army Medical Museum at Washington," with which the
volume concludes — an admirable historical and descriptive
sketch, particularly appropriate to the proceedings of this first
meeting of the Congress.

Lectures on Nervous Diseases, from the Standpoint
OF Cerebral and Spinal Localization, and the Later
Methods Employed in the Diagnosis and Treatment
OF these Affections. By Ambrose L. Ranney, A.M.,
M.D., Professor of Anatomy and Physiology of the Nervous
System in the New York Post-graduate Medical School and
Hospital ; of Nervous and Mental Diseases in the Medical
Department of the University of Vermont ; late Adjunct-
professor of Anatomy in the Medical Department of the Uni-
versity of the City of New York ; Member of the New York
County Medical Society ; author of the '* Applied Anatomy
of the Nervous System," " Practical Medical Anatomy,'*
" Electricity in Medicine," etc., etc. Profusely illustrated.
8vo, pp. 792. Price, $5.50. Philadelphia, Pa. : F. A. Davis.

The author of this work has long been known as a contrib-
utor to the subject of which it treats, herein systematized
and fortified by a liberal use of that which has been written
upon it by other observers ; but in the arrangement of the
subject it radically differs from any other work that has fallen
under our observation. It takes up, firstly, the anatomical,
physiological, and pathological conditions, as the essential
basis of all that is known of cerebral and spinal localization.
Secondly, there is given a risumi of the practical conclusions
deducible from the facts elicited by the foregoing descriptions,
and, thirdly, treats of individual diseases of the brain and
spinal cord from a clinical standpoint — the localization of the
lesions described. " Functional " nervous diseases follow,
with special reference to the researches of Dr. George T.
Stevens respecting the bearings of " eye-defect," etc. Elec-
tricity is fully treated of as a special agent in neurotherapeu-
tics, and very fully illustrated, as, indeed, is all the rest. The
illustrations are numerous and excellent, and the work alto-
gether is well gotten up.

Literary Notices. 567

Fasciculus XIII. : Atlas of Venereal and Skin Dis-
eases, WITH Original Text by Prince A. Morrow,
A.M., M.D., and others, maintains the same degree of excel-
lence as tlie preceding numbers before reviewed. This num-
ber contains five plates true to nature, as follows : Elephan-
tiasis of the Leg and Scrotum ; Leucoderma, Alopecia Areata ;
Keloid, Fibroma ; Xanthelasma, Rhinolascleroma ; Xeroderma
Picmentosa, and a lucid descriptive context. Complete in
fifteen parts — two more only to appear — each containing five
folio chromo-lithographic plates, many of them containing
numerous figures, all printed in flesh tints and colors, together
with descriptive text for each plate. Subscription price, $2 a
part. New York : William Wood & Co.

Diphtheria : its Nature and Treatment, by C. E. BiL-
lington, M.D., and Intubation in Croup, and other Acute
and Chronic Forms of Stenosis of the Larynx, by JOSEPH
O'DWYER, M.D. 8vo, 326 pp. Price, muslin, $3.50. New
York : William Wood & Co.

This is a work of much importance, summing up the most
recent practical knowledge on the, at present, most universally
prevalent of infectious diseases. The recent progress made
by Loeffler, Roux, Yersin, Prudden, and others into the true
etiological nature of the disease by their biological researches
and experiments as here given, show that we are, at the least,
on the eve of a clear recognition of tfie bacillus against which
all sanitarians will be called upon to make war. But mean-
while the author would not have it forgotten that the intro-
duction and prevalence of the disease is closely related to
unsanitary conditions — to filth of every kind — and the more
during cold and damp weather. Notwithstanding, from its
well-known contagiousness, when once introduced, it is liable
to prevail independently of all local and climatic conditions.
Its greater prevalence among children than adults is attributed
by the author " mainly to the softness and delicacy of their
mucous membranes, which are consequently especially sus-
ceptible to irritating influences, penetrable by morbific poisons,
and liable to inflammatory affections in general.'* This ex-
planation is illogical when applied to the same degree of exces-
sive liability of children to several other diseases against

568 Literary Notioes.

which, in common with diphtheria, the power of resistance by
children, compared with adults, is alike feeble — probably on
account of physiological conditions. Moreover, the increased
proneness of children enfeebled by other diseases to contract
diphtheria, which the author recognizes, strengthens this view.
The results of bacteriological investigations are briefly stated,
from which the author concludes that diphtheria is caused by
a parasite, of which he gives a description, but " no bacterium
thus far discovered in connection with diphtheria can furnish
by its presence or its absence a reliable criterion for diagnosis."
Primarily, he believes the disease to be local in its attack,
occurring first, in the great majority of cases, upon the outer
avenues of entrance of inspired air and of food and drink, and
with the greatest relative frequency in exactly those positions
where particles of matter introduced by them would most
naturally be deposited, which fact suggests a probability that
the disease is directly and locally caused by such contact or
implantation ; the constitutional affection is consecutive. A
good deal of space is taken up under several heads with an
endeavor to show the difference between diphtheria and croup,
contrary to the more general conclusion of other observers,
but it appears to be a distinction without a difference, in
either pathological conditions or results of treatment. Pro-
phylaxis, treatment, and disinfection are well summed up in
relation with the best results.

The chapter on Intubation, by Dr. O'Dwyer, gives a very
Complete history and description of this operation, which he
has done more than any one else to introduce and perfect.
The work is well illustrated, gotten up in the excellent manner
common to the publishers, and eminently worthy the atten-
tion of all medical practitioners and sanitarians.

The Medical Student as Pictured in " Punch." Smith.
The London Medical Student. By Albert Smith. i2mo.
cloth, so cents. New York : John B. Alden, This is a very
entertaining book for doctors, as a pillow-soother at the end
of a hard day's work, reminding them of the joyful anticipa-
tions of professional life. It follows the career of a student in
a London medical college in a broadly humorous manner, from
his outset to the appearance of the "new man," when he

Literary Noticea. 669

comes up from the country to continue his medical studies ;
and the zeal with which he enters upon his new duties is de-
lineated in a laughable manner. His subsequent course^ his
dodging of recitations, the letters home for money with which,
ostensibly, to purchase books, his examination, and the vari-
ous ** Curiosities of Medical Experience,*' follow in a similar
strain. The work is reprinted from Punchy in which it ap-
peared as a serial.

Alden's Manifold Cyclopaedia of Knowledge and
Language. Vols. V., VI., and VIL, from Bilbilis to Ce-
vennes, with numerous illustrations, fully sustain our previous
comments on its excellence. Along with its manifold number
of words and topics treated briefly, there are many extended
articles, as for instance, Book-trade, twenty-one pages ; Bos-
ton, ten pages ; Brazil, seven pages ; Breech-loading Guns,
eleven pages ; Bridge, eleven pages ; British Museum, ten
pages ; Brooklyn, five pages ; Buddhism, fifteen pages ; Cali-
fornia, sixteen pages ; Cattle-plague, eleven pages ; Cell
Theory, eleven pages. While so full, its exceeding handiness
gives it very great advantage as compared with the bulky vol-
umes of other cyclopaedias, and greatly adds to 'its usefulness.
The publisher sends specimen pages free to any applicant, or
specimen volumes, which may be returned if not wanted, for
60 cents for cloth binding, 75 cents for half Morocco, post-
paid ; the better binding is particularly commended. John
B. Alden, Publisher, 393 Pearl Street, New York, 218 Clark
Street, Chicago.

Electricity in Facial Blemishes. By Plvm. S. Haves,
A.M., M.D., late Professor of Chemistry and Toxicology,
Woman's Medical College ; Professor of Analytical Chemistry,
Chicago College of Pharmacy ; of Gynecology and of Elec-
tro-Therapeutics, Chicago Polyclinic, etc., i2mo, pp. 128, is
a monograph on a subject well calculated to interest phy-
sicians on the practicability of electrolysis for the removal of
superfluous hair and other superficial blemishes. It describes
the anatomy of the skin, the electrical apparatus, and its mode
of application with clearness, illustrated with numerous cuts.
Chicago : W. T. Keener.

570 Medical Hccerpt,

MEDICAL EXCERPT.

Saccharin as an Antiseptic— Dr. Constant in Paul
thinks that if saccharin should be interdicted as an aliment, it
might, on the contrary, be utilized as a medicament, and prin-
cipally as an antiseptic. In this last point of view, it is sus-
ceptible of preventing the ammonlacal fermentation of the
urine, as well as the development of the micro-oi^nisms of
pus or of puerperal-fever. It may be utilized, for example,
as a dentifrice or antiseptic for the mouth. A teaspoonful of
an alkaline solution with six per cent of 'saccharin in half a glass
of water constitutes a good dentifrice. It may be utilized also
for the washing of the stomach, and it may be advantageously
substituted for boric acid for washing out the bladder. — Paris
Letter^ Boston Medical and Surgical youmal^ May 2^, 1889.

Beta-NAPHTHOL has recently been administered in three
one-fourth grain doses, repeated every two hours, to some
patients suffering with typhoid-fever. The results obtained
appear to have been, almost without exception, extremely
satisfactory — this internally applied antiseptic reducing the
temperature, rendering the breath, skin, and excreta compar-
atively sweet, and, generally speaking, lessening fetor and
otherwise promoting recovery. Even the period of the disease
seems to have been shortened in those instances where the
drug was given, as compared with others where it was not
used. Only in two cases, some gastric irritation occurring, it
was found expedient to alter the treatment, and in each in-
stance a relapse took place on the intermission of the beta-
naphthol. The alpha modification, which is now said by some
inquirers to be less liable to cause irritation of the mucous
membrane of sensitive patients, does not appear to have been
tried. — London Letter^ American Practitioner.

m

Dermatoses Following Mental Shock.— A lady, after
witnessing a violent assault upon her husband, was much pros-
trated by the fright, and three weeks later a bullous eruption.

Medical Eccerpt 571

having the characteristics of foliaceous pemphigus and accom-
panied by incessant pruritus, made its appearance. Another
case was a little girl who was rescued from burning, and re-
mained for some time in a condition of prostration from fright.
A month afterward a pemphigoid eruption made its appear-
ance on the body, disappeared under treatment, but reap-
peared again several times. A third case was that of a woman
who became very much excited in a quarrel with her husband.
A few days afterward an exudative erythema made its appear-
ance on the arms, hands, and feet ; and vesicles on the lips.
E. de Smet has recorded cases of purpura hemorrhagica from
the same cause. — Progrh midicale.

Cardiac Medicaments. — Various experiments having been
performed with certain cardiac medicaments, the following re-
sults have been attained with three of the principal — viz.,
digitaline, strophanthin, and sparteine. In some cases, which
are rare, where a strong impulse is necessary to excite the
functions of the heart, strophanthin will be employed with suc-
cess. Sparteine is the stimulant par excellence of the contrac-
tion of the heart, only it does not modify the arterial pressure.
But neither the one nor the other of these medicaments will
surpass digitaline, which acts distinctly, although very moder-
ately, on the sanguineous pressure, while at the same time it
regulates the contractions of the heart. The recent works of
Dr. Laborde, the eminent physiologist, give support to this
assertion. — Paris Letter^ American Practitioner.

Phenic Acid in Malignant Pustule. — Contento recom-
mends very warmly the treatment of malignant pustule by
means of hypodermic injections of a three per cent solution of
carbolic acid, from the very good results he obtained. This
method has also been tried by Maffuci, Raimbert, Gallozzi,
and others. He employed this treatment in six very grave
cases of malignant pustule, of which he gives a full history.
He injects the solution round about the centre of the pustule
about one centimetre removed from the line of demarkation
at about one and a half centimetre from each other. Besides
that, he injects a couple 6f syringefuls directly into its centre.

The number of injections made at one sitting varies, accord-

573 Medical Eaooerpt.

ing to the size of the pustule, from six to twenty-five. Usually
after twenty-four hours such a striking improvement takes
place that repetition of the injections is rarely necessary. — Dr.
ContentOy Gazzetta degli ospitali^ xxviii., 1888.

Acute Pancreatitis.— Dr. Reginald H. Fitz lately deliv-
ered an interesting lecture upon this subject, and his con-
clusions are as follows, he believing that the evidence he
has presented is intended to establish the fact that acute in-
flammation of the pancreas is both a well-characterized disease,
and one which is much more frequent than is generally
thought. It is of great consequence that it should be recog-
nized, for the following reasons. It represents a serious com-
plication of what, by itself, is a relatively simple affection —
viz., gastroduodenitis. It is an important cause of peritonitis,
and one readily overlooked. It has been repeatedly con-
founded with acute intestinal obstruction, and has thus led, in
several instances, to an ineffective laparotomy ; an operation
which, in the early stages of this disease, is extremely hazard-
ous.— Cincinnati Medical News.

REED & CARNRICK'S SOLUBLE FOOD.

Nsw York City, November 9, z888.
Messrs. Reed & Carnrick.

Gentlemen : In recognition of the courtesy shown us by
your invitation to visit your laboratory at Goshen and person-
ally observe the several successive steps in the process of pre-
paring your Soluble Food, we desire to express our thanks.
We were very forcibly impres ed with the precaution exercised
in obtaining practically sterilized and partly digested milk,
and the absolute cleanliness observed throughout the entire
process. We unhesitatingly endorse your Soluble Food^ and
shall continue prescribing it for our babies. Edward Molitor,
M.D., Somonauk, 111. ; J. Gill. Allan, M.D., Shelbyville, Ky. ;
J. D. Herrmann, M.D., Eastman, Ga. ; S. T. Turner, M.D.,
El Paso, Tex. ; J. I. McConnell, M.D., Chattanooga, Tenn. ;
J. C. B. Justice, M.D., Ashville, N. C. ; B. Z. Henslee,
M.D., Dickson, Tenn. ; W. G. Ferguson, M.D., Hughesvilie,
Mo. ; J. H. McDuffee, M.D., Keyser, N. C. ; W. H. Hud-
son, M.D., La Fayette, Ala. — From New York Polyclinic
School.

INDEX.

Adams J. W., C.E., "The Fatnre of

the New York Water-Snpply, " 26.
Aged One Hundred and Nine, 868.
Alimentary Sabstances, An Interna-
tional Exhibition of, 152.
AniBathetiata, A Warning to, 96.
Anderson, E. H.. M.D., Local Condi-
tions and YeUow-Fever-— Jackson^
Miss., 214.
Anderson, Winslow, M.D., Infeotion

by Books, 548.
Annato Ftote, Parasites in, J. Schirmer,

644.
Antipyrin, Antibacterial Action^ 185.
Antiseptic, an, Otycyanide of Mercury

as, 186.
Antiseptics^ Comparative Efficacy, 94.
Antiseptics, Incompatible, 379.
Ashmun, G. C, M.D., What is Bani.

tation ? 49.
Associations, CoMYKNTiom, Etc. :
American International Congress of
Medical Jurisprudence, 384 ;
American Medical Association,
883 ; Conyention for the Berision
and Publication of the U. 8.
Pharmacopoeia, 384 ; Hungarian
Public Health Association, 469 ;
International Exhibition of Ali-
mentary Substances, 152 ; Medi-
oal Society of the State of New
York, 353; North Carolina Sanitary
Convention, 223 ; Ohio State Sani-
tary Association, 47; Quarantine
Conference at Montgomery, Ala.,
262 ; Americal Climatological, 548.

Bacteria in Water, Smart, 490.
Bacteria, Pathof^enic Origin and

Sources of, Smith, 110.
Beehler, W. H., Use of Oil to Still the

Waters, 305.
BeU,A. N., A.M., M.D., Malaria and

the Causes of Fever in N. Y., 432.
Bell, A. N., Crystal Brook, 538.
Beta-Naphthol, 570.
Blood, A Simple Test for, 190.
Board of Health, A National. 150.
Boards of Health, Local, and Sanitary

Condition of Public Institutions,

Improvement of. Report, 230.
Breatii, Offensive Odor of, 548.
Bromidia as a Hypnotic, 473.
Bums, Cocaine and Lanolin for, 381.

Calomel as a Diuretic. 381.

Camphorated Naphthol,94.

Cancer, An Alleged Increase of, 190.

Canned Goods, How to Use, 64.

Cardiac Medicaments, 671.

Cardiac Tonics, 286.

Cataract of Glaiasmakers, 161.

Centenarians, Levasseur. 131.

Cerebral Localization, 470.

Chadwick, Sir Edwin, K.C.B., Condi-
tion of Sanitary Science, 385.

Chevreul, Michel Eugene, 536.

Chlorine in Water, Smart 409.

Cholera, A New Bemedy for, 284.

Cholera Propagated by Impure Water,
Smart, 501.

CigaretteJSmoking, 91.

Cleanliness, Prize for, 647.

Climate and Sanitaiy Qualities of
Western North Carolina, Maroy, 196.

Cocaine Injections, 472.

Cochran, J., M.D., Problems in Be-
gurd to Yellow -Fever and the Pre-
vention of Epidemics, 97.

Cochran, J. H., M.D., Influence of a
Better Water-Supply on Health, 519.

Cod-Liver OU, The Alkaloids of, 287.

Color, Medical Value of, 431.

Consumption. See Fhthisis,

Cooking, Sanitary and Economic, 266.

Coolest Town in the World, 46.

Cremator, A, Cremated, 368.

Creoline and the Comma-Bacillu8» 187.

Crystal Brook, Bell. 538.

Cystitis, Salol in, 285.

Decomposing Organic Matters, Effects

of in Water, Smart, 489.
Dermatoses Following Shock, 670.
Diphtheria, Borax in the Treatment

of, 283.
Diphtheria, Prevention of, 264.
Diphtheria, The True Belations of

FUth to, 89.
Diphtheria, Topical Treatment with

Pulverized Sugar. 283.
Diseases Propagated by Drinking

Water, Smart, 492.
Disinfectant, a Plractical, The Value of

Mercuric Chloride as, Vaughn, 193.
Disinfection and Tempering of Bub-

ber Drains, 377.
Disinfection of the Hands, 96.
Disinfection with Steam, 148, 361.

574

Index.

Durham Honse Draimige, 64.
Dysentery, Salol in, 92.

Examining and Cram'g, Harriaon, 327.
'•£z" and*' Bel/* 266.

Fat. Determination of, in Milk and

Chream.
Filtration of Water. Smart. 508.
Fistula, Anal, Treatment of, without

Operation, 380.
Flannels, To Wash, Ed., 647.
Forceps and Idiocy, 380.
Fusible Metal, 109.

Qerms, How do. Induce Disease ? 366.
Gouty, the. Alimentary Begimen, 90.
Grant-Bey, I. A. 8., M.D., Sanitary

Condition of India, and its Teach.

ings, 396.
Graveyard Pestilences, 161.

Hanan, A., M.D., Theoiy of Becoyo^
and Immunity from Infective Dis-
eases, 120.

Harrison, F., Examining and Cram-
ming, 327.

Hartzell. Canton's Water-Suoply, 48.

Health Department, the New York,
646.

Heating and Ventilating Dwellings,
Hot Air vertua Steam for, 49.

Homoeopathic Therapeutics, 189.

Humphreys, N. H., Light without
Heut, 326.

Hughes, M. Clovis, Hypnotism Extra-
ordinary, 546.

Hygiene, 160, 263.

Hypnotism, M. Hughes, 645.

Ice. Danger of Impure Smart, 602.

Ice in the Sick Boom, Ed., 6^.

Ideal Physician, Sexton, 641.

Immigrants, The Number of, 369.

India, Sanitary Condition of, Grant-
Bey, 396.

Infants, Nursing with Asses' Milk,
323.

Infection, a Source of. The Nail Brush
as, 377.

Infection by B<iok8, Winslow Ander.
son, M.D., 643.

Infectious Diseases And Quar., 146.

Infective Diseases, Becovery and Im-
munity from, Hanan, 120.

Impure Water, Effects of, Smart, 489.

Inoculation, Pasteurian, Prevention of
Babies by, 325.

Institutions, Charity, of Paris, 323.

Institutions, Public, Sanitary Condi-
tion of. Improvement of Local
• Boards of Health and, 230.
Intestinal Occlusions, 471.
Intoxication, 369.

Jackson, Miss., Local Conditions and
yellow-Fever, Anderson, 214.

Lake Waters, Smart, 418.

Lanolin and Boric Acid in the Skin
Diseases of Children, 187.

Lean, so. Why he was, 234.

Levasseur, E., Centenarians, 131.

Light without Heat, Humphreys, 326.

Listerine, 383, 648.

LrnouLBT Noncss :
A New Mode of Treating and Dis-
posing of Night-Soil (Aserappa),
179 ; Alden*s Manifold Cydopss-
dia, 182, 369 ; American Besorts

games), 474 ; Artesian Wells of
akota (iTarpers*), 183 ; Atlas of
Venereal and Skin Diseases, 368 ;
Calendars, 87 ; Canadian Prac
iUioner, 86 ; Cataract Extraction
(Chisholm), 86 ; Ventary, 372 ; Con.
tributions to American Educa-
tional History (Adams), 371 ;
Cyclopaedia of the Diseases of
Children (Keating), 182; Eating
for Strength (Holbrook), 86 ; Elec-
tricity in the Diseases of Women
(Massey), 282 ; Extermination of
the Buffalo (Harper8'\ 480 ; Fa.
vorite Prescriptions (Palmer), 181 ;
Ghrimsbaw's Boiler Catechisn^87 ;
Handbook for the U. S. A. Hos-
pital Coxps (Smart), 476 ; Hand-
book of Histologi<»l and Geo-
graphical Phthisiology - (Evans) ,
280 ; Handbook of Materia Med-
ica (Bowen), 182 ; Headache, Neu.
ralgia. Sleep and its Derange,
ments. and Spinal Irritation
(Coming), 86 ; How to Succeed on
the Boa^ as a Commercial Trav-
eller, 373 ; Industrial Education
in the South (Mayo), 372 ; Insane
in Foreign Countries (Letch-
worth), 367 ; Jean Fran<^is Millet
{(kntwy), 478 ; Manual of Dietet-
ics (ratchard), 476; Medical
Bulletin Visiting List, 87 ; Medi-
cal Diagnosis (Brown), 84;
Merck's Index, 369 ; Milroy Leo-
tures (Lawson). 179 ; Nervons
Exhaustion (Beard), 180 ; Neuras-
thenia (Gray), 85 ; Physical Cul-
ture (A. J. Beech & Co.). 86 ; Pop-
rdar ^ience Monihiy, 282 ; Preven-
tion of Consumption (Candler),

Index.

675

63 ; Proclamation of Department
of Saperintendenoe of the Nation,
al Educational Association, 372 ;.
Psychic Life of Micro-organisms
(Binet). 369 ; Public Health Be.
sorts ver^tu Institutions fot the
Treatment of Bacillary Phthisis
(Kretsohmar), 85 ; Report of the
Oommissioner of Education, 270 ;
Beport of the New Jersey State
Dairy Commissioner, 475 ; Selec-
tion of Lives for Insurance (Hoi.
den), 373 ; Transactions of the
Medical Association of Missouri,
478 ; Trazisactions of the Medical
and Ghirurgical Faculty of Mary,
land, 476 ; Vestf ocket Anato-
, mist (Leonard), 282 ; Why Wom-
en get Short of Breath (Scnb-
ner'a), 183 ; Wonders of the Cam-
era {ScribMr^s), 479 ; Wood's
Medical and Surgical Monographs,
181, 370, 475 ; Transactions of
Congress of American Physicians
and ' Surgeons, 665 ; Lectures on
Nervous Diseases (Banney), 566 ;
Atlas of Venereal and Skin Dis.
eases (Morrow), 567 ; Diphtheria
(Billington), 568 ; Intubation
(0*Dwyer). 668 ; Medical Student
Pictured in Punch (Smith), 568 ;
Alden*s Manifold Qrolopaddia of
Knowledge. 569 ; Electricity in
Facial Blemishes (Hayes), 569.
Long Life, The Lesson of, 536.

Malaria Communicated by Drinking

Water, Smart, 497.
Malaria and the Causes of FeTer in the

State of New York, Bell, 432.
Malaria, The Microbe of, 350.
Marine Hospital Serrice Law, The

New, 133.
Marcy, H. 0., A.M., M.D., L.L.D.,

The Climate and Sanitary Qualities

of Western North Carolina, 196.
MatKoon, 92.

Mausoleum Company, The New, 58.
Medals, Jetons, and Tokens Illustra.

tive of Sanitation, Storer, 134, 235,

328, 521.
Medical Antisepsis, 186.
Medical Expert Testimony, Ward, 438.
Medical Society State of N. Y., 353.
Miasmatic Exhalations, Effects of in

Water, Smart, 497.
Medicolegal, A, Question Decided,

287.
Microbes, Infectiye, The Bdle of, Ad-
vantages of Woollen Clothins, 60.
Micro.<hganisms, Lanolin on, 91.
Milk Jelly, 381.

Milk, Mischief-Makers in, Alice B.

Tweedy. 540.
Mortality among Seamen and Soldiers

in the French Colonies, 466.

MOBTAUTY AND MOBBXLXTT StATISTIGS :

Abroad, 174. 277, 278, 465 ; Canada,
79. 174 ; Havana, 81, 174, 271, 366,
466 : Panama, 280 ; United States,
66, 153, 268, 359, 451, 549 ; U. S.
Navy, 174 ; Cholera, 564 ; Small,
pox, 81, 278, 366, 466, 564 ; Yel-
low.Fever, 67, 280, 366, 466, 564.
Mustard, Tincture of, 382.

Napthalin, 288.

Nations, The Happiest— France ? 361.

Navy, the. Vacancies in the Medical

Corps of, 149.
Nitrates in Water, Smart, 407.
Nitro-Glycerine in Cardiac and Benal

Diseases, 188.
North Carolina, Western, The Climate

of. 196.

Obituabt :

Allen, N., A.M.. M.D.. L.L.D.,82.

Snow, E. M., M.D., 81.
Offensive Odor of Breath, 548.
Oil. Use of, to Still the Waters, Beeh.

ler, 305.
Oleum Lan»,288.

Pancreatitis, Acute.

Paraldehyde, 288.

Paralysis, Facial, in Infants, 471.

Pavement, India-Bubber, 35, 448.

Pebsonal :

Hamilton, J. B., M.D., 184.
Kilvington. 8. S., M.D., 152.

Phenacetin, 288.

Phenic Acid in Malignant Pustule, 571.

Phthisis. Fluoric Acid in, 472.

Phthisis from House-S weepings. 357.

Pthisia, Hot-Air Inhalations, 356.

Piatt's Chlorides, 96.

Poisoning by Chrome Yellow Used as
a Cake Dye, 265.

Poisoning, Carbonic-Oxide, Transfu.
sion in, 285.

Poisoning, Naphtha, in Bubber Fac-
tories, 437.

Potatoes, Dried, 358.

Prize Essay. 153.

Pyle's Pearline, 547.

Quinine and Antipyrin in Combina-
tion, 186.

Quarantine, Infectious Diseases, 146.

Quarantine. The New York, Establish-
ment, 449.

Bain-Water, Smart, 483.

L

576

Ind'CX.

Beed, B. H., M D., How to Prevent
the Spread of Typhoid-Fever, 47.

Beed and Camriok*B Sol. Food. 572.

Bicketo, The Treatment of, 379.

Bnah, G. W., U. S. N., Sitka— Inhat.
itantB, Diseases, and Climate, 348.

Saccharine as hn Antiseptio, 570.
Salmon, D. £., D.V.M., Origin and

Prevention of Tuberculosis, 28.
S^itary and Economic Cooking, 266.
Sanitary Condition of India and its

Teachings, GranUBey, 396.
Sanitaiy Science, A New Institnte for

the Practical Study of, 152.
Sanitary Science, Present Condition

ot Chadwick, 385.
Sanitation, Medals, Jetons, and To.

kens Illustrative of, Storer, 134,

235, 328, 521.
Sanitation, What is, Ashmun. 49.
Sarcoma, Primitive, of the Pancreas,

A Case of, 191.
Saucepan, a, Shaking Hands with, 317.
Scarlatina, Prophylaxis in, 228.
Sohirmer, J. , Parasites in Annate Paste,

544.
Sewage Irrigation and Salubrity, Cor-

nil, 401.
Sexton, Luther, M.D., The Ideal Phy.

sician, 541.
Sitka — Inhabitants, Diseases, and Cli.

mate. Bush, 348.
Small-pox, 81. 278, 366, 466.
Smart, C, M.D., U. S. A., PoUation of

Water-Supplies, 1 ; Water Analysis,

289, 404.
Smith, T., M.D., Origin and Sources

of Pathogenic Bacteria, 110 ; Bela-

tion of Drinking Water to Some In-
fectious Diseases, 423.
Smoke-Cloud, the, Weight of, over

London, 403.
Soap, Use of Scraps, Ed., 547.
Soluble Food, Camxick's. 572.
Sphincter, a, A New Method of Form-
ing, after Gastrotomy, 191.
Sternberg, G. M., M.D., U. S. A.,

Hunting YolJow-Fever Germs, 306.
Stomach, tbe^ Common Salt in Ner-
vous Aifections of, 379.
Storer, H. B., M.D., Medals, Jetons,

and Tokens Illustrative of Sanita.

tion, 134, 235, 328, 521.
Sulphonal, 93.

Superstitions, Medical, Popular, 447.
Surgery Bun Wild, 379.

Ten Good Things to Know, 65.
Terraline, 186.

Throat, ApplicaHon of Steam to, 284.
Tobacco Amblyopia, 377.

Tuberculosis, Origin and Prevention

of. Salmon, 28.
Tuberculosis, Pulmonary, Climatic

Treatment of, 89.
Typhoid-Fever, Defend Yourselves

from, 262.
Typhoid-Fever in Brooklyn and the

Water-Supply, 55.
Typhoid-Fever, the Spread of, How to

Prevent, Beed, 47.
TVphoid-Fever Propagated by Fool

Water, Smart, 494.

Vaccination, Practical Illustration of
the Neglects and Benefits of, 64.

Vaseline Subcutaneous Injections^ 189.

Vaughn, V. C, M.D., The Value of
Merouric-ClUoride as a Practical Dis-
. infectant, 193.

Vermifuge, a, Coooanutas, 286.

Ward, S. B., M.D., Medical Expert
Testimony, 438.

Waring, The. System, 261.

Wash-Basins, Setting, 63.

Water Analysis, Smart, 289, 404, 483.

Water, Bacteria in. Smart, 490.

Water, Drinking, Belation of, to Some
Infectious Diseases, Smith, 423.

Water, Effects of Decomposing Ani-
mal Matters in, Smart, 492.

Water, Effects of Decomposing Vege-
table Matter on, Smart, 490.

Water, Effects of Impure. Smarts 489.

Water, Leaden Pipe, Smart, 489.

Water, Effects of Zinc on. Smarts 489.

Water, Filtration of, Smart, 608.

Water, Influence of Improved Supply
on Health, Cochran, 619.

Water, ** Self-Purification." Smart» 492.

Water, Storage and Purification of,
Smart, 504.

Water-Supplies, Pollution, ot Smart, 1.

Water-Supply, Canton*s, Haftsell, 48.

Water-Supply, the New York, The Fu-
ture of — A Correction, Adams, 26.

Waters, Classification of, Smart, 297.

Weil's Disease, 378.

Woman, Largest, in the World, 132.

Yellow-Fever and the Prevention of
Epidemics, Cochran, 97.

Yellow-Fever Germs, Hunting, Stem-
berg, 306.

Yellow-Fever Infection and the Pro-
posed Method of Disinfection of the
U. S.S.'* Boston," 36.

Yellow-Fever, Anderson, 214.

Yellow-Fever Microbe, The, 62.

YellowJf'ever, Statistics of, 67, 280,
366, 466, 564.

i

''V