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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 


a 


u 


9«; 


S 




Ibumin 
Ammo 


p 


rganic 
VoUtil 




fe 


< 


>* 





H 


O.OI38 


0.0097 


9.2 


7.5 


16.7 


0.018 


0.0084 


10.7 


6.1 


16.8 


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 enforc