Recent Progress in Preventive Medicine. Well, Dr. Klein was the first to declare he had found a microbe characteristic of Typhoid Fever. In 1880, Eberth described the Typhoid Fever bacterium and there is little or no doubt that it is the true germ of the disease; and the later investigations of Dr. Sternberg fortify us here. Beumer, Peiper and others have demonstrated that a ptomaine produced by these bacilli, induces in animals a disease in all respects like Typhoid Fever. There is hardly room to question the discovery of the germ of Scarlet Fever by Klein. The bacillus of consumption is very well known. That of Asiatic Cholera, described by Koch, although still much disputed, will probably stand the test of time and investigation. Bujwid claims to have a sure means of its detection. We are on the verge of accepting Pasteur's croupous-pneumonia inicrobe. At last the microbe of Yellow Fever has been demonstrated by Dr. Freire, whose inoculations are declared to have been successful. As to Small Pox, the infinitely minute particles seen in the virus under microscopes of the highest power are found to have alone the potency of the lymph. Days count in this work of investigating disease-germs. We are marching furiously. If we allow the imagination any play whatever, as we are fully entitled to do, we can hardly fail to bring in under the conditions of germ causation all the infectious diseases. And here the prospect becomes too dazzling for a concentrated gaze. What Pasteur has done for animal diseases of microbe origin, what he claims to have done for hydrophobia, what it is claimed is being done for Yellow Fever, and what has long been done for Small Pox-inoculation against the disease with a growing hope of extinction — will that be done for Cholera, Typhoid Fever, Diphtheria, Scarlet Fever, Measles, Whooping Cough, Pneumonia, Consumption? Will a man take his virus in advance against these diseases, as he takes his whisky in advance against snake-bites? At any rate, even if no saving virus can be found, will the way be Recent Progress in Preventive Medicine. clear, through these studies, to rational methods of limiting or preventing the distribution and development of the germs of these diseases? To come down to the certain and the practicable, sanitarians have studied to some purpose the manner in which the germs of disease, whether they are micro-organisms or not, are conveyed, and the conditions under which they are multiplied. Give them a larger control over the water and milk we drink and over the air we breathe - give them a positive control over sewage disposal and water-supply and plumbing arrangements and dairy direction - and they know well how to reduce the death-rate from infectious diseases. This is a mighty poor country to appeal to for evidence of what they have done, because they have no free scope here- a country in which the quarantine arrangements against Cholera are frightfully imperfect even at New York, because a governor vetoed the small sanitary appropriation bill. Still we can show something, even here where statistics are wofully defective. Nowhere in this country has the sanitarian been more energetic than in the lower valley of the Mississippi. Typhoid Fever is never absent from New Orleans and with no other change in conditions except the enforcement of sanitary regulations, the death rate from that disease has been reduced. from 68 per 100,000 of population, to 16 in less than twenty years; and the decrease has exactly kept pace with the sanitary improvements. And here is a place for comparison. The sewage of New Orleans cannot pollute the water supply, rain water from huge tanks being used. In Philadelphia, where the water is known to be contaminated, the deathrate from the same disease has increased from 56 to 66 per 100,000 in the same period. Pennsylvania has at last found it expedient to establish a health board. Dr. Rohé gave some facts at the last meeting of the American Medical Association. In Michigan, the saving of life from Scarlet Fever in the last eleven years amounted to 3,718; and in Recent Progress in Preventive Medicine. 1886, appropriate sanitary measures saved the lives of 298 persons, who, under the usual conditions and according to former epidemics, would have died of Diphtheria in a few localities. In Memphis the death rate has been reduced in six years from 35 per 1,000 to 23.8 per 1,000. In Chicago the death rate has been reduced in the last five years from 26 per 1,000 to 19.46, a saving of nearly twenty thousand lives. These important facts are little in comparison with the incalculable work that is being done, and are thrown out as simple indications that things are done to justify the confidence of the public in measures of public health. Defective statistics leave the best work unnoted. In Massachusetts, where statistics are collected, sanitary regulation has reduced the death rate from infectious disease in ten years from 28.6 per 100,000 to 18.5. More has been learned in the past few years about the management of epidemics than can be told in these pages. Epidemic diseases have been studied as never before, and sanitarians are getting their facts in such shape that they must be irresistible. Self-preservation is not the first law of nature for the individual. Nature, "so careful of the type," is " careless of the single life," and all the fancies, appetites and passions which insure the preservation of the race, are in such excess they drive the individual toward his own destruction. We do what we like, mostly; and mostly what we like to do is self-destructive in some degree. We are prone to abuse whatever tickles a fancy, pleases an appetite or ministers to a passion, though the hurtful consequences are in full sight. We are prone to neglect whatever exertions are conducive to health when they involve an interference with pernicious habits or indulgent sloth. Tell us that a heedless government allows us to be surrounded by the easily preventable causes of disease and death, and we haven't the faculty of indignation; but threaten to interfere in any degree with a Recent Progress in Preventive Medicine. personal indulgence that may be harmful, and we are quick enough to take fire. They may poison us if they will But damn their eyes, if ever they tries To rob a poor man of his beer! Self-indulgence is stronger than fear of disease or death— whether the indulgence is of the baser sort or whether it is excess of labor. Men are not doing the best they know in the care for their own health; men never do it, except fitfully. Men are not waiting for a final decree as to whether this or that thing which they do is harmful. We sing: Ah! what avail the largest gifts of heaven When drooping health and spirits go amiss? And then we go immediately to some excess, either of work or pleasure, which shatters health. The physician who knows what it all means and who warns us, goes with the rest of us into these abuses - Carlyle talking dismally against dismal talking; Sydney Smith drinking in reddest wine to the cause of clear water. No; there is no hope that disease and untimely death will be crowded out of this world through the individual's care for his own health; that the sad inheritance of defective bodies and minds will ever be broken by the self-denial and foresight of individual progenitors. Men will continue to eat, drink and be merry, and men will slave and worry, and kidneys will break down and brains will fall into premature decay, to the end of the chapter. We may learn to cut out broken-down tissues and to bore into paralytic brains, but there will always be such tissues and such brains, though the certain laws of personal health should glitter in letters of gold on every wall. Franklins will be forever few. If there is ever to be any less of untimely dying; of mourning for the fleet decay of lives in which center so many pos Recent Progress in Preventive Medicine. sibilities; if the pitiless scythe of death is to cut down less of the unripe grain; if early orphanage, widowhood, childlessness are ever to be reduced in a world which is only endurable through the ties of blood and affection, it must come through public sanitation. Most of us find "a grave never dug by nature." We are struck down by monsters more merciless and more insatiable than the vindictive gods for whose propitiation an earlier age raised temples of worship. Conquerable monsters, slaying their thousands a day while our weapons are only half drawn. Typhoid Fever, Diphteria, Scarlet Fever, Cholera, Small-pox, a score of fatal diseases, can be absolutely abolished. It isn't ignorance that allows these diseases to invade our homes and carry away the fondest treasures, but simply the indolence of mankind about things that are not pressing; the disposition of men to take chances rather than busy themselves about dangers which may, after all, pass them by. There are some amiable people who labor mightily against these preventable diseases which slay more than bullets. The mass of mankind will never have any concern about the matter. It is easy to persuade a man to make a colossal fool of himself about his personal health for a short time— he may even go through the superstitious folly of "metaphysical" treatment - but about public health matters he will take as little thought and trouble as possible, except when a general scare is on. All the more reason, therefore, why the amiable and devoted few who center their attention on public health should be sustained and held in large authority. We are right to resist any authority in opinion about matters we are likely to study for ourselves; but in a warfare on preventable diseases in which we take no active part, we are right to vote supplies and confidence to those who are in the fight. In other words, the men who tell us that tens of thousands of lives can be saved every year, ought not to be compelled to beg and to lobby like political jobbers for necessary appropriations, or be looked upon as |